Metropolitan 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
Metropolitan 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 12:42 PM
Commercial
Medicare
Advantage
MHCP-MC
2012
H
184
16
NR
NR
NR
NR
8.70%
180
0.00%
180
16
8.89%
0
Number of administrative data records excluded
3
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
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2013 (Reporting Year 2012)
0
NR
NR
NR
NR
NR
NR
0
180
16
145
89.44%
84.68%
94.21%
Page 3
Effectiveness of Care
Metropolitan Health Plan
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
Data Last Refreshed:
Nov 15, 2013 12:42 PM
Commercial
Counseling for Nutrition
BMI Percentile
Data Elements
General
Measure
Data
Ages 3-11 Ages 12-17
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 4
Effectiveness of Care
Metropolitan Health Plan
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
Data Last Refreshed:
Nov 15, 2013 12:42 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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
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
0
0
0
0
0
0
0
0
0
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
0
0
0
0
0
0
0
0
0
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
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
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Nov 15, 2013 12:42 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
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 6
Effectiveness of Care
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Nov 15, 2013 12:42 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
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 7
Effectiveness of Care
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Nov 15, 2013 12:42 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
0
0
0
0
0
0
0
0
0
0
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2012
A
0
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
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Nov 15, 2013 12:42 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
0
0
0
0
0
0
0
0
0
0
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2012
A
0
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
Metropolitan Health Plan
Data Last Refreshed:
Nov 15, 2013 12:42 PM
Immunizations for Adolescents
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
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
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
HEDIS 2013 (Reporting Year 2012)
Page 10
Effectiveness of Care
Metropolitan Health Plan
Data Last Refreshed:
Nov 15, 2013 12:42 PM
Immunizations for Adolescents
Commercial
Minnesota Health Care Programs - Managed Care (MHCP-MC)
General
Data Elements
Measure Data
Measurement Year
2012
Data Collection Methodology
A
Eligible Member Population
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
Meningococcal
Tdap
Combo 1
NR
NR
NR
NR
NR
NR
0
0
0
NA
NA
NA
NA
NA
NA
NA
NA
NA
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
Metropolitan 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 12:42 PM
Commercial
NR
NR
NR
Medicare
Advantage
NR
NR
NR
MSHO
SNBC
MHCP-MC
2012
A
32
19
59.38%
40.80%
77.95%
2012
A
53
31
58.49%
44.28%
72.70%
2012
A
57
26
45.61%
31.81%
59.42%
Page 12
Effectiveness of Care
Metropolitan 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 12:42 PM
Commercial
MHCP-MC
2012
H
504
185
NR
NR
36.71%
411
5.00%
432
162
37.50%
1
6
5
0
NR
NR
NR
5
411
158
88
59.85%
54.99%
64.71%
Page 13
Effectiveness of Care
Metropolitan Health Plan
Colorectal Cancer Screening
Data Last Refreshed:
Nov 15, 2013 12:42 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
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
MSHO
SNBC
2012
H
233
2012
H
92
58
25
24.89%
233
0.00%
233
57
24.46%
0
0
0
0
0
233
57
62
51.07%
44.44%
57.71%
27.17%
91
0.00%
91
25
27.47%
0
1
0
0
0
91
25
18
47.25%
36.45%
58.06%
Page 14
Effectiveness of Care
Metropolitan Health Plan
Chlamydia Screening in Women
Data Last Refreshed:
Nov 15, 2013 12:42 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
NR
NR
NR
Ages 21-24
Total
NR
NR
NR
NR
NR
NR
NR
NR
Page 15
Effectiveness of Care
Metropolitan Health Plan
Chlamydia Screening in Women
Data Last Refreshed:
Nov 15, 2013 12:42 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
Ages 21-24
Total
0
0
NR
NR
NR
24
18
NA
NA
NA
24
18
NA
NA
NA
2012
A
Page 16
Effectiveness of Care
