Metropolitan Health Plan
Plan Name
2007
Reporting Year
Submission #
General Info
Disclaimers
Code
CIS
Plan ID
1
Last Refreshed:
Page
Childhood Immunization Status
10/7/2009 1:33:46 PM
Use of Services Measures
Code
Page
21 W15
Well Child Visits in the First 15 Months of Life
39
22 W34
Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life
41
Page
23 AWC
Adolescent Well-Care Visits
42
3
24 FSP
2
Effectiveness of Care Measures
7
Frequency of Selected Procedures
43
Inpatient Utilization - General Hospital/Acute Care
47
URI
Appropriate Treatment for Children with Upper Respiratory Infection
5
25
COL
Colorectal Cancer Screening
6
26 AMB
Ambulatory Care
51
55
IPU
BCS
Breast Cancer Screening
7
27 NON
Inpatient Utilization - Nonacute Care
CCS
Cervical Cancer Screening
11
28
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory Services
59
29 IAD
Identification of Alcohol and Other Drug Services
63
30 ORX
Outpatient Drug Utilization
67
MPT
CHL
Chlamydia Screening in Women
12
OMW
Osteoporosis Management in Women Who had a Fracture
13
CBP
Controlling High Blood Pressure
14
PBH
Persistence of Beta Blocker Treatment After Hearth Attack
15
CMC
Cholesterol Management for Patients with Cardiovascular Conditions
16
Code
CDC
Comprehensive Diabetes Care
20
31 AAP
Adult's Access to Preventive/Ambulatory Health Services
71
ASM
Use of Appropriate Medications for People with Asthma
24
32 CAP
Children's and Adolescents' Access to Primary Care Practitioners
75
AMM
Antidepressant Medication Management
26
33 PPC
ADD
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
30
GSO
Glaucoma Screening in Older Adults
31
34
Code
35
MPM
Annual Monitoring for Patients on Persistent Medications
32
DAE
Use of High Risk Medications in the Elderly
36
DDE
Potentially Harmful Drug-Disease Interactions in the Elderly
HEDIS 2008 (Reporting Year 2007)
37
IET
YIB
Code
36 ENP
Access / Availability of Care Measures
Page
Prenatal and Postpartum Care
77
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
79
Health Plan Stability Measures
Page
Years in Business / Total Membership
Health Plan Descriptive Information Measures
Enrollment by Product Line (Age & Sex)
83
Page
87
Page 1
DISCLAIMERS
-1
0. Disclaimer Query located below
1. In October 2009, it was discoverd that the formulas in the Inpatient Utilization: General
Hospital/Acute Care measure contained error. The formula was fixed and the data displayed now
correctly reflects the rest of the data on the sheet.
HEDIS 2008 (Reporting Year 2007)
Page 2
Effectiveness of Care
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Data Elements
General
Measure
Data
DTaP/DT
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 2008 (Reporting Year 2007)
Page 3
Effectiveness of Care
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
HiB
Hepatitis B
VZV
Pneumococcal
Conjugate
Combo 2
Combo 3
188
78.33%
210
87.50%
228
95.00%
200
83.33%
203
84.58%
226
94.17%
188
78.33%
163
67.92%
154
64.17%
188
78.33%
210
87.50%
228
95.00%
200
83.33%
203
84.58%
226
94.17%
188
78.33%
163
67.92%
154
64.17%
188
18
85.83%
81.21%
90.45%
210
21
96.25%
93.64%
98.86%
228
4
96.67%
94.19%
99.15%
200
27
94.58%
91.51%
97.66%
203
27
95.83%
93.10%
98.57%
226
2
95.00%
92.03%
97.97%
188
16
85.00%
80.27%
89.73%
163
38
83.75%
78.87%
88.63%
154
36
79.17%
73.82%
84.51%
240
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 2008 (Reporting Year 2007)
MMR
240
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
2007
H
240
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/DT
240
Page 4
Effectiveness of Care
Metropolitan Health Plan
Appropriate Treatment for Children with Upper
Respiratory Infection
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Data Elements
Commercial
Measurement Year
Medicaid
2007
Data Collection Methodology
A
Eligible Member Population
239
Numerator Events by Admin Data
15
Reported Rate
NR
93.72%
Lower 95% Confidence Interval
NR
90.44%
Upper 95% Confidence Interval
NR
97.01%
HEDIS 2008 (Reporting Year 2007)
Page 5
Effectiveness of Care
Metropolitan Health Plan
Colorectal Cancer Screening
Data Elements
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Medicare
Advantage
MSHO
2007
Measurement Year
H
Data collection methodology (administrative or hybrid)
Eligible population
540
Number of numerator events by administrative data in eligible
population (before exclusions)
151
Current year's administrative rate (before exclusions)
NR
NR
27.96%
Minimum required sample size (MRSS) or other sample size
411
Oversampling rate
0.15
Final sample size (FSS)
473
Number of numerator events by administrative data in FSS
131
Administrative rate on FSS
NR
NR
27.70%
Number of original sample records excluded because of valid data
errors
0
Number of administrative data records excluded
4
Number of medical record data records excluded
1
Number of employee/dependent medical records excluded
0
Records added from the oversample list
1
Denominator
411
Numerator events by administrative data
111
91
Numerator events by medical records
Reported rate
NR
NR
49.15%
Lower 95% confidence interval
NR
NR
44.19%
Upper 95% confidence interval
NR
NR
54.10%
HEDIS 2008 (Reporting Year 2007)
Page 6
Effectiveness of Care
Metropolitan Health Plan
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Data Elements
General Measure
Data
Ages 42-51
Ages 52-69
Total
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2008 (Reporting Year 2007)
NR
NR
NR
Page 7
Effectiveness of Care
Metropolitan Health Plan
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 2008 (Reporting Year 2007)
General Measure
Data
Ages 42-51
NR
NR
NR
Ages 52-69
Total
NR
NR
NR
NR
NR
NR
NR
NR
Page 8
Effectiveness of Care
Metropolitan Health Plan
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 2008 (Reporting Year 2007)
General Measure
Data
Ages 42-51
Ages 52-69
Total
0
0
NA
NA
NA
61
46
75.41%
63.78%
87.04%
61
46
75.41%
63.78%
87.04%
2007
A
Page 9
Effectiveness of Care
Metropolitan Health Plan
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
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 2008 (Reporting Year 2007)
General Measure
Data
Ages 42-51
Ages 52-69
Total
149
87
58.39%
50.14%
66.64%
187
108
57.75%
50.41%
65.10%
336
195
58.04%
52.61%
63.46%
