Metropolitan Health Plan
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
Metropolitan Health Plan
Weight Assessment and Counseling for Nutrition and Physical Activity
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Weight Assessment and Counseling for Nutrition and Physical Activity
Data Last Refreshed:
Jan 6, 2011 9:55 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
2173
939
3112
2173
939
3112
2173
939
3112
63
2.90%
27
2.88%
90
2.89%
122
5.61%
43
4.58%
165
5.30%
0
0.00%
1
0.11%
1
0.03%
0
0.00%
0
0.00%
0
0.00%
411
0.00%
411
0.00%
473
411
0.00%
473
11
2.33%
6
1.27%
17
3.59%
473
19
4.02%
6
1.27%
25
5.29%
Number of Records Excluded Because of
Valid Data Errors
0
0
0
Number of administrative data records
excluded
28
28
28
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)
277
134
411
277
134
411
277
134
411
9
172
65.34%
59.56%
71.13%
4
74
58.21%
49.48%
66.93%
13
246
63.02%
58.23%
67.81%
17
187
73.65%
68.28%
79.01%
3
78
60.45%
51.80%
69.10%
20
265
69.34%
64.76%
73.92%
0
184
66.43%
60.68%
72.17%
0
76
56.72%
47.95%
65.48%
0
260
63.26%
58.48%
68.04%
Page 4
Effectiveness of Care
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Jan 6, 2011 9:55 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
182
48.92%
217
58.33%
305
81.99%
272
73.12%
191
51.34%
309
83.06%
173
46.51%
86
23.12%
184
49.46%
216
58.06%
182
48.92%
217
58.33%
305
81.99%
272
73.12%
191
51.34%
309
83.06%
173
46.51%
86
23.12%
184
49.46%
216
58.06%
182
146
88.17%
84.76%
91.59%
217
137
95.16%
92.85%
97.48%
305
47
94.62%
92.20%
97.05%
272
87
96.51%
94.50%
98.51%
191
162
94.89%
92.52%
97.26%
309
44
94.89%
92.52%
97.26%
173
145
85.48%
81.77%
89.20%
86
37
33.06%
28.15%
37.98%
184
93
74.46%
69.90%
79.03%
216
41
69.09%
64.26%
73.92%
372
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
372
0
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
372
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
372
Page 7
Effectiveness of Care
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Jan 6, 2011 9:55 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
147
39.52%
134
36.02%
46
12.37%
110
29.57%
106
28.49%
36
9.68%
40
10.75%
87
23.39%
30
8.06%
147
39.52%
134
36.02%
46
12.37%
110
29.57%
106
28.49%
36
9.68%
40
10.75%
87
23.39%
30
8.06%
147
166
84.14%
80.29%
87.99%
134
167
80.91%
76.79%
85.04%
46
64
29.57%
24.80%
34.34%
110
138
66.67%
61.74%
71.59%
106
131
63.71%
58.69%
68.73%
36
58
25.27%
20.72%
29.82%
40
52
24.73%
20.21%
29.25%
87
112
53.49%
48.29%
58.70%
30
48
20.97%
16.70%
25.24%
372
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
372
0
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
372
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
372
Page 8
Effectiveness of Care
Metropolitan Health Plan
Breast Cancer Screening
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2010 (Reporting Year 2009)
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Commercial
NR
NR
NR
Medicare
Advantage
MSHO
SNBC
MHCP-MC
2009
A
31
24
77.42%
61.09%
93.75%
2009
A
32
18
56.25%
37.50%
75.00%
2009
A
4
2
NA
NA
NA
2009
A
288
188
65.28%
59.61%
70.95%
Page 9
Effectiveness of Care
Metropolitan Health Plan
Cervical Cancer Screening
Data Elements
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Commercial
MHCP-MC
Measurement Year
Data Collection Methodology
Eligible Member Population
2009
H
1198
Numerator Events by Admin Data on Eligible
Population (before exclusions)
783
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
65.36%
411
15.00%
473
315
66.60%
2
10
5
0
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
NR
7
411
279
28
74.70%
Lower 95% Confidence Interval
Upper 95% Confidence Interval
NR
NR
70.37%
79.02%
HEDIS 2010 (Reporting Year 2009)
Page 10
Effectiveness of Care
Metropolitan Health Plan
Colorectal Cancer Screening
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Data Elements
Commercial
Measurement Year
Data collection methodology (administrative or hybrid)
Eligible population
Medicare
Advantage
2009
A
74
Number of numerator events by administrative data in eligible population
(before exclusions)
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of valid data errors
Number of administrative data records excluded
Number of medical record data records excluded
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical records
NR
NR
NR
NR
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
NR
NR
NR
HEDIS 2010 (Reporting Year 2009)
29
39.19%
27.39%
50.99%
MSHO
SNBC
2009
H
282
2009
H
3
65
0
23.05%
281
0.00%
281
65
23.13%
0
1
0
0
0
281
65
70
48.04%
42.02%
54.06%
0.00%
3
0.00%
3
0
0.00%
0
0
0
0
0
3
0
0
NA
NA
NA
Page 11
Effectiveness of Care
Metropolitan Health Plan
Chlamydia Screening in Women
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Chlamydia Screening in Women
Data Last Refreshed:
Jan 6, 2011 9:55 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
248
173
69.76%
63.84%
75.68%
149
111
74.50%
67.16%
81.83%
397
284
71.54%
66.97%
76.10%
Page 13
Effectiveness of Care
Metropolitan Health Plan
Glaucoma Screening in Older Adults
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2010 (Reporting Year 2009)
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Medicare
Advantage
MSHO
2009
A
79
58
73.42%
63.04%
83.79%
2009
A
618
472
76.38%
72.95%
79.81%
Page 14
Effectiveness of Care
Metropolitan Health Plan
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Lead Screening in Children
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
MHCP-MC
2009
A
372
Numerator Events by Admin Data on Eligible
Population (before exclusions)
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
339
Reported Rate
91.13%
Lower 95% Confidence Interval
88.11%
Upper 95% Confidence Interval
94.15%
HEDIS 2010 (Reporting Year 2009)
Page 15
Effectiveness of Care
Metropolitan Health Plan
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Care for Older Adults
MSHO
Medication Review
Functional
Status
Assessment
Pain
Screening
0
1
0
0
0.00%
0.14%
0.00%
0.00%
0
0.00%
1
0.21%
0
0.00%
0
0.00%
0
132
1
371
0
254
0
233
Reported Rate
32.12%
90.51%
61.80%
56.69%
Lower 95% Confidence Interval
27.48%
87.56%
56.98%
51.78%
Upper 95% Confidence Interval
36.75%
93.47%
66.62%
61.60%
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General Measure
Data
2009
H
700
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