Metropolitan 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 12:42 PM
Medicare
Advantage
NR
NR
NR
MSHO
2012
A
544
426
78.31%
74.75%
81.86%
Page 17
Effectiveness of Care
Metropolitan Health Plan
Data Last Refreshed:
Nov 15, 2013 12:42 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)
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
MHCP-MC
2012
A
0
NR
NR
NR
NR
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
NR
NA
Lower 95% Confidence Interval
NR
NA
Upper 95% Confidence Interval
NR
NA
HEDIS 2013 (Reporting Year 2012)
0
Page 18
Effectiveness of Care
Metropolitan Health Plan
Data Last Refreshed:
Nov 15, 2013 12:42 PM
Care for Older Adults
MSHO
Advance Care
Planning
Medication Review
Functional
Status
Assessment
Pain
Screening
0
0
0
0
0.00%
0.00%
0.00%
0.00%
0
0.00%
0
0.00%
0
0.00%
0
0.00%
0
318
77.37%
0
378
91.97%
0
332
80.78%
0
296
72.02%
Lower 95% Confidence Interval
73.21%
89.22%
76.85%
67.56%
Upper 95% Confidence Interval
81.54%
94.72%
84.71%
76.48%
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on
Eligible Population (before exclusions)
General Measure
Data
2012
H
614
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
HEDIS 2013 (Reporting Year 2012)
411
5.00%
432
0
0
0
411
Page 19
Effectiveness of Care
Metropolitan Health Plan
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Nov 15, 2013 12:42 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
16
NA
NA
NA
14
NA
NA
NA
2012
A
17
Page 21
Effectiveness of Care
Metropolitan Health Plan
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Nov 15, 2013 12:42 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
15
NA
NA
NA
18
NA
NA
NA
2012
A
24
Page 22
Effectiveness of Care
Metropolitan 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)
Medicare
Advantage
NR
NR
NR
Data Last Refreshed:
Nov 15, 2013 12:42 PM
MSHO
SNBC
2012
A
22
6
NA
NA
NA
2012
A
2
1
NA
NA
NA
Page 23
Effectiveness of Care
Metropolitan Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Nov 15, 2013 12:42 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
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 24
Effectiveness of Care
Metropolitan Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Nov 15, 2013 12:42 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
Ages 12-18
Ages 19-50
Ages 51-64
Total
0
0
0
NR
NR
NR
0
0
0
NR
NR
NR
3
3
0
NA
NA
NA
4
4
4
NA
NA
NA
7
7
4
NA
NA
NA
2012
A
Page 25
Effectiveness of Care
Metropolitan Health Plan
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Nov 15, 2013 12:42 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
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 26
Effectiveness of Care
Metropolitan Health Plan
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Nov 15, 2013 12:42 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
3
50.00%
0
0.00%
3
50.00%
0
0.00%
3
0
NA
NA
NA
0
2
NA
NA
NA
2012
H
6
6
0.00%
6
0
0
0
6
Page 28
Effectiveness of Care
Metropolitan Health Plan
Controlling High Blood Pressure
Data Last Refreshed:
Nov 15, 2013 12:42 PM
Data Elements
Medicare
Advantage
MSHO
SNBC
MHCP-MC
2012
H
301
2012
H
79
2012
H
445
0
0
0
0.00%
246
0.00%
246
0
0.00%
0.00%
73
0.00%
73
0
0.00%
0.00%
411
5.00%
432
0
0.00%
0
0
0
Number of records excluded because of
false positive diagnoses
0
0
0
Number of administrative data records
excluded
55
8
7
Number of medical record data records
excluded
0
0
0
0
0
0
0
246
0
176
71.54%
65.70%
77.39%
0
73
0
44
60.27%
48.36%
72.18%
0
411
0
239
58.15%
53.26%
63.04%
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
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)
Commercial
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 29
Effectiveness of Care
Metropolitan 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
NR
NR
NR
Data Last Refreshed:
Nov 15, 2013 12:42 PM
Medicare
Advantage
NR
NR
NR
MSHO
SNBC
MHCP-MC
2012
A
1
2012
A
0
2012
A
0
1
0
0
NA
NA
NA
NR
NR
NR
NR
NR
NR
Page 30
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Nov 15, 2013 12:42 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%)
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 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)
Page 31
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Nov 15, 2013 12:42 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
2012
H
111
2012
H
111
102
91.89%
109
0%
109
98
89.91%
111
100.00%
109
0%
109
19
17.43%
Good HbA1c
Control
(<7.0%)
NR
NR
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
