Prime West
General Info
Disclaimers
Code
WCC
Effectiveness of Care Measures
Prevention and Screening
Weight Assessment and Counseling for Nutrition and Physical Activity for
Children/Adolescents
HEDIS 2010 (Reporting Year 2009)
Data Last Refreshed: 1/6/2011
Page
2
Page
28
Page
Adult's Access to Preventive/Ambulatory Health Services
54
CAP
Children's and Adolescents' Access to Primary Care Practitioners
59
IET
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
61
Prenatal and Postpartum Care
66
27 AAP
3
Access / Availability of Care Measures
0 Code
CIS
Childhood Immunization Status
5
29
BCS
Breast Cancer Screening
9
30 PPC
CCS
Cervical Cancer Screening
10
COL
Colorectal Cancer Screening
11
0 Code
CHL
Chlamydia Screening in Women
12
Well Child Visits in the First 15 Months of Life
68
GSO
Glaucoma Screening in Older Adults
14
31 W15
32 W34
Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life
70
LSC
Lead Screening in Children
15
33 AWC
Adolescent Well-Care Visits
71
COA
Care for Older Adults
34 AMB
Ambulatory Care
72
16
Respiratory Conditions
IPU
Inpatient Utilization - General Hospital/Acute Care
77
IAD
Identification of Alcohol and Other Drug Services
82
Pharmacotherapy Management of COPD Exacerbation
17
36
SPR
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
20
37 MPT
ASM
Use of Appropriate Medications for People with Asthma
21
Cardiovascular
0 Code
Cholesterol Management for Patients with Cardiovascular Conditions
23
CBP
Controlling High Blood Pressure
26
Persistence of Beta Blocker Treatment After Hearth Attack
27
PBH
Diabetes
CDC
Comprehensive Diabetes Care
28
Musculoskeletal
OMW
Osteoporosis Management in Women Who had a Fracture
33
Behavioral Health
AMM
Antidepressant Medication Management
34
ADD
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
39
FUH
Follow-up After Hospitalization for Mental Illness
41
Medication Management
Annual Monitoring for Patients on Persistent Medications
44
MRP
Medication Reconciliation Post Discharge
49
DDE
Potentially Harmful Drug-Disease Interactions in the Elderly
50
DAE
Use of High Risk Medications in the Elderly
52
MPM
Page
35
PCE
CMC
Use of Services Measures
38 BCR
39 ENP
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services87
Health Plan Descriptive Information Measures
Page
Board Certification
92
Enrollment by Product Line (Age & Sex)
94
DISCLAIMERS
-1
( this page left blank intentionally )
0. Disclaimer Query located below
HEDIS 2010 (Reporting Year 2009)
Page 2
Effectiveness of Care
Prime West
Weight Assessment and Counseling for Nutrition and Physical Activity
Data Last Refreshed:
Jan 6, 2011 10:23 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
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
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 2010 (Reporting Year 2009)
Page 3
Effectiveness of Care
Prime West
Weight Assessment and Counseling for Nutrition and Physical Activity
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
BMI Percentile
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
Total
2009
H
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
Ages 3-11 Ages 12-17
Counseling for Nutrition
General
Measure
Data
Ages 3-11 Ages 12-17
Total
2009
H
Counseling for Physical Activity
General
Ages 12Measure
Ages 3-11
Total
17
Data
2009
H
2452
1125
3577
2452
1125
3577
2452
1125
3577
3
0.12%
4
0.36%
7
0.20%
12
0.49%
17
1.51%
29
0.81%
5
0.20%
1
0.09%
6
0.17%
2
0.46%
0
0.00%
2
0.46%
411
5.00%
411
5.00%
432
411
5.00%
432
0
0.00%
0
0.00%
0
0.00%
432
2
0.46%
1
0.23%
3
0.69%
Number of Records Excluded Because of
Valid Data Errors
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 2010 (Reporting Year 2009)
288
144
432
288
144
432
288
144
432
0
97
33.68%
28.05%
39.31%
0
54
37.50%
29.25%
45.75%
0
151
34.95%
30.34%
39.57%
2
111
39.24%
33.42%
45.05%
1
51
36.11%
27.92%
44.30%
3
162
38.19%
33.50%
42.89%
2
86
30.56%
25.06%
36.05%
0
54
37.50%
29.25%
45.75%
2
140
32.87%
28.32%
37.42%
Page 4
Effectiveness of Care
Prime West
Childhood Immunization Status
Data Last Refreshed:
Jan 6, 2011 10:23 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 Records Excluded because of
Contraindications by Admin Data
Number of Records Excluded because of
Contraindications by Medical Record
Review
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 2010 (Reporting Year 2009)
Page 5
Effectiveness of Care
Prime West
Childhood Immunization Status
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Commercial
Data Elements
General
Measure
Data
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
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 Records Excluded because of
Contraindications by Admin Data
Number of Records Excluded because of
Contraindications by Medical Record
Review
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 2010 (Reporting Year 2009)
Page 6
Effectiveness of Care
Prime West
Childhood Immunization Status
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
HiB
Hepatitis B
VZV
Influenza
315
76.27%
361
87.41%
370
89.59%
373
90.31%
378
91.53%
355
85.96%
324
78.45%
36
8.72%
193
46.73%
138
33.41%
315
76.27%
361
87.41%
370
89.59%
373
90.31%
378
91.53%
355
85.96%
324
78.45%
36
8.72%
193
46.73%
138
33.41%
315
20
81.11%
77.22%
85.01%
361
14
90.80%
87.89%
93.71%
370
9
91.77%
89.00%
94.54%
373
4
91.28%
88.44%
94.12%
378
6
92.98%
90.39%
95.56%
355
10
88.38%
85.17%
91.59%
324
13
81.60%
77.74%
85.46%
36
13
11.86%
8.62%
15.10%
193
13
49.88%
44.94%
54.82%
138
36
42.13%
37.25%
47.01%
413
0
Number of Records Excluded because of
Contraindications by Admin Data
0
Number of Records Excluded because of
Contraindications by Medical Record
Review
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
HEDIS 2010 (Reporting Year 2009)
MMR
411
0.05
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
IPV
2009
H
413
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
413
Page 7
Effectiveness of Care
Prime West
Childhood Immunization Status
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Minnesota Health Care Programs - Managed Care (MHC
