Prime West
General Info
Disclaimers
HEDIS 2014 (Reporting Year 2013)
Page
Data Last Refreshed: 7/15/2015
2
Effectiveness of Care Measures
Code
Effectiveness of Care Measures
Code
Page
Medication Management
Page
26 MPM
Annual Monitoring for Patients on Persistent Medications
62
ABA
Adult BMI Assessment
3
27 MRP
Medication Reconciliation Post Discharge
69
WCC
Weight Assessment and Counseling for Nutrition and Physical Activity for
Children/Adolescents
4
DDE
Potentially Harmful Drug-Disease Interactions in the Elderly
70
CIS
Childhood Immunization Status
7
Use of High Risk Medications in the Elderly
72
IMA
Immunizations for Adolescents
13
Prevention and Screening
28
29 DAE
BCS
Breast Cancer Screening
16
Code
CCS
Cervical Cancer Screening
17
30 AAP
Adult's Access to Preventive/Ambulatory Health Services
74
COL
Colorectal Cancer Screening
18
31 CAP
Children's and Adolescents' Access to Primary Care Practitioners
81
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
84
Prenatal and Postpartum Care
91
CHL
Chlamydia Screening in Women
19
32
GSO
Glaucoma Screening in Older Adults
22
33 PPC
HPV
Human Papillomavirus Vaccine for Female Adolescents
23
34
Care for Older Adults
24
56 Code
COA
Respiratory Conditions
PCE
Pharmacotherapy Management of COPD Exacerbation
25
SPR
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
29
Use of Appropriate Medications for People with Asthma
30
ASM
Cardiovascular
IET
Access / Availability of Care Measures
Use of Services Measures
Page
Page
34 W15
Well Child Visits in the First 15 Months of Life
35 W34
Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life
97
Adolescent Well-Care Visits
98
36
AWC
94
Ambulatory Care
99
38
IPU
Inpatient Utilization - General Hospital/Acute Care
106
IAD
Identification of Alcohol and Other Drug Services
113
37 AMB
CMC
Cholesterol Management for Patients with Cardiovascular Conditions
33
39
CBP
Controlling High Blood Pressure
37
40 MPT
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services 120
Persistence of Beta Blocker Treatment After Heart Attack
38
41 PCR
Plan All-Cause Readmissions
PBH
Diabetes
CDC
Comprehensive Diabetes Care
39
Musculoskeletal
ART
OMW
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis
46
Osteoporosis Management in Women Who had a Fracture
47
Behavioral Health
AMM
Antidepressant Medication Management
48
ADD
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
55
FUH
Follow-up After Hospitalization for Mental Illness
58
HEDIS 2014 (Reporting Year 2013)
127
41
Code
Health Plan Descriptive Information Measures
Page
42 BCR
Board Certification
131
43 ENP
Enrollment by Product Line (Age & Sex)
134
43
DISCLAIMERS
-1
( this page left blank intentionally )
0. Disclaimer Query located below
HEDIS 2014 (Reporting Year 2013)
Page 2
Effectiveness of Care
Prime West
Adult BMI Assessment
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Data Elements
Commercial
Medicare
Advantage
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on Eligible
Population (before exclusions)
MA Expand
F& C
2013
H
1546
MN Care
2013
H
523
166
82
10.74%
411
5.00%
432
90
20.83%
15.68%
411
5.00%
432
72
16.67%
Number of Records Excluded Because of Valid
Data Errors
0
0
Number of administrative data records excluded
0
0
Number of medical record data records excluded
0
0
Number of employee/dependent medical records
excluded
0
0
0
411
85
235
77.86%
73.72%
81.99%
0
411
70
248
77.37%
73.21%
81.54%
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 3
Effectiveness of Care
Prime West
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
BMI Percentile
Data Elements
General
Measure
Data
Ages 3-11 Ages 12-17
Counseling for Nutrition
Total
General
Measure
Data
Ages 3-11 Ages 12-17
Counseling for Physical Activity
Total
General
Measure
Data
Ages 3-11
Ages 1217
Total
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number of Records Excluded Because of
Valid Data Errors
Number of administrative data records
excluded
Number of medical records excluded
Number of employee/dependent records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
Page 4
Effectiveness of Care
Prime West
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F&C)
BMI Percentile
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
General
Measure
Data
Ages 3-11 Ages 12-17
Counseling for Nutrition
Total
General
Measure
Data
Ages 3-11 Ages 12-17
Counseling for Physical Activity
Total
2013
H
General
Measure
Data
Total
2161
1125
3286
2161
1125
3286
2161
1125
3286
14
0.65%
17
1.51%
31
0.94%
10
0.46%
9
0.80%
19
0.58%
0
0.00%
0
0.00%
0
0.00%
0
NR
0
NR
0
NR
411
5.00%
411
5.00%
432
2
NR
3
NR
5
NR
432
3
NR
2
NR
5
NR
0
0
Number of administrative data records
excluded
0
0
Number of medical records excluded
0
0
Number of employee/dependent records
excluded
0
0
Records Added from the Oversample List
0
0
HEDIS 2014 (Reporting Year 2013)
Ages 1217
2013
H
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
Ages 3-11
276
135
411
276
135
411
276
135
411
1
152
55.43%
49.39%
61.48%
3
69
53.33%
44.55%
62.12%
4
221
54.74%
49.81%
59.68%
2
119
43.84%
37.81%
49.88%
1
52
39.26%
30.65%
47.87%
3
171
42.34%
37.44%
47.23%
0
109
39.49%
33.54%
45.44%
0
65
48.15%
39.35%
56.95%
0
174
42.34%
37.44%
47.23%
Page 5
Effectiveness of Care
Prime West
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Number of administrative data records
Number of medical records excluded
Number of employee/dependent records
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
2013
H
BMI Percentile
Ages 3-11 Ages 12-17
281
5
1.78%
127
2
1.57%
Total
General
2013
H
408
7
1.72%
407
0.00%
407
Counseling for Nutrition
Ages 3-11 Ages 12-17
Total
281
1
0.36%
127
1
0.79%
408
2
0.49%
1
0.25%
1
0.25%
2
0.49%
281
1
136
48.75%
42.73%
54.78%
126
1
45
36.51%
27.70%
45.31%
407
2
181
44.96%
40.01%
49.92%
407
0.00%
407
5
1.23%
2
0.49%
7
1.72%
0
1
0
0
0
0
1
0
0
0
281
5
119
44.13%
38.14%
50.11%
126
2
66
53.97%
44.87%
63.07%
407
7
185
47.17%
42.20%
52.15%
Counseling for Physical Activity
General
Ages 3-11 Ages 12Total
2013
H
281
127
408
0
0
0
0.00%
0.00%
0.00%
407
0.00%
407
0
0
0
0.00%
0.00%
0.00%
0
1
0
0
0
281
126
407
0
0
0
121
63
184
43.06%
50.00%
45.21%
37.09%
40.87%
40.25%
49.03%
59.13%
50.17%
Page 6
Effectiveness of Care
Prime West
Childhood Immunization Status
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Data Elements
General
Measure
Data
Pneumococcal
Hepatitis A Rotavirus
Conjugate
DTaP
IPV
MMR
HiB
Hepatitis B
VZV
Influenza
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Reported Rate
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Lower 95% Confidence Interval
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Upper 95% Confidence Interval
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of administrative data records
excluded
Number of medical data records excluded
Number of employee/dependent records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by administrative Data
Numerator Events by Medical Record
HEDIS 2014 (Reporting Year 2013)
Page 7
Effectiveness of Care
Prime West
Childhood Immunization Status
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Data Elements
General
Measure
Data
DTaP
Combo 2
Combo 3
Combo 4
Combo 5
Combo 6
Combo 7
Combo 8
Combo 9
Combo10
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Reported Rate
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Lower 95% Confidence Interval
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Upper 95% Confidence Interval
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of administrative data records
excluded
Number of medical data records excluded
Number of employee/dependent records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by administrative Data
Numerator Events by Medical Record
HEDIS 2014 (Reporting Year 2013)
Page 8
Effectiveness of Care
Prime West
Childhood Immunization Status
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F&C)
Data Elements
General
Measure
Data
Pneumococcal
Hepatitis A Rotavirus
Conjugate
DTaP
IPV
MMR
HiB
Hepatitis B
VZV
321
80.86%
366
92.19%
366
92.19%
367
92.44%
341
85.89%
359
90.43%
331
83.38%
222
55.92%
256
64.48%
185
46.60%
321
366
366
367
341
359
331
222
256
185
80.86%
92.19%
92.19%
92.44%
85.89%
90.43%
83.38%
55.92%
64.48%
46.60%
Numerator Events by administrative Data
321
366
366
367
341
359
331
222
256
185
Numerator Events by Medical Record
12
8
1
9
23
1
0
5
22
24
Reported Rate
83.88%
94.21%
92.44%
94.71%
91.69%
90.68%
83.38%
57.18%
70.03%
52.64%
Lower 95% Confidence Interval
80.14%
91.78%
89.72%
92.38%
88.85%
87.69%
79.59%
52.19%
65.39%
47.61%
Upper 95% Confidence Interval
87.62%
96.63%
95.17%
97.04%
94.53%
93.67%
87.16%
62.17%
74.66%
57.68%
Measurement Year
2013
Data Collection Methodology
H
Eligible Member Population
397
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
397
0
397
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
0
Number of administrative data records
excluded
0
Number of medical data records excluded
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
Denominator
HEDIS 2014 (Reporting Year 2013)
Influenza
397
Page 9
Effectiveness of Care
Prime West
Childhood Immunization Status
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F&C)
Data Elements
General
Measure
Data
DTaP
Combo 2
Combo 3
Combo 4
Combo 5
Combo 6
Combo 7
Combo 8
Combo 9
Combo10
321
80.86%
288
72.54%
277
69.77%
177
44.58%
204
51.39%
156
39.29%
138
34.76%
109
27.46%
113
28.46%
88
22.17%
321
288
277
177
204
156
138
109
113
88
80.86%
72.54%
69.77%
44.58%
51.39%
39.29%
34.76%
27.46%
28.46%
22.17%
Numerator Events by administrative Data
321
288
277
177
204
156
138
109
113
88
Numerator Events by Medical Record
12
23
15
13
25
33
22
27
36
30
Reported Rate
83.88%
78.34%
73.55%
47.86%
57.68%
47.61%
40.30%
34.26%
37.53%
29.72%
Lower 95% Confidence Interval
80.14%
74.16%
69.09%
42.82%
52.70%
42.57%
35.35%
29.46%
32.64%
25.10%
Upper 95% Confidence Interval
87.62%
82.52%
78.02%
52.90%
62.67%
52.65%
45.25%
39.05%
42.42%
34.34%
Measurement Year
2013
Data Collection Methodology
H
Eligible Member Population
397
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
397
0
397
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
0
Number of administrative data records
excluded
0
Number of medical data records excluded
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
Denominator
HEDIS 2014 (Reporting Year 2013)
397
Page 10
Effectiveness of Care
Prime West
Childhood Immunization Status
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
Data Elements
Measurement Year
General
Measure
Data
H
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
17
Minimum Required Sample Size
17
Oversampling Rate
0
Final Sample Size (FSS)
17
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
0
Number of administrative data records
excluded
0