2012
H
111
2012
H
111
2012
H
111
2012
H
111
2012
H
111
2012
H
111
2012
H
111
0
0.00%
109
0%
109
0
0.00%
75
67.57%
109
0%
109
73
66.97%
84
75.68%
109
0%
109
83
76.15%
0
0.00%
109
0%
109
0
0.00%
98
88.29%
109
0%
109
96
88.07%
0
0.00%
109
0%
109
0
0.00%
0
0.00%
109
0%
109
0
0.00%
0
0
0
0
0
0
0
0
0
Number of administrative data records
excluded
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
Number of employee/dependent medical
records excluded
0
0
0
0
0
0
0
0
0
0
109
86
16
93.58%
88.52%
98.64%
0
109
11
8
17.43%
9.85%
25.01%
0
109
0
81
74.31%
65.65%
82.97%
0
109
68
18
78.90%
70.78%
87.02%
0
109
77
8
77.98%
69.74%
86.22%
0
109
0
61
55.96%
46.18%
65.74%
0
109
96
2
89.91%
83.79%
96.02%
0
109
0
80
73.39%
64.64%
82.15%
0
109
0
76
69.72%
60.64%
78.81%
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)
NR
NR
NR
Page 33
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Nov 15, 2013 12:42 PM
SNBC
HbA1c
Testing
Poor HbA1c
Control
2012
H
53
2012
H
53
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
49
92.45%
48
0%
48
44
91.67%
53
100.00%
48
0%
48
16
33.33%
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
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
2012
H
53
2012
H
53
2012
H
53
2012
H
53
2012
H
53
2012
H
53
2012
H
53
0
0.00%
48
0%
48
0
0.00%
29
54.72%
48
0%
48
26
54.17%
42
79.25%
48
0%
48
37
77.08%
0
0.00%
48
0%
48
0
0.00%
45
84.91%
48
0%
48
41
85.42%
0
0.00%
48
0%
48
0
0.00%
0
0.00%
48
0%
48
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
48
36
8
91.67%
82.81%
100.00%
0
48
7
9
33.33%
18.96%
47.71%
0
48
0
29
60.42%
45.54%
75.29%
0
48
23
12
72.92%
59.30%
86.53%
0
48
36
5
85.42%
74.39%
96.44%
0
48
0
24
50.00%
34.81%
65.19%
0
48
41
0
85.42%
74.39%
96.44%
0
48
0
33
68.75%
54.60%
82.90%
0
48
0
15
31.25%
17.10%
45.40%
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 2013 (Reporting Year 2012)
NR
NR
NR
Page 34
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Nov 15, 2013 12:42 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
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
HbA1c
Testing
Poor HbA1c
Control
Good HbA1c
Control
(<7.0%)
Adequate
HbA1c
Control
(<8.0%)
2012
H
213
2012
H
213
2012
H
183
194
91.08%
203
0%
203
177
87.19%
213
100.00%
203
0%
203
73
35.96%
0
Eye Exam
2012
H
213
2012
H
213
2012
H
213
2012
H
213
2012
H
213
2012
H
213
2012
H
213
0
0.00%
178
0%
178
0
0.00%
0
0.00%
203
0%
203
0
0.00%
103
48.36%
203
0%
203
100
49.26%
152
71.36%
203
0%
203
145
71.43%
0
0.00%
203
0%
203
0
0.00%
182
85.45%
203
0%
203
175
86.21%
0
0.00%
203
0%
203
0
0.00%
0
0.00%
203
0%
203
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
0
0
0
0
203
0
115
56.65%
49.59%
63.71%
0
203
95
24
58.62%
51.60%
65.64%
0
203
140
17
77.34%
71.33%
83.35%
0
203
0
77
37.93%
31.01%
44.85%
0
203
175
5
88.67%
84.06%
93.28%
0
203
0
133
65.52%
58.73%
72.30%
0
203
0
87
42.86%
35.80%
49.91%
25
Number of Hybrid required exclusions
HEDIS 2013 (Reporting Year 2012)
Blood
Pressure
<140/80
mm Hg
LDL-C Level
<100 mg/dL
Number of Administrative 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
Blood
Monitoring for
Pressure
Diabetic
<140/90 mm
Nephropathy
Hg
LDL-C
Screening
0
0
203
157
33
93.60%
89.98%
97.21%
0
203
17
56
35.96%
29.11%
42.81%
0
178
0
79
44.38%
36.80%
51.96%
Page 35
Effectiveness of Care
Metropolitan 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 12:42 PM
Medicare
Advantage
NR
NR
NR
Page 36
Effectiveness of Care
Metropolitan 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)
Medicare
Advantage
NR
NR
NR
Data Last Refreshed:
Nov 15, 2013 12:42 PM
MSHO
2012
A
17
5
NA
NA
NA
Page 37
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Nov 15, 2013 12:42 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
NR
NR
NR
NR
NR
NR
Page 38
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Nov 15, 2013 12:42 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
2012
A
9
8
NA
NA
NA
9
NA
NA
NA
Page 40
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Nov 15, 2013 12:42 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
2012
A
23
16
NA
NA
NA
13
NA
NA
NA
Page 41
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Nov 15, 2013 12:42 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
2012
A
82
37
45.12%
33.74%
56.50%
28
34.15%
23.27%
45.02%
Page 42
Effectiveness of Care
Metropolitan Health Plan
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Nov 15, 2013 12:42 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
