HEDIS: Medicaid and CHIP Health Plans
This report displays results showing the quality of care members received under each Medicaid and CHIP health plan (i.e., managed care or accountable care organization) reporting to the Office of Health Care Statistics as measured using HEDIS technical specifications during calendar year 2022. The previous year’s results are also listed. Each year is reported separately. All results were calculated by each individual health plan and validated by an accredited third-party auditor prior to submitting results to the Office of Health Care Statistics at the Utah Department of Health.
Results are sorted alphabetically by plan for each quality measure for the most recent reported year with national averages presented along with plan results. For some measures, rates are not reported for the following reasons determined during the third-party audit:
- *Small Denominator. The organization followed the specifications, but the denominator was too small (<30) to report a valid rate (see Data Note below the tables for more information).
- Not Reported** The organization did not report the measure.
- † Not Required. The organization was not required to report the measure.
- § No Benefit. The organization did not offer the health benefit required by the measure (e.g., mental health, chemical dependency).
All participating health plans were given the chance to review these results prior to publication pursuant to the requirements depicted in UCA 26-33a-107.
Results are reported for the following health plans:
- Medicaid
- Health Choice Utah
- Healthy U
- Molina
- SelectHealth Community Care
- CHIP
- Molina
- SelectHealth
For information and results about commercial plans, please see the section covering commercial plans.
Maternity Care
Prenatal and Postpartum Care – Postpartum Care
Prenatal and Postpartum Care – Timeliness of Prenatal Care
Newborn and Infant Care
Childhood Immunization Status – Combo 3
Well-Child Visits in the first 15 Months of Life – 6 or more visits
Pediatric Care
Appropriate Treatment for Children With Upper Respiratory Infection
Immunizations for Adolescents – Combination 2
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents – BMI percentile – Total
Adult Care
Adult Access to Preventive and Ambulatory Health Services – Total
Antidepressant Medication Management – Effective Acute Phase Treatment
Asthma Medication Ratio
Breast Cancer Screening
Cervical Cancer Screening
Comprehensive Diabetes Care – HbA1c Testing
Comprehensive Diabetes Care – Eye Exams
Controlling High Blood Pressure
Use of Imaging Studies for Low Back Pain
Follow-Up After Hospitalization for Mental Illness
Follow-Up Within 7 Days Post-Discharge
Follow-Up Within 30 Days Post-Discharge
Dental Care
Maternity Care
Prenatal and Postpartum Care – Postpartum Care
The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery.
| Health Plan | 2022 | 2021 | 2020 | 2019 |
|---|---|---|---|---|
| HealthChoice Utah (Medicaid) | 63% | 62% | 66% | 66% |
| Healthy U (Medicaid) | 34% | 67% | 77% | 55% |
| Molina (Medicaid) | 70% | 66% | 75% | 53% |
| SelectHealth Community Care (Medicaid) | 86% | 80% | 80% | 76% |
| National Average (Medicaid) | 76% | 75% | 75% | 64% |
| Molina (CHIP) | 50% | 57% | * | * |
| SelectHealth (CHIP) | NR | ** | † | ** |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Prenatal and Postpartum Care (PPC).
Prenatal and Postpartum Care – Timeliness of Prenatal Care
The percentage of deliveries that received a prenatal care visit as a member of the organization in the first trimester, on the enrollment start date or within 42 days of enrollment in the organization.
| Health Plan | 2022 | 2021 | 2020 | 2019 |
|---|---|---|---|---|
| HealthChoice Utah (Medicaid) | 63% | 61% | 69% | 69% |
| Healthy U (Medicaid) | 85% | 78% | 85% | 74% |
| Molina (Medicaid) | 67% | 61% | 91% | 62% |
| SelectHealth Community Care (Medicaid) | 94% | 94% | 96% | 91% |
| National Average (Medicaid) | 84% | 84% | 87% | 82% |
| Molina (CHIP) | % | 57% | * | * |
| SelectHealth (CHIP) | NR | ** | † | ** |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Prenatal and Postpartum Care (PPC).