Number of medical data records excluded
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
Denominator
17
HEDIS 2014 (Reporting Year 2013)
IPV
MMR
HiB
Hepatitis B
VZV
Influenza
15
16
15
16
15
14
16
8
11
10
88.24%
94.12%
88.24%
94.12%
88.24%
82.35%
94.12%
47.06%
64.71%
58.82%
15
16
15
16
15
14
16
8
11
10
88.24%
94.12%
88.24%
94.12%
88.24%
82.35%
94.12%
47.06%
64.71%
58.82%
15
16
15
16
15
14
16
8
11
10
2013
Data Collection Methodology
Numerator Events by administrative Data
Pneumococcal
Hepatitis A Rotavirus
Conjugate
DTaP
Page 11
Effectiveness of Care
Prime West
Childhood Immunization Status
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
Data Elements
Measurement Year
General
Measure
Data
H
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
17
Minimum Required Sample Size
17
Oversampling Rate
0
Final Sample Size (FSS)
17
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
0
Number of administrative data records
excluded
0
Number of medical data records excluded
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
Denominator
17
HEDIS 2014 (Reporting Year 2013)
Combo 2
Combo 3
Combo 4
Combo 5
Combo 6
Combo 7
Combo 8
Combo 9
Combo10
15
14
14
8
10
8
6
5
6
4
88.24%
82.35%
82.35%
47.06%
58.82%
47.06%
35.29%
29.41%
35.29%
23.53%
15
14
14
8
10
8
6
5
6
4
88.24%
82.35%
82.35%
47.06%
58.82%
47.06%
35.29%
29.41%
35.29%
23.53%
15
14
14
8
10
8
6
5
6
4
2013
Data Collection Methodology
Numerator Events by administrative Data
DTaP
Page 12
Effectiveness of Care
Prime West
Immunizations for Adolescents
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Commercial
Data Elements
General
Measure Data
Meningococcal
Tdap
Combo 1
Current Year's Admin Rate
NR
NR
NR
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
NR
NR
NR
Reported Rate
NR
NR
NR
Lower 95% Confidence Interval
NR
NR
NR
Upper 95% Confidence Interval
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on Eligible
Population (before exclusions)
Records Excluded because of Valid Data Errors
Number of administrative data records excluded
Number of medical data records excluded
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
HEDIS 2014 (Reporting Year 2013)
Page 13
Effectiveness of Care
Prime West
Immunizations for Adolescents
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Minnesota Health Care Programs - Managed Care (MA-Expand)
General
Data Elements
Measure Data
Measurement Year
2013
Data Collection Methodology
H
Eligible Member Population
258
Numerator Events by Admin Data on Eligible
Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
0
Number of administrative data records excluded
0
Number of medical data records excluded
0
Number of employee/dependent medical records
excluded
0
HEDIS 2014 (Reporting Year 2013)
Tdap
Combo 1
100
217
98
38.76%
84.11%
37.98%
100
38.76%
217
84.11%
98
37.98%
100
4
40.31%
34.13%
46.49%
217
2
84.88%
80.32%
89.45%
98
4
39.53%
33.38%
45.69%
258
0.00%
258
Records Excluded because of Valid Data Errors
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
Meningococcal
0
258
Page 14
Effectiveness of Care
Prime West
Immunizations for Adolescents
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Minnesota Health Care Programs - Managed Care (MN Care)
General
Data Elements
Measure Data
Measurement Year
2013
Data Collection Methodology
H
Eligible Member Population
17
Numerator Events by Admin Data on Eligible
Current Year's Admin Rate
Minimum Required Sample Size
17
Oversampling Rate
0.00%
Final Sample Size (FSS)
17
Numerator events by admin data in FSS
Admin Rate on FSS
Records Excluded because of Valid Data Errors
0
Number of administrative data records excluded
0
Number of medical data records excluded
0
Number of employee/dependent medical records
0
Records Added from the Oversample List
0
Denominator
17
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
Meningococcal
Tdap
Combo 1
12
70.59%
16
94.12%
12
70.59%
12
70.59%
16
94.12%
12
70.59%
12
0
NA
NA
NA
16
0
NA
NA
NA
12
0
NA
NA
NA
Page 15
Effectiveness of Care
Prime West
Breast Cancer Screening
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
Commercial
NR
NR
NR
Medicare
Advantage
NR
NR
NR
MSHO
MA Expand
F& C
MN Care
SNBC
SNP
SNBC
Non SNP
2013
A
240
140
58.33%
51.89%
64.78%
2013
A
107
55
51.40%
41.46%
61.34%
2013
A
93
58
62.37%
51.98%
72.75%
2013
A
54
41
75.93%
63.60%
88.26%
2013
A
18
14
NA
NA
NA
Page 16
Effectiveness of Care
Prime West
Cervical Cancer Screening
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MA Expand
F& C
MN Care
Measurement Year
Data Collection Methodology
Eligible Member Population
2013
H
1796
2013
H
525
Numerator Events by Admin Data on Eligible
Population (before exclusions)
993
298
55.29%
411
5.00%
432
247
57.18%
0
2
7
56.76%
411
5.00%
432
256
59.26%
0
4
11
0
0
7
411
236
28
64.23%
59.48%
68.99%
9
411
251
17
65.21%
60.48%
69.93%
Data Elements
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
Records Excluded because of Valid Data Errors
Number of administrative data records excluded
Number of medical record data records excluded
Commercial
NR
NR
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
NR
NR
NR
Page 17
Effectiveness of Care
Prime West
Colorectal Cancer Screening
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare
Advantage
Measurement Year
Data collection methodology (administrative or hybrid)
Eligible population
2013
H
410
SNBC
SNP
2013
H
101
Number of numerator events by administrative data in eligible population
(before exclusions)
197
62
48.05%
407
0.00%
407
197
48.40%
0
3
0
0
0
407
197
29
55.53%
50.58%
60.48%
61.39%
101
0.00%
101
62
61.39%
0
0
0
0
0
101
62
6
67.33%
57.68%
76.97%
Data Elements
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of valid data errors
Number of administrative data records excluded
Number of medical record data records excluded
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical records
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
Commercial
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
MSHO
SNBC
Non SNP
NR
NR
NR
NR
NR
Page 18
Effectiveness of Care
Prime West
Chlamydia Screening in Women
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure Data
Ages 16-20
NR
NR
NR
Ages 21-24
Total
NR
NR
NR
NR
NR
NR
NR
NR
Page 19
Effectiveness of Care
Prime West
Chlamydia Screening in Women
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F& C)
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure Data
Ages 16-20
Ages 21-24
Total
227
69
30.40%
24.19%
36.60%
237
83
35.02%
28.74%
41.31%
464
152
32.76%
28.38%
37.14%
2013
A
Page 20
Effectiveness of Care
Prime West
Chlamydia Screening in Women
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
Data Elements
General
Measurement Year
2013
Data Collection Methodology
A
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
Ages 16-20
Ages 21-24
Total
40
10
25.00%
10.33%
39.67%
29
11
NA
NA
NA
69
21
30.43%
18.85%
42.02%
Page 21
Effectiveness of Care
Prime West
Glaucoma Screening in Older Adults
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
Medicare
Advantage
NR
NR
NR
MSHO
2013
A
1363
1001
73.44%
71.06%
75.82%
Page 22
Effectiveness of Care
Prime West
Human Papillomavirus Vaccine for Female Adolescents
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Commercial
MA Expand F & C
2013
H
116
MN Care
2013
H
8
15
1
NR
12.93%
12.50%
NR
116
0.00%
116
15
12.93%
8
0.00%
8
1
12.50%
Records Excluded because of Valid Data
Errors
0
0
Number of administrative data records
excluded
0
0
Number of medical record data records
excluded
0
0
Number of employee/dependent medical
records excluded
0
0
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
0
116
15
2
0
8
1
0
Numerator Events by Admin Data on
Eligible Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
Reported Rate
NR
14.66%
NA
Lower 95% Confidence Interval
NR
7.79%
NA
Upper 95% Confidence Interval
NR
21.52%
NA
HEDIS 2014 (Reporting Year 2013)
Page 23
Effectiveness of Care
Prime West
Care for Older Adults
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
Medication Review
Functional
Status
Assessment
Pain
Screening
804
4
825
690
46.10%
0.23%
47.31%
39.56%
215
49.77%
0
0.00%
201
46.53%
165
38.19%
208
73
0
160
194
121
160
168
Reported Rate
68.37%
38.93%
76.64%
79.81%
Lower 95% Confidence Interval
63.75%
34.09%
72.43%
75.80%
Upper 95% Confidence Interval
72.99%
43.77%
80.85%
83.81%
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General Measure
Data
2013
H
1744
Numerator Events by Admin Data on
Eligible Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
411
5.00%
432
Records Excluded because of Valid Data
Errors
2
Number of employee/dependent medical
records excluded
0
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
HEDIS 2014 (Reporting Year 2013)
Advance Care
Planning
2
411
Page 24
Effectiveness of Care
Prime West
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare Advantage
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
NR
NR
NR
NR
NR
NR
Page 25
Effectiveness of Care
Prime West
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
36
64.29%
50.84%
77.73%
47
83.93%
73.42%
94.44%
2013
A
56
Page 26
Effectiveness of Care
Prime West
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-SNP
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
8
NA
NA
NA
10
NA
NA
NA
2013
A
10
Page 27
Effectiveness of Care
Prime West
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-Non SNP
Data Elements
Measurement Year
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
1
NA
NA
NA
3
NA
NA
NA
2013
23
Page 28
Effectiveness of Care
Prime West
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
Medicare
Advantage
NR
NR
NR
MSHO
SNBC
SNP
SNBC Non
SNP
2013
A
41
6
14.63%
2.60%
26.67%
2013
A
4
1
NA
NA
NA
2013
A
3
0
NA
NA
NA
Page 29
Effectiveness of Care
Prime West
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Number of required exclusions
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure Data
Ages 5-11
NR
NR
NR
Ages 12-18
NR
NR
NR
Ages 19-50
NR
NR
NR
Ages 51-64
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
`
Page 30
Effectiveness of Care
Prime West
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F&C)
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Number of required exclusions
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure Data
Ages 5-11
Ages 12-18
Ages 19-50
Ages 51-64
Total
29
28
3
NA
NA
NA
26
25
1
NA
NA
NA
47
38
8
80.85%
68.54%
93.16%
8
8
11
NA
NA
NA
110
99
23
90.00%
83.94%
96.06%
2013
A
Page 31
Effectiveness of Care
Prime West
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
Data Elements
General
Ages 5-11
Measurement Year
2013
Data Collection Methodology
A
4
Eligible Member Population
4
Numerator Events by Admin Data
0
Number of required exclusions
NA
Reported Rate
NA
Lower 95% Confidence Interval
NA