NR
NR
NR
NR
NR
NR
Page 43
Effectiveness of Care
Metropolitan Health Plan
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Nov 15, 2013 12:42 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
0
0
NA
NA
NA
0
0
NA
NA
NA
2012
A
Page 44
Effectiveness of Care
Metropolitan Health Plan
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Nov 15, 2013 12:42 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
10
NA
NA
NA
5
NA
NA
NA
2012
A
18
Page 46
Effectiveness of Care
Metropolitan Health Plan
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Nov 15, 2013 12:42 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
53
53.54%
43.21%
63.87%
25
25.25%
16.19%
34.32%
2012
A
99
Page 47
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Nov 15, 2013 12:42 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
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 48
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Nov 15, 2013 12:42 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
304
279
91.78%
88.52%
95.03%
5
4
NA
NA
NA
248
233
93.95%
90.78%
97.12%
27
19
NA
NA
NA
584
535
91.61%
89.28%
93.94%
2012
A
Page 50
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Nov 15, 2013 12:42 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
48
43
89.58%
79.90%
99.27%
1
1
NA
NA
NA
47
41
87.23%
76.63%
97.84%
11
9
NA
NA
NA
107
94
87.85%
81.19%
94.51%
2012
A
Page 51
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Nov 15, 2013 12:42 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
264
217
82.20%
77.39%
87.00%
2
2
NA
NA
NA
236
192
81.36%
76.18%
86.54%
29
19
NA
NA
NA
531
430
80.98%
77.55%
84.41%
2012
A
Page 52
Access/Availability of Care
Metropolitan Health Plan
Medication Reconciliation Post Discharge
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)
Data Last Refreshed:
Nov 15, 2013 12:42 PM
MSHO
2012
H
259
0
0.00%
275
207
0
0.00%
2
0
0
205
0
70
34.15%
27.41%
40.88%
Page 53
Effectiveness of Care
Metropolitan Health Plan
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Nov 15, 2013 12:42 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
Chronic Renal
Failure +
Nonaspirin
NSAIDs or Cox-2
Selective NSAIDs
Total
23
1
NA
NA
NA
142
30
21.13%
14.06%
28.19%
2012
A
7
2
NA
NA
NA
112
27
24.11%
15.74%
32.48%
Page 55
Effectiveness of Care
Metropolitan Health Plan
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Nov 15, 2013 12:42 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
2012
A
614
At least 1
Prescription
At least 2
Prescriptions
160
26.06%
22.51%
29.61%
51
8.31%
6.04%
10.57%
Page 57
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Nov 15, 2013 12:42 PM
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)
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 58
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Nov 15, 2013 12:42 PM
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 2013 (Reporting Year 2012)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
0
0
616
616
0
NA
NA
NA
0
NA
NA
NA
600
97.40%
96.07%
98.74%
600
97.40%
96.07%
98.74%
2012
A
Page 60
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Nov 15, 2013 12:42 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
68
173
4
245
63
92.65%
85.71%
99.59%
166
95.95%
92.73%
99.18%
4
NA
NA
NA
233
95.10%
92.20%
98.01%
2012
A
Page 61
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Nov 15, 2013 12:42 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
788
1112
0
1900
630
79.95%
77.09%
82.81%
958
86.15%
84.08%
88.23%
0
NA
NA
NA
1588
83.58%
81.89%
85.27%
2012
A
Page 62
Access/Availability of Care
Metropolitan Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Nov 15, 2013 12:42 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.
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 63
Access/Availability of Care
Metropolitan Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Nov 15, 2013 12:42 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.
0
0
NA
NA
NA
0
0
NA
NA
NA
0
0
NA
NA
NA
0
0
NA
NA
NA
2012
A
Page 64
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Nov 15, 2013 12:42 PM
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
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 65
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Nov 15, 2013 12:42 PM
MSHO
18+ Year Olds
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
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
Total