Newborn and Infant Care
Childhood Immunization Status – Combo 3
The percentage of children 2 years of age who had a four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB); one chicken pox (VZV); and four pneumococcal conjugate (PCV) by their second birthday.
| Health Plan | 2022 | 2021 | 2020 | 2019 |
|---|---|---|---|---|
| HealthChoice Utah (Medicaid) | 63% | 69% | 78% | 72% |
| Healthy U (Medicaid) | 66% | 74% | 75% | 79% |
| Molina (Medicaid) | 56% | 62% | 72% | 71% |
| SelectHealth Community Care (Medicaid) | 72% | 75% | 73% | 76% |
| National Average (Medicaid) | 63% | 68% | 70% | 68% |
| Molina (CHIP) | 68% | 84% | 85% | 79% |
| SelectHealth (CHIP) | 74% | 81% | 81% | 78% |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Childhood Immunization Status (CIS).
Well-Child Visits in the first 15 Months of Life – 6 or more visits
Assesses children who turned 15 months old during the measurement year and had 6 well-child visits with a primary care physician during their first 15 months of life.
| Health Plan | 2022 | 2021 | 2020 | 2019 |
|---|---|---|---|---|
| HealthChoice Utah (Medicaid) | 48% | 43% | 59% | 59% |
| Healthy U (Medicaid) | 43% | 43% | 57% | 60% |
| Molina (Medicaid) | 45% | 43% | 69% | 61% |
| SelectHealth Community Care (Medicaid) | 58% | 55% | 65% | 63% |
| National Average (Medicaid) | 54% | 71% | 66% | 63% |
| Molina (CHIP) | 70% | 54% | 80% | 73% |
| SelectHealth (CHIP) | 75% | 71% | 79% | 74% |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Child and Adolescent Well-Care Visits (W30).
Pediatric Care
Appropriate Treatment for Children With Upper Respiratory Infection
Assesses children 3 months–17 years of age who were given a diagnosis of upper respiratory infection (URI) and were not dispensed an antibiotic prescription. A higher rate indicates appropriate treatment of children with URI (i.e., the proportion for whom antibiotics were not prescribed).
| Health Plan | 2022 | 2021 | 2020 | 2019 |
|---|---|---|---|---|
| HealthChoice Utah (Medicaid) | 95% | 94% | 93% | 94% |
| Healthy U (Medicaid) | 95% | 95% | 94% | 95% |
| Molina (Medicaid) | 94% | 93% | 93% | 94% |
| SelectHealth Community Care (Medicaid) | 96% | 96% | 95% | 95% |
| National Average (Medicaid) | 93% | 92% | 91% | 90% |
| Molina (CHIP) | 97% | 93% | 92% | 95% |
| SelectHealth (CHIP) | 96% | 93% | 93% | 94% |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Appropriate Treatment for Children With Upper Respiratory Infection (URI).
Immunizations for Adolescents – Combination 2
Assesses adolescents 13 years of age who had one dose of meningococcal vaccine, one Tdap vaccine and the complete human papillomavirus vaccine series by their 13th birthday.
| Health Plan | 2022 | 2021 | 2020 | 2019 |
|---|---|---|---|---|
| HealthChoice Utah (Medicaid) | 27% | 28% | 31% | 31% |
| Healthy U (Medicaid) | 37% | 43% | 40% | 44% |
| Molina (Medicaid) | 26% | 27% | 27% | 28% |
| SelectHealth Community Care (Medicaid) | 37% | 35% | 37% | 31% |
| National Average (Medicaid) | 36% | 38% | 38% | 35% |
| Molina (CHIP) | 39% | 39% | 40% | 37% |
| SelectHealth (CHIP) | 45% | 42% | 43% | 37% |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Immunizations for Adolescents (IMA).
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents – BMI percentile – Total
Assesses children and adolescents 3-17 years of age who had an outpatient visit with a primary care practitioner or OB/GYN during the measurement year and had evidence of Body mass index (BMI) percentile documentation.
| Health Plan | 2022 | 2021 | 2020 | 2019 |
|---|---|---|---|---|
| HealthChoice Utah (Medicaid) | 57% | 65% | 57% | 57% |
| Healthy U (Medicaid) | 80% | 79% | 85% | 84% |
| Molina (Medicaid) | 57% | 78% | 79% | 63% |
| SelectHealth Community Care (Medicaid) | 87% | 88% | 90% | 91% |
| National Average (Medicaid) | 76% | 75% | 77% | 74% |
| Molina (CHIP) | 60% | 67% | 82% | 64% |
| SelectHealth (CHIP) | 89% | 90% | 93% | 89% |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC).