411
15.00%
473
Records Excluded because of Valid Data
Errors
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
HEDIS 2010 (Reporting Year 2009)
Advance Care
Planning
0
411
Page 16
Effectiveness of Care
Metropolitan Health Plan
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Medicare Advantage
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
0
0
Page 17
Effectiveness of Care
Metropolitan Health Plan
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Jan 6, 2011 9:55 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
27
64.29%
48.60%
79.97%
36
85.71%
73.94%
97.49%
2009
A
42
0
0
Page 18
Effectiveness of Care
Metropolitan Health Plan
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Jan 6, 2011 9:55 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
3
NA
NA
NA
3
NA
NA
NA
2009
A
3
0
0
Page 19
Effectiveness of Care
Metropolitan Health Plan
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2010 (Reporting Year 2009)
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Medicare
Advantage
MSHO
SNBC
2009
A
0
0
NA
NA
NA
2009
A
21
2
NA
NA
NA
2009
A
0
0
NA
NA
NA
Page 20
Effectiveness of Care
Metropolitan Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Jan 6, 2011 9:55 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
56
52
92.86%
85.22%
100.00%
99
89
89.90%
83.46%
96.34%
155
141
90.97%
86.13%
95.80%
2009
A
Page 22
Effectiveness of Care
Metropolitan Health Plan
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Jan 6, 2011 9:55 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
10
0
NA
NA
NA
NA
NA
NA
2009
A
12
Page 24
Effectiveness of Care
Metropolitan Health Plan
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Jan 6, 2011 9:55 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
15
0
68.18%
0.00%
15
0
68.18%
0.00%
15
2
0
10
NA
NA
NA
NA
NA
NA
2009
H
22
22
0.00%
22
0
0
0
22
Page 25
Effectiveness of Care
Metropolitan Health Plan
Controlling High Blood Pressure
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Medicare
Advantage
MSHO
SNBC
MHCP-MC
Measurement Year
Data Collection Methodology (Hybrid)
Eligible Member Population
2009
H
66
2009
H
344
2009
H
17
2009
H
402
Numerator Events by Admin Data on
Eligible Population (before exclusions)
0
0
0
0
0.00%
63
0.00%
63
0.00%
316
0.00%
316
0.00%
17
0.00%
17
0.00%
384
0.00%
384
0
0.00%
0
0.00%
0
0.00%
0
0.00%
Records Excluded because of Valid Data
Errors
0
0
0
0
Number of records excluded because of
false positive diagnoses
0
0
0
Number of administrative data records
excluded
3
34
0
18
Number of medical record data records
excluded
0
2
0
0
Number of employee/dependent medical
records excluded
0
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
63
0
50
79.37%
68.58%
90.15%
0
314
0
202
64.33%
58.87%
69.79%
0
17
0
14
NA
NA
NA
0
384
0
223
58.07%
53.01%
63.14%
Data Elements
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
Page 26
Effectiveness of Care
Metropolitan Health Plan
Persistence of Beta Blocker Treatment After Hearth Attack
Data Elements
Commercial
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
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Medicare
Advantage
MSHO
SNBC
MHCP-MC
2009
A
0
2009
A
7
2009
A
0
2009
A
11
0
7
0
9
NR
NR
NR
NA
NA
NA
NR
NR
NR
NA
NA
NA
Page 27
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Medicare Advantage
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
40
2009
H
40
40
100.00%
40
0%
40
38
95.00%
40
100.00%
40
0%
40
3
7.50%
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
40
2009
H
40
2009
H
40
2009
H
40
2009
H
40
2009
H
40
2009
H
40
0
0.00%
40
0%
40
0
0.00%
30
75.00%
40
0%
40
30
75.00%
37
92.50%
40
0%
40
35
87.50%
0
0.00%
40
0%
40
0
0.00%
37
92.50%
40
0%
40
37
92.50%
0
0.00%
40
0%
40
0
0.00%
0
0.00%
40
0%
40
0
0.00%
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
40
38
2
100.00%
98.75%
100.00%
0
40
2
1
7.50%
0.00%
16.91%
0
40
0
35
87.50%
76.00%
99.00%
0
40
30
3
82.50%
69.47%
95.53%
0
40
35
3
95.00%
87.00%
100.00%
0
40
0
27
67.50%
51.73%
83.27%
0
40
37
0
92.50%
83.09%
100.00%
0
40
0
32
80.00%
66.35%
93.65%
0
40
0
24
60.00%
43.57%
76.43%
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 29
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Jan 6, 2011 9:55 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
122
2009
H
122
110
90.16%
122
0%
122
92
75.41%
122
100.00%
122
0%
122
1
0.82%
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
122
2009
H
122
2009
H
122
2009
H
122
2009
H
122
2009
H
122
2009
H
122
0
0.00%
122
0%
122
0
0.00%
89
72.95%
122
0%
122
89
72.95%
82
67.21%
122
0%
122
81
66.39%
0
0.00%
122
0%
122
0
0.00%
114
93.44%
122
0%
122
114
93.44%
0
0.00%
122
0%
122
0
0.00%
0
0.00%
122
0%
122
0
0.00%
Blood
Blood
Monitoring
Pressure
Pressure
for Diabetic
<140/90 mm <130/80
Nephropathy
Hg
mm Hg
7
7
7
7
7
7
7
7
7
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
115
92
21
98.26%
95.44%
100.00%
0
115
3
14
14.78%
7.86%
21.70%
0
115
0
81
70.43%
61.66%
79.21%
0
115
85
5
78.26%
70.29%
86.23%
0
115
76
13
77.39%
69.31%
85.47%
0
115
0
60
52.17%
42.61%
61.74%
0
115
109
1
95.65%
91.49%
99.81%
0
115
0
87
75.65%
67.37%
83.93%
0
115
0
52
45.22%
35.69%
54.75%
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
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Jan 6, 2011 9:55 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
11
2009
H
11
11
100.00%
11
0%
11
8
72.73%
11
100.00%
11
0%
11
0
0.00%
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
11
2009
H
11
2009
H
11
2009
H
11
2009
H
11
2009
H
11
2009
H
11
0
0.00%
11
0%
11
0
0.00%
5
45.45%
11
0%
11
5
45.45%
10
90.91%
11
0%
11
9
81.82%
0
0.00%
11
0%
11
0
0.00%
10
90.91%
11
0%
11
10
90.91%
0
0.00%
11
0%
11
0
0.00%
0
0.00%
11
0%
11
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
11
8
3
NA
NA
NA
0
11
0
3
NA
NA
NA
0
11
0
6
NA
NA
NA
0
11
5
0
NA
NA
NA
0
11
9
1
NA
NA
NA
0
11
0
7
NA
NA
NA
0
11
10
0
NA
NA
NA
0
11
0
11
NA
NA
NA
0
11
0
9
NA
NA
NA
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
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Jan 6, 2011 9:55 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
247
2009
H
247
2009
H
247
2009
H
247
2009
H
247
2009
H
247
2009
H
247
2009
H
247
2009
H
247
2009
H
247
204
82.59%
242
0%
242
186
76.86%
247
100.00%
242
0%
242
3
1.24%
0
0.00%
242
0%
242
0
0.00%
0
0.00%
242
0%
242
0
0.00%
114
46.15%
