Medica Health Plans
Plan Name
2007
Reporting Year
Submission #
General Info
Disclaimers
Code
CIS
Plan ID
1
Last Refreshed:
Page
Childhood Immunization Status
10/7/2009 1:32:48 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
18
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
Medica Health Plans
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
HiB
Hepatitis B
VZV
Pneumococcal
Conjugate
Combo 2
Combo 3
2381
73.28%
2496
76.82%
2945
90.64%
2475
76.18%
2457
75.62%
2857
87.93%
2338
71.96%
2081
64.05%
1984
61.06%
321
70.86%
347
76.60%
412
90.95%
335
73.95%
338
74.61%
395
87.20%
324
71.52%
281
62.03%
272
60.04%
337
26
88.32%
85.09%
91.55%
339
51
94.89%
92.64%
97.14%
353
39
95.38%
93.23%
97.53%
341
33
91.00%
88.11%
93.89%
335
39
91.00%
88.11%
93.89%
346
30
91.48%
88.66%
94.30%
339
6
83.94%
80.27%
87.61%
322
13
81.51%
77.63%
85.38%
312
4
76.89%
72.69%
81.08%
453
0
Number of Records Excluded because of
Contraindications by Admin Data
1
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
2
HEDIS 2008 (Reporting Year 2007)
MMR
411
10.00%
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
3249
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
411
Page 3
Effectiveness of Care
Medica Health Plans
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:32 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
2040
75.78%
2224
82.62%
2434
90.42%
2133
79.23%
2195
81.54%
2372
88.11%
2036
75.63%
1723
64.00%
1632
60.62%
345
76.16%
373
82.34%
417
92.05%
360
79.47%
371
81.90%
404
89.18%
345
76.16%
284
62.69%
266
58.72%
350
8
87.10%
83.74%
90.47%
368
15
93.19%
90.63%
95.74%
377
14
95.13%
92.93%
97.34%
366
11
91.73%
88.94%
94.51%
371
9
92.46%
89.78%
95.13%
364
12
91.48%
88.66%
94.30%
336
4
82.73%
78.95%
86.50%
319
5
78.83%
74.76%
82.90%
298
2
72.99%
68.58%
77.41%
453
0
Number of Records Excluded because of
Contraindications by Admin Data
6
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
1
HEDIS 2008 (Reporting Year 2007)
MMR
411
10.00%
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
2692
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
411
Page 4
Effectiveness of Care
Medica Health Plans
Appropriate Treatment for Children with Upper
Respiratory Infection
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
Data Elements
Commercial
Medicaid
2007
2007
A
A
Eligible Member Population
5753
5174
Numerator Events by Admin Data
733
568
Reported Rate
87.26%
89.02%
Lower 95% Confidence Interval
86.39%
88.16%
Upper 95% Confidence Interval
88.13%
89.88%
Measurement Year
Data Collection Methodology
HEDIS 2008 (Reporting Year 2007)
Page 5
Effectiveness of Care
Medica Health Plans
Colorectal Cancer Screening
Data Elements
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
Medicare
Advantage
MSHO
2007
2007
H
H
Eligible population
43978
3607
Number of numerator events by administrative data in eligible
population (before exclusions)
21948
1502
Measurement Year
Data collection methodology (administrative or hybrid)
Current year's administrative rate (before exclusions)
49.91%
NR
41.64%
Minimum required sample size (MRSS) or other sample size
411
411
Oversampling rate
0.1
0
Final sample size (FSS)
453
453
Number of numerator events by administrative data in FSS
214
171
Administrative rate on FSS
Number of original sample records excluded because of valid data
errors
47.24%
NR
37.75%
0
0
Number of administrative data records excluded
35
12
Number of medical record data records excluded
0
0
Number of employee/dependent medical records excluded
0
0
Records added from the oversample list
0
0
Denominator
411
411
Numerator events by administrative data
154
134
Numerator events by medical records
75
47
Reported rate
55.72%
NR
44.04%
Lower 95% confidence interval
50.79%
NR
39.12%
Upper 95% confidence interval
60.64%
NR
48.96%
HEDIS 2008 (Reporting Year 2007)
Page 6
Effectiveness of Care
Medica Health Plans
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:32 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 42-51
Ages 52-69
Total
20062
13862
69.10%
68.45%
69.74%
19862
14826
74.65%
74.04%
75.25%
39924
28688
71.86%
71.41%
72.30%
2007
A
Page 7
Effectiveness of Care
Medica Health Plans
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:32 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
511
315
61.64%
57.33%
65.96%
511
315
61.64%
57.33%
65.96%
2007
A
Page 9
Effectiveness of Care
Medica Health Plans
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:32 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
1858
1014
54.57%
52.28%
56.87%
1357
807
59.47%
56.82%
62.12%
3215
1821
56.64%
54.91%
58.37%
2007
A
Page 10
Effectiveness of Care
Medica Health Plans
Cervical Cancer Screening
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
Medicaid
2007
A
43966
2007
A
12369
NR
NR
NR
NR
35435
9447
80.60%
80.23%
80.97%
76.38%
75.62%
77.13%
Numerator Events by Admin Data on Eligible
Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
Records Excluded because of Valid Data Errors
Number of 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 11
Effectiveness of Care
Medica Health Plans
Chlamydia Screening in Women
Data Last Refreshed:
Oct 7, 2009 1:32 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
2007
A
General
Measure Ages 16-20 Ages 21-25
Data
Total
2007
A
4552
1680
36.91%
35.49%
38.32%
5729
2391
41.74%
40.45%
43.02%
10281
4071
39.60%
38.65%
40.55%
1754
964
54.96%
52.60%
57.32%
2096
1172
55.92%
53.77%
58.07%
3850
2136
55.48%
53.90%
57.06%
Page 12
Effectiveness of Care
Medica Health Plans
Data Last Refreshed:
Oct 7, 2009 1:32 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