2007
A
Page 10
Effectiveness of Care
Metropolitan Health Plan
Cervical Cancer Screening
Data Elements
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Measurement Year
Data Collection Methodology
Eligible Member Population
Medicaid
2007
A
1028
Numerator Events by Admin Data on Eligible
Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
Records Excluded because of Valid Data Errors
NR
NR
NR
NR
Number of administrative data records excluded
Number of medical record data records excluded
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2008 (Reporting Year 2007)
696
NR
NR
NR
67.70%
64.80%
70.61%
Page 11
Effectiveness of Care
Metropolitan Health Plan
Chlamydia Screening in Women
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 2008 (Reporting Year 2007)
General
Measure Ages 16-20 Ages 21-25
Data
Medicaid
Total
General
Measure Ages 16-20 Ages 21-25
Data
Total
2007
A
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
178
131
73.60%
66.84%
80.35%
157
116
73.89%
66.70%
81.07%
335
247
73.73%
68.87%
78.59%
Page 12
Effectiveness of Care
Metropolitan Health Plan
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 Interva
HEDIS 2008 (Reporting Year 2007)
Medicare
Advantage
NR
NR
NR
MSHO
2007
A
25
4
NA
NA
NA
Page 13
Effectiveness of Care
Metropolitan Health Plan
Controlling High Blood Pressure
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Data Elements
Commercial
Medicare Advantage
Measurement Year
2007
Data Collection Methodology (Hybrid)
H
Eligible Member Population
340
Numerator Events by Admin Data on
Eligible Population (before exclusions)
Current Year's Admin Rate
0
NR
NR
Minimum Required Sample Size
0.00%
317
Oversampling Rate
0.00%
Final Sample Size (FSS)
317
Numerator events by admin data in FSS
Admin rate on FSS
MSHO
0
NR
NR
0.00%
Records Excluded because of Valid Data
Errors
4
Number of administrative data records
excluded
18
Number of medical record data records
excluded
0
Number of employee/dependent medical
records excluded
0
Records Added from the OverSample List
0
Denominator
310
Numerator Events by Admin Data
0
Numerator Events by Medical Record
198
Reported Rate
NR
NR
63.87%
Lower 95% Confidence Interval
NR
NR
58.36%
Upper 95% Confidence Interval
NR
NR
69.38%
HEDIS 2008 (Reporting Year 2007)
Page 14
Effectiveness of Care
Metropolitan Health Plan
Persistence of Beta Blocker Treatment After Hearth Attack
Data Elements
Commercial
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicare Advantage
MSHO
Medicaid
2007
2007
Data Collection Methodology
A
A
Eligible Member Population
8
6
Numerator Events by Admin Data on
Eligible Population
6
1
Measurement Year
Reported Rate
NR
NR
NA
NA
Lower 95% Confidence Interval
NR
NR
NA
NA
Upper 95% Confidence Interval
NR
NR
NA
NA
HEDIS 2008 (Reporting Year 2007)
Page 15
Effectiveness of Care
Metropolitan Health Plan
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Data Elements
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on Eligible
Population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Records Excluded because of Valid Data Errors
Number of administrative data records excluded
Number of medical record data records excluded
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2008 (Reporting Year 2007)
Page 16
Effectiveness of Care
Metropolitan Health Plan
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicare Advantage
Data Elements
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on Eligible
Population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Records Excluded because of Valid Data Errors
Number of administrative data records excluded
Number of medical record data records excluded
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2008 (Reporting Year 2007)
Page 17
Effectiveness of Care
Metropolitan Health Plan
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:33 PM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
Records Excluded because of Valid Data Errors
LDL-C Level of
<100 mg/dL
28
0
63.64%
0.00%
27
0
62.79%
0.00%
27
10
0
24
86.05%
74.53%
97.57%
55.81%
39.81%
71.82%
2007
H
44
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
LDL-C
screening
43
0.00%
43
0
Number of administrative data records excluded
Number of medical record data records excluded
0
Number of employee/dependent medical records
excluded
0
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2008 (Reporting Year 2007)
0
43
Page 18
Effectiveness of Care
Metropolitan Health Plan
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
0
Number of administrative data records excluded
0
Number of medical record data records excluded
0
Number of employee/dependent medical records
excluded
0
HEDIS 2008 (Reporting Year 2007)
19
0
55.88%
0.00%
16
0
47.06%
0.00%
16
7
0
15
67.65%
50.45%
84.84%
44.12%
25.96%
62.28%
34
0.00%
34
Records Excluded because of Valid Data Errors
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
LDL-C Level of
<100 mg/dL
2007
H
34
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
LDL-C
screening
0
34
Page 19
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Data Elements
HbA1c
Testing
Poor HbA1c Good HbA1c
Control
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
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
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number of Records Excluded Because of
Valid Data Errors
Number of administrative data records
excluded
Number of medical 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 2008 (Reporting Year 2007)
Page 20
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicare Advantage
Data Elements
HbA1c
Testing
Poor HbA1c Good HbA1c
Control
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
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
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2008 (Reporting Year 2007)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 21
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:33 PM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
HbA1c
Testing
Poor HbA1c Good HbA1c
Control
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
Blood
Monitoring
Pressure
for Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<130/80 mm
Hg
2007
H
145
2007
H
145
2007
H