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
2012
A
33
0
33
0
0
8
0
NA
NA
NA
NA
NA
NA
24.24%
8.11%
40.38%
0.00%
0.00%
1.52%
8
24.24%
8.11%
40.38%
0
0.00%
0.00%
1.52%
Page 67
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Nov 15, 2013 12:42 PM
SNBC
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
0
225
225
0
0
70
14
NA
NA
NA
NA
NA
NA
31.11%
24.84%
37.38%
6.22%
2.84%
9.60%
70
31.11%
24.84%
37.38%
14
6.22%
2.84%
9.60%
Page 68
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Nov 15, 2013 12:42 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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
0
646
646
0
0
174
40
NA
NA
NA
NA
NA
NA
26.93%
23.44%
30.43%
6.19%
4.26%
8.13%
174
26.93%
23.44%
30.43%
40
6.19%
4.26%
8.13%
Page 69
Access/Availability of Care
Metropolitan Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Nov 15, 2013 12:42 PM
Commercial
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 70
Access/Availability of Care
Metropolitan Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Nov 15, 2013 12:42 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
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
A
1
Postpartum
Care
2012
A
1
NR
NR
NR
NR
1
0
NA
NA
NA
NA
NA
NA
Page 71
Use of Services
Metropolitan Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Nov 15, 2013 12:42 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
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 72
Use of Services
Metropolitan Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Nov 15, 2013 12:42 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
0
0
0
0
0
0
0
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2012
A
0
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
Metropolitan 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 12:42 PM
Commercial
MHCP-MC
2012
A
0
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)
0
NR
NR
NR
NA
NA
NA
Page 74
Use of Services
Metropolitan 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 12:42 PM
Commercial
MHCP-MC
2012
A
0
NR
NR
NR
NR
0
NR
NR
NR
NA
NA
NA
Page 75
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Nov 15, 2013 12:42 PM
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 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 76
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Nov 15, 2013 12:42 PM
MSHO
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
0
0
0
0
0
3454
3523
1268
0
8245
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
0
3348
3248
965
0
7561
HEDIS 2013 (Reporting Year 2012)
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
969.31
921.94
761.04
917.04
Emergency Room Visits
Visits
0
0
0
0
0
278
228
44
0
550
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
80.49
64.72
34.70
66.71
Page 78
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Nov 15, 2013 12:42 PM
SNBC
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
0
0
327
9386
14100
172
0
0
0
23985
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
4179
9679
121
0
0
0
14052
HEDIS 2013 (Reporting Year 2012)
Visits/ 1,000
Member
Months
NA
NA
223.24
445.24
686.45
703.49
NA
NA
585.87
Emergency Room Visits
Visits
0
0
30
1332
1779
13
0
0
0
3154
Visits/ 1,000
Member
Months
NA
NA
91.74
141.91
126.17
75.58
NA
NA
131.50
Page 79
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Nov 15, 2013 12:42 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
0
0
0
37356
25010
7
0
0
0
62373
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
10193
12917
5
0
0
0
23115
HEDIS 2013 (Reporting Year 2012)
Visits/ 1,000
Member
Months
NA
NA
NA
272.86
516.47
714.29
NA
NA
370.59
Emergency Room Visits
Visits
0
0
0
5521
2952
1
0
0
0
8474
Visits/ 1,000
Member
Months
NA
NA
NA
147.79
118.03
142.86
NA
NA
135.86
Page 80
Use of Services
Metropolitan 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 12:42 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 81
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan 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 12:42 PM
Member Months
0
0
0
0
0
3454
3523
1268
0
8245
Discharges
Discharges /
1,000 Member
Months
0
0
0
0
0
170
181
55
0
406
NA
NA
NA
NA
NA
49.22
51.38
43.38
0
0
0
0
0
141
150
49
0
340
NA
NA
NA
NA
NA
40.82
42.58
38.64
0
0
0
0
0
29
31
6
0
66
NA
NA
NA
NA
NA
8.40
8.80
4.73
0
0
0
0
0
NA
NA
NA
HEDIS 2013 (Reporting Year 2012)
49.24
41.24
8.00
NA
Days
Days / 1,000
Member
Months
0
0
0
0
0
853
1013
311
0
2177
NA
NA
NA
