Metropolitan Health Plan
General Info
Disclaimers
HEDIS 2012 (Reporting Year 2011)
Page
Data Last Refreshed: 10/22/2012
2
Effectiveness of Care Measures
Code
Effectiveness of Care Measures
Code
Medication Management
Page
Prevention and Screening
ABA
Adult BMI Assessment
3
WCC
Weight Assessment and Counseling for Nutrition and Physical Activity for
Children/Adolescents
4
CIS
Childhood Immunization Status
6
IMA
Immunizations for Adolescents
10
Page
26 MPM
Annual Monitoring for Patients on Persistent Medications
48
27 MRP
Medication Reconciliation Post Discharge
53
Potentially Harmful Drug-Disease Interactions in the Elderly
54
Use of High Risk Medications in the Elderly
56
28
DDE
29 DAE
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
IET
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
65
GSO
Glaucoma Screening in Older Adults
17
33 PPC
Prenatal and Postpartum Care
70
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
ASM
Use of Appropriate Medications for People with Asthma
24
Cardiovascular
Access / Availability of Care Measures
Use of Services Measures
0 Code
Page
Page
34 W15
Well Child Visits in the First 15 Months of Life
72
35 W34
Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life
74
Adolescent Well-Care Visits
75
36
AWC
Ambulatory Care
76
38
IPU
Inpatient Utilization - General Hospital/Acute Care
81
IAD
37 AMB
CMC
Cholesterol Management for Patients with Cardiovascular Conditions
26
39
Identification of Alcohol and Other Drug Services
86
CBP
Controlling High Blood Pressure
29
40 MPT
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
91
PBH
Persistence of Beta Blocker Treatment After Heart Attack
30
41 PCR
Plan All-Cause Readmissions
96
Diabetes
CDC
Comprehensive Diabetes Care
41
31
Musculoskeletal
ART
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis
36
OMW
Osteoporosis Management in Women Who had a Fracture
37
Behavioral Health
AMM
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
HEDIS 2012 (Reporting Year 2011)
0 Code
Health Plan Descriptive Information Measures
Page
42 BCR
Board Certification
99
43 ENP
Enrollment by Product Line (Age & Sex)
101
43
DISCLAIMERS
-1
( this page left blank intentionally )
0. Disclaimer Query located below
HEDIS 2012 (Reporting Year 2011)
Page 2
Effectiveness of Care
Metropolitan Health Plan
Adult BMI Assessment
Data Elements
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Medicare
Advantage
MHCP-MC
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 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
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 2012 (Reporting Year 2011)
Page 3
Effectiveness of Care
Metropolitan Health Plan
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
BMI Percentile
Data Elements
General
Measure
Data
Ages 3-11 Ages 12-17
Counseling for Nutrition
Total
General
Measure
Data
Ages 3-11 Ages 12-17
Counseling for Physical Activity
Total
General
Measure
Data
Ages 3-11
Ages 1217
Total
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number of Records Excluded Because of
Valid Data Errors
Number of administrative data records
excluded
Number of medical records excluded
Number of employee/dependent records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
Page 4
Effectiveness of Care
Metropolitan Health Plan
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
Data Last Refreshed:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
Page 5
Effectiveness of Care
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Data Elements
General
Measure
Data
Pneumococcal
Hepatitis A Rotavirus
Conjugate
DTaP
IPV
MMR
HiB
Hepatitis B
VZV
Influenza
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 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 2012 (Reporting Year 2011)
Page 6
Effectiveness of Care
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Data Elements
General
Measure
Data
DTaP
Combo 2
Combo 3
Combo 4
Combo 5
Combo 6
Combo 7
Combo 8
Combo 9
Combo10
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 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 2012 (Reporting Year 2011)
Page 7
Effectiveness of Care
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Data Elements
General
Measure
Data
Pneumococcal
Hepatitis A Rotavirus
Conjugate
DTaP
IPV
MMR
HiB
Hepatitis B
VZV
Influenza
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 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 2012 (Reporting Year 2011)
Page 8
Effectiveness of Care
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Data Elements
General
Measure
Data
DTaP
Combo 2
Combo 3
Combo 4
Combo 5
Combo 6
Combo 7
Combo 8
Combo 9
Combo10
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 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 2012 (Reporting Year 2011)
Page 9
Effectiveness of Care
Metropolitan Health Plan
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Immunizations for Adolescents
Commercial
Data Elements
General
Measure Data
Meningococcal
Tdap
Combo 1
Current Year's Admin Rate
NR
NR
NR
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
NR
NR
NR
Reported Rate
NR
NR
NR
Lower 95% Confidence Interval
NR
NR
NR
Upper 95% Confidence Interval
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on Eligible
Population (before exclusions)
Records Excluded because of Valid Data Errors
Number of administrative data records excluded
Number of medical data records excluded
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
HEDIS 2012 (Reporting Year 2011)
Page 10
Effectiveness of Care
Metropolitan Health Plan
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Immunizations for Adolescents
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 2012 (Reporting Year 2011)
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 2012 (Reporting Year 2011)
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
NR
NR
NR
Medicare
Advantage
NR
NR
NR
MSHO
SNBC
MHCP-MC
2011
A
37
18
48.65%
31.19%
66.11%
2011
A
76
43
56.58%
44.78%
68.38%
NR
NR
NR
Page 12
Effectiveness of Care
Metropolitan Health Plan
Cervical Cancer Screening
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
MHCP-MC
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 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 2012 (Reporting Year 2011)
Page 13
Effectiveness of Care
Metropolitan Health Plan
Colorectal Cancer Screening
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Data Elements
Commercial
Medicare
Advantage
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 2012 (Reporting Year 2011)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
MSHO
SNBC
2011
H
238
2011
H
93
62
24
26.05%
238
0.00%
238
62
26.05%
0
0
0
0
0
238
62
63
52.52%
45.97%
59.08%
25.81%
93
0.00%
93
24
25.81%
0
0
0
0
0
93
24
18
45.16%
34.51%
55.81%
Page 14
Effectiveness of Care
Metropolitan Health Plan
Chlamydia Screening in Women
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
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
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 2012 (Reporting Year 2011)
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Medicare
Advantage
NR
NR
NR
MSHO
2011
A
575
440
76.52%
72.97%
80.07%
Page 17
Effectiveness of Care
Metropolitan Health Plan
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Lead Screening in Children
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Commercial
MHCP-MC
Current Year's Admin Rate
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
Reported Rate
NR
NR
Lower 95% Confidence Interval
NR
NR
Upper 95% Confidence Interval
NR
NR
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 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
HEDIS 2012 (Reporting Year 2011)
Page 18
Effectiveness of Care
Metropolitan Health Plan
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Care for Older Adults
MSHO
Medication Review
Functional
Status
Assessment
Pain
Screening
NR
NR
NR
NR
NR
NR
NR
NR
Reported Rate
NR
NR
NR
NR
Lower 95% Confidence Interval
NR
NR
NR
NR
Upper 95% Confidence Interval
NR
NR
NR
NR
Advance Care
Planning
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
Data Elements
General Measure
Data
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 employee/dependent medical
records excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
HEDIS 2012 (Reporting Year 2011)
Page 19
Effectiveness of Care
Metropolitan Health Plan
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Medicare Advantage
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
22
NA
NA
NA
25
NA
NA
NA
2011
A
25
Page 21
Effectiveness of Care
Metropolitan Health Plan
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
9
NA
NA
NA
10
NA
NA
NA
2011
A
10
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 2012 (Reporting Year 2011)
Medicare
Advantage
NR
NR
NR
Data Last Refreshed:
Oct 22, 2012 9:42 AM
MSHO
SNBC
2011
A
18
6
NA
NA
NA
2011
A
1
1
NA
NA
NA
Page 23
Effectiveness of Care
Metropolitan Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Number of required exclusions
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
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
Metropolitan Health Plan
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on Eligible Population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Records Excluded because of Valid Data Errors
Number of employee/dependent medical records excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
Medicare Advantage
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on Eligible Population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Records Excluded because of Valid Data Errors
Number of employee/dependent medical records excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
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
Metropolitan Health Plan
Controlling High Blood Pressure
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Data Elements
Medicare
Advantage
MSHO
SNBC
Measurement Year
Data Collection Methodology (Hybrid)
Eligible Member Population
2011
H
312
2011
H
128
Numerator Events by Admin Data on
Eligible Population (before exclusions)
0
0
0.00%
267
0.00%
267
0.00%
120
0.00%
120
0
0.00%
0
0.00%
Records Excluded because of Valid Data
Errors
2
0
Number of records excluded because of
false positive diagnoses
0
0
Number of administrative data records
excluded
49
11
Number of medical record data records
excluded
0
0
Number of employee/dependent medical
records excluded
0
0
Records Added from the OverSample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
0
265
0
186
70.19%
64.49%
75.88%
0
120
0
84
70.00%
61.38%
78.62%
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
HEDIS 2012 (Reporting Year 2011)
Commercial
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
MHCP-MC
NR
NR
NR
NR
NR
Page 29
Effectiveness of Care
Metropolitan Health Plan
Persistence of Beta Blocker Treatment After Heart Attack
Data Elements
Commercial
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Medicare
Advantage
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on
Eligible Population
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
NR
NR
NR
NR
NR
NR
MSHO
SNBC
2011
A
2
2011
A
2
2
1
NA
NA
NA
NA
NA
NA
MHCP-MC
NR
NR
NR
Page 30
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Data Elements
HbA1c
Testing
Poor HbA1c
Control
(>9.0%)
Good HbA1c
Control
(<7.0%)
Adequate
HbA1c
Control
(<8.0%)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Blood
Monitoring for
Pressure
Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<140/80
mm Hg
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
Number of HbA1c < 7 required administrative
data records excluded
Number of HbA1c < 7 required medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
Page 31
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Medicare Advantage
Data Elements
HbA1c
Testing
Poor HbA1c
Control
Good HbA1c
Control
(<7.0%)
Adequate
HbA1c
Control
(<8.0%)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Blood
Monitoring for
Pressure
Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<140/80
mm Hg
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
Number of Administrative required exclusions
Number of Hybrid required exclusions
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
Page 32
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 22, 2012 9:42 AM
MSHO
LDL-C
Screening
LDL-C Level
<100 mg/dL
2011
H
101
2011
H
101
2011
H
101
2011
H
101
2011
H
101
2011
H
101
2011
H
101
0
0.00%
101
0%
101
0
0.00%
72
71.29%
101
0%
101
72
71.29%
77
76.24%
101
0%
101
73
72.28%
0
0.00%
101
0%
101
0
0.00%
90
89.11%
101
0%
101
90
89.11%
0
0.00%
101
0%
101
0
0.00%
0
0.00%
101
0%
101
0
0.00%
3
3
3
3
3
3
3
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
98
85
9
95.92%
91.49%
100.00%
0
98
6
11
17.35%
9.34%
25.35%
0
98
0
73
74.49%
65.35%
83.63%
0
98
69
7
77.55%
68.78%
86.32%
0
98
72
9
82.65%
74.65%
90.66%
0
98
0
58
59.18%
48.94%
69.42%
0
98
88
1
90.82%
84.59%
97.04%
0
98
0
71
72.45%
63.09%
81.80%
0
98
0
63
64.29%
54.29%
74.28%
2011
H
101
2011
H
101
92
91.09%
101
0%
101
90
89.11%
101
100.00%
101
0%
101
101
100.00%
Number of Records Excluded Because of
Valid Data Errors
3
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Blood
Pressure
<140/80
mm Hg
Eye Exam
Poor HbA1c
Control
Measurement Year
Data Collection Methodology
Eligible Member Population
Blood
Monitoring for
Pressure
Diabetic
<140/90 mm
Nephropathy
Hg
Adequate
HbA1c
Control
(<8.0%)
HbA1c
Testing
Data Elements
Good HbA1c
Control
(<7.0%)
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 2012 (Reporting Year 2011)
NR
NR
NR
Page 33
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 22, 2012 9:42 AM
SNBC
2011
H
88
2011
H
88
2011
H
88
2011
H
88
2011
H
88
2011
H
88
0
0.00%
88
0%
88
0
0.00%
58
65.91%
88
0%
88
116
NR
65
73.86%
88
0%
88
127
NR
0
0.00%
88
0%
88
0
0.00%
75
85.23%
88
0%
88
150
NR
0
0.00%
88
0%
88
0
0.00%
0
0.00%
88
0%
88
0
0.00%
7
7
7
7
7
7
7
7
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
81
68
13
100.00%
99.38%
100.00%
0
81
2
15
20.99%
11.50%
30.47%
0
81
0
55
67.90%
57.12%
78.69%
0
81
54
8
76.54%
66.70%
86.39%
0
81
58
8
81.48%
72.40%
90.56%
0
81
0
43
53.09%
41.60%
64.57%
0
81
74
0
91.36%
84.62%
98.09%
0
81
0
62
76.54%
66.70%
86.39%
0
81
0
41
50.62%
39.11%
62.12%
80
90.91%
88
0%
88
157
NR
88
100.00%
88
0%
88
131
NR
Number of Records Excluded Because of
Valid Data Errors
7
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Blood
Pressure
<140/80
mm Hg
2011
H
88
2011
H
88
Numerator events by admin data in eligible
population
Blood
Monitoring for
Pressure
Diabetic
<140/90 mm
Nephropathy
Hg
Eye Exam
2011
H
88
Measurement Year
Data Collection Methodology
Eligible Member Population
Adequate
HbA1c
Control
(<8.0%)
LDL-C Level
<100 mg/dL
Poor HbA1c
Control
Data Elements
Good HbA1c
Control
(<7.0%)
LDL-C
Screening
HbA1c
Testing
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 2012 (Reporting Year 2011)
NR
NR
NR
Page 34
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Data Elements
Blood
Monitoring for
Pressure
Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<140/80
mm Hg
HbA1c
Testing
Poor HbA1c
Control
Good HbA1c
Control
(<7.0%)
Adequate
HbA1c
Control
(<8.0%)
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
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 2012 (Reporting Year 2011)
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 2012 (Reporting Year 2011)
Data Last Refreshed:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
Medicare
Advantage
NR
NR
NR
Data Last Refreshed:
Oct 22, 2012 9:42 AM
MSHO
2011
A
20
1
NA
NA
NA
Page 37
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
Medicare Advantage
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
General
Measure Data
Effective
Effective Acute
Continuation
Phase
Phase
Treatment
Treatment
2011
A
7
7
NA
NA
NA
6
NA
NA
NA
Page 40
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
General
Measure Data
Effective
Effective Acute
Continuation
Phase
Phase
Treatment
Treatment
2011
A
13
5
NA
NA
NA
4
NA
NA
NA
Page 41
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
General
Measure Data
Effective
Effective Acute
Continuation
Phase
Phase
Treatment
Treatment
NR
NR
NR
NR
NR
NR
Page 42
Effectiveness of Care
Metropolitan Health Plan
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
General
Measure
Data
Initiation
Phase
Continuation
and
Maintenance
Phase
NR
NR
NR
NR
NR
NR
Page 44
Effectiveness of Care
Metropolitan Health Plan
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Medicare Advantage
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
General
Measure
Data
30 Days
7 Days
3
NA
NA
NA
2
NA
NA
NA
2011
A
6
Page 46
Effectiveness of Care
Metropolitan Health Plan
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
General
Measure
Data
30 Days
7 Days
28
66.67%
51.22%
82.11%
15
35.71%
20.03%
51.40%
2011
A
42
Page 47
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
Medicare Advantage
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
311
286
91.96%
88.78%
95.14%
7
7
NA
NA
NA
254
234
92.13%
88.62%
95.64%
26
20
NA
NA
NA
598
547
91.47%
89.15%
93.79%
2011
A
Page 50
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
92
84
91.30%
85.00%
97.61%
3
3
NA
NA
NA
91
85
93.41%
87.76%
99.05%
25
21
NA
NA
NA
211
193
91.47%
87.46%
95.48%
2011
A
Page 51
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
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
Metropolitan Health Plan
Medication Reconciliation Post Discharge
Data Elements
Data Last Refreshed:
Oct 22, 2012 9:42 AM
MSHO
Measurement Year
Data collection methodology (Administrative or Hybrid)
Eligible member population
Number of numerator events by administrative data in eligible
population (before exclusions)
Current year's administrative rate (before exclusions)
NR
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
NR
Number of original sample records excluded because of valid
data errors
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2012 (Reporting Year 2011)
NR
NR
NR
Page 53
Effectiveness of Care
Metropolitan Health Plan
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Medicare Advantage
Drug-Disease Interactions
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
MSHO
Drug-Disease Interactions
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
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
17
0
NA
NA
NA
154
45
29.22%
21.71%
36.73%
2011
A
6
1
NA
NA
NA
131
44
33.59%
25.12%
42.06%
Page 55
Effectiveness of Care
Metropolitan Health Plan
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Medicare Advantage
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
General
Measure
Data
2011
A
645
At least 1
Prescription
At least 2
Prescriptions
114
17.67%
14.65%
20.70%
20
3.10%
1.69%
4.52%
Page 57
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Data Elements
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
NR
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
NR
NR
NR
NR
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
Medicare Advantage
Data Elements
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
NR
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
NR
NR
NR
NR
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
MSHO
Data Elements
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2012 (Reporting Year 2011)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
0
0
645
645
0
0
631
NA
NA
NA
NA
NA
NA
97.83%
96.63%
99.03%
631
97.83%
96.63%
99.03%
2011
A
Page 60
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
104
286
6
396
98
274
6
94.23%
89.27%
99.19%
95.80%
93.31%
98.30%
NA
NA
NA
378
95.45%
93.28%
97.63%
2011
A
Page 61
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Data Elements
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
NR
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
NR
NR
NR
NR
HEDIS 2012 (Reporting Year 2011)
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 62
Access/Availability of Care
Metropolitan Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Data Elements
Measurement Year
Data collection methodology (Administrative only)
Eligible member population
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Data Elements
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
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 2012 (Reporting Year 2011)
Page 64
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
13-17 Year Olds
Data Elements
General
Measure
Data
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
18+ Year Olds
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
Total
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
Measurement Year
Data collection methodology (Administrative only)
Eligible member population
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2012 (Reporting Year 2011)
NR
NR
NR
NR
NR
NR
NR
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:
Oct 22, 2012 9:42 AM
Medicare Advantage
13-17 Year Olds
Data Elements
General
Measure
Data
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
Total
18+ Year Olds
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
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 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
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
2011
A
19
0
19
0
0
6
0
6
0
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Page 67
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
General
Measure
Data
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
Total
18+ Year Olds
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
2011
A
0
137
137
0
0
31
8
31
8
NA
NA
NA
NA
NA
NA
22.63%
15.26%
30.00%
5.84%
1.55%
10.13%
22.63%
15.26%
30.00%
5.84%
1.55%
10.13%
Page 68
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
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
Metropolitan Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Timeliness of
Prenatal Care
Postpartum
Care
Current year's administrative rate (before exclusions)
NR
NR
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
NR
NR
NR
NR
NR
NR
NR
NR
Data Elements
Measurement Year
Data collection methodology (Administrative or Hybrid)
Eligible member population
Number of numerator events by administrative data in eligible
population (before exclusions)
Number of original sample records excluded because of valid
data errors
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2012 (Reporting Year 2011)
Page 70
Access/Availability of Care
Metropolitan Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Timeliness of
Prenatal Care
Postpartum
Care
Current year's administrative rate (before exclusions)
NR
NR
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
NR
NR
NR
NR
NR
NR
NR
NR
Data Elements
Measurement Year
Data collection methodology (Administrative or Hybrid)
Eligible member population
Number of numerator events by administrative data in eligible
population (before exclusions)
Number of original sample records excluded because of valid
data errors
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2012 (Reporting Year 2011)
Page 71
Use of Services
Metropolitan Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Data Elements
General
Measure
Data
Zero Visits
1 visit
2 visits
3 visits
4 visits
5 visits
6 or more
visits
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
Page 72
Use of Services
Metropolitan Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Data Elements
General
Measure
Data
Zero Visits
1 visit
2 visits
3 visits
4 visits
5 visits
6 or more
visits
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
Commercial
MHCP-MC
NR
NR
NR
NR
NR
NR
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 2012 (Reporting Year 2011)
Page 74
Use of Services
Metropolitan Health Plan
Adolescent Well-Care Visits
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
MHCP-MC
NR
NR
NR
NR
NR
NR
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 2012 (Reporting Year 2011)
Page 75
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
NR
Outpatient Visits (Excludes
MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
NR
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
Medicare Advantage
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
NR
Outpatient Visits (Excludes
MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
NR
HEDIS 2012 (Reporting Year 2011)
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:
Oct 22, 2012 9:42 AM
MSHO
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
0
0
0
0
0
3367
3799
1325
0
8491
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
3186
3331
953
0
7470
HEDIS 2012 (Reporting Year 2011)
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
946.24
876.81
719.25
879.76
Emergency Room Visits
Visits
0
0
0
0
0
258
233
57
0
548
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
76.63
61.33
43.02
64.54
Page 78
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Oct 22, 2012 9:42 AM
SNBC
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
0
0
26
1929
4455
55
0
0
0
6465
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
3
1323
4322
34
0
0
0
5682
HEDIS 2012 (Reporting Year 2011)
Visits/ 1,000
Member
Months
NA
NA
115.38
685.85
970.15
618.18
NA
NA
878.89
Emergency Room Visits
Visits
0
0
0
415
833
6
0
0
0
1254
Visits/ 1,000
Member
Months
NA
NA
0.00
215.14
186.98
109.09
NA
NA
193.97
Page 79
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Oct 22, 2012 9:42 AM
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 2012 (Reporting Year 2011)
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
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Member Months
NR
Discharges
Discharges /
1,000 Member
Months
Days
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2012 (Reporting Year 2011)
NR
NR
NR
NR
NR
NR
NR
NR
NR
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:
Oct 22, 2012 9:42 AM
Medicare Advantage
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Member Months
NR
Discharges
Discharges /
1,000 Member
Months
Days
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2012 (Reporting Year 2011)
NR
NR
NR
NR
NR
NR
NR
NR
NR
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
Data Last Refreshed:
Oct 22, 2012 9:42 AM
MSHO
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Member Months
0
0
0
0
0
3367
3799
1325
0
8491
Discharges
0
0
0
0
0
155
174
68
0
397
0
0
0
0
0
121
149
63
0
333
Discharges /
1,000 Member
Months
NA
NA
NA
NA
NA
46.04
45.80
51.32
46.76
NA
NA
NA
NA
NA
35.94
39.22
47.55
39.22
0
0
0
0
0
34
25
5
0
64
NA
NA
NA
NA
NA
10.10
6.58
3.77
0
0
0
0
0
NA
NA
NA
HEDIS 2012 (Reporting Year 2011)
7.54
NA
Days
0
0
0
0
0
769
824
324
0
1917
0
0
0
0
0
473
650
295
0
1418
Days / 1,000
Member
Months
NA
NA
NA
NA
NA
228.39
216.90
244.53
225.77
NA
NA
NA
NA
NA
140.48
171.10
222.64
167.00
0
0
0
0
0
296
174
29
0
499
NA
NA
NA
NA
NA
87.91
45.80
21.89
0
0
0
0
0
NA
NA
NA
58.77
NA
Average
Length of Stay
NA
NA
NA
NA
NA
4.96
4.74
4.76
NA
4.83
NA
NA
NA
NA
NA
3.91
4.36
4.68
NA
4.26
NA
NA
NA
NA
NA
8.71
6.96
5.80
NA
7.80
NA
NA
NA
NA
NA
Page 83
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 22, 2012 9:42 AM
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
Member Months
0
0
26
1929
4455
55
0
0
0
6465
Discharges
0
0
0
24
80
0
0
0
0
104
0
0
0
20
45
0
0
0
0
65
0
0
0
2
35
0
0
0
0
37
0
2
0
0
2
HEDIS 2012 (Reporting Year 2011)
Discharges /
1,000 Member
Months
NA
NA
0.00
12.44
17.96
0.00
NA
NA
16.09
NA
NA
0.00
10.37
10.10
0.00
NA
NA
10.05
NA
NA
0.00
1.04
7.86
0.00
NA
NA
5.72
0.00
1.04
0.00
0.31
Days
0
0
0
79
397
0
0
0
0
476
0
0
0
67
176
0
0
0
0
243
0
0
0
5
221
0
0
0
0
226
0
7
0
0
7
Days / 1,000
Member
Months
NA
NA
0.00
40.95
89.11
0.00
NA
NA
73.63
NA
NA
0.00
34.73
39.51
0.00
NA
NA
37.59
NA
NA
0.00
2.59
49.61
0.00
NA
NA
34.96
0.00
3.63
0.00
1.09
Average
Length of Stay
NA
NA
NA
3.29
4.96
NA
NA
NA
NA
4.58
NA
NA
NA
3.35
3.91
NA
NA
NA
NA
3.74
NA
NA
NA
2.50
6.31
NA
NA
NA
NA
6.11
NA
3.50
NA
NA
3.50
Page 84
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 22, 2012 9:42 AM
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
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Member Months
NR
Discharges
Discharges /
1,000 Member
Months
Days
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2012 (Reporting Year 2011)
NR
NR
NR
NR
NR
NR
NR
NR
NR
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
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Any Services
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2012 (Reporting Year 2011)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Member Months
(Any)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
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
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months
(Outpatient/ED)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
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
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:
Oct 22, 2012 9:42 AM
Medicare Advantage
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 2012 (Reporting Year 2011)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient
Any Services
Age
0-12
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(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
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months
(Outpatient/ED)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
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
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:
Oct 22, 2012 9:42 AM
MSHO
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
13-17
18-24
25-34
35-64
65+
Unknown
Total
Member Months
(Outpatient/ED)
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
0
0
0
0
0
3097
0
3097
0
0
0
0
0
5394
0
5394
0
0
0
0
0
8491
0
8491
0
0
0
0
0
3097
0
3097
0
0
0
0
0
5394
0
5394
0
0
0
0
0
8491
0
8491
0
0
0
0
0
3097
0
3097
0
0
0
0
0
5394
0
5394
0
0
0
0
0
8491
0
8491
0
0
0
0
0
3097
0
3097
0
0
0
0
0
5394
0
5394
0
0
0
0
0
8491
0
8491
Inpatient
Any Services
Age
0-12
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
24
10
34
0
0
0
24
10
34
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
9.30%
2.22%
4.81%
NA
NA
NA
9.30%
2.22%
4.81%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
9
3
12
0
0
0
9
3
12
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.49%
0.67%
1.70%
NA
NA
NA
3.49%
0.67%
1.70%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
21
8
29
0
0
0
21
8
29
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
8.14%
1.78%
4.10%
NA
NA
NA
8.14%
1.78%
4.10%
HEDIS 2012 (Reporting Year 2011)
Page 88
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 22, 2012 9:42 AM
SNBC
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
13-17
18-24
25-34
35-64
65+
Unknown
Total
Member Months
(Outpatient/ED)
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
0
0
127
202
3267
29
0
3625
0
0
149
253
2412
26
0
2840
0
0
276
455
5679
55
0
6465
0
0
127
202
3267
29
0
3625
0
0
149
253
2412
26
0
2840
0
0
276
455
5679
55
0
6465
0
0
127
202
3267
29
0
3625
0
0
149
253
2412
26
0
2840
0
0
276
455
5679
55
0
6465
0
0
127
202
3267
29
0
3625
0
0
149
253
2412
26
0
2840
0
0
276
455
5679
55
0
6465
Any Services
Age
0-12
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Inpatient
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
0
0
0
0
0
0
2
1
3
11
4
15
173
83
256
0
1
1
0
0
0
186
89
275
NA
NA
NA
NA
NA
NA
18.90%
8.05%
13.04%
65.35%
18.97%
39.56%
63.54%
41.29%
54.09%
0.00%
46.15%
21.82%
NA
NA
NA
61.57%
37.61%
51.04%
0
0
0
0
0
0
0
0
0
4
1
5
31
11
42
0
0
0
0
0
0
35
12
47
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
23.76%
4.74%
13.19%
11.39%
5.47%
8.87%
0.00%
0.00%
0.00%
NA
NA
NA
11.59%
5.07%
8.72%
0
0
0
0
0
0
0
1
1
0
1
1
4
1
5
0
0