145
2007
H
145
2007
H
145
2007
H
145
2007
H
145
2007
H
145
2007
H
145
130
75.35%
145
15.49%
0
0.00%
96
65.49%
89
58.45%
0
0.00%
111
76.76%
0
0.00%
0
0.00%
Number of Records Excluded Because of
Valid Data Errors
1
1
1
1
1
1
1
1
1
Number of administrative data records
excluded
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
141
107
29
96.45%
93.05%
99.86%
0
141
22
3
17.73%
11.07%
24.39%
0
141
0
80
56.74%
48.21%
65.27%
0
141
92
17
77.30%
70.04%
84.57%
0
141
83
21
73.76%
66.14%
81.38%
0
141
0
68
48.23%
39.62%
56.83%
0
141
108
16
87.94%
82.21%
93.67%
0
141
0
89
63.12%
54.80%
71.44%
0
141
0
53
37.59%
29.24%
45.94%
Numerator events by admin data in eligible
population
Admin rate on FSS
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 2008 (Reporting Year 2007)
Page 22
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
HbA1c
Testing
Poor HbA1c Good HbA1c
Control
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
Blood
Monitoring
Pressure
for Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<130/80 mm
Hg
2007
H
305
2007
H
305
2007
H
305
2007
H
305
2007
H
305
2007
H
305
2007
H
305
2007
H
305
2007
H
305
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
253
82.95%
303
0%
303
219
72.28%
305
100.00%
303
0%
303
83
27.39%
0
0.00%
303
0%
303
0
0.00%
159
52.13%
303
0%
303
156
51.49%
176
57.70%
303
0%
303
162
53.47%
0
0.00%
303
0%
303
0
0.00%
217
71.15%
303
0%
303
206
67.99%
0
0.00%
303
0%
303
0
0.00%
0
0.00%
303
0%
303
0
0.00%
Number of Records Excluded Because of
Valid Data Errors
4
4
4
4
4
4
4
4
4
Number of administrative data records
excluded
1
1
1
1
1
1
1
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
293
216
51
91.13%
87.70%
94.55%
0
293
75
9
28.67%
23.32%
34.02%
0
293
0
128
43.69%
37.84%
49.54%
0
293
151
32
62.46%
56.74%
68.17%
0
293
160
43
69.28%
63.83%
74.74%
0
293
0
108
36.86%
31.17%
42.55%
0
293
204
25
78.16%
73.26%
83.06%
0
293
0
189
64.51%
58.86%
70.15%
0
293
0
121
41.30%
35.49%
47.11%
Numerator events by admin data in eligible
population
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 2008 (Reporting Year 2007)
Page 23
Effectiveness of Care
Metropolitan Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 2008 (Reporting Year 2007)
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 24
Effectiveness of Care
Metropolitan Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
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 2008 (Reporting Year 2007)
General
Measure Data
Ages 5-9
Ages 10-17
Ages 18-56
Total
21
18
NA
NA
NA
25
21
NA
NA
NA
31
22
70.97%
53.38%
88.56%
77
61
79.22%
69.51%
88.93%
2007
A
Page 25
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 2008 (Reporting Year 2007)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 26
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 2008 (Reporting Year 2007)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 27
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 2008 (Reporting Year 2007)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
2
NA
NA
NA
7
NA
NA
NA
6
NA
NA
NA
2007
A
9
Page 28
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
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 2008 (Reporting Year 2007)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
21
30.43%
18.85%
42.02%
35
50.72%
38.20%
63.25%
20
28.99%
17.56%
40.42%
2007
A
69
Page 29
Effectiveness of Care
Metropolitan Health Plan
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 2008 (Reporting Year 2007)
General
Measure
Data
Initiation
Phase
Medicaid
Continuation
and
Maintenance
Phase
General
Measure
Data
Initiation
Phase
Continuation
and
Maintenance
Phase
32
13
40.63%
22.05%
59.20%
2
2
NA
NA
NA
2007
A
NR
NR
NR
NR
NR
NR
Page 30
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 Interva
HEDIS 2008 (Reporting Year 2007)
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicare
Advantage
NR
NR
NR
MSHO
2007
A
693
528
76.19%
72.95%
79.43%
Page 31
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 2008 (Reporting Year 2007)
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 32
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 2008 (Reporting Year 2007)
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 33
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 2008 (Reporting Year 2007)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
75
70
93.33%
87.02%
99.65%
4
4
NA
NA
NA
64
57
89.06%
80.63%
97.49%
7
7
NA
NA
NA
150
138
92.00%
87.33%
96.67%
2007
A
Page 34
Effectiveness of Care
Metropolitan Health Plan
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
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 2008 (Reporting Year 2007)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
106
88
83.02%
75.40%
90.64%
2
2
NA
NA
NA
94
76
80.85%
72.36%
89.34%
14
10
NA
NA
NA
216
176
81.48%
76.07%
86.89%
2007
A
Page 35
Effectiveness of Care
Metropolitan Health Plan
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 2008 (Reporting Year 2007)
General
Measure
Data
1 or More
Prescriptions
NR
NR
NR
MSHO
2 or More
Prescriptions
NR
NR
NR
General
Measure
Data
2007
A
775
1 or More
Prescriptions
2 or More
Prescriptions
36
4.65%
3.10%
6.19%
6
0.77%
0.09%
1.46%
Page 36
Effectiveness of Care
Metropolitan Health Plan
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 2008 (Reporting Year 2007)
General
Measure
Data
History of Falls +
Dementia +
Chronic Renal
Tricyclic
Tricyclic
Failure +
Antidepressants, Antidepressants or Nonaspirin NSAIDs
Antipsychotics or
Anticholinergic or Cox-2 Selective
Sleep Agents
Agents
NSAIDs
NR
NR
NR
NR
NR
NR
NR
NR
NR
Total
NR
NR
NR
Page 37
Effectiveness of Care
Metropolitan Health Plan
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 2008 (Reporting Year 2007)
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
2007
A
12
2
NA
NA
NA
148
12
8.11%
3.37%
12.84%
25
1
NA
NA
NA
185
15
8.11%
3.90%
12.31%
Page 38
Use of Services
Metropolitan Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 records excluded because of
contraindications identified through
administrative data
Number of records excluded because of
contraindications identified through medical
record review
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 2008 (Reporting Year 2007)
Page 39
Use of Services
Metropolitan Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
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
8
7
28
29
55
90
246
1.73%
0.43%
3.02%
1.51%
0.29%
2.73%
6.05%
3.77%
8.33%
6.26%
3.95%
8.58%
11.88%
8.82%
14.93%
19.44%
15.73%
23.15%
53.13%
48.48%
57.79%
2007
A
463
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 records excluded because of
contraindications identified through
administrative data
Number of records excluded because of
contraindications identified through medical
record review
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 2008 (Reporting Year 2007)
Page 40
Use of Services
Metropolitan Health Plan
Well Child Visits in the 3rd, 4th,
5th and 6th Years of Life
Data Elements
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Measurement Year
Data Collection Methodology
Eligible Member Population
Medicaid
2007
A
858
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
Records Excluded - Contraindications/Admin Data
Records Excluded - Contraindications/Medical
Record Review
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 2008 (Reporting Year 2007)
607
NR
NR
NR
70.75%
67.64%
73.85%
Page 41
Use of Services
Metropolitan Health Plan
Adolescent Well-Care Visits
Data Elements
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Measurement Year
Data Collection Methodology
Eligible Member Population
Medicaid
2007
A
1448
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
Records Excluded - Contraindications/Admin Data
Records Excluded - Contraindications/Medical
Record Review
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 2008 (Reporting Year 2007)
539
NR
NR
NR
37.22%
34.70%
39.75%
Page 42
Use of Services
Metropolitan Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Member Months
Total
Age
0-4
0-9
5-19
10-19
Total
Procedure
Myringotomy
Tonsillectomy
Age
15-44
20-44
30-64
45-64
65+
Age
0-4
5-19
0-9
10-19
Number of
Procedures
Procedures /
1,000 Member
Months
NR
NR
NR
NR
Member Months
Male
Female
Female
Male
Procedure
Dilation &
Curettage
Hysterectomy,
Abdominal
Age
15-44
45-64
15-44
45-64
65+
Hysterectomy,
15-44
Vaginal
45-64
65+
Cholecystectomy,
30-64
Open
15-44
45-64
65+
Cholecystectomy,
30-64
Closed
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+
Prostatectomy
45-64
65+
Mastectomy
15-44
45-64
65+
Lumpectomy
15-44
45-64
65+
HEDIS 2008 (Reporting Year 2007)
Number of
Procedures
Procedures /
1,000 Member
Months
Number of
Procedures
Procedures /
1,000 Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 43
Use of Services
Metropolitan Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicare Advantage
Age
< 65
65-74
75-84
85+
Member Months
Male
Female
Male
Procedure
CABG
Angioplasty
(PTCA)
Cardiac
Catheterization
Carotid
Endarterectomy
Reduction of
Fracture of Femur
Total Hip
Replacement
Total Knee
Replacement
Partial Excision of
Large Inestine
Cholecystectomy,
Open
Cholecystectomy,
Closed
(laparoscopic)
Back Surgery
Hysterectomy
Abdominal
Hysterectomy,
Vaginal
Mastectomy
Lumpectomy
Age
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
HEDIS 2008 (Reporting Year 2007)
Number of
Procedures
Procedures /
1,000 Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Female
Number of
Procedures
Procedures /
1,000 Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 44
Use of Services
Metropolitan Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:33 PM
MSHO
Age
< 65
65-74
75-84
85+
Member Months
Male
Female
0
0
2250
2973
1362
2637
249
1064
Male
Procedure
CABG
Angioplasty
(PTCA)
Cardiac
Catheterization
Carotid
Endarterectomy
Reduction of
Fracture of Femur
Total Hip
Replacement
Total Knee
Replacement
Partial Excision of
Large Inestine
Cholecystectomy,
Open
Cholecystectomy,
Closed
(laparoscopic)
Back Surgery
Hysterectomy
Abdominal
Hysterectomy,
Vaginal
Mastectomy
Lumpectomy
Age
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
HEDIS 2008 (Reporting Year 2007)
Number of
Procedures
0
0
1
0
0
3
0
1
0
1
7
0
0
0
0
0
0
1
0
0
0
1
0
0
0
3
1
0
0
0
0
0
0
1
0
0
0
0
2
0
0
0
1
0
Procedures /
1,000 Member
Months
NA
0.00
0.73
0.00
NA
1.33
0.00
4.02
NA
0.44
5.14
0.00
NA
0.00
0.00
0.00
NA
0.44
0.00
0.00
NA
0.44
0.00
0.00
NA
1.33
0.73
0.00
NA
0.00
0.00
0.00
NA
0.44
0.00
0.00
NA
0.00
1.47
0.00
NA
0.00
0.73
0.00
Female
Number of
Procedures
0
2
0
0
0
4
5
0
0
6
4
0
0
0
1
0
0
0
5
2
0
0
0
0
0
2
3
0
0
2
1
0
0
0
0
0
0
1
1
0
0
4
1
0
0
1
0
0
0
2
0
0
0
0
1
0
0
0
1
0
Procedures /
1,000 Member
Months
NA
0.67
0.00
0.00
NA
1.35
1.90
0.00
NA
2.02
1.52
0.00
NA
0.00
0.38
0.00
NA
0.00
1.90
1.88
NA
0.00
0.00
0.00
NA
0.67
1.14
0.00
NA
0.67
0.38
0.00
NA
0.00
0.00
0.00
NA
0.34
0.38
0.00
NA
1.35
0.38
0.00
NA
0.34
0.00
0.00
NA
0.67
0.00
0.00
NA
0.00
0.38
0.00
NA
0.00
0.38
0.00
Page 45
Use of Services
Metropolitan Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
Member Months
Total
40256
70875
74304
43685
Age
0-4
0-9
5-19
10-19
Total
Procedure
Myringotomy
Tonsillectomy
Age
15-44
20-44
30-64
45-64
Age
0-4
5-19
0-9
10-19
Number of
Procedures
62
24
17
10
Procedures /
1,000 Member
Months
1.54
0.32
0.24
0.23
Member Months
Male
Female
42788
16756
31464
21238
11492
9018
Male
Procedure
Dilation &
Curettage
Hysterectomy,
Abdominal
Hysterectomy,
Vaginal
Cholecystectomy,
Open
Cholecystectomy,
Closed
Back Surgery
Mastectomy
Lumpectomy
Age
15-44
45-64
15-44
45-64
15-44
45-64
30-64
15-44
45-64
30-64
15-44
45-64
20-44
45-64
15-44
45-64
15-44
45-64
HEDIS 2008 (Reporting Year 2007)
Female
Number of
Procedures
Procedures /
1,000 Member
Months
0
0.00
1
8
10
Number of
Procedures
3
1
10
8
3
1
Procedures /
1,000 Member
Months
0.07
0.11
0.23
0.89
0.07
0.11
4
1
0.09
0.11
35
8
3
5
1
2
1
9
0.82
0.89
0.10
0.55
0.02
0.22
0.02
1.00
0.05
0.48
0.87
Page 46
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:
Oct 7, 2009 1:33 PM
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 2008 (Reporting Year 2007)
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 47
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicare Advantage
Age
Member Months
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
NR
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
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 2008 (Reporting Year 2007)
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 48
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:
Oct 7, 2009 1:33 PM
Member Months
0
0
0
0
0
5223
3999
1313
0
10535
Discharges
Discharges /
1,000 Member
Months
0
0
0
0
0
225
246
53
0
524
NA
NA
NA
NA
NA
43.08
61.52
40.37
0
0
0
0
0
153
184
44
0
381
NA
NA
NA
NA
NA
29.29
46.01
33.51
0
0
0
0
0
69
59
9
0
137
NA
NA
NA
NA
NA
13.21
14.75
6.85
0
0
0
0
0
HEDIS 2008 (Reporting Year 2007)
49.74
36.17
13.00
NA
NA
NA
NA
Days
Days / 1,000
Member
Months
0
0
0
0
0
1584
1737
251
0
3572
NA
NA
NA
NA
NA
303.27
434.36
191.17
0
0
0
0
0
670
943
216
0
1829
NA
NA
NA
NA
NA
128.28
235.81
164.51
0
0
0
0
0
906
785
35
0
1726
0
0
0
0
0
339.06
173.61
NA
NA
NA
NA
NA
173.46
196.30
26.66
163.83
NA
NA
NA
NA
Average
Length of Stay
NA
NA
NA
NA
NA
7.04
7.06
4.74
NA
6.82
NA
NA
NA
NA
NA
4.38
5.13
4.91
NA
4.80
NA
NA
NA
NA
NA
13.13
13.31
3.89
NA
12.60
NA
NA
NA
NA
NA
Page 49
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Medicaid
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Member Months
12937
57938
43685
48220
20510
5086
1811
1060
0
191247
Discharges
Discharges /
1,000 Member
Months
225
145
257
1234
433
218
76
44
0
2632
17.39
2.50
5.88
25.59
21.11
42.86
41.97
41.51
192
111
47
249
281
157
58
28
0
1123
14.84
1.92
1.08
5.16
13.70
30.87
32.03
26.42
32
33
36
151
148
58
17
14
0
489
2.47
0.57
0.82
3.13
7.22
11.40
9.39
13.21
174
833
4
0
1011
3.98
17.27
0.20
HEDIS 2008 (Reporting Year 2007)
13.76
5.87
2.56
8.99
Days
Days / 1,000
Member
Months
830
430
868
3856
2086
1664
407
258
0
10399
64.16
7.42
19.87
79.97
101.71
327.17
224.74
243.40
587
327
121
776
1101
983
278
120
0
4293
45.37
5.64
2.77
16.09
53.68
193.28
153.51
113.21
237
100
279
893
975
619
127
136
0
3366
18.32
1.73
6.39
18.52
47.54
121.71
70.13
128.30
468
2185
10
0
2663
10.71
45.31
0.49
54.37
22.45
17.60
23.69
Average
Length of Stay
3.69
2.97
3.38
3.12
4.82
7.63
5.36
5.86
NA
3.95
3.06
2.95
2.57
3.12
3.92
6.26
4.79
4.29
NA
3.82
7.41
3.03
7.75
5.91
6.59
10.67
7.47
9.71
NA
6.88
2.69
2.62
2.50
NA
2.63
Page 50
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
NR
Outpatient Visits
(Excludes MH/CD)
Age
Visits
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits/ 1,000
Member
Months
NR
NR
Emergency Room Visits
Visits
NR
NR
NR
NR
NR
NR
NR
HEDIS 2008 (Reporting Year 2007)
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 51
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicare Advantage
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Member
Months
NR
Total
Outpatient Visits
(Excludes MH/CD)
Age
Visits
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits/ 1,000
Member
Months
NR
NR
Emergency Room Visits
Visits
NR
NR
NR
NR
NR
NR
NR
HEDIS 2008 (Reporting Year 2007)
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 52
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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
5223
3999
1313
0
10535
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
Visits
0
0
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
0
0
0
3961
3442
585
0
7988
HEDIS 2008 (Reporting Year 2007)
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
758.38
860.72
445.54
758.23
Emergency Room Visits
Visits
0
0
0
0
0
500
525
94
0
1119
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
95.73
131.28
71.59
106.22
Ambulatory
Surgery/Procedures
Procedures
0
0
0
0
0
136
111
17
0
264
Procedures/
1,000 Member
Months
NA
NA
NA
NA
NA
26.04
27.76
12.95
25.06
Observation Room Stays
Resulting in Discharge
Stays
0
0
0
0
0
8
15
0
0
23
Stays/ 1,000
Member
Months
NA
NA
NA
NA
NA
1.53
3.75
0.00
2.18
Page 53
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
12937
57938
43685
48220
20510
5086
1811
1060
0
191247
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
Visits
0
25010
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
10289
25831
12455
3301
1217
385
0
78488
HEDIS 2008 (Reporting Year 2007)
Visits/ 1,000
Member
Months
0.00
431.67
235.53
535.69
607.26
649.04
672.00
363.21
410.40
Emergency Room Visits
Visits
0
5931
2070
6335
2590
459
180
86
0
17651
Visits/ 1,000
Member
Months
0.00
102.37
47.38
131.38
126.28
90.25
99.39
81.13
92.29
Ambulatory
Surgery/Procedures
Procedures
0
200
74
379
493
147
47
6
0
1346
Procedures/
1,000 Member
Months
0.00
3.45
1.69
7.86
24.04
28.90
25.95
5.66
7.04
Observation Room Stays
Resulting in Discharge
Stays
0
8
164
969
21
7
1
1
0
1171
Stays/ 1,000
Member
Months
0.00
0.14
3.75
20.10
1.02
1.38
0.55
0.94
6.12
Page 54
Use of Services
Metropolitan Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Age
Member
Months
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
NR
Discharges
Discharges /
1,000 Member
Months
Days
Days / 1,000
Member
Months
Average Length
of Stay
<1
NR
NR
NR
1-9
NR
NR
NR
10-19
NR
NR
NR
20-44
NR
NR
NR
45-64
NR
NR
NR
65-74
NR
NR
NR
75-84
NR
NR
NR
85+
NR
NR
NR
NR
NR
NR
Unknown
Total
NR
HEDIS 2008 (Reporting Year 2007)
NR
NR
Page 55
Use of Services
Metropolitan Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicare Advantage
Age
Member
Months
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
NR
Discharges
Discharges /
1,000 Member
Months
Days
Days / 1,000
Member
Months
Average Length
of Stay
<1
NR
NR
NR
1-9
NR
NR
NR
10-19
NR
NR
NR
20-44
NR
NR
NR
45-64
NR
NR
NR
65-74
NR
NR
NR
75-84
NR
NR
NR
85+
NR
NR
NR
NR
NR
NR
Unknown
Total
NR
HEDIS 2008 (Reporting Year 2007)
NR
NR
Page 56
Use of Services
Metropolitan Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:33 PM
MSHO
Age
Member
Months
<1
0
1-9
0
10-19
0
20-44
0
45-64
0
65-74
5223
75-84
3999
85+
1313
Unknown
0
10535
Total
Discharges
Discharges /
1,000 Member
Months
Days
Days / 1,000
Member
Months
Average Length
of Stay
<1
0
NA
0
NA
NA
1-9
0
NA
0
NA
NA
10-19
0
NA
0
NA
NA
20-44
0
NA
0
NA
NA
45-64
0
NA
0
NA
NA
65-74
2
0.38
20
3.83
10.00
75-84
2
0.50
19
4.75
9.50
85+
0
0.00
0
0.00
NA
Unknown
0
4
0.38
0
39
3.70
NA
9.75
Age
Total
HEDIS 2008 (Reporting Year 2007)
Page 57
Use of Services
Metropolitan Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
Age
Member
Months
<1
12937
1-9
57938
10-19
43685
20-44
48220
45-64
20510
65-74
5086
75-84
1811
85+
1060
Unknown
Total
0
191247
Discharges
Discharges /
1,000 Member
Months
<1
0
1-9
Days
Days / 1,000
Member
Months
Average Length
of Stay
0.00
0
0.00
NA
0
0.00
0
0.00
NA
10-19
0
0.00
0
0.00
NA
20-44
4
