Metropolitan Health Plan
General Info
Disclaimers
Data Last Refreshed: 1/10/2011
2
Effectiveness of Care Measures
Code
HEDIS 2009 (Reporting Year 2008)
Page
Page
Prevention and Screening
0 Code
Access / Availability of Care Measures
Page
25 AAP
Adult's Access to Preventive/Ambulatory Health Services
57
Children's and Adolescents' Access to Primary Care Practitioners
63
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
65
Prenatal and Postpartum Care
71
CIS
Childhood Immunization Status
3
26 CAP
BCS
Breast Cancer Screening
5
27
CCS
Cervical Cancer Screening
6
28 PPC
COL
Colorectal Cancer Screening
7
CHL
Chlamydia Screening in Women
8
GSO
Glaucoma Screening in Older Adults
10
29 W15
Well Child Visits in the First 15 Months of Life
73
LSC
Lead Screening in Children
11
30 W34
Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life
75
31 AWC
Adolescent Well-Care Visits
76
Respiratory Conditions
IET
Use of Services Measures
0 Code
Page
URI
Appropriate Treatment for Children with Upper Respiratory Infection
12
32 FSP
Frequency of Selected Procedures
77
PCE
Pharmacotherapy Management of COPD Exacerbation
13
33 AMB
Ambulatory Care
83
SPR
Use of Spirometry Testing in the Assessment and Diagnosis of COPD
17
34
Inpatient Utilization - General Hospital/Acute Care
89
ASM
Use of Appropriate Medications for People with Asthma
18
35 NON
Inpatient Utilization - Nonacute Care
95
Identification of Alcohol and Other Drug Services
101
36 IAD
Cardiovascular
CMC
Cholesterol Management for Patients with Cardiovascular Conditions
20
CBP
Controlling High Blood Pressure
26
PBH
Persistence of Beta Blocker Treatment After Hearth Attack
27
Diabetes
CDC
Comprehensive Diabetes Care
Osteoporosis Management in Women Who had a Fracture
37
MPT
38 ORX
0 Code
28
Musculoskeletal
OMW
IPU
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Outpatient Drug Utilization
Health Plan Descriptive Information Measures
107
113
Page
39 BCR
Board Certification
119
40 ENP
Enrollment by Product Line (Age & Sex)
122
34
Behavioral Health
0 Code
AMM
Antidepressant Medication Management
35
ADD
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
41
FUH
Follow-up After Hospitalization for Mental Illness
43
Medication Management
MPM
Annual Monitoring for Patients on Persistent Medications
47
DDE
Potentially Harmful Drug-Disease Interactions in the Elderly
53
DAE
Use of High Risk Medications in the Elderly
55
41
YIB
Health Plan Stability Measures
Years in Business / Total Membership
Page
128
DISCLAIMERS
-1
0. Disclaimer Query located below
1. In January 2011, it was discovered that the Good HbA1c Control (<7.0%) was not displayed in
comprehensive diabetes care measure and Adequate HbA1c Control (<8.0%) data was displayed
under Good HbA1c Control. This issue was corrected on January 10,2011.
HEDIS 2009 (Reporting Year 2008)
Page 2
Effectiveness of Care
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Commercial
Data Elements
General
Measure
Data
DTaP
IPV
MMR
HiB
Hepatitis B
VZV
Pneumococcal
Conjugate
Combo 2
Combo 3
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 2009 (Reporting Year 2008)
Page 3
Effectiveness of Care
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Jan 10, 2011 10:01 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
Pneumococcal
Conjugate
Combo 2
Combo 3
117
65.73%
126
70.79%
160
89.89%
151
84.83%
120
67.42%
158
88.76%
112
62.92%
98
55.06%
91
51.12%
117
65.73%
126
70.79%
160
89.89%
151
84.83%
120
67.42%
158
88.76%
112
62.92%
98
55.06%
91
51.12%
117
39
87.64%
82.52%
92.76%
126
40
93.26%
89.29%
97.22%
160
8
94.38%
90.72%
98.05%
151
21
96.63%
93.70%
99.56%
120
45
92.70%
88.59%
96.80%
158
8
93.26%
89.29%
97.22%
112
36
83.15%
77.37%
88.93%
98
48
82.02%
76.10%
87.94%
91
46
76.97%
70.50%
83.43%
178
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 2009 (Reporting Year 2008)
MMR
178
0.00%
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
2008
H
178
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
DTaP
178
Page 4
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 2009 (Reporting Year 2008)
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Commercial
NR
NR
NR
Medicare
Advantage
MSHO
2008
A
14
12
NA
NA
NA
2008
A
36
27
75.00%
59.47%
90.53%
MnDHO
SNBC
MHCP-MC
NR
NR
NR
2008
A
3
1
NA
NA
NA
2008
A
344
204
59.30%
53.97%
64.64%
Page 5
Effectiveness of Care
Metropolitan Health Plan
Cervical Cancer Screening
Data Elements
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Commercial
MHCP-MC
Measurement Year
Data Collection Methodology
Eligible Member Population
2008
H
1084
Numerator Events by Admin Data on Eligible
Population (before exclusions)
712
Current Year's Admin Rate
NR
Records Excluded because of Valid Data Errors
65.68%
411
15.00%
473
323
68.29%
0
Number of administrative data records excluded
5
Number of medical record data records excluded
9
Number of employee/dependent medical records
excluded
0
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
NR
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 2009 (Reporting Year 2008)
NR
NR
NR
9
411
286
22
74.94%
70.63%
79.25%
Page 6
Effectiveness of Care
Metropolitan Health Plan
Colorectal Cancer Screening
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Data Elements
Commercial
Measurement Year
Data collection methodology (administrative or hybrid)
Eligible population
Number of numerator events by administrative data in eligible population
(before exclusions)
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
NR
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
NR
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical records
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2009 (Reporting Year 2008)
NR
NR
NR
Medicare
Advantage
2008
H
23
MSHO
MnDHO
2008
H
473
7
124
30.43%
23
0
23
7
30.43%
0
0
0
0
0
23
7
6
NA
NA
NA
26.22%
411
0.15
471
124
26.33%
0
2
0
0
0
411
103
98
48.91%
43.95%
53.86%
SNBC
2008
H
1
NR
NR
NR
NR
NR
NR
NR
1
0
1
NA
NA
NA
Page 7
Effectiveness of Care
Metropolitan Health Plan
Chlamydia Screening in Women
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Commercial
Data Elements
General
Measure Ages 16-20 Ages 21-24
Data
Total
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2009 (Reporting Year 2008)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 8
Effectiveness of Care
Metropolitan Health Plan
Chlamydia Screening in Women
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
General
Data Elements
Measure Ages 16-20 Ages 21-24
Data
Measurement Year
2008
Data Collection Methodology
A
Eligible Member Population
247
131
Numerator Events by Admin Data
172
98
Reported Rate
69.64%
74.81%
Lower 95% Confidence Interval
63.70%
66.99%
Upper 95% Confidence Interval
75.57%
82.62%
HEDIS 2009 (Reporting Year 2008)
Total
378
270
71.43%
66.74%
76.12%
Page 9
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 2009 (Reporting Year 2008)
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Medicare
Advantage
MSHO
2008
A
13
8
NA
NA
NA
2008
A
635
489
77.01%
73.66%
80.36%
Page 10
Effectiveness of Care
Metropolitan Health Plan
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Lead Screening in Children
Data Elements
Commercial
Measurement Year
Data Collection Methodology
Eligible Member Population
MHCP-MC
2008
A
178
Numerator Events by Admin Data on Eligible
Population (before exclusions)
Current Year's Admin Rate
NR
NR
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
NR
NR
Records Excluded because of Valid Data
Errors
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
162
Reported Rate
NR
91.01%
Lower 95% Confidence Interval
NR
86.53%
Upper 95% Confidence Interval
NR
95.49%
HEDIS 2009 (Reporting Year 2008)
Page 11
Effectiveness of Care
Metropolitan Health Plan
Appropriate Treatment for Children with Upper Respiratory Infection
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 2009 (Reporting Year 2008)
Commercial
MHCP-MC
NR
NR
NR
2008
A
235
10
95.74%
92.95%
98.54%
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Page 12
Effectiveness of Care
Metropolitan Health Plan
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
3
NA
NA
NA
3
NA
NA
NA
2008
A
3
0
Page 13
Effectiveness of Care
Metropolitan Health Plan
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
41
56.16%
44.10%
68.23%
66
90.41%
82.97%
97.85%
2008
A
73
0
Page 14
Effectiveness of Care
Metropolitan Health Plan
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MnDHO
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 2009 (Reporting Year 2008)
Page 15
Effectiveness of Care
Metropolitan Health Plan
Pharmacotherapy Management of COPD Exacerbation