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
Combo 5
Combo 6
Combo 7
Combo 8
Combo 9
Combo10
293
70.94%
284
68.77%
33
7.99%
157
38.01%
124
30.02%
26
6.30%
17
4.12%
68
16.46%
15
3.63%
293
70.94%
284
68.77%
33
7.99%
157
38.01%
124
30.02%
26
6.30%
17
4.12%
68
16.46%
15
3.63%
293
26
77.24%
73.07%
81.40%
284
25
74.82%
70.51%
79.13%
33
11
10.65%
7.56%
13.75%
157
24
43.83%
38.92%
48.73%
124
31
37.53%
32.74%
42.32%
26
8
8.23%
5.46%
11.00%
17
6
5.57%
3.24%
7.90%
68
30
23.73%
19.50%
27.95%
15
5
4.84%
2.65%
7.03%
413
0
Number of Records Excluded because of
Contraindications by Admin Data
0
Number of Records Excluded because of
Contraindications by Medical Record
Review
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
HEDIS 2010 (Reporting Year 2009)
Combo 4
411
0.05
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
Combo 3
2009
H
413
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
Combo 2
413
Page 8
Effectiveness of Care
Prime West
Breast Cancer Screening
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
Commercial
NR
NR
NR
Medicare
Advantage
NR
NR
NR
MSHO
SNBC
MHCP-MC
2009
A
81
57
70.37%
59.81%
80.93%
2009
A
11
8
NA
NA
NA
2009
A
156
97
62.18%
54.25%
70.11%
Page 9
Effectiveness of Care
Prime West
Cervical Cancer Screening
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Data Elements
Commercial
MHCP-MC
Measurement Year
Data Collection Methodology
Eligible Member Population
2009
H
1629
Numerator Events by Admin Data on Eligible
Population (before exclusions)
1107
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
NR
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
NR
Number of medical record data records excluded
Number of employee/dependent medical records
excluded
67.96%
411
5.00%
432
293
67.82%
0
0
14
0
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
NR
0
418
293
20
74.88%
Lower 95% Confidence Interval
Upper 95% Confidence Interval
NR
NR
70.60%
79.16%
HEDIS 2010 (Reporting Year 2009)
Page 10
Effectiveness of Care
Prime West
Colorectal Cancer Screening
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Data Elements
Commercial
Medicare
Advantage
MSHO
SNBC
Measurement Year
Data collection methodology (administrative or hybrid)
Eligible population
2009
H
328
2009
H
13
Number of numerator events by administrative data in eligible population
(before exclusions)
100
5
30.49%
328
5.00%
328
101
30.79%
0
0
0
0
0
328
101
56
47.87%
42.31%
53.42%
38.46%
13
5.00%
13
6
46.15%
0
0
0
0
0
13
6
5
NA
NA
NA
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
NR
NR
NR
NR
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
NR
NR
NR
NR
NR
NR
HEDIS 2010 (Reporting Year 2009)
Page 11
Effectiveness of Care
Prime West
Chlamydia Screening in Women
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General
Measure
Data
Ages 1620
NR
NR
NR
Ages 2124
NR
NR
NR
Total
NR
NR
NR
NR
NR
Page 12
Effectiveness of Care
Prime West
Chlamydia Screening in Women
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
General
Data Elements
Measure
Data
Measurement Year
2009
Data Collection Methodology
A
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2010 (Reporting Year 2009)
Ages 1620
Ages 2124
Total
274
106
38.69%
32.74%
44.64%
274
111
40.51%
34.52%
46.51%
548
217
39.60%
35.41%
43.78%
Page 13
Effectiveness of Care
Prime West
Glaucoma Screening in Older Adults
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
Medicare
Advantage
NR
NR
NR
MSHO
2009
A
1384
1063
76.81%
74.55%
79.07%
Page 14
Effectiveness of Care
Prime West
Lead Screening in Children
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Data Elements
MHCP-MC
Measurement Year
Data Collection Methodology
Eligible Member Population
2009
H
413
Numerator Events by Admin Data on Eligible
Population (before exclusions)
327
Current Year's Admin Rate
79.18%
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
411
5.00%
413
330
79.90%
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
0
413
330
0
Reported Rate
79.90%
Lower 95% Confidence Interval
75.92%
Upper 95% Confidence Interval
83.89%
HEDIS 2010 (Reporting Year 2009)
Page 15
Effectiveness of Care
Prime West
Care for Older Adults
Data Last Refreshed:
Jan 6, 2011 10:23 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
Data Elements
General Measure
Data
Advance Care
Planning
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on Eligible
Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
Records Excluded because of Valid Data
Errors
Number of employee/dependent medical
records excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
HEDIS 2010 (Reporting Year 2009)
Page 16
Effectiveness of Care
Prime West
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Medicare Advantage
Data Elements
General
Measure Data
Systemic
corticosteroid
Bronchodilator
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Exclusions based on direct transfers to
another facility
Exclusions based on readmissions
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2010 (Reporting Year 2009)
Page 17
Effectiveness of Care
Prime West
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Jan 6, 2011 10:23 AM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Exclusions based on direct transfers to
another facility
Exclusions based on readmissions
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2010 (Reporting Year 2009)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
14
40.00%
22.34%
57.66%
27
77.14%
61.80%
92.48%
2009
A
35
13
13
Page 18
Effectiveness of Care
Prime West
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Jan 6, 2011 10:23 AM
SNBC
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Exclusions based on direct transfers to
another facility
Exclusions based on readmissions
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2010 (Reporting Year 2009)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
1
NA
NA
NA
1
NA
NA
NA
2009
A
1
1
4
Page 19
Effectiveness of Care
Prime West
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
Medicare
Advantage