Adult Care
Adult Access to Preventive and Ambulatory Health Services – Total
The percentage of members 20 years and older who had an ambulatory or preventive care visit during the measurement year.
| Health Plan | 2022 | 2021 | 2020 | 2019 |
|---|---|---|---|---|
| Traditional Medicaid Plans | ||||
| HealthChoice Utah | 74% | 81% | 84% | 83% |
| Healthy U | 77% | 82% | 86% | 85% |
| Molina | 76% | 80% | 83% | 83% |
| SelectHealth Community Care | 81% | 85% | 88% | 88% |
| Expansion Medicaid Plans | ||||
| HealthChoice Utah | 60% | |||
| Healthy U | 69% | |||
| Molina | 67% | |||
| SelectHealth Community Care | 76% | |||
| National Average (Medicaid) | 76% | 77% | 80% | 80% |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Adults’ Access to Preventive and Ambulatory Health Services (AAP).
Antidepressant Medication Management – Effective Acute Phase Treatment
Assesses adults 18 years of age and older with a diagnosis of major depression who were newly treated with antidepressant medication and remained on an antidepressant medication for at least 84 days (12 weeks).
| Health Plan | 2022 | 2021 | 2020 | 2019 |
|---|---|---|---|---|
| Traditional Medicaid Plans | ||||
| HealthChoice Utah | 69% | 90% | * | * |
| Healthy U | 60% | 59% | 51% | 47% |
| Molina | 75% | 25% | * | * |
| SelectHealth Community Care | 70% | 62% | 51% | 54% |
| Expansion Medicaid Plans | ||||
| HealthChoice Utah | 58% | |||
| Healthy U | 60% | |||
| Molina | 40% | |||
| SelectHealth Community Care | 59% | |||
| National Average (Medicaid) | 61% | 57% | 55% | 53% |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Antidepressant Medication Management (AMM).
Asthma Medication Ratio
Assesses adults and children 5–64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year.
| Health Plan | 2022 | 2021 | 2020 | 2019 |
|---|---|---|---|---|
| Traditional Medicaid Plans | ||||
| HealthChoice Utah | 62% | % | % | % |
| Healthy U | 59% | % | % | % |
| Molina | 62% | % | % | % |
| SelectHealth Community Care | 72% | % | % | % |
| Expansion Medicaid Plans | ||||
| HealthChoice Utah | 41% | |||
| Healthy U | 52% | |||
| Molina | 49% | |||
| SelectHealth Community Care | 58% | |||
| National Average (Medicaid) | % | % | % | % |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Asthma Medication Ratio (AMR).
Breast Cancer Screening
Assesses women 50–74 years of age who had at least one mammogram to screen for breast cancer in the past two years.
| Health Plan | 2022 | 2021 | 2020 | 2019 |
|---|---|---|---|---|
| Traditional Medicaid Plans | ||||
| HealthChoice Utah | 37% | 44% | 35% | 29% |
| Healthy U | 38% | 44% | 49% | 48% |
| Molina | 36% | 36% | 40% | 40% |
| SelectHealth Community Care | 48% | 48% | 50% | 47% |
| Expansion Medicaid Plans | ||||
| HealthChoice Utah | 38% | |||
| Healthy U | 47% | |||
| Molina | 36% | |||
| SelectHealth Community Care | 57% | |||
| National Average (Medicaid) | 51% | 54% | 58% | 58% |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Breast Cancer Screening.
Cervical Cancer Screening
Assesses women 21–64 years of age who were screened for cervical cancer using either of the following criteria:
- Women age 21–64 who had cervical cytology performed every 3 years.
- Women age 30–64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years.
| Health Plan | 2022 | 2021 | 2020 | 2019 |
|---|---|---|---|---|
| Traditional Medicaid Plans | ||||
| HealthChoice Utah | 42% | 44% | 44% | 44% |
| Healthy U | 49% | 48% | 48% | 57% |
| Molina | 46% | 50% | 55% | 53% |
| SelectHealth Community Care | 61% | 59% | 58% | 57% |
| Expansion Medicaid Plans | ||||
| HealthChoice Utah | 31% | |||
| Healthy U | 40% | |||
| Molina | 36% | |||
| SelectHealth Community Care | 58% | |||
| National Average (Medicaid) | 56% | 57% | 60% | 59% |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Cervical Cancer Screening (CCS).