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure Data
Systemic
corticosteroid
Bronchodilator
1
NA
NA
NA
1
NA
NA
NA
2008
A
1
0
Page 16
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 2009 (Reporting Year 2008)
Medicare
Advantage
MSHO
2008
A
0
0
NA
NA
NA
2008
A
29
1
NA
NA
NA
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MnDHO
SNBC
NR
NR
NR
2008
A
0
0
NA
NA
NA
Page 17
Effectiveness of Care
Metropolitan Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure Data
Ages 5-9
NR
NR
NR
Ages 10-17
NR
NR
NR
Ages 18-56
Total
NR
NR
NR
NR
NR
NR
NR
NR
Page 18
Effectiveness of Care
Metropolitan Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure Data
Ages 5-9
Ages 10-17
Ages 18-56
Total
28
27
NA
NA
NA
59
56
94.92%
88.46%
100.00%
46
39
84.78%
73.32%
96.25%
133
122
91.73%
86.67%
96.79%
2008
A
Page 19
Effectiveness of Care
Metropolitan Health Plan
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 20
Effectiveness of Care
Metropolitan Health Plan
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
1
0
100.00%
0.00%
1
0
100.00%
0.00%
1
0
0
1
NA
NA
NA
NA
NA
NA
2008
H
1
1
0.00%
1
0
0
0
1
Page 21
Effectiveness of Care
Metropolitan Health Plan
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MSHO
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 2009 (Reporting Year 2008)
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
28
0
59.57%
0.00%
28
0
60.87%
0.00%
28
6
0
25
73.91%
60.14%
87.69%
54.35%
38.87%
69.83%
2008
H
47
46
0.00%
46
0
0
0
46
Page 22
Effectiveness of Care
Metropolitan Health Plan
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MnDHO
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 2009 (Reporting Year 2008)
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 10, 2011 10:01 AM
SNBC
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 2009 (Reporting Year 2008)
General
Measure
Data
2008
H
0
LDL-C
screening
LDL-C Level of
<100 mg/dL
0
0
NA
NA
NR
NR
0
0
0
0
NA
NA
NA
NA
NA
NA
0
0.00%
0
0
0
0
0
Page 24
Effectiveness of Care
Metropolitan Health Plan
Cholesterol Management for Patients with Cardiovascular Conditions
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
General
Measure
Data
2008
H
48
LDL-C
screening
LDL-C Level of
<100 mg/dL
35
0
72.92%
0.00%
34
0
72.34%
0.00%
34
6
0
20
85.11%
42.55%
Lower 95% Confidence Interval
73.86%
27.35%
Upper 95% Confidence Interval
96.35%
57.75%
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
47
0.00%
47
Records Excluded because of Valid Data Errors
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
0
0
47
HEDIS 2009 (Reporting Year 2008)
Page 25
Effectiveness of Care
Metropolitan Health Plan
Controlling High Blood Pressure
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Medicare
Advantage
MSHO
Measurement Year
Data Collection Methodology (Hybrid)
Eligible Member Population
2008
H
42
Numerator Events by Admin Data on
Eligible Population (before exclusions)
Data Elements
SNBC
MHCP-MC
2008
H
354
2008
H
1
2008
H
549
0
0
0
0
0.00%
42
0.00%
42
0.00%
331
0.00%
331
0.00%
0
0.00%
1
0.00%
411
0.00%
473
0
0.00%
0
0.00%
0
0.00%
0
0.00%
Records Excluded because of Valid Data
Errors
0
1
0
3
Number of records excluded because of
false positive diagnoses
0
0
0
0
Number of administrative data records
excluded
0
22
0
30
Number of medical record data records
excluded
0
0
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
42
0
26
61.90%
46.03%
77.78%
0
330
0
209
63.33%
57.98%
68.68%
0
1
0
1
NA
NA
NA
2
411
0
244
59.37%
54.50%
64.24%
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 2009 (Reporting Year 2008)
Commercial
NR
NR
NR
NR
NR
MnDHO
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 2009 (Reporting Year 2008)
NR
NR
NR
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Medicare
Advantage
MSHO
2008
A
0
MnDHO
SNBC
MHCP-MC
2008
A
6
2008
A
0
2008
A
9
0
6
0
3
NR
NR
NR
NA
NA
NA
NR
NR
NR
NA
NA
NA
NR
NR
NR
Page 27
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Commercial
Data Elements
HbA1c
Testing
Poor HbA1c
Control
Good HbA1c
Control
(<7.0%)
Adequate
HbA1c
Control
(<8.0%)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Blood
Monitoring
Pressure
for Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<130/80 mm
Hg
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
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 2009 (Reporting Year 2008)
Page 28
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Jan 10, 2011 10:01 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
Good HbA1c
Control
(<7.0%)
Adequate
HbA1c
Control
(<8.0%)
2008
H
28
2008
H
28
2008
H
28
26
92.86%
28
0%
28
26
92.86%
28
100.00%
28
0%
28
12
42.86%
Blood
Monitoring
Pressure
for Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<130/80 mm
Hg
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
2008
H
28
2008
H
28
2008
H
28
2008
H
28
2008
H
28
2008
H
28
2008
H
28
0
0.00%
1
0%
1
0
0.00%
0
0.00%
28
0%
28
0
0.00%
16
57.14%
28
0%
28
16
57.14%
23
82.14%
28
0%
28
23
82.14%
0
0.00%
28
0%
28
0
0.00%
25
89.29%
28
0%
28
25
89.29%
0
0.00%
28
0%
28
0
0.00%
0
0.00%
28
0%
28
0
0.00%
0
0
0
0
0
0
0
0
0
0
Number of administrative data records
excluded
0
0
27
0
0
0
0
0
0
0
Number of medical record data records
excluded
0
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
0
28
26
0
NA
NA
NA
0
28
12
3
NA
NA
NA
0
1
0
0
NA
NA
NA
0
28
0
12
NA
NA
NA
0
28
16
3
NA
NA
NA
0
28
23
0
NA
NA
NA
0
28
0
12
NA
NA
NA
0
28
25
0
NA
NA
NA
0
28
0
15
NA
NA
NA
0
28
0
10
NA
NA
NA
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 2009 (Reporting Year 2008)
Page 29
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Jan 10, 2011 10:01 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
Good HbA1c
Control
(<7.0%)
Adequate
HbA1c
Control
(<8.0%)
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
2008
H
130
2008
H
130
2008
H
130
2008
H
130
2008
H
130
2008
H
130
2008
H
130
2008
H
130
2008
H
130
2008
H
130
114
87.69%
129
0%
129
97
75.19%
130
100.00%
129
0%
129
9
6.98%
0
0.00%
0
0%
0
0
NR
0
0.00%
129
0%
129
0
0.00%
95
73.08%
129
0%
129
94
72.87%
83
63.85%
129
0%
129
74
57.36%
0
0.00%
129
0%
129
0
0.00%
121
93.08%
129
0%
129
120
93.02%
0
0.00%
129
0%
129
0
0.00%
0
0.00%
129
0%
129
0
0.00%
Blood
Monitoring
Pressure
for Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<130/80 mm
Hg
4
4
0
4
4
4
4
4
4
4
Number of administrative data records
excluded
0
0
130
0
0
0
0
0
0
0
Number of medical record data records
excluded
0
0
1
0
0
0
0
0
0
0
Number of employee/dependent medical
records excluded
0
0
0
0
0
0
0
0
0
0
0
125
97
25
97.60%
94.52%
100.00%
0
125
5
10
12.00%
5.90%
18.10%
0
0
0
0
NA
NA
NA
0
125
0
89
71.20%
62.86%
79.54%
0
125
92
6
78.40%
70.79%
86.01%
0
125
73
19
73.60%
65.47%
81.73%
0
125
0
54
43.20%
34.12%
52.28%
0
125
118
3
96.80%
93.31%
100.00%
0
125
0
86
68.80%
60.28%
77.32%
0
125
0
53
42.40%
33.34%
51.46%
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 2009 (Reporting Year 2008)
Page 30
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MnDHO
Data Elements
HbA1c
Testing
Poor HbA1c
Control
Good HbA1c
Control
(<7.0%)
Adequate
HbA1c
Control
(<8.0%)
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Blood
Monitoring
Pressure
for Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<130/80 mm
Hg
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
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 2009 (Reporting Year 2008)
Page 31
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Jan 10, 2011 10:01 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
Good HbA1c
Control
(<7.0%)
Adequate
HbA1c
Control
(<8.0%)
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
2008
H
0
2008
H
0
2008
H
0
2008
H
0
2008
H
0
2008
H
0
2008
H
0
2008
H
0
2008
H
0
2008
H
0
0
NR
0
0%
0
0
NR
0
NR
0
0%
0
0
NR
0
NR
0
0%
0
0
NR
0
NR
0
0%
0
0
NR
0
NR
0
0%
0
0
NR
0
NR
0
0%
0
0
NR
0
NR
0
0%
0
0
NR
0
NR
0
0%
0
0
NR
0
NR
0
0%
0
0
NR
0
NR
0
0%
0
0
NR
Blood
Monitoring
Pressure
for Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<130/80 mm
Hg
0
0
0
0
0
0
0
0
0
0
Number of administrative data records
excluded
0
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
0
Number of employee/dependent medical
records excluded
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NA
NA
NA
0
0
0
0
NA
NA
NA
0
0
0
0
NA
NA
NA
0
0
0
0
NA
NA
NA
0
0
0
0
NA
NA
NA
0
0
0
0
NA
NA
NA
0
0
0
0
NA
NA
NA
0
0
0
0
NA
NA
NA
0
0
0
0
NA
NA
NA
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 2009 (Reporting Year 2008)
NA
NA
NA
Page 32
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Jan 10, 2011 10:01 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