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
Ages 12-18
Ages 19-50
Ages 51-64
Total
2
2
0
NA
NA
NA
11
10
1
NA
NA
NA
8
7
4
NA
NA
NA
25
23
5
NA
NA
NA
Page 32
Effectiveness of Care
Prime West
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on Eligible Population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Records Excluded because of Valid Data Errors
Number of employee/dependent medical records excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 33
Effectiveness of Care
Prime West
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare Advantage
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on Eligible Population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Records Excluded because of Valid Data Errors
Number of employee/dependent medical records excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 34
Effectiveness of Care
Prime West
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F&C)
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on Eligible Population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Records Excluded because of Valid Data Errors
Number of employee/dependent medical records excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
10
0
66.67%
0.00%
10
0
66.67%
0.00%
10
0
0
5
NA
NA
NA
NA
NA
NA
2013
H
15
15
0.00%
15
0
0
0
15
Page 35
Effectiveness of Care
Prime West
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on Eligible Population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Records Excluded because of Valid Data Errors
Number of employee/dependent medical records excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
9
0
81.82%
0.00%
2013
H
11
11
0.00%
11
9
0
81.82%
0.00%
9
0
0
7
NA
NA
NA
NA
NA
NA
0
0
0
11
Page 36
Effectiveness of Care
Prime West
Controlling High Blood Pressure
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare
Advantage
MSHO
SNBC-SNP
SNBC
Non SNP
MA Expand
F&C
MN Care
Measurement Year
Data Collection Methodology (Hybrid)
Eligible Member Population
2013
H
388
2013
H
39
2013
H
179
2013
H
277
2013
H
106
Numerator Events by Admin Data on
Eligible Population (before exclusions)
0
0
0
0
0
0.00%
284
0.00%
284
0.00%
37
0.00%
37
0.00%
160
0.00%
160
0.00%
259
0.00%
259
0.00%
105
0.00%
105
0
0.00%
0
0.00%
0
0.00%
0
0.00%
0
0.00%
Records Excluded because of Valid Data
Errors
0
1
3
6
2
Number of records excluded because of
false positive diagnoses
0
1
3
6
2
Number of administrative data records
excluded
104
2
16
12
1
Number of medical record data records
excluded
0
0
0
0
0
Number of employee/dependent medical
records excluded
0
0
0
0
0
Records Added from the OverSample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
0
283
0
197
69.61%
64.08%
75.15%
0
35
0
27
77.14%
61.80%
92.48%
0
157
0
99
63.06%
55.19%
70.93%
0
253
0
149
58.89%
52.63%
65.15%
0
103
0
63
61.17%
51.27%
71.06%
Data Elements
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
HEDIS 2014 (Reporting Year 2013)
Commercial
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 37
Effectiveness of Care
Prime West
Persistence of Beta Blocker Treatment After Heart Attack
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Data Elements
Commercial
Medicare
Advantage
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on
Eligible Population
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
NR
NR
NR
NR
NR
NR
MSHO
SNBC
SNP
SNBC
Non SNP
MA Expand
F&C
MN Care
2013
A
17
2013
A
0
2013
A
3
2013
A
5
2013
A
1
16
0
2
5
1
NA
NA
NA
NR
NR
NR
NA
NA
NA
NA
NA
NA
NA
NA
NA
Page 38
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Data Elements
HbA1c
Testing
Poor HbA1c
Control
(>9.0%)
Good HbA1c
Control
(<7.0%)
Adequate
HbA1c
Control
(<8.0%)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Blood
Monitoring for
Pressure
Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<140/80
mm Hg
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
Number of HbA1c < 7 required administrative
data records excluded
Number of HbA1c < 7 required medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
Page 39
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare Advantage
Data Elements
HbA1c
Testing
Poor HbA1c
Control
Good HbA1c
Control
(<7.0%)
Adequate
HbA1c
Control
(<8.0%)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Blood
Monitoring for
Pressure
Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<140/80
mm Hg
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
Number of Administrative required exclusions
Number of Hybrid required exclusions
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
Page 40
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
Adequate
HbA1c
Control
(<8.0%)
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
2013
H
200
2013
H
200
2013
H
200
2013
H
200
2013
H
200
2013
H
200
2013
H
200
0
0.00%
200
0%
200
0
0.00%
121
60.50%
200
0%
200
121
60.50%
163
81.50%
200
0%
200
163
81.50%
1
0.50%
200
0%
200
1
0.50%
159
79.50%
200
0%
200
159
79.50%
0
0.00%
200
0%
200
0
0.00%
0
0.00%
200
0%
200
0
0.00%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
200
185
0
92.50%
88.60%
96.40%
0
200
83
8
45.50%
38.35%
52.65%
0
200
0
94
47.00%
39.83%
54.17%
0
200
121
22
71.50%
64.99%
78.01%
0
200
163
1
82.00%
76.43%
87.57%
0
200
1
78
39.50%
32.47%
46.53%
0
200
159
4
81.50%
75.87%
87.13%
0
200
0
138
69.00%
62.34%
75.66%
0
200
0
117
58.50%
51.42%
65.58%
HbA1c
Testing
Poor HbA1c
Control
2013
H
200
2013
H
200
185
92.50%
200
0%
200
185
92.50%
199
99.50%
200
0%
200
199
99.50%
Number of Records Excluded Because of
Valid Data Errors
0
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Good HbA1c
Control
(<7.0%)
NR
NR
Blood
Monitoring for
Pressure
Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<140/80
mm Hg
Number of Administrative required exclusions
Number of Hybrid required exclusions
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
NR
NR
NR
Page 41
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC - SNP
HbA1c
Testing
Poor HbA1c
Control
2013
H
52
2013
H
52
47
90.38%
52
0%
52
47
90.38%
52
100.00%
52
0%
52
52
100.00%
Number of Records Excluded Because of
Valid Data Errors
0
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Good HbA1c
Control
(<7.0%)
Adequate
HbA1c
Control
(<8.0%)
Blood
Monitoring for
Pressure
Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<140/80
mm Hg
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
2013
H
52
2013
H
52
2013
H
52
2013
H
52
2013
H
52
2013
H
52
2013
H
52
0
0.00%
52
0%
52
0
0.00%
38
73.08%
52
0%
52
38
73.08%
36
69.23%
52
0%
52
36
69.23%
1
1.92%
52
0%
52
1
1.92%
40
76.92%
52
0%
52
40
76.92%
0
0.00%
52
0%
52
0
0.00%
0
0.00%
52
0%
52
0
0.00%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
52
0
52
20
2
42.31%
27.92%
56.70%
0
52
0
24
46.15%
31.64%
60.67%
0
52
38
5
82.69%
71.45%
93.94%
0
52
36
2
73.08%
60.06%
86.09%
0
52
1
21
42.31%
27.92%
56.70%
0
52
40
3
82.69%
71.45%
93.94%
0
52
0
39
75.00%
62.27%
87.73%
0
52
0
32
61.54%
47.35%
75.72%
NR
NR
Number of Administrative required exclusions
Number of Hybrid required exclusions
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
NR
NR
NR
NR
NR
NR
Page 42
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC - Non SNP
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
Adequate
HbA1c
Control
(<8.0%)
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
2013
H
214
2013
H
214
2013
H
214
2013
H
214
2013
H
214
2013
H
214
2013
H
214
0
0.00%
214
0%
214
0
0.00%
119
55.61%
214
0%
214
119
55.61%
156
72.90%
214
0%
214
156
72.90%
1
0.47%
214
0%
214
1
0.47%
132
61.68%
214
0%
214
132
61.68%
0
0.00%
214
0%
214
0
0.00%
0
0.00%
214
0%
214
0
0.00%
1
1
1
1
1
1
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
213
176
3
84.04%
78.88%
89.19%
0
213
90
20
51.64%
44.70%
58.59%
0
213
0
92
43.19%
36.31%
50.08%
0
213
119
26
68.08%
61.58%
74.57%
0
213
156
3
74.65%
68.57%
80.72%
0
213
1
69
32.86%
26.32%
39.41%
0
213
132
29
75.59%
69.58%
81.59%
0
213
0
148
69.48%
63.06%
75.90%
0
213
0
111
52.11%
45.17%
59.06%
HbA1c
Testing
Poor HbA1c
Control
2013
H
214
2013
H
214
176
82.24%
214
0%
214
176
82.24%
214
100.00%
214
0%
214
214
100.00%
1
Good HbA1c
Control
(<7.0%)
NR
NR
Blood
Monitoring for
Pressure
Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<140/80
mm Hg
Number of Administrative required exclusions
Number of Hybrid required exclusions
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
NR
NR
NR
Page 43
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F&C)
HbA1c
Testing
Poor HbA1c
Control
Good HbA1c
Control
(<7.0%)
Adequate
HbA1c
Control
(<8.0%)
2013
H
225
2013
H
225
H
181
80.44%
222
0%
222
181
81.53%
225
100.00%
222
0%
222
222
100.00%
Number of Records Excluded Because of
Valid Data Errors
1
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Blood
Monitoring for
Pressure
Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<140/80
mm Hg
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
2013
H
225
2013
H
225
2013
H
225
2013
H
225
2013
H
225
2013
H
225
2013
H
225
0
0.00%
222
0%
222
0
0.00%
124
55.11%
222
0%
222
121
54.50%
155
68.89%
222
0%
222
154
69.37%
0
0.00%
222
0%
222
0
0.00%
154
68.44%
222
0%
222
153
68.92%
0
0.00%
222
0%
222
0
0.00%
0
0.00%
222
0%
222
0
0.00%
1
1
1
1
1
1
1
1
3
3
3
3
3
3
3
3
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
221
181
6
84.62%
79.63%
89.60%
0
221
88
29
52.94%
46.13%
59.75%
0
221
0
87
39.37%
32.70%
46.03%
0
221
121
17
62.44%
55.83%
69.05%
0
221
154
1
70.14%
63.88%
76.40%
0
221
0
59
26.70%
20.64%
32.76%
0
221
153
13
75.11%
69.19%
81.04%
0
221
0
166
75.11%
69.19%
81.04%
0
221
0
118
53.39%
46.59%
60.20%
NR
NR
Number of Administrative required exclusions
Number of Hybrid required exclusions
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
NR
NR
NR
Page 44
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
Data Elements
HbA1c
2013
Measurement Year
H
Data Collection Methodology
98
Eligible Member Population
91
Numerator events by admin data in eligible
92.86%
Current Year's Administrative Rate
97
Minimum Required Sample Size
0%
Oversampling Rate
97
Final Sample Size (FSS)
89
Numerator events by admin data in FSS
91.75%
Admin rate on FSS
0
Number of Records Excluded Because of
1
Number of administrative data records
0
Number of medical record data records
0
Number of employee/dependent medical
Number of Administrative required exclusions
Number of Hybrid required exclusions
0
Additional Records Added from the
97
Denominator
89
Numerator Events by Admin Data
1
Numerator Events by Medical Record
92.78%
Reported Rate
87.12%
Lower 95% Confidence Interval
98.45%
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
Poor HbA1c
2013
H
98
98
100.00%
97
0%
97
97
100.00%
0
1
0
0
0
97
23
14
38.14%
27.96%
48.33%
Good HbA1c
H
NR
NR
NR
NR
NR
Adequate
2013
H
98
0
0.00%
97
0%
97
0
0.00%
0
1
0
0
Eye Exam
2013
H
98
59
60.20%
97
0%
97
58
59.79%
0
1
0
0
LDL-C
2013
H
98