242
0%
242
113
46.69%
152
61.54%
242
0%
242
146
60.33%
0
0.00%
242
0%
242
0
0.00%
189
76.52%
242
0%
242
188
77.69%
0
0.00%
242
0%
242
0
0.00%
0
0.00%
242
0%
242
0
0.00%
17
17
17
17
17
17
17
17
17
17
4
4
4
4
4
4
4
4
4
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
225
0
132
58.67%
52.01%
65.32%
0
225
110
16
56.00%
49.29%
62.71%
0
225
144
26
75.56%
69.72%
81.39%
0
225
0
100
44.44%
37.73%
51.16%
0
225
182
2
81.78%
76.51%
87.04%
0
225
0
160
71.11%
64.97%
77.26%
0
225
0
109
48.44%
41.69%
55.20%
Number of Administrative required exclusions
0
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
0
0
225
181
24
91.11%
87.17%
95.05%
0
225
20
52
32.00%
25.68%
38.32%
0
186
0
78
41.94%
34.58%
49.30%
Page 32
Effectiveness of Care
Metropolitan Health Plan
Osteoporosis Management in Women Who had a Fracture
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2010 (Reporting Year 2009)
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Medicare
Advantage
MSHO
2009
A
0
0
NA
NA
NA
2009
A
22
1
NA
NA
NA
Page 33
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Jan 6, 2011 9:55 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
Effective
Continuation
Phase
Treatment
2009
A
1
1
NA
NA
NA
1
NA
NA
NA
Page 35
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Jan 6, 2011 9:55 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
10
2
NA
NA
NA
0
NA
NA
NA
Page 36
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Jan 6, 2011 9:55 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
2
1
NA
NA
NA
1
NA
NA
NA
Page 37
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Jan 6, 2011 9:55 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
106
32
30.19%
20.98%
39.40%
18
16.98%
9.36%
24.60%
Page 38
Effectiveness of Care
Metropolitan Health Plan
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Jan 6, 2011 9:55 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
39
15
38.46%
21.91%
55.01%
9
3
NA
NA
NA
2009
A
Page 40
Effectiveness of Care
Metropolitan Health Plan
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Jan 6, 2011 9:55 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
2
NA
NA
NA
2
NA
NA
NA
2009
A
5
Page 41
Effectiveness of Care
Metropolitan Health Plan
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Jan 6, 2011 9:55 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
0
NA
NA
NA
2009
A
8
Page 42
Effectiveness of Care
Metropolitan Health Plan
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Jan 6, 2011 9:55 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
13
NA
NA
NA
6
NA
NA
NA
2009
A
25
Page 43
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jan 6, 2011 9:55 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
64
60
93.75%
87.04%
100.00%
2
1
NA
NA
NA
52
48
92.31%
84.10%
100.00%
2
1
NA
NA
NA
120
110
91.67%
86.30%
97.03%
2009
A
Page 45
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jan 6, 2011 9:55 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
334
312
93.41%
90.60%
96.22%
8
8
NA
NA
NA
281
271
96.44%
94.10%
98.79%
32
28
87.50%
74.48%
100.00%
655
619
94.50%
92.68%
96.33%
2009
A
Page 46
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jan 6, 2011 9:55 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
11
11
NA
NA
NA
0
0
NA
NA
NA
10
10
NA
NA
NA
4
1
NA
NA
NA
25
22
NA
NA
NA
2009
A
Page 47
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jan 6, 2011 9:55 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
203
174
85.71%
80.65%
90.77%
3
3
NA
NA
NA
191
167
87.43%
82.47%
92.40%
18
12
NA
NA
NA
415
356
85.78%
82.30%
89.26%
2009
A
Page 48
Access/Availability of Care
Metropolitan Health Plan
Medication Reconciliation Post Discharge
Data Elements
Measurement Year
Data collection methodology (Administrative or Hybrid)
Eligible member population
Number of numerator events by administrative data in eligible
population (before exclusions)
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of valid
data errors
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2010 (Reporting Year 2009)
Data Last Refreshed:
Jan 6, 2011 9:55 AM
MSHO
2009
H
384
0
0.00%
263
0%
263
0
0.00%
0
0
0
263
0
190
72.24%
66.64%
77.85%
Page 49
Effectiveness of Care
Metropolitan Health Plan
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Jan 6, 2011 9:55 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
Total
2009
A
0
0
NA
NA
NA
5
1
NA
NA
NA
0
0
NA
NA
NA
5
1
NA
NA
NA
Page 50
Effectiveness of Care
Metropolitan Health Plan
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Jan 6, 2011 9:55 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
10
3
NA
NA
NA
155
39
25.16%
18.01%
32.32%
28
4
NA
NA
NA
193
46
23.83%
17.56%
30.10%
Page 51
Effectiveness of Care
Metropolitan Health Plan
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Jan 6, 2011 9:55 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
2009
A
153
At least 1
Prescription
At least 2
Prescriptions
17
11.11%
5.80%
16.42%
2
1.31%
0.00%
3.43%
Page 52
Effectiveness of Care
Metropolitan Health Plan
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Jan 6, 2011 9:55 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
700
At least 1
Prescription
At least 2
Prescriptions
132
18.86%
15.89%
21.83%
26
3.71%
2.24%
5.19%
Page 53
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Medicare Advantage
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
6
32
153
191
6
29
146
NA
NA
NA
90.63%
78.96%
100.00%
95.42%
91.79%
99.06%
181
94.76%
91.34%
98.19%
2009
A
Page 55
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jan 6, 2011 9:55 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
700
700
0
0
678
NA
NA
NA
NA
NA
NA
96.86%
95.49%
98.22%
678
96.86%
95.49%
98.22%
2009
A
Page 56
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jan 6, 2011 9:55 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
18
36
1
55
17
36
1
NA
NA
NA
100.00%
98.61%
100.00%
NA
NA
NA
54
98.18%
93.74%
100.00%
2009
A
Page 57
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jan 6, 2011 9:55 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
1424
975
1
2400
1232
854
0
86.52%
84.71%
88.33%
87.59%
85.47%
89.71%
NA
NA
NA
2086
86.92%
85.55%
88.29%
2009
A
Page 58
Access/Availability of Care
Metropolitan Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Jan 6, 2011 9:55 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.