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
2008
H
351
2008
H
351
2008
H
351
2008
H
351
2008
H
351
2008
H
351
2008
H
351
2008
H
351
2008
H
351
2008
H
351
291
82.91%
345
0%
345
248
71.88%
351
100.00%
345
0%
345
56
16.23%
0
0.00%
0
0%
0
0
NR
0
0.00%
345
0%
345
0
0.00%
185
52.71%
345
0%
345
184
53.33%
233
66.38%
345
0%
345
216
62.61%
0
0.00%
345
0%
345
0
0.00%
266
75.78%
345
0%
345
266
77.10%
0
0.00%
345
0%
345
0
0.00%
0
0.00%
345
0%
345
0
0.00%
Blood
Monitoring
Pressure
for Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<130/80 mm
Hg
9
9
0
9
9
9
9
9
9
9
Number of administrative data records
excluded
3
3
351
3
3
3
3
3
3
3
Number of medical record data records
excluded
0
0
1
0
0
0
0
0
0
0
Number of employee/dependent medical
records excluded
0
0
0
0
0
0
0
0
0
0
0
336
246
61
91.37%
88.22%
94.52%
0
336
42
53
28.27%
23.31%
33.24%
0
0
0
0
NA
NA
NA
0
336
0
202
60.12%
54.73%
65.50%
0
336
182
17
59.23%
53.82%
64.63%
0
336
212
46
76.79%
72.12%
81.45%
0
336
0
140
41.67%
36.25%
47.09%
0
336
261
11
80.95%
76.60%
85.30%
0
336
0
217
64.58%
59.32%
69.85%
0
336
0
139
41.37%
35.95%
46.78%
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 2009 (Reporting Year 2008)
Page 33
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 2009 (Reporting Year 2008)
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Medicare
Advantage
MSHO
2008
A
0
0
NA
NA
NA
2008
A
24
5
NA
NA
NA
Page 34
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General Effective Acute
Measure
Phase
Data
Treatment
NR
NR
NR
Effective
Continuation
Phase
Treatment
NR
NR
NR
Page 35
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General Effective Acute
Measure
Phase
Data
Treatment
Effective
Continuation
Phase
Treatment
2008
A
1
1
NA
NA
NA
1
NA
NA
NA
Page 36
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General Effective Acute
Measure
Phase
Data
Treatment
Effective
Continuation
Phase
Treatment
2008
A
6
6
NA
NA
NA
6
NA
NA
NA
Page 37
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MnDHO
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 2009 (Reporting Year 2008)
General Effective Acute
Measure
Phase
Data
Treatment
NR
NR
NR
Effective
Continuation
Phase
Treatment
NR
NR
NR
Page 38
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General Effective Acute
Measure
Phase
Data
Treatment
Effective
Continuation
Phase
Treatment
2008
A
0
0
NA
NA
NA
0
NA
NA
NA
Page 39
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General Effective Acute
Measure
Phase
Data
Treatment
Effective
Continuation
Phase
Treatment
2008
A
96
42
43.75%
33.31%
54.19%
29
30.21%
20.50%
39.91%
Page 40
Effectiveness of Care
Metropolitan Health Plan
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure
Data
Initiation
Phase
Continuation
and
Maintenance
Phase
NR
NR
NR
NR
NR
NR
Page 41
Effectiveness of Care
Metropolitan Health Plan
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure
Data
Initiation
Phase
Continuation
and
Maintenance
Phase
34
12
35.29%
17.76%
52.83%
8
5
NA
NA
NA
2008
A
Page 42
Effectiveness of Care
Metropolitan Health Plan
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure
Data
30 Days
7 Days
1
NA
NA
NA
1
NA
NA
NA
2008
A
1
Page 43
Effectiveness of Care
Metropolitan Health Plan
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure
Data
30 Days
7 Days
2
NA
NA
NA
2
NA
NA
NA
2008
A
5
Page 44
Effectiveness of Care
Metropolitan Health Plan
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MnDHO
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 2009 (Reporting Year 2008)
General
Measure
Data
30 Days
7 Days
NR
NR
NR
NR
NR
NR
Page 45
Effectiveness of Care
Metropolitan Health Plan
Follow-up After Hospitalization for Mental Illness
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure
Data
30 Days
7 Days
0
NA
NA
NA
0
NA
NA
NA
2008
A
1
Page 46
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
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 47
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
38
31
81.58%
67.94%
95.22%
0
0
NA
NA
NA
40
35
87.50%
76.00%
99.00%
2
1
NA
NA
NA
80
67
83.75%
75.04%
92.46%
2008
A
Page 48
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
332
312
93.98%
91.27%
96.69%
12
11
NA
NA
NA
275
261
94.91%
92.13%
97.69%
34
28
82.35%
68.07%
96.64%
653
612
93.72%
91.78%
95.66%
2008
A
Page 49
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MnDHO
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 2009 (Reporting Year 2008)
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 50
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
0
0
NA
NA
NA
0
0
NA
NA
NA
0
0
NA
NA
NA
0
0
NA
NA
NA
0
0
NA
NA
NA
2008
A
Page 51
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persistent Medications
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
213
190
89.20%
84.80%
93.60%
6
6
NA
NA
NA
210
183
87.14%
82.38%
91.91%
23
18
NA
NA
NA
452
397
87.83%
84.71%
90.96%
2008
A
Page 52
Effectiveness of Care
Metropolitan Health Plan
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
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
2008
A
0
0
NA
NA
NA
1
0
NA
NA
NA
0
0
NA
NA
NA
1
0
NA
NA
NA
Page 53
Effectiveness of Care
Metropolitan Health Plan
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
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
2008
A
12
4
NA
NA
NA
162
33
20.37%
13.86%
26.88%
25
4
NA
NA
NA
199
41
20.60%
14.73%
26.47%
Page 54
Effectiveness of Care
Metropolitan Health Plan
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure
Data
2008
A
75
At least 1
Prescription
At least 2
Prescriptions
11
14.67%
5.99%
23.34%
3
4.00%
0.00%
9.10%
Page 55
Effectiveness of Care
Metropolitan Health Plan
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General
Measure
Data
2008
A
707
At least 1
Prescription
At least 2
Prescriptions
144
20.37%
17.33%
23.41%
22
3.11%
1.76%
4.46%
Page 56
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Commercial
Data Elements
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 2009 (Reporting Year 2008)
Page 57
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
3
21
75
3
20
73
NA
NA
NA
NA
NA
NA
97.33%
93.02%
100.00%
2008
A
Page 58
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
0
0
707
0
0
684
NA
NA
NA
NA
NA
NA
96.75%
95.37%
98.13%
2008
A
Page 59
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MnDHO
Data Elements
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 2009 (Reporting Year 2008)
Page 60
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
2
3
0
2
3
0
NA
NA
NA
NA
NA
NA
NA
NA
NA
2008
A
Page 61
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
1229
920
473
1068
808
444
86.90%
84.97%
88.83%
87.83%
85.66%
89.99%
93.87%
91.60%
96.14%
2008
A
Page 62
Access/Availability of Care
Metropolitan Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Commercial
Data Elements
General Measure
Data
12-24 months
25 months 6 yrs.
7-11 yrs.
12-19 yrs.
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data collection methodology (Administrative
only)
Eligible member population
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2009 (Reporting Year 2008)
Page 63
Access/Availability of Care
Metropolitan Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
General Measure
Data
12-24 months
25 months 6 yrs.
7-11 yrs.
12-19 yrs.
645
634
1196
1068
673
598
854
750
98.29%
97.22%
99.37%
89.30%
87.50%
91.09%
88.86%
86.40%
91.31%
87.82%
85.57%
90.07%
2008
A
Page 64
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 65
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
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
2008
A
0
2
2
0
0
1
0
1
0
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Page 66
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
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
2008
A
0
28
28
0
0
7
0
7
0
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Page 67
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MnDHO
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 2009 (Reporting Year 2008)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 68
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
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
2008
A
0
0
0
0
0
0
0
0
0
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Page 69
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
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
2008
A
30
529
559
6
1
141
28
147
29
20.00%
4.02%
35.98%
3.33%
0.00%
11.42%
26.65%
22.79%
30.52%
5.29%
3.29%
7.30%
26.30%
22.56%
30.04%
5.19%
3.26%
7.12%
Page 70
Access/Availability of Care
Metropolitan Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
Page 71
Access/Availability of Care
Metropolitan Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Timeliness of
Prenatal Care
Postpartum
Care
2008
A
964
2008
A
964
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
831
663
86.20%
83.97%
88.43%
68.78%
65.80%
71.75%
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 2009 (Reporting Year 2008)
Page 72
Use of Services
Metropolitan Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
Page 73
Use of Services
Metropolitan Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Jan 10, 2011 10:01 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
5
4
8
23
60
78
322
1.00%
0.03%
1.97%
0.80%
0.00%
1.68%
1.60%
0.40%
2.80%
4.60%
2.66%
6.54%
12.00%
9.05%
14.95%
15.60%
12.32%
18.88%
64.40%
60.10%
68.70%
2008
A
500
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 2009 (Reporting Year 2008)
Page 74
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 10, 2011 10:01 AM
MHCP-MC
2008
A
957
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
NR
NR
NR
NR
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 2009 (Reporting Year 2008)
693
NR
NR
NR
72.41%
69.53%
75.30%
Page 75
Use of Services
Metropolitan Health Plan
Adolescent Well-Care Visits
Data Elements
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Commercial
Measurement Year
Data Collection Methodology
Eligible Member Population
MHCP-MC
2008
A
1513
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 2009 (Reporting Year 2008)
608
NR
NR
NR
40.19%
37.68%
42.69%
Page 76
Use of Services
Metropolitan Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Commercial
Member Months
Total
Age
0-4
0-9
5-19
10-19
Total
Number of
Procedures
Procedures /
1,000 Member
Months
Procedure
Myringotomy
Age
0-4
5-19
NR
NR
Tonsillectomy
0-9
10-19
NR
NR
Member Months
Age
Male
Female
15-44
20-44
30-64
45-64
65+
Female
Male
Procedure
Age
Dilation & Curettage 15-44
45-64
Hysterectomy,
15-44
Abdominal
45-64
Number of
Procedures
Procedures /
1,000 Member
Months
Number of
Procedures
Procedures /
1,000 Member
Months
NR
NR
65+
NR
NR
NR
Hysterectomy,
Vaginal
15-44
45-64
65+
NR
NR
NR
Cholecystectomy,
Open
30-64
15-44
45-64
65+
NR
30-64
15-44
45-64
65+
20-44
Back Surgery
45-64
65+
Angioplasty (PTCA) 45-64
65+
45-64
Cardiac
Catheterization
65+
45-64
CABG
65+
NR
Prostatectomy
45-64
65+
NR
NR
Mastectomy
15-44
45-64
65+
NR
NR
NR
Lumpectomy
15-44
45-64
65+
NR
NR
NR
Cholecystectomy,
Closed
HEDIS 2009 (Reporting Year 2008)
NR
NR
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
Frequency of Selected Procedures
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Medicare Advantage
Member Months
Age
Male
72
439
52
2
< 65
65-74
75-84
85+
Female
284
415
116
50
Male
Procedure
Age
CABG
<65
65-74
75-84
85+
Angioplasty
(PTCA)
<65
65-74
75-84
85+
Cardiac
Catheterization
<65
65-74
75-84
85+
Carotid
Endarterectomy
<65
65-74
75-84
85+
Reduction of
Fracture of Femur
<65
65-74
75-84
85+
Total Hip
Replacement
<65
65-74
75-84
85+
Total Knee
Replacement
<65
65-74
75-84
85+
Partial Excision of
Large Inestine
<65
65-74
75-84
85+
Cholecystectomy,
Open
<65
65-74
75-84
85+
Cholecystectomy,
Closed
(laparoscopic)
<65
65-74
75-84
85+
Back Surgery
<65
65-74
75-84
85+
Hysterectomy
Abdominal
<65
65-74
75-84
85+
Hysterectomy,
Vaginal
<65
65-74
75-84
85+
Mastectomy
<65
65-74
75-84
85+
Lumpectomy
<65
65-74
75-84
85+
HEDIS 2009 (Reporting Year 2008)
Number of
Procedures
0
0
0
0
1
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
1
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Female
Procedures /
1,000 Member
Months
0.00
0.00
0.00
0.00
13.89
2.28
0.00
0.00
0.00
2.28
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
13.89
2.28
0.00
0.00
0.00
2.28
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Number of
Procedures
0
0
1
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
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Procedures /
1,000 Member
Months
0.00
0.00
8.62
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2.41
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Page 78
Use of Services
Metropolitan Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MSHO
Member Months
Age
Male
0
1845
1360
201
< 65
65-74
75-84
85+
Female
0
2520
2554
1015
Male
Procedure
Age
CABG
<65
65-74
75-84
85+
Angioplasty
(PTCA)
<65
65-74
75-84
85+
Cardiac
Catheterization
<65
65-74
75-84
85+
Carotid
Endarterectomy
<65
65-74
75-84
85+
Reduction of
Fracture of Femur
<65
65-74
75-84
85+
Total Hip
Replacement
<65
65-74
75-84
85+
Total Knee
Replacement
<65
65-74
75-84
85+
Partial Excision of
Large Inestine
<65
65-74
75-84
85+
Cholecystectomy,
Open
<65
65-74
75-84
85+
Cholecystectomy,
Closed
(laparoscopic)
<65
65-74
75-84
85+
Back Surgery
<65
65-74
75-84
85+
Hysterectomy
Abdominal
<65
65-74
75-84
85+
Hysterectomy,
Vaginal
<65
65-74
75-84
85+
Mastectomy
<65
65-74
75-84
85+
Lumpectomy
<65
65-74
75-84
85+
HEDIS 2009 (Reporting Year 2008)
Number of
Procedures
0
0
0
0
0
0
0
0
0
7
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
1
0
0
1
0
0
0
0
0
0
0
0
1
0
0
0
0
0
Female
Procedures /
1,000 Member
Months
NA
0.00
0.00
0.00
NA
0.00
0.00
0.00
NA
3.79
0.74
0.00
NA
0.00
0.00
0.00
NA
0.00
0.00
0.00
NA
0.00
0.74
0.00
NA
0.00
0.74
0.00
NA
0.54
0.00
0.00
NA
0.00
0.00
0.00
NA
0.00
0.74
0.00
NA
0.00
0.00
0.00
Number of
Procedures
0
1
0
0
0
1
0
0
0
8
3
1
0
0
0
0
0
1
2
1
0
0
1
0
0
4
2
0
0
0
0
1
0
0
1
1
0
0
0
1
0
2
1
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
1
0
Procedures /
1,000 Member
Months
NA
0.40
0.00
0.00
NA
0.40
0.00
0.00
NA
3.17
1.17
0.99
NA
0.00
0.00
0.00
NA
0.40
0.78
0.99
NA
0.00
0.39
0.00
NA
1.59
0.78
0.00
NA
0.00
0.00
0.99
NA
0.00
0.39
0.99
NA
0.00
0.00
0.99
NA
0.79
0.39
0.00
NA
0.40
0.39
0.00
NA
0.00
0.00
0.00
NA
0.00
0.00
0.00
NA
0.00
0.39
0.00
Page 79
Use of Services
Metropolitan Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MnDHO
Member Months
Male
Female
Age
< 65
65-74
75-84
85+
Male
Number of
Procedures
Female
Procedures /
1,000 Member
Months
Number of
Procedures
Procedures /
1,000 Member
Months
Procedure
Age
CABG
<65
65-74
75-84
85+
NR
NR
NR
NR
NR
NR
NR
NR
Angioplasty
(PTCA)
<65
65-74
75-84
85+
NR
NR
NR
NR
NR
NR
NR
NR
Cardiac
Catheterization
<65
65-74
75-84
85+
NR
NR
NR
NR
NR
NR
NR
NR
Carotid
Endarterectomy
<65
65-74
75-84
85+
NR
NR
NR
NR
NR
NR
NR
NR
Reduction of
Fracture of Femur
<65
65-74
75-84
85+
NR
NR
NR
NR
NR
NR
NR
NR
Total Hip
Replacement
<65
65-74
75-84
85+
NR
NR
NR
NR
NR
NR
NR
NR
Total Knee
Replacement
<65
65-74
75-84
85+
NR
NR
NR
NR
NR
NR
NR
NR
Partial Excision of
Large Inestine
<65
65-74
75-84
85+
NR
NR
NR
NR
NR
NR
NR
NR
Cholecystectomy,
Open
<65
65-74
75-84
85+
NR
NR
NR
NR
NR
NR
NR
NR
Cholecystectomy,
Closed
(laparoscopic)
<65
65-74
75-84
85+
NR
NR
NR
NR
NR
NR
NR
NR
Back Surgery
<65
65-74
75-84
85+
NR
NR
NR
NR
NR
NR
NR
NR
Hysterectomy
Abdominal
<65
65-74
75-84
85+
NR
NR
NR
NR
Hysterectomy,
Vaginal
<65
65-74
75-84
85+
NR
NR
NR
NR
Mastectomy
<65
65-74
75-84
85+
NR
NR
NR
NR
Lumpectomy
<65
65-74
75-84
85+
NR
NR
NR
NR
HEDIS 2009 (Reporting Year 2008)
Page 80
Use of Services
Metropolitan Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Jan 10, 2011 10:01 AM
SNBC
Member Months
Age
Male
89
0
0
0
< 65
65-74
75-84
85+
Female
186
0
0
0
Male
Procedure
Age
CABG
<65
65-74
75-84
85+
Angioplasty
(PTCA)
<65
65-74
75-84
85+
Cardiac
Catheterization
<65
65-74
75-84
85+
Carotid
Endarterectomy
<65
65-74
75-84
85+
Reduction of
Fracture of Femur
<65
65-74
75-84
85+
Total Hip
Replacement
<65
65-74
75-84
85+
Total Knee
Replacement
<65
65-74
75-84
85+
Partial Excision of
Large Inestine
<65
65-74
75-84
85+
Cholecystectomy,
Open
<65
65-74
75-84
85+
Cholecystectomy,
Closed
(laparoscopic)
<65
65-74
75-84
85+
Back Surgery
<65
65-74
75-84
85+
Hysterectomy
Abdominal
<65
65-74
75-84
85+
Hysterectomy,
Vaginal
<65
65-74
75-84
85+
Mastectomy
<65
65-74
75-84
85+
Lumpectomy
<65
65-74
75-84
85+
HEDIS 2009 (Reporting Year 2008)
Number of
Procedures
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
1
0
0
0
0
0
0
0
0
0
0
0
Female
Procedures /
1,000 Member
Months
0.00
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
11.24
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
Number of
Procedures
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Procedures /
1,000 Member
Months
0.00
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
5.38
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
0.00
NA
NA
NA
Page 81
Use of Services
Metropolitan Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC
Member Months
Total
Age
43778
0-4
74601
0-9
72408
5-19
41585
10-19
Total
Number of
Procedures
Procedure
Myringotomy
Age
Tonsillectomy
0-9
10-19
Procedures /
1,000 Member