384
63
16.41%
12.57%
20.24%
Page 13
Effectiveness of Care
Medica Health Plans
Controlling High Blood Pressure
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology (Hybrid)
Eligible Member Population
Numerator Events by Admin Data on
Eligible Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Records Excluded because of Valid Data
Errors
Commercial
Medicare Advantage
MSHO
2007
2007
H
H
17616
2168
0
0
0.00%
NR
0.00%
411
411
15.00%
0.00%
473
473
0
0
0.00%
NR
0.00%
0
0
Number of administrative data records
excluded
326
162
Number of medical record data records
excluded
0
0
Number of employee/dependent medical
records excluded
0
0
Records Added from the OverSample List
14
16
Denominator
411
411
0
0
Numerator Events by Admin Data
Numerator Events by Medical Record
248
252
Reported Rate
60.34%
NR
61.31%
Lower 95% Confidence Interval
55.49%
NR
56.48%
Upper 95% Confidence Interval
65.19%
NR
66.14%
HEDIS 2008 (Reporting Year 2007)
Page 14
Effectiveness of Care
Medica Health Plans
Persistence of Beta Blocker Treatment After Hearth Attack
Data Elements
MSHO
Medicaid
2007
2007
2007
A
A
A
Eligible Member Population
248
67
50
Numerator Events by Admin Data on
Eligible Population
190
61
25
Measurement Year
Data Collection Methodology
Commercial
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Medicare Advantage
Reported Rate
76.61%
NR
91.04%
50.00%
Lower 95% Confidence Interval
71.14%
NR
83.46%
35.14%
Upper 95% Confidence Interval
82.08%
NR
98.63%
64.86%
HEDIS 2008 (Reporting Year 2007)
Page 15
Effectiveness of Care
Medica Health Plans
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
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)
1495
22
83.71%
1.23%
371
5
81.90%
1.10%
30
331
0
262
87.83%
84.55%
91.12%
63.75%
58.98%
68.52%
411
10.00%
453
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
1786
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
411
Page 16
Effectiveness of Care
Medica Health Plans
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:32 PM
MSHO
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)
182
4
75.21%
1.65%
175
4
74.79%
1.71%
26
160
0
121
79.49%
74.10%
84.87%
51.71%
45.09%
58.33%
242
0.00%
234
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
242
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
234
Page 18
Effectiveness of Care
Medica Health Plans
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:32 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)
184
2
71.60%
0.78%
183
2
71.21%
0.78%
14
192
0
138
80.16%
75.08%
85.23%
53.70%
47.41%
59.99%
257
0.00%
257
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
257
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
257
Page 19
Effectiveness of Care
Medica Health Plans
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
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
9254
2007
H
9254
2007
H
9254
2007
H
9254
2007
H
9254
2007
H
9254
2007
H
9254
2007
H
9254
2007
H
9254
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
8018
86.64%
411
10%
453
409
90.29%
9070
98.01%
411
10%
453
452
99.78%
60
0.65%
411
10%
453
1
0.22%
4830
52.19%
411
10%
453
238
52.54%
7299
78.87%
411
10%
453
364
80.35%
89
0.96%
411
10%
453
0
0.00%
7434
80.33%
411
10%
453
373
82.34%
109
1.18%
411
10%
453
3
0.66%
71
0.77%
411
10%
453
2
0.44%
Number of Records Excluded Because of
Valid Data Errors
0
0
0
0
0
0
0
0
0
Number of administrative data records
excluded
96
96
96
96
96
96
96
96
96
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
411
17
359
91.48%
88.66%
94.30%
3
411
114
0
27.74%
23.29%
32.19%
3
411
0
199
48.42%
43.47%
53.37%
3
411
12
219
56.20%
51.29%
61.12%
3
411
28
313
82.97%
79.21%
86.72%
3
411
0
206
50.12%
45.17%
55.08%
3
411
218
129
84.43%
80.80%
88.06%
3
411
0
311
75.67%
71.40%
79.94%
3
411
0
192
46.72%
41.77%
51.66%
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 20
Effectiveness of Care
Medica Health Plans
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:32 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
973
2007
H
973
2007
H
973
2007
H
973
2007
H
973
2007
H
973
2007
H
973
2007
H
973
2007
H
973
857
88.30%
951
98.68%
16
1.10%
615
65.12%
717
73.73%
12
0.88%
813
86.53%
21
2.65%
16
2.21%
Number of Records Excluded Because of
Valid Data Errors
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
411
74
301
91.24%
88.39%
94.10%
0
411
170
1
41.61%
36.72%
46.49%
0
411
0
191
46.47%
41.53%
51.42%
0
411
27
243
65.69%
60.98%
70.40%
0
411
67
255
78.35%
74.24%
82.45%
0
411
0
177
43.07%
38.16%
47.97%
0
411
252
109
87.83%
84.55%
91.12%
0
411
3
258
63.50%
58.73%
68.28%
0
411
3
174
43.07%
38.16%
47.97%
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
Medica Health Plans
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:32 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
2017
2007
H
2017
2007
H
2017
2007
H
2017
2007
H
2017
2007
H
2017
2007
H
2017
2007
H
2017
2007
H
2017
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
1581
78.38%
411
10%
453
356
78.59%
1937
96.03%
411
10%
453
448
98.90%
14
0.69%
411
10%
453
3
0.66%
1059
52.50%
411
10%
453
249
54.97%
1316
65.25%
411
10%
453
307
67.77%
30
1.49%
411
10%
453
10
2.21%
1370
67.92%
411
10%
453
311
68.65%
31
1.54%
411
10%
453
9
1.99%
22
1.09%
411
10%
453
8
1.77%
Number of Records Excluded Because of
Valid Data Errors
0
0
0
0
0
0
0
0
0
Number of administrative data records
excluded
55
55
55
55
55
55
55
55
55
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
411
24
331
86.37%
82.94%
89.81%
6
411
160
1
39.17%
34.33%
44.01%
6
411
0
196
47.69%
42.74%
52.64%
6
411
14
225
58.15%
53.26%
63.04%
6
411
42
274
76.89%
72.69%
81.08%
6
411