83
84.69%
97
0%
97
82
84.54%
0
1
0
0
0
97
0
54
55.67%
45.27%
66.07%
0
97
58
8
68.04%
58.25%
77.84%
0
97
82
0
84.54%
76.83%
92.25%
LDL-C Level Monitoring for
2013
2013
H
H
98
98
0
81
0.00%
82.65%
97
97
0%
0%
97
97
0
80
0.00%
82.47%
0
0
1
1
0
0
0
0
0
97
0
38
39.18%
28.95%
49.41%
0
97
80
3
85.57%
78.06%
93.08%
Blood
2013
H
98
0
0.00%
97
0%
97
0
0.00%
0
1
0
0
Blood
2013
H
98
0
0.00%
97
0%
97
0
0.00%
0
1
0
0
0
97
0
72
74.23%
65.01%
83.45%
0
97
0
49
50.52%
40.05%
60.98%
Page 45
Effectiveness of Care
Prime West
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
Medicare
Advantage
NR
NR
NR
Page 46
Effectiveness of Care
Prime West
Osteoporosis Management in Women Who had a Fracture
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
Medicare
Advantage
NR
NR
NR
MSHO
2013
A
74
13
17.57%
8.22%
26.91%
Page 47
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure Data
Effective
Effective Acute
Continuation
Phase
Phase
Treatment
Treatment
NR
NR
NR
NR
NR
NR
Page 48
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare Advantage
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure Data
Effective
Effective Acute
Continuation
Phase
Phase
Treatment
Treatment
NR
NR
NR
NR
NR
NR
Page 49
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure Data
Effective
Effective Acute
Continuation
Phase
Phase
Treatment
Treatment
2013
A
45
39
86.67%
75.62%
97.71%
34
75.56%
61.89%
89.22%
Page 50
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-SNP
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure Data
Effective
Effective Acute
Continuation
Phase
Phase
Treatment
Treatment
NR
NR
NR
NR
NR
NR
Page 51
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-Non SNP
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure Data
Effective
Effective Acute
Continuation
Phase
Phase
Treatment
Treatment
2013
A
27
12
NA
NA
NA
10
NA
NA
NA
Page 52
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F& C)
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure Data
Effective
Effective Acute
Continuation
Phase
Phase
Treatment
Treatment
2013
A
269
137
50.93%
44.77%
57.09%
98
36.43%
30.49%
42.37%
Page 53
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
Data Elements
General
Measurement Year
2013
Data Collection Methodology
A
Eligible Member Population
39
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
Effective Acute
Effective
25
64.10%
47.77%
80.44%
17
43.59%
26.74%
60.43%
Page 54
Effectiveness of Care
Prime West
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
Initiation
Phase
Continuation
and
Maintenance
Phase
NR
NR
NR
NR
NR
NR
Page 55
Effectiveness of Care
Prime West
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F& C)
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
Initiation
Phase
Continuation
and
Maintenance
Phase
91
33
36.26%
25.84%
46.69%
30
14
46.67%
27.15%
66.19%
2013
A
Page 56
Effectiveness of Care
Prime West
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Minnesota Health Care Programs - Managed Care (MN Care)
Data Elements
General
Measurement Year
2013
Data Collection Methodology
A
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
Jul 15, 2015 8:02 AM
Initiation
Continuation
8
2
NA
NA
NA
5
1
NA
NA
NA
Page 57
Effectiveness of Care
Prime West
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare Advantage
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
30 Days
7 Days
NR
NR
NR
NR
NR
NR
Page 58
Effectiveness of Care
Prime West
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
30 Days
7 Days
2
NA
NA
NA
0
NA
NA
NA
2013
A
5
Page 59
Effectiveness of Care
Prime West
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC - SNP
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
30 Days
7 Days
5
NA
NA
NA
5
NA
NA
NA
2013
A
7
Page 60
Effectiveness of Care
Follow-up After Hospitalization for Mental Illness
SNBC-Non SNP
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
30 Days
7 Days
40
88.89%
78.60%
99.18%
28
62.22%
46.95%
77.50%
2013
A
45
Page 61
Effectiveness of Care
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 62
Effectiveness of Care
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare Advantage
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 63
Effectiveness of Care
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
715
672
93.99%
92.17%
95.80%
107
104
97.20%
93.60%
100.00%
842
791
93.94%
92.27%
95.61%
99
76
76.77%
67.94%
85.59%
1763
1643
93.19%
91.99%
94.40%
2013
A
Page 64
Effectiveness of Care
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-SNP
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
46
40
86.96%
76.14%
97.78%
1
1
NA
NA
NA
31
30
96.77%
88.94%
100.00%
24
20
NA
NA
NA
102
91
89.22%
82.71%
95.73%
2013
A
Page 65
Effectiveness of Care
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-Non SNP
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
68
55
80.88%
70.80%
90.96%
2
2
NA
NA
NA
48
43
89.58%
79.90%
99.27%
27
21
NA
NA
NA
145
121
83.45%
77.05%
89.84%
2013
A
Page 66
Effectiveness of Care
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F&C)
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
227
181
79.74%
74.29%
85.19%
4
4
NA
NA
NA
170
144
84.71%
79.00%
90.41%
27
17
NA
NA
NA
428
346
80.84%
77.00%
84.69%
2013
A
Page 67
Effectiveness of Care
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
General
Data Elements
Measure
Measurement Year
2013
Data Collection Methodology
A
Eligible Member Population
Numerator Events by Admin Data
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
ACE Inhibitors
108
93
79.13%
93.10%
Annual Monitoring for Members on
Digoxin
Diuretics
Anti-
1
1
NA
NA
57
46
69.58%
91.82%
10
9
NA
NA
Total
176
149
79.05%
90.27%
Page 68
Access/Availability of Care
Prime West
Medication Reconciliation Post Discharge
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Data Elements
MSHO
Measurement Year
Data collection methodology (Administrative or Hybrid)
Eligible member population
Number of numerator events by administrative data in eligible
population (before exclusions)
Current year's administrative rate (before exclusions)
NR
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
NR
Number of original sample records excluded because of valid
data errors
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
NR
NR
NR
Page 69
Effectiveness of Care
Prime West
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare Advantage
Drug-Disease Interactions
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
History of Falls +
Dementia +
Tricyclic
Tricyclic
Antidepressants, Antidepressants
Antipsychotics or or Anticholinergic
Sleep Agents
Agents
NR
NR
NR
NR
NR
NR
Chronic Renal
Failure +
Nonaspirin
NSAIDs or Cox-2
Selective NSAIDs
Total
NR
NR
NR
NR
NR
NR
Page 70
Effectiveness of Care
Prime West
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
Drug-Disease Interactions
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
History of Falls +
Dementia +
Tricyclic
Tricyclic
Antidepressants, Antidepressants
Antipsychotics or or Anticholinergic
Sleep Agents
Agents
Chronic Renal
Failure +
Nonaspirin
NSAIDs or Cox-2
Selective NSAIDs
Total
51
3
5.88%
0.00%
13.32%
369
190
51.49%
46.26%
56.73%
2013
A
31
17
54.84%
35.71%
73.97%
287
170
59.23%
53.37%
65.09%
Page 71
Effectiveness of Care
Prime West
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare Advantage
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
At least 1
Prescription
At least 2
Prescriptions
NR
NR
NR
NR
NR
NR
Page 72
Effectiveness of Care
Prime West
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
General
Measure
Data
2013
A
1744
At least 1
Prescription
At least 2
Prescriptions
398
22.82%
20.82%
24.82%
69
3.96%
3.01%
4.90%
Page 73
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Data Elements
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
NR
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
NR
NR
NR
NR
HEDIS 2014 (Reporting Year 2013)
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 74
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare Advantage
Data Elements
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
NR
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
NR
NR
NR
NR
HEDIS 2014 (Reporting Year 2013)
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 75
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
Data Elements
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
0
0
1759
1759
0
0
1725
NA
NA
NA
NA
NA
NA
98.07%
97.40%
98.74%
1725
98.07%
97.40%
98.74%
2013
A
Page 76
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-SNP
Data Elements
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
45
133
9
187
45
132
9
100.00%
98.89%
100.00%
99.25%
97.40%
100.00%
NA
NA
NA
186
99.47%
98.15%
100.00%
2013
A
Page 77
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-Non SNP
Data Elements
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
394
608
39
1041
362
582
38
91.88%
89.05%
94.70%
95.72%
94.03%
97.41%
97.44%
91.19%
100.00%
982
94.33%
92.88%
95.79%
2013
A
Page 78
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F&C)
Data Elements
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
2148
890
0
3038
1951
794
0
90.83%
89.58%
92.07%
89.21%
87.12%
91.31%
NA
NA
NA
2745
90.36%
89.29%
91.42%
2013
A
Page 79
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
General Measure
Data Elements
Measurement Year
2013
Data collection methodology
A
Eligible member population (i.e. members
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
Ages 20-44
Ages 45-64
Ages 65+
Total
505
440
87.13%
84.11%
90.15%
435
396
91.03%
88.23%
93.83%
0
0
NA
NA
NA
940
836
88.94%
86.88%
90.99%
Page 80
Access/Availability of Care
Prime West
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Data Elements
Measurement Year
Data collection methodology (Administrative only)
Eligible member population
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
General Measure
Data
12-24 months
25 months 6 yrs.
7-11 yrs.
12-19 yrs.
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 81
Access/Availability of Care
Prime West
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F&C)
Data Elements
Measurement Year
Data collection methodology (Administrative only)
Eligible member population
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
General Measure
Data
12-24 months
25 months 6 yrs.
7-11 yrs.
12-19 yrs.
567
539
1504
1303
1021
939
1165
1072
95.06%
93.19%
96.93%
86.64%
84.88%
88.39%
91.97%
90.25%
93.68%
92.02%
90.42%
93.62%
2013
A
Page 82
Access/Availability of Care
Prime West
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
General Measure
Data Elements
Measurement Year
2013
Data collection methodology (Administrative only)
A
Eligible member population
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
12-24 months
25 months -
7-11 yrs.
12-19 yrs.