Months
114
34
42
14
0-4
5-19
2.60
0.47
0.56
0.34
Member Months
Age
15-44
20-44
30-64
45-64
Male
16178
21004
11654
Female
41612
30593
8887
Male
Procedure
Age
Dilation & Curettage 15-44
45-64
Hysterectomy,
15-44
Abdominal
45-64
Number of
Procedures
Hysterectomy,
Vaginal
15-44
45-64
Cholecystectomy,
Open
30-64
15-44
45-64
1
Cholecystectomy,
Closed
30-64
15-44
45-64
20-44
45-64
5
Back Surgery
Mastectomy
15-44
45-64
Lumpectomy
15-44
45-64
HEDIS 2009 (Reporting Year 2008)
4
10
Female
Procedures /
1,000 Member
Months
Number of
Procedures
Procedures /
1,000 Member
Months
1
0
10
1
1
1
0.02
0.00
0
0
0.00
0.00
36
6
4
7
1
3
8
5
0.87
0.68
0.24
0.11
0.02
0.11
0.05
0.24
0.25
0.86
0.13
0.79
0.02
0.34
0.19
0.56
Page 82
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Commercial
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
Visits/ 1,000
Member
Months
NR
NR
Emergency Room Visits
Visits
NR
NR
NR
NR
NR
NR
NR
HEDIS 2009 (Reporting Year 2008)
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 83
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Jan 10, 2011 10:01 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
57
299
854
168
52
0
1430
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
37
255
685
148
62
0
1187
HEDIS 2009 (Reporting Year 2008)
Visits/ 1,000
Member
Months
NA
NA
NA
649.12
852.84
802.11
880.95
1192.31
830.07
Emergency Room Visits
Visits
0
0
0
3
11
27
14
7
0
62
Visits/ 1,000
Member
Months
NA
NA
NA
52.63
36.79
31.62
83.33
134.62
43.36
Ambulatory
Surgery/Procedures
Procedures
0
0
0
2
24
16
8
3
0
53
Procedures/
1,000 Member
Months
NA
NA
NA
35.09
80.27
18.74
47.62
57.69
37.06
Observation Room Stays
Resulting in Discharge
Stays
0
0
0
0
1
0
1
1
0
3
Stays/ 1,000
Member
Months
NA
NA
NA
0.00
3.34
0.00
5.95
19.23
2.10
Page 84
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Jan 10, 2011 10:01 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
4365
3914
1216
0
9495
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
4133
3548
815
0
8496
HEDIS 2009 (Reporting Year 2008)
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
946.85
906.49
670.23
894.79
Emergency Room Visits
Visits
0
0
0
0
0
267
184
36
0
487
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
61.17
47.01
29.61
51.29
Ambulatory
Surgery/Procedures
Procedures
0
0
0
0
0
268
238
30
0
536
Procedures/
1,000 Member
Months
NA
NA
NA
NA
NA
61.40
60.81
24.67
56.45
Observation Room Stays
Resulting in Discharge
Stays
0
0
0
0
0
11
10
0
0
21
Stays/ 1,000
Member
Months
NA
NA
NA
NA
NA
2.52
2.55
0.00
2.21
Page 85
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MnDHO
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
NR
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
NR
HEDIS 2009 (Reporting Year 2008)
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 86
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Jan 10, 2011 10:01 AM
SNBC
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
0
0
0
126
149
0
0
0
0
275
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
159
134
0
0
0
0
293
HEDIS 2009 (Reporting Year 2008)
Visits/ 1,000
Member
Months
NA
NA
NA
1261.90
899.33
NA
NA
NA
1065.45
Emergency Room Visits
Visits
0
0
0
19
23
0
0
0
0
42
Visits/ 1,000
Member
Months
NA
NA
NA
150.79
154.36
NA
NA
NA
152.73
Ambulatory
Surgery/Procedures
Procedures
0
0
0
7
5
0
0
0
0
12
Procedures/
1,000 Member
Months
NA
NA
NA
55.56
33.56
NA
NA
NA
43.64
Observation Room Stays
Resulting in Discharge
Stays
0
0
0
0
1
0
0
0
0
1
Stays/ 1,000
Member
Months
NA
NA
NA
0.00
6.71
NA
NA
NA
3.64
Page 87
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Jan 10, 2011 10:01 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
15484
59117
41585
46771
20541
5115
1912
1078
0
191603
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
0
28839
10606
26755
12094
3740
1596
635
0
84265
HEDIS 2009 (Reporting Year 2008)
Visits/ 1,000
Member
Months
0.00
487.83
255.04
572.04
588.77
731.18
834.73
589.05
439.79
Emergency Room Visits
Visits
0
6122
2053
5910
2142
215
80
31
0
16553
Visits/ 1,000
Member
Months
0.00
103.56
49.37
126.36
104.28
42.03
41.84
28.76
86.39
Ambulatory
Surgery/Procedures
Procedures
0
614
423
1528
865
234
113
41
0
3818
Procedures/
1,000 Member
Months
0.00
10.39
10.17
32.67
42.11
45.75
59.10
38.03
19.93
Observation Room Stays
Resulting in Discharge
Stays
0
16
81
440
47
6
1
1
0
592
Stays/ 1,000
Member
Months
0.00
0.27
1.95
9.41
2.29
1.17
0.52
0.93
3.09
Page 88
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 10, 2011 10:01 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 2009 (Reporting Year 2008)
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 89
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Medicare Advantage
Age
Member Months
<1
0
1-9
0
10-19
0
20-44
57
45-64
299
65-74
854
75-84
168
85+
52
Unknown
0
Total
1430
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
2
11
21
6
4
0
44
NA
NA
NA
35.09
36.79
24.59
35.71
76.92
0
0
0
1
5
9
3
2
0
20
NA
NA
NA
17.54
16.72
10.54
17.86
38.46
30.77
13.99
0
0
0
1
6
12
2
2
0
23
NA
NA
NA
17.54
20.07
14.05
11.90
38.46
0
0
0
0
0
NA
0.00
0.00
HEDIS 2009 (Reporting Year 2008)
16.08
0.00
Days
0
0
0
3
26
96
16
16
0
157
Days / 1,000
Member
Months
NA
NA
NA
52.63
86.96
112.41
95.24
307.69
109.79
0
0
0
2
8
57
7
11
0
85
NA
NA
NA
35.09
26.76
66.74
41.67
211.54
0
0
0
1
18
39
6
5
0
69
NA
NA
NA
17.54
60.20
45.67
35.71
96.15
0
0
0
0
0
NA
0.00
0.00
59.44
48.25
0.00
Average
Length of Stay
NA
NA
NA
1.50
2.36
4.57
2.67
4.00
NA
3.57
NA
NA
NA
2.00
1.60
6.33
2.33
5.50
NA
4.25
NA
NA
NA
1.00
3.00
3.25
3.00
2.50
NA
3.00
NA
NA
NA
NA
NA
Page 90
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 10, 2011 10:01 AM
Member Months
0
0
0
0
0
4365
3914
1216
0
9495
Discharges
Discharges /
1,000 Member
Months
0
0
0
0
0
231
209
63
0
503
NA
NA
NA
NA
NA
52.92
53.40
51.81
0
0
0
0
0
179
150
45
0
374
NA
NA
NA
NA
NA
41.01
38.32
37.01
0
0
0
0
0
51
58
18
0
127
NA
NA
NA
NA
NA
11.68
14.82
14.80
0
0
0
0
0
HEDIS 2009 (Reporting Year 2008)
52.98
39.39
13.38
NA
NA
NA
NA
Days
Days / 1,000
Member
Months
0
0
0
0
0
1183
1253
284
0
2720
NA
NA
NA
NA
NA
271.02
320.13
233.55
0
0
0
0
0
771
624
182
0
1577
NA
NA
NA
NA
NA
176.63
159.43
149.67
0
0
0
0
0
407
625
102
0
1134
0
0
0
0
0
286.47
166.09
NA
NA
NA
NA
NA
93.24
159.68
83.88
119.43
NA
NA
NA
NA
Average
Length of Stay
NA
NA
NA
NA
NA
5.12
6.00
4.51
NA
5.41
NA
NA
NA
NA
NA
4.31
4.16
4.04
NA
4.22
NA
NA
NA
NA
NA
7.98
10.78
5.67
NA
8.93
NA
NA
NA
NA
NA
Page 91
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
MnDHO
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 10, 2011 10:01 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 2009 (Reporting Year 2008)
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 92
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 10, 2011 10:01 AM
Member Months
0
0
0
126
149
0
0
0
0
275
Discharges
Discharges /
1,000 Member
Months
0
0
0
4
10
0
0
0
0
14
NA
NA
NA
31.75
67.11
NA
NA
NA
0
0
0
1
2
0
0
0
0
3
NA
NA
NA
7.94
13.42
NA
NA
NA
0
0
0
3
8
0
0
0
0
11
NA
NA
NA
23.81
53.69
NA
NA
NA
0
0
0
0
0
HEDIS 2009 (Reporting Year 2008)
50.91
10.91
40.00
NA
0.00
0.00
0.00
Days
Days / 1,000
Member
Months
0
0
0
7
34
0
0
0
0
41
NA
NA
NA
55.56
228.19
NA
NA
NA
0
0
0
2
7
0
0
0
0
9
NA
NA
NA
15.87
46.98
NA
NA
NA
0
0
0
5
27
0
0
0
0
32
NA
NA
NA
39.68
181.21
NA
NA
NA
0
0
0
0
0
149.09
32.73
116.36
NA
0.00
0.00
0.00
Average
Length of Stay
NA
NA
NA
1.75
3.40
NA
NA
NA
NA
2.93
NA
NA
NA
2.00
3.50
NA
NA
NA
NA
3.00
NA
NA
NA
1.67
3.38
NA
NA
NA
NA
2.91
NA
NA
NA
NA
NA
Page 93
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Age
Member Months
<1
15484
1-9
59117
10-19
41585
20-44
46771
45-64
20541
65-74
5115
75-84
1912
85+
1078
Unknown
0
Total
191603
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
228
202
264
1504
459
213
101
65
0
3036
14.72
3.42
6.35
32.16
22.35
41.64
52.82
60.30
185
144
40
233
263
99
59
26
0
1049
11.95
2.44
0.96
4.98
12.80
19.35
30.86
24.12
42
58
39
175
184
103
39
33
0
673
2.71
0.98
0.94
3.74
8.96
20.14
20.40
30.61
185
1096
12
0
1293
4.45
23.43
0.58
HEDIS 2009 (Reporting Year 2008)
15.85
5.47
3.51
11.87
Days
Days / 1,000
Member
Months
938
503
853
4757
2585
1675
953
612
0
12876
60.58
8.51
20.51
101.71
125.85
327.47
498.43
567.72
673
330
224
904
1224
647
628
269
0
4899
43.46
5.58
5.39
19.33
59.59
126.49
328.45
249.54
258
173
87
824
1317
924
309
295
0
4187
16.66
2.93
2.09
17.62
64.12
180.65
161.61
273.65
542
3029
44
0
3615
13.03
64.76
2.14
67.20
25.57
21.85
33.20
Average
Length of Stay
4.11
2.49
3.23
3.16
5.63
7.86
9.44
9.42
NA
4.24
3.64
2.29
5.60
3.88
4.65
6.54
10.64
10.35
NA
4.67
6.14
2.98
2.23
4.71
7.16
8.97
7.92
8.94
NA
6.22
2.93
2.76
3.67
NA
2.80
Page 94
Use of Services