619
602
1452
1336
812
751
903
819
97.25%
95.89%
98.62%
92.01%
90.58%
93.44%
92.49%
90.61%
94.36%
90.70%
88.75%
92.65%
2009
A
Page 60
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Medicare Advantage
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
6
6
0
0
3
0
3
0
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Page 62
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jan 6, 2011 9:55 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
34
0
34
0
0
19
1
19
1
NA
NA
NA
NA
NA
NA
55.88%
37.72%
74.04%
2.94%
0.00%
10.09%
55.88%
37.72%
74.04%
2.94%
0.00%
10.09%
Page 63
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jan 6, 2011 9:55 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
21
21
0
0
7
2
7
2
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Page 64
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jan 6, 2011 9:55 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
28
600
628
7
2
151
26
158
28
NA
NA
NA
NA
NA
NA
25.17%
21.61%
28.72%
4.33%
2.62%
6.05%
25.16%
21.69%
28.63%
4.46%
2.76%
6.15%
Page 65
Access/Availability of Care
Metropolitan Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Timeliness of
Prenatal Care
Postpartum
Care
2009
A
931
2009
A
931
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
796
659
85.50%
83.18%
87.81%
70.78%
67.81%
73.76%
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 67
Use of Services
Metropolitan Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
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
6
6
13
25
48
97
393
1.02%
0.12%
1.92%
1.02%
0.12%
1.92%
2.21%
0.94%
3.48%
4.25%
2.54%
5.97%
8.16%
5.87%
10.46%
16.50%
13.41%
19.58%
66.84%
62.95%
70.73%
2009
A
588
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 69
Use of Services
Metropolitan Health Plan
Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life
Data Elements
Commercial
Measurement Year
Data Collection Methodology
Eligible Member Population
Data Last Refreshed:
Jan 6, 2011 9:55 AM
MHCP-MC
2009
A
1116
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)
840
NR
NR
NR
75.27%
72.69%
77.84%
Page 70
Use of Services
Metropolitan Health Plan
Adolescent Well-Care Visits
Data Elements
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Commercial
Measurement Year
Data Collection Methodology
Eligible Member Population
MHCP-MC
2009
A
1624
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)
688
NR
NR
NR
42.36%
39.93%
44.80%
Page 71
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Medicare Advantage
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
0
0
0
91
483
1495
444
116
0
2629
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
59
382
1004
242
81
0
1768
HEDIS 2010 (Reporting Year 2009)
Visits/ 1,000
Member
Months
NA
NA
NA
648.35
790.89
671.57
545.05
698.28
672.50
Emergency Room Visits
Visits
0
0
0
5
11
35
16
6
0
73
Visits/ 1,000
Member
Months
NA
NA
NA
54.95
22.77
23.41
36.04
51.72
27.77
Ambulatory
Surgery/Procedures
Procedures
0
0
0
2
25
46
14
1
0
88
Procedures/
1,000 Member
Months
NA
NA
NA
21.98
51.76
30.77
31.53
8.62
33.47
Observation Room Stays
Resulting in Discharge
Stays
0
0
0
1
2
1
0
0
0
4
Stays/ 1,000
Member
Months
NA
NA
NA
10.99
4.14
0.67
0.00
0.00
1.52
Page 73
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Jan 6, 2011 9:55 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
4114
3882
1327
0
9323
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
3773
3463
939
0
8175
HEDIS 2010 (Reporting Year 2009)
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
917.11
892.07
707.61
876.86
Emergency Room Visits
Visits
0
0
0
0
0
275
214
50
0
539
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
66.84
55.13
37.68
57.81
Ambulatory
Surgery/Procedures
Procedures
0
0
0
0
0
259
234
36
0
529
Procedures/
1,000 Member
Months
NA
NA
NA
NA
NA
62.96
60.28
27.13
56.74
Observation Room Stays
Resulting in Discharge
Stays
0
0
0
0
0
16
30
2
0
48
Stays/ 1,000
Member
Months
NA
NA
NA
NA
NA
3.89
7.73
1.51
5.15
Page 74
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Jan 6, 2011 9:55 AM
SNBC
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
0
0
6
608
1059
9
0
0
0
1682
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
1
498
1052
5
0
0
0
1556
HEDIS 2010 (Reporting Year 2009)
Visits/ 1,000
Member
Months
NA
NA
166.67
819.08
993.39
555.56
NA
NA
925.09
Emergency Room Visits
Visits
0
0
0
193
204
1
0
0
0
398
Visits/ 1,000
Member
Months
NA
NA
0.00
317.43
192.63
111.11
NA
NA
236.62
Ambulatory
Surgery/Procedures
Procedures
0
0
0
12
52
0
0
0
0
64
Procedures/
1,000 Member
Months
NA
NA
0.00
19.74
49.10
0.00
NA
NA
38.05
Observation Room Stays
Resulting in Discharge
Stays
0
0
0
1
6
0
0
0
0
7
Stays/ 1,000
Member
Months
NA
NA
0.00
1.64
5.67
0.00
NA
NA
4.16
Page 75
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Jan 6, 2011 9:55 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
14080
65173
43062
49858
21242
37
0
0
0
193452
Outpatient Visits (Excludes
MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
0
31770
11354
29150
12576
81
10
0
0
84941
HEDIS 2010 (Reporting Year 2009)
Visits/ 1,000
Member
Months
0.00
487.47
263.67
584.66
592.03
2189.19
NA
NA
439.08
Emergency Room Visits
Visits
0
7142
2269
6429
2295
12
0
0
0
18147
Visits/ 1,000
Member
Months
0.00
109.59
52.69
128.95
108.04
324.32
NA
NA
93.81
Ambulatory
Surgery/Procedures
Procedures
0
718
498
1757
895
4
0
0
0
3872
Procedures/
1,000 Member
Months
0.00
11.02
11.56
35.24
42.13
108.11
NA
NA
20.02
Observation Room Stays
Resulting in Discharge
Stays
0
40
33
150
66
3
0
0
0
292
Stays/ 1,000
Member
Months
0.00
0.61
0.77
3.01
3.11
81.08
NA
NA
1.51
Page 76
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Data Last Refreshed:
Jan 6, 2011 9:55 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 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
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Medicare Advantage
Age
Member Months
<1
0
1-9
0
10-19
0
20-44
91
45-64
483
65-74
1495
75-84
444
85+
116
Unknown
0
Total
2629
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Discharges
Discharges /
1,000 Member
Months
0
0
0
1
13
25
3
2
0
44
NA
NA
NA
10.99
26.92
16.72
6.76
17.24
0
0
0
0
7
12
2
2
0
23
NA
NA
NA
0.00
14.49
8.03
4.50
17.24
0
0
0
1
6
12
1
0
0
20
NA
NA
NA
10.99
12.42
8.03
2.25
0.00
0
0
0
0
0
NA
0.00
0.00
HEDIS 2010 (Reporting Year 2009)
16.74
8.75
7.61
0.00
Days
Days / 1,000
Member
Months
0
0
0
5
43
116
9
6
0
179
NA
NA
NA
54.95
89.03
77.59
20.27
51.72
0
0
0
0
23
42
5
6
0
76
NA
NA
NA
0.00
47.62
28.09
11.26
51.72
0
0
0
5
20
72
4
0
0
101
NA
NA
NA
54.95
41.41
48.16
9.01
0.00
0
0
0
0
0
68.09
28.91
38.42
NA
0.00
0.00
0.00
Average
Length of Stay
NA
NA
NA
5.00
3.31
4.64
3.00
3.00
NA
4.07
NA
NA
NA
NA
3.29
3.50
2.50
3.00
NA
3.30
NA
NA
NA
5.00
3.33
6.00
4.00
NA
NA
5.05
NA
NA
NA
NA
NA
Page 78
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
MSHO
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Member Months
0
0
0
0
0
4114
3882
1327
0
9323
Discharges
Discharges /
1,000 Member
Months
0
0
0
0
0
161
176
57
0
394
NA
NA
NA
NA
NA
39.13
45.34
42.95
0
0
0
0
0
121
131
39
0
291
NA
NA
NA
NA
NA
29.41
33.75
29.39
0
0
0
0
0
37
43
17
0
97
NA
NA
NA
NA
NA
8.99
11.08
12.81
0
0
0
0
0
NA
NA
NA
HEDIS 2010 (Reporting Year 2009)
42.26
31.21
10.40
NA
Days
0
0
0
0
0
795
948
246
0
1989
0
0
0
0
0
499
616
168
0
1283
Days / 1,000
Member
Months
NA
NA
NA
NA
NA
193.24
244.20
185.38
213.34
NA
NA
NA
NA
NA
121.29
158.68
126.60
137.62
0
0
0
0
0
285
320
75
0
680
NA
NA
NA
NA
NA
69.28
82.43
56.52
0
0
0
0
0
NA
NA
NA
72.94
NA
Average
Length of Stay
NA
NA
NA
NA
NA
4.94
5.39
4.32
NA
5.05
NA
NA
NA
NA
NA
4.12
4.70
4.31
NA
4.41
NA
NA
NA
NA
NA
7.70
7.44
4.41
NA
7.01
NA
NA
NA
NA
NA
Page 79
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
SNBC
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Member Months
0
0
6
608
1059
9
0
0
0
1682
Discharges
Discharges /
1,000 Member
Months
0
0
0
11
33
0
0
0
0
44
NA
NA
0.00
18.09
31.16
0.00
NA
NA
0
0
0
2
18
0
0
0
0
20
NA
NA
0.00
3.29
17.00
0.00
NA
NA
0
0
0
5
14
0
0
0
0
19
NA
NA
0.00
8.22
13.22
0.00
NA
NA
0
4
1
0
5
0.00
6.58
0.94
HEDIS 2010 (Reporting Year 2009)
26.16
11.89
11.30
2.99
Days
Days / 1,000
Member
Months
0
0
0
37
118
0
0
0
0
155
NA
NA
0.00
60.86
111.43
0.00
NA
NA
0
0
0
12
65
0
0
0
0
77
NA
NA
0.00
19.74
61.38
0.00
NA
NA
0
0
0
14
48
0
0
0
0
62
NA
NA
0.00
23.03
45.33
0.00
NA
NA
0
11
5
0
16
0.00
18.09
4.72
92.15
45.78
36.86
9.56
Average
Length of Stay
NA
NA
NA
3.36
3.58
NA
NA
NA
NA
3.52
NA
NA
NA
6.00
3.61
NA
NA
NA
NA
3.85
NA
NA
NA
2.80
3.43
NA
NA
NA
NA
3.26
NA
2.75
5.00
NA
3.20
Page 80
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Age
Member Months
<1
14080
1-9
65173
10-19
43062
20-44
49858
45-64
21242
65-74
37
75-84
0
85+
0
Unknown
0
Total
193452
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
198
199
241
1289
358
1
0
0
0
2286
14.06
3.05
5.60
25.85
16.85
27.03
NA
NA
165
154
28
189
205
1
0
0
0
742
11.72
2.36
0.65
3.79
9.65
27.03
NA
NA
32
45
25
119
145
0
0
0
0
366
2.27
0.69
0.58
2.39
6.83
0.00
NA
NA
188
981
8
0
1177
4.37
19.68
0.38
HEDIS 2010 (Reporting Year 2009)
11.82
3.84
1.89