NR
NR
NR
MSHO
SNBC
2009
A
51
5
9.80%
0.66%
18.95%
2009
A
0
0
NA
NA
NA
Page 20
Effectiveness of Care
Prime West
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General
Measure Data
Ages 5-11
NR
NR
NR
Ages 12-50
Total
NR
NR
NR
NR
NR
NR
NR
NR
`
Page 21
Effectiveness of Care
Prime West
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General
Measure Data
Ages 5-11
Ages 12-50
Total
37
35
94.59%
85.96%
100.00%
51
45
88.24%
78.41%
98.06%
88
80
90.91%
84.33%
97.48%
2009
A
Page 22
Effectiveness of Care
Prime West
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 23
Effectiveness of Care
Prime West
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 24
Effectiveness of Care
Prime West
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
6
0
75.00%
0.00%
6
0
75.00%
0.00%
6
0
0
4
NA
NA
NA
NA
NA
NA
2009
H
8
8
5.00%
8
0
0
0
8
Page 25
Effectiveness of Care
Prime West
Controlling High Blood Pressure
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Data Elements
Medicare
Advantage
MSHO
SNBC
MHCP-MC
Measurement Year
Data Collection Methodology (Hybrid)
Eligible Member Population
2009
H
339
2009
H
58
2009
H
211
Numerator Events by Admin Data on
Eligible Population (before exclusions)
0
0
0
0.00%
240
5.00%
240
0.00%
49
5.00%
49
0.00%
204
5.00%
204
0
0.00%
0
0.00%
0
0.00%
Records Excluded because of Valid Data
Errors
0
1
0
Number of records excluded because of
false positive diagnoses
0
0
0
Number of administrative data records
excluded
0
0
0
Number of medical record data records
excluded
0
0
0
Number of employee/dependent medical
records excluded
0
0
0
Records Added from the OverSample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
0
240
0
148
61.67%
55.31%
68.03%
0
48
0
30
62.50%
47.76%
77.24%
0
204
0
123
60.29%
53.33%
67.25%
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 2010 (Reporting Year 2009)
Commercial
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 26
Effectiveness of Care
Prime West
Persistence of Beta Blocker Treatment After Hearth Attack
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
NR
NR
NR
NR
NR
NR
MSHO
SNBC
MHCP-MC
2009
A
14
2009
A
0
2009
A
0
11
0
0
NA
NA
NA
NR
NR
NR
NR
NR
NR
Page 27
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Commercial
Data Elements
HbA1c
Testing
Poor HbA1c Good HbA1c
Control
Control
(>9.0%)
(<7.0%)
Adequate
HbA1c
Control
(<8.0%)
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
Blood
Blood
Monitoring
Pressure
Pressure
for Diabetic
<140/90 mm <130/80
Nephropathy
Hg
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
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
Number of Administrative required exclusions
Number of Hybrid required exclusions
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2010 (Reporting Year 2009)
Page 28
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Jan 6, 2011 10:23 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
Blood
Monitoring
Pressure
Pressure
for Diabetic
<140/90 mm <130/80
Nephropathy
Hg
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 2010 (Reporting Year 2009)
Page 29
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Jan 6, 2011 10:23 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
2009
H
160
2009
H
160
144
90.00%
160
5%
160
145
90.63%
159
99.38%
160
5%
160
160
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
2009
H
160
2009
H
160
2009
H
160
2009
H
160
2009
H
160
2009
H
160
2009
H
160
0
0.00%
160
5%
160
0
0.00%
123
76.88%
160
5%
160
126
78.75%
119
74.38%
160
5%
160
121
75.63%
5
3.13%
160
5%
160
5
3.13%
138
86.25%
160
5%
160
138
86.25%
5
3.13%
160
5%
160
1
0.63%
4
2.50%
160
5%
160
1
0.63%
Blood
Blood
Monitoring
Pressure
Pressure
for Diabetic
<140/90 mm <130/80
Nephropathy
Hg
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
160
145
6
94.38%
90.49%
98.26%
0
160
31
9
25.00%
17.98%
32.02%
0
160
0
112
70.00%
62.59%
77.41%
0
160
126
8
83.75%
77.72%
89.78%
0
160
121
1
76.25%
69.34%
83.16%
0
160
5
72
48.13%
40.07%
56.18%
0
160
138
4
88.75%
83.54%
93.96%
0
160
1
106
66.88%
59.27%
74.48%
0
160
1
67
42.50%
34.53%
50.47%
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 2010 (Reporting Year 2009)
NR
NR
NR
Page 30
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Jan 6, 2011 10:23 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
2009
H
59
2009
H
59
53
89.83%
59
5%
59
45
76.27%
59
100.00%
59
5%
59
59
100.00%
Good HbA1c
Control
(<7.0%)
NR
NR
Adequate
HbA1c
Control
(<8.0%)
Blood
Blood
Monitoring
Pressure
Pressure
for Diabetic
<140/90 mm <130/80
Nephropathy
Hg
mm Hg
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
2009
H
59
2009
H
59
2009
H
59
2009
H
59
2009
H
59
2009
H
59
2009
H
59
0
0.00%
59
5%
59
0
0.00%
41
69.49%
59
5%
59
38
64.41%
48
81.36%
59
5%
59
44
74.58%
0
0.00%
59
5%
59
0
0.00%
45
76.27%
59
5%
59
39
66.10%
0
0.00%
59
5%
59
0
0.00%
0
0.00%
59
5%
59
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
59
53
0
89.83%
81.27%
98.39%
0
59
12
3
25.42%
13.47%
37.38%
0
59
0
42
71.19%
58.78%
83.59%
0
59
42
0
71.19%
58.78%
83.59%
0
59
48
0
81.36%
70.57%
92.14%
0
59
0
19
32.20%
19.43%
44.97%
0
59
45
7
88.14%
79.04%
97.23%
0
59
0
44
74.58%
62.62%
86.53%
0
59
0
31
52.54%
38.95%
66.13%
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 2010 (Reporting Year 2009)
NR
NR
NR
Page 31
Effectiveness of Care
Prime West
Comprehensive Diabetes Care
Data Last Refreshed:
Jan 6, 2011 10:23 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
2009
H
183
2009
H
183
2009
H
162
2009
H
183
2009
H
183
2009
H
183
2009
H
183
2009
H
183
2009
H
183
2009
H
183
135
73.77%
180
5%
180
138
76.67%
183
100.00%
180
5%
180
180
100.00%
0
0.00%
180
5%
180
0
0.00%
0
0.00%
180
5%
180
0
0.00%
84
45.90%
180
5%
180
89
49.44%
114
62.30%
180
5%
180
118
65.56%
0
0.00%
180
5%
180
0
0.00%
120
65.57%
180
5%
180
123
68.33%
1
0.55%
180
5%
180
1
0.56%
1
0.55%
180
5%
180
1
0.56%
0
0
26
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
180
0
87
48.33%
40.76%
55.91%
0
180
89
13
56.67%
49.15%
64.18%
0
180
118
5
68.33%
61.26%
75.41%
0
180
0
62
34.44%
27.22%
41.66%
0
180
123
9
73.33%
66.60%
80.07%
0
180
1
139
77.78%
71.43%
84.13%
0
180
1
92
51.67%
44.09%
59.24%
Number of Administrative required exclusions
21
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 2010 (Reporting Year 2009)
Blood
Blood
Monitoring
Pressure
Pressure
for Diabetic
<140/90 mm <130/80
Nephropathy
Hg
mm Hg
5
0
180
138
13
83.89%
78.24%
89.54%
0
180
49
27
42.22%
34.73%
49.72%
0
154
0
57
37.01%
29.06%
44.96%
Page 32
Effectiveness of Care
Prime West
Osteoporosis Management in Women Who had a Fracture
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
Medicare
Advantage
NR
NR
NR
MSHO
2009
A
86
13
15.12%
6.96%
23.27%
Page 33
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General Effective Acute
Measure
Phase
Data
Treatment
NR
NR
NR
Effective
Continuation
Phase
Treatment
NR
NR
NR
Page 34
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General Effective Acute
Measure
Phase
Data
Treatment
NR
NR
NR
Effective
Continuation
Phase
Treatment
NR
NR
NR
Page 35
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General Effective Acute
Measure
Phase
Data
Treatment
Effective
Continuation
Phase
Treatment
2009
A
31
24
77.42%
61.09%
93.75%
22
70.97%
53.38%
88.56%
Page 36
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General Effective Acute
Measure
Phase
Data
Treatment
Effective
Continuation
Phase
Treatment
2009
A
4
4
NA
NA
NA
4
NA
NA
NA
Page 37
Effectiveness of Care
Prime West
Antidepressant Medication Management
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General Effective Acute
Measure
Phase
Data
Treatment
Effective
Continuation
Phase
Treatment
2009
A
110
50
45.45%
35.69%
55.21%
33
30.00%
20.98%
39.02%
Page 38
Effectiveness of Care
Prime West
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Jan 6, 2011 10:23 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 Interva
HEDIS 2010 (Reporting Year 2009)
General
Measure
Data
Initiation
Phase
Continuation
and
Maintenance
Phase
NR
NR
NR
NR
NR
NR
Page 39
Effectiveness of Care
Prime West
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Jan 6, 2011 10:23 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 Interva
HEDIS 2010 (Reporting Year 2009)
General
Measure
Data
Initiation
Phase
Continuation
and
Maintenance
Phase
81
21
25.93%
15.77%
36.09%
23
5
NA
NA
NA
2009
A
Page 40
Effectiveness of Care
Prime West
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General
Measure
Data
30 Days
7 Days
NR
NR
NR
NR
NR
NR
Page 41
Effectiveness of Care
Prime West
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General
Measure
Data
30 Days
7 Days
3
NA
NA
NA
1
NA
NA
NA
2009
A
8
Page 42
Effectiveness of Care
Prime West
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General
Measure
Data
30 Days
7 Days
15
NA
NA
NA
12
NA
NA
NA
2009
A
16
Page 43
Effectiveness of Care
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
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 44
Effectiveness of Care
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
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 45
Effectiveness of Care
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
732
712
97.27%
96.02%
98.52%
149
145
97.32%
94.38%
100.00%
902
883
97.89%
96.90%
98.89%
94
85
90.43%
83.95%
96.91%
1877
1825
97.23%
96.46%
98.00%
2009
A
Page 46
Effectiveness of Care
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
48
45
93.75%
85.86%
100.00%
3
3
NA
NA
NA
49
48
97.96%
92.98%
100.00%
40
35
87.50%
76.00%
99.00%
140
131
93.57%
89.15%
97.99%
2009
A
Page 47
Effectiveness of Care
Prime West
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
150
120
80.00%
73.27%
86.73%
7
6
NA
NA
NA
102
85
83.33%
75.61%
91.06%
24
19
NA
NA
NA
283
230
81.27%
76.55%
85.99%
2009
A
Page 48
Access/Availability of Care
Prime West
Medication Reconciliation Post Discharge
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
NR
NR
NR
Page 49
Effectiveness of Care
Prime West
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General
Measure
Data
History of Falls +
Dementia +
Chronic Renal
Tricyclic
Tricyclic
Failure +
Antidepressants, Antidepressants or Nonaspirin NSAIDs
Antipsychotics or
Anticholinergic or Cox-2 Selective
Sleep Agents
Agents
NSAIDs
NR
NR
NR
NR
NR
NR
NR
NR
NR
Total
NR
NR
NR
Page 50
Effectiveness of Care
Prime West
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General
Measure
Data
History of Falls +
Dementia +
Chronic Renal
Tricyclic
Tricyclic
Failure +
Antidepressants, Antidepressants or Nonaspirin NSAIDs
Antipsychotics or
Anticholinergic or Cox-2 Selective
Sleep Agents
Agents
NSAIDs
Total
2009
A
62
11
17.74%
7.43%
28.06%
507
125
24.65%
20.80%
28.51%
12
3
NA
NA
NA
581
139
23.92%
20.37%
27.48%
Page 51
Effectiveness of Care
Prime West
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General
Measure
Data
At least 1
Prescription
At least 2
Prescriptions
NR
NR
NR
NR
NR
NR
Page 52
Effectiveness of Care
Prime West
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General
Measure
Data
2009
A
1732
At least 1
Prescription
At least 2
Prescriptions
466
26.91%
24.79%
29.02%
108
6.24%
5.07%
7.40%
Page 53
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 54
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 55
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
0
0
1732
1732
0
0
1715
NA
NA
NA
NA
NA
NA
99.02%
98.53%
99.51%
1715
99.02%
98.53%
99.51%
2009
A
Page 56
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
65
149
6
220
65
148
6
100.00%
99.23%
100.00%
99.33%
97.68%
100.00%
NA
NA
NA
219
99.55%
98.43%
100.00%
2009
A
Page 57
Access/Availability of Care
Prime West
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
Total
2130
571
0
2701
1968
533
0
92.39%
91.25%
93.54%
93.35%
91.21%
95.48%
NA
NA
NA
2501
92.60%
91.59%
93.60%
2009
A
Page 58
Access/Availability of Care
Prime West
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
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 59
Access/Availability of Care
Prime West
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
General Measure
Data
12-24 months
25 months 6 yrs.
7-11 yrs.
12-19 yrs.
653
628
1711
1587
603
560
740
689
96.17%
94.62%
97.72%
92.75%
91.50%
94.01%
92.87%
90.73%
95.01%
93.11%
91.22%
95.00%
2009
A
Page 60
Access/Availability of Care
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 61
Access/Availability of Care
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 62
Access/Availability of Care
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
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
2009
A
29
0
29
0
0
20
0
20
0
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Page 63
Access/Availability of Care
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
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
2009
A
0
23
23
0
0
16
3
16
3
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Page 64
Access/Availability of Care
Prime West
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
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
2009
A
35
337
372
17
9
153
58
170
67
48.57%
30.58%
66.56%
25.71%
9.81%
41.62%
45.40%
39.94%
50.86%
17.21%
13.03%
21.39%
45.70%
40.50%
50.90%
18.01%
13.97%
22.05%
Page 65
Access/Availability of Care
Prime West
Prenatal and Postpartum Care
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
Page 66
Access/Availability of Care
Prime West
Prenatal and Postpartum Care
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Timeliness of
Prenatal Care
Postpartum
Care
Measurement Year
Data collection methodology (Administrative or Hybrid)
Eligible member population
2008
H
564
2008
H
564
Number of numerator events by administrative data in eligible
population (before exclusions)
323
266
57.27%
411
5%
432
253
47.16%
411
5%
432
215
58.56%
49.77%
2
2
0
0
430
253
145
0
0
430
215
60
92.56%
89.96%
95.16%
63.95%
59.30%
68.61%
Data Elements
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of valid
data errors
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2010 (Reporting Year 2009)
Page 67
Use of Services
Prime West
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
Page 68
Use of Services
Prime West
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
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 69
Use of Services
Prime West
Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Data Elements
Commercial
MHCP-MC
Measurement Year
Data Collection Methodology
Eligible Member Population
2009
H
1351
Numerator events by admin data in eligible
population
798
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
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 2010 (Reporting Year 2009)
0
NR
NR
NR
0
432
247
5
58.33%
53.57%
63.10%
Page 70
Use of Services
Prime West
Adolescent Well-Care Visits
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Data Elements
Commercial
Measurement Year
Data Collection Methodology
Eligible Member Population
MHCP-MC
2009
A
1745
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
NR
NR
NR
NR
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2010 (Reporting Year 2009)
533
NR
NR
NR
30.54%
28.35%
32.73%
Page 71
Use of Services
Prime West
Ambulatory Care
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
NR
Visits/ 1,000
Member
Months
NR
NR
Ambulatory
Surgery/Procedures
Procedures
NR
NR
NR
NR
NR
NR
NR
NR
Procedures/
1,000 Member
Months
NR
NR
Observation Room Stays
Resulting in Discharge
Stays
NR
NR
NR
NR
NR
NR
NR
NR
Stays/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 72
Use of Services
Prime West
Ambulatory Care
Data Last Refreshed:
Jan 6, 2011 10:23 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
Visits
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
NR
HEDIS 2010 (Reporting Year 2009)
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
Ambulatory
Surgery/Procedures
Procedures
NR
Procedures/
1,000 Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Observation Room Stays
Resulting in Discharge
Stays
NR
Stays/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 73
Use of Services
Prime West
Ambulatory Care
Data Last Refreshed:
Jan 6, 2011 10:23 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
5463
7806
11530
0
24799
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
5402
7541
9812
0
22755
HEDIS 2010 (Reporting Year 2009)
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
988.83
966.05
851.00
917.58
Emergency Room Visits
Visits
0
0
0
0
0
198
283
352
0
833
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
36.24
36.25
30.53
33.59
Ambulatory
Surgery/Procedures
Procedures
0
0
0
0
0
230
288
149
0
667
Procedures/
1,000 Member
Months
NA
NA
NA
NA
NA
42.10
36.89
12.92
26.90
Observation Room Stays
Resulting in Discharge
Stays
0
0
0
0
0
23
49
43
0
115
Stays/ 1,000
Member
Months
NA
NA
NA
NA
NA
4.21
6.28
3.73
4.64
Page 74
Use of Services
Prime West
Ambulatory Care
Data Last Refreshed:
Jan 6, 2011 10:23 AM
SNBC
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
0
0
18
956
2032
43
0
0
0
3049
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
13
1099
2324
54
0
0
0
3490
HEDIS 2010 (Reporting Year 2009)
Visits/ 1,000
Member
Months
NA
NA
722.22
1149.58
1143.70
1255.81
NA
NA
1144.64
Emergency Room Visits
Visits
0
0
3
91
147
4
0
0
0
245
Visits/ 1,000
Member
Months
NA
NA
166.67
95.19
72.34
93.02
NA
NA
80.35
Ambulatory
Surgery/Procedures
Procedures
0
0
0
33
83
2
0
0
0
118
Procedures/
1,000 Member
Months
NA
NA
0.00
34.52
40.85
46.51
NA
NA
38.70
Observation Room Stays
Resulting in Discharge
Stays
0
0
0
3
10
0
0
0
0
13
Stays/ 1,000
Member
Months
NA
NA
0.00
3.14
4.92
0.00
NA
NA
4.26
Page 75
Use of Services
Prime West
Ambulatory Care
Data Last Refreshed:
Jan 6, 2011 10:23 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
13626
65102
42441
61133
13422
4
0
0
0
195728
Outpatient Visits (Excludes
MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
11392
24136
13439
32036
8041
0
0
0
0
89044
HEDIS 2010 (Reporting Year 2009)
Visits/ 1,000
Member
Months
836.05
370.74
316.65
524.04
599.09
0.00
NA
NA
454.94
Emergency Room Visits
Visits
1368
3744
1793
4927
626
0
0
0
0
12458
Visits/ 1,000
Member
Months
100.40
57.51
42.25
80.59
46.64
0.00
NA
NA
63.65
Ambulatory
Surgery/Procedures
Procedures
67
325
229
1229
478
0
0
0
0
2328
Procedures/
1,000 Member
Months
4.92
4.99
5.40
20.10
35.61
0.00
NA
NA
11.89
Observation Room Stays
Resulting in Discharge
Stays
26
50
114
579
25
0
0
0
0
794
Stays/ 1,000
Member
Months
1.91
0.77
2.69
9.47
1.86
0.00
NA
NA
4.06
Page 76
Use of Services
Prime West
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 77
Use of Services
Prime West
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 78
Use of Services
Prime West
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Jan 6, 2011 10:23 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
5463
7806
11530
0
24799
Discharges
0
0
0
0
0
230
335
502
0
1067
Discharges /
1,000 Member
Months
NA
NA
NA
NA
NA
42.10
42.92
43.54
43.03
0
0
0
0
0
176
259
425
0
860
NA
NA
NA
NA
NA
32.22
33.18
36.86
0
0
0
0
0
47
60
63
0
170
NA
NA
NA
NA
NA
8.60
7.69
5.46
0
0
0
0
0
HEDIS 2010 (Reporting Year 2009)
34.68
6.86
NA
NA
NA
NA
Days
0
0
0
0
0
1138
1519
2172
0
4829
Days / 1,000
Member
Months
NA
NA
NA
NA
NA
208.31
194.59
188.38
194.73
0
0
0
0
0
807
1093
1743
0
3643
NA
NA
NA
NA
NA
147.72
140.02
151.17
0
0
0
0
0
248
297
375
0
920
NA
NA
NA
NA
NA
45.40
38.05
32.52
0
0
0
0
0
146.90
37.10
NA
NA
NA
NA
Average
Length of Stay
NA
NA
NA
NA
NA
4.95
4.53
4.33
NA
4.53
NA
NA
NA
NA
NA
4.59
4.22
4.10
NA
4.24
NA
NA
NA
NA
NA
5.28
4.95
5.95
NA
5.41
NA
NA
NA
NA
NA
Page 79
Use of Services
Prime West
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Jan 6, 2011 10:23 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
18
956
2032
43
0
0
0
3049
Discharges
Discharges /
1,000 Member
Months
0
0
0
13
60
1
0
0
0
74
NA
NA
0.00
13.60
29.53
23.26
NA
NA
0
0
0
8
41
1
0
0
0
50
NA
NA
0.00
8.37
20.18
23.26
NA
NA
0
0
0
4
16
0
0
0
0
20
NA
NA
0.00
4.18
7.87
0.00
NA
NA
0
0
0
0
0
0.00
0.00
0.00
HEDIS 2010 (Reporting Year 2009)
24.27
16.40
6.56
0.00
Days
Days / 1,000
Member
Months
0
0
0
42
178
3
0
0
0
223
NA
NA
0.00
43.93
87.60
69.77
NA
NA
0
0
0
21
119
3
0
0
0
143
NA
NA
0.00
21.97
58.56
69.77
NA
NA
0
0
0
10
46
0
0
0
0
56
NA
NA
0.00
10.46
22.64
0.00
NA
NA
0
0
0
0
0
0.00
0.00
0.00
73.14
46.90
18.37
0.00
Average
Length of Stay
NA
NA
NA
3.23
2.97
3.00
NA
NA
NA
3.01
NA
NA
NA
2.63
2.90
3.00
NA
NA
NA
2.86
NA
NA
NA
2.50
2.88
NA
NA
NA
NA
2.80
NA
NA
NA
NA
NA
Page 80
Use of Services
Prime West
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Age
Member Months
<1
13626
1-9
65102
10-19
42441
20-44
61133
45-64
13422
65-74
4
75-84
0
85+
0
Unknown
0
Total
195728
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
133
153
201
1325
219
0
0
0
0
2031
9.76
2.35
4.74
21.67
16.32
0.00
NA
NA
118
126
29
220
115
0
0
0
0
608
8.66
1.94
0.68
3.60
8.57
0.00
NA
NA
15
23
25
161
100
0
0
0
0
324
1.10
0.35
0.59
2.63
7.45
0.00
NA
NA
146
937
1
0
1084
3.44
15.33
0.07
HEDIS 2010 (Reporting Year 2009)
10.38
3.11
1.66
9.27
Days
Days / 1,000
Member
Months
591
369
549
3629
848
0
0
0
0
5986
43.37
5.67
12.94
59.36
63.18
0.00
NA
NA
532
284
67
552
398
0
0
0
0
1833
39.04
4.36
1.58
9.03
29.65
0.00
NA
NA
59
52
71
511
433
0
0
0
0
1126
4.33
0.80
1.67
8.36
32.26
0.00
NA
NA
410
2505
3
0
2918
9.66
40.98
0.22
30.58
9.37
5.75
24.94
Average
Length of Stay
4.44
2.41
2.73
2.74
3.87
NA
NA
NA
NA
2.95
4.51
2.25
2.31
2.51
3.46
NA
NA
NA
NA
3.01
3.93
2.26
2.84
3.17
4.33
NA
NA
NA
NA
3.48
2.81
2.67
3.00
NA
2.69
Page 81
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Commercial
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
NR
Female
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2010 (Reporting Year 2009)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
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
Member Months
(Outpatient/ED)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Outpatient/ED
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 82
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Medicare Advantage
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 2010 (Reporting Year 2009)
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 83
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jan 6, 2011 10:23 AM
MSHO
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
0
0
0
0
0
6324
0
6324
Female
0
0
0
0
0
18475
0
18475
Total
0
0
0
0
0
24799
0
24799
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
21
22
43
0
0
0
21
22
43
HEDIS 2010 (Reporting Year 2009)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
0
0
0
0
0
6324
0
6324
Female
0
0
0
0
0
18475
0
18475
Total
0
0
0
0
0
24799
0
24799
Inpatient
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.98%
1.43%
2.08%
NA
NA
NA
3.98%
1.43%
2.08%
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
11
14
25
0
0
0
11
14
25
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.09%
0.91%
1.21%
NA
NA
NA
2.09%
0.91%
1.21%
Male
0
0
0
0
0
6324
0
6324
Female
0
0
0
0
0
18475
0
18475
Total
0
0
0
0
0
24799
0
24799
Member Months
(Outpatient/ED)
Male
0
0
0
0
0
6324
0
6324
Female
0
0
0
0
0
18475
0
18475
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
0
0
0
0
0
0
14
10
24
0
0
0
14
10
24
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%
Total
0
0
0
0
0
24799
0
24799
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.66%