Metropolitan Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
NR
Discharges
NR
HEDIS 2009 (Reporting Year 2008)
Discharges /
1,000 Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Days
NR
Days / 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Average Length
of Stay
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 95
Use of Services
Metropolitan Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Medicare Advantage
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
0
0
0
57
299
854
168
52
0
1430
Discharges
0
0
0
0
0
1
0
0
0
1
HEDIS 2009 (Reporting Year 2008)
Discharges /
1,000 Member
Months
NA
NA
NA
0.00
0.00
1.17
0.00
0.00
0.70
Days
0
0
0
0
0
22
0
0
0
22
Days / 1,000
Member
Months
NA
NA
NA
0.00
0.00
25.76
0.00
0.00
15.38
Average Length
of Stay
NA
NA
NA
NA
NA
22.00
NA
NA
NA
22.00
Page 96
Use of Services
Metropolitan Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MSHO
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
0
0
0
0
0
4365
3914
1216
0
9495
Discharges
0
0
0
0
0
0
1
1
0
2
HEDIS 2009 (Reporting Year 2008)
Discharges /
1,000 Member
Months
NA
NA
NA
NA
NA
0.00
0.26
0.82
0.21
Days
0
0
0
0
0
0
7
1
0
8
Days / 1,000
Member
Months
NA
NA
NA
NA
NA
0.00
1.79
0.82
0.84
Average Length
of Stay
NA
NA
NA
NA
NA
NA
7.00
1.00
NA
4.00
Page 97
Use of Services
Metropolitan Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MnDHO
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
NR
Discharges
NR
HEDIS 2009 (Reporting Year 2008)
Discharges /
1,000 Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Days
NR
Days / 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Average Length
of Stay
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 98
Use of Services
Metropolitan Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Jan 10, 2011 10:01 AM
SNBC
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
0
0
0
126
149
0
0
0
0
275
Discharges
0
0
0
0
0
0
0
0
0
0
HEDIS 2009 (Reporting Year 2008)
Discharges /
1,000 Member
Months
NA
NA
NA
0.00
0.00
NA
NA
NA
0.00
Days
0
0
0
0
0
0
0
0
0
0
Days / 1,000
Member
Months
NA
NA
NA
0.00
0.00
NA
NA
NA
0.00
Average Length
of Stay
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Page 99
Use of Services
Metropolitan Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
15484
59117
41585
46771
20541
5115
1912
1078
0
191603
Discharges
0
0
0
2
6
1
0
0
0
9
HEDIS 2009 (Reporting Year 2008)
Discharges /
1,000 Member
Months
0.00
0.00
0.00
0.04
0.29
0.20
0.00
0.00
0.05
Days
0
0
0
96
52
54
0
0
0
202
Days / 1,000
Member
Months
0.00
0.00
0.00
2.05
2.53
10.56
0.00
0.00
1.05
Average Length
of Stay
NA
NA
NA
48.00
8.67
54.00
NA
NA
NA
22.44
Page 100
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Commercial
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Any Services
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2009 (Reporting Year 2008)
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 101
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Medicare Advantage
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
0
0
12
0
60
493
0
565
Female
0
0
0
0
284
581
0
865
Total
0
0
12
0
344
1074
0
1430
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
2
1
3
2
0
2
0
0
0
4
1
5
HEDIS 2009 (Reporting Year 2008)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Member Months
(Any)
Male
0
0
12
0
60
493
0
565
Female
0
0
0
0
284
581
0
865
Total
0
0
12
0
344
1074
0
1430
Inpatient
Percent
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
NA
NA
NA
40.00%
4.23%
10.47%
4.87%
0.00%
2.23%
NA
NA
NA
8.50%
1.39%
4.20%
Number
0
0
0
0
0
0
0
0
0
0
0
0
1
1
2
0
0
0
0
0
0
1
1
2
Percent
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
NA
NA
NA
20.00%
4.23%
6.98%
0.00%
0.00%
0.00%
NA
NA
NA
2.12%
1.39%
1.68%
Male
0
0
12
0
60
493
0
565
Female
0
0
0
0
284
581
0
865
Total
0
0
12
0
344
1074
0
1430
Member Months
(Outpatient/ED)
Male
0
0
12
0
60
493
0
565
Female
0
0
0
0
284
581
0
865
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
2
1
3
2
0
2
0
0
0
4
1
5
Percent
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
Total
0
0
12
0
344
1074
0
1430
Percent
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
NA
NA
NA
40.00%
4.23%
10.47%
4.87%
0.00%
2.23%
NA
NA
NA
8.50%
1.39%
4.20%
Page 102
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jan 10, 2011 10:01 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
3406
0
3406
Female
0
0
0
0
0
6089
0
6089
Total
0
0
0
0
0
9495
0
9495
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
35
11
46
0
0
0
35
11
46
HEDIS 2009 (Reporting Year 2008)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
0
0
0
0
0
3406
0
3406
Female
0
0
0
0
0
6089
0
6089
Total
0
0
0
0
0
9495
0
9495
Inpatient
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
12.33%
2.17%
5.81%
NA
NA
NA
12.33%
2.17%
5.81%
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
15
7
22
0
0
0
15
7
22
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
5.28%
1.38%
2.78%
NA
NA
NA
5.28%
1.38%
2.78%
Male
0
0
0
0
0
3406
0
3406
Female
0
0
0
0
0
6089
0
6089
Total
0
0
0
0
0
9495
0
9495
Member Months
(Outpatient/ED)
Male
0
0
0
0
0
3406
0
3406
Female
0
0
0
0
0
6089
0
6089
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
35
10
45
0
0
0
35
10
45
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
9495
0
9495
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
12.33%
1.97%
5.69%
NA
NA
NA
12.33%
1.97%
5.69%
Page 103
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MnDHO
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 2009 (Reporting Year 2008)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Member Months
(Any)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Member Months
(Outpatient/ED)
Male
Female
NR
NR
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 104
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jan 10, 2011 10:01 AM
SNBC
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
0
0
5
9
75
0
0
89
Female
0
0
1
14
171
0
0
186
Total
0
0
6
23
246
0
0
275
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
1
2
3
4
4
8
0
0
0
0
0
0
5
6
11
HEDIS 2009 (Reporting Year 2008)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Member Months
(Any)
Male
0
0
5
9
75
0
0
89
Female
0
0
1
14
171
0
0
186
Total
0
0
6
23
246
0
0
275
Inpatient
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
133.33%
171.43%
156.52%
64.00%
28.07%
39.02%
NA
NA
NA
NA
NA
NA
67.42%
38.71%
48.00%
Number
0
0
0
0
0
0
0
0
0
0
1
1
1
0
1
0
0
0
0
0
0
1
1
2
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
0.00%
85.71%
52.17%
16.00%
0.00%
4.88%
NA
NA
NA
NA
NA
NA
13.48%
6.45%
8.73%
Male
0
0
5
9
75
0
0
89
Female
0
0
1
14
171
0
0
186
Total
0
0
6
23
246
0
0
275
Member Months
(Outpatient/ED)
Male
0
0
5
9
75
0
0
89
Female
0
0
1
14
171
0
0
186
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
2
2
0
0
0
0
0
0
0
2
2
Number
0
0
0
0
0
0
0
0
0
1
2
3
4
4
8
0
0
0
0
0
0
5
6
11
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
14.04%
9.76%
NA
NA
NA
NA
NA
NA
0.00%
12.90%
8.73%
Total
0
0
6
23
246
0
0
275
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
133.33%
171.43%
156.52%
64.00%
28.07%
39.02%
NA
NA
NA
NA
NA
NA
67.42%
38.71%
48.00%
Page 105
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
44581
10081
6395
5730
18441
3290
0
88518
Female
43718
10921
13006
13527
17097
4815
0
103084
Total
88299
21002
19401
19257
35538
8105
0
191602
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
5
6
11
33
29
62
98
92
190
157
142
299
682
338
1020
31
18
49
0
0
0
1006
625
1631
HEDIS 2009 (Reporting Year 2008)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
44581
10081
6395
5730
18441
3290
0
88518
Female
43718
10921
13006
13527
17097
4815
0
103084
Total
88299
21002
19401
19257
35538
8105
0
191602
Inpatient
Percent
0.13%
0.16%
0.15%
3.93%
3.19%
3.54%
18.39%
8.49%
11.75%
32.88%
12.60%
18.63%
44.38%
23.72%
34.44%
11.31%
4.49%
7.25%
NA
NA
NA
13.64%
7.28%
10.21%
Number
1
2
3
3
6
9
23
28
51
39
33
72
172
75
247
13
5
18
0
0
0
251
149
400
Percent
0.03%
0.05%
0.04%
0.36%
0.66%
0.51%
4.32%
2.58%
3.15%
8.17%
2.93%
4.49%
11.19%
5.26%
8.34%
4.74%
1.25%
2.67%
NA
NA
NA
3.40%
1.73%
2.51%
Male
44581
10081
6395
5730
18441
3290
0
88518
Female
43718
10921
13006
13527
17097
4815
0
103084
Total
88299
21002
19401
19257
35538
8105
0
191602
Member Months
(Outpatient/ED)
Male
44581
10081
6395
5730
18441
3290
0
88518
Female
43718
10921
13006
13527
17097
4815
0
103084
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
0
1
1
1
1
2
8
2
10
14
6
20
46
18
64
1
0
1
0
0
0
70
28
98
Number
5
6
11
33
28
61
94
83
177
152
139
291
669
329
998
31
16
47
0
0
0
984
601
1585
Percent
0.00%
0.03%
0.01%
0.12%