10.31
Days
Days / 1,000
Member
Months
853
522
685
3741
1833
3
0
0
0
7637
60.58
8.01
15.91
75.03
86.29
81.08
NA
NA
489
420
86
638
989
3
0
0
0
2625
34.73
6.44
2.00
12.80
46.56
81.08
NA
NA
362
102
84
583
829
0
0
0
0
1960
25.71
1.57
1.95
11.69
39.03
0.00
NA
NA
515
2520
15
0
3050
39.48
13.57
10.13
11.96
50.54
0.71
26.72
Average
Length of Stay
4.31
2.62
2.84
2.90
5.12
3.00
NA
NA
NA
3.34
2.96
2.73
3.07
3.38
4.82
3.00
NA
NA
NA
3.54
11.31
2.27
3.36
4.90
5.72
NA
NA
NA
NA
5.36
2.74
2.57
1.88
NA
2.59
Page 81
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Medicare Advantage
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
0
0
12
0
168
1154
0
1334
Female
0
0
0
0
394
901
0
1295
Total
0
0
12
0
562
2055
0
2629
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
3
3
6
2
1
3
0
0
0
5
4
9
HEDIS 2010 (Reporting Year 2009)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
0
0
12
0
168
1154
0
1334
Female
0
0
0
0
394
901
0
1295
Total
0
0
12
0
562
2055
0
2629
Inpatient
Percent
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
NA
NA
NA
21.43%
9.14%
12.81%
2.08%
1.33%
1.75%
NA
NA
NA
4.50%
3.71%
4.11%
Number
0
0
0
0
0
0
0
0
0
0
0
0
2
1
3
0
1
1
0
0
0
2
2
4
Percent
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
NA
NA
NA
14.29%
3.05%
6.41%
0.00%
1.33%
0.58%
NA
NA
NA
1.80%
1.85%
1.83%
Male
0
0
12
0
168
1154
0
1334
Female
0
0
0
0
394
901
0
1295
Total
0
0
12
0
562
2055
0
2629
Member Months
(Outpatient/ED)
Male
0
0
12
0
168
1154
0
1334
Female
0
0
0
0
394
901
0
1295
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
1
1
Number
0
0
0
0
0
0
0
0
0
0
0
0
3
3
6
2
1
3
0
0
0
5
4
9
Percent
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
NA
NA
NA
0.00%
3.05%
2.14%
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.93%
0.46%
Total
0
0
12
0
562
2055
0
2629
Percent
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
NA
NA
NA
21.43%
9.14%
12.81%
2.08%
1.33%
1.75%
NA
NA
NA
4.50%
3.71%
4.11%
Page 83
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jan 6, 2011 9:55 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
3390
0
3390
Female
0
0
0
0
0
5933
0
5933
Total
0
0
0
0
0
9323
0
9323
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
31
13
44
0
0
0
31
13
44
HEDIS 2010 (Reporting Year 2009)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
0
0
0
0
0
3390
0
3390
Female
0
0
0
0
0
5933
0
5933
Total
0
0
0
0
0
9323
0
9323
Inpatient
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
10.97%
2.63%
5.66%
NA
NA
NA
10.97%
2.63%
5.66%
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
18
9
27
0
0
0
18
9
27
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
6.37%
1.82%
3.48%
NA
NA
NA
6.37%
1.82%
3.48%
Male
0
0
0
0
0
3390
0
3390
Female
0
0
0
0
0
5933
0
5933
Total
0
0
0
0
0
9323
0
9323
Member Months
(Outpatient/ED)
Male
0
0
0
0
0
3390
0
3390
Female
0
0
0
0
0
5933
0
5933
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
29
11
40
0
0
0
29
11
40
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
9323
0
9323
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
10.27%
2.22%
5.15%
NA
NA
NA
10.27%
2.22%
5.15%
Page 84
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jan 6, 2011 9:55 AM
SNBC
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
0
0
41
98
667
0
0
806
Female
0
0
26
92
749
9
0
876
Total
0
0
67
190
1416
9
0
1682
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
1
0
1
7
5
12
37
41
78
0
0
0
0
0
0
45
46
91
HEDIS 2010 (Reporting Year 2009)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Member Months
(Any)
Male
0
0
41
98
667
0
0
806
Female
0
0
26
92
749
9
0
876
Total
0
0
67
190
1416
9
0
1682
Inpatient
Percent
NA
NA
NA
NA
NA
NA
29.27%
0.00%
17.91%
85.71%
65.22%
75.79%
66.57%
65.69%
66.10%
NA
0.00%
0.00%
NA
NA
NA
67.00%
63.01%
64.92%
Number
0
0
0
0
0
0
0
0
0
4
4
8
11
16
27
0
0
0
0
0
0
15
20
35
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
48.98%
52.17%
50.53%
19.79%
25.63%
22.88%
NA
0.00%
0.00%
NA
NA
NA
22.33%
27.40%
24.97%
Male
0
0
41
98
667
0
0
806
Female
0
0
26
92
749
9
0
876
Total
0
0
67
190
1416
9
0
1682
Member Months
(Outpatient/ED)
Male
0
0
41
98
667
0
0
806
Female
0
0
26
92
749
9
0
876
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
0
0
0
0
0
0
0
0
0
3
2
5
0
2
2
0
0
0
0
0
0
3
4
7
Number
0
0
0
0
0
0
1
0
1
7
5
12
37
40
77
0
0
0
0
0
0
45
45
90
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
36.73%
26.09%
31.58%
0.00%
3.20%
1.69%
NA
0.00%
0.00%
NA
NA
NA
4.47%
5.48%
4.99%
Total
0
0
67
190
1416
9
0
1682
Percent
NA
NA
NA
NA
NA
NA
29.27%
0.00%
17.91%
85.71%
65.22%
75.79%
