Preferred One Community Health Plan
General Info
Disclaimers
HEDIS 2013 (Reporting Year 2012)
Page
Data Last Refreshed: 11/15/2013
2
Effectiveness of Care Measures
Code
Effectiveness of Care Measures
Code
Prevention and Screening
Page
Medication Management
Page
26 MPM
Annual Monitoring for Patients on Persistent Medications
48
ABA
Adult BMI Assessment
3
27 MRP
Medication Reconciliation Post Discharge
53
WCC
Weight Assessment and Counseling for Nutrition and Physical Activity for
Children/Adolescents
4
DDE
Potentially Harmful Drug-Disease Interactions in the Elderly
54
CIS
Childhood Immunization Status
6
Use of High Risk Medications in the Elderly
56
IMA
Immunizations for Adolescents
10
28
29 DAE
Access / Availability of Care Measures
BCS
Breast Cancer Screening
12
0 Code
CCS
Cervical Cancer Screening
13
30 AAP
Adult's Access to Preventive/Ambulatory Health Services
58
COL
Colorectal Cancer Screening
14
31 CAP
Children's and Adolescents' Access to Primary Care Practitioners
63
CHL
Chlamydia Screening in Women
15
32
GSO
Glaucoma Screening in Older Adults
17
33 PPC
LSC
Lead Screening in Children
18
34
COA
Care for Older Adults
19
Respiratory Conditions
PCE
Pharmacotherapy Management of COPD Exacerbation
20
SPR
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
23
Use of Appropriate Medications for People with Asthma
24
ASM
Cardiovascular
IET
Page
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
65
Prenatal and Postpartum Care
70
Use of Services Measures
0 Code
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
74
Adolescent Well-Care Visits
75
36
AWC
72
Ambulatory Care
76
38
IPU
Inpatient Utilization - General Hospital/Acute Care
81
IAD
Identification of Alcohol and Other Drug Services
86
37 AMB
CMC
Cholesterol Management for Patients with Cardiovascular Conditions
26
39
CBP
Controlling High Blood Pressure
29
40 MPT
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services 91
Persistence of Beta Blocker Treatment After Heart Attack
30
41 PCR
Plan All-Cause Readmissions
PBH
Diabetes
CDC
Comprehensive Diabetes Care
31
Musculoskeletal
ART
OMW
0 Code
99
Enrollment by Product Line (Age & Sex)
101
43 ENP
Osteoporosis Management in Women Who had a Fracture
37
43
Behavioral Health
Antidepressant Medication Management
38
ADD
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
43
FUH
Follow-up After Hospitalization for Mental Illness
45
Page
Board Certification
36
AMM
Health Plan Descriptive Information Measures
42 BCR
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis
HEDIS 2013 (Reporting Year 2012)
96
41
DISCLAIMERS
-1
( this page left blank intentionally )
0. Disclaimer Query located below
HEDIS 2013 (Reporting Year 2012)
Page 2
Effectiveness of Care
Preferred One Community Health Plan
Adult BMI Assessment
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
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
Number of Records Excluded Because of Valid
Data Errors
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Medicare
Advantage
MHCP-MC
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Commercial
2012
A
6553
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 Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2013 (Reporting Year 2012)
162
2.47%
2.09%
2.86%
Page 3
Effectiveness of Care
Preferred One Community Health Plan
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Commercial
Counseling for Nutrition
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
Total
2012
A
General
Measure
Data
Ages 3-11 Ages 12-17
Counseling for Physical Activity
Total
2012
A
General
Measure
Data
Ages 3-11
Ages 1217
Total
2012
A
1240
871
2111
1240
871
2111
1240
871
2111
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
56
34
90
4
2
6
0
0
0
4.52%
3.32%
5.71%
3.90%
2.56%
5.25%
4.26%
3.38%
5.15%
0.32%
0.00%
0.68%
0.23%
0.00%
0.60%
0.28%
0.03%
0.54%
0.00%
0.00%
0.04%
0.00%
0.00%
0.06%
0.00%
0.00%
0.02%
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 2013 (Reporting Year 2012)
Page 4
Effectiveness of Care
Preferred One Community Health Plan
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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 2013 (Reporting Year 2012)
Page 5
Effectiveness of Care
Preferred One Community Health Plan
Childhood Immunization Status
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Commercial
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
General
Measure
Data
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2013 (Reporting Year 2012)
HiB
Hepatitis B
VZV
Influenza
124
82.67%
138
92.00%
136
90.67%
140
93.33%
126
84.00%
133
88.67%
123
82.00%
112
74.67%
115
76.67%
95
63.33%
124
82.67%
138
92.00%
136
90.67%
140
93.33%
126
84.00%
133
88.67%
123
82.00%
112
74.67%
115
76.67%
95
63.33%
124
138
136
140
126
133
123
112
115
95
6
86.67%
80.89%
92.44%
6
96.00%
92.53%
99.47%
2
92.00%
87.33%
96.67%
5
96.67%
93.46%
99.87%
12
92.00%
87.33%
96.67%
3
90.67%
85.68%
95.66%
9
88.00%
82.47%
93.53%
2
76.00%
68.83%
83.17%
9
82.67%
76.28%
89.06%
5
66.67%
58.79%
74.54%
0
Number of medical data records excluded
Numerator Events by Medical Record
MMR
150
0.00%
150
0
Numerator Events by administrative Data
IPV
2012
H
150
Number of administrative data records
excluded
Denominator
Pneumococcal
Hepatitis A Rotavirus
Conjugate
DTaP
150
Page 6
Effectiveness of Care
Preferred One Community Health Plan
Childhood Immunization Status
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Commercial
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
General
Measure
Data
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2013 (Reporting Year 2012)
Combo 4
Combo 5
Combo 6
Combo 7
Combo 8
Combo 9
Combo10
124
82.67%
107
71.33%
102
68.00%
85
56.67%
90
60.00%
76
50.67%
78
52.00%
68
45.33%
69
46.00%
61
40.67%
124
82.67%
107
71.33%
102
68.00%
85
56.67%
90
60.00%
76
50.67%
78
52.00%
68
45.33%
69
46.00%
61
40.67%
124
107
102
85
90
76
78
68
69
61
6
86.67%
80.89%
92.44%
11
78.67%
71.78%
85.56%
14
77.33%
70.30%
84.37%
13
65.33%
57.38%
73.28%
17
71.33%
63.76%
78.90%
10
57.33%
49.08%
65.58%
16
62.67%
54.59%
70.74%
10
52.00%
43.67%
60.33%
13
54.67%
46.37%
62.97%
13
49.33%
41.00%
57.67%
0
Number of medical data records excluded
Numerator Events by Medical Record
Combo 3
150
0.00%
150
0
Numerator Events by administrative Data
Combo 2
2012
H
150
Number of administrative data records
excluded
Denominator
DTaP
150
Page 7
Effectiveness of Care
Preferred One Community Health Plan
Childhood Immunization Status
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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
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
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 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
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2013 (Reporting Year 2012)
Page 8
Effectiveness of Care
Preferred One Community Health Plan
Childhood Immunization Status
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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
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
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 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
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2013 (Reporting Year 2012)
Page 9
Effectiveness of Care
Preferred One Community Health Plan
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Immunizations for Adolescents
Commercial
Commercial
Data Elements
Measurement Year
General
Measure Data
H
Eligible Member Population
217
Numerator Events by Admin Data on Eligible
Population (before exclusions)
Current Year's Admin Rate
Combo 1
116
168
114
53.46%
77.42%
52.53%
116
53.46%
168
77.42%
114
52.53%
116
11
168
13
114
12
217
0.00%
217
Records Excluded because of Valid Data Errors
0
Number of administrative data records excluded
0
Number of medical data records excluded
1
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
Reported Rate
Tdap
2012
Data Collection Methodology
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
Meningococcal
0
216
58.80%
83.80%
58.33%
Lower 95% Confidence Interval
52.00%
78.65%
51.53%
Upper 95% Confidence Interval
65.59%
88.94%
65.14%
HEDIS 2013 (Reporting Year 2012)
Page 10
Effectiveness of Care
Preferred One Community Health Plan
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Immunizations for Adolescents
Commercial
Minnesota Health Care Programs - Managed Care (MHCP-MC)
General
Data Elements
Measure Data
Measurement Year
Data Collection Methodology
Eligible Member Population
Meningococcal
Tdap
Combo 1
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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
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
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2013 (Reporting Year 2012)
Page 11
Effectiveness of Care
Preferred One Community Health Plan
Breast Cancer Screening
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 2013 (Reporting Year 2012)
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Commercial
2012
A
2101
1432
68.16%
66.14%
70.17%
Medicare
Advantage
MSHO
SNBC
MHCP-MC
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 12
Effectiveness of Care
Preferred One Community Health Plan
Cervical Cancer Screening
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
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
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 Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2013 (Reporting Year 2012)
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Commercial
2012
A
2372
MHCP-MC
NR
NR
NR
NR
1683
70.95%
69.10%
72.80%
NR
NR
NR
Page 13
Effectiveness of Care
Preferred One Community Health Plan
Colorectal Cancer Screening
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Data Elements
Measurement Year
Data collection methodology (administrative or hybrid)
Eligible population
Number of numerator events by administrative data in eligible population
(before exclusions)
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 2013 (Reporting Year 2012)
Commercial
Medicare
Advantage
MSHO
SNBC
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
2012
H
2737
1265
46.22%
411
0.05
432
202
46.76%
0
0
1
0
1
411
195
73
65.21%
60.48%
69.93%
Page 14
Effectiveness of Care
Preferred One Community Health Plan
Chlamydia Screening in Women
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
General
Measure Data
Ages 16-20
Ages 21-24
Total
207
67
32.37%
25.75%
38.98%
206
102
49.51%
42.44%
56.58%
413
169
40.92%
36.06%
45.78%
2012
A
Page 15
Effectiveness of Care
Preferred One Community Health Plan
Chlamydia Screening in Women
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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 2013 (Reporting Year 2012)
General
Measure Data
Ages 16-20
NR
NR
NR
Ages 21-24
Total
NR
NR
NR
NR
NR
NR
NR
NR
Page 16
Effectiveness of Care
Preferred One Community Health Plan
Glaucoma Screening in Older Adults
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 2013 (Reporting Year 2012)
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Medicare
Advantage
MSHO
NR
NR
NR
NR
NR
NR
Page 17
Effectiveness of Care
Preferred One Community Health Plan
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Lead Screening in Children
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on
Eligible Population (before exclusions)
Commercial
2012
A
200
MHCP-MC
105
Current Year's Admin Rate
52.50%
NR
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
200
0.00%
200
105
52.50%
NR
Number of administrative data records
excluded
0
Number of medical record data records
excluded
0
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
0
200
105
0
52.50%
NR
Lower 95% Confidence Interval
45.33%
NR
Upper 95% Confidence Interval
59.67%
NR
HEDIS 2013 (Reporting Year 2012)
0
Page 18
Effectiveness of Care
Preferred One Community Health Plan
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Care for Older Adults
MSHO
Advance Care
Planning
Medication Review
Functional
Status
Assessment
Pain
Screening
NR
NR
NR
NR
NR
NR
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
NR
NR
NR
NR
Lower 95% Confidence Interval
NR
NR
NR
NR
Upper 95% Confidence Interval
NR
NR
NR
NR
Data Elements
General Measure
Data
Measurement Year
Data Collection Methodology
Eligible Member Population
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
Records Excluded because of Valid Data
Errors
HEDIS 2013 (Reporting Year 2012)
Page 19
Effectiveness of Care
Preferred One Community Health Plan
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
NR
NR
NR
NR
NR
NR
Page 20
Effectiveness of Care
Preferred One Community Health Plan
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
NR
NR
NR
NR
NR
NR
Page 21
Effectiveness of Care
Preferred One Community Health Plan
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Nov 15, 2013 1:50 PM
SNBC
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 2013 (Reporting Year 2012)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
NR
NR
NR
NR
NR
NR
Page 22
Effectiveness of Care
Preferred One Community Health Plan
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
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 2013 (Reporting Year 2012)
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Medicare
Advantage
MSHO
SNBC
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 23
Effectiveness of Care
Preferred One Community Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
General
Measure Data
Ages 5-11
Ages 12-18
Ages 19-50
Ages 51-64
Total
16
15
0
NA
NA
NA
28
26
1
NA
NA
NA
59
47
5
79.66%
68.54%
90.78%
35
32
20
91.43%
80.73%
100.00%
138
120
26
86.96%
80.98%
92.94%
2012
A
`
Page 24
Effectiveness of Care
Preferred One Community Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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 2013 (Reporting Year 2012)
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 25
Effectiveness of Care
Preferred One Community Health Plan
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
76
91.57%
0
0.00%
76
91.57%
0
0.00%
76
1
92.77%
86.60%
98.94%
0
57
68.67%
58.09%
79.26%
2012
H
83
83
0.00%
83
0
0
0
83
Page 26
Effectiveness of Care
Preferred One Community Health Plan
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 27
Effectiveness of Care
Preferred One Community Health Plan
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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 2013 (Reporting Year 2012)
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 28
Effectiveness of Care
Preferred One Community Health Plan
Controlling High Blood Pressure
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Data Elements
Measurement Year
Data Collection Methodology (Hybrid)
Eligible Member Population
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
Records Excluded because of Valid Data
Errors
Commercial
SNBC
MHCP-MC
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
0
0.00%
411
10.00%
453
0
0.00%
0
1
Number of administrative data records
excluded
0
Number of medical record data records
excluded
0
HEDIS 2013 (Reporting Year 2012)
MSHO
2012
H
759
Number of records excluded because of
false positive diagnoses
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
Medicare
Advantage
0
1
411
0
289
70.32%
65.78%
74.85%
Page 29
Effectiveness of Care
Preferred One Community Health Plan
Persistence of Beta Blocker Treatment After Heart Attack
Data Elements
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 2013 (Reporting Year 2012)
Commercial
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Medicare
Advantage
MSHO
SNBC
MHCP-MC
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
2012
A
5
4
NA
NA
NA
Page 30
Effectiveness of Care
Preferred One Community Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Commercial
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
HbA1c
Testing
Poor HbA1c
Control
(>9.0%)
Good HbA1c
Control
(<7.0%)
Adequate
HbA1c
Control
(<8.0%)
2012
H
423
2012
H
423
2012
H
348
386
91.25%
423
0%
423
386
91.25%
422
99.76%
423
0%
423
422
99.76%
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
2012
H
423
2012
H
423
2012
H
423
2012
H
423
2012
H
423
2012
H
423
2012
H
423
1
0.29%
348
0%
348
1
0.29%
1
0.24%
423
0%
423
1
0.24%
214
50.59%
423
0%
423
214
50.59%
351
82.98%
423
0%
423
351
82.98%
1
0.24%
423
0%
423
1
0.24%
359
84.87%
423
0%
423
359
84.87%
1
0.24%
423
0%
423
1
0.24%
0
0.00%
423
0%
423
0
0.00%
0
0
0
0
0
0
0
0
0
0
Number of administrative data records
excluded
0
0
0
0
0
0
0
0
0
0
Number of medical record data records
excluded
0
0
0
0
0
0
0
0
0
0
Number of employee/dependent medical
records excluded
0
0
0
0
0
0
0
0
0
0
0
423
1
280
66.43%
61.81%
71.05%
0
423
214
75
68.32%
63.77%
72.87%
0
423
351
8
84.87%
81.34%
88.40%
0
423
1
240
56.97%
52.14%
61.81%
0
423
359
14
88.18%
84.98%
91.37%
0
423
1
343
81.32%
77.49%
85.16%
0
423
0
270
63.83%
59.13%
68.53%
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 2013 (Reporting Year 2012)
77
20
0
423
386
8
93.14%
90.62%
95.67%
0
423
40
50
21.28%
17.26%
25.30%
0
326
1
140
43.25%
37.72%
48.78%
Page 31
Effectiveness of Care
Preferred One Community Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
Page 32
Effectiveness of Care
Preferred One Community Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Nov 15, 2013 1:50 PM
MSHO
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
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
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 2013 (Reporting Year 2012)
Page 33
Effectiveness of Care
Preferred One Community Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Nov 15, 2013 1:50 PM
SNBC
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 2013 (Reporting Year 2012)
Page 34
Effectiveness of Care
Preferred One Community Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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 2013 (Reporting Year 2012)
Page 35
Effectiveness of Care
Preferred One Community Health Plan
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis
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 2013 (Reporting Year 2012)
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Medicare
Advantage
NR
NR
NR
Page 36
Effectiveness of Care
Preferred One Community Health Plan
Osteoporosis Management in Women Who had a Fracture
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 2013 (Reporting Year 2012)
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Medicare
Advantage
MSHO
NR
NR
NR
NR
NR
NR
Page 37
Effectiveness of Care
Preferred One Community Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
General
Measure Data
Effective
Effective Acute
Continuation
Phase
Phase
Treatment
Treatment
2012
A
153
114
74.51%
67.28%
81.74%
86
56.21%
48.02%
64.40%
Page 38
Effectiveness of Care
Preferred One Community Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
General
Measure Data
Effective
Effective Acute
Continuation
Phase
Phase
Treatment
Treatment
NR
NR
NR
NR
NR
NR
Page 39
Effectiveness of Care
Preferred One Community Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
General
Measure Data
Effective
Effective Acute
Continuation
Phase
Phase
Treatment
Treatment
NR
NR
NR
NR
NR
NR
Page 40
Effectiveness of Care
Preferred One Community Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Nov 15, 2013 1:50 PM
SNBC
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 2013 (Reporting Year 2012)
General
Measure Data
Effective
Effective Acute
Continuation
Phase
Phase
Treatment
Treatment
NR
NR
NR
NR
NR
NR
Page 41
Effectiveness of Care
Preferred One Community Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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 2013 (Reporting Year 2012)
General
Measure Data
Effective
Effective Acute
Continuation
Phase
Phase
Treatment
Treatment
NR
NR
NR
NR
NR
NR
Page 42
Effectiveness of Care
Preferred One Community Health Plan
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
General
Measure
Data
Initiation
Phase
Continuation
and
Maintenance
Phase
40
14
35.00%
18.97%
51.03%
13
7
NA
NA
NA
2012
A
Page 43
Effectiveness of Care
Preferred One Community Health Plan
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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 2013 (Reporting Year 2012)
General
Measure
Data
Initiation
Phase
Continuation
and
Maintenance
Phase
NR
NR
NR
NR
NR
NR
Page 44
Effectiveness of Care
Preferred One Community Health Plan
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
General
Measure
Data
30 Days
7 Days
NR
NR
NR
NR
NR
NR
Page 45
Effectiveness of Care
Preferred One Community Health Plan
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
General
Measure
Data
30 Days
7 Days
NR
NR
NR
NR
NR
NR
Page 46
Effectiveness of Care
Preferred One Community Health Plan
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Nov 15, 2013 1:50 PM
SNBC
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 2013 (Reporting Year 2012)
General
Measure
Data
30 Days
7 Days
NR
NR
NR
NR
NR
NR
Page 47
Effectiveness of Care
Preferred One Community Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
751
591
78.70%
75.70%
81.69%
6
5
NA
NA
NA
610
500
81.97%
78.83%
85.10%
48
23
47.92%
32.74%
63.09%
1415
1119
79.08%
76.93%
81.24%
2012
A
Page 48
Effectiveness of Care
Preferred One Community Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
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 49
Effectiveness of Care
Preferred One Community Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
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 50
Effectiveness of Care
Preferred One Community Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Nov 15, 2013 1:50 PM
SNBC
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 2013 (Reporting Year 2012)
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 51
Effectiveness of Care
Preferred One Community Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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 2013 (Reporting Year 2012)
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 52
Access/Availability of Care
Preferred One Community Health Plan
Medication Reconciliation Post Discharge
Data Elements
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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)
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
NR
NR
NR
HEDIS 2013 (Reporting Year 2012)
NR
Page 53
Effectiveness of Care
Preferred One Community Health Plan
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
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 54
Effectiveness of Care
Preferred One Community Health Plan
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
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 55
Effectiveness of Care
Preferred One Community Health Plan
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
General
Measure
Data
At least 1
Prescription
At least 2
Prescriptions
NR
NR
NR
NR
NR
NR
Page 56
Effectiveness of Care
Preferred One Community Health Plan
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
General
Measure
Data
At least 1
Prescription
At least 2
Prescriptions
NR
NR
NR
NR
NR
NR
Page 57
Access/Availability of Care
Preferred One Community Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Commercial
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 2013 (Reporting Year 2012)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
2812
2998
132
5942
2576
91.61%
90.56%
92.65%
2861
95.43%
94.67%
96.19%
129
97.73%
94.81%
100.00%
5566
93.67%
93.04%
94.30%
2012
A
Page 58
Access/Availability of Care
Preferred One Community Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2013 (Reporting Year 2012)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 59
Access/Availability of Care
Preferred One Community Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Nov 15, 2013 1:50 PM
MSHO
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)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2013 (Reporting Year 2012)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 60
Access/Availability of Care
Preferred One Community Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Nov 15, 2013 1:50 PM
SNBC
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 2013 (Reporting Year 2012)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 61
Access/Availability of Care
Preferred One Community Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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 2013 (Reporting Year 2012)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 62
Access/Availability of Care
Preferred One Community Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
General Measure
Data
12-24 months
25 months 6 yrs.
7-11 yrs.
12-19 yrs.
151
150
99.34%
97.71%
100.00%
754
693
91.91%
89.90%
93.92%
766
684
89.30%
87.04%
91.55%
1364
1216
89.15%
87.46%
90.84%
2012
A
Page 63
Access/Availability of Care
Preferred One Community Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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 2013 (Reporting Year 2012)
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 64
Access/Availability of Care
Preferred One Community Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Commercial
13-17 Year Olds
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 2013 (Reporting Year 2012)
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
2012
A
6
171
177
0
0
54
17
NA
NA
NA
NA
NA
NA
31.58%
24.32%
38.84%
9.94%
5.16%
14.72%
54
30.51%
23.44%
37.57%
17
9.60%
4.98%
14.23%
Page 65
Access/Availability of Care
Preferred One Community Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Medicare Advantage
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 2013 (Reporting Year 2012)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 66
Access/Availability of Care
Preferred One Community Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Nov 15, 2013 1:50 PM
MSHO
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 2013 (Reporting Year 2012)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 67
Access/Availability of Care
Preferred One Community Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Nov 15, 2013 1:50 PM
SNBC
13-17 Year Olds
Data Elements
General
Measure
Data
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
18+ Year Olds
Initiation of
AOD
Treatment
Total
Engagement
of AOD
Treatment
Initiation of
AOD
Treatment
NR
NR
NR
NR
NR
NR
NR
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 2013 (Reporting Year 2012)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 68
Access/Availability of Care
Preferred One Community Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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 2013 (Reporting Year 2012)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 69
Access/Availability of Care
Preferred One Community Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Commercial
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)
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 2013 (Reporting Year 2012)
Timeliness of
Prenatal Care
2012
H
193
Postpartum
Care
2012
H
193
132
106
68.39%
193
0.00%
193
132
68.39%
54.92%
193
0.00%
193
106
54.92%
2
2
0
0
191
132
53
96.86%
94.12%
99.59%
0
0
191
106
54
83.77%
78.28%
89.26%
Page 70
Access/Availability of Care
Preferred One Community Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Data Elements
Timeliness of
Prenatal Care
Postpartum
Care
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)
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
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
NR
NR
NR
NR
NR
NR
HEDIS 2013 (Reporting Year 2012)
Page 71
Use of Services
Preferred One Community Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Commercial
Data Elements
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
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
0
2
6
2
8
18
113
0.00%
0.00%
0.34%
1.34%
0.00%
3.53%
4.03%
0.53%
7.52%
1.34%
0.00%
3.53%
5.37%
1.41%
9.32%
12.08%
6.51%
17.65%
75.84%
68.63%
83.05%
2012
A
149
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 2013 (Reporting Year 2012)
Page 72
Use of Services
Preferred One Community Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Data Elements
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
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
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 2013 (Reporting Year 2012)
Page 73
Use of Services
Preferred One Community Health Plan
Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Commercial
2012
A
629
MHCP-MC
NR
NR
NR
NR
Numerator events by admin data in eligible
population
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
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 2013 (Reporting Year 2012)
452
71.86%
68.27%
75.45%
NR
NR
NR
Page 74
Use of Services
Preferred One Community Health Plan
Adolescent Well-Care Visits
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
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
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 2013 (Reporting Year 2012)
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Commercial
2012
A
1984
MHCP-MC
NR
NR
NR
NR
653
32.91%
30.82%
35.01%
NR
NR
NR
Page 75
Use of Services
Preferred One Community Health Plan
Ambulatory Care
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
2369
24055
29516
82394
65220
1878
145
11
0
205588
Outpatient Visits (Excludes
MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
2015
6572
6227
17655
18893
968
100
7
0
52437
HEDIS 2013 (Reporting Year 2012)
Visits/ 1,000
Member
Months
850.57
273.21
210.97
214.28
289.68
515.44
689.66
636.36
255.06
Emergency Room Visits
Visits
53
333
305
840
506
24
2
0
0
2063
Visits/ 1,000
Member
Months
22.37
13.84
10.33
10.19
7.76
12.78
13.79
0.00
10.03
Page 76
Use of Services
Preferred One Community Health Plan
Ambulatory Care
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
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 77
Use of Services
Preferred One Community Health Plan
Ambulatory Care
Data Last Refreshed:
Nov 15, 2013 1:50 PM
MSHO
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 2013 (Reporting Year 2012)
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 78
Use of Services
Preferred One Community Health Plan
Ambulatory Care
Data Last Refreshed:
Nov 15, 2013 1:50 PM
SNBC
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 2013 (Reporting Year 2012)
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 79
Use of Services
Preferred One Community Health Plan
Ambulatory Care
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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 2013 (Reporting Year 2012)
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 80
Use of Services
Preferred One Community Health Plan
Inpatient Utilization - General Hospital/Acute Care
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
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Member Months
2369
24055
29516
82394
65220
1878
145
11
0
205588
Discharges
Discharges /
1,000 Member
Months
22
40
43
414
340
25
5
0
0
889
9.29
1.66
1.46
5.02
5.21
13.31
34.48
0.00
15
34
19
77
151
17
3
0
0
316
6.33
1.41
0.64
0.93
2.32
9.05
20.69
0.00
3
9
18
87
192
8
2
0
0
319
1.27
0.37
0.61
1.06
2.94
4.26
13.79
0.00
6
247
0
0
253
0.20
3.00
0.00
HEDIS 2013 (Reporting Year 2012)
4.32
1.54
1.55
1.43
Days
Days / 1,000
Member
Months
142
126
140
1159
1342
77
31
0
0
3017
59.94
5.24
4.74
14.07
20.58
41.00
213.79
0.00
80
101
67
295
664
33
8
0
0
1248
33.77
4.20
2.27
3.58
10.18
17.57
55.17
0.00
61
25
61
270
678
44
23
0
0
1162
25.75
1.04
2.07
3.28
10.40
23.43
158.62
0.00
12
594
0
0
606
0.41
7.21
0.00
14.67
6.07
5.65
3.42
Average
Length of Stay
6.45
3.15
3.26
2.80
3.95
3.08
6.20
NA
NA
3.39
5.33
2.97
3.53
3.83
4.40
1.94
2.67
NA
NA
3.95
20.33
2.78
3.39
3.10
3.53
5.50
11.50
NA
NA
3.64
2.00
2.40
NA
NA
2.40
Page 81
Use of Services
Preferred One Community Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Medicare Advantage
Age
Member Months
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
NR
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 /
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 2013 (Reporting Year 2012)
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 82
Use of Services
Preferred One Community Health Plan
Inpatient Utilization - General Hospital/Acute Care
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
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
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 83
Use of Services
Preferred One Community Health Plan
Inpatient Utilization - General Hospital/Acute Care
SNBC
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
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
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 84
Use of Services
Preferred One Community Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Age
Member Months
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
NR
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 /
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 2013 (Reporting Year 2012)
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 85
Use of Services
Preferred One Community Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Commercial
Member Months
(Inpatient)
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
17591
7900
11875
18273
52777
1219
0
109635
Female
17391
6964
9900
15380
45503
815
0
95953
Total
34982
14864
21775
33653
98280
2034
0
205588
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
1
1
8
1
9
38
16
54
39
24
63
98
41
139
2
1
3
0
0
0
185
84
269
HEDIS 2013 (Reporting Year 2012)
Male
17591
7900
11875
18273
52777
1219
0
109635
Female
17391
6964
9900
15380
45503
815
0
95953
Total
34982
14864
21775
33653
98280
2034
0
205588
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
0.00%
0.07%
0.03%
1.22%
0.17%
0.73%
3.84%
1.94%
2.98%
2.56%
1.87%
2.25%
2.23%
1.08%
1.70%
1.97%
1.47%
1.77%
NA
NA
NA
2.02%
1.05%
1.57%
Number
0
1
1
2
0
2
5
4
9
7
9
16
22
12
34
1
1
2
0
0
0
37
27
64
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
17591
17391
34982
7900
6964
14864
11875
9900
21775
18273
15380
33653
52777
45503
98280
1219
815
2034
0
0
0
109635
95953
205588
Percent
0.00%
0.07%
0.03%
0.30%
0.00%
0.16%
0.51%
0.48%
0.50%
0.46%
0.70%
0.57%
0.50%
0.32%
0.42%
0.98%
1.47%
1.18%
NA
NA
NA
0.40%
0.34%
0.37%
Number
0
0
0
0
1
1
2
0
2
2
3
5
4
7
11
0
0
0
0
0
0
8
11
19
Percent
0.00%
0.00%
0.00%
0.00%
0.17%
0.08%
0.20%
0.00%
0.11%
0.13%
0.23%
0.18%
0.09%
0.18%
0.13%
0.00%
0.00%
0.00%
NA
NA
NA
0.09%
0.14%
0.11%
Member Months
(Outpatient/ED)
Male
17591
7900
11875
18273
52777
1219
0
109635
Female
17391
6964
9900
15380
45503
815
0
95953
Total
34982
14864
21775
33653
98280
2034
0
205588
Outpatient/ED
Number
0
1
1
8
1
9
38
15
53
38
23
61
98
41
139
2
1
3
0
0
0
184
82
266
Percent
0.00%
0.07%
0.03%
1.22%
0.17%
0.73%
3.84%
1.82%
2.92%
2.50%
1.79%
2.18%
2.23%
1.08%
1.70%
1.97%
1.47%
1.77%
NA
NA
NA
2.01%
1.03%
1.55%
Page 86
Use of Services
Preferred One Community Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Medicare Advantage
Member Months
(Inpatient)
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
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 2013 (Reporting Year 2012)
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Inpatient
Any Services
Age
0-12
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
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
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
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
Female
NR
NR
Total
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 87
Use of Services
Preferred One Community Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Nov 15, 2013 1:50 PM
MSHO
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
Female
NR
NR
Member Months
(Inpatient)
Total
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 2013 (Reporting Year 2012)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Inpatient
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
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
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
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
Female
NR
NR
Total
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 88
Use of Services
Preferred One Community Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Nov 15, 2013 1:50 PM
SNBC
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
Female
NR
NR
Member Months
(Inpatient)
Total
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 2013 (Reporting Year 2012)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Inpatient
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
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
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
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
Female
NR
NR
Total
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 89
Use of Services
Preferred One Community Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
Female
NR
NR
Member Months
(Inpatient)
Total
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 2013 (Reporting Year 2012)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient
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
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Percent
Number
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
Member Months
(Outpatient/ED)
Male
Female
NR
NR
Total
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 90
Use of Services
Preferred One Community Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Commercial
Member Months
(Inpatient)
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
17591
7900
82925
1219
0
109635
Female
17391
6964
70783
815
0
95953
Total
34982
14864
153708
2034
0
205588
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
103
66
169
66
86
152
368
608
976
1
4
5
0
0
0
538
764
1302
HEDIS 2013 (Reporting Year 2012)
Male
17591
7900
82925
1219
0
109635
Female
17391
6964
70783
815
0
95953
Total
34982
14864
153708
2034
0
205588
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
7.03%
4.55%
5.80%
10.03%
14.82%
12.27%
5.33%
10.31%
7.62%
0.98%
5.89%
2.95%
NA
NA
NA
5.89%
9.55%
7.60%
Number
0
1
1
4
6
10
21
25
46
0
0
0
0
0
0
25
32
57
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
17591
17391
34982
7900
6964
14864
82925
70783
153708
1219
815
2034
0
0
0
109635
95953
205588
Percent
0.00%
0.07%
0.03%
0.61%
1.03%
0.81%
0.30%
0.42%
0.36%
0.00%
0.00%
0.00%
NA
NA
NA
0.27%
0.40%
0.33%
Number
10
4
14
2
5
7
10
36
46
0
1
1
0
0
0
22
46
68
Percent
0.68%
0.28%
0.48%
0.30%
0.86%
0.57%
0.14%
0.61%
0.36%
0.00%
1.47%
0.59%
NA
NA
NA
0.24%
0.58%
0.40%
Member Months
(Outpatient/ED)
Male
17591
7900
82925
1219
0
109635
Total
34982
14864
153708
2034
0
205588
Female
17391
6964
70783
815
0
95953
Outpatient/ED
Number
103
66
169
65
86
151
355
599
954
1
4
5
0
0
0
524
755
1279
Percent
7.03%
4.55%
5.80%
9.87%
14.82%
12.19%
5.14%
10.15%
7.45%
0.98%
5.89%
2.95%
NA
NA
NA
5.74%
9.44%
7.47%
Page 91
Use of Services
Preferred One Community Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Medicare Advantage
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Female
NR
NR
Member Months
(Inpatient)
Total
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 2013 (Reporting Year 2012)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Inpatient
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
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
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
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
Female
NR
NR
Total
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 92
Use of Services
Preferred One Community Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Nov 15, 2013 1:50 PM
MSHO
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Female
NR
NR
Member Months
(Inpatient)
Total
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 2013 (Reporting Year 2012)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Inpatient
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
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
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
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
Female
NR
NR
Total
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 93
Use of Services
Preferred One Community Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Nov 15, 2013 1:50 PM
SNBC
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Female
NR
NR
Member Months
(Inpatient)
Total
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 2013 (Reporting Year 2012)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Inpatient
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
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
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
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
Female
NR
NR
Total
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 94
Use of Services
Preferred One Community Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Minnesota Health Care Programs - Managed Care(MHCP-MC)
Member Months
(Inpatient)
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Female
NR
NR
Total
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 2013 (Reporting Year 2012)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Inpatient
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
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
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
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
Female
NR
NR
Total
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 95
Use of Services
Preferred One Community Health Plan
Plan All-Cause Readmissions
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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 2013 (Reporting Year 2012)
Page 96
Use of Services
Preferred One Community Health Plan
Plan All-Cause Readmissions
Data Last Refreshed:
Nov 15, 2013 1:50 PM
MSHO
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 2013 (Reporting Year 2012)
Page 97
Use of Services
Preferred One Community Health Plan
Plan All-Cause Readmissions
Data Last Refreshed:
Nov 15, 2013 1:50 PM
SNBC
Age
18-44
45-54
55-64
Total
Age
65-74
75-84
85+
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
Total
HEDIS 2013 (Reporting Year 2012)
Page 98
Health Plan Descriptive Information
Preferred One Community Health Plan
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Board Certification
MSHO
MSHO
Type of Physician
Family Medicine
Internal Medicine
Geriatricians
Other practitioner Specialists
HEDIS 2013 (Reporting Year 2012)
SNBC
Number of Physicians in Active Board Certification
Each Practice Area
Percent
Number
NR
NR
NR
NR
Page 99
Health Plan Descriptive Information
Preferred One Community Health Plan
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Board Certification
MSHO
SNBC
Type of Physician
Family Medicine
Internal Medicine
Geriatricians
Other practitioner Specialists
HEDIS 2013 (Reporting Year 2012)
SNBC
Number of Physicians in Active Board Certification
Each Practice Area
Percent
Number
NR
NR
NR
NR
Page 100
Health Plan Descriptive Information
Preferred One Community Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Nov 15, 2013 1:50 PM
Commercial
<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
1212
4881
7128
7427
4843
3078
Member Months
Female
1157
5163
6883
6983
4169
3016
28569
26.06%
8797
8861
9412
8392
9465
27371
28.53%
6884
7210
8170
7179
8024
44927
40.98%
9612
10885
8984
5439
37467
39.05%
9022
9214
7150
4914
34920
31.85%
935
159
83
34
8
0
30300
31.58%
694
90
20
8
3
0
1219
1.11%
0
109635
815
0.85%
0
95953
HEDIS 2013 (Reporting Year 2012)
Total
2369
10044
14011
14410
9012
6094
55940
27.21%
15681
16071
17582
15571
17489
82394
40.08%
18634
20099
16134
10353
65220
31.72%
1629
249
103
42
11
0
2034
0.99%
0
205588
Page 101
Health Plan Descriptive Information
Preferred One Community Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2013 (Reporting Year 2012)
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
Page 102
Health Plan Descriptive Information
Preferred One Community Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Nov 15, 2013 1:50 PM
MSHO
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
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2013 (Reporting Year 2012)
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
Page 103
Health Plan Descriptive Information
Preferred One Community Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Nov 15, 2013 1:50 PM
SNBC
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
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2013 (Reporting Year 2012)
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
Page 104
Health Plan Descriptive Information
Preferred One Community Health Plan
Enrollment by Product Line (Age & Sex)
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Member Months
Male
Female
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
NR
NR
0-19 Subtotal: %
NR
NR
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
NR
NR
20-44 Subtotal: %
NR
NR
45-49
50-54
55-59
60-64
45-64 Subtotal
NR
NR
45-64 Subtotal: %
NR
NR
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
NR
NR
>=65 Subtotal: %
NR
NR
Age Unknown
Total
NR
NR
HEDIS 2013 (Reporting Year 2012)
Data Last Refreshed:
Nov 15, 2013 1:50 PM
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
Page 105