MOUNT VERNON — As a 22-year-old soon turning 23 with chronic rheumatoid arthritis, medical terms used to confuse me.
Yes, you heard that right. A fairly young person with arthritis.
I don’t find it fun and wouldn’t wish it on my worst enemy, but by the grace of God and some good doctors, I remain able-bodied and doing just fine.
If you find me casting a line and complaining about tying my lures, I just might share my entire battle with the not-so-fishing-friendly disease.
However, since my rheumatologist diagnosed me at 19, I’ve developed an interest in understanding medical terms from a layperson’s perspective.
With that said, Knox County Community Health Center released its year-to-date 2025 quality report on Jan. 21, and I want to translate a few points for everyday folks.
CareSource’s Medical Loss Ratio in Knox County
CareSource is a health insurance provider that primarily deals with government-sponsored programs. According to the nonprofit’s website, plans include:
- Medicaid
- Dual Eligible Special Needs Plan
- Marketplace
- TRICARE Prime® Demo by CareSource Military & Veterans™
“Medical loss ratio (MLR) is a measure of the percentage of premium dollars that a health plan spends on medical claims and quality improvements, versus administrative costs,” according to health insurance.org.
Obamacare, or the Affordable Care Act, “requires health insurance carriers to spend the bulk of the premiums they collect on medical expenses for their insureds,” the website continues.
The ACA requires smaller health insurance carriers to spend, at a minimum, 80 percent of premiums on medical expenses and 85 percent for larger-group carriers.
“Profits and other administrative expenses can make up no more than 20 percent (15 percent for large groups) of premiums collected,” the website states. “If administrative expenses exceed those amounts, the insurer must remit rebates to their insureds.”
According to KCCHC’s quality report, MLR for just CareSource declined from 99 percent (from January to March 2025) to 92 percent (from January to September 2025).
“[This percentage decline reflects] improved cost management through a renewed focus on adult ER discharge follow-ups,” the report states.
“[This is a] continued trend in a positive direction to meeting the target of 75 to 85 percent.”
Clinical Quality Measures (CQMs)
Eight of 16 clinical quality measures improved in comparison to 2024’s data.
“[CQMs] are tools that help measure or quantify healthcare processes, outcomes, patient perceptions and organizational structure and/or systems that are associated with the ability to provide high-quality health care,” the CDC defines.
“[Childhood weight assessment & counseling’s] compliance increased by 33 percent, reaching 68 percent year-to-date through quarter four 2025,” the report states.
“[The depression remission at 12 months measure] is extremely difficult to meet. For 2025, our medical and behavior health service lines did a great job meeting the measure threshold of 20 percent and achieving 21.3-percent compliance,” the report notes.
“That is a 14.5-percent improvement from 2024.”
Below is a graph from KCCHC’s quality report that lays out the data for all 16 CQMs:
Patient satisfaction
Patient satisfaction falls under three service lines: behavioral health, dental and medical.
“Behavioral health, dental and medical patients reported feeling supported, well-informed and actively involved in their care, with strong ratings for staff professionalism, provider communication, access and wait times,” the report and its surveys found.
“Across all service lines, patients expressed a high likelihood to return and recommend services to others, reflected in excellent likelihood-to-return scores.”
Read KCCHC’s entire report below: