Prime West
General Info
Disclaimers
HEDIS 2011 (Reporting Year 2010)
Data Last Refreshed: 10/24/2011
Page
2
Effectiveness of Care Measures
Code
Code
Effectiveness of Care Measures
Prevention and Screening
Medication Management
Page
ABA
Adult BMI Assessment
3
WCC
Weight Assessment and Counseling for Nutrition and Physical Activity for
Children/Adolescents
4
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
CIS
Childhood Immunization Status
6
IMA
Immunizations for Adolescents
10
BCS
Breast Cancer Screening
12
0 Code
CCS
Cervical Cancer Screening
13
COL
Colorectal Cancer Screening
14
30 AAP
31 CAP
29 DAE
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
ASM
Use of Appropriate Medications for People with Asthma
24
Page
IET
Access / Availability of Care Measures
Page
Adult's Access to Preventive/Ambulatory Health Services
58
Children's and Adolescents' Access to Primary Care Practitioners
63
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
72
35 W34
Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life
74
Adolescent Well-Care Visits
75
Ambulatory Care
76
36
AWC
37 AMB
38
IPU
Inpatient Utilization - General Hospital/Acute Care
81
CMC
Cholesterol Management for Patients with Cardiovascular Conditions
26
39
IAD
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
31
41 BCR
Board Certification
96
42 ENP
Enrollment by Product Line (Age & Sex)
98
Cardiovascular
Diabetes
CDC
Comprehensive Diabetes Care
0 Code
Musculoskeletal
ART
OMW
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis
36
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
43
Health Plan Descriptive Information Measures
Page
DISCLAIMERS
-1
( this page left blank intentionally )
0. Disclaimer Query located below
HEDIS 2011 (Reporting Year 2010)
Page 2
Effectiveness of Care
Prime West
Adult BMI Assessment
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Data Elements
Commercial
Medicare
Advantage
2010
H
1484
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
MHCP-MC
71
NR
NR
NR
NR
4.78%
411
5.00%
432
26
6.02%
Number of Records Excluded Because of Valid
Data Errors
0
Number of administrative data records excluded
0
Number of medical record data records excluded
0
Number of employee/dependent medical records
excluded
0
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2011 (Reporting Year 2010)
NR
NR
NR
NR
NR
NR
0
432
26
193
50.69%
45.86%
55.52%
Page 3
Effectiveness of Care
Prime West
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
Data Last Refreshed:
Oct 24, 2011 8:57 AM
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
Total
Counseling for Physical Activity
General
Ages 12Measure Ages 3-11
Total
17
Data
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
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 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 2011 (Reporting Year 2010)
Page 4
Effectiveness of Care
Prime West
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
Data Last Refreshed:
Oct 24, 2011 8:57 AM
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
Number of Records Excluded Because of
Valid Data Errors
General
Measure
Data
Ages 3-11 Ages 12-17
Counseling for Nutrition
Total
2010
H
General
Measure
Data
Ages 3-11 Ages 12-17
Total
2010
H
Counseling for Physical Activity
General
Ages 12Measure Ages 3-11
Total
17
Data
2010
H
2556
1154
3710
2556
1154
3710
2556
1154
3710
5
0.20%
7
0.61%
12
0.32%
11
0.43%
8
0.69%
19
0.51%
0
0.00%
1
0.09%
1
0.03%
0
0.00%
0
0.00%
0
0.00%
411
5.00%
411
5.00%
432
411
5.00%
432
0
0.00%
0
0.00%
0
0.00%
432
2
0.46%
0
0.00%
2
0.46%
0
0
0
Number of administrative data records
excluded
0
0
0
Number of medical records excluded
0
0
0
Number of employee/dependent records
excluded
0
0
0
Records Added from the Oversample List
0
0
0
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2011 (Reporting Year 2010)
295
116
411
295
116
411
295
116
411
0
157
53.22%
47.36%
59.08%
0
63
54.31%
44.81%
63.81%
0
220
53.53%
48.58%
58.47%
2
143
49.15%
43.28%
55.03%
0
46
39.66%
30.32%
48.99%
2
189
46.47%
41.53%
51.42%
0
130
44.07%
38.23%
49.90%
0
56
48.28%
38.75%
57.80%
0
186
45.26%
40.32%
50.19%
Page 5
Effectiveness of Care
Prime West
Childhood Immunization Status
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
Page 6
Effectiveness of Care
Prime West
Childhood Immunization Status
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
Page 7
Effectiveness of Care
Prime West
Childhood Immunization Status
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
Number of administrative data records
excluded
0
Number of medical data records excluded
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2011 (Reporting Year 2010)
HiB
Hepatitis B
VZV
Influenza
353
77.92%
413
91.17%
415
91.61%
402
88.74%
405
89.40%
400
88.30%
354
78.15%
55
12.14%
229
50.55%
166
36.64%
334
77.31%
392
90.74%
394
91.20%
382
88.43%
384
88.89%
381
88.19%
334
77.31%
51
11.81%
215
49.77%
157
36.34%
319
21
82.73%
78.95%
86.50%
373
16
94.65%
92.35%
96.94%
377
4
92.70%
90.06%
95.34%
365
7
90.51%
87.56%
93.47%
365
17
92.94%
90.35%
95.54%
364
8
90.51%
87.56%
93.47%
321
20
82.97%
79.21%
86.72%
48
11
14.36%
10.84%
17.87%
203
24
55.23%
50.30%
60.16%
151
71
54.01%
49.07%
58.95%
432
0
Numerator Events by administrative Data
MMR
411
0.05
Number of Records Excluded Because of
Valid Data Errors
Denominator
IPV
2010
H
453
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
Pneumococcal
Hepatitis A Rotavirus
Conjugate
DTaP
411
Page 8
Effectiveness of Care
Prime West
Childhood Immunization Status
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
Number of administrative data records
excluded
0
Number of medical data records excluded
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2011 (Reporting Year 2010)
Combo 4
Combo 5
Combo 6
Combo 7
Combo 8
Combo 9
Combo10
353
77.92%
314
69.32%
295
65.12%
51
11.26%
176
38.85%
134
29.58%
31
6.84%
35
7.73%
85
18.76%
27
5.96%
334
77.31%
296
68.52%
277
64.12%
47
10.88%
164
37.96%
126
29.17%
29
6.71%
31
7.18%
80
18.52%
25
5.79%
319
21
82.73%
78.95%
86.50%
283
30
76.16%
71.91%
80.40%
265
32
72.26%
67.81%
76.71%
44
13
13.87%
10.41%
17.33%
156
30
45.26%
40.32%
50.19%
120
65
45.01%
40.08%
49.94%
26
17
10.46%
7.38%
13.54%
28
13
9.98%
6.96%
12.99%
76
51
30.90%
26.31%
35.49%
22
12
8.27%
5.49%
11.06%
432
0
Numerator Events by administrative Data
Combo 3
411
0.05
Number of Records Excluded Because of
Valid Data Errors
Denominator
Combo 2
2010
H
453
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
DTaP
411
Page 9
Effectiveness of Care
Prime West
Immunizations for Adolescents
Data Last Refreshed:
Oct 24, 2011 8:57 AM
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 2011 (Reporting Year 2010)
Page 10
Effectiveness of Care
Prime West
Immunizations for Adolescents
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
General
Data Elements
Measure Data
2010
Measurement Year
H
Data Collection Methodology
256
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
0
Number of administrative data records excluded
0
Number of medical data records excluded
0
Number of employee/dependent medical records
excluded
0
HEDIS 2011 (Reporting Year 2010)
Tdap
Combo 1
49
152
48
19.14%
59.38%
18.75%
49
19.14%
152
59.38%
48
18.75%
49
12
23.83%
18.41%
29.24%
152
44
76.56%
71.18%
81.95%
48
12
23.44%
18.05%
28.82%
256
5.00%
256
Records Excluded because of Valid Data Errors
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
Meningococcal
0
256
Page 11
Effectiveness of Care
Prime West
Breast Cancer Screening
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2011 (Reporting Year 2010)
Commercial
NR
NR
NR
Medicare
Advantage
NR
NR
NR
MSHO
SNBC
MHCP-MC
2010
A
85
53
62.35%
51.46%
73.24%
2010
A
97
72
74.23%
65.01%
83.45%
2010
A
269
144
53.53%
47.39%
59.68%
Page 12
Effectiveness of Care
Prime West
Cervical Cancer Screening
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Data Elements
Commercial
MHCP-MC
Measurement Year
Data Collection Methodology
Eligible Member Population
2010
H
1937
Numerator Events by Admin Data on Eligible
Population (before exclusions)
1315
Current Year's Admin Rate
NR
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
NR
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 2011 (Reporting Year 2010)
67.89%
411
5.00%
432
300
69.44%
0
0
0
0
NR
0
411
287
21
74.94%
NR
NR
70.63%
79.25%
Page 13
Effectiveness of Care
Prime West
Colorectal Cancer Screening
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Data Elements
Medicare
Advantage
MSHO
SNBC
Measurement Year
Data collection methodology (administrative or hybrid)
Eligible population
2010
H
381
2010
H
106
Number of numerator events by administrative data in eligible population
(before exclusions)
161
40
42.26%
379
5.00%
379
161
42.48%
0
0
0
0
0
379
161
53
56.46%
51.34%
61.59%
37.74%
105
5.00%
105
40
38.10%
0
0
0
0
0
105
40
21
58.10%
48.18%
68.01%
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 2011 (Reporting Year 2010)
Commercial
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 14
Effectiveness of Care
Prime West
Chlamydia Screening in Women
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
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
Prime West
Chlamydia Screening in Women
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure Data
Ages 16-20
Ages 21-24
Total
284
113
39.79%
33.92%
45.66%
344
158
45.93%
40.52%
51.34%
628
271
43.15%
39.20%
47.11%
2010
A
Page 16
Effectiveness of Care
Prime West
Glaucoma Screening in Older Adults
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2011 (Reporting Year 2010)
Medicare
Advantage
NR
NR
NR
MSHO
2010
A
1480
1103
74.53%
72.27%
76.78%
Page 17
Effectiveness of Care
Prime West
Lead Screening in Children
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Data Elements
Commercial
Measurement Year
Data Collection Methodology
Eligible Member Population
MHCP-MC
2010
A
453
Numerator Events by Admin Data on
Eligible Population (before exclusions)
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
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
401
Reported Rate
NR
88.52%
Lower 95% Confidence Interval
NR
85.48%
Upper 95% Confidence Interval
NR
91.57%
HEDIS 2011 (Reporting Year 2010)
Page 18
Effectiveness of Care
Prime West
Care for Older Adults
Data Last Refreshed:
Oct 24, 2011 8:57 AM
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 2011 (Reporting Year 2010)
Page 19
Effectiveness of Care
Prime West
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
NR
NR
NR
NR
NR
NR
Page 20
Effectiveness of Care
Prime West
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
36
62.07%
48.72%
75.42%
54
93.10%
85.72%
100.00%
2010
A
58
Page 21
Effectiveness of Care
Prime West
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
1
NA
NA
NA
1
NA
NA
NA
2010
A
1
Page 22
Effectiveness of Care
Prime West
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2011 (Reporting Year 2010)
Medicare
Advantage
NR
NR
NR
MSHO
SNBC
2010
A
48
11
22.92%
9.98%
35.85%
2010
A
2
0
NA
NA
NA
Page 23
Effectiveness of Care
Prime West
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure Data
Ages 5-11
NR
NR
NR
Ages 12-50
Total
NR
NR
NR
NR
NR
NR
NR
NR
`
Page 24
Effectiveness of Care
Prime West
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure Data
Ages 5-11
Ages 12-50
Total
51
50
98.04%
93.25%
100.00%
87
69
79.31%
70.22%
88.40%
138
119
86.23%
80.12%
92.34%
2010
A
Page 25
Effectiveness of Care
Prime West
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
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
Prime West
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
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
Prime West
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
9
0
64.29%
0.00%
9
0
64.29%
0.00%
9
0
0
5
NA
NA
NA
NA
NA
NA
2010
H
14
14
5.00%
14
0
0
0
14
Page 28
Effectiveness of Care
Prime West
Controlling High Blood Pressure
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Data Elements
Medicare
Advantage
MSHO
SNBC
MHCP-MC
Measurement Year
Data Collection Methodology (Hybrid)
Eligible Member Population
2010
H
340
2010
H
53
2010
H
213
Numerator Events by Admin Data on
Eligible Population (before exclusions)
0
0
0
0.00%
248
5.00%
248
0.00%
48
5.00%
48
0.00%
197
5.00%
197
0
0.00%
0
0.00%
0
0.00%
Records Excluded because of Valid Data
Errors
0
0
0
Number of records excluded because of
false positive diagnoses
0
0
0
Number of administrative data records
excluded
2
0
1
Number of medical record data records
excluded
0
0
0
Number of employee/dependent medical
records excluded
0
0
0
0
246
0
167
67.89%
61.85%
73.92%
0
48
0
35
72.92%
59.30%
86.53%
0
196
0
127
64.80%
57.85%
71.74%
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Records Added from the OverSample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2011 (Reporting Year 2010)
Commercial
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 29
Effectiveness of Care
Prime West
Persistence of Beta Blocker Treatment After Heart Attack
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Data Elements
Commercial
Medicare
Advantage
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on
Eligible Population
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2011 (Reporting Year 2010)
NR
NR
NR
NR
NR
NR
MSHO
SNBC
MHCP-MC
2010
A
15
2010
A
0
2010
A
6
12
0
4
NA
NA
NA
NR
NR
NR
NA
NA
NA
Page 30
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 24, 2011 8:57 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
Pressure
for Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<130/80
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 2011 (Reporting Year 2010)
Page 31
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Medicare Advantage
Data Elements
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
Blood
Monitoring
Pressure
for Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<130/80
mm Hg
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 2011 (Reporting Year 2010)
Page 32
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 24, 2011 8:57 AM
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
2010
H
188
2010
H
188
163
86.70%
188
5%
188
163
86.70%
188
100.00%
188
5%
188
188
100.00%
Good HbA1c
Control
(<7.0%)
NR
NR
Adequate
HbA1c
Control
(<8.0%)
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
2010
H
188
2010
H
188
2010
H
188
2010
H
188
2010
H
188
2010
H
188
2010
H
188
0
0.00%
188
5%
188
0
0.00%
134
71.28%
188
5%
188
134
71.28%
134
71.28%
188
5%
188
134
71.28%
0
0.00%
188
5%
188
0
0.00%
157
83.51%
188
5%
188
157
83.51%
0
0.00%
188
5%
188
0
0.00%
0
0.00%
188
5%
188
0
0.00%
Blood
Monitoring
Pressure
for Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<130/80
mm Hg
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
188
163
10
92.02%
87.88%
96.16%
0
188
52
5
30.32%
23.48%
37.16%
0
188
0
121
64.36%
57.25%
71.47%
0
188
134
9
76.06%
69.70%
82.43%
0
188
134
2
72.34%
65.68%
79.00%
0
188
0
74
39.36%
32.11%
46.61%
0
188
157
4
85.64%
80.36%
90.92%
0
188
0
138
73.40%
66.82%
79.99%
0
188
0
123
65.43%
58.36%
72.49%
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 2011 (Reporting Year 2010)
NR
NR
NR
Page 33
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 24, 2011 8:57 AM
SNBC
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
2010
H
64
2010
H
64
58
90.63%
64
5%
64
58
90.63%
64
100.00%
64
5%
64
64
100.00%
Good HbA1c
Control
(<7.0%)
NR
NR
Adequate
HbA1c
Control
(<8.0%)
Blood
Monitoring
Pressure
for Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<130/80
mm Hg
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
2010
H
64
2010
H
64
2010
H
64
2010
H
64
2010
H
64
2010
H
64
2010
H
64
0
0.00%
64
5%
64
0
0.00%
49
76.56%
64
5%
64
49
76.56%
51
79.69%
64
5%
64
51
79.69%
0
0.00%
64
5%
64
0
0.00%
50
78.13%
64
5%
64
50
78.13%
0
0.00%
64
5%
64
0
0.00%
0
0.00%
64
5%
64
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
64
58
2
93.75%
87.04%
100.00%
0
64
15
1
25.00%
13.61%
36.39%
0
64
0
43
67.19%
54.90%
79.47%
0
64
49
0
76.56%
65.40%
87.72%
0
64
51
0
79.69%
69.05%
90.33%
0
64
0
27
42.19%
29.31%
55.07%
0
64
50
2
81.25%
70.91%
91.59%
0
64
0
51
79.69%
69.05%
90.33%
0
64
0
36
56.25%
43.31%
69.19%
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 2011 (Reporting Year 2010)
NR
NR
NR
Page 34
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 24, 2011 8:57 AM
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%)
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
2010
H
212
2010
H
212
2010
H
185
2010
H
212
2010
H
212
2010
H
212
2010
H
212
2010
H
212
2010
H
212
2010
H
212
166
78.30%
204
5%
204
166
81.37%
212
100.00%
204
5%
204
204
100.00%
0
0.00%
204
5%
204
0
0.00%
0
0.00%
204
5%
204
0
0.00%
117
55.19%
204
5%
204
115
56.37%
140
66.04%
204
5%
204
140
68.63%
0
0.00%
204
5%
204
0
0.00%
139
65.57%
204
5%
204
139
68.14%
0
0.00%
204
5%
204
0
0.00%
0
0.00%
204
5%
204
0
0.00%
0
0
31
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
204
0
113
55.39%
48.33%
62.46%
0
204
115
12
62.25%
55.36%
69.15%
0
204
140
4
70.59%
64.09%
77.09%
0
204
0
70
34.31%
27.55%
41.07%
0
204
139
4
70.10%
63.57%
76.63%
0
204
0
155
75.98%
69.87%
82.09%
0
204
0
112
54.90%
47.83%
61.98%
Number of Administrative required exclusions
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2011 (Reporting Year 2010)
Blood
Pressure
<130/80
mm Hg
28
Number of Hybrid required exclusions
Additional Records Added from the
Oversample List
Blood
Monitoring
Pressure
for Diabetic
<140/90 mm
Nephropathy
Hg
3
0
204
166
13
87.75%
83.00%
92.49%
0
204
45
26
34.80%
28.02%
41.59%
0
173
0
60
34.68%
27.30%
42.06%
Page 35
Effectiveness of Care
Prime West
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2011 (Reporting Year 2010)
Medicare
Advantage
NR
NR
NR
Page 36
Effectiveness of Care
Prime West
Osteoporosis Management in Women Who had a Fracture
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2011 (Reporting Year 2010)
Medicare
Advantage
NR
NR
NR
MSHO
2010
A
90
8
8.89%
2.45%
15.32%
Page 37
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure Data
Effective
Acute Phase
Treatment
Effective
Continuation
Phase
Treatment
NR
NR
NR
NR
NR
NR
Page 38
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure Data
Effective
Acute Phase
Treatment
Effective
Continuation
Phase
Treatment
NR
NR
NR
NR
NR
NR
Page 39
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure Data
Effective
Acute Phase
Treatment
Effective
Continuation
Phase
Treatment
23
NA
NA
NA
21
NA
NA
NA
2010
A
27
Page 40
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure Data
Effective
Acute Phase
Treatment
Effective
Continuation
Phase
Treatment
1
NA
NA
NA
1
NA
NA
NA
2010
A
1
Page 41
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure Data
Effective
Acute Phase
Treatment
Effective
Continuation
Phase
Treatment
71
51.45%
42.75%
60.15%
53
38.41%
29.93%
46.88%
2010
A
138
Page 42
Effectiveness of Care
Prime West
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure
Data
Initiation
Phase
Continuation
and
Maintenance
Phase
NR
NR
NR
NR
NR
NR
Page 43
Effectiveness of Care
Prime West
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure
Data
Initiation
Phase
Continuation
and
Maintenance
Phase
77
24
31.17%
20.17%
42.16%
22
7
NA
NA
NA
2010
A
Page 44
Effectiveness of Care
Prime West
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure
Data
30 Days
7 Days
NR
NR
NR
NR
NR
NR
Page 45
Effectiveness of Care
Prime West
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure
Data
30 Days
7 Days
3
NA
NA
NA
1
NA
NA
NA
2010
A
8
Page 46
Effectiveness of Care
Prime West
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure
Data
30 Days
7 Days
10
NA
NA
NA
7
NA
NA
NA
2010
A
10
Page 47
Effectiveness of Care
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
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
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
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
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
754
715
94.83%
93.18%
96.47%
141
139
98.58%
96.28%
100.00%
934
899
96.25%
94.98%
97.52%
103
93
90.29%
84.09%
96.49%
1932
1846
95.55%
94.60%
96.49%
2010
A
Page 50
Effectiveness of Care
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
52
50
96.15%
89.97%
100.00%
2
2
NA
NA
NA
47
44
93.62%
85.56%
100.00%
39
35
89.74%
78.94%
100.00%
140
131
93.57%
89.15%
97.99%
2010
A
Page 51
Effectiveness of Care
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
175
141
80.57%
74.42%
86.72%
5
5
NA
NA
NA
117
102
87.18%
80.69%
93.66%
24
20
NA
NA
NA
321
268
83.49%
79.27%
87.71%
2010
A
Page 52
Access/Availability of Care
Prime West
Medication Reconciliation Post Discharge
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Data Elements
MSHO
Measurement Year
Data collection methodology (Administrative or Hybrid)
Eligible member population
Number of numerator events by administrative data in eligible
population (before exclusions)
Current year's administrative rate (before exclusions)
NR
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
NR
Number of original sample records excluded because of valid
data errors
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2011 (Reporting Year 2010)
NR
NR
NR
Page 53
Effectiveness of Care
Prime West
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure
Data
History of Falls +
Tricyclic
Antidepressants,
Antipsychotics or
Sleep Agents
NR
NR
NR
Chronic Renal
Dementia +
Failure +
Tricyclic
Antidepressants Nonaspirin NSAIDs
or Anticholinergic or Cox-2 Selective
NSAIDs
Agents
NR
NR
NR
NR
NR
NR
Total
NR
NR
NR
Page 54
Effectiveness of Care
Prime West
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure
Data
History of Falls +
Tricyclic
Antidepressants,
Antipsychotics or
Sleep Agents
Chronic Renal
Dementia +
Failure +
Tricyclic
Antidepressants Nonaspirin NSAIDs
or Anticholinergic or Cox-2 Selective
NSAIDs
Agents
Total
2010
A
52
12
23.08%
10.66%
35.49%
559
124
22.18%
18.65%
25.72%
18
5
NA
NA
NA
629
141
22.42%
19.08%
25.76%
Page 55
Effectiveness of Care
Prime West
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure
Data
At least 1
Prescription
At least 2
Prescriptions
NR
NR
NR
NR
NR
NR
Page 56
Effectiveness of Care
Prime West
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure
Data
2010
A
1817
At least 1
Prescription
At least 2
Prescriptions
419
23.06%
21.10%
25.02%
67
3.69%
2.79%
4.58%
Page 57
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 58
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 59
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure Data
Ages 20-44
Ages 45-64
Ages 65+
Total
0
0
1817
1817
0
0
1791
NA
NA
NA
NA
NA
NA
98.57%
98.00%
99.14%
1791
98.57%
98.00%
99.14%
2010
A
Page 60
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
General
Measure Data
Ages 20-44
Ages 45-64
Ages 65+
Total
66
153
8
227
65
152
8
98.48%
94.78%
100.00%
99.35%
97.74%
100.00%
NA
NA
NA
225
99.12%
97.68%
100.00%
2010
A
Page 61
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 24, 2011 8:57 AM
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 2011 (Reporting Year 2010)
General
Measure Data
Ages 20-44
Ages 45-64
Ages 65+
Total
2578
630
2
3210
2378
575
1
92.24%
91.19%
93.29%
91.27%
88.99%
93.55%
NA
NA
NA
2954
92.02%
91.07%
92.98%
2010
A
Page 62
Access/Availability of Care
Prime West
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
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
Prime West
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 24, 2011 8:57 AM
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 2011 (Reporting Year 2010)
General Measure
Data
12-24 months
25 months 6 yrs.
7-11 yrs.
12-19 yrs.
726
710
1931
1716
1029
944
1072
1004
97.80%
96.66%
98.93%
88.87%
87.44%
90.29%
91.74%
90.01%
93.47%
93.66%
92.15%
95.16%
2010
A
Page 64
Access/Availability of Care
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
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
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 24, 2011 8:57 AM
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 2011 (Reporting Year 2010)
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
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 24, 2011 8:57 AM
MSHO
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 2011 (Reporting Year 2010)
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
2010
A
0
40
40
0
0
21
2
21
2
NA
NA
NA
NA
NA
NA
52.50%
35.77%
69.23%
5.00%
0.00%
13.00%
52.50%
35.77%
69.23%
5.00%
0.00%
13.00%
Page 67
Access/Availability of Care
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
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
2010
A
0
18
18
0
0
10
3
10
3
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Page 68
Access/Availability of Care
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 24, 2011 8:57 AM
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 2011 (Reporting Year 2010)
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
2010
A
39
342
381
17
9
149
59
166
68
43.59%
26.74%
60.43%
23.08%
8.57%
37.58%
43.57%
38.17%
48.97%
17.25%
13.10%
21.40%
43.57%
38.46%
48.68%
17.85%
13.87%
21.82%
Page 69
Access/Availability of Care
Prime West
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
Page 70
Access/Availability of Care
Prime West
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 24, 2011 8:57 AM
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 2011 (Reporting Year 2010)
Timeliness of
Prenatal Care
Postpartum
Care
2010
H
817
2010
H
817
437
448
53.49%
411
5%
432
235
54.83%
411
5%
432
242
54.40%
56.02%
1
1
0
0
431
235
146
0
0
431
242
48
88.40%
85.26%
91.54%
67.29%
62.74%
71.83%
Page 71
Use of Services
Prime West
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 24, 2011 8:57 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 2011 (Reporting Year 2010)
Page 72
Use of Services
Prime West
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
0
Number of employee/dependent medical
records excluded
0
Additional Records Added from the
Oversample List
0
HEDIS 2011 (Reporting Year 2010)
2 visits
3 visits
4 visits
5 visits
6 or more
visits
6
1.37%
8
1.83%
13
2.97%
28
6.41%
56
12.81%
103
23.57%
223
51.03%
6
1.39%
8
1.85%
13
3.01%
28
6.48%
56
12.96%
102
23.61%
219
50.69%
6
0
1.39%
0.17%
2.61%
4
0
0.93%
0.00%
1.94%
11
1
2.78%
1.11%
4.44%
22
2
5.56%
3.28%
7.83%
36
4
9.26%
6.41%
12.11%
74
15
20.60%
16.67%
24.53%
222
35
59.49%
54.75%
64.24%
411
5.00%
432
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
1 visit
2009
H
437
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Zero Visits
432
Page 73
Use of Services
Prime West
Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Data Elements
Commercial
Measurement Year
Data Collection Methodology
2009
H
1351
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
798
NR
59.07%
411
5.00%
432
247
NR
57.18%
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 2011 (Reporting Year 2010)
MHCP-MC
0
NR
NR
NR
0
432
247
5
58.33%
53.57%
63.10%
Page 74
Use of Services
Prime West
Adolescent Well-Care Visits
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Data Elements
Commercial
MHCP-MC
Measurement Year
Data Collection Methodology
Eligible Member Population
2010
H
1929
Numerator events by admin data in eligible
population
560
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
NR
29.03%
411
5.00%
432
137
NR
31.71%
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 2011 (Reporting Year 2010)
0
NR
NR
NR
0
411
142
10
36.98%
32.19%
41.77%
Page 75
Use of Services
Prime West
Ambulatory Care
Data Last Refreshed:
Oct 24, 2011 8:57 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
Visits
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits/ 1,000
Member
Months
NR
NR
Emergency Room Visits
Visits
NR
NR
NR
NR
NR
NR
NR
HEDIS 2011 (Reporting Year 2010)
NR
Visits/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 76
Use of Services
Prime West
Ambulatory Care
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Medicare Advantage
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Member Months
NR
Total
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 2011 (Reporting Year 2010)
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
Prime West
Ambulatory Care
Data Last Refreshed:
Oct 24, 2011 8:57 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
6078
8139
11732
0
25949
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
5492
7518
9239
0
22249
HEDIS 2011 (Reporting Year 2010)
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
903.59
923.70
787.50
857.41
Emergency Room Visits
Visits
0
0
0
0
0
260
335
401
0
996
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
42.78
41.16
34.18
38.38
Page 78
Use of Services
Prime West
Ambulatory Care
Data Last Refreshed:
Oct 24, 2011 8:57 AM
SNBC
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
0
0
14
938
2000
94
0
0
0
3046
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
5
996
1972
104
0
0
0
3077
HEDIS 2011 (Reporting Year 2010)
Visits/ 1,000
Member
Months
NA
NA
357.14
1061.83
986.00
1106.38
NA
NA
1010.18
Emergency Room Visits
Visits
0
0
1
103
130
5
0
0
0
239
Visits/ 1,000
Member
Months
NA
NA
71.43
109.81
65.00
53.19
NA
NA
78.46
Page 79
Use of Services
Prime West
Ambulatory Care
Data Last Refreshed:
Oct 24, 2011 8:57 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
13930
71417
46753
66939
14063
15
1
1
0
213119
Outpatient Visits (Excludes
MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
11544
24685
13751
33937
8140
5
0
1
0
92063
HEDIS 2011 (Reporting Year 2010)
Visits/ 1,000
Member
Months
828.72
345.65
294.12
506.98
578.82
333.33
0.00
1000.00
431.98
Emergency Room Visits
Visits
1308
3648
1848
4907
600
0
0
0
0
12311
Visits/ 1,000
Member
Months
93.90
51.08
39.53
73.31
42.67
0.00
0.00
0.00
57.77
Page 80
Use of Services
Prime West
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:
Oct 24, 2011 8:57 AM
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 2011 (Reporting Year 2010)
NR
NR
NR
NR
NR
NR
NR
NR
NR
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
Prime West
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Medicare Advantage
Age
Member Months
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
NR
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 2011 (Reporting Year 2010)
NR
NR
NR
NR
NR
NR
NR
NR
NR
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
Prime West
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:
Oct 24, 2011 8:57 AM
Member Months
0
0
0
0
0
6078
8139
11732
0
25949
Discharges
0
0
0
0
0
262
385
490
0
1137
Discharges /
1,000 Member
Months
NA
NA
NA
NA
NA
43.11
47.30
41.77
43.82
0
0
0
0
0
184
285
413
0
882
NA
NA
NA
NA
NA
30.27
35.02
35.20
0
0
0
0
0
76
86
69
0
231
NA
NA
NA
NA
NA
12.50
10.57
5.88
0
0
0
0
0
NA
NA
NA
HEDIS 2011 (Reporting Year 2010)
33.99
8.90
NA
Days
0
0
0
0
0
1113
1954
1973
0
5040
Days / 1,000
Member
Months
NA
NA
NA
NA
NA
183.12
240.08
168.17
194.23
0
0
0
0
0
670
1177
1581
0
3428
NA
NA
NA
NA
NA
110.23
144.61
134.76
0
0
0
0
0
436
669
365
0
1470
NA
NA
NA
NA
NA
71.73
82.20
31.11
0
0
0
0
0
132.11
56.65
NA
NA
NA
NA
Average
Length of Stay
NA
NA
NA
NA
NA
4.25
5.08
4.03
NA
4.43
NA
NA
NA
NA
NA
3.64
4.13
3.83
NA
3.89
NA
NA
NA
NA
NA
5.74
7.78
5.29
NA
6.36
NA
NA
NA
NA
NA
Page 83
Use of Services
Prime West
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:
Oct 24, 2011 8:57 AM
Member Months
0
0
14
938
2000
94
0
0
0
3046
Discharges
Discharges /
1,000 Member
Months
0
0
0
18
41
5
0
0
0
64
NA
NA
0.00
19.19
20.50
53.19
NA
NA
0
0
0
10
21
4
0
0
0
35
NA
NA
0.00
10.66
10.50
42.55
NA
NA
0
0
0
8
20
1
0
0
0
29
NA
NA
0.00
8.53
10.00
10.64
NA
NA
0
0
0
0
0
0.00
0.00
0.00
HEDIS 2011 (Reporting Year 2010)
21.01
11.49
9.52
0.00
Days
Days / 1,000
Member
Months
0
0
0
41
169
16
0
0
0
226
NA
NA
0.00
43.71
84.50
170.21
NA
NA
0
0
0
24
62
12
0
0
0
98
NA
NA
0.00
25.59
31.00
127.66
NA
NA
0
0
0
17
107
4
0
0
0
128
NA
NA
0.00
18.12
53.50
42.55
NA
NA
0
0
0
0
0
0.00
0.00
0.00
74.20
32.17
42.02
0.00
Average
Length of Stay
NA
NA
NA
2.28
4.12
3.20
NA
NA
NA
3.53
NA
NA
NA
2.40
2.95
3.00
NA
NA
NA
2.80
NA
NA
NA
2.13
5.35
4.00
NA
NA
NA
4.41
NA
NA
NA
NA
NA
Page 84
Use of Services
Prime West
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Age
Member Months
<1
13930
1-9
71417
10-19
46753
20-44
66939
45-64
14063
65-74
15
75-84
1
85+
1
Unknown
0
Total
213119
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
123
117
216
1230
183
0
1
0
0
1870
8.83
1.64
4.62
18.37
13.01
0.00
1000.00
0.00
109
94
54
158
92
0
1
0
0
508
7.82
1.32
1.16
2.36
6.54
0.00
1000.00
0.00
14
23
37
164
89
0
0
0
0
327
1.01
0.32
0.79
2.45
6.33
0.00
0.00
0.00
125
906
1
0
1032
2.67
13.53
0.07
HEDIS 2011 (Reporting Year 2010)
8.77
2.38
1.53
8.08
Days
Days / 1,000
Member
Months
494
246
537
3202
637
0
5
0
0
5121
35.46
3.44
11.49
47.83
45.30
0.00
5000.00
0.00
359
195
107
376
304
0
5
0
0
1346
25.77
2.73
2.29
5.62
21.62
0.00
5000.00
0.00
135
51
105
519
330
0
0
0
0
1140
9.69
0.71
2.25
7.75
23.47
0.00
0.00
0.00
325
2281
2
0
2608
6.95
34.08
0.14
24.03
6.32
5.35
20.41
Average
Length of Stay
4.02
2.10
2.49
2.60
3.48
NA
5.00
NA
NA
2.74
3.29
2.07
1.98
2.38
3.30
NA
5.00
NA
NA
2.65
9.64
2.22
2.84
3.16
3.71
NA
NA
NA
NA
3.49
2.60
2.52
2.00
NA
2.53
Page 85
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Commercial
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 2011 (Reporting Year 2010)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Member Months
(Outpatient/ED)
Male
Female
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
Total
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 86
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Medicare Advantage
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 2011 (Reporting Year 2010)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Member Months
(Any)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Member Months
(Outpatient/ED)
Male
Female
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
Total
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 87
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 24, 2011 8:57 AM
MSHO
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
0
0
0
0
0
6838
0
6838
Female
0
0
0
0
0
19111
0
19111
Total
0
0
0
0
0
25949
0
25949
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
26
31
57
0
0
0
26
31
57
HEDIS 2011 (Reporting Year 2010)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Member Months
(Any)
Male
0
0
0
0
0
6838
0
6838
Female
0
0
0
0
0
19111
0
19111
Total
0
0
0
0
0
25949
0
25949
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16
13
29
0
0
0
16
13
29
Female
0
0
0
0
0
19111
0
19111
Total
0
0
0
0
0
25949
0
25949
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.56%
1.95%
2.64%
NA
NA
NA
4.56%
1.95%
2.64%
Male
0
0
0
0
0
6838
0
6838
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.81%
0.82%
1.34%
NA
NA
NA
2.81%
0.82%
1.34%
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
6838
0
6838
Female
0
0
0
0
0
19111
0
19111
Total
0
0
0
0
0
25949
0
25949
Outpatient/ED