0.11%
0.11%
1.50%
0.18%
0.62%
2.93%
0.53%
1.25%
2.99%
1.26%
2.16%
0.36%
0.00%
0.15%
NA
NA
NA
0.95%
0.33%
0.61%
Total
88299
21002
19401
19257
35538
8105
0
191602
Percent
0.13%
0.16%
0.15%
3.93%
3.08%
3.49%
17.64%
7.66%
10.95%
31.83%
12.33%
18.13%
43.53%
23.09%
33.70%
11.31%
3.99%
6.96%
NA
NA
NA
13.34%
7.00%
9.93%
Page 106
Use of Services
Metropolitan Health Plan
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jan 10, 2011 10:01 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
M
Total
F
Total
Age
Number
0-12
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2009 (Reporting Year 2008)
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 107
Use of Services
Metropolitan Health Plan
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Medicare Advantage
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
0
0
72
493
0
565
Female
0
0
284
581
0
865
Total
0
0
356
1074
0
1430
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
4
10
14
4
4
8
0
0
0
8
14
22
HEDIS 2009 (Reporting Year 2008)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
0
0
72
493
0
565
Female
0
0
284
581
0
865
Total
0
0
356
1074
0
1430
Number
0
0
0
0
0
0
0
1
1
1
0
1
0
0
0
1
1
2
Female
0
0
284
581
0
865
Total
0
0
356
1074
0
1430
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
NA
NA
NA
NA
NA
NA
66.67%
42.25%
47.19%
9.74%
8.26%
8.94%
NA
NA
NA
16.99%
19.42%
18.46%
Male
0
0
72
493
0
565
Percent
NA
NA
NA
NA
NA
NA
0.00%
4.23%
3.37%
2.43%
0.00%
1.12%
NA
NA
NA
2.12%
1.39%
1.68%
Number
0
0
0
0
0
0
0
0
0
2
1
3
0
0
0
2
1
3
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
4.87%
2.07%
3.35%
NA
NA
NA
4.25%
1.39%
2.52%
Member Months
(Outpatient/ED)
Male
0
0
72
493
0
565
Female
0
0
284
581
0
865
Total
0
0
356
1074
0
1430
Outpatient/ED
Number
0
0
0
0
0
0
4
10
14
3
4
7
0
0
0
7
14
21
Percent
NA
NA
NA
NA
NA
NA
66.67%
42.25%
47.19%
7.30%
8.26%
7.82%
NA
NA
NA
14.87%
19.42%
17.62%
Page 108
Use of Services
Metropolitan Health Plan
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MSHO
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
0
0
0
3406
0
3406
Female
0
0
0
6089
0
6089
Total
0
0
0
9495
0
9495
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
46
85
131
0
0
0
46
85
131
HEDIS 2009 (Reporting Year 2008)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
0
0
0
3406
0
3406
Female
0
0
0
6089
0
6089
Total
0
0
0
9495
0
9495
Number
0
0
0
0
0
0
0
0
0
3
7
10
0
0
0
3
7
10
Female
0
0
0
6089
0
6089
Total
0
0
0
9495
0
9495
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
16.21%
16.75%
16.56%
NA
NA
NA
16.21%
16.75%
16.56%
Male
0
0
0
3406
0
3406
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.06%
1.38%
1.26%
NA
NA
NA
1.06%
1.38%
1.26%
Number
0
0
0
0
0
0
0
0
0
1
1
2
0
0
0
1
1
2
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.35%
0.20%
0.25%
NA
NA
NA
0.35%
0.20%
0.25%
Member Months
(Outpatient/ED)
Male
0
0
0
3406
0
3406
Female
0
0
0
6089
0
6089
Total
0
0
0
9495
0
9495
Outpatient/ED
Number
0
0
0
0
0
0
0
0
0
45
84
129
0
0
0
45
84
129
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
15.85%
16.55%
16.30%
NA
NA
NA
15.85%
16.55%
16.30%
Page 109
Use of Services
Metropolitan Health Plan
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MnDHO
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 2009 (Reporting Year 2008)
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 110
Use of Services
Metropolitan Health Plan
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jan 10, 2011 10:01 AM
SNBC
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
0
0
89
0
0
89
Female
0
0
186
0
0
186
Total
0
0
275
0
0
275
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
6
20
26
0
0
0
0
0
0
6
20
26
HEDIS 2009 (Reporting Year 2008)
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Male
0
0
89
0
0
89
Female
0
0
186
0
0
186
Total
0
0
275
0
0
275
Number
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
1
1
Female
0
0
186
0
0
186
Total
0
0
275
0
0
275
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
NA
NA
NA
NA
NA
NA
80.90%
129.03%
113.45%
NA
NA
NA
NA
NA
NA
80.90%
129.03%
113.45%
Male
0
0
89
0
0
89
Percent
NA
NA
NA
NA
NA
NA
0.00%
6.45%
4.36%
NA
NA
NA
NA
NA
NA
0.00%
6.45%
4.36%
Number
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
1
1
Percent
NA
NA
NA
NA
NA
NA
0.00%
6.45%
4.36%
NA
NA
NA
NA
NA
NA
0.00%
6.45%
4.36%
Member Months
(Outpatient/ED)
Male
0
0
89
0
0
89
Female
0
0
186
0
0
186
Total
0
0
275
0
0
275
Outpatient/ED
Number
0
0
0
0
0
0
6
20
26
0
0
0
0
0
0
6
20
26
Percent
NA
NA
NA
NA
NA
NA
80.90%
129.03%
113.45%
NA
NA
NA
NA
NA
NA
80.90%
129.03%
113.45%
Page 111
Use of Services
Metropolitan Health Plan
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Minnesota Health Care Programs - Managed Care(MHCP-MC)
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
44581
10081
30566
3290
0
88518
Female
43718
10921
43630
4815
0
103084
Total
88299
21002
74196
8105
0
191602
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
263
178
441
136
155
291
749
911
1660
46
65
111
0
0
0
1194
1309
2503
HEDIS 2009 (Reporting Year 2008)
Male
44581
10081
30566
3290
0
88518
Female
43718
10921
43630
4815
0
103084
Total
88299
21002
74196
8105
0
191602
Percent
7.08%
4.89%
5.99%
16.19%
17.03%
16.63%
29.41%
25.06%
26.85%
16.78%
16.20%
16.43%
NA
NA
NA
16.19%
15.24%
15.68%
Number
4
3
7
0
11
11
76
60
136
3
1
4
0
0
0
83
75
158
Male
44581
10081
30566
3290
0
88518
Female
43718
10921
43630
4815
0
103084
Total
88299
21002
74196
8105
0
191602
Intensive Outpatient/Partial
Hospitalization
Inpatient
Any Services
0-12
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Member Months
(Inpatient)
Percent
0.11%
0.08%
0.10%
0.00%
1.21%
0.63%
2.98%
1.65%
2.20%
1.09%
0.25%
0.59%
NA
NA
NA
1.13%
0.87%
0.99%
Number
12
8
20
8
19
27
47
47
94
2
0
2
0
0
0
69
74
143
Percent
0.32%
0.22%
0.27%
0.95%
2.09%
1.54%
1.85%
1.29%
1.52%
0.73%
0.00%
0.30%
NA
NA
NA
0.94%
0.86%
0.90%
Member Months
(Outpatient/ED)
Male
44581
10081
30566
3290
0
88518
Female
43718
10921
43630
4815
0
103084
Total
88299
21002
74196
8105
0
191602
Outpatient/ED
Number
263
177
440
136
155
291
749
908
1657
45
65
110
0
0
0
1193
1305
2498
Percent
7.08%
4.86%
5.98%
16.19%
17.03%
16.63%
29.41%
24.97%
26.80%
16.41%
16.20%
16.29%
NA
NA
NA
16.17%
15.19%
15.64%
Page 112
Use of Services
Metropolitan Health Plan
Outpatient Drug Utilization
Commercial
Age
0-9
10-17
18-34
35-49
50-64
65-74
75-84
85+
Unknown
Total
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Member Months
NR
Age
Total Cost of
Prescriptions
0-9
10-17
18-34
35-49
50-64
65-74
75-84
85+
Unknown
Total
Avg. Cost of
Prescriptions /
Per Member Per
Month
Total Number of
Prescriptions
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2009 (Reporting Year 2008)
NR
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 113
Use of Services
Metropolitan Health Plan
Outpatient Drug Utilization
Medicare Advantage
Age
Member Months
0-9
0
10-17
0
18-34
12
35-49
87
50-64
257
65-74
854
75-84
168
85+
52
Unknown
0
Total
1430
Age
Total Cost of
Prescriptions
0-9
10-17
18-34
35-49
50-64
65-74
75-84
85+
Unknown
Total
$0.00
$0.00
$1,051.28
$88,714.21
$169,987.63
$324,509.98
$46,334.08
$11,000.75
$0.00
$641,597.93
HEDIS 2009 (Reporting Year 2008)
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Avg. Cost of
Prescriptions /
Per Member Per
Month
NA
NA
$87.61
$1,019.70
$661.43
$379.99
$275.80
$211.55
$448.67
Total Number of
Prescriptions
0
0
24
662
2095
6179
1229
389
0
10578
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NA
NA
24.00
91.31
97.82
86.82
87.79
89.77
88.77
Page 114
Use of Services
Metropolitan Health Plan
Outpatient Drug Utilization
MSHO
Age
0-9
10-17
18-34
35-49
50-64
65-74
75-84
85+
Unknown
Total
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Member Months
0
0
0
0
0
4365
3914
1216
0
9495
Age
Total Cost of
Prescriptions
0-9
10-17
18-34
35-49
50-64
65-74
75-84
85+
Unknown
Total
$0.00
$0.00
$0.00
$0.00
$0.00
$1,838,237.17
$1,538,898.91
$324,284.97
$0.00
$3,701,421.05
HEDIS 2009 (Reporting Year 2008)
Avg. Cost of
Prescriptions /
Per Member Per
Month
NA
NA
NA
NA
NA
$421.13
$393.18
$266.68
$389.83
Total Number of
Prescriptions
0
0
0
0
0
33913
32201
8748
0
74862
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NA
NA
NA
NA
NA
93.23
98.73
86.33
94.61
Page 115
Use of Services
Metropolitan Health Plan
Outpatient Drug Utilization
MnDHO
Age
0-9
10-17
18-34
35-49
50-64
65-74
75-84
85+
Unknown
Total
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Member Months
NR
Age
Total Cost of
Prescriptions
0-9
10-17
18-34
35-49
50-64
65-74
75-84
85+
Unknown
Total
Avg. Cost of
Prescriptions /
Per Member Per
Month
Total Number of
Prescriptions
