Blue Plus
Plan Name
2007
Reporting Year
Submission #
General Info
Disclaimers
Code
CIS
Plan ID
1
Last Refreshed:
Page
Childhood Immunization Status
10/7/2009 1:26:09 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
8
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
Blue Plus
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:26 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
1050
78.95%
1144
86.02%
1233
92.71%
1116
83.91%
1086
81.65%
1179
88.65%
1066
80.15%
891
66.99%
856
64.36%
345
79.86%
380
87.96%
399
92.36%
366
84.72%
360
83.33%
378
87.50%
354
81.94%
286
66.20%
275
63.66%
345
43
90.23%
87.31%
93.15%
380
31
95.58%
93.52%
97.64%
399
9
94.88%
92.68%
97.08%
366
32
92.56%
89.96%
95.16%
360
47
94.65%
92.41%
96.89%
378
15
91.40%
88.63%
94.16%
354
30
89.30%
86.26%
92.34%
286
75
83.95%
80.37%
87.54%
275
72
80.70%
76.85%
84.54%
432
2
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
2
HEDIS 2008 (Reporting Year 2007)
MMR
411
5.00%
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
1330
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
430
Page 3
Effectiveness of Care
Blue Plus
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:26 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
1484
75.06%
1615
81.69%
1800
91.05%
1570
79.41%
1486
75.16%
1719
86.95%
1490
75.37%
1174
59.38%
1110
56.15%
335
77.55%
358
82.87%
395
91.44%
337
78.01%
329
76.16%
377
87.27%
338
78.24%
260
60.19%
244
56.48%
335
40
86.81%
83.50%
90.11%
358
42
92.59%
90.01%
95.18%
395
11
93.98%
91.62%
96.34%
337
53
90.28%
87.37%
93.19%
329
76
93.75%
91.35%
96.15%
377
15
90.74%
87.89%
93.59%
338
36
86.57%
83.24%
89.90%
260
85
79.86%
75.96%
83.76%
244
86
76.39%
72.27%
80.51%
432
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
411
5.00%
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
1977
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
432
Page 4
Effectiveness of Care
Blue Plus
Appropriate Treatment for Children with Upper
Respiratory Infection
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Commercial
Data Elements
Commercial
Medicaid
2007
2007
A
A
Eligible Member Population
2206
4548
Numerator Events by Admin Data
370
988
Reported Rate
83.23%
78.28%
Lower 95% Confidence Interval
81.65%
77.07%
Upper 95% Confidence Interval
84.81%
79.49%
Measurement Year
Data Collection Methodology
HEDIS 2008 (Reporting Year 2007)
Page 5
Effectiveness of Care
Blue Plus
Colorectal Cancer Screening
Data Elements
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Commercial
Medicare
Advantage
MSHO
2007
2007
H
H
Eligible population
30908
2986
Number of numerator events by administrative data in eligible
population (before exclusions)
17328
997
Measurement Year
Data collection methodology (administrative or hybrid)
Current year's administrative rate (before exclusions)
56.06%
NR
33.39%
Minimum required sample size (MRSS) or other sample size
411
411
Oversampling rate
0.1
0.05
Final sample size (FSS)
453
432
Number of numerator events by administrative data in FSS
265
151
Administrative rate on FSS
58.50%
NR
34.95%
Number of original sample records excluded because of valid data
errors
0
0
Number of administrative data records excluded
0
0
Number of medical record data records excluded
1
2
Number of employee/dependent medical records excluded
0
0
Records added from the oversample list
1
0
Denominator
452
430
Numerator events by administrative data
265
151
Numerator events by medical records
36
50
Reported rate
66.59%
NR
46.74%
Lower 95% confidence interval
62.13%
NR
41.91%
Upper 95% confidence interval