0.08
52
1.08
13.00
45-64
5
0.24
102
4.97
20.40
65-74
0
0.00
0
0.00
NA
75-84
1
0.55
7
3.87
7.00
85+
0
0.00
0
0.00
NA
Unknown
0
10
0.05
0
161
0.84
NA
16.10
Age
Total
HEDIS 2008 (Reporting Year 2007)
Page 58
Use of Services
ropolitan Health Plan
Mental Health Utilization
% of Members Receiving Inpatient, Day/Night and Ambulato
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Member Months
(Any)
Age
Male
Female
0-12
13-17
18-64
65+
Unknown
Total
NR
NR
Member Months
(Inpatient)
Total
Sex
M
F
Total
M
F
NR
13-17
Total
M
F
NR
18-64
Total
M
F
NR
65+
Total
M
F
NR
Unknown
Total
NR
NR
NR
NR
Age
Total
M
F
Total
Number
HEDIS 2008 (Reporting Year 2007)
Female
Total
Member Months
(Outpatient/ED)
Male
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
Any Services
0-12
Male
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
NR
NR
Inpatient
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
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
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 59
Use of Services
ropolitan Health Plan
Mental Health Utilization
% of Members Receiving Inpatient, Day/Night and Ambulato
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicare Advantage
Member Months
(Inpatient)
Member Months
(Any)
Male
Age
Female
0-12
13-17
18-64
65+
Unknown
Total
NR
NR
Total
Age
Sex
M
F
Total
Number
NR
13-17
M
F
Total
NR
18-64
M
F
Total
NR
65+
M
F
Unknown
Total
Total
M
F
NR
Total
M
F
Total
NR
NR
NR
NR
HEDIS 2008 (Reporting Year 2007)
Female
Total
Member Months
(Outpatient/ED)
Male
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
Any Services
0-12
Male
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
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
Intensive Outpatient/Partial
Hospitalization
Inpatient
Percent
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Outpatient/ED
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 60
Use of Services
ropolitan Health Plan
Mental Health Utilization
% of Members Receiving Inpatient, Day/Night and Ambulato
Data Last Refreshed:
Oct 7, 2009 1:33 PM
MSHO
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Member Months
(Inpatient)
Male
Female
Total
Male
Female
Total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3861
0
3861
0
6674
0
6674
0
10535
0
10535
0
3861
0
3861
0
6674
0
6674
0
10535
0
10535
0
3861
0
3861
0
6674
0
6674
Any Services
Age
0-12
Sex
M
F
Total
13-17
M
F
Total
18-64
M
F
Total
65+
M
F
Total
Unknown
M
F
Total
M
F
Total
Total
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
Male
Female
Total
0
0
0
0
0
0
0
0
0
10535
0
10535
0
3861
0
3861
0
6674
0
6674
0
10535
0
10535
Intensive Outpatient/Partial
Hospitalization
Inpatient
Member Months
(Outpatient/ED)
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
0
0
0
0
0
0
0
0
0
55
88
143
0
0
0
55
88
143
NA
NA
NA
NA
NA
NA
NA
NA
NA
17.09%
15.82%
16.29%
NA
NA
NA
17.09%
15.82%
16.29%
0
0
0
0
0
0
0
0
0
4
6
10
0
0
0
4
6
10
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.24%
1.08%
1.14%
NA
NA
NA
1.24%
1.08%
1.14%
0
0
0
0
0
0
0
0
0
2
2
4
0
0
0
2
2
4
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.62%
0.36%
0.46%
NA
NA
NA
0.62%
0.36%
0.46%
0
0
0
0
0
0
0
0
0
54
86
140
0
0
0
54
86
140
NA
NA
NA
NA
NA
NA
NA
NA
NA
16.78%
15.46%
15.95%
NA
NA
NA
16.78%
15.46%
15.95%
HEDIS 2008 (Reporting Year 2007)
Page 61
Use of Services
ropolitan Health Plan
Mental Health Utilization
% of Members Receiving Inpatient, Day/Night and Ambulato
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
Male
Female
Total
Male
Female
Total
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
42846
10853
41888
11772
84734
22625
42846
10853
41888
11772
84734
22625
42846
10853
41888
11772
84734
22625
42846
10853
41888
11772
84734
22625
31220
3135
0
88054
44711
4822
0
103193
75931
7957
0
191247
31220
3135
0
88054
44711
4822
0
103193
75931
7957
0
191247
31220
3135
0
88054
44711
4822
0
103193
75931
7957
0
191247
31220
3135
0
88054
44711
4822
0
103193
75931
7957
0
191247
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Member Months
(Inpatient)
Any Services
Age
0-12
Sex
M
F
Total
13-17
M
F
Total
18-64
M
F
Total
65+
M
F
Total
Unknown
M
F
Total
M
F
Total
Total
Intensive Outpatient/Partial
Hospitalization
Inpatient
Member Months
(Outpatient/ED)
Male
Female
Total
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
2
4
6
3
13
16
76
46
122
3
4
7
0
0
0
84
67
151
0.06%
0.11%
0.08%
0.33%
1.33%
0.85%
2.92%
1.23%
1.93%
1.15%
1.00%
1.06%
NA
NA
NA
1.14%
0.78%
0.95%
2
4
6
3
13
16
76
46
122
3
4
7
0
0
0
84
67
151
0.06%
0.11%
0.08%
0.33%
1.33%
0.85%
2.92%
1.23%
1.93%
1.15%
1.00%
1.06%
NA
NA
NA
1.14%
0.78%
0.95%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
2
2
4
3
9
12
59
30
89
2
1
3
0
0
0
66
42
108
0.06%
0.06%
0.06%
0.33%
0.92%
0.64%
2.27%
0.81%
1.41%
0.77%
0.25%
0.45%
NA
NA
NA
0.90%
0.49%
0.68%
HEDIS 2008 (Reporting Year 2007)
Page 62
ropolitan Health Plan
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
Female
NR
NR
Member Months
(Inpatient)
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 2008 (Reporting Year 2007)
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
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
NR
NR
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 63
ropolitan Health Plan
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicare Advantage
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
Female
NR
NR
Member Months
(Inpatient)
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 2008 (Reporting Year 2007)
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
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
NR
NR
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 64
ropolitan Health Plan
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:33 PM
MSHO
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
0
0
0
0
0
3861
0
3861
Female
0
0
0
0
0
6674
0
6674
Member Months
(Inpatient)
Total
0
0
0
0
0
10535
0
10535
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
29
4
33
0
0
0
29
4
33
HEDIS 2008 (Reporting Year 2007)
Male
0
0
0
0
0
3861
0
3861
Female
0
0
0
0
0
6674
0
6674
Total
0
0
0
0
0
10535
0
10535
Inpatient
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
9.01%
0.72%
3.76%
NA
NA
NA
9.01%
0.72%
3.76%
