Executive Overview
Unified performance summary across all data sources -- Virginia/Mid-Atlantic regional health plan (~125,000 members)
Total Members
124,892
+3.2% YoY
Avg CAHPS Overall
8.4/10
Natl avg 8.1
Overall Star Rating
4.0 stars
Up from 3.5
HEDIS Composite
78.3%
Target 80%
Claims PMPM
$847
-2.1% YoY
Network Adequacy
94.7%
Above 90% target
Monthly CAHPS Composite Trend
Star Rating Components
Member Satisfaction Distribution
Utilization Metrics
Readmission Rate
11.2%
Below 12% target
ED Utilization
284
per 1,000 members
Preventive Care
73.8%
Completion rate
CAHPS Survey Analytics
Consumer Assessment of Healthcare Providers and Systems -- composite scores, trends, and outreach effectiveness
Response Rate
80.7%
1,893 of 2,347 sampled
Overall Rating
8.4/10
+0.3 from prior year
Net Promoter Score
+17.6
Strong positive
Getting Needed Care
8.1
+0.2 YoY
Getting Care Quickly
7.8
+0.4 YoY
Customer Service
8.6
+0.1 YoY
5-Year CAHPS Composite Trends (2021-2025)
Score by Composite Measure
Promoter / Passive / Detractor by Year
Outreach Program Effectiveness
| Program | Improvement Rate | Score Lift | Status |
|---|---|---|---|
| Detractor Recovery | 50.0% | +1.4 | Active |
| Care Coordination | 54.7% | +1.8 | Active |
| Care Gap Closure | 43.0% | +0.9 | Active |
| New Member Welcome | 42.9% | +1.2 | Active |
| Wellness Program | 37.9% | +0.8 | Scaling |
| Benefits Education | 40.9% | +1.1 | Scaling |
Provider Network Map
Interactive map of contracted provider locations across the Virginia/Mid-Atlantic service area
Total Providers
847
Primary Care
312
Specialists
535
Network Adequacy
94.7%
Top Providers by Quality
Avg Panel Size
1,248
Member Demographics
Geographic and demographic composition of the Medicare Advantage population
Dual-Eligible
18.3%
22,855 members
Average Age
74.2
Years
Avg Tenure
4.8 yrs
Member retention
New Members (12mo)
12,847
+8.4% vs prior
Age Distribution
Gender
Plan Type
Risk Level
Top 10 Virginia Counties by Enrollment
Chronic Conditions Prevalence
Visit-to-Score Correlation
Quantifying the relationship between PCP visit frequency and CAHPS quality scores
Members with 4+ annual PCP visits score 2.4 points higher on CAHPS Overall Rating
Each additional PCP visit correlates with +0.38 CAHPS score improvement
High-risk members benefit most: +3.1 points with consistent visit engagement
Visit-driven outreach programs show 54.7% member improvement rate
PCP Visit Frequency vs. CAHPS Overall Score (R2 = 0.73)
Average CAHPS Score by Visit Frequency
Score Improvement Trajectory
Quality Measures Tracker
HEDIS measures and CMS Star Ratings performance monitoring
2
At 5-Star
6
At 4-Star
2
At 3-Star
0
At 2-Star or Below
Star Ratings Detail
| Measure | Current Rate | Benchmark | Stars | Prior Year | Trend | Performance |
|---|
Performance vs. Benchmark by Measure
Performance Radar by Category