71.05%
NR
51.58%
HEDIS 2008 (Reporting Year 2007)
Page 6
Effectiveness of Care
Blue Plus
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:26 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
12097
8529
70.51%
69.69%
71.32%
14321
11135
77.75%
77.07%
78.44%
26418
19664
74.43%
73.91%
74.96%
2007
A
Page 7
Effectiveness of Care
Blue Plus
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:26 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
438
238
54.34%
49.56%
59.12%
438
238
54.34%
49.56%
59.12%
2007
A
Page 9
Effectiveness of Care
Blue Plus
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:26 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
2685
1623
60.45%
58.58%
62.32%
2053
1272
61.96%
59.83%
64.08%
4738
2895
61.10%
59.70%
62.50%
2007
A
Page 10
Effectiveness of Care
Blue Plus
Cervical Cancer Screening
Data Elements
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Commercial
Medicaid
Measurement Year
Data Collection Methodology
Eligible Member Population
2006
H
34783
2006
H
15326
Numerator Events by Admin Data on Eligible
Population (before exclusions)
26666
11003
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
Records Excluded because of Valid Data Errors
76.66%
411
10.00%
453
352
77.70%
0
71.79%
411
10.00%
453
313
69.09%
0
Number of administrative data records excluded
0
0
Number of medical record data records excluded
16
13
Number of employee/dependent medical records
excluded
4
0
18
411
352
11
88.32%
85.09%
91.55%
13
411
313
24
82.00%
78.16%
85.83%
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
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
Blue Plus
Chlamydia Screening in Women
Data Last Refreshed:
Oct 7, 2009 1:26 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
2567
898
34.98%
33.12%
36.85%
2261
931
41.18%
39.13%
43.23%
4828
1829
37.88%
36.50%
39.26%
1692
701
41.43%
39.05%
43.81%
2029
910
44.85%
42.66%
47.04%
3721
1611
43.29%
41.69%
44.90%
Page 12
Effectiveness of Care
Blue Plus
Data Last Refreshed:
Oct 7, 2009 1:26 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
280
34
12.14%
8.14%
16.15%
Page 13
Effectiveness of Care
Blue Plus
Controlling High Blood Pressure
Data Last Refreshed:
Oct 7, 2009 1:26 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
Commercial
Medicare Advantage
MSHO
2007
2007
H
H
8503
1805
0
0
0.00%
NR
0.00%
411
411
20.00%
15.00%
494
473
0
0
0.00%
NR
0.00%
Records Excluded because of Valid Data
Errors
0
0
Number of administrative data records
excluded
0
25
Number of medical record data records
excluded
0
13
Number of employee/dependent medical
records excluded
0
0
Records Added from the OverSample List
1
0
493
435
0
0
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
311
288
Reported Rate
63.08%
NR
66.21%
Lower 95% Confidence Interval
58.72%
NR
61.65%
Upper 95% Confidence Interval
67.44%
NR
70.77%
HEDIS 2008 (Reporting Year 2007)
Page 14
Effectiveness of Care
Blue Plus
Persistence of Beta Blocker Treatment After Hearth Attack
Data Elements
MSHO
Medicaid
2007
2007
2007
Data Collection Methodology
A
A
A
Eligible Member Population
89
60
41
Numerator Events by Admin Data on
Eligible Population
71
55
31
Measurement Year
Commercial
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Medicare Advantage
Reported Rate
79.78%
NR
91.67%
75.61%
Lower 95% Confidence Interval
70.87%
NR
83.84%
61.25%
Upper 95% Confidence Interval
88.68%
NR
99.49%
89.97%
HEDIS 2008 (Reporting Year 2007)
Page 15
Effectiveness of Care
Blue Plus
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:26 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)