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16
20
36
0
0
0
16
20
36
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.81%
1.26%
1.66%
NA
NA
NA
2.81%
1.26%
1.66%
Page 88
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 24, 2011 8:57 AM
SNBC
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
0
0
95
124
903
54
0
1176
Female
0
0
12
221
1597
40
0
1870
Total
0
0
107
345
2500
94
0
3046
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
2
3
5
7
19
26
0
0
0
0
0
0
9
22
31
HEDIS 2011 (Reporting Year 2010)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
0
0
95
124
903
54
0
1176
Female
0
0
12
221
1597
40
0
1870
Total
0
0
107
345
2500
94
0
3046
Inpatient
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
19.35%
16.29%
17.39%
9.30%
14.28%
12.48%
0.00%
0.00%
0.00%
NA
NA
NA
9.18%
14.12%
12.21%
Number
0
0
0
0
0
0
0
0
0
1
3
4
2
6
8
0
0
0
0
0
0
3
9
12
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
9.68%
16.29%
13.91%
2.66%
4.51%
3.84%
0.00%
0.00%
0.00%
NA
NA
NA
3.06%
5.78%
4.73%
Male
0
0
95
124
903
54
0
1176
Female
0
0
12
221
1597
40
0
1870
Total
0
0
107
345
2500
94
0
3046
Member Months
(Outpatient/ED)
Male
0
0
95
124
903
54
0
1176
Female
0
0
12
221
1597
40
0
1870
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
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
Number
0
0
0
0
0
0
0
0
0
1
3
4
7
17
24
0
0
0
0
0
0
8
20
28
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
Total
0
0
107
345
2500
94
0
3046
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
9.68%
16.29%
13.91%
9.30%
12.77%
11.52%
0.00%
0.00%
0.00%
NA
NA
NA
8.16%
12.83%
11.03%
Page 89
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
51442
11297
7846
9306
12366
2
0
92259
Female
50349
11615
17748
21813
19320
15
0
120860
Total
101791
22912
25594
31119
31686
17
0
213119
Any Services
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
0
1
1
64
60
124
123
149
272
152
208
360
214
200
414
0
0
0
0
0
0
553
618
1171
HEDIS 2011 (Reporting Year 2010)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Member Months
(Any)
Male
51442
11297
7846
9306
12366
2
0
92259
Female
50349
11615
17748
21813
19320
15
0
120860
Total
101791
22912
25594
31119
31686
17
0
213119
Inpatient
Percent
0.00%
0.02%
0.01%
6.80%
6.20%
6.49%
18.81%
10.07%
12.75%
19.60%
11.44%
13.88%
20.77%
12.42%
15.68%
0.00%
0.00%
0.00%
NA
NA
NA
7.19%
6.14%
6.59%
Number
0
1
1
23
17
40
38
50
88
38
50
88
54
54
108
0
0
0
0
0
0
153
172
325
Percent
0.00%
0.02%
0.01%
2.44%
1.76%
2.09%
5.81%
3.38%
4.13%
4.90%
2.75%
3.39%
5.24%
3.35%
4.09%
0.00%
0.00%
0.00%
NA
NA
NA
1.99%
1.71%
1.83%
Male
51442
11297
7846
9306
12366
2
0
92259
Female
50349
11615
17748
21813
19320
15
0
120860
Total
101791
22912
25594
31119
31686
17
0
213119
Member Months
(Outpatient/ED)
Male
51442
11297
7846
9306
12366
2
0
92259
Female
50349
11615
17748
21813
19320
15
0
120860
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
0
0
0
0
0
0
0
0
0
0
0
0
1
1
2
0
0
0
0
0
0
1
1
2
Number
0
1
1
59
55
114
113
128
241
148
199
347
203
182
385
0
0
0
0
0
0
523
565
1088
Percent
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.10%
0.06%
0.08%
0.00%
0.00%
0.00%
NA
NA
NA
0.01%
0.01%
0.01%
Total
101791
22912
25594
31119
31686
17
0
213119
Percent
0.00%
0.02%
0.01%
6.27%
5.68%
5.97%
17.28%
8.65%
11.30%
19.08%
10.95%
13.38%
19.70%
11.30%
14.58%
0.00%
0.00%
0.00%
NA
NA
NA
6.80%
5.61%
6.13%
Page 90
Use of Services
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Commercial
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 2011 (Reporting Year 2010)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
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
Male
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
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Medicare Advantage
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 2011 (Reporting Year 2010)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
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
Male
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
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 24, 2011 8:57 AM
MSHO
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
0
0
0
6838
0
6838
Female
0
0
0
19111
0
19111
Total
0
0
0
25949
0
25949
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
69
165
234
0
0
0
69
165
234
HEDIS 2011 (Reporting Year 2010)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
0
0
0
6838
0
6838
Female
0
0
0
19111
0
19111
Total
0
0
0
25949
0
25949
Number
0
0
0
0
0
0
0
0
0
24
73
97
0
0
0
24
73
97
Female
0
0
0
19111
0
19111
Total
0
0
0
25949
0
25949
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
12.11%
10.36%
10.82%
NA
NA
NA
12.11%
10.36%
10.82%
Male
0
0
0
6838
0
6838
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.21%
4.58%
4.49%
NA
NA
NA
4.21%
4.58%
4.49%
Number
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
1
0
1
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.18%
0.00%
0.05%
NA
NA
NA
0.18%
0.00%
0.05%
Member Months
(Outpatient/ED)
Male
0
0
0
6838
0
6838
Female
0
0
0
19111
0
19111
Total
0
0
0
25949
0
25949
Outpatient/ED
Number
0
0
0
0
0
0
0
0
0
48
99
147
0
0
0
48
99
147
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
8.42%
6.22%
6.80%
NA
NA
NA
8.42%
6.22%
6.80%
Page 93
Use of Services
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 24, 2011 8:57 AM
SNBC
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
0
0
1122
54
0
1176
Female
0
0
1830
40
0
1870
Total
0
0
2952
94
0
3046
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
61
113
174
1
1
2
0
0
0
62
114
176
HEDIS 2011 (Reporting Year 2010)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
0
0
1122
54
0
1176
Female
0
0