17
17
NA
NA
NA
227
203
89.43%
85.21%
93.65%
100
93
93.00%
87.50%
98.50%
115
111
96.52%
92.74%
100.00%
Page 83
Access/Availability of Care
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
13-17 Year Olds
Data Elements
General
Measure
Data
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
18+ Year Olds
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
Total
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
Measurement Year
Data collection methodology (Administrative only)
Eligible member population
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 84
Access/Availability of Care
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare Advantage
Data Elements
Measurement Year
Data collection methodology (Administrative only)
Eligible member population
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
General
13-17 Year Olds
Initiation of Engagement
18+ Year Olds
Initiation of Engagement
Total
Initiation of Engagement
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 85
Access/Availability of Care
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
Data Elements
Measurement Year
Data collection methodology (Administrative only)
Eligible member population
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
General
2013
A
13-17 Year Olds
Initiation of Engagement
18+ Year Olds
Initiation of Engagement
0
0
NA
NA
NA
Total
Initiation of Engagement
12
0
NA
NA
NA
5
NA
NA
NA
12
1
NA
NA
NA
5
NA
NA
NA
1
NA
NA
NA
Page 86
Access/Availability of Care
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-SNP
Data Elements
Measurement Year
Data collection methodology (Administrative only)
Eligible member population
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
General
2013
A
13-17 Year Olds
Initiation of Engagement
18+ Year Olds
Initiation of Engagement
0
0
NA
NA
NA
Total
Initiation of Engagement
14
14
0
NA
NA
NA
6
NA
NA
NA
2
NA
NA
NA
6
NA
NA
NA
2
NA
NA
NA
Page 87
Access/Availability of Care
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-Non SNP
Data Elements
Measurement Year
Data collection methodology (Administrative only)
Eligible member population
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
General
2013
A
13-17 Year Olds
Initiation of Engagement
18+ Year Olds
Initiation of Engagement
0
0
NA
NA
NA
Total
Initiation of Engagement
139
0
NA
NA
NA
54
38.85%
30.39%
47.31%
139
9
6.47%
2.02%
10.93%
54
38.85%
30.39%
47.31%
9
6.47%
2.02%
10.93%
Page 88
Access/Availability of Care
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F&C)
Data Elements
Measurement Year
Data collection methodology (Administrative only)
Eligible member population
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
General
2013
A
13-17 Year Olds
Initiation of Engagement
18+ Year Olds
Initiation of Engagement
38
19
50.00%
32.79%
67.21%
Total
Initiation of Engagement
401
3
7.89%
0.00%
17.78%
163
40.65%
35.72%
45.58%
439
63
15.71%
12.02%
19.40%
182
41.46%
36.74%
46.18%
66
15.03%
11.58%
18.49%
Page 89
Access/Availability of Care
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
Data Elements
Measurement Year
Data collection methodology (Administrative only)
Eligible member population
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
General
2013
A
13-17 Year Olds
Initiation of Engagement
18+ Year Olds
Initiation of Engagement
1
0
NA
NA
NA
Total
Initiation of Engagement
43
0
NA
NA
NA
19
44.19%
28.18%
60.19%
44
6
13.95%
2.43%
25.47%
19
43.18%
27.41%
58.95%
6
13.64%
2.36%
24.91%
Page 90
Access/Availability of Care
Prime West
Prenatal and Postpartum Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Timeliness of
Prenatal Care
Postpartum
Care
Current year's administrative rate (before exclusions)
NR
NR
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
NR
NR
NR
NR
NR
NR
NR
NR
Data Elements
Measurement Year
Data collection methodology (Administrative or Hybrid)
Eligible member population
Number of numerator events by administrative data in eligible
population (before exclusions)
Number of original sample records excluded because of valid
data errors
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
Page 91
Access/Availability of Care
Prime West
Prenatal and Postpartum Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F&C)
Timeliness of
Prenatal Care
Postpartum
Care
Measurement Year
Data collection methodology (Administrative or Hybrid)
Eligible member population
2013
H
735
2013
H
735
Number of numerator events by administrative data in eligible
population (before exclusions)
314
339
42.72%
411
5.00%
432
204
46.12%
411
5.00%
432
222
47.22%
51.39%
0
0
0
0
411
194
94
0
0
411
208
70.07%
65.52%
74.62%
50.61%
45.65%
55.56%
Data Elements
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of valid
data errors
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
Page 92
Access/Availability of Care
Prime West
Prenatal and Postpartum Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
Data Elements
Measurement Year
Data collection methodology (Administrative or Hybrid)
Eligible member population
Number of numerator events by administrative data in eligible
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of valid
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2014 (Reporting Year 2013)
Timeliness of
2013
H
21
10
47.62%
21
0.00%
21
10
47.62%
0
0
0
21
10
2
NA
NA
NA
Postpartum
2013
H
21
13
61.90%
21
0.00%
21
13
61.90%
0
0
0
21
13
5
NA
NA
NA
Page 93
Use of Services
Prime West
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Data Elements
General
Measure
Data
Zero Visits
1 visit
2 visits
3 visits
4 visits
5 visits
6 or more
visits
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
Page 94
Use of Services
Prime West
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F&C)
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
0
Number of employee/dependent medical
records excluded
0
Additional Records Added from the
Oversample List
0
HEDIS 2014 (Reporting Year 2013)
2 visits
3 visits
4 visits
5 visits
6 or more
visits
14
2.68%
19
3.64%
19
3.64%
34
6.51%
76
14.56%
86
16.48%
274
52.49%
12
2.78%
14
3.24%
17
3.94%
30
6.94%
62
14.35%
68
15.74%
229
53.01%
8
0
1.95%
0.49%
3.40%
11
2
3.16%
1.35%
4.98%
11
0
2.68%
0.99%
4.36%
22
2
5.84%
3.45%
8.23%
38
4
10.22%
7.17%
13.27%
44
15
14.36%
10.84%
17.87%
224
30
61.80%
56.98%
66.62%
411
5.00%
432
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
1 visit
2013
H
522
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Zero Visits
411
Page 95
Use of Services
Prime West
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
Data Elements
General
Zero Visits
Measurement Year
2013
Data Collection Methodology
H
Eligible Member Population
13
1
Numerator events by admin data in eligible
7.69%
Currect Year's Administrative Rate
Minimum Required Sample Size
13
Oversampling Rate
0.00%
Final sample size (FSS)
13
1
Numerator events by admin data in FSS
7.69%
Administrative rate on FSS
Number of Records Excluded Because of
0
Number of employee/dependent medical
0
Additional Records Added from the
0
Denominator
13
1
Numerator Events by Admin Data
0
Numerator Events by Medical Record
NA
Reported Rate
NA
Lower 95% Confidence Interval
NA
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
1 visit
2 visits
3 visits
4 visits
5 visits
6 or more
0
0.00%
2
15.38%
1
7.69%
0
0.00%
3
23.08%
6
46.15%
0
0.00%
2
15.38%
1
7.69%
0
0.00%
3
23.08%
6
46.15%
0
0
NA
NA
NA
1
0
NA
NA
NA
1
0
NA
NA
NA
0
1
NA
NA
NA
3
0
NA
NA
NA
6
0
NA
NA
NA
Page 96
Use of Services
Prime West
Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MA Expand
F&C
MN Care
Measurement Year
Data Collection Methodology
Eligible Member Population
2013
H
1192
2013
H
194
Numerator events by admin data in eligible
population
577
108
NR
48.41%
411
5.00%
432
229
55.67%
194
0.00%
194
108
NR
53.01%
0
55.67%
0
0
0
0
411
220
12
56.45%
51.53%
61.36%
0
194
108
5
58.25%
51.05%
65.44%
Data Elements
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Records Excluded because of Valid Data Errors
Commercial
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
NR
NR
NR
Page 97
Use of Services
Prime West
Adolescent Well-Care Visits
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MA Expand
F&C
MN Care
Measurement Year
Data Collection Methodology
Eligible Member Population
2013
H
1814
2013
H
256
Numerator events by admin data in eligible
population
537
74
NR
29.60%
411
5.00%
432
144
28.91%
256
0.00%
256
74
NR
33.33%
0
28.91%
0
0
0
0
411
140
27
40.63%
35.76%
45.50%
0
256
74
20
36.72%
30.62%
42.82%
Data Elements
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Records Excluded because of Valid Data Errors
Commercial
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2014 (Reporting Year 2013)
NR
NR
NR
Page 98
Use of Services
Prime West
Ambulatory Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
NR
Outpatient Visits (Excludes
MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
NR
HEDIS 2014 (Reporting Year 2013)
Visits/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Emergency Room Visits
Visits
NR
Visits/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 99
Use of Services
Prime West
Ambulatory Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare Advantage
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
NR
Outpatient Visits (Excludes
MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
NR
HEDIS 2014 (Reporting Year 2013)
Visits/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Emergency Room Visits
Visits
NR
Visits/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 100
Use of Services
Prime West
Ambulatory Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
0
0
0
0
3
6523
7832
10567
0
24925
Outpatient Visits (Excludes
MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
0
0
0
0
9
6429
7823
8665
0
22926
HEDIS 2014 (Reporting Year 2013)
Visits/ 1,000
Member
Months
NA
NA
NA
NA
3000.00
985.59
998.85
820.01
919.80
Emergency Room Visits
Visits
0
0
0
0
0
345
365
446
0
1156
Visits/ 1,000
Member
Months
NA
NA
NA
NA
0.00
52.89
46.60
42.21
46.38
Page 101
Use of Services
Prime West
Ambulatory Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-SNP
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
0
0
0
591
1671
104
0
0
0
2366
Outpatient Visits (Excludes
MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
0
0
0
656
1840
126
0
0
0
2622
HEDIS 2014 (Reporting Year 2013)
Visits/ 1,000
Member
Months
NA
NA
NA
1109.98