0
159
38.69%
33.86%
43.52%
6
411
198
125
78.59%
74.50%
82.68%
6
411
1
295
72.02%
67.56%
76.48%
6
411
1
199
48.66%
43.71%
53.62%
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
Medica Health Plans
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 1:32 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
Ages 10-17
Ages 18-56
Total
355
344
96.90%
94.96%
98.84%
535
513
95.89%
94.11%
97.66%
2404
2196
91.35%
90.20%
92.49%
3294
3053
92.68%
91.78%
93.59%
2007
A
Page 24
Effectiveness of Care
Medica Health Plans
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 1:32 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
278
254
91.37%
87.89%
94.85%
387
338
87.34%
83.90%
90.78%
567
475
83.77%
80.65%
86.90%
1232
1067
86.61%
84.66%
88.55%
2007
A
Page 25
Effectiveness of Care
Medica Health Plans
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:32 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
414
16.20%
14.75%
17.65%
1792
70.11%
68.32%
71.90%
1371
53.64%
51.69%
55.59%
2007
A
2556
Page 26
Effectiveness of Care
Medica Health Plans
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:32 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
8
6.40%
1.71%
11.09%
83
66.40%
57.72%
75.08%
73
58.40%
49.36%
67.44%
2007
A
125
Page 28
Effectiveness of Care
Medica Health Plans
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:32 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
155
20.29%
17.37%
23.21%
369
48.30%
44.69%
51.91%
246
32.20%
28.82%
35.58%
2007
A
764
Page 29
Effectiveness of Care
Medica Health Plans
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Oct 7, 2009 1:32 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
2007
A
General
Measure
Data
Initiation
Phase
Continuation
and
Maintenance
Phase
594
221
37.21%
33.23%
41.18%
141
60
42.55%
34.04%
51.07%
2007
A
818
291
35.57%
32.23%
38.92%
210
76
36.19%
29.45%
42.93%
Page 30
Effectiveness of Care
Medica Health Plans
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 1:32 PM
Medicare
Advantage
NR
NR
NR
MSHO
2007
A
6756
4942
73.15%
72.09%
74.21%
Page 31
Effectiveness of Care
Medica Health Plans
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:32 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
15751
12556
79.72%
79.08%
80.35%
287
240
83.62%
79.17%
88.08%
12653
10178
80.44%
79.74%
81.13%
963
699
72.59%
69.72%
75.46%
29654
23673
79.83%
79.37%
80.29%
2007
A
Page 32
Effectiveness of Care
Medica Health Plans
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:32 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
2783
2649
95.19%
94.37%
96.00%
352
339
96.31%
94.19%
98.42%
3087
2959
95.85%
95.13%
96.57%
414
395
95.41%
93.27%
97.55%
6636
6342
95.57%
95.07%
96.07%
2007
A
Page 34
Effectiveness of Care
Medica Health Plans
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:32 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
1320
1156
87.58%
85.76%
89.39%
25
20
NA
NA
NA
1175
1023
87.06%
85.10%
89.03%
209
171
81.82%
76.35%
87.29%
2729
2370
86.84%
85.56%
88.13%
2007
A
Page 35
Effectiveness of Care
Medica Health Plans
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Oct 7, 2009 1:32 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
7843
1 or More
Prescriptions
2 or More
Prescriptions
1999
25.49%
24.52%
26.46%
459
5.85%
5.33%
6.38%
Page 36
Effectiveness of Care
Medica Health Plans
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Oct 7, 2009 1:32 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
550
140
25.45%
21.72%
29.19%
2410
693
28.76%
26.93%
30.58%
326
54
16.56%
12.38%
20.75%
3286
887
26.99%
25.46%
28.53%
Page 38
Use of Services
Medica Health Plans
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
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
23
16
18
62
124
383
2245
0.80%
0.46%
1.14%
0.56%
0.27%
0.85%
0.63%
0.32%
0.93%
2.16%
1.61%
2.71%
4.32%
3.56%
5.08%
13.34%
12.08%
14.60%
78.20%
76.67%
79.72%
2007
A
2871
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
Medica Health Plans
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 1:32 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
44
50
88
167
343
650
2535
1.13%
0.79%
1.48%
1.29%
0.92%
1.66%
2.27%
1.79%
2.75%
4.31%
3.66%
4.96%
8.85%
7.94%
9.75%
16.77%
15.58%
17.95%
65.39%
63.88%
66.90%
2007
A
3877
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
Medica Health Plans
Well Child Visits in the 3rd, 4th,
5th and 6th Years of Life
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
Medicaid
2007
A
14825
2007
A
8349
NR
NR
NR
NR
9678
5671
65.28%
64.51%
66.05%
67.92%
66.92%
68.93%
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
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)
Page 41
Use of Services
Medica Health Plans
Adolescent Well-Care Visits
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
Medicaid
2007
A
39981
2007
A
12834
NR
NR
NR
NR
13551
4717
33.89%
33.43%
34.36%
36.75%
35.92%
37.59%
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
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)
Page 42
Use of Services
Medica Health Plans
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
Member Months
Total
292179
587164
921160
626175
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
1313
346
495
212
Procedures /
1,000 Member
Months
4.49
0.38
0.84
0.34
Member Months
Male
Female
1003637
897203
848916
1230876
659891
651804
29070
22688
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+
Back Surgery
20-44
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
22
0.02
2
220
9
198
275
15
382
37
435
50
84
12
180
34
0.07
0.18
0.31
0.22
0.42
0.52
0.58
1.27
0.66
1.72
0.13
0.41
0.27
1.17