NA
NA
246.96
287.54
245.27
0
0
0
0
0
588
679
222
0
1489
NA
NA
NA
NA
NA
170.24
192.73
175.08
0
0
0
0
0
265
334
89
0
688
NA
NA
NA
NA
NA
76.72
94.81
70.19
0
0
0
0
0
NA
NA
NA
264.04
180.59
83.44
NA
Average
Length of Stay
NA
NA
NA
NA
NA
5.02
5.60
5.65
NA
5.36
NA
NA
NA
NA
NA
4.17
4.53
4.53
NA
4.38
NA
NA
NA
NA
NA
9.14
10.77
14.83
NA
10.42
NA
NA
NA
NA
NA
Page 83
Use of Services
Metropolitan 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 12:42 PM
Member Months
0
0
327
9386
14100
172
0
0
0
23985
Discharges
Discharges /
1,000 Member
Months
0
0
5
169
365
6
0
0
0
545
NA
NA
15.29
18.01
25.89
34.88
NA
NA
0
0
2
112
288
4
0
0
0
406
NA
NA
6.12
11.93
20.43
23.26
NA
NA
0
0
0
37
77
2
0
0
0
116
NA
NA
0.00
3.94
5.46
11.63
NA
NA
3
20
0
0
23
9.17
2.13
0.00
HEDIS 2013 (Reporting Year 2012)
22.72
16.93
4.84
0.97
Days
Days / 1,000
Member
Months
0
0
14
683
1606
23
0
0
0
2326
NA
NA
42.81
72.77
113.90
133.72
NA
NA
0
0
8
407
1235
13
0
0
0
1663
NA
NA
24.46
43.36
87.59
75.58
NA
NA
0
0
0
206
371
10
0
0
0
587
NA
NA
0.00
21.95
26.31
58.14
NA
NA
6
70
0
0
76
96.98
69.34
24.47
18.35
7.46
0.00
3.19
Average
Length of Stay
NA
NA
2.80
4.04
4.40
3.83
NA
NA
NA
4.27
NA
NA
4.00
3.63
4.29
3.25
NA
NA
NA
4.10
NA
NA
NA
5.57
4.82
5.00
NA
NA
NA
5.06
2.00
3.50
NA
NA
3.30
Page 84
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Nov 15, 2013 12:42 PM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Age
Member Months
<1
0
1-9
0
10-19
0
20-44
37356
45-64
25010
65-74
7
75-84
0
85+
0
Unknown
0
62373
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
0
0
0
270
357
1
0
0
0
628
NA
NA
NA
7.23
14.27
142.86
NA
NA
0
0
0
172
264
1
0
0
0
437
NA
NA
NA
4.60
10.56
142.86
NA
NA
0
0
0
83
92
0
0
0
0
175
NA
NA
NA
2.22
3.68
0.00
NA
NA
0
15
1
0
16
HEDIS 2013 (Reporting Year 2012)
10.07
7.01
2.81
NA
0.40
0.04
0.26
Days
Days / 1,000
Member
Months
0
0
0
1041
1487
1
0
0
0
2529
NA
NA
NA
27.87
59.46
142.86
NA
NA
0
0
0
591
1008
1
0
0
0
1600
NA
NA
NA
15.82
40.30
142.86
NA
NA
0
0
0
422
465
0
0
0
0
887
NA
NA
NA
11.30
18.59
0.00
NA
NA
0
28
14
0
42
40.55
25.65
14.22
NA
0.75
0.56
0.67
Average
Length of Stay
NA
NA
NA
3.86
4.17
1.00
NA
NA
NA
4.03
NA
NA
NA
3.44
3.82
1.00
NA
NA
NA
3.66
NA
NA
NA
5.08
5.05
NA
NA
NA
NA
5.07
NA
1.87
14.00
NA
2.63
Page 85
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Nov 15, 2013 12:42 PM
Commercial
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
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 86
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Nov 15, 2013 12:42 PM
MSHO
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
0
0
0
0
0
3059
0
3059
Female
0
0
0
0
0
5186
0
5186
Member Months
(Inpatient)
Total
0
0
0
0
0
8245
0
8245
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
0
0
0
0
0
0
0
0
0
0
0
0
36
21
57
0
0
0
36
21
57
HEDIS 2013 (Reporting Year 2012)
Male
0
0
0
0
0
3059
0
3059
Female
0
0
0
0
0
5186
0
5186
Total
0
0
0
0
0
8245
0
8245
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
14.12%
4.86%
8.30%
NA
NA
NA
14.12%
4.86%
8.30%
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
21
8
29
0
0
0
21
8
29
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3059
5186
8245
0
0
0
3059
5186
8245
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
8.24%
1.85%
4.22%
NA
NA
NA
8.24%
1.85%
4.22%
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
Member Months
(Outpatient/ED)
Male
0
0
0
0
0
3059
0
3059
Female
0
0
0
0
0
5186
0
5186
Total
0
0
0
0
0
8245
0
8245
Outpatient/ED
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
26
17
43
0
0
0
26
17
43
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
10.20%
3.93%
6.26%
NA
NA
NA
10.20%
3.93%
6.26%
Page 88
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Nov 15, 2013 12:42 PM
SNBC
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
0
0
981
1837
9844
107
0
12769
Female
0
0
630
1656
8865
65
0
11216
Member Months
(Inpatient)
Total
0
0
1611
3493
18709
172
0
23985
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
0
0
0
15
9
24
41
23
64
355
212
567
1
1
2
0
0
0
412
245
657
HEDIS 2013 (Reporting Year 2012)
Male
0
0
981
1837
9844
107
0
12769
Female
0
0
630
1656
8865
65
0
11216
Total
0
0
1611
3493
18709
172
0
23985
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
NA
NA
NA
NA
NA
NA
18.35%
17.14%
17.88%
26.78%
16.67%
21.99%
43.28%
28.70%
36.37%
11.21%
18.46%
13.95%
NA
NA
NA
38.72%
26.21%
32.87%
Number
0
0
0
0
0
0
6
2
8
13
7
20
94
57
151
0
0
0
0
0
0
113
66
179
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