66.57%
64.09%
65.25%
NA
0.00%
0.00%
NA
NA
NA
67.00%
61.64%
64.21%
Page 85
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Member Months
Member Months
(Any)
(Inpatient)
Age
Male
Female
Male
Female
Total
0-12
47449
46801
94250
47449
46801
13-17
10063
10780
20843
10063
10780
18-24
7354
13331
20685
7354
13331
25-34
6880
13868
20748
6880
13868
35-64
18975
17914
36889
18975
17914
65+
26
11
37
26
11
Unknown
0
0
0
0
0
Total
90747
102705
193452
90747
102705
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
3
3
6
34
31
65
133
97
230
199
144
343
670
292
962
0
0
0
0
0
0
1039
567
1606
HEDIS 2010 (Reporting Year 2009)
Total
94250
20843
20685
20748
36889
37
0
193452
Inpatient
Percent
0.08%
0.08%
0.08%
4.05%
3.45%
3.74%
21.70%
8.73%
13.34%
34.71%
12.46%
19.84%
42.37%
19.56%
31.29%
0.00%
0.00%
0.00%
NA
NA
NA
13.74%
6.62%
9.96%
Number
0
0
0
5
8
13
20
26
46
38
31
69
148
73
221
0
0
0
0
0
0
211
138
349
Percent
0.00%
0.00%
0.00%
0.60%
0.89%
0.75%
3.26%
2.34%
2.67%
6.63%
2.68%
3.99%
9.36%
4.89%
7.19%
0.00%
0.00%
0.00%
NA
NA
NA
2.79%
1.61%
2.16%
Member Months
(Intensive Outpatient/Partial
Male
Female
Total
47449
46801
94250
10063
10780
20843
7354
13331
20685
6880
13868
20748
18975
17914
36889
26
11
37
0
0
0
90747
102705
193452
Male
47449
10063
7354
6880
18975
26
0
90747
Member Months
(Outpatient/ED)
Female
46801
10780
13331
13868
17914
11
0
102705
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
0
0
0
2
2
4
8
4
12
12
4
16
33
13
46
0
0
0
0
0
0
55
23
78
Number
3
3
6
34
31
65
132
90
222
198
137
335
657
290
947
0
0
0
0
0
0
1024
551
1575
Percent
0.00%
0.00%
0.00%
0.24%
0.22%
0.23%
1.31%
0.36%
0.70%
2.09%
0.35%
0.93%
2.09%
0.87%
1.50%
0.00%
0.00%
0.00%
NA
NA
NA
0.73%
0.27%
0.48%
Total
94250
20843
20685
20748
36889
37
0
193452
Percent
0.08%
0.08%
0.08%
4.05%
3.45%
3.74%
21.54%
8.10%
12.88%
34.53%
11.85%
19.38%
41.55%
19.43%
30.81%
0.00%
0.00%
0.00%
NA
NA
NA
13.54%
6.44%
9.77%
Page 86
Use of Services
Metropolitan Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Medicare Advantage
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
0
0
180
1154
0
1334
Female
0
0
394
901
0
1295
Total
0
0
574
2055
0
2629
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
0
0
0
0
0
5
14
19
4
5
9
0
0
0
9
19
28
HEDIS 2010 (Reporting Year 2009)
Male
0
0
180
1154
0
1334
Female
0
0
394
901
0
1295
Total
0
0
574
2055
0
2629
Percent
NA
NA
NA
NA
NA
NA
33.33%
42.64%
39.72%
4.16%
6.66%
5.26%
NA
NA
NA
8.10%
17.61%
12.78%
Number
0
0
0
0
0
0
1
1
2
1
0
1
0
0
0
2
1
3
Male
0
0
180
1154
0
1334
Female
0
0
394
901
0
1295
Total
0
0
574
2055
0
2629
Intensive Outpatient/Partial
Hospitalization
Inpatient
Any Services
0-12
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Percent
NA
NA
NA
NA
NA
NA
6.67%
3.05%
4.18%
1.04%
0.00%
0.58%
NA
NA
NA
1.80%
0.93%
1.37%
Number
0
0
0
0
0
0
0
2
2
1
1
2
0
0
0
1
3
4
Percent
NA
NA
NA
NA
NA
NA
0.00%
6.09%
4.18%
1.04%
1.33%
1.17%
NA
NA
NA
0.90%
2.78%
1.83%
Member Months
(Outpatient/ED)
Male
0
0
180
1154
0
1334
Female
0
0
394
901
0
1295
Total
0
0
574
2055
0
2629
Outpatient/ED
Number
0
0
0
0
0
0
5
14
19
4
5
9
0
0
0
9
19
28
Percent
NA
NA
NA
NA
NA
NA
33.33%
42.64%
39.72%
4.16%
6.66%
5.26%
NA
NA
NA
8.10%
17.61%
12.78%
Page 88
Use of Services
Metropolitan Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jan 6, 2011 9:55 AM
MSHO
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
0
0
0
3390
0
3390
Female
0
0
0
5933
0
5933
Total
0
0
0
9323
0
9323
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
59
91
150
0
0
0
59
91
150
HEDIS 2010 (Reporting Year 2009)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
0
0
0
3390
0
3390
Female
0
0
0
5933
0
5933
Total
0
0
0
9323
0
9323
Number
0
0
0
0
0
0
0
0
0
5
9
14
0
0
0
5
9
14
Female
0
0
0
5933
0
5933
Total
0
0
0
9323
0
9323
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
20.88%
18.41%
19.31%
NA
NA
NA
20.88%
18.41%
19.31%
Male
0
0
0
3390
0
3390
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.77%
1.82%
1.80%
NA
NA
NA
1.77%
1.82%
1.80%
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
3390
0
3390
Female
0
0
0
5933
0
5933
Total
0
0
0
9323
0
9323
Outpatient/ED
Number
0
0
0
0
0
0
0
0
0
56
88
144
0
0
0
56
88
144
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
19.82%
17.80%
18.53%
NA
NA
NA
19.82%
17.80%
18.53%
Page 89
Use of Services
Metropolitan Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jan 6, 2011 9:55 AM
SNBC
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
0
0
806
0
0
806
Female
0
0
867
9
0
876
Total
0
0
1673
9
0
1682