947
2
87.12%
0.18%
381
1
88.19%
0.23%
381
12
1
276
90.97%
88.15%
93.79%
64.12%
59.48%
68.76%
411
5.00%
432
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
1087
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
432
Page 16
Effectiveness of Care
Blue Plus
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:26 PM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
1
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)
154
3
75.49%
1.47%
156
3
76.47%
1.47%
156
9
3
131
81.28%
75.67%
86.89%
66.01%
59.25%
72.77%
204
5.00%
204
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
204
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
203
Page 18
Effectiveness of Care
Blue Plus
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:26 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)
169
0
80.09%
0.00%
172
0
81.52%
0.00%
172
3
0
115
82.94%
77.63%
88.25%
54.50%
47.55%
61.46%
211
5.00%
211
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
211
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
211
Page 19
Effectiveness of Care
Blue Plus
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:26 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
4779
2007
H
4779
2007
H
4779
2007
H
4779
2007
H
4779
2007
H
4779
2007
H
4779
2007
H
4779
2007
H
4779
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
4268
89.31%
411
10%
453
405
89.40%
4773
99.87%
411
10%
453
453
100.00%
5
0.10%
411
10%
453
0
0.00%
2913
60.95%
411
10%
453
281
62.03%
3993
83.55%
411
10%
453
392
86.53%
6
0.13%
411
10%
453
0
0.00%
3921
82.05%
411
10%
453
371
81.90%
7
0.15%
411
10%
453
0
0.00%
4
0.08%
411
10%
453
0
0.00%
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
453
405
6
90.73%
87.95%
93.51%
0
453
83
29
24.72%
20.64%
28.81%
0
453
0
222
49.01%
44.29%
53.72%
0
453
281
39
70.64%
66.34%
74.94%
0
453
392
4
87.42%
84.25%
90.58%
0
453
0
244
53.86%
49.16%
58.56%
0
453
371
10
84.11%
80.63%
87.58%
0
453
0
331
73.07%
68.87%
77.26%
0
453
0
217
47.90%
43.19%
52.61%
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
Blue Plus
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:26 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
847
2007
H
847
2007
H
847
2007
H
847
2007
H
847
2007
H
847
2007
H
847
2007
H
847
2007
H
847
752
89.35%
830
98.15%
7
0.69%
569
69.68%
645
76.16%
15
1.85%
725
86.81%
19
0.93%
13
0.46%
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
432
386
11
91.90%
89.21%
94.59%
0
432
118
18
31.48%
26.99%
35.98%
0
432
3
203
47.69%
42.86%
52.51%
0
432
301
27
75.93%
71.78%
80.07%
0
432
329
16
79.86%
75.96%
83.76%
0
432
8
204
49.07%
44.24%
53.90%
0
432
375
4
87.73%
84.52%
90.94%
0
432
4
292
68.52%
64.02%
73.01%
0
432
2
200
46.76%
41.94%
51.58%
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
Blue Plus
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:26 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
1650
2007
H
1650
2007
H
1650
2007
H
1650
2007
H
1650
2007
H
1650
2007
H
1650
2007
H
1650
2007
H
1650
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
1426
86.42%
411
10%
453
394
86.98%
1646
99.76%
411
10%
453
452
99.78%
2
0.12%
411
10%
453
0
0.00%
850
51.52%
411
10%
453
235
51.88%
1236
74.91%
411
10%
453
349
77.04%
4
0.24%
411
10%
453
2
0.44%
1274
77.21%
411
10%
453
352
77.70%
6
0.36%
411
10%
453
1
0.22%
5
0.30%
411
10%
453
0
0.00%
Number of Records Excluded Because of
Valid Data Errors
3
3
3
3
3
3
3
3
3
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
3
450
394
8
89.33%
86.37%
92.30%
3
450
91
56
32.67%
28.22%
37.11%
3
450
0
184
40.89%
36.24%
45.54%
3
450
235
39