0
0
0
0
0
0
981
630
1611
1837
1656
3493
9844
8865
18709
107
65
172
0
0
0
12769
11216
23985
Percent
NA
NA
NA
NA
NA
NA
7.34%
3.81%
5.96%
8.49%
5.07%
6.87%
11.46%
7.72%
9.69%
0.00%
0.00%
0.00%
NA
NA
NA
10.62%
7.06%
8.96%
Number
0
0
0
0
0
0
0
0
0
2
3
5
6
10
16
0
0
0
0
0
0
8
13
21
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
1.31%
2.17%
1.72%
0.73%
1.35%
1.03%
0.00%
0.00%
0.00%
NA
NA
NA
0.75%
1.39%
1.05%
Member Months
(Outpatient/ED)
Male
0
0
981
1837
9844
107
0
12769
Female
0
0
630
1656
8865
65
0
11216
Total
0
0
1611
3493
18709
172
0
23985
Outpatient/ED
Number
0
0
0
0
0
0
11
8
19
33
20
53
330
198
528
1
1
2
0
0
0
375
227
602
Percent
NA
NA
NA
NA
NA
NA
13.46%
15.24%
14.15%
21.56%
14.49%
18.21%
40.23%
26.80%
33.87%
11.21%
18.46%
13.95%
NA
NA
NA
35.24%
24.29%
30.12%
Page 89
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Nov 15, 2013 12:42 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
0
0
5587
12827
27380
4
0
45798
Female
0
0
2480
3847
10245
3
0
16575
Member Months
(Inpatient)
Total
0
0
8067
16674
37625
7
0
62373
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
0
0
0
143
49
192
427
118
545
1124
343
1467
0
0
0
0
0
0
1694
510
2204
HEDIS 2013 (Reporting Year 2012)
Male
0
0
5587
12827
27380
4
0
45798
Female
0
0
2480
3847
10245
3
0
16575
Total
0
0
8067
16674
37625
7
0
62373
Inpatient
Percent
NA
NA
NA
NA
NA
NA
30.71%
23.71%
28.56%
39.95%
36.81%
39.22%
49.26%
40.18%
46.79%
0.00%
0.00%
0.00%
NA
NA
NA
44.39%
36.92%
42.40%
Number
0
0
0
0
0
0
24
11
35
63
24
87
204
74
278
0
0
0
0
0
0
291
109
400
Percent
NA
NA
NA
NA
NA
NA
5.15%
5.32%
5.21%
5.89%
7.49%
6.26%
8.94%
8.67%
8.87%
0.00%
0.00%
0.00%
NA
NA
NA
7.62%
7.89%
7.70%
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
0
0
0
0
0
0
5587
2480
8067
12827
3847
16674
27380
10245
37625
4
3
7
0
0
0
45798
16575
62373
Intensive Outpatient/Partial
Hospitalization
Percent
Number
0
NA
0
NA
0
NA
0
NA
0
NA
0
NA
2
0.43%
0
0.00%
2
0.30%
1
0.09%
1
0.31%
2
0.14%
23
1.01%
8
0.94%
31
0.99%
0
0.00%
0
0.00%
0
0.00%
0
NA
0
NA
0
NA
26
0.68%
9
0.65%
35
0.67%
Member Months
(Outpatient/ED)
Male
0
0
5587
12827
27380
4
0
45798
Female
0
0
2480
3847
10245
3
0
16575
Total
0
0
8067
16674
37625
7
0
62373
Outpatient/ED
Number
0
0
0
0
0
0
135
46
181
400
111
511
1071
316
1387
0
0
0
0
0
0
1606
473
2079
Percent
NA
NA
NA
NA
NA
NA
29.00%
22.26%
26.92%
37.42%
34.62%
36.78%
46.94%
37.01%
44.24%
0.00%
0.00%
0.00%
NA
NA
NA
42.08%
34.24%
40.00%
Page 90
Use of Services
Metropolitan Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Nov 15, 2013 12:42 PM
Commercial
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)
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 91
Use of Services
Metropolitan Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Nov 15, 2013 12:42 PM
MSHO
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
0
0
0
3059
0
3059
Female
0
0
0
5186
0
5186
Member Months
(Inpatient)
Total
0
0
0
8245
0
8245
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
0
0
0
0
0
0
0
0
0
62
88
150
0
0
0
62
88
150
HEDIS 2013 (Reporting Year 2012)
Male
0
0
0
3059
0
3059
Female
0
0
0
5186
0
5186
Total
0
0
0
8245
0
8245
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
24.32%
20.36%
21.83%
NA
NA
NA
24.32%
20.36%
21.83%
Number
0
0
0
0
0
0
0
0
0
14
18
32
0
0
0
14
18
32
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
0
0
0
0
0
0
0
0
0
3059
5186
8245
0
0
0
3059
5186
8245
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
5.49%
4.17%
4.66%
NA
NA
NA
5.49%
4.17%
4.66%
Number
0
0
0
0
0
0
0
0
0
1
2
3
0
0
0
1
2
3
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.39%
0.46%
0.44%
NA
NA
NA
0.39%
0.46%
0.44%
Member Months
(Outpatient/ED)
Male
0
0
0
3059
0
3059
Total
0
0
0
8245
0
8245
Female
0
0
0
5186
0
5186
Outpatient/ED
Number
0
0
0
0
0
0
0
0
0
57
83
140
0
0
0
57
83
140
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
22.36%
19.21%
20.38%
NA
NA
NA
22.36%
19.21%
20.38%
Page 93
Use of Services
Metropolitan Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Nov 15, 2013 12:42 PM
SNBC
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
0
0
12662
107
0
12769
Female
0
0
11151
65
0
11216
Member Months
(Inpatient)
Total
0
0
23813
172
0
23985
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
0
0
0
0
0
0
681
644
1325
1
2
3
0
0
0
682
646
1328
HEDIS 2013 (Reporting Year 2012)
Male
0
0
12662
107
0
12769
Female
0
0
11151
65
0
11216
Total
0
0
23813
172
0
23985
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