1830
40
0
1870
Total
0
0
2952
94
0
3046
Number
0
0
0
0
0
0
2
6
8
0
0
0
0
0
0
2
6
8
Female
0
0
1830
40
0
1870
Total
0
0
2952
94
0
3046
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
NA
NA
NA
NA
NA
NA
65.24%
74.10%
70.73%
22.22%
30.00%
25.53%
NA
NA
NA
63.27%
73.16%
69.34%
Male
0
0
1122
54
0
1176
Percent
NA
NA
NA
NA
NA
NA
2.14%
3.93%
3.25%
0.00%
0.00%
0.00%
NA
NA
NA
2.04%
3.85%
3.15%
Number
0
0
0
0
0
0
3
5
8
0
0
0
0
0
0
3
5
8
Percent
NA
NA
NA
NA
NA
NA
3.21%
3.28%
3.25%
0.00%
0.00%
0.00%
NA
NA
NA
3.06%
3.21%
3.15%
Member Months
(Outpatient/ED)
Male
0
0
1122
54
0
1176
Female
0
0
1830
40
0
1870
Total
0
0
2952
94
0
3046
Outpatient/ED
Number
0
0
0
0
0
0
61
113
174
1
1
2
0
0
0
62
114
176
Percent
NA
NA
NA
NA
NA
NA
65.24%
74.10%
70.73%
22.22%
30.00%
25.53%
NA
NA
NA
63.27%
73.16%
69.34%
Page 94
Use of Services
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Minnesota Health Care Programs - Managed Care(MHCP-MC)
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
51442
11297
29518
2
0
92259
Female
50349
11615
58881
15
0
120860
Total
101791
22912
88399
17
0
213119
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
526
388
914
243
286
529
561
1262
1823
0
0
0
0
0
0
1330
1936
3266
HEDIS 2011 (Reporting Year 2010)
Male
51442
11297
29518
2
0
92259
Female
50349
11615
58881
15
0
120860
Total
101791
22912
88399
17
0
213119
Percent
12.27%
9.25%
10.78%
25.81%
29.55%
27.71%
22.81%
25.72%
24.75%
0.00%
0.00%
0.00%
NA
NA
NA
17.30%
19.22%
18.39%
Number
10
5
15
14
17
31
43
65
108
0
0
0
0
0
0
67
87
154
Male
51442
11297
29518
2
0
92259
Female
50349
11615
58881
15
0
120860
Total
101791
22912
88399
17
0
213119
Intensive Outpatient/Partial
Hospitalization
Inpatient
Any Services
Age
0-12
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Percent
0.23%
0.12%
0.18%
1.49%
1.76%
1.62%
1.75%
1.32%
1.47%
0.00%
0.00%
0.00%
NA
NA
NA
0.87%
0.86%
0.87%
Number
4
5
9
2
4
6
5
10
15
0
0
0
0
0
0
11
19
30
Percent
0.09%
0.12%
0.11%
0.21%
0.41%
0.31%
0.20%
0.20%
0.20%
0.00%
0.00%
0.00%
NA
NA
NA
0.14%
0.19%
0.17%
Member Months
(Outpatient/ED)
Male
51442
11297
29518
2
0
92259
Female
50349
11615
58881
15
0
120860
Total
101791
22912
88399
17
0
213119
Outpatient/ED
Number
525
388
913
241
285
526
550
1249
1799
0
0
0
0
0
0
1316
1922
3238
Percent
12.25%
9.25%
10.76%
25.60%
29.44%
27.55%
22.36%
25.45%
24.42%
0.00%
0.00%
0.00%
NA
NA
NA
17.12%
19.08%
18.23%
Page 95
Health Plan Descriptive Information
Prime West
Board Certification
Data Last Refreshed:
Oct 24, 2011 8:57 AM
MSHO
Type of Physician
Family Medicine
Internal Medicine
Geriatricians
Other practitioner Specialists
HEDIS 2011 (Reporting Year 2010)
Number of Physicians in Active Board Certification
Each Practice Area
Percent
Number
1164
548
37
1579
751
402
15
1148
64.52%
73.36%
40.54%
72.70%
Page 96
Health Plan Descriptive Information
Prime West
Board Certification
Data Last Refreshed:
Oct 24, 2011 8:57 AM
SNBC
Type of Physician
Family Medicine
Internal Medicine
Geriatricians
Other practitioner Specialists
HEDIS 2011 (Reporting Year 2010)
Number of Physicians in Active Board Certification
Each Practice Area
Percent
Number
1164
548
37
1579
751
402
15
1148
64.52%
73.36%
40.54%
72.70%
Page 97
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 24, 2011 8:57 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
HEDIS 2011 (Reporting Year 2010)
NR
NR
NR
NR
NR
NR
NR
Page 98
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 24, 2011 8:57 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: %
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
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
NR
NR
NR
NR
NR
NR
Age Unknown
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2011 (Reporting Year 2010)
Page 99
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 24, 2011 8:57 AM
MSHO
Member Months
Female
0
0
0
0
0
0
<1
1-4
5-9
10-14
15-17
18-19
Male
0
0
0
0
0
0
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
0
0.00%
0
0
0
0
0
0
0.00%
0
0
0
0
0
0
0.00%
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
0
0.00%
0
0
0
0
0
0.00%
0
0
0
0
0
0.00%
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
0
0.00%
936
1234
1113
1231
1267
1057
0
0.00%
1923
1985
2611
3184
3956
5452
0
0.00%
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
6838
100.00%
0
19111
100.00%
0
25949
100.00%
6838
19111
HEDIS 2011 (Reporting Year 2010)
Total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2859
3219
3724
4415
5223
6509
0
25949
Page 100
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 24, 2011 8:57 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
14
Member Months
Female
0
0
0
0
0
0
Total
0
0
0
0
0
14
14
1.19%
81
43
81
77
115
0
0.00%
12
72
149
88
220
14
0.46%
397
33.76%
174
243
170
124
541
28.93%
264
306
415
304
938
30.79%
711
60.46%
54
0
0
0
0
0
1289
68.93%
40
0
0
0
0
0
2000
65.66%
54
4.59%
0
40
2.14%
0
94
3.09%
1176
1870
HEDIS 2011 (Reporting Year 2010)
93
115
230
165
335
438
549
585
428
94
0
0
0
0
0
0
3046
Page 101
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 24, 2011 8:57 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
<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
7063
19383
17154
12663
6476
3087
Member Months
Female
6867
18166
16714
13615
6602
4310
Total
13930
37549
33868
26278
13078
7397
65826
71.35%
4759
4916
4390
3226
2764
66274
54.84%
13438
12751
9062
6712
4921
132100
61.98%
20055
21.74%
2484
2007
1323
562
46884
38.79%
3590
2165
1182
750
66939
31.41%
6376
6.91%
1
0
1
0
0
0
7687
6.36%
14
0
0
0
0
1
14063
6.60%
2
0.00%
0
15
0.01%
0
17
0.01%
92259
120860
HEDIS 2011 (Reporting Year 2010)
18197
17667
13452
9938
7685
6074
4172
2505
1312
15
0
1
0
0
1
0
213119
Page 102