1101.14
1211.54
NA
NA
1108.20
Emergency Room Visits
Visits
0
0
0
73
89
12
0
0
0
174
Visits/ 1,000
Member
Months
NA
NA
NA
123.52
53.26
115.38
NA
NA
73.54
Page 102
Use of Services
Prime West
Ambulatory Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-Non SNP
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
0
0
198
7670
10696
434
0
0
0
18998
Outpatient Visits (Excludes
MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
0
0
73
5217
9315
467
0
0
0
15072
HEDIS 2014 (Reporting Year 2013)
Visits/ 1,000
Member
Months
NA
NA
368.69
680.18
870.89
1076.04
NA
NA
793.35
Emergency Room Visits
Visits
0
0
9
707
815
29
0
0
0
1560
Visits/ 1,000
Member
Months
NA
NA
45.45
92.18
76.20
66.82
NA
NA
82.11
Page 103
Use of Services
Prime West
Ambulatory Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F&C)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
13234
67456
46572
64562
17973
5
0
0
0
209802
Outpatient Visits (Excludes
MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
12337
24613
14851
36406
11897
4
0
0
0
100108
HEDIS 2014 (Reporting Year 2013)
Visits/ 1,000
Member
Months
932.22
364.87
318.88
563.89
661.94
800.00
NA
NA
477.15
Emergency Room Visits
Visits
1231
3185
1680
5292
941
0
0
0
0
12329
Visits/ 1,000
Member
Months
93.02
47.22
36.07
81.97
52.36
0.00
NA
NA
58.76
Page 104
Use of Services
Prime West
Ambulatory Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
Member Months
Age
<1
247
1-9
5673
10-19
4030
20-44
10396
45-64
7676
65-74
2
75-84
0
85+
0
Unknown
0
28024
Total
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Outpatient Visits (Excludes
Visits
Visits/ 1,000
213
862.35
2031
358.01
1532
380.15
4932
474.41
5080
661.80
0
0.00
0
NA
0
NA
0
13788
492.01
HEDIS 2014 (Reporting Year 2013)
Emergency Room Visits
Visits
Visits/ 1,000
15
60.73
126
22.21
107
26.55
385
37.03
250
32.57
0
0.00
0
NA
0
NA
0
883
31.51
Page 105
Use of Services
Prime West
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Member Months
NR
Discharges
Discharges /
1,000 Member
Months
Days
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2014 (Reporting Year 2013)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Days / 1,000
Member
Months
NR
NR
NR
NR
NR
NR
Average
Length of Stay
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 106
Use of Services
Prime West
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare Advantage
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Member Months
NR
Discharges
Discharges /
1,000 Member
Months
Days
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2014 (Reporting Year 2013)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Days / 1,000
Member
Months
NR
NR
NR
NR
NR
NR
Average
Length of Stay
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 107
Use of Services
Prime West
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Member Months
0
0
0
0
3
6523
7832
10567
0
24925
Discharges
Discharges /
1,000 Member
Months
0
0
0
0
0
232
267
390
0
889
NA
NA
NA
NA
0.00
35.57
34.09
36.91
0
0
0
0
0
168
213
343
0
724
NA
NA
NA
NA
0.00
25.76
27.20
32.46
0
0
0
0
0
64
54
47
0
165
NA
NA
NA
NA
0.00
9.81
6.89
4.45
0
0
0
0
0
HEDIS 2014 (Reporting Year 2013)
35.67
29.05
6.62
NA
NA
0.00
0.00
Days
Days / 1,000
Member
Months
0
0
0
0
0
1342
1297
1954
0
4593
NA
NA
NA
NA
0.00
205.73
165.60
184.92
0
0
0
0
0
895
996
1616
0
3507
NA
NA
NA
NA
0.00
137.21
127.17
152.93
0
0
0
0
0
447
301
338
0
1086
NA
NA
NA
NA
0.00
68.53
38.43
31.99
0
0
0
0
0
NA
NA
0.00
184.27
140.70
43.57
0.00
Average
Length of Stay
NA
NA
NA
NA
NA
5.78
4.86
5.01
NA
5.17
NA
NA
NA
NA
NA
5.33
4.68
4.71
NA
4.84
NA
NA
NA
NA
NA
6.98
5.57
7.19
NA
6.58
NA
NA
NA
NA
NA
Page 108
Use of Services
Prime West
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-SNP
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Member Months
0
0
0
591
1671
104
0
0
0
2366
Discharges
Discharges /
1,000 Member
Months
0
0
0
3
42
4
0
0
0
49
NA
NA
NA
5.08
25.13
38.46
NA
NA
0
0
0
1
31
4
0
0
0
36
NA
NA
NA
1.69
18.55
38.46
NA
NA
0
0
0
2
11
0
0
0
0
13
NA
NA
NA
3.38
6.58
0.00
NA
NA
0
0
0
0
0
NA
0.00
0.00
HEDIS 2014 (Reporting Year 2013)
20.71
15.22
5.49
0.00
Days
Days / 1,000
Member
Months
0
0
0
26
225
15
0
0
0
266
NA
NA
NA
43.99
134.65
144.23
NA
NA
0
0
0
2
152
15
0
0
0
169
NA
NA
NA
3.38
90.96
144.23
NA
NA
0
0
0
24
73
0
0
0
0
97
NA
NA
NA
40.61
43.69
0.00
NA
NA
0
0
0
0
0
NA
0.00
0.00
112.43
71.43
41.00
0.00
Average
Length of Stay
NA
NA
NA
8.67
5.36
3.75
NA
NA
NA
5.43
NA
NA
NA
2.00
4.90
3.75
NA
NA
NA
4.69
NA
NA
NA
12.00
6.64
NA
NA
NA
NA
7.46
NA
NA
NA
NA
NA
Page 109
Use of Services
Prime West
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-Non SNP
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Member Months
0
0
198
7670
10696
434
0
0
0
18998
Discharges
Discharges /
1,000 Member
Months
0
0
0
128
306
12
0
0
0
446
NA
NA
0.00
16.69
28.61
27.65
NA
NA
0
0
0
85
213
10
0
0
0
308
NA
NA
0.00
11.08
19.91
23.04
NA
NA
0
0
0
33
93
2
0
0
0
128
NA
NA
0.00
4.30
8.69
4.61
NA
NA
0
10
0
0
10
HEDIS 2014 (Reporting Year 2013)
23.48
16.21
6.74
0.00
1.30
0.00
0.54
Days
Days / 1,000
Member
Months
0
0
0
591
1468
39
0
0
0
2098
NA
NA
0.00
77.05
137.25
89.86
NA
NA
0
0
0
369
889
31
0
0
0
1289
NA
NA
0.00
48.11
83.12
71.43
NA
NA
0
0
0
194
579
8
0
0
0
781
NA
NA
0.00
25.29
54.13
18.43
NA
NA
0
28
0
0
28
110.43
67.85
41.11
0.00
3.65
0.00
1.51
Average
Length of Stay
NA
NA
NA
4.62
4.80
3.25
NA
NA
NA
4.70
NA
NA
NA
4.34
4.17
3.10
NA
NA
NA
4.19
NA
NA
NA
5.88
6.23
4.00
NA
NA
NA
6.10
NA
2.80
NA
NA
2.80
Page 110
Use of Services
Prime West
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F&C)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Member Months
13234
67456
46572
64562
17973
5
0
0
0
209802
Discharges
Discharges /
1,000 Member
Months
100
85
134
1153
204
0
0
0
0
1676
7.56
1.26
2.88
17.86
11.35
0.00
NA
NA
86
66
29
170
99
0
0
0
0
450
6.50
0.98
0.62
2.63
5.51
0.00
NA
NA
14
19
26
138
105
0
0
0
0
302
1.06
0.28
0.56
2.14
5.84
0.00
NA
NA
79
844
0
0
923
1.70
13.07
0.00
HEDIS 2014 (Reporting Year 2013)
7.99
2.14
1.44
7.15
Days
Days / 1,000
Member
Months
661
399
370
3162
798
0
0
0
0
5390
49.95
5.91
7.94
48.98
44.40
0.00
NA
NA
438
157
76
621
393
0
0
0
0
1685
33.10
2.33
1.63
9.62
21.87
0.00
NA
NA
223
242
67
454
405
0
0
0
0
1391
16.85
3.59
1.44
7.03
22.53
0.00
NA
NA
227
2084
0
0
2311
4.87
32.28
0.00
25.69
8.03
6.63
17.90
Average
Length of Stay
6.61
4.69
2.76
2.74
3.91
NA
NA
NA
NA
3.22
5.09
2.38
2.62
3.65
3.97
NA
NA
NA
NA
3.74
15.93
12.74
2.58
3.29
3.86
NA
NA
NA
NA
4.61
2.87
2.47
NA
NA
2.50
Page 111
Use of Services
Prime West
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
Age
Member Months
<1
247
1-9
5673
10-19
4030
20-44
10396
45-64
7676
65-74
2
75-84
0
85+
0
Unknown
0
28024
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Discharges
Discharges /
Days
Days / 1,000
Average
3
1
6
46
14
0
0
0
0
70
12.15
0.18
1.49
4.42
1.82
0.00
NA
NA
8
1
17
126
48
0
0
0
0
200
32.39
0.18
4.22
12.12
6.25
0.00
NA
NA
2.67
1.00
2.83
2.74
3.43
NA
NA
NA
NA
2.86
3
0
4
8
5
0
0
0
0
20
12.15
0.00
0.99
0.77
0.65
0.00
NA
NA
8
0
11
29
16
0
0
0
0
64
32.39
0.00
2.73
2.79
2.08
0.00
NA
NA
0
1
2
16
9
0
0
0
0
28
0.00
0.18
0.50
1.54
1.17
0.00
NA
NA
0
1
6
51
32
0
0
0
0
90
0.00
0.18
1.49
4.91
4.17
0.00
NA
NA
0
22
0
0
22
0.00
2.12
0.00
0
46
0
0
46
0.00
4.42
0.00
HEDIS 2014 (Reporting Year 2013)
2.50
0.71
1.00
1.00
7.14
2.28
3.21
2.08
2.67
NA
2.75
3.63
3.20
NA
NA
NA
NA
3.20
NA
1.00
3.00
3.19
3.56
NA
NA
NA
NA
3.21
NA
2.09
NA
NA
2.09
Page 112
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Any Services
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2014 (Reporting Year 2013)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Member Months
(Any)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
Male
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months
(Outpatient/ED)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Outpatient/ED
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 113
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare Advantage
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Any Services
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2014 (Reporting Year 2013)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
Male
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months
(Outpatient/ED)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Outpatient/ED
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 114
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
13-17
18-24
25-34
35-64
65+
Unknown
Total
Member Months
(Outpatient/ED)
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
0
0
0
0
0
6413
0
6413
0
0
0
0
3
18509
0
18512
0
0
0
0
3
24922
0
24925
0
0
0
0
0
6413
0
6413
0
0
0
0
3
18509
0
18512
0
0
0
0
3
24922
0
24925
0
0
0
0
0
6413
0
6413
0
0
0
0
3
18509
0
18512
0
0
0
0
3
24922
0
24925
0
0
0
0
0
6413
0
6413
0
0
0
0
3
18509
0
18512
0
0
0
0
3
24922
0
24925
Any Services
Age
0-12
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Intensive Outpatient/Partial
Hospitalization
Inpatient
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
21
24
45
0
0
0
21
24
45
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
3.93%
1.56%
2.17%
NA
NA
NA
3.93%
1.56%
2.17%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
12
11
23
0
0
0
12
11
23
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
2.25%
0.71%
1.11%
NA
NA
NA
2.25%
0.71%
1.11%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
14
16
30
0
0
0
14
16
30
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
2.62%
1.04%
1.44%
NA
NA
NA
2.62%
1.04%
1.44%
HEDIS 2014 (Reporting Year 2013)
Page 115
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-SNP
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
13-17
18-24
25-34
35-64
65+
Unknown
Total
Member Months
(Outpatient/ED)
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
0
0
32
65
896
57
0
1050
0
0
0
109
1160
47
0
1316
0
0
32
174
2056
104
0
2366
0
0
32
65
896
57
0
1050
0
0
0
109
1160
47
0
1316
0
0
32
174
2056
104
0
2366
0
0
32
65
896
57
0
1050
0
0
0
109
1160
47
0
1316
0
0
32
174
2056
104
0
2366
0
0
32
65
896
57
0
1050
0
0
0
109
1160
47
0
1316
0
0
32
174
2056
104
0
2366
Any Services
Age
0-12
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Intensive Outpatient/Partial
Hospitalization
Inpatient
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
0
0
0
0
0
0
0
0
0
1
0
1
10
13
23
0
1
1
0
0
0
11
14
25
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
18.46%
0.00%
6.90%
13.39%