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
3
7
0
0
0
4
3
7
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.24%
0.54%
0.80%
NA
NA
NA
1.24%
0.54%
0.80%
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3861
6674
10535
0
0
0
3861
6674
10535
Member Months
(Outpatient/ED)
Male
0
0
0
0
0
3861
0
3861
Female
0
0
0
0
0
6674
0
6674
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
1
0
1
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
27
4
31
0
0
0
27
4
31
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.31%
0.00%
0.11%
NA
NA
NA
0.31%
0.00%
0.11%
Total
0
0
0
0
0
10535
0
10535
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
8.39%
0.72%
3.53%
NA
NA
NA
8.39%
0.72%
3.53%
Page 65
ropolitan Health Plan
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
42846
10853
7054
5486
18680
3135
0
88054
Female
41888
11772
12964
13977
17770
4822
0
103193
Member Months
(Inpatient)
Total
84734
22625
20018
19463
36450
7957
0
191247
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
2
4
6
15
19
34
93
70
163
140
117
257
630
302
932
28
11
39
0
0
0
908
523
1431
HEDIS 2008 (Reporting Year 2007)
Male
42846
10853
7054
5486
18680
3135
0
88054
Female
41888
11772
12964
13977
17770
4822
0
103193
Total
84734
22625
20018
19463
36450
7957
0
191247
Inpatient
Percent
0.06%
0.11%
0.08%
1.66%
1.94%
1.80%
15.82%
6.48%
9.77%
30.62%
10.05%
15.85%
40.47%
20.39%
30.68%
10.72%
2.74%
5.88%
NA
NA
NA
12.37%
6.08%
8.98%
Number
0
0
0
2
6
8
10
9
19
26
21
47
131
53
184
8
3
11
0
0
0
177
92
269
Percent
0.00%
0.00%
0.00%
0.22%
0.61%
0.42%
1.70%
0.83%
1.14%
5.69%
1.80%
2.90%
8.42%
3.58%
6.06%
3.06%
0.75%
1.66%
NA
NA
NA
2.41%
1.07%
1.69%
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
42846
10853
7054
5486
18680
3135
0
88054
41888
11772
12964
13977
17770
4822
0
103193
84734
22625
20018
19463
36450
7957
0
191247
Member Months
(Outpatient/ED)
Male
42846
10853
7054
5486
18680
3135
0
88054
Female
41888
11772
12964
13977
17770
4822
0
103193
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
0
1
1
0
2
2
4
2
6
6
8
14
33
10
43
0
0
0
0
0
0
43
23
66
Number
2
4
6
15
19
34
91
68
159
135
111
246
615
299
914
28
11
39
0
0
0
886
512
1398
Percent
0.00%
0.03%
0.01%
0.00%
0.20%
0.11%
0.68%
0.19%
0.36%
1.31%
0.69%
0.86%
2.12%
0.68%
1.42%
0.00%
0.00%
0.00%
NA
NA
NA
0.59%
0.27%
0.41%
Total
84734
22625
20018
19463
36450
7957
0
191247
Percent
0.06%
0.11%
0.08%
1.66%
1.94%
1.80%
15.48%
6.29%
9.53%
29.53%
9.53%
15.17%
39.51%
20.19%
30.09%
10.72%
2.74%
5.88%
NA
NA
NA
12.07%
5.95%
8.77%
Page 66
Use of Services
Metropolitan Health Plan
Outpatient Drug Utilization
Commercial
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Member Months
NR
Total Cost of
Prescriptions
0-9
10-19
20-44
45-64
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
HEDIS 2008 (Reporting Year 2007)
NR
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 67
Use of Services
Metropolitan Health Plan
Outpatient Drug Utilization
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicare Advantage
Age
Member Months
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
NR
Age
Total Cost of
Prescriptions
0-9
10-19
20-44
45-64
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
HEDIS 2008 (Reporting Year 2007)
NR
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 68
Use of Services
Metropolitan Health Plan
Outpatient Drug Utilization
MSHO
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Member Months
0
0
0
0
5223
3999
1313
0
10535
Total Cost of
Prescriptions
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
$1,127.91
$0.00
$0.00
$0.00
$570,334.57
$460,883.72
$197,785.14
$0.00
$1,230,131.34
HEDIS 2008 (Reporting Year 2007)
Avg. Cost of
Prescriptions /
Per Member Per
Month
NA
NA
NA
NA
$109.20
$115.25
$150.64
$116.77
Total Number of
Prescriptions
24
0
0
0
10108
10207
4399
0
24738
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NA
NA
NA
NA
23.22
30.63
40.20
28.18
Page 69
Use of Services
Metropolitan Health Plan
Outpatient Drug Utilization
Medicaid
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
70875
43685
48220
20510
5086
1811
1060
0
191247
Total Cost of
Prescriptions
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 1:33 PM
$590,941.42
$632,180.11
$2,467,788.96
$2,001,864.25
$198,243.28
$63,086.72
$156,302.77
$0.00
$6,110,407.51
HEDIS 2008 (Reporting Year 2007)
Avg. Cost of
Prescriptions /
Per Member Per
Month
$8.34
$14.47
$51.18
$97.60
$38.98
$34.84
$147.46
$31.95
Total Number of
Prescriptions
15766
11105
45934
35282
4879
2028
2996
0
117990
Avg. Num. Of
Prescriptions /
Per Member Per
Year
2.67
3.05
11.43
20.64
11.51
13.44
33.92
7.40
Page 70
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 (Administrativ
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 2008 (Reporting Year 2007)
Page 71
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicare Advantage
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 (Administrativ
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 2008 (Reporting Year 2007)
Page 72
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:33 PM
MSHO
Data Elements
General Measure
Data
Measurement Year
Data collection methodology (Administrativ
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 2008 (Reporting Year 2007)
Ages 20-44
Ages 45-64
Ages 65+
0
0
775
2007
A
0
0
740
NA
NA
NA
NA
NA
NA
95.48%
93.96%
97.01%
Page 73
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
Data Elements
General Measure
Data
Measurement Year
Data collection methodology (Administrativ
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 2008 (Reporting Year 2007)
Ages 20-44
Ages 45-64
Ages 65+
1200
856
415
2007
A
1055
739
389
87.92%
86.03%
89.80%
86.33%
83.97%
88.69%
93.73%
91.28%
96.19%
Page 74
Access/Availability of Care
Metropolitan Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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 (Administrativ
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 2008 (Reporting Year 2007)
Page 75
Access/Availability of Care
Metropolitan Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
Data Elements
Measurement Year
Data collection methodology (Administrativ
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 2008 (Reporting Year 2007)
General Measure
Data
12-24 months
25 months 6 yrs.