60.89%
56.27%
65.51%
3
450
349
10
79.78%
75.96%
83.60%
3
450
2
181
40.67%
36.02%
45.32%
3
450
352
10
80.44%
76.67%
84.22%
3
450
1
324
72.22%
67.97%
76.47%
3
450
0
200
44.44%
39.74%
49.15%
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
Blue Plus
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 1:26 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
178
172
96.63%
93.70%
99.56%
320
307
95.94%
93.62%
98.26%
1275
1184
92.86%
91.41%
94.32%
1773
1663
93.80%
92.64%
94.95%
2007
A
Page 24
Effectiveness of Care
Blue Plus
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 1:26 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
182
175
96.15%
93.09%
99.22%
305
276
90.49%
87.04%
93.95%
558
474
84.95%
81.89%
88.00%
1045
925
88.52%
86.54%
90.50%
2007
A
Page 25
Effectiveness of Care
Blue Plus
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:26 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
226
17.60%
15.48%
19.72%
897
69.86%
67.31%
72.41%
674
52.49%
49.72%
55.26%
2007
A
1284
Page 26
Effectiveness of Care
Blue Plus
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:26 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
4
2.88%
0.00%
6.02%
100
71.94%
64.11%
79.77%
85
61.15%
52.69%
69.61%
2007
A
139
Page 28
Effectiveness of Care
Blue Plus
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:26 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
132
17.03%
14.32%
19.74%
379
48.90%
45.32%
52.49%
253
32.65%
29.28%
36.01%
2007
A
775
Page 29
Effectiveness of Care
Blue Plus
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Oct 7, 2009 1:26 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
404
146
36.14%
31.33%
40.95%
114
48
42.11%
32.60%
51.61%
2007
A
321
125
38.94%
33.45%
44.43%
108
39
36.11%
26.59%
45.63%
Page 30
Effectiveness of Care
Blue Plus
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 1:26 PM
Medicare
Advantage
NR
NR
NR
MSHO
2007
A
6170
4343
70.39%
69.24%
71.54%
Page 31
Effectiveness of Care
Blue Plus
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:26 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
8760
6910
78.88%
78.02%
79.74%
135
111
82.22%
75.40%
89.04%
7330
5834
79.59%
78.66%
80.52%
501
350
69.86%
65.74%
73.98%
16726
13205
78.95%
78.33%
79.57%
2007
A
Page 32
Effectiveness of Care
Blue Plus
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:26 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
3278
2990
91.21%
90.23%
92.20%
560
527
94.11%
92.07%
96.15%
3977
3682
92.58%
91.76%
93.41%
466
397
85.19%
81.86%
88.53%
8281
7596
91.73%
91.13%
92.33%
2007
A
Page 34
Effectiveness of Care
Blue Plus
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:26 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
1929
1542
79.94%
78.12%
81.75%
45
41
91.11%
81.69%
100.00%
1578
1259
79.78%
77.77%
81.80%
230
177
76.96%
71.30%
82.62%
3782
3019
79.83%
78.53%
81.12%
2007
A
Page 35
Effectiveness of Care
Blue Plus
Use of High Risk Medications in the Elderly
Data Last Refreshed:
Oct 7, 2009 1:26 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
8279
1 or More
Prescriptions
2 or More
Prescriptions
2123
25.64%
24.70%
26.59%
406
4.90%
4.43%
5.38%
Page 36
Effectiveness of Care
Blue Plus
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Oct 7, 2009 1:26 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
126
22.91%
19.31%
26.51%
1836
443
24.13%
22.14%
26.11%
113
10
8.85%
3.17%
14.53%
2499
579
23.17%
21.50%
24.84%
Page 38
Use of Services
Blue Plus
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 1:26 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