Number of
Procedures
91
84
254
340
8
198
203
5
Procedures /
1,000 Member
Months
0.09
0.13
0.25
0.52
0.35
0.20
0.31
0.22
13
38
3
0.01
0.06
0.13
414
326
11
154
265
6
111
8
241
15
11
3
0.41
0.50
0.48
0.18
0.41
0.26
0.17
0.35
0.37
0.66
0.02
0.13
60
147
4
212
279
12
0.06
0.23
0.18
0.21
0.43
0.53
Page 43
Use of Services
Medica Health Plans
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:32 PM
MSHO
Age
< 65
65-74
75-84
85+
Member Months
Male
Female
0
0
11808
21823
9866
26293
5201
30280
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
4
1
0
0
17
8
1
0
20
7
1
0
0
0
0
0
5
11
7
0
3
4
1
0
3
9
0
0
5
3
1
0
1
2
0
0
7
3
1
0
4
3
1
Procedures /
1,000 Member
Months
NA
0.34
0.10
0.00
NA
1.44
0.81
0.19
NA
1.69
0.71
0.19
NA
0.00
0.00
0.00
NA
0.42
1.11
1.35
NA
0.25
0.41
0.19
NA
0.25
0.91
0.00
NA
0.42
0.30
0.19
NA
0.08
0.20
0.00
NA
0.59
0.30
0.19
NA
0.34
0.30
0.19
Female
Number of
Procedures
0
3
3
1
0
16
12
7
0
28
24
4
0
3
1
0
0
15
23
57
0
7
8
6
0
17
20
3
0
2
10
8
0
0
6
3
0
10
14
10
0
10
19
9
0
1
0
0
0
2
2
0
0
2
4
2
0
9
5
8
Procedures /
1,000 Member
Months
NA
0.14
0.11
0.03
NA
0.73
0.46
0.23
NA
1.28
0.91
0.13
NA
0.14
0.04
0.00
NA
0.69
0.87
1.88
NA
0.32
0.30
0.20
NA
0.78
0.76
0.10
NA
0.09
0.38
0.26
NA
0.00
0.23
0.10
NA
0.46
0.53
0.33
NA
0.46
0.72
0.30
NA
0.05
0.00
0.00
NA
0.09
0.08
0.00
NA
0.09
0.15
0.07
NA
0.41
0.19
0.26
Page 45
Use of Services
Medica Health Plans
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Medicaid
Member Months
Total
311697
515061
515673
312309
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
1261
330
401
151
Procedures /
1,000 Member
Months
4.05
0.64
0.78
0.48
Member Months
Male
Female
361544
117569
284426
122829
52878
67253
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
5
0.04
30
67
39
Number of
Procedures
38
13
105
36
74
22
Procedures /
1,000 Member
Months
0.11
0.19
0.29
0.54
0.20
0.33
21
4
0.06
0.06
302
50
76
45
4
8
66
33
0.84
0.74
0.27
0.67
0.01
0.12
0.18
0.49
0.24
0.57
0.74
Page 46
Use of Services
Medica Health Plans
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 1:32 PM
Member Months
57394
529770
626175
1746119
1311695
45707
4978
1073
0
4322911
Discharges
Discharges /
1,000 Member
Months
508
837
944
9328
7630
522
103
29
0
19901
8.85
1.58
1.51
5.34
5.82
11.42
20.69
27.03
408
643
464
1861
3406
247
70
19
0
7118
7.11
1.21
0.74
1.07
2.60
5.40
14.06
17.71
94
194
346
2224
4207
274
32
10
0
7381
1.64
0.37
0.55
1.27
3.21
5.99
6.43
9.32
132
5233
8
0
5373
0.21
3.00
0.01
HEDIS 2008 (Reporting Year 2007)
4.60
1.65
1.71
1.46
Days
Days / 1,000
Member
Months
2483
2461
3081
24971
24237
2085
351
166
0
59835
43.26
4.65
4.92
14.30
18.48
45.62
70.51
154.71
1548
1567
1419
4899
9644
871
231
108
0
20287
26.97
2.96
2.27
2.81
7.35
19.06
46.40
100.65
917
894
1359
6237
14493
1213
119
58
0
25290
15.98
1.69
2.17
3.57
11.05
26.54
23.91
54.05
301
13818
27
0
14146
0.48
7.91
0.02
13.84
4.69
5.85
3.84
Average
Length of Stay
4.89
2.94
3.26
2.68
3.18
3.99
3.41
5.72
NA
3.01
3.79
2.44
3.06
2.63
2.83
3.53
3.30
5.68
NA
2.85
9.76
4.61
3.93
2.80
3.44
4.43
3.72
5.80
NA
3.43
2.28
2.64
3.38
NA
2.63
Page 47
Use of Services
Medica Health Plans
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
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 1:32 PM
Member Months
0
0
0
0
0
33631
36159
35481
0
105271
Discharges
Discharges /
1,000 Member
Months
0
0
0
0
0
1102
1102
871
0
3075
NA
NA
NA
NA
NA
32.77
30.48
24.55
0
0
0
0
0
882
914
738
0
2534
NA
NA
NA
NA
NA
26.23
25.28
20.80
29.21
24.07
0
0
0
0
0
207
175
117
0
499
NA
NA
NA
NA
NA
6.16
4.84
3.30
0
0
0
0
0
NA
NA
NA
HEDIS 2008 (Reporting Year 2007)
4.74
NA
Days
0
0
0
0
0
4574
4625
3766
0
12965
Days / 1,000
Member
Months
NA
NA
NA
NA
NA
136.01
127.91
106.14
123.16
0
0
0
0
0
3441
3545
2994
0
9980
NA
NA
NA
NA
NA
102.32
98.04
84.38
0
0
0
0
0
1097
1039
713
0
2849
NA
NA
NA
NA
NA
32.62
28.73
20.10
0
0
0
0
0
NA
NA
NA
94.80
27.06
NA
Average
Length of Stay
NA
NA
NA
NA
NA
4.15
4.20
4.32
NA
4.22
NA
NA
NA
NA
NA
3.90
3.88
4.06
NA
3.94
NA
NA
NA
NA
NA
5.30
5.94
6.09
NA
5.71
NA
NA
NA
NA
NA
Page 49
Use of Services
Medica Health Plans
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 1:32 PM
Member Months
91829
423232
312309
401995
120131
22392
15747
10420
0
1398055
Discharges
1234
1193
1495
8694
1862
480
411
330
0
15699
Discharges /
1,000 Member
Months
13.44
2.82
4.79
21.63
15.50
21.44
26.10
31.67
11.23
1105
998
364
1637
1195
350
324
285
0
6258
12.03
2.36
1.17
4.07
9.95
15.63
20.58
27.35
126
195
228
1062
653
129
86
45
0
2524
1.37
0.46
0.73
2.64
5.44
5.76
5.46
4.32
901
5981
9
0
6891
2.88
14.88
0.07
HEDIS 2008 (Reporting Year 2007)
4.48
1.81
8.26
Days
Days / 1,000
Member
Months
5211
2990
4114
23210
6970
2136
1685
1583
0
47899
56.75
7.06
13.17
57.74
58.02
95.39
107.00
151.92
3834
2212
920
4598
3916
1269
1214
1275
0
19238
41.75
5.23
2.95
11.44
32.60
56.67
77.09
122.36
1362
778
876
3131
3020
863
469
308
0
10807
14.83
1.84
2.80
7.79
25.14
38.54
29.78
29.56
2275
15369
22
0
17666
7.28
38.23
0.18
34.26
13.76
7.73
21.17
Average
Length of Stay
4.22
2.51
2.75
2.67
3.74
4.45
4.10
4.80
NA
3.05
3.47
2.22
2.53
2.81
3.28
3.63
3.75
4.47
NA
3.07
10.81
3.99
3.84
2.95
4.62
6.69
5.45
6.84
NA
4.28
2.52
2.57
2.44
NA
2.56
Page 50
Use of Services
Medica Health Plans
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
57394
529770
626175
1746119
1311695
45707
4978
1073
0
4322911
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
Visits
46667
141893
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
120393
382530
393578
21387
3250
619
0
1110317
HEDIS 2008 (Reporting Year 2007)
Visits/ 1,000
Member
Months
813.10
267.84
192.27
219.07
300.05
467.92
652.87
576.89
256.84
Emergency Room Visits