7-11 yrs.
12-19 yrs.
495
1034
631
829
2007
A
487
923
557
710
98.38%
97.17%
99.60%
89.26%
87.33%
91.20%
88.27%
85.68%
90.86%
85.65%
83.20%
88.09%
Page 76
Access/Availability of Care
Metropolitan Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Data Elements
Timeliness of
Prenatal Care
Postpartum
Care
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Data collection methodology (Administrative or Hybrid)
Eligible member population (i.e. members who meet all
denominator criteria)
Number of numerator events by administrative data in
eligible population (before exclusions)
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of
valid data errors
Number of administrative data records excluded
Number of medical records data records excluded
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2008 (Reporting Year 2007)
Page 77
Access/Availability of Care
Metropolitan Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
Timeliness of
Prenatal Care
Postpartum
Care
Data collection methodology (Administrative or Hybrid)
A
A
Eligible member population (i.e. members who meet all
denominator criteria)
742
742
82.08%
65.90%
NR
NR
609
489
NR
NR
NR
NR
NR
NR
Data Elements
Number of numerator events by administrative data in
eligible population (before exclusions)
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of
valid data errors
Number of administrative data records excluded
Number of medical records data records excluded
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2008 (Reporting Year 2007)
Page 78
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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
Overall Rate
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members who
meet all denominator criteria)
NR
Numerator events by administrative data
NR
NR
Reported rate
NR
NR
NR
NR
NR
NR
Lower 95% confidence interval
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Upper 95% confidence interval
HEDIS 2008 (Reporting Year 2007)
Page 79
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicare Advantage
13-17 Year Olds
Data Elements
General
Measure
Data
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
18+ Year Olds
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
Overall Rate
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members who
meet all denominator criteria)
NR
Numerator events by administrative data
NR
NR
Reported rate
NR
NR
NR
NR
NR
NR
Lower 95% confidence interval
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Upper 95% confidence interval
HEDIS 2008 (Reporting Year 2007)
Page 80
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:33 PM
MSHO
13-17 Year Olds
Data Elements
Measurement Year
Data collection methodology
(Administrative only)
General
Measure
Data
Initiation of
AOD
Treatment
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
Overall Rate
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
2007
A
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Engagement
of AOD
Treatment
18+ Year Olds
0
21
21
0
0
5
0
5
0
Reported rate
NA
NA
NA
NA
NA
NA
Lower 95% confidence interval
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Upper 95% confidence interval
HEDIS 2008 (Reporting Year 2007)
Page 81
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
13-17 Year Olds
Data Elements
Measurement Year
Data collection methodology
(Administrative only)
General
Measure
Data
Initiation of
AOD
Treatment
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
Overall Rate
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
2007
A
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Engagement
of AOD
Treatment
18+ Year Olds
15
491
506
2
2
120
26
122
28
Reported rate
NA
NA
24.44%
5.30%
24.11%
5.53%
Lower 95% confidence interval
NA
NA
NA
NA
20.54%
28.34%
3.21%
7.38%
20.28%
27.94%
3.44%
7.62%
Upper 95% confidence interval
HEDIS 2008 (Reporting Year 2007)
Page 82
Health Plan Stability
Metropolitan Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Product/Product Line
Years in Business
Members*
NR
NR
NR
NR
NR
NR
NR
HMO
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
Total HMO:
PPO
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
Total PPO:
POS
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
Total POS:
Total:
* Total number of members in each category as of December 31, 2007
HEDIS 2008 (Reporting Year 2007)
Page 83
Health Plan Stability
Metropolitan Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicare Advantage
Product/Product Line
Years in Business
Members*
NR
NR
NR
NR
NR
NR
NR
HMO
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
Total HMO:
PPO
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
Total PPO:
POS
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
Total POS:
Total:
* Total number of members in each category as of December 31, 2007
HEDIS 2008 (Reporting Year 2007)
Page 84
Health Plan Stability
Metropolitan Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:33 PM
MSHO
Product/Product Line
Years in Business
Members*
25.00
0.00
11.00
0.00
0.00
25.00
12556
0
827
0
0
13383
0.00
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
0
0.00
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
0
13383
HMO
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
Total HMO:
PPO
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
Total PPO:
POS
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
Total POS:
Total:
* Total number of members in each category as of December 31, 2007
HEDIS 2008 (Reporting Year 2007)
Page 85
Health Plan Stability
Metropolitan Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
Product/Product Line
Years in Business
Members*
25.00
0.00
11.00
0.00
0.00
25.00
12556
0
827
0
0
13383
0.00
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
0
0.00
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
0
13383
HMO
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
Total HMO:
PPO
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
Total PPO:
POS
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
Total POS:
Total:
* Total number of members in each category as of December 31, 2007
HEDIS 2008 (Reporting Year 2007)
Page 86
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Commercial
Male
Member Months
Female
<1
1-4
5-9
10-14
15-17
18-19
Total
NR
NR
NR
NR
NR
NR
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
NR
NR
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
NR
NR
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
NR
NR
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
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
HEDIS 2008 (Reporting Year 2007)
NR
NR
NR
NR
NR
NR
NR
Page 87
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicare Advantage
Male
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
NR
NR
NR
NR
NR
NR
Age Unknown
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2008 (Reporting Year 2007)
Page 88
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:33 PM
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%
972
1284
924
444
156
96
0
0.00%
1224
1752
1524
1116
648
420
0
0.00%
3876
100.00%
0
6684
100.00%
0
10560
100.00%
3876
6684
HEDIS 2008 (Reporting Year 2007)
0
0
0
0
0
0
0
0
0
2196
3036
2448
1560
804
516
0
10560
Page 89
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:33 PM
Medicaid
<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
6653
13969
15262
11532
6283
2972
Member Months
Female
6284
13350
15357
11574
7095
4229
Total
12937
27319
30619
23106
13378
7201
56671
64.36%
4082
2928
2558
3235
3953
57889
56.10%
8735
8090
5887
4679
4073
114560
59.90%
16756
19.03%
4480
3495
2451
1066
31464
30.49%
3640
2502
1828
1048
48220
25.21%
11492
13.05%
1503
682
456
271
187
36
9018
8.74%
1922
979
669
415
452
385
20510
10.72%
3135
3.56%
0
4822
4.67%
0
7957
4.16%
88054
103193
HEDIS 2008 (Reporting Year 2007)
12817
11018
8445
7914
8026
8120
5997
4279
2114
3425
1661
1125
686
639
421
0
191247
Page 90