0
0
0
0
4
3
7
NA
NA
NA
NA
NA
NA
0.00%
8.05%
4.35%
0.00%
4.74%
2.64%
1.47%
0.50%
1.06%
0.00%
0.00%
0.00%
NA
NA
NA
1.32%
1.27%
1.30%
0
0
0
0
0
0
2
1
3
9
4
13
164
80
244
0
1
1
0
0
0
175
86
261
NA
NA
NA
NA
NA
NA
18.90%
8.05%
13.04%
53.47%
18.97%
34.29%
60.24%
39.80%
51.56%
0.00%
46.15%
21.82%
NA
NA
NA
57.93%
36.34%
48.45%
HEDIS 2012 (Reporting Year 2011)
Page 89
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Any Services
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2012 (Reporting Year 2011)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Member Months
(Any)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
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
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months
(Outpatient/ED)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
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
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
Metropolitan Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
Member Months
(Inpatient)
Female
Total
NR
NR
NR
NR
NR
NR
NR
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 2012 (Reporting Year 2011)
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Inpatient
Any Services
Age
0-12
Male
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months
(Outpatient/ED)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
Outpatient/ED
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 91
Use of Services
Metropolitan Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Medicare Advantage
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
Member Months
(Inpatient)
Female
Total
NR
NR
NR
NR
NR
NR
NR
13-17
18-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2012 (Reporting Year 2011)
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Inpatient
Any Services
Age
0-12
Male
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months
(Outpatient/ED)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
Outpatient/ED
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 92
Use of Services
Metropolitan Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 22, 2012 9:42 AM
MSHO
Male
Female
Total
Male
Female
Total
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
0
0
0
3097
0
3097
0
0
0
5394
0
5394
0
0
0
8491
0
8491
0
0
0
3097
0
3097
0
0
0
5394
0
5394
0
0
0
8491
0
8491
0
0
0
3097
0
3097
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Member Months
(Inpatient)
Any Services
Age
0-12
13-17
18-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
0
0
0
5394
0
5394
0
0
0
8491
0
8491
Intensive Outpatient/Partial
Hospitalization
Inpatient
Member Months
(Outpatient/ED)
Male
Female
Total
0
0
0
3097
0
3097
0
0
0
5394
0
5394
0
0
0
8491
0
8491
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
0
0
0
0
0
0
0
0
0
54
83
137
0
0
0
54
83
137
NA
NA
NA
NA
NA
NA
NA
NA
NA
20.92%
18.46%
19.36%
NA
NA
NA
20.92%
18.46%
19.36%
0
0
0
0
0
0
0
0
0
7
19
26
0
0
0
7
19
26
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.71%
4.23%
3.67%
NA
NA
NA
2.71%
4.23%
3.67%
0
0
0
0
0
0
0
0
0
1
3
4
0
0
0
1
3
4
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.39%
0.67%
0.57%
NA
NA
NA
0.39%
0.67%
0.57%
0
0
0
0
0
0
0
0
0
53
71
124
0
0
0
53
71
124
NA
NA
NA
NA
NA
NA
NA
NA
NA
20.54%
15.80%
17.52%
NA
NA
NA
20.54%
15.80%
17.52%
HEDIS 2012 (Reporting Year 2011)
Page 93
Use of Services
Metropolitan Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 22, 2012 9:42 AM
SNBC
Male
Female
Total
Male
Female
Total
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
0
0
3596
29
0
3625
0
0
2814
26
0
2840
0
0
6410
55
0
6465
0
0
3596
29
0
3625
0
0
2814
26
0
2840
0
0
6410
55
0
6465
0
0
3596
29
0
3625
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Member Months
(Inpatient)
Any Services
Age
0-12
13-17
18-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
0
0
2814
26
0
2840
0
0
6410
55
0
6465
Intensive Outpatient/Partial
Hospitalization
Inpatient
Member Months
(Outpatient/ED)
Male
Female
Total
0
0
3596
29
0
3625
0
0
2814
26
0
2840
0
0
6410
55
0
6465
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
0
0
0
0
0
0
241
212
453
0
2
2
0
0
0
241
214
455
NA
NA
NA
NA
NA
NA
80.42%
90.41%
84.80%
0.00%
92.31%
43.64%
NA
NA
NA
79.78%
90.42%
84.45%
0
0
0
0
0
0
25
13
38
0
1
1
0
0
0
25
14
39
NA
NA
NA
NA
NA
NA
8.34%
5.54%
7.11%
0.00%
46.15%
21.82%
NA
NA
NA
8.28%
5.92%
7.24%
0
0
0
0
0
0
10
14
24
0
0
0
0
0
0
10
14
24
NA
NA
NA
NA
NA
NA
3.34%
5.97%
4.49%
0.00%
0.00%
0.00%
NA
NA
NA
3.31%
5.92%
4.45%
0
0
0
0
0
0
239
212
451
0
2
2
0
0
0
239
214
453
NA
NA
NA
NA
NA
NA
79.76%
90.41%
84.43%
0.00%
92.31%
43.64%
NA
NA
NA
79.12%
90.42%
84.08%
HEDIS 2012 (Reporting Year 2011)
Page 94
Use of Services
Metropolitan Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 22, 2012 9:42 AM
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
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
Any Services
Age
0-12
13-17
18-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2012 (Reporting Year 2011)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months
(Outpatient/ED)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
Outpatient/ED
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 95
Use of Services
Metropolitan Health Plan
Plan All-Cause Readmissions
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Medicare Advantage