Visits
1793
8819
7653
22534
13421
628
103
43
0
54994
Visits/ 1,000
Member
Months
31.24
16.65
12.22
12.91
10.23
13.74
20.69
40.07
12.72
Ambulatory
Surgery/Procedures
Procedures
372
2186
1873
11526
23591
1315
169
26
0
41058
Procedures/
1,000 Member
Months
6.48
4.13
2.99
6.60
17.99
28.77
33.95
24.23
9.50
Observation Room Stays
Resulting in Discharge
Stays
57
100
104
1161
516
22
2
2
0
1964
Stays/ 1,000
Member
Months
0.99
0.19
0.17
0.66
0.39
0.48
0.40
1.86
0.45
Page 51
Use of Services
Medica Health Plans
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:32 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
33631
36159
35481
0
105271
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
24241
21692
12650
0
58583
HEDIS 2008 (Reporting Year 2007)
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
720.79
599.91
356.53
556.50
Emergency Room Visits
Visits
0
0
0
0
0
2124
1922
1673
0
5719
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
63.16
53.15
47.15
54.33
Ambulatory
Surgery/Procedures
Procedures
0
0
0
0
0
1284
1362
797
0
3443
Procedures/
1,000 Member
Months
NA
NA
NA
NA
NA
38.18
37.67
22.46
32.71
Observation Room Stays
Resulting in Discharge
Stays
0
0
0
0
0
54
68
38
0
160
Stays/ 1,000
Member
Months
NA
NA
NA
NA
NA
1.61
1.88
1.07
1.52
Page 53
Use of Services
Medica Health Plans
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Medicaid
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
91829
423232
312309
401995
120131
22392
15747
10420
0
1398055
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
Visits
74603
141616
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
78875
186324
68597
17726
12584
5005
0
585330
HEDIS 2008 (Reporting Year 2007)
Visits/ 1,000
Member
Months
812.41
334.61
252.55
463.50
571.02
791.62
799.14
480.33
418.67
Emergency Room Visits
Visits
10356
22668
11504
31380
6578
966
591
431
0
84474
Visits/ 1,000
Member
Months
112.77
53.56
36.84
78.06
54.76
43.14
37.53
41.36
60.42
Ambulatory
Surgery/Procedures
Procedures
440
1915
855
4366
2796
456
236
97
0
11161
Procedures/
1,000 Member
Months
4.79
4.52
2.74
10.86
23.27
20.36
14.99
9.31
7.98
Observation Room Stays
Resulting in Discharge
Stays
91
103
393
1737
117
32
10
17
0
2500
Stays/ 1,000
Member
Months
0.99
0.24
1.26
4.32
0.97
1.43
0.64
1.63
1.79
Page 54
Use of Services
Medica Health Plans
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
Age
Member
Months
<1
57394
1-9
529770
10-19
626175
20-44
1746119
45-64
1311695
65-74
45707
75-84
4978
85+
1073
Unknown
Total
0
4322911
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
6
0.01
125
0.20
20.83
20-44
39
0.02
686
0.39
17.59
45-64
271
0.21
3183
2.43
11.75
65-74
37
0.81
423
9.25
11.43
75-84
12
2.41
148
29.73
12.33
4
3.73
47
43.80
11.75
0.09
0
4612
1.07
NA
12.50
Age
85+
Unknown
Total
0
369
HEDIS 2008 (Reporting Year 2007)
Page 55
Use of Services
Medica Health Plans
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:32 PM
MSHO
Age
Member
Months
<1
1-9
10-19
20-44
45-64
65-74
33624
75-84
36168
85+
35479
Unknown
Total
Age
105271
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
195
5.80
1544
45.92
7.92
75-84
346
9.57
2336
64.59
6.75
85+
336
9.47
1953
55.05
5.81
55.41
NR
6.65
Unknown
Total
877
HEDIS 2008 (Reporting Year 2007)
8.33
5833
Page 57
Use of Services
Medica Health Plans
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Medicaid
Age
Member
Months
<1
91829
1-9
423232
10-19
312309
20-44
401995
45-64
120131
65-74
22392
75-84
15747
85+
10420
Unknown
Total
0
1398055
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
1
0.00
35
0.11
35.00
20-44
13
0.03
287
0.71
22.08
45-64
20
0.17
293
2.44
14.65
65-74
7
0.31
107
4.78
15.29
75-84
5
0.32
25
1.59
5.00
85+
7
0.67
174
16.70
24.86
0.04
0
921
0.66
NA
17.38
Age
Unknown
Total
0
53
HEDIS 2008 (Reporting Year 2007)
Page 58
Use of Services
Medica Health Plans
Mental Health Utilization
% of Members Receiving Inpatient, Day/Night and Ambulato
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Member Months
(Inpatient)
Male
Female
Total
Male
Female
Total
Male
Female
Total
378045
159801
769621
325416
391576
165615
378045
159801
769621
325416
391576
165615
378045
159801
769621
325416
391576
165615
378045
159801
769621
325416
1617502
29068
0
2203761
1557634
22688
0
2118168
3175136
51756
0
4321929
1617502
29068
0
2203761
1557634
22688
0
2118168
3175136
51756
0
4321929
1617502
29068
0
2203761
1557634
22688
0
2118168
3175136
51756
0
4321929
1617502
29068
0
2203761
1557634
22688
0
2118168
3175136
51756
0
4321929
0-12
Sex
M
F
13-17
Total
M
F
18-64
Total
M
F
65+
Total
M
F
Unknown
Total
M
F
Total
Total
Member Months
(Outpatient/ED)
391576
165615
Any Services
Age
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
M
F
Total
Inpatient
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
1879
1085
2964
1454
1569
3023
7486
13215
20701
68
75
143
0
0
0
10887
15944
26831
5.76%
3.44%
4.62%
10.54%
11.78%
11.15%
5.55%
10.18%
7.82%
2.81%
3.97%
3.32%
NA
NA
NA
5.93%
9.03%
7.45%
30
15
45
82
155
237
280
436
716
1
3
4
0
0
0
393
609
1002
0.09%
0.05%
0.07%
0.59%
1.16%
0.87%
0.21%
0.34%
0.27%
0.04%
0.16%
0.09%
NA
NA
NA
0.21%
0.35%
0.28%
96
56
152
132
137
269
344
584
928
2
7
9
0
0
0
574
784
1358
0.29%
0.18%
0.24%
0.96%
1.03%
0.99%
0.26%
0.45%
0.35%
0.08%
0.37%
0.21%
NA
NA
NA
0.31%
0.44%
0.38%
1852
1063
2915
1412
1538
2950
7298
13021
20319
67
71
138
0
0
0
10629
15693
26322
5.68%
3.37%
4.55%
10.23%
11.55%
10.88%
5.41%
10.03%
7.68%
2.77%
3.76%
3.20%
NA
NA
NA
5.79%
8.89%
7.31%
HEDIS 2008 (Reporting Year 2007)
Page 59
Use of Services
Medica Health Plans
Mental Health Utilization
% of Members Receiving Inpatient, Day/Night and Ambulato