0.65%
1.16%
NA
NA
NA
2.66%
0.65%
1.16%
Page 84
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jan 6, 2011 10:23 AM
SNBC
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
0
0
82
109
953
26
0
1170
Female
0
0
16
250
1596
17
0
1879
Total
0
0
98
359
2549
43
0
3049
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
13
26
39
0
0
0
0
0
0
15
29
44
HEDIS 2010 (Reporting Year 2009)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Member Months
(Any)
Male
0
0
82
109
953
26
0
1170
Female
0
0
16
250
1596
17
0
1879
Total
0
0
98
359
2549
43
0
3049
Inpatient
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
22.02%
14.40%
16.71%
16.37%
19.55%
18.36%
0.00%
0.00%
0.00%
NA
NA
NA
15.38%
18.52%
17.32%
Number
0
0
0
0
0
0
0
0
0
2
1
3
4
10
14
0
0
0
0
0
0
6
11
17
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
22.02%
4.80%
10.03%
5.04%
7.52%
6.59%
0.00%
0.00%
0.00%
NA
NA
NA
6.15%
7.03%
6.69%
Male
0
0
82
109
953
26
0
1170
Female
0
0
16
250
1596
17
0
1879
Total
0
0
98
359
2549
43
0
3049
Member Months
(Outpatient/ED)
Male
0
0
82
109
953
26
0
1170
Female
0
0
16
250
1596
17
0
1879
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
10
20
30
0
0
0
0
0
0
11
23
34
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
98
359
2549
43
0
3049
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
11.01%
14.40%
13.37%
12.59%
15.04%
14.12%
0.00%
0.00%
0.00%
NA
NA
NA
11.28%
14.69%
13.38%
Page 85
Use of Services
Prime West
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Member Months
Member Months
(Any)
(Inpatient)
Age
Male
Female
Male
Female
Total
0-12
47967
45766
93733
47967
45766
13-17
10411
10281
20692
10411
10281
18-24
6828
16913
23741
6828
16913
25-34
8265
19305
27570
8265
19305
35-64
12511
17477
29988
12511
17477
65+
2
2
4
2
2
Unknown
0
0
0
0
0
Total
85984
109744
195728
85984
109744
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
1
3
4
56
54
110
124
141
265
167
206
373
247
206
453
0
0
0
0
0
0
595
610
1205
HEDIS 2010 (Reporting Year 2009)
Total
93733
20692
23741
27570
29988
4
0
195728
Inpatient
Percent
0.03%
0.08%
0.05%
6.45%
6.30%
6.38%
21.79%
10.00%
13.39%
24.25%
12.80%
16.24%
23.69%
14.14%
18.13%
0.00%
0.00%
0.00%
NA
NA
NA
8.30%
6.67%
7.39%
Number
0
2
2
21
18
39
33
43
76
45
57
102
89
57
146
0
0
0
0
0
0
188
177
365
Percent
0.00%
0.05%
0.03%
2.42%
2.10%
2.26%
5.80%
3.05%
3.84%
6.53%
3.54%
4.44%
8.54%
3.91%
5.84%
0.00%
0.00%
0.00%
NA
NA
NA
2.62%
1.94%
2.24%
Member Months
(Intensive Outpatient/Partial
Male
Female
Total
47967
45766
93733
10411
10281
20692
6828
16913
23741
8265
19305
27570
12511
17477
29988
2
2
4
0
0
0
85984
109744
195728
Male
47967
10411
6828
8265
12511
2
0
85984
Member Months
(Outpatient/ED)
Female
45766
10281
16913
19305
17477
2
0
109744
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
0
0
0
0
3
3
2
0
2
1
1
2
0
0
0
0
0
0
0
0
0
3
4
7
Number
1
2
3
53
50
103
119
117
236
164
189
353
229
189
418
0
0
0
0
0
0
566
547
1113
Percent
0.00%
0.00%
0.00%
0.00%
0.35%
0.17%
0.35%
0.00%
0.10%
0.15%
0.06%
0.09%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
NA
NA
NA
0.04%
0.04%
0.04%
Total
93733
20692
23741
27570
29988
4
0
195728
Percent
0.03%
0.05%
0.04%
6.11%
5.84%
5.97%
20.91%
8.30%
11.93%
23.81%
11.75%
15.36%
21.96%
12.98%
16.73%
0.00%
0.00%
0.00%
NA
NA
NA
7.90%
5.98%
6.82%
Page 86
Use of Services
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Commercial
Member Months
(Any)
Age
Male
Female
0-12
13-17
18-64
65+
Unknown
Total
NR
NR
Total
NR
NR
NR
NR
NR
NR
Any Services
Sex
M
F
Total
M
13-17
F
Total
M
18-64
F
Total
M
65+
F
Total
Unknown M
F
Total
Total
M
F
Total
Age
Number
0-12
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2010 (Reporting Year 2009)
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 87
Use of Services
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Medicare Advantage
Member Months
(Any)
Age
Male
Female
0-12
13-17
18-64
65+
Unknown
Total
NR
NR
Total
NR
NR
NR
NR
NR
NR
Sex
M
F
Total
M
13-17
F
Total
M
18-64
F
Total
M
65+
F
Total
Unknown M
F
Total
Total
M
F
Total
Age
Number
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2010 (Reporting Year 2009)
Male
Female
NR
NR
Total
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
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Inpatient
Any Services
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
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 88
Use of Services
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jan 6, 2011 10:23 AM
MSHO
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
0
0
0
6324
0
6324
Female
0
0
0
18475
0
18475
Total
0
0
0
24799
0
24799
Any Services
Sex
M
F
Total
M
13-17
F
Total
M
18-64
F
Total
M
65+
F
Total
Unknown M
F
Total
Total
M
F
Total
Age
0-12
Number
0
0
0
0
0
0
0
0
0
69
185
254
0
0
0
69
185
254
HEDIS 2010 (Reporting Year 2009)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
0
0
0
6324
0
6324
Female
0
0
0
18475
0
18475
Total
0
0
0
24799
0
24799
Number
0
0
0
0
0
0
0
0
0
26
86
112
0
0
0
26
86
112
Female
0
0
0
18475
0
18475
Total
0
0
0
24799
0
24799
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
13.09%
12.02%
12.29%
NA
NA
NA
13.09%
12.02%
12.29%
Male
0
0
0
6324
0
6324
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.93%
5.59%
5.42%
NA
NA
NA
4.93%
5.59%
5.42%
Number
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
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
Member Months
(Outpatient/ED)
Male
0
0
0
6324
0
6324
Female
0
0
0
18475
0
18475
Total
0
0
0
24799
0
24799
Outpatient/ED
Number
0
0
0
0
0
0
0
0
0
47
115
162
0
0
0
47
115
162
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