NA
NA
NA
NA
NA
NA
64.54%
69.30%
66.77%
11.21%
36.92%
20.93%
NA
NA
NA
64.09%
69.12%
66.44%
Number
0
0
0
0
0
0
62
49
111
0
0
0
0
0
0
62
49
111
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
0
0
0
0
0
0
12662
11151
23813
107
65
172
0
0
0
12769
11216
23985
Percent
NA
NA
NA
NA
NA
NA
5.88%
5.27%
5.59%
0.00%
0.00%
0.00%
NA
NA
NA
5.83%
5.24%
5.55%
Number
0
0
0
0
0
0
23
35
58
0
0
0
0
0
0
23
35
58
Percent
NA
NA
NA
NA
NA
NA
2.18%
3.77%
2.92%
0.00%
0.00%
0.00%
NA
NA
NA
2.16%
3.74%
2.90%
Member Months
(Outpatient/ED)
Male
0
0
12662
107
0
12769
Female
0
0
11151
65
0
11216
Total
0
0
23813
172
0
23985
Outpatient/ED
Number
0
0
0
0
0
0
674
639
1313
1
2
3
0
0
0
675
641
1316
Percent
NA
NA
NA
NA
NA
NA
63.88%
68.77%
66.17%
11.21%
36.92%
20.93%
NA
NA
NA
63.43%
68.58%
65.84%
Page 94
Use of Services
Metropolitan Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Nov 15, 2013 12:42 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
0
0
45794
4
0
45798
Female
0
0
16572
3
0
16575
Total
0
0
62366
7
0
62373
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
0
0
0
0
0
0
1362
686
2048
0
0
0
0
0
0
1362
686
2048
HEDIS 2013 (Reporting Year 2012)
Male
0
0
45794
4
0
45798
Female
0
0
16572
3
0
16575
Total
0
0
62366
7
0
62373
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
NA
NA
NA
NA
NA
NA
35.69%
49.67%
39.41%
0.00%
0.00%
0.00%
NA
NA
NA
35.69%
49.67%
39.40%
Number
0
0
0
0
0
0
89
41
130
0
0
0
0
0
0
89
41
130
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
0
0
0
0
0
0
45794
16572
62366
4
3
7
0
0
0
45798
16575
62373
Percent
NA
NA
NA
NA
NA
NA
2.33%
2.97%
2.50%
0.00%
0.00%
0.00%
NA
NA
NA
2.33%
2.97%
2.50%
Number
0
0
0
0
0
0
57
35
92
0
0
0
0
0
0
57
35
92
Percent
NA
NA
NA
NA
NA
NA
1.49%
2.53%
1.77%
0.00%
0.00%
0.00%
NA
NA
NA
1.49%
2.53%
1.77%
Member Months
(Outpatient/ED)
Male
0
0
45794
4
0
45798
Female
0
0
16572
3
0
16575
Total
0
0
62366
7
0
62373
Outpatient/ED
Number
0
0
0
0
0
0
1339
674
2013
0
0
0
0
0
0
1339
674
2013
Percent
NA
NA
NA
NA
NA
NA
35.09%
48.81%
38.73%
0.00%
0.00%
0.00%
NA
NA
NA
35.08%
48.80%
38.73%
Page 95
Use of Services
Metropolitan Health Plan
Plan All-Cause Readmissions
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Plan All-Cause Readmissions
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Plan All-Cause Readmissions
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Nov 15, 2013 12:42 PM
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
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 101
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Nov 15, 2013 12:42 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
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Nov 15, 2013 12:42 PM
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
0
0.00%
0
0
0
0
0
0
0.00%
0
0
0
0
0
0
0.00%
0
0
0
0
0
0.00%
0
0
0
0
0
0.00%
658
884
722
492
214
89
0
0.00%
855
1057
1289
1020
545
420
3059
100.00%
0
3059
5186
100.00%
0
5186
HEDIS 2013 (Reporting Year 2012)
Total
0
0
0
0
0
0
0
0.00%
0
0
0
0
0
0
0.00%
0
0
0
0
0
0.00%
1513
1941
2011
1512
759
509
8245
100.00%
0
8245
Page 103
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Nov 15, 2013 12:42 PM
SNBC
<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
258
Member Months
Female
0
0
0
0
0
69
258
2.02%
723
887
950
1136
1328
69
0.62%
561
784
872
962
1183
5024
39.35%
1629
2504
1819
1428
4362
38.89%
1618
1983
1757
1362
7380
57.80%
107
0
0
0
0
0
6720
59.91%
65
0
0
0
0
0
107
0.84%
0
12769
65
0.58%
0
11216
HEDIS 2013 (Reporting Year 2012)
Total
0
0
0
0
0
327
327
1.36%
1284
1671
1822
2098
2511
9386
39.13%
3247
4487
3576
2790
14100
58.79%
172
0
0
0
0
0
172
0.72%
0
23985
Page 104
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Member Months
Male
Female
0
0
<1
0
0
1-4
0
0
5-9
0
0
10-14
0
0
15-17
0
0
18-19
0-19 Subtotal
0
0
0-19 Subtotal: %
0.00%
0.00%
5587
2480
20-24
7203
2355
25-29
5624
1492
30-34
4277
1104
35-39
5442
1792
40-44
20-44 Subtotal
28133
9223
20-44 Subtotal: %
61.43%
55.64%
6572
2217
45-49
5728
2506
50-54
3681
1624
55-59
1680
1002
60-64
45-64 Subtotal
17661
7349
45-64 Subtotal: %
38.56%
44.34%
4
3
65-69
0
0
70-74
0
0
75-79
0
0
80-84
0
0
85-89
0
0
>=90
>=65 Subtotal
4
3
>=65 Subtotal: %
0.01%
0.02%
0
0
Age Unknown
Total
45798
16575
HEDIS 2013 (Reporting Year 2012)
Data Last Refreshed:
Nov 15, 2013 12:42 PM
Total
0
0
0
0
0
0
0
0.00%
8067
9558
7116
5381
7234
37356
59.89%
8789
8234
5305
2682
25010
40.10%
7
0
0
0
0
0
7
0.01%
0
62373
Page 105