Comprehensive Diabetes Care – HbA1c Testing
Assesses adults 18–75 years of age with diabetes (type 1 and type 2) who had Hemoglobin A1c (HbA1c) testing.
| Health Plan | 2022 | 2021 | 2020 | 2019 |
|---|---|---|---|---|
| Traditional Medicaid Plans | ||||
| HealthChoice Utah | 81% | 81% | 88% | 82% |
| Healthy U | 86% | 84% | 89% | 89% |
| Molina | 86% | 86% | 88% | 87% |
| SelectHealth Community Care | 93% | 89% | 92% | 89% |
| Expansion Medicaid Plans | ||||
| HealthChoice Utah | 75% | |||
| Healthy U | 87% | |||
| Molina | 84% | |||
| SelectHealth Community Care | 88% | |||
| National Average (Medicaid) | 85% | 83% | 88% | 88% |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Comprehensive Diabetes Care (CDC).
Comprehensive Diabetes Care – Eye Exams
Assesses adults 18–75 years of age with diabetes (type 1 and type 2) who had an eye exam (retinal) performed.
| Health Plan | 2022 | 2021 | 2020 | 2019 |
|---|---|---|---|---|
| Traditional Medicaid Plans | ||||
| HealthChoice Utah | 44% | 44% | 57% | 49% |
| Healthy U | 50% | 51% | 59% | 56% |
| Molina | 47% | 44% | 52% | 52% |
| SelectHealth Community Care | 64% | 64% | 65% | 66% |
| Expansion Medicaid Plans | ||||
| HealthChoice Utah | 31% | |||
| Healthy U | 44% | |||
| Molina | 37% | |||
| SelectHealth Community Care | 54% | |||
| National Average (Medicaid) | 51% | 50% | 57% | 57% |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Comprehensive Diabetes Care (CDC).
Controlling High Blood Pressure
Assesses adults 18–85 years of age with a diagnosis of hypertension and whose blood pressure was adequately controlled based on the following criteria:
- Adults 18-59 years of age whose blood pressure was <140/90 mm Hg.
- Adults 60-85 years of age, with a diagnosis of diabetes, whose blood pressure was <140/90 mm Hg.
- Adults 60-85 years of age, without a diagnosis of diabetes, whose blood pressure was <150/90 mm Hg.
| Health Plan | 2022 | 2021 | 2020 | 2019 |
|---|---|---|---|---|
| Traditional Medicaid Plans | ||||
| HealthChoice Utah | 69% | 62% | 61% | 61% |
| Healthy U | 71% | 65% | 81% | 76% |
| Molina | 49% | 55% | 61% | 55% |
| SelectHealth Community Care | 67% | 73% | 76% | 73% |
| Expansion Medicaid Plans | ||||
| HealthChoice Utah | 60% | |||
| Healthy U | 62% | |||
| Molina | 44% | |||
| SelectHealth Community Care | 68% | |||
| National Average (Medicaid) | 59% | 56% | 61% | 59% |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Controlling High Blood Pressure (CBP).
Use of Imaging Studies for Low Back Pain
Assesses adults 18–50 with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI or CT scan) within 28 days of the diagnosis (a higher score indicates better performance).
| Health Plan | 2022 | 2021 | 2020 | 2019 |
|---|---|---|---|---|
| Traditional Medicaid Plans | ||||
| HealthChoice Utah | 78% | 62% | 78% | 61% |
| Healthy U | 70% | 69% | 72% | 76% |
| Molina | 75% | 75% | 73% | 55% |
| SelectHealth Community Care | 75% | 74% | 75% | 73% |
| Expansion Medicaid Plans | ||||
| HealthChoice Utah | 77% | |||
| Healthy U | 69% | |||
| Molina | 71% | |||
| SelectHealth Community Care | 72% | |||
| National Average (Medicaid) | 75% | 76% | 75% | 59% |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Use of Imaging Studies for Low Back Pain (LBP).