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2009 (Reporting Year 2008)
NR
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 116
Use of Services
Metropolitan Health Plan
Outpatient Drug Utilization
SNBC
Age
0-9
10-17
18-34
35-49
50-64
65-74
75-84
85+
Unknown
Total
Age
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Member Months
0
0
29
148
98
0
0
0
0
275
Total Cost of
Prescriptions
0-9
10-17
18-34
35-49
50-64
65-74
75-84
85+
Unknown
Total
$0.00
$0.00
$9,777.67
$120,698.49
$22,415.02
$0.00
$0.00
$0.00
$0.00
$152,891.18
HEDIS 2009 (Reporting Year 2008)
Avg. Cost of
Prescriptions /
Per Member Per
Month
NA
NA
$337.16
$815.53
$228.72
NA
NA
NA
$555.97
Total Number of
Prescriptions
0
0
62
740
323
0
0
0
0
1125
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NA
NA
25.66
60.00
39.55
NA
NA
NA
49.09
Page 117
Use of Services
Metropolitan Health Plan
Outpatient Drug Utilization
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Age
Member Months
0-9
74600
10-17
34701
18-34
38658
35-49
22863
50-64
12675
65-74
5115
75-84
1912
85+
1078
Unknown
0
Total
Age
191602
Total Cost of
Prescriptions
0-9
10-17
18-34
35-49
50-64
65-74
75-84
85+
Unknown
Total
$995,588.29
$875,267.70
$1,848,344.15
$2,713,724.73
$1,922,943.85
$256,864.75
$72,899.78
$13,347.71
$0.00
$8,698,980.96
HEDIS 2009 (Reporting Year 2008)
Avg. Cost of
Prescriptions /
Per Member Per
Month
$13.35
$25.22
$47.81
$118.70
$151.71
$50.22
$38.13
$12.38
$45.40
Total Number of
Prescriptions
28672
12538
38556
46077
38781
8960
3693
1502
0
178779
Avg. Num. Of
Prescriptions /
Per Member Per
Year
4.61
4.34
11.97
24.18
36.72
21.02
23.18
16.72
11.20
Page 118
Health Plan Descriptive Information
Metropolitan Health Plan
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Board Certification
MSHO
Type of Physician
Family Medicine
Internal Medicine
Geriatricians
Other practitioner Specialists
HEDIS 2009 (Reporting Year 2008)
Number of Physicians in Active Board Certification
Each Practice Area
Percent
Number
2146
2413
156
4922
1819
2129
121
4337
84.76%
88.23%
77.56%
88.11%
Page 119
Health Plan Descriptive Information
Metropolitan Health Plan
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Board Certification
MnDHO
Type of Physician
Family Medicine
Internal Medicine
Geriatricians
Other practitioner Specialists
HEDIS 2009 (Reporting Year 2008)
Number of Physicians in Active Board Certification
Each Practice Area
Percent
Number
1578
1377
93
3164
1344
1226
73
2770
85.17%
89.03%
78.49%
87.55%
Page 120
Health Plan Descriptive Information
Metropolitan Health Plan
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Board Certification
SNBC
Type of Physician
Family Medicine
Internal Medicine
Geriatricians
Other practitioner Specialists
HEDIS 2009 (Reporting Year 2008)
Number of Physicians in Active Board Certification
Each Practice Area
Percent
Number
2267
2424
160
4955
1928
2137
124
4369
85.05%
88.16%
77.50%
88.17%
Page 121
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jan 10, 2011 10:01 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 2009 (Reporting Year 2008)
NR
NR
NR
NR
NR
NR
NR
Page 122
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jan 10, 2011 10:01 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
9
12
0
0.00%
0
0
0
12
12
0
0.00%
33
5.84%
6
0
14
19
24
2.77%
36
63
86
75
57
3.99%
39
6.90%
307
132
24
28
2
0
260
30.06%
249
166
74
42
26
24
299
20.91%
493
87.26%
0
581
67.17%
0
1074
75.10%
565
865
HEDIS 2009 (Reporting Year 2008)
12
0
0
21
24
42
63
100
94
556
298
98
70
28
24
0
1430
Page 123
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jan 10, 2011 10:01 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%
701
1144
909
451
139
62
0
0.00%
898
1622
1463
1091
602
413
0
0.00%
3406
100.00%
0
6089
100.00%
0
9495
100.00%
3406
6089
HEDIS 2009 (Reporting Year 2008)
0
0
0
0
0
0
0
0
0
1599
2766
2372
1542
741
475
0
9495
Page 124
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MnDHO
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 2009 (Reporting Year 2008)
Page 125
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jan 10, 2011 10:01 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
0
Member Months
Female
0
0
0
0
0
0
Total
0
0
0
0
0
0
0
0.00%
5
1
8
5
8
0
0.00%
1
5
9
31
53
0
0.00%
27
30.34%
19
11
27
5
99
53.23%
32
23
23
9
126
45.82%
62
69.66%
0
0
0
0
0
0
87
46.77%
0
0
0
0
0
0
149
54.18%
0
0.00%
0
0
0.00%
0
0
0.00%
89
186
HEDIS 2009 (Reporting Year 2008)
6
6
17
36
61
51
34
50
14
0
0
0
0
0
0
0
275
Page 126
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Jan 10, 2011 10:01 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
7728
14428
15538
11129
5839
2734
Member Months
Female
7756
13866
15284
10864
6869
4150
Total
15484
28294
30822
21993
12708
6884
57396
64.84%
3661
3167
2563
3141
3646
58789
57.03%
8856
7682
5845
4513
3697
116185
60.64%
16178
18.28%
4246
3727
2419
1262
30593
29.68%
3620
2492
1853
922
46771
24.41%
11654
13.17%
1538
694
535
262
188
73
8887
8.62%
1864
1019
610
505
411
406
20541
10.72%
3290
3.72%
0
4815
4.67%
0
8105
4.23%
88518
103084
HEDIS 2009 (Reporting Year 2008)
12517
10849
8408
7654
7343
7866
6219
4272
2184
3402
1713
1145
767
599
479
0
191602
Page 127
Health Plan Stability
Metropolitan Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Commercial
Product/Product Line
Years in Business
Members*
NR
NR
NR
NR
NR
NR
NR
HMO
MHCP_MC
Commercial
Medicare (cost or risk)
Other
Total HMO:
PPO
MHCP_MC
Commercial
Medicare (cost or risk)
Other
Total PPO:
POS
MHCP_MC
Commercial
Medicare (cost or risk)
Other
Total POS:
Total:
* Total number of members in each category as of December 31, 2008
HEDIS 2009 (Reporting Year 2008)
Page 128
Health Plan Stability
Metropolitan Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Medicare Advantage
Product/Product Line
Years in Business
Members*
26.00
0.00
2.00
0.00
26.00
16200
0
133
0
16333
0.00
0.00
12.00
0.00
12.00
0
0
766
0
766
0.00
0.00
1.00
0.00
1.00
0
0
49
0
49
17148
HMO
MHCP_MC
Commercial
Medicare (cost or risk)
Other
Total HMO:
PPO
MHCP_MC
Commercial
Medicare (cost or risk)
Other
Total PPO:
POS
MHCP_MC
Commercial
Medicare (cost or risk)
Other
Total POS:
Total:
* Total number of members in each category as of December 31, 2008
HEDIS 2009 (Reporting Year 2008)
Page 129
Health Plan Stability
Metropolitan Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MSHO
Product/Product Line
Years in Business
Members*
26.00
0.00
12.00
0.00
26.00
16200
0
766
0
16966
0.00
0.00
1.00
0.00
1.00
0
0
49
0
49
0.00
0.00
2.00
0.00
2.00
0
0
133
0
133
17148
HMO
MHCP_MC
Commercial
Medicare (cost or risk)
Other
Total HMO:
PPO
MHCP_MC
Commercial
Medicare (cost or risk)
Other
Total PPO:
POS
MHCP_MC
Commercial
Medicare (cost or risk)
Other
Total POS:
Total:
* Total number of members in each category as of December 31, 2008
HEDIS 2009 (Reporting Year 2008)
Page 130
Health Plan Stability
Metropolitan Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Jan 10, 2011 10:01 AM
MnDHO
Product/Product Line
Years in Business
Members*
NR
NR
NR
NR
NR
NR
NR
HMO
MHCP_MC
Commercial
Medicare (cost or risk)
Other
Total HMO:
PPO
MHCP_MC
Commercial
Medicare (cost or risk)
Other
Total PPO:
POS
MHCP_MC
Commercial
Medicare (cost or risk)
Other
Total POS:
Total:
* Total number of members in each category as of December 31, 2008
HEDIS 2009 (Reporting Year 2008)
Page 131
Health Plan Stability
Metropolitan Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Jan 10, 2011 10:01 AM
SNBC
Product/Product Line
Years in Business
Members*
26.00
0.00
1.00
0.00
26.00
16200
0
49
0
16249
0.00
0.00
12.00
0.00
12.00
0
0
766
0
766
HMO
MHCP_MC
Commercial
Medicare (cost or risk)
Other
Total HMO:
PPO
MHCP_MC
Commercial
Medicare (cost or risk)
Other
Total PPO:
POS
MHCP_MC
0.00
0
Commercial
0.00
0
Medicare (cost or risk)
2.00
133
Other
0.00
0
Total POS:
2.00
133
Total:
17148
* Total number of members in each category as of December 31, 2008
HEDIS 2009 (Reporting Year 2008)
Page 132
Health Plan Stability
Metropolitan Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Jan 10, 2011 10:01 AM
Minnesota Health Care Programs - Managed Care (MHCP-MC)
Product/Product Line
Years in Business
Members*
26.00
0.00
12.00
0.00
26.00
16200
0
766
0
16966
0.00
0.00
1.00
0.00
1.00
0
0
49
0
49
HMO
MHCP_MC
Commercial
Medicare (cost or risk)
Other
Total HMO:
PPO
MHCP_MC
Commercial
Medicare (cost or risk)
Other
Total PPO:
POS
MHCP_MC
0.00
0
Commercial
0.00
0
Medicare (cost or risk)
2.00
133
Other
0.00
0
Total POS:
2.00
133
Total:
17148
* Total number of members in each category as of December 31, 2008
HEDIS 2009 (Reporting Year 2008)
Page 133