8.92%
7.47%
7.84%
NA
NA
NA
8.92%
7.47%
7.84%
Page 89
Use of Services
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jan 6, 2011 10:23 AM
SNBC
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
0
0
1144
26
0
1170
Female
0
0
1862
17
0
1879
Total
0
0
3006
43
0
3049
Any Services
Sex
M
F
Total
M
13-17
F
Total
M
18-64
F
Total
M
65+
F
Total
Unknown M
F
Total
Total
M
F
Total
Age
0-12
Number
0
0
0
0
0
0
53
110
163
1
1
2
0
0
0
54
111
165
HEDIS 2010 (Reporting Year 2009)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
0
0
1144
26
0
1170
Female
0
0
1862
17
0
1879
Total
0
0
3006
43
0
3049
Number
0
0
0
0
0
0
6
9
15
0
0
0
0
0
0
6
9
15
Female
0
0
1862
17
0
1879
Total
0
0
3006
43
0
3049
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
NA
NA
NA
NA
NA
NA
55.59%
70.89%
65.07%
46.15%
70.59%
55.81%
NA
NA
NA
55.38%
70.89%
64.94%
Male
0
0
1144
26
0
1170
Percent
NA
NA
NA
NA
NA
NA
6.29%
5.80%
5.99%
0.00%
0.00%
0.00%
NA
NA
NA
6.15%
5.75%
5.90%
Number
0
0
0
0
0
0
3
1
4
0
0
0
0
0
0
3
1
4
Percent
NA
NA
NA
NA
NA
NA
3.15%
0.64%
1.60%
0.00%
0.00%
0.00%
NA
NA
NA
3.08%
0.64%
1.57%
Member Months
(Outpatient/ED)
Male
0
0
1144
26
0
1170
Female
0
0
1862
17
0
1879
Total
0
0
3006
43
0
3049
Outpatient/ED
Number
0
0
0
0
0
0
52
110
162
1
1
2
0
0
0
53
111
164
Percent
NA
NA
NA
NA
NA
NA
54.55%
70.89%
64.67%
46.15%
70.59%
55.81%
NA
NA
NA
54.36%
70.89%
64.55%
Page 90
Use of Services
Prime West
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jan 6, 2011 10:23 AM
Minnesota Health Care Programs - Managed Care(MHCP-MC
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
47967
10411
27604
2
0
85984
Female
45766
10281
53695
2
0
109744
Total
93733
20692
81299
4
0
195728
Any Services
Sex
M
F
Total
M
13-17
F
Total
M
18-64
F
Total
M
65+
F
Total
Unknown M
F
Total
Total
M
F
Total
Age
0-12
Number
508
390
898
219
253
472
561
1186
1747
0
0
0
0
0
0
1288
1829
3117
HEDIS 2010 (Reporting Year 2009)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
47967
10411
27604
2
0
85984
Female
45766
10281
53695
2
0
109744
Total
93733
20692
81299
4
0
195728
Number
7
4
11
11
29
40
34
76
110
0
0
0
0
0
0
52
109
161
Female
45766
10281
53695
2
0
109744
Total
93733
20692
81299
4
0
195728
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
12.71%
10.23%
11.50%
25.24%
29.53%
27.37%
24.39%
26.51%
25.79%
0.00%
0.00%
0.00%
NA
NA
NA
17.98%
20.00%
19.11%
Male
47967
10411
27604
2
0
85984
Percent
0.18%
0.10%
0.14%
1.27%
3.38%
2.32%
1.48%
1.70%
1.62%
0.00%
0.00%
0.00%
NA
NA
NA
0.73%
1.19%
0.99%
Number
2
2
4
3
6
9
4
22
26
0
0
0
0
0
0
9
30
39
Percent
0.05%
0.05%
0.05%
0.35%
0.70%
0.52%
0.17%
0.49%
0.38%
0.00%
0.00%
0.00%
NA
NA
NA
0.13%
0.33%
0.24%
Member Months
(Outpatient/ED)
Male
47967
10411
27604
2
0
85984
Female
45766
10281
53695
2
0
109744
Total
93733
20692
81299
4
0
195728
Outpatient/ED
Number
507
390
897
217
249
466
551
1170
1721
0
0
0
0
0
0
1275
1809
3084
Percent
12.68%
10.23%
11.48%
25.01%
29.06%
27.02%
23.95%
26.15%
25.40%
0.00%
0.00%
0.00%
NA
NA
NA
17.79%
19.78%
18.91%
Page 91
Health Plan Descriptive Information
Prime West
Board Certification
Data Last Refreshed:
Jan 6, 2011 10:23 AM
MSHO
Type of Physician
Family Medicine
Internal Medicine
Geriatricians
Other practitioner Specialists
HEDIS 2010 (Reporting Year 2009)
Number of Physicians in Active Board Certification
Each Practice Area
Percent
Number
3353
3146
148
6588
2921
2803
146
5877
87.12%
89.10%
98.65%
89.21%
Page 92
Health Plan Descriptive Information
Prime West
Board Certification
Data Last Refreshed:
Jan 6, 2011 10:23 AM
SNBC
Type of Physician
Family Medicine
Internal Medicine
Geriatricians
Other practitioner Specialists
HEDIS 2010 (Reporting Year 2009)
Number of Physicians in Active Board Certification
Each Practice Area
Percent
Number
3353
3146
148
6588
2921
2803
146
5877
87.12%
89.10%
98.65%
89.21%
Page 93
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
NR
NR
NR
NR
NR
NR
NR
Page 94
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jan 6, 2011 10:23 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 2010 (Reporting Year 2009)
Page 95
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jan 6, 2011 10:23 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%
845
1008
1034
1248
1177
1012
0
0.00%
1765
1845
2495
3029
4085
5256
0
0.00%
6324
100.00%
0
18475
100.00%
0
24799
100.00%
6324
18475
HEDIS 2010 (Reporting Year 2009)
0
0
0
0
0
0
0
0
0
2610
2853
3529
4277
5262
6268
0
24799
Page 96
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jan 6, 2011 10:23 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
17
Member Months
Female
0
0
0
0
0
1
Total
0
0
0
0
0
18
17
1.45%
65
54
55
87
98
1
0.05%
15
91
159
110
222
18
0.59%
359
30.68%
200
260
173
135
597
31.77%
274
290
434
266
956
31.35%
768
65.64%
26
0
0
0
0
0
1264
67.27%
17
0
0
0
0
0
2032
66.64%
26
2.22%
0
17
0.90%
0
43
1.41%
1170
1879
HEDIS 2010 (Reporting Year 2009)
80
145
214
197
320
474
550
607
401
43
0
0
0
0
0
0
3049
Page 97
Health Plan Descriptive Information
Prime West
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jan 6, 2011 10:23 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
6984
17971
15614
11819
5990
2436
Member Months
Female
6642
16521
14996
11810
6078
4308
Total
13626
34492
30610
23629
12068
6744
60814
70.73%
4392
4362
3903
3191
2883
60355
55.00%
12605
11585
7720
6056
4436
121169
61.91%
18731
21.78%
2700
2015
1239
483
42402
38.64%
3317
1957
1042
669
61133
31.23%
6437
7.49%
1
1
0
0
0
0
6985
6.36%
2
0
0
0
0
0
13422
6.86%
2
0.00%
0
2
0.00%
0
4
0.00%
85984
109744
HEDIS 2010 (Reporting Year 2009)
16997
15947
11623
9247
7319
6017
3972
2281
1152
3
1
0
0
0
0
0
195728
Page 98