26
3
9
14
43
159
888
2.28%
1.37%
3.19%
0.26%
0.00%
0.60%
0.79%
0.23%
1.34%
1.23%
0.54%
1.91%
3.77%
2.62%
4.91%
13.92%
11.87%
15.97%
77.76%
75.30%
80.21%
2007
A
1142
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
Blue Plus
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 1:26 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
20
35
64
127
279
603
1444
0.78%
0.42%
1.14%
1.36%
0.89%
1.83%
2.49%
1.87%
3.11%
4.94%
4.08%
5.79%
10.85%
9.63%
12.07%
23.44%
21.79%
25.10%
56.14%
54.21%
58.08%
2007
A
2572
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
Blue Plus
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 1:26 PM
Commercial
Medicaid
2007
A
6075
2007
A
6729
NR
NR
NR
NR
3857
4119
63.49%
62.27%
64.71%
61.21%
60.04%
62.38%
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
Blue Plus
Adolescent Well-Care Visits
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Commercial
Medicaid
2007
A
19699
2007
A
12751
NR
NR
NR
NR
6528
4095
33.14%
32.48%
33.80%
32.12%
31.30%
32.93%
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 42
Use of Services
Blue Plus
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Commercial
Member Months
Total
99485
209825
379175
268835
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
688
183
225
91
Procedures /
1,000 Member
Months
6.92
0.48
1.07
0.34
Member Months
Male
Female
368241
245031
296831
451193
287420
323157
12510
7595
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
14
0.03
0
94
4
57
134
12
163
21
181
14
42
6
108
18
0.00
0.21
0.32
0.23
0.47
0.96
0.57
1.68
0.63
1.12
0.15
0.48
0.38
1.44
Number of
Procedures
37
38
115
118
0
77
112
4
Procedures /
1,000 Member
Months
0.10
0.12
0.31
0.37
0.00
0.21
0.35
0.53
6
11
1
0.02
0.03
0.13
144
154
2
58
114
3
38
3
108
6
10
2
0.39
0.48
0.26
0.20
0.35
0.39
0.12
0.39
0.33
0.79
0.03
0.26
14
45
5
75
142
3
0.04
0.14
0.66
0.20
0.44
0.39
Page 43
Use of Services
Blue Plus
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:26 PM
MSHO
Age
< 65
65-74
75-84
85+
Member Months
Male
Female
3
0
11159
19326
10864
27905
8136
37645
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
2
1
1
0
16
14
4
0
19
10
5
0
3
1
0
0
10
14
25
0
5
3
3
0
7
5
1
0
4
4
3
0
1
1
0
0
7
1
4
0
8
4
1
Procedures /
1,000 Member
Months
0.00
0.18
0.09
0.12
0.00
1.43
1.29
0.49
0.00
1.70
0.92
0.61
0.00
0.27
0.09
0.00
0.00
0.90
1.29
3.07
0.00
0.45
0.28
0.37
0.00
0.63
0.46
0.12
0.00
0.36
0.37
0.37
0.00
0.09
0.09
0.00
0.00
0.63
0.09
0.49
0.00
0.72
0.37
0.12
Female
Number of
Procedures
0
3
6
0
0
18
20
15
0
42
29
8
0
1
5
2
0
9
48
89
0
12
16
10
0
26
16
3
0
12
12
19
0
3
3
0
0
9
11
5
0
14
19
8
0
0
3
0
0
3
0
1
0
4
6
2
0
8
7
5
Procedures /
1,000 Member
Months
NA
0.16
0.22
0.00
NA
0.93
0.72
0.40
NA
2.17
1.04
0.21
NA
0.05
0.18
0.05
NA
0.47
1.72
2.36
NA
0.62
0.57
0.27
NA
1.35
0.57
0.08
NA
0.62
0.43
0.50
NA
0.16
0.11
0.00
NA
0.47
0.39
0.13
NA
0.72
0.68
0.21
NA
0.00
0.11
0.00
NA
0.16
0.00
0.03
NA
0.21
0.22
0.05
NA
0.41
0.25
0.13
Page 45
Use of Services
Blue Plus
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Medicaid
Member Months
Total
208252
361160
417445
264537
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
1257
368
444
152
Procedures /
1,000 Member
Months
6.04
0.88
1.23
0.57
Member Months
Male
Female
305116
114291
238793
128139
63699
85790
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
4
0.03
33
61
35
Number of
Procedures
31
12
71
36
66
30
Procedures /
1,000 Member
Months
0.10
0.14
0.23
0.42
0.22
0.35
6
7
0.02
0.08
239
59
99
58
12
9
55
35
0.78
0.69
0.41
0.68
0.04
0.10
0.18
0.41
0.26
0.53
0.55
Page 46
Use of Services
Blue Plus