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
Mental Health Utilization
% of Members Receiving Inpatient, Day/Night and Ambulato
Data Last Refreshed:
Oct 7, 2009 1:32 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
25391
0
25391
0
73160
0
73160
0
98551
0
98551
0
25391
0
25391
0
73160
0
73160
0
98551
0
98551
0
25391
0
25391
0
73160
0
73160
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
98551
0
98551
0
25391
0
25391
0
73160
0
73160
0
98551
0
98551
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
204
563
767
0
0
0
204
563
767
NA
NA
NA
NA
NA
NA
NA
NA
NA
9.64%
9.23%
9.34%
NA
NA
NA
9.64%
9.23%
9.34%
0
0
0
0
0
0
0
0
0
12
58
70
0
0
0
12
58
70
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.57%
0.95%
0.85%
NA
NA
NA
0.57%
0.95%
0.85%
0
0
0
0
0
0
0
0
0
21
56
77
0
0
0
21
56
77
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.99%
0.92%
0.94%
NA
NA
NA
0.99%
0.92%
0.94%
0
0
0
0
0
0
0
0
0
181
517
698
0
0
0
181
517
698
NA
NA
NA
NA
NA
NA
NA
NA
NA
8.55%
8.48%
8.50%
NA
NA
NA
8.55%
8.48%
8.50%
HEDIS 2008 (Reporting Year 2007)
Page 61
Use of Services
Medica Health Plans
Mental Health Utilization
% of Members Receiving Inpatient, Day/Night and Ambulato
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Medicaid
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Member Months
(Inpatient)
Male
Female
Total
Male
Female
Total
310241
79428
306675
81900
616916
161328
310241
79428
306675
81900
616916
161328
310241
79428
306675
81900
191179
15613
0
596461
380073
32946
0
801594
571252
48559
0
1398055
191179
15613
0
596461
380073
32946
0
801594
571252
48559
0
1398055
191179
15613
0
596461
380073
32946
0
801594
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
616916
161328
310241
79428
306675
81900
616916
161328
571252
48559
0
1398055
191179
15613
0
596461
380073
32946
0
801594
571252
48559
0
1398055
Intensive Outpatient/Partial
Hospitalization
Inpatient
Member Months
(Outpatient/ED)
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
2677
1796
4473
1303
1437
2740
3500
7971
11471
160
325
485
0
0
0
7640
11529
19169
10.35%
7.03%
8.70%
19.69%
21.05%
20.38%
21.97%
25.17%
24.10%
12.30%
11.84%
11.99%
NA
NA
NA
15.37%
17.26%
16.45%
46
33
79
69
126
195
379
487
866
7
22
29
0
0
0
501
668
1169
0.18%
0.13%
0.15%
1.04%
1.85%
1.45%
2.38%
1.54%
1.82%
0.54%
0.80%
0.72%
NA
NA
NA
1.01%
1.00%
1.00%
330
205
535
194
224
418
510
1069
1579
19
17
36
0
0
0
1053
1515
2568
1.28%
0.80%
1.04%
2.93%
3.28%
3.11%
3.20%
3.38%
3.32%
1.46%
0.62%
0.89%
NA
NA
NA
2.12%
2.27%
2.20%
2597
1748
4345
1261
1384
2645
3266
7638
10904
144
314
458
0
0
0
7268
11084
18352
10.05%
6.84%
8.45%
19.05%
20.28%
19.67%
20.50%
24.12%
22.91%
11.07%
11.44%
11.32%
NA
NA
NA
14.62%
16.59%
15.75%
HEDIS 2008 (Reporting Year 2007)
Page 62
Medica Health Plans
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
391576
165615
209130
348584
1059788
29068
0
2203761
Female
378045
159801
196888
326130
1034616
22688
0
2118168
Member Months
(Inpatient)
Total
769621
325416
406018
674714
2094404
51756
0
4321929
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
7
5
12
274
204
478
619
260
879
797
344
1141
1839
1009
2848
33
13
46
0
0
0
3569
1835
5404
HEDIS 2008 (Reporting Year 2007)
Male
391576
165615
209130
348584
1059788
29068
0
2203761
Female
378045
159801
196888
326130
1034616
22688
0
2118168
Total
769621
325416
406018
674714
2094404
51756
0
4321929
Inpatient
Percent
0.02%
0.02%
0.02%
1.99%
1.53%
1.76%
3.55%
1.58%
2.60%
2.74%
1.27%
2.03%
2.08%
1.17%
1.63%
1.36%
0.69%
1.07%
NA
NA
NA
1.94%
1.04%
1.50%
Number
3
2
5
62
72
134
91
58
149
131
74
205
504
332
836
15
8
23
0
0
0
806
546
1352
Percent
0.01%
0.01%
0.01%
0.45%
0.54%
0.49%
0.52%
0.35%
0.44%
0.45%
0.27%
0.36%
0.57%
0.39%
0.48%
0.62%
0.42%
0.53%
NA
NA
NA
0.44%
0.31%
0.38%
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
391576
378045
769621
165615
159801
325416
209130
196888
406018
348584
326130
674714
1059788
1034616
2094404
29068
22688
51756
0
0
0
2203761
2118168
4321929
Member Months
(Outpatient/ED)
Male
391576
165615
209130
348584
1059788
29068
0
2203761
Female
378045
159801
196888
326130
1034616
22688
0
2118168
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
0
1
1
51
27
78
80
21
101
99
24
123
152
62
214
1
0
1
0
0
0
383
135
518
Number
4
4
8
248
174
422
547
227
774
701
298
999
1539
838
2377
20
6
26
0
0
0
3059
1547
4606
Percent
0.00%
0.00%
0.00%
0.37%
0.20%
0.29%
0.46%
0.13%
0.30%
0.34%
0.09%
0.22%
0.17%
0.07%
0.12%
0.04%
0.00%
0.02%
NA
NA
NA
0.21%
0.08%
0.14%
Total
769621
325416
406018
674714
2094404
51756
0
4321929
Percent
0.01%
0.01%
0.01%
1.80%
1.31%
1.56%
3.14%
1.38%
2.29%
2.41%
1.10%
1.78%
1.74%
0.97%
1.36%
0.83%
0.32%
0.60%
NA
NA
NA
1.67%
0.88%
1.28%
Page 63
Medica Health Plans
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:32 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
25391
0
25391
Female
0
0
0
0
0
73160
0
73160
Member Months
(Inpatient)
Total
0
0
0
0
0
98551
0
98551
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
97
86
183
0
0
0
97
86
183
HEDIS 2008 (Reporting Year 2007)
Male
0
0
0
0
0
25391
0
25391
Female
0
0
0
0
0
73160
0
73160
Total
0
0
0
0
0
98551
0
98551
Inpatient
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
4.58%
1.41%
2.23%
NA
NA
NA
4.58%
1.41%
2.23%
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
47
57
104
0
0
0
47
57
104
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
2.22%
0.93%
1.27%
NA
NA
NA
2.22%
0.93%
1.27%
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
25391
73160
98551
0
0
0
25391
73160
98551
Member Months
(Outpatient/ED)
Male
0
0
0
0
0
25391
0
25391
Female
0
0
0
0
0
73160
0
73160