13.45%
13.42%
0.00%
25.53%
11.54%
NA
NA
NA
12.57%
12.77%
12.68%
0
0
0
0
0
0
0
0
0
0
0
0
2
2
4
0
0
0
0
0
0
2
2
4
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
0.00%
0.00%
0.00%
2.68%
2.07%
2.33%
0.00%
0.00%
0.00%
NA
NA
NA
2.29%
1.82%
2.03%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
0
0
0
0
0
0
0
0
0
1
0
1
9
12
21
0
1
1
0
0
0
10
13
23
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
18.46%
0.00%
6.90%
12.05%
12.41%
12.26%
0.00%
25.53%
11.54%
NA
NA
NA
11.43%
11.85%
11.67%
HEDIS 2014 (Reporting Year 2013)
Page 116
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-Non SNP
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
13-17
18-24
25-34
35-64
65+
Unknown
Total
Member Months
(Outpatient/ED)
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
0
0
792
1665
6844
146
0
9447
0
0
568
1362
7333
288
0
9551
0
0
1360
3027
14177
434
0
18998
0
0
792
1665
6844
146
0
9447
0
0
568
1362
7333
288
0
9551
0
0
1360
3027
14177
434
0
18998
0
0
792
1665
6844
146
0
9447
0
0
568
1362
7333
288
0
9551
0
0
1360
3027
14177
434
0
18998
0
0
792
1665
6844
146
0
9447
0
0
568
1362
7333
288
0
9551
0
0
1360
3027
14177
434
0
18998
Any Services
Age
0-12
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Member Months
(Any)
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Intensive Outpatient/Partial
Hospitalization
Inpatient
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
0
0
0
0
0
0
7
5
12
26
28
54
99
109
208
0
2
2
0
0
0
132
144
276
NA
NA
NA
NA
NA
NA
10.61%
10.56%
10.59%
18.74%
24.67%
21.41%
17.36%
17.84%
17.61%
0.00%
8.33%
5.53%
NA
NA
NA
16.77%
18.09%
17.43%
0
0
0
0
0
0
1
4
5
8
9
17
30
28
58
0
1
1
0
0
0
39
42
81
NA
NA
NA
NA
NA
NA
1.52%
8.45%
4.41%
5.77%
7.93%
6.74%
5.26%
4.58%
4.91%
0.00%
4.17%
2.76%
NA
NA
NA
4.95%
5.28%
5.12%
0
0
0
0
0
0
0
0
0
2
0
2
0
0
0
0
0
0
0
0
0
2
0
2
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
1.44%
0.00%
0.79%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
NA
NA
NA
0.25%
0.00%
0.13%
0
0
0
0
0
0
7
3
10
23
25
48
92
98
190
0
1
1
0
0
0
122
127
249
NA
NA
NA
NA
NA
NA
10.61%
6.34%
8.82%
16.58%
22.03%
19.03%
16.13%
16.04%
16.08%
0.00%
4.17%
2.76%
NA
NA
NA
15.50%
15.96%
15.73%
HEDIS 2014 (Reporting Year 2013)
Page 117
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F&C)
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Total
13-17
18-24
25-34
35-64
65+
Unknown
Total
Member Months
(Outpatient/ED)
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
49474
11477
7106
9554
15603
2
93216
48407
11827
14455
21889
20005
3
116586
97881
23304
21561
31443
35608
5
209802
49474
11477
7106
9554
15603
2
93216
48407
11827
14455
21889
20005
3
116586
97881
23304
21561
31443
35608
5
209802
49474
11477
7106
9554
15603
2
93216
48407
11827
14455
21889
20005
3
116586
97881
23304
21561
31443
35608
5
209802
49474
11477
7106
9554
15603
2
93216
48407
11827
14455
21889
20005
3
116586
97881
23304
21561
31443
35608
5
209802
Any Services
Age
0-12
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Sex
M
Total
M
Total
M
Total
M
Total
M
Total
M
Total
M
Total
M
F
Total
Intensive Outpatient/Partial
Hospitalization
Inpatient
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
4
4
49
49
116
116
236
236
268
268
0
0
0
0
673
NR
673
0.10%
0.05%
5.12%
2.52%
19.59%
6.46%
29.64%
9.01%
20.61%
9.03%
0.00%
0.00%
NR
NR
8.66%
NR
3.85%
0
0
24
24
37
37
70
70
84
84
0
0
0
0
215
NR
215
0.00%
0.00%
2.51%
1.24%
6.25%
2.06%
8.79%
2.67%
6.46%
2.83%
0.00%
0.00%
NR
NR
2.77%
NR
1.23%
0
0
1
1
1
1
2
2
1
1
0
0
0
0
5
NR
5
0.00%
0.00%
0.10%
0.05%
0.17%
0.06%
0.25%
0.08%
0.08%
0.03%
0.00%
0.00%
NR
NR
0.06%
NR
0.03%
4
4
41
41
112
112
231
231
252
252
0
0
0
0
640
NR
640
0.10%
0.05%
4.29%
2.11%
18.91%
6.23%
29.01%
8.82%
19.38%
8.49%
0.00%
0.00%
NR
NR
8.24%
NR
3.66%
HEDIS 2014 (Reporting Year 2013)
Page 118
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
4108
873
1045
2078
4753
2
0
12859
Female
3198
1023
1809
2670
6465
0
0
15165
Member Months
(Inpatient)
Total
7306
1896
2854
4748
11218
2
0
28024
Any Services
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
0
0
0
4
1
5
8
4
12
15
7
22
37
33
70
0
0
0
0
0
0
64
45
109
HEDIS 2014 (Reporting Year 2013)
Male
4108
873
1045
2078
4753
2
0
12859
Female
3198
1023
1809
2670
6465
0
0
15165
Total
7306
1896
2854
4748
11218
2
0
28024
Inpatient
Percent
0.00%
0.00%
0.00%
5.50%
1.17%
3.16%
9.19%
2.65%
5.05%
8.66%
3.15%
5.56%
9.34%
6.13%
7.49%
0.00%
NA
0.00%
NA
NA
NA
5.97%
3.56%
4.67%
Number
0
0
0
2
0
2
3
0
3
4
1
5
4
5
9
0
0
0
0
0
0
13
6
19
Percent
0.00%
0.00%
0.00%
2.75%
0.00%
1.27%
3.44%
0.00%
1.26%
2.31%
0.45%
1.26%
1.01%
0.93%
0.96%
0.00%
NA
0.00%
NA
NA
NA
1.21%
0.47%
0.81%
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
4108
3198
7306
873
1023
1896
1045
1809
2854
2078
2670
4748
4753
6465
11218
2
0
2
0
0
0
12859
15165
28024
Intensive Outpatient/Partial
Hospitalization
Number
Percent
0
0.00%
0
0.00%
0
0.00%
0
0.00%
0
0.00%
0
0.00%
1
1.15%
0
0.00%
1
0.42%
0
0.00%
0
0.00%
0
0.00%
0
0.00%
0
0.00%
0
0.00%
0
0.00%
0
NA
0
0.00%
0
NA
0
NA
0
NA
1
0.09%
0
0.00%
1
0.04%
Member Months
(Outpatient/ED)
Male
4108
873
1045
2078
4753
2
0
12859
Female
3198
1023
1809
2670
6465
0
0
15165
Total
7306
1896
2854
4748
11218
2
0
28024
Outpatient/ED
Number
0
0
0
4
1
5
8
4
12
15
7
22
36
32
68
0
0
0
0
0
0
63
44
107
Percent
0.00%
0.00%
0.00%
5.50%
1.17%
3.16%
9.19%
2.65%
5.05%
8.66%
3.15%
5.56%
9.09%
5.94%
7.27%
0.00%
NA
0.00%
NA
NA
NA
5.88%
3.48%
4.58%
Page 119
Use of Services
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
Member Months
(Inpatient)
Female
Total
NR
NR
NR
NR
NR
NR
NR
Any Services
Age
0-12
13-17
18-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2014 (Reporting Year 2013)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months
(Outpatient/ED)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
Outpatient/ED
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 120
Use of Services
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare Advantage
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
Member Months
(Inpatient)
Female
Total
NR
NR
NR
NR
NR
NR
NR
13-17
18-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2014 (Reporting Year 2013)
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Inpatient
Any Services
Age
0-12
Male
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months
(Outpatient/ED)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
Outpatient/ED
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 121
Use of Services
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
Male
Female
Total
Male
Female
Total
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
0
0
0
6413
0
6413
0
0
3
18509
0
18512
0
0
3
24922
0
24925
0
0
0
6413
0
6413
0
0
3
18509
0
18512
0
0
3
24922
0
24925
0
0
0
6413
0
6413
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Member Months
(Inpatient)
Any Services
Age
0-12
13-17
18-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
0
0
3
18509
0
18512
0
0
3
24922
0
24925
Intensive Outpatient/Partial
Hospitalization
Inpatient
Member Months
(Outpatient/ED)
Male
Female
Total
0
0
0
6413
0
6413
0
0
3
18509
0
18512
0
0
3
24922
0
24925
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
0
0
0
0
0
0
0
0
0
66
174
240
0
0
0
66
174
240
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
12.35%
11.28%
11.56%
NA
NA
NA
12.35%
11.28%
11.55%
0
0
0
0
0
0
0
0
0
17
46
63
0
0
0
17
46
63
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
3.18%
2.98%
3.03%
NA
NA
NA
3.18%
2.98%
3.03%
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
1
0
1
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.19%
0.00%
0.05%
NA
NA
NA
0.19%
0.00%
0.05%
0
0
0
0
0
0
0
0
0
50
137
187
0
0
0
50
137
187
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
9.36%
8.88%
9.00%
NA
NA
NA
9.36%
8.88%
9.00%
HEDIS 2014 (Reporting Year 2013)
Page 122
Use of Services
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-SNP
Male
Female
Total
Male
Female
Total
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
0
0
993
57
0
1050
0
0
1269
47
0
1316
0
0
2262
104
0
2366
0
0
993
57
0
1050
0
0
1269
47
0
1316
0
0
2262
104
0
2366
0
0
993
57
0
1050
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Member Months
(Inpatient)
Any Services
Age
0-12
13-17
18-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
0
0
1269
47
0
1316
0
0
2262
104
0
2366
Intensive Outpatient/Partial
Hospitalization
Inpatient
Member Months
(Outpatient/ED)
Male
Female
Total
0
0
993
57
0
1050
0
0
1269
47
0
1316
0
0
2262
104
0
2366
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
0
0
0
0
0
0
44
68
112
2
3
5
0
0
0
46
71
117
NA
NA
NA
NA
NA
NA
53.17%
64.30%
59.42%
42.11%
76.60%
57.69%
NA
NA
NA
52.57%
64.74%
59.34%
0
0
0
0
0
0
3
5
8
0
0
0
0
0
0
3
5
8
NA
NA
NA
NA
NA
NA
3.63%
4.73%
4.24%
0.00%
0.00%
0.00%
NA
NA
NA
3.43%
4.56%
4.06%
0
0
0
0
0
0
1
2
3
0
0
0
0
0
0
1
2
3
NA
NA
NA
NA
NA
NA
1.21%
1.89%
1.59%
0.00%
0.00%
0.00%
NA
NA
NA
1.14%
1.82%
1.52%
0
0
0
0
0
0
43
67
110
2
3
5
0
0
0
45
70
115
NA
NA
NA
NA
NA
NA
51.96%
63.36%
58.36%
42.11%
76.60%
57.69%
NA
NA
NA
51.43%
63.83%
58.33%
HEDIS 2014 (Reporting Year 2013)
Page 123
Use of Services
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-Non SNP
Male
Female
Total
Male
Female
Total
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
0
0
9301
146
0
9447
0
0
9263
288
0
9551
0
0
18564
434
0
18998
0
0
9301
146
0
9447
0
0
9263
288
0
9551
0
0
18564
434
0
18998
0
0
9301
146
0
9447
Member Months
(Inpatient)
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Any Services
Age
0-12
13-17
18-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
0
0
9263
288
0
9551
0
0
18564
434
0
18998
Intensive Outpatient/Partial
Hospitalization
Inpatient
Member Months
(Outpatient/ED)
Male
Female
Total
0
0
9301
146
0
9447
0
0
9263
288
0
9551
0
0
18564
434
0
18998
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
0
0
0
0
0
0
294
356
650
4
5
9
0
0
0
298
361
659
NA
NA
NA
NA
NA
NA
37.93%
46.12%
42.02%
32.88%
20.83%
24.88%
NA
NA
NA
37.85%
45.36%
41.63%
0
0
0
0
0
0
20
28
48
0
0
0
0
0
0
20
28
48
NA
NA
NA
NA
NA
NA
2.58%
3.63%
3.10%
0.00%
0.00%
0.00%
NA
NA
NA
2.54%
3.52%
3.03%
0
0
0
0
0
0
8
12
20
0
0
0
0
0
0
8
12
20
NA
NA
NA
NA
NA
NA
1.03%
1.55%
1.29%
0.00%
0.00%
0.00%
NA
NA
NA
1.02%
1.51%
1.26%
0
0
0
0
0
0
291
352
643
4
5
9
0
0
0
295
357
652
NA
NA
NA
NA
NA
NA
37.54%
45.60%
41.56%
32.88%
20.83%
24.88%
NA
NA
NA
37.47%
44.85%
41.18%
HEDIS 2014 (Reporting Year 2013)
Page 124
Use of Services