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
80
86
166
0
0
0
0
0
0
80
86
166
HEDIS 2010 (Reporting Year 2009)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
0
0
806
0
0
806
Female
0
0
867
9
0
876
Total
0
0
1673
9
0
1682
Number
0
0
0
0
0
0
9
13
22
0
0
0
0
0
0
9
13
22
Female
0
0
867
9
0
876
Total
0
0
1673
9
0
1682
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
NA
NA
NA
NA
NA
NA
119.11%
119.03%
119.07%
NA
0.00%
0.00%
NA
NA
NA
119.11%
117.81%
118.43%
Male
0
0
806
0
0
806
Percent
NA
NA
NA
NA
NA
NA
13.40%
17.99%
15.78%
NA
0.00%
0.00%
NA
NA
NA
13.40%
17.81%
15.70%
Number
0
0
0
0
0
0
5
12
17
0
0
0
0
0
0
5
12
17
Percent
NA
NA
NA
NA
NA
NA
7.44%
16.61%
12.19%
NA
0.00%
0.00%
NA
NA
NA
7.44%
16.44%
12.13%
Member Months
(Outpatient/ED)
Male
0
0
806
0
0
806
Female
0
0
867
9
0
876
Total
0
0
1673
9
0
1682
Outpatient/ED
Number
0
0
0
0
0
0
80
86
166
0
0
0
0
0
0
80
86
166
Percent
NA
NA
NA
NA
NA
NA
119.11%
119.03%
119.07%
NA
0.00%
0.00%
NA
NA
NA
119.11%
117.81%
118.43%
Page 90
Use of Services
Metropolitan Health Plan
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Minnesota Health Care Programs - Managed Care(MHCP-MC
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
47449
10063
33209
26
0
90747
Female
46801
10780
45113
11
0
102705
Total
94250
20843
78322
37
0
193452
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
311
210
521
147
158
305
838
982
1820
0
0
0
0
0
0
1296
1350
2646
HEDIS 2010 (Reporting Year 2009)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
47449
10063
33209
26
0
90747
Female
46801
10780
45113
11
0
102705
Total
94250
20843
78322
37
0
193452
Number
8
2
10
6
17
23
57
47
104
0
0
0
0
0
0
71
66
137
Female
46801
10780
45113
11
0
102705
Total
94250
20843
78322
37
0
193452
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
7.87%
5.38%
6.63%
17.53%
17.59%
17.56%
30.28%
26.12%
27.88%
0.00%
0.00%
0.00%
NA
NA
NA
17.14%
15.77%
16.41%
Male
47449
10063
33209
26
0
90747
Percent
0.20%
0.05%
0.13%
0.72%
1.89%
1.32%
2.06%
1.25%
1.59%
0.00%
0.00%
0.00%
NA
NA
NA
0.94%
0.77%
0.85%
Number
30
21
51
15
15
30
59
63
122
0
0
0
0
0
0
104
99
203
Percent
0.76%
0.54%
0.65%
1.79%
1.67%
1.73%
2.13%
1.68%
1.87%
0.00%
0.00%
0.00%
NA
NA
NA
1.38%
1.16%
1.26%
Member Months
(Outpatient/ED)
Male
47449
10063
33209
26
0
90747
Female
46801
10780
45113
11
0
102705
Total
94250
20843
78322
37
0
193452
Outpatient/ED
Number
310
209
519
147
158
305
837
981
1818
0
0
0
0
0
0
1294
1348
2642
Percent
7.84%
5.36%
6.61%
17.53%
17.59%
17.56%
30.24%
26.09%
27.85%
0.00%
0.00%
0.00%
NA
NA
NA
17.11%
15.75%
16.39%
Page 91
Health Plan Descriptive Information
Metropolitan Health Plan
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Board Certification
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
Metropolitan Health Plan
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Board Certification
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
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jan 6, 2011 9:55 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
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Medicare Advantage
<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%
12
0
0
19
13
0
0.00%
0
0
0
12
35
0
0.00%
44
3.30%
17
19
54
46
47
3.63%
64
85
111
87
91
3.46%
136
10.19%
591
330
126
72
35
0
347
26.80%
396
178
143
103
57
24
483
18.37%
1154
86.51%
0
901
69.58%
0
2055
78.17%
1334
1295
HEDIS 2010 (Reporting Year 2009)
12
0
0
31
48
81
104
165
133
987
508
269
175
92
24
0
2629
Page 95
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jan 6, 2011 9:55 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%
559
1205
948
449
189
40
0
0.00%
754
1596
1311
1174
665
433
0
0.00%
3390
100.00%
0
5933
100.00%
0
9323
100.00%
3390
5933
HEDIS 2010 (Reporting Year 2009)
0
0
0
0
0
0
0
0
0
1313
2801
2259
1623
854
473
0
9323
Page 96
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jan 6, 2011 9:55 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
6
Member Months
Female
0
0
0
0
0
0
Total
0
0
0
0
0
6
6
0.74%
35
33
65
64
51
0
0.00%
26
52
40
84
158
6
0.36%
248
30.77%
199
146
132
75
360
41.10%
177
187
118
25
608
36.15%
552
68.49%
0
0
0
0
0
0
507
57.88%
9
0
0
0
0
0
1059
62.96%
0
0.00%
0
9
1.03%
0
9
0.54%
806
876
HEDIS 2010 (Reporting Year 2009)
61
85
105
148
209
376
333
250
100
9
0
0
0
0
0
0
1682
Page 97
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jan 6, 2011 9:55 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Male
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
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 98