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 1:26 PM
Member Months
18532
191293
268835
541862
610577
19071
985
49
0
1651204
Discharges
Discharges /
1,000 Member
Months
154
305
428
3279
3955
255
34
1
0
8411
8.31
1.59
1.59
6.05
6.48
13.37
34.52
20.41
133
227
185
675
1827
118
23
1
0
3189
7.18
1.19
0.69
1.25
2.99
6.19
23.35
20.41
21
78
184
853
2125
137
11
0
0
3409
1.13
0.41
0.68
1.57
3.48
7.18
11.17
0.00
59
1751
2
0
1812
0.22
3.23
0.00
HEDIS 2008 (Reporting Year 2007)
5.09
1.93
2.06
1.27
Days
Days / 1,000
Member
Months
654
1270
1293
9217
13778
922
116
5
0
27255
35.29
6.64
4.81
17.01
22.57
48.35
117.77
102.04
477
533
488
2222
5774
402
84
5
0
9985
25.74
2.79
1.82
4.10
9.46
21.08
85.28
102.04
177
737
652
2470
7955
520
32
0
0
12543
9.55
3.85
2.43
4.56
13.03
27.27
32.49
0.00
153
4525
38
0
4716
0.57
8.35
0.06
16.51
6.05
7.60
3.32
Average
Length of Stay
4.25
4.16
3.02
2.81
3.48
3.62
3.41
5.00
NA
3.24
3.59
2.35
2.64
3.29
3.16
3.41
3.65
5.00
NA
3.13
8.43
9.45
3.54
2.90
3.74
3.80
2.91
NA
NA
3.68
2.59
2.58
19.00
NA
2.60
Page 47
Use of Services
Blue Plus
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
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 1:26 PM
Member Months
0
0
0
3
0
30485
38769
45781
0
115038
Discharges
Discharges /
1,000 Member
Months
0
0
0
1
0
1292
1867
2029
0
5189
NA
NA
NA
333.33
NA
42.38
48.16
44.32
0
0
0
1
0
997
1517
1718
0
4233
NA
NA
NA
333.33
NA
32.70
39.13
37.53
0
0
0
0
0
293
347
306
0
946
NA
NA
NA
0.00
NA
9.61
8.95
6.68
0
0
0
0
0
NA
0.00
NA
HEDIS 2008 (Reporting Year 2007)
45.11
36.80
8.22
0.00
Days
0
0
0
1
0
5996
8391
9016
0
23404
0
0
0
1
0
4279
6425
7013
0
17718
Days / 1,000
Member
Months
NA
NA
NA
333.33
NA
196.69
216.44
196.94
203.45
NA
NA
NA
333.33
NA
140.36
165.73
153.19
154.02
0
0
0
0
0
1703
1956
1986
0
5645
NA
NA
NA
0.00
NA
55.86
50.45
43.38
0
0
0
0
0
NA
0.00
NA
49.07
0.00
Average
Length of Stay
NA
NA
NA
1.00
NA
4.64
4.49
4.44
NA
4.51
NA
NA
NA
1.00
NA
4.29
4.24
4.08
NA
4.19
NA
NA
NA
NA
NA
5.81
5.64
6.49
NA
5.97
NA
NA
NA
NA
NA
Page 49
Use of Services
Blue Plus
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 1:26 PM
Member Months
61006
300154
264537
353084
149489
3398
1782
1611
0
1135061
Discharges
Discharges /
1,000 Member
Months
683
745
1130
6267
1718
87
73
61
0
10764
11.20
2.48
4.27
17.75
11.49
25.60
40.97
37.86
594
612
302
1143
962
71
61
57
0
3802
9.74
2.04
1.14
3.24
6.44
20.89
34.23
35.38
89
133
200
891
755
16
12
4
0
2100
1.46
0.44
0.76
2.52
5.05
4.71
6.73
2.48
627
4230
1
0
4858
HEDIS 2008 (Reporting Year 2007)
9.48
3.35
1.85
2.37
11.98
0.01
6.33
Days
Days / 1,000
Member
Months
2785
1831
3223
16424
6358
445
346
243
0
31655
45.65
6.10
12.18
46.52
42.53
130.96
194.16
150.84
1982
1372
832
3116
3260
291
245
225
0
11323
32.49
4.57
3.15
8.83
21.81
85.64
137.49
139.66
803
459
779
2788
3095
154
101
18
0
8197
13.16
1.53
2.94
7.90
20.70
45.32
56.68
11.17
1611
10516
3
0
12130
6.09
29.78
0.02
27.89
9.98
7.22
15.81
Average
Length of Stay
4.08
2.46
2.85
2.62
3.70
5.11
4.74
3.98
NA
2.94
3.34
2.24
2.75
2.73
3.39
4.10
4.02
3.95
NA
2.98
9.02
3.45
3.90
3.13
4.10
9.63
8.42
4.50
NA
3.90
2.57
2.49
3.00
NA
2.50
Page 50
Use of Services
Blue Plus
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
18532
191293
268835
541862
610577
19071
985
49
0
1651204
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
Visits
15526
55164
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
58773
138159
209448
9183
713
16
0
486982
HEDIS 2008 (Reporting Year 2007)
Visits/ 1,000
Member
Months
837.79
288.37
218.62
254.97
343.03
481.52
723.86
326.53
294.93
Emergency Room Visits
Visits
696
3696