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
66
44
110
0
0
0
66
44
110
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.05%
0.00%
0.01%
NA
NA
NA
0.05%
0.00%
0.01%
Total
0
0
0
0
0
98551
0
98551
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
3.12%
0.72%
1.34%
NA
NA
NA
3.12%
0.72%
1.34%
Page 65
Medica Health Plans
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Medicaid
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
310241
79428
44416
45526
101237
15613
0
596461
Female
306675
81900
101513
128409
150151
32946
0
801594
Member Months
(Inpatient)
Total
616916
161328
145929
173935
251388
48559
0
1398055
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
18
11
29
342
287
629
536
660
1196
770
1146
1916
1974
1557
3531
48
38
86
0
0
0
3688
3699
7387
HEDIS 2008 (Reporting Year 2007)
Male
310241
79428
44416
45526
101237
15613
0
596461
Female
306675
81900
101513
128409
150151
32946
0
801594
Total
616916
161328
145929
173935
251388
48559
0
1398055
Inpatient
Percent
0.07%
0.04%
0.06%
5.17%
4.21%
4.68%
14.48%
7.80%
9.83%
20.30%
10.71%
13.22%
23.40%
12.44%
16.86%
3.69%
1.38%
2.13%
NA
NA
NA
7.42%
5.54%
6.34%
Number
1
2
3
76
82
158
120
176
296
189
285
474
571
467
1038
19
21
40
0
0
0
976
1033
2009
Percent
0.00%
0.01%
0.01%
1.15%
1.20%
1.18%
3.24%
2.08%
2.43%
4.98%
2.66%
3.27%
6.77%
3.73%
4.95%
1.46%
0.76%
0.99%
NA
NA
NA
1.96%
1.55%
1.72%
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
310241
79428
44416
45526
101237
15613
0
596461
306675
81900
101513
128409
150151
32946
0
801594
616916
161328
145929
173935
251388
48559
0
1398055
Member Months
(Outpatient/ED)
Male
310241
79428
44416
45526
101237
15613
0
596461
Female
306675
81900
101513
128409
150151
32946
0
801594
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
0
0
0
71
44
115
100
90
190
109
154
263
224
147
371
1
1
2
0
0
0
505
436
941
Number
17
9
26
302
247
549
463
563
1026
685
1019
1704
1764
1381
3145
34
21
55
0
0
0
3265
3240
6505
Percent
0.00%
0.00%
0.00%
1.07%
0.64%
0.86%
2.70%
1.06%
1.56%
2.87%
1.44%
1.81%
2.66%
1.17%
1.77%
0.08%
0.04%
0.05%
NA
NA
NA
1.02%
0.65%
0.81%
Total
616916
161328
145929
173935
251388
48559
0
1398055
Percent
0.07%
0.04%
0.05%
4.56%
3.62%
4.08%
12.51%
6.66%
8.44%
18.06%
9.52%
11.76%
20.91%
11.04%
15.01%
2.61%
0.76%
1.36%
NA
NA
NA
6.57%
4.85%
5.58%
Page 66
Use of Services
Medica Health Plans
Outpatient Drug Utilization
Commercial
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
587164
626175
1746119
1311695
45707
4978
1073
0
4322911
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 1:32 PM
$8,213,495.00
$17,471,755.00
$70,075,382.00
$122,747,635.00
$7,588,320.00
$1,001,439.00
$255,594.00
$0.00
$227,353,620.00
HEDIS 2008 (Reporting Year 2007)
Avg. Cost of
Prescriptions /
Per Member Per
Month
$13.99
$27.90
$40.13
$93.58
$166.02
$201.17
$238.21
$52.59
Total Number of
Prescriptions
155305
220563
1052595
1789144
109098
16215
3712
0
3346632
Avg. Num. Of
Prescriptions /
Per Member Per
Year
3.17
4.23
7.23
16.37
28.64
39.09
41.51
9.29
Page 67
Use of Services
Medica Health Plans
Outpatient Drug Utilization
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
Outpatient Drug Utilization
MSHO
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
0
0
0
0
33631
36159
35481
0
105271
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 1:32 PM
$0.00
$0.00
$0.00
$0.00
$12,677,047.00
$13,828,213.00
$11,672,369.00
$0.00
$38,177,629.00
HEDIS 2008 (Reporting Year 2007)
Avg. Cost of
Prescriptions /
Per Member Per
Month
NA
NA
NA
NA
$376.95
$382.43
$328.98
$362.66
Total Number of
Prescriptions
0
0
0
0
229575
286201
302669
0
818445
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NA
NA
NA
NA
81.92
94.98
102.37
93.30
Page 69
Use of Services
Medica Health Plans
Outpatient Drug Utilization
Medicaid
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
515061
312309
401995
120131
22392
15747
10420
0
1398055
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 1:32 PM
$7,792,430.00
$9,171,853.00
$30,746,818.00
$17,690,862.00
$877,623.00
$369,384.00
$251,265.00
$0.00
$66,900,235.00
HEDIS 2008 (Reporting Year 2007)
Avg. Cost of
Prescriptions /
Per Member Per
Month
$15.13
$29.37
$76.49
$147.26
$39.19
$23.46
$24.11
$47.85
Total Number of
Prescriptions
195284
143962
541795
318643
30529
22981
18850
0
1272044
Avg. Num. Of
Prescriptions /
Per Member Per
Year
4.55
5.53
16.17
31.83
16.36
17.51
21.71
10.92
Page 70
Access/Availability of Care
Medica Health Plans
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
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+
44966
49666
2431
42875
48109
2372
95.35%
95.15%
95.55%
96.87%
96.71%
97.02%
97.57%
96.94%
98.21%
2007
A
Page 71
Access/Availability of Care
Medica Health Plans
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:32 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
7843
2007
A
0
0
7649
NA
NA
NA
NA
NA
NA
97.53%
97.18%
97.88%
Page 73
Access/Availability of Care
Medica Health Plans
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:32 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+
14892
5764
3096
2007
A
13362
5194
2992
89.73%
89.24%
90.22%
90.11%
89.33%
90.89%
96.64%
95.99%
97.29%
Page 74
Access/Availability of Care
Medica Health Plans
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
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.
3778
18145
13118
23080
3738
16750
12092
21398
98.94%
98.60%
99.28%
92.31%
91.92%
92.70%
92.18%
91.72%
92.64%
92.71%
92.37%
93.05%
2007
A
Page 75
Access/Availability of Care
Medica Health Plans
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 1:32 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.