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care(MA Expand F&C)
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Member Months
(Inpatient)
Male
Female
Total
Male
Female
Total
49474
11477
32263
2
0
93216
48407
11827
56349
3
0
116586
97881
23304
88612
5
0
209802
49474
11477
32263
2
0
93216
48407
11827
56349
3
0
116586
97881
23304
88612
5
0
209802
Any Services
Age
0-12
13-17
18-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
Male
Female
Total
49474
11477
32263
2
0
93216
49474
11477
32263
2
0
93216
48407
11827
56349
3
0
116586
97881
23304
88612
5
0
209802
48407
11827
56349
3
0
116586
97881
23304
88612
5
0
209802
Intensive Outpatient/Partial
Hospitalization
Inpatient
Member Months
(Outpatient/ED)
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
702
491
1193
269
316
585
633
1345
1978
0
0
0
0
0
0
1604
2152
3756
17.03%
12.17%
14.63%
28.13%
32.06%
30.12%
23.54%
28.64%
26.79%
0.00%
0.00%
0.00%
NA
NA
NA
20.65%
22.15%
21.48%
5
8
13
15
31
46
40
71
111
0
0
0
0
0
0
60
110
170
0.12%
0.20%
0.16%
1.57%
3.15%
2.37%
1.49%
1.51%
1.50%
0.00%
0.00%
0.00%
NA
NA
NA
0.77%
1.13%
0.97%
13
6
19
7
18
25
13
34
47
0
0
0
0
0
0
33
58
91
0.32%
0.15%
0.23%
0.73%
1.83%
1.29%
0.48%
0.72%
0.64%
0.00%
0.00%
0.00%
NA
NA
NA
0.42%
0.60%
0.52%
702
490
1192
264
313
577
618
1329
1947
0
0
0
0
0
0
1584
2132
3716
17.03%
12.15%
14.61%
27.60%
31.76%
29.71%
22.99%
28.30%
26.37%
0.00%
0.00%
0.00%
NA
NA
NA
20.39%
21.94%
21.25%
HEDIS 2014 (Reporting Year 2013)
Page 125
Use of Services
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care(MN Care)
Male
Female
Total
Male
Female
Total
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
4108
873
7876
2
0
12859
3198
1023
10944
0
0
15165
7306
1896
18820
2
0
28024
4108
873
7876
2
0
12859
3198
1023
10944
0
0
15165
7306
1896
18820
2
0
28024
4108
873
7876
2
0
12859
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Member Months
(Inpatient)
Any Services
Age
0-12
13-17
18-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
3198
1023
10944
0
0
15165
7306
1896
18820
2
0
28024
Intensive Outpatient/Partial
Hospitalization
Inpatient
Member Months
(Outpatient/ED)
Male
Female
Total
4108
873
7876
2
0
12859
3198
1023
10944
0
0
15165
7306
1896
18820
2
0
28024
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
33
19
52
11
20
31
98
136
234
0
0
0
0
0
0
142
175
317
9.64%
7.13%
8.54%
15.12%
23.46%
19.62%
14.93%
14.91%
14.92%
0.00%
NA
0.00%
NA
NA
NA
13.25%
13.85%
13.57%
0
0
0
2
2
4
2
2
4
0
0
0
0
0
0
4
4
8
0.00%
0.00%
0.00%
2.75%
2.35%
2.53%
0.30%
0.22%
0.26%
0.00%
NA
0.00%
NA
NA
NA
0.37%
0.32%
0.34%
0
0
0
1
1
2
3
2
5
0
0
0
0
0
0
4
3
7
0.00%
0.00%
0.00%
1.37%
1.17%
1.27%
0.46%
0.22%
0.32%
0.00%
NA
0.00%
NA
NA
NA
0.37%
0.24%
0.30%
33
19
52
10
20
30
96
136
232
0
0
0
0
0
0
139
175
314
9.64%
7.13%
8.54%
13.75%
23.46%
18.99%
14.63%
14.91%
14.79%
0.00%
NA
0.00%
NA
NA
NA
12.97%
13.85%
13.45%
HEDIS 2014 (Reporting Year 2013)
Page 126
Use of Services
Prime West
Plan All-Cause Readmissions
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare Advantage
Age
18-44
45-54
55-64
Total
Age
65-74
75-84
85+
Total
Count of Index Stays
(Denominator)
Count of 30-Day
Readmissions
(Numerator)
Observed
Readmission
(Num/Den)
Average Adjusted
Probability
Total Variance
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Count of Index Stays
(Denominator)
Count of 30-Day
Readmissions
(Numerator)
Observed
Readmission
(Num/Den)
Average Adjusted
Probability
Total Variance
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
HEDIS 2014 (Reporting Year 2013)
Page 127
Use of Services
Prime West
Plan All-Cause Readmissions
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
Count of Index Stays
(Denominator)
Age
18-44
45-54
55-64
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
0
0
0
0
0
0
0
0
0
0
0
0
Count of Index Stays
(Denominator)
Age
65-74
75-84
85+
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
HEDIS 2014 (Reporting Year 2013)
33
92
125
46
108
154
46
148
194
125
348
473
Count of 30-Day
Readmissions
(Numerator)
0
0
0
0
0
0
0
0
0
0
0
0
Observed
Readmission
(Num/Den)
0.00%
0.00%
NA
0.00%
0.00%
NA
0.00%
0.00%
NA
0
0
0
Average Adjusted
Probability
Total Variance
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
Count of 30-Day
Readmissions
(Numerator)
6
14
20
5
9
14
5
20
25
16
43
59
Observed
Readmission
(Num/Den)
18.18%
15.22%
16.00%
10.87%
8.33%
9.09%
10.87%
13.51%
12.89%
12.80%
12.36%
12.47%
Average Adjusted
Probability
Total Variance
17.14%
15.04%
15.59%
17.22%
16.38%
16.63%
18.30%
14.84%
15.66%
17.60%
15.37%
15.96%
448.70%
1123.37%
1572.07%
631.39%
1435.52%
2066.91%
664.52%
1824.50%
2489.02%
1744.61%
4383.39%
6128.00%
Page 128
Use of Services
Prime West
Plan All-Cause Readmissions
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-SNP
Count of Index Stays
(Denominator)
Age
18-44
45-54
55-64
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
0
0
0
0
0
0
0
0
0
0
0
0
Count of Index Stays
(Denominator)
Age
65-74
75-84
85+
Sex
M
F
Total
M
F
Total
M
F
Total
M
Total
HEDIS 2014 (Reporting Year 2013)
0
3
3
0
0
0
0
0
0
0
3
3
Count of 30-Day
Readmissions
(Numerator)
0
Average Adjusted
Probability
Total Variance
NA
0
0
0
0
0
0
0
0
0
Observed
Readmission
(Num/Den)
0.00%
0.00%
NA
0.00%
0.00%
NA
0.00%
0.00%
NA
NA
33.33%
33.33%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
Count of 30-Day
Readmissions
(Numerator)
Observed
Readmission
(Num/Den)
Average Adjusted
Probability
Total Variance
NR
NA
NR
NR
NR
NA
NR
NR
NR
NR
NR
NR
NA
NA
NA
NA
NR
NR
NR
NR
NR
NR
NR
NR
Page 129
Use of Services
Prime West
Plan All-Cause Readmissions
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-Non SNP
Age
18-44
45-54
55-64
Total
Age
65-74
75-84
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Count of Index Stays
(Denominator)
Count of 30-Day
Readmissions
Observed
Readmission
Average Adjusted
Probability
Total Variance
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Count of Index Stays
(Denominator)
Count of 30-Day
Readmissions
(Numerator)
Observed
Readmission
(Num/Den)
Average Adjusted
Probability
Total Variance
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Sex
M
F
Total
M
F
Total
M
F
85+
Total
M
Total
HEDIS 2014 (Reporting Year 2013)
Page 130
Health Plan Descriptive Information
Prime West
Board Certification
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
MSHO
Type of Physician
Family Medicine
Internal Medicine
Geriatricians
Other practitioner Specialists
HEDIS 2014 (Reporting Year 2013)
SNBC
Number of Physicians in Active Board Certification
Each Practice Area
Percent
Number
706
246
25
6170
691
237
23
5371
97.88%
96.34%
92.00%
87.05%
Page 131
Health Plan Descriptive Information
Prime West
Board Certification
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
SNBC-SNP
Type of Physician
Family Medicine
Internal Medicine
Geriatricians
Other practitioner Specialists
HEDIS 2014 (Reporting Year 2013)
SNBC
Number of Physicians in Active Board Certification
Each Practice Area
Percent
Number
NR
NR
NR
NR
Page 132
Health Plan Descriptive Information
Prime West
Board Certification
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
SNBC-Non SNP
Type of Physician
Family Medicine
Internal Medicine
Geriatricians
Other practitioner Specialists
HEDIS 2014 (Reporting Year 2013)
SNBC
Number of Physicians in Active Board Certification
Each Practice Area
Percent
Number
NR
NR
NR
NR
Page 133
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Commercial
Male
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2014 (Reporting Year 2013)
Page 134
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Medicare Advantage
Male
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2014 (Reporting Year 2013)
Page 135
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jul 15, 2015 8:02 AM
MSHO
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Male
0
0
0
0
0
0
Member Months
Female
0
0
0
0
0
0
Total
0
0
0
0
0
0
0
0.00%
0
0
0
0
0
0
0.00%
0
0
0
0
0
0
0.00%
0
0.00%
0
0
0
0
0
0.00%
0
0
0
3
0
0.00%
0
0.00%
923
1102
1258
1111
1019
1000
3
0.02%
2149
2349
2461
3002
3471
5077
3
0.01%
6413
100.00%
0
18509
99.98%
0
24922
99.99%
6413
18512
HEDIS 2014 (Reporting Year 2013)
0
0
0
0
0
0
0
0
3
3072
3451
3719
4113
4490
6077
0
24925
Page 136
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-SNP
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Male
0
0
0
0
0
0
Member Months
Female
0
0
0
0
0
0
Total
0
0
0
0
0
0
0
0.00%
32
32
33
100
75
0
0.00%
0
7
102
98
112
0
0.00%
272
25.90%
205
180
223
113
319
24.24%
200
259
264
227
591
24.98%
721
68.67%
54
3
0
0
0
0
950
72.19%
47
0
0
0
0
0
1671
70.63%
57
5.43%
0
47
3.57%
0
104
4.40%
1050
1316
HEDIS 2014 (Reporting Year 2013)
32
39
135
198
187
405
439
487
340
101
3
0
0
0
0
0
2366
Page 137
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jul 15, 2015 8:02 AM
SNBC-Non SNP
Male
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2014 (Reporting Year 2013)
Page 138
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MA Expand F&C)
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Male
6616
16122
18091
13765
6357
2717
Member Months
Female
6618
15790
17453
13774
6599
3360
Total
13234
31912
35544
27539
12956
6077
63668
68.30%
4389
4680
4874
3614
3131
63594
54.55%
11095
11947
9942
6183
4707
127262
60.66%
20688
22.19%
2895
2950
1999
1014
43874
37.63%
3459
2933
1783
940
64562
30.77%
8858
9.50%
2
0
0
0
0
0
9115
7.82%
3
0
0
0
0
0
17973
8.57%
2
0.00%
0
3
0.00%
0
5
0.00%
93216
116586
HEDIS 2014 (Reporting Year 2013)
15484
16627
14816
9797
7838
6354
5883
3782
1954
5
0
0
0
0
0
0
209802
Page 139
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jul 15, 2015 8:02 AM
Minnesota Health Care Programs - Managed Care (MN Care)
Member Months
Male
Female
142
105
<1
1381
1203
1-4
1823
1266
5-9
1101
1031
10-14
534
616
15-17
261
487
18-19
5242
4708
0-19 Subtotal
40.77%
31.05%
0-19 Subtotal: %
784
1322
20-24
1107
1425
25-29
971
1245
30-34
912
884
35-39
742
1004
40-44
4516
5880
20-44 Subtotal
35.12%
38.77%
20-44 Subtotal: %
710
1210
45-49
980
1393
50-54
710
958
55-59
699
1016
60-64
3099
4577
45-64 Subtotal
24.10%
30.18%
45-64 Subtotal: %
2
0
65-69
0
0
70-74
0
0
75-79
0
0
80-84
0
0
85-89
0
0
>=90
2
0
>=65 Subtotal
0.02%
0.00%
>=65 Subtotal: %
0
0
Age Unknown
12859
15165
Total
HEDIS 2014 (Reporting Year 2013)
Total
247
2584
3089
2132
1150
748
9950
35.51%
2106
2532
2216
1796
1746
10396
37.10%
1920
2373
1668
1715
7676
27.39%
2
0
0
0
0
0
2
0.01%
0
28024
Page 140