3918
7388
6679
260
21
0
0
22658
Visits/ 1,000
Member
Months
37.56
19.32
14.57
13.63
10.94
13.63
21.32
0.00
13.72
Ambulatory
Surgery/Procedures
Procedures
141
875
812
3892
11966
558
34
0
0
18278
Procedures/
1,000 Member
Months
7.61
4.57
3.02
7.18
19.60
29.26
34.52
0.00
11.07
Observation Room Stays
Resulting in Discharge
Stays
39
78
48
546
293
16
0
0
0
1020
Stays/ 1,000
Member
Months
2.10
0.41
0.18
1.01
0.48
0.84
0.00
0.00
0.62
Page 51
Use of Services
Blue Plus
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:26 PM
MSHO
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
0
0
0
3
0
30485
38769
45781
0
115038
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
2
0
21643
25253
20945
0
67843
HEDIS 2008 (Reporting Year 2007)
Visits/ 1,000
Member
Months
NA
NA
NA
666.67
NA
709.96
651.37
457.50
589.74
Emergency Room Visits
Visits
0
0
0
0
0
1185
1451
1602
0
4238
Visits/ 1,000
Member
Months
NA
NA
NA
0.00
NA
38.87
37.43
34.99
36.84
Ambulatory
Surgery/Procedures
Procedures
0
0
0
0
0
936
1173
574
0
2683
Procedures/
1,000 Member
Months
NA
NA
NA
0.00
NA
30.70
30.26
12.54
23.32
Observation Room Stays
Resulting in Discharge
Stays
0
0
0
0
0
81
99
120
0
300
Stays/ 1,000
Member
Months
NA
NA
NA
0.00
NA
2.66
2.55
2.62
2.61
Page 53
Use of Services
Blue Plus
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Medicaid
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
61006
300154
264537
353084
149489
3398
1782
1611
0
1135061
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
Visits
48731
95742
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
67407
143748
66992
1716
801
497
0
425634
HEDIS 2008 (Reporting Year 2007)
Visits/ 1,000
Member
Months
798.79
318.98
254.81
407.12
448.14
505.00
449.49
308.50
374.99
Emergency Room Visits
Visits
5537
13355
8118
19118
4069
104
63
59
0
50423
Visits/ 1,000
Member
Months
90.76
44.49
30.69
54.15
27.22
30.61
35.35
36.62
44.42
Ambulatory
Surgery/Procedures
Procedures
347
1474
853
3782
3233
61
36
8
0
9794
Procedures/
1,000 Member
Months
5.69
4.91
3.22
10.71
21.63
17.95
20.20
4.97
8.63
Observation Room Stays
Resulting in Discharge
Stays
105
160
386
2034
307
2
3
2
0
2999
Stays/ 1,000
Member
Months
1.72
0.53
1.46
5.76
2.05
0.59
1.68
1.24
2.64
Page 54
Use of Services
Blue Plus
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Commercial
Age
Member
Months
<1
18532
1-9
191293
10-19
268835
20-44
541862
45-64
610577
65-74
19071
75-84
985
85+
49
Unknown
Total
0
1651204
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
1
0.01
19
0.10
19.00
10-19
1
0.00
7
0.03
7.00
20-44
14
0.03
257
0.47
18.36
45-64
132
0.22
1996
3.27
15.12
65-74
18
0.94
234
12.27
13.00
75-84
4
4.06
70
71.07
17.50
85+
1
20.41
21
428.57
21.00
0.10
0
2604
1.58
NA
15.23
Age
Unknown
Total
0
171
HEDIS 2008 (Reporting Year 2007)
Page 55
Use of Services
Blue Plus
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:26 PM
MSHO
Age
Member
Months
<1
0
1-9
0
10-19
0
20-44
3
45-64
0
65-74
30485
75-84
38769
85+
45781
Unknown
0
115038
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
0.00
0
0.00
NA
45-64
0
NA
0
NA
NA
65-74
413
13.55
11111
364.47
26.90
75-84
934
24.09
28993
747.84
31.04
85+
1488
32.50
51431
1123.41
34.56
Unknown
0
2835
24.64
0
91535
795.69
NA
32.29
Age
Total
HEDIS 2008 (Reporting Year 2007)
Page 57
Use of Services
Blue Plus
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Medicaid
Age
Member
Months
<1
61006
1-9
300154
10-19
264537
20-44
353084
45-64
149489
65-74
3398
75-84
1782
85+
1611
Unknown
Total
0
1135061
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
3
0.01
19
0.07
6.33
20-44
2