4323
10513
6141
8087
2007
A
4283
9670
5662
7403
99.07%
98.78%
99.37%
91.98%
91.46%
92.51%
92.20%
91.52%
92.88%
91.54%
90.93%
92.15%
Page 76
Access/Availability of Care
Medica Health Plans
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
Timeliness of
Prenatal Care
Postpartum
Care
Data collection methodology (Administrative or Hybrid)
H
H
Eligible member population (i.e. members who meet all
denominator criteria)
4439
4439
Number of numerator events by administrative data in
eligible population (before exclusions)
3155
2583
Current year's administrative rate (before exclusions)
71.07%
58.19%
Minimum required sample size (MRSS) or other sample size
411
411
Oversampling rate
Final sample size (FSS)
10%
453
10%
453
Number of numerator events by administrative data in FSS
326
258
Data Elements
Administrative rate on FSS
71.96%
56.95%
Number of original sample records excluded because of
valid data errors
0
0
Number of administrative data records excluded
0
0
Number of medical records data records excluded
0
0
Number of employee/dependent medical records excluded
0
0
5
411
292
78
5
411
236
85
90.02%
87.01%
93.04%
78.10%
73.98%
82.22%
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
Medica Health Plans
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Medicaid
Timeliness of
Prenatal Care
Postpartum
Care
Data collection methodology (Administrative or Hybrid)
H
H
Eligible member population (i.e. members who meet all
denominator criteria)
5907
5907
Number of numerator events by administrative data in
eligible population (before exclusions)
3163
3255
Current year's administrative rate (before exclusions)
53.55%
55.10%
Minimum required sample size (MRSS) or other sample size
371
371
Oversampling rate
Final sample size (FSS)
5%
390
5%
390
Number of numerator events by administrative data in FSS
207
220
53.08%
56.41%
Number of original sample records excluded because of
valid data errors
0
0
Number of administrative data records excluded
0
0
Number of medical records data records excluded
0
0
Number of employee/dependent medical records excluded
0
0
0
371
197
137
0
371
213
49
90.03%
86.84%
93.21%
70.62%
65.85%
75.39%
Data Elements
Administrative rate on FSS
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
Medica Health Plans
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
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
278
3478
3756
99
40
1319
395
1418
435
Reported rate
35.61%
14.39%
37.92%
11.36%
37.75%
11.58%
Lower 95% confidence interval
29.80%
41.42%
10.08%
18.69%
36.30%
39.55%
10.29%
12.43%
36.19%
39.32%
10.54%
12.62%
Upper 95% confidence interval
HEDIS 2008 (Reporting Year 2007)
Page 79
Access/Availability of Care
Medica Health Plans
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:32 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
119
119
0
0
73
2
73
2
Reported rate
NA
NA
61.34%
1.68%
61.34%
1.68%
Lower 95% confidence interval
NA
NA
NA
NA
52.18%
70.51%
0.00%
4.41%
52.18%
70.51%
0.00%
4.41%
Upper 95% confidence interval
HEDIS 2008 (Reporting Year 2007)
Page 81
Access/Availability of Care
Medica Health Plans
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:32 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
275
2721
2996
115
37
1104
324
1219
361
Reported rate
41.82%
13.45%
40.57%
11.91%
40.69%
12.05%
Lower 95% confidence interval
35.81%
47.83%
9.24%
17.67%
38.71%
42.44%
10.67%
13.14%
38.91%
42.46%
10.87%
13.23%
Upper 95% confidence interval
HEDIS 2008 (Reporting Year 2007)
Page 82
Health Plan Stability
Medica Health Plans
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
Product/Product Line
Years in Business
Members*
33.00
50950
33.00
50950
33.00
259379
33.00
259379
33.00
44168
33.00
44168
354497
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
Medica Health Plans
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:32 PM
MSHO
Product/Product Line
Years in Business
Members*
33.00
33.00
10.00
115660
50950
8671
33.00
175281
33.00
2.00
259379
2511
33.00
261890
33.00
23.00
44168
42248
33.00
86416
523587
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
Medica Health Plans
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Medicaid
Product/Product Line
Years in Business
Members*
33.00
115765
0
HMO
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
Total HMO:
0
33.00
115765
PPO
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
Total PPO:
0
NR
0
0
0
POS
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
Total POS:
Total:
0
NR
0
0
0
115765
* Total number of members in each category as of December 31, 2007
HEDIS 2008 (Reporting Year 2007)
Page 86
Health Plan Descriptive Information
Medica Health Plans
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:32 PM
Commercial
Member Months
Female
28536
115668
144864
151500
97404
57312
<1
1-4
5-9
10-14
15-17
18-19
Male
28860
119112
150132
158004
101172
60780
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
618060
28.04%
148428
177792
170904
192276
207804
595284
28.10%
139632
166680
159588
182424
200592
1213344
28.07%
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
897204
40.70%
220296
191364
150912
97320
848916
40.07%
217440
187380
150216
96756
1746120
40.39%
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
659892
29.94%
20136
5724
1944
768
384
108
651792
30.76%
16056
3792
1488
780
432
144
1311684
30.34%
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
29064
1.32%
0
22692
1.07%
0
51756
1.20%
2204220
2118684
HEDIS 2008 (Reporting Year 2007)
Total
57396
234780
294996
309504
198576
118092
288060
344472
330492
374700
408396
437736
378744
301128
194076
36192
9516
3432
1548
816
252
0
4322904
Page 87
Health Plan Descriptive Information
Medica Health Plans
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:32 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
Medica Health Plans
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:32 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%
5376
6432
5628
4236
2976
2220
0
0.00%
9456
12360
12840
13452
14268
16008
0
0.00%
26868
100.00%
0
78384
100.00%
0
105252
100.00%
26868
78384
HEDIS 2008 (Reporting Year 2007)
0
0
0
0
0
0
0
0
0
14832
18792
18468
17688
17244
18228
0
105252
Page 89
Health Plan Descriptive Information
Medica Health Plans
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:32 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
46899
112328
100722
82138
47582
20732
Member Months
Female
44930
107540
102642
84739
48724
28394
Total
91829
219868
203364
166877
96306
49126
410401
68.81%
23684
23934
21592
24271
24088
416969
52.02%
73119
73023
55386
46698
36200
827370
59.18%
117569
19.71%
22218
15969
9425
5266
284426
35.48%
29260
18203
12351
7439
401995
28.75%
52878
8.87%
5245
3350
2839
2197
1200
782
67253
8.39%
8507
5290
5531
5180
4207
4231
120131
8.59%
15613
2.62%
0
32946
4.11%
0
48559
3.47%
596461
801594
HEDIS 2008 (Reporting Year 2007)
96803
96957
76978
70969
60288
51478
34172
21776
12705
13752
8640
8370
7377
5407
5013
0
1398055
Page 90