Age
18-44
45-54
55-64
Total
Age
65-74
75-84
85+
Total
Count of Index Stays
(Denominator)
Count of 30-Day
Readmissions
(Numerator)
Observed
Readmission
(Num/Den)
Average Adjusted
Probability
Total Variance
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Count of Index Stays
(Denominator)
Count of 30-Day
Readmissions
(Numerator)
Observed
Readmission
(Num/Den)
Average Adjusted
Probability
Total Variance
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
HEDIS 2012 (Reporting Year 2011)
Page 96
Use of Services
Metropolitan Health Plan
Plan All-Cause Readmissions
Data Last Refreshed:
Oct 22, 2012 9:42 AM
MSHO
Count of Index Stays
(Denominator)
Age
18-44
45-54
55-64
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
0
0
0
0
0
0
0
0
0
0
0
0
Count of Index Stays
(Denominator)
Age
65-74
75-84
85+
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
HEDIS 2012 (Reporting Year 2011)
36
60
96
37
73
110
13
27
40
86
160
246
Count of 30-Day
Readmissions
(Numerator)
0
0
0
0
0
0
0
0
0
0
0
0
Observed
Readmission
(Num/Den)
Count of 30-Day
Readmissions
(Numerator)
9
8
17
4
9
13
3
7
10
16
24
40
Observed
Readmission
(Num/Den)
25.00%
13.33%
17.71%
10.81%
12.33%
11.82%
23.08%
25.93%
25.00%
18.60%
15.00%
16.26%
NA
NA
NA
NA
NA
NA
Average Adjusted
Probability
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
Total Variance
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
NA
0.00%
0.00%
0.00%
Average Adjusted
Probability
Total Variance
21.59%
19.64%
20.37%
19.13%
16.98%
17.70%
23.60%
14.21%
17.26%
20.84%
17.51%
18.67%
16.93%
15.79%
32.72%
15.47%
14.09%
29.56%
18.03%
12.19%
30.22%
50.43%
42.07%
92.50%
Page 97
Use of Services
Metropolitan Health Plan
Plan All-Cause Readmissions
Data Last Refreshed:
Oct 22, 2012 9:42 AM
SNBC
Count of Index Stays
(Denominator)
Age
18-44
45-54
55-64
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
13
8
21
17
14
31
5
7
12
35
29
64
Count of Index Stays
(Denominator)
Age
65-74
75-84
85+
Sex
M
F
Total
M
F
Total
M
F
Total
M
Total
HEDIS 2012 (Reporting Year 2011)
0
1
1
0
0
0
0
0
0
0
1
1
Count of 30-Day
Readmissions
(Numerator)
3
0
3
1
2
3
0
0
0
4
2
6
Observed
Readmission
(Num/Den)
23.08%
0.00%
14.29%
5.88%
14.29%
9.68%
0.00%
0.00%
0.00%
11.43%
6.90%
9.38%
Average Adjusted
Probability
Total Variance
21.34%
19.59%
20.67%
15.57%
19.30%
17.25%
14.38%
16.03%
15.35%
17.54%
18.59%
18.02%
16.79%
15.75%
32.54%
13.15%
15.57%
28.72%
12.31%
13.46%
25.77%
42.25%
44.78%
87.03%
Count of 30-Day
Readmissions
(Numerator)
0
0
0
0
0
0
0
0
0
0
0
0
Observed
Readmission
(Num/Den)
Average Adjusted
Probability
Total Variance
0.00%
17.62%
17.62%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
17.62%
17.62%
0.00%
14.52%
14.52%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
14.52%
14.52%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
Page 98
Health Plan Descriptive Information
Metropolitan Health Plan
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Board Certification
MSHO
Type of Physician
Family Medicine
Internal Medicine
Geriatricians
Other practitioner Specialists
HEDIS 2012 (Reporting Year 2011)
Number of Physicians in Active Board Certification
Each Practice Area
Percent
Number
954
903
4
2123
846
799
4
1729
88.68%
88.48%
100.00%
81.44%
Page 99
Health Plan Descriptive Information
Metropolitan Health Plan
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Board Certification
SNBC
Type of Physician
Family Medicine
Internal Medicine
Geriatricians
Other practitioner Specialists
HEDIS 2012 (Reporting Year 2011)
Number of Physicians in Active Board Certification
Each Practice Area
Percent
Number
954
903
4
2123
846
799
4
1729
88.68%
88.48%
100.00%
81.44%
Page 100
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Commercial
Male
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2012 (Reporting Year 2011)
Page 101
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Medicare Advantage
Male
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2012 (Reporting Year 2011)
Page 102
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 22, 2012 9:42 AM
MSHO
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Male
0
0
0
0
0
0
Member Months
Female
0
0
0
0
0
0
Total
0
0
0
0
0
0
0
0.00%
0
0
0
0
0
0
0.00%
0
0
0
0
0
0
0.00%
0
0.00%
0
0
0
0
0
0.00%
0
0
0
0
0
0.00%
0
0.00%
541
950
794
471
258
83
0
0.00%
779
1097
1403
1131
503
481
0
0.00%
3097
100.00%
0
5394
100.00%
0
8491
100.00%
3097
5394
HEDIS 2012 (Reporting Year 2011)
0
0
0
0
0
0
0
0
0
1320
2047
2197
1602
761
564
0
8491
Page 103
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 22, 2012 9:42 AM
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
12
Member Months
Female
0
0
0
0
0
14
Total
0
0
0
0
0
26
12
0.33%
115
112
90
235
366
14
0.49%
135
116
137
254
369
26
0.40%
918
25.32%
773
834
665
394
1011
35.60%
539
660
387
203
1929
29.84%
2666
73.54%
29
0
0
0
0
0
1789
62.99%
26
0
0
0
0
0
4455
68.91%
29
0.80%
0
26
0.92%
0
55
0.85%
3625
2840
HEDIS 2012 (Reporting Year 2011)
250
228
227
489
735
1312
1494
1052
597
55
0
0
0
0
0
0
6465
Page 104
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 22, 2012 9:42 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Male
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2012 (Reporting Year 2011)
Page 105