Follow-Up After Hospitalization for Mental Illness
Follow-Up Within 7 Days Post-Discharge
The percentage of adults and children 6 years of age and older who were hospitalized for treatment of selected mental illness or intentional self-harm and had an outpatient visit, an intensive outpatient encounter or a partial hospitalization, with a mental health practitioner within 7 days of discharge.
| Health Plan | 2022 | 2021 | 2020 | 2019 | 2018 |
|---|---|---|---|---|---|
| Bear River Mental Health | 60% | 45% | 60% | 44% | 65% |
| Central Utah Counseling Center | 79% | 58% | 42% | 82% | 85% |
| Davis Behavioral Health | 52% | 76% | 70% | 80% | 79% |
| Four Corners Community Behavioral Health | 49% | 36% | 38% | 72% | 73% |
| Healthy U Behavioral Health | 36% | 67% | ** | ** | ** |
| Healthy Outcomes Medical Excellence | 37% | 37% | 50% | 45% | ** |
| Northeastern Counseling Center | 60% | 68% | 63% | 72% | 63% |
| Optum Tooele County (New for 2022) | 48% | ||||
| Salt Lake County Division of Behavioral Health Services/Optum | 48% | 49% | 41% | 44% | 56% |
| Southwest Behavioral Health Center | 52% | 60% | 60% | 62% | ** |
| Valley Behavioral Health (Retired after 2021) | ** | 65% | ** | ** | |
| Wasatch Behavioral Health | 62% | 62% | 61% | 56% | 67% |
| Weber Human Services | 47% | 38% | 49% | 60% | 61% |
| National Average (Medicaid HMO Rate) |
38% |
39% | 36% | 36% | 37% |
Follow-Up Within 30 Days Post-Discharge
The percentage of adults and children 6 years of age and older who were hospitalized for treatment of selected mental illness or intentional self-harm and had an outpatient visit, an intensive outpatient encounter or a partial hospitalization, with a mental health practitioner within 30 days of discharge.
| Health Plan | 2022 | 2021 | 2020 | 2019 | 2018 |
|---|---|---|---|---|---|
| Bear River Mental Health | 74% | 60% | 70% | 55% | 73% |
| Central Utah Counseling Center | 93% | 72% | 78% | 89% | 96% |
| Davis Behavioral Health | 79% | 89% | 83% | 86% | 89% |
| Four Corners Community Behavioral Health | 60% | 42% | 50% | 88% | 55% |
| Healthy U Behavioral Health | 68% | 78% | ** | ** | ** |
| Healthy Outcomes Medical Excellence | 90% | 93% | 97% | 94% | ** |
| Northeastern Counseling Center | 73% | 76% | 73% | 81% | 92% |
| Optum Tooele County (New for 2022) | 58% | ||||
| Salt Lake County Division of Behavioral Health Services/Optum | 65% | 64% | 60% | 62% | 71% |
| Southwest Behavioral Health Center | 65% | 72% | 72% | 76% | ** |
| Valley Behavioral Health (Retired after 2021) | ** | 82% | ** | ** | |
| Wasatch Behavioral Health | 77% | 82% | 79% | 78% | 92% |
| Weber Human Services | 65% | 60% | 68% | 75% | 76% |
| National Average (Medicaid HMO Rate) | 59% | 59% | 57% | 57% | 58% |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Follow-Up After Hospitalization for Mental Illness (FUH).
Annual Dental Visit
Assesses Medicaid members 2 – 20 years of age with dental benefits, who had at least one dental visit during the year.
| Health Plan | 2022 | 2021 | 2020 |
|---|---|---|---|
| MCNA | 55% | 58% | 66% |
| Premier Access (Medicaid) | 59% | 56% | 65% |
| Premier Access (CHIP) | 75% | 45% | 55% |
| National Average (Medicaid) | 47% | 43% | 56% |
For more information, please visit the National Committee for Quality Assurance (NCQA) website for Annual Dental Visit (ADV).
Data Note: For table cells with an * , the organization followed the specifications, but the denominator was too small to report a valid rate.
- For Effectiveness of Care (EOC) and EOC-like measures, the denominator was <30.
- For all risk-adjusted utilization measures, the denominator was <150.
- For ECDS measures, the denominator was <30.