0.01
21
0.06
10.50
45-64
14
0.09
150
1.00
10.71
65-74
21
6.18
471
138.61
22.43
75-84
20
11.22
414
232.32
20.70
85+
20
12.41
636
394.79
31.80
Unknown
0
80
0.07
0
1711
1.51
NA
21.39
Age
Total
HEDIS 2008 (Reporting Year 2007)
Page 58
Use of Services
Blue Plus
Mental Health Utilization
% of Members Receiving Inpatient, Day/Night and Ambulato
Data Last Refreshed:
Oct 7, 2009 1:26 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
137177
68729
282594
140799
145417
72070
137177
68729
282594
140799
145417
72070
137177
68729
282594
140799
145417
72070
137177
68729
282594
140799
559946
12510
0
789943
647760
7595
0
861261
1207706
20105
0
1651204
559946
12510
0
789943
647760
7595
0
861261
1207706
20105
0
1651204
559946
12510
0
789943
647760
7595
0
861261
1207706
20105
0
1651204
559946
12510
0
789943
647760
7595
0
861261
1207706
20105
0
1651204
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)
145417
72070
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
833
483
1316
784
816
1600
3097
6195
9292
37
17
54
0
0
0
4751
7511
12262
6.87%
4.23%
5.59%
13.05%
14.25%
13.64%
6.64%
11.48%
9.23%
3.55%
2.69%
3.22%
NA
NA
NA
7.22%
10.47%
8.91%
13
6
19
52
84
136
123
182
305
4
1
5
0
0
0
192
273
465
0.11%
0.05%
0.08%
0.87%
1.47%
1.16%
0.26%
0.34%
0.30%
0.38%
0.16%
0.30%
NA
NA
NA
0.29%
0.38%
0.34%
8
3
11
18
25
43
22
53
75
0
0
0
0
0
0
48
81
129
0.07%
0.03%
0.05%
0.30%
0.44%
0.37%
0.05%
0.10%
0.07%
0.00%
0.00%
0.00%
NA
NA
NA
0.07%
0.11%
0.09%
832
482
1314
774
812
1586
3085
6186
9271
34
16
50
0
0
0
4725
7496
12221
6.87%
4.22%
5.58%
12.89%
14.18%
13.52%
6.61%
11.46%
9.21%
3.26%
2.53%
2.98%
NA
NA
NA
7.18%
10.44%
8.88%
HEDIS 2008 (Reporting Year 2007)
Page 59
Use of Services
Blue Plus
Mental Health Utilization
% of Members Receiving Inpatient, Day/Night and Ambulato
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
Mental Health Utilization
% of Members Receiving Inpatient, Day/Night and Ambulato
Data Last Refreshed:
Oct 7, 2009 1:26 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
3
30159
0
30162
0
84876
0
84876
3
115035
0
115038
3
30159
0
30162
0
84876
0
84876
3
115035
0
115038
3
30159
0
30162
0
84876
0
84876
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
3
115035
0
115038
3
30159
0
30162
0
84876
0
84876
3
115035
0
115038
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
1
0
1
314
774
1088
0
0
0
315
774
1089
NA
NA
NA
NA
NA
NA
400.00%
NA
400.00%
12.49%
10.94%
11.35%
NA
NA
NA
12.53%
10.94%
11.36%
0
0
0
0
0
0
0
0
0
78
215
293
0
0
0
78
215
293
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
3.10%
3.04%
3.06%
NA
NA
NA
3.10%
3.04%
3.06%
0
0
0
0
0
0
0
0
0
3
11
14
0
0
0
3
11
14
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
0.12%
0.16%
0.15%
NA
NA
NA
0.12%
0.16%
0.15%
0
0
0
0
0
0
1
0
1
265
614
879
0
0
0
266
614
880
NA
NA
NA
NA
NA
NA
400.00%
NA
400.00%
10.54%
8.68%
9.17%
NA
NA
NA
10.58%
8.68%
9.18%
HEDIS 2008 (Reporting Year 2007)
Page 61
Use of Services
Blue Plus
Mental Health Utilization
% of Members Receiving Inpatient, Day/Night and Ambulato
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Medicaid
Member Months
(Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Member Months
(Inpatient)
Male
Female
Total
Male
Female
Total
225632
68484
218462
68522
444094
137006
225632
68484
218462
68522
444094
137006
225632
68484
218462
68522
197803
2378
0
494297
349367
4413
0
640764
547170
6791
0
1135061
197803
2378
0
494297
349367
4413
0
640764
547170
6791
0
1135061
197803
2378
0
494297
349367
4413
0
640764
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
444094
137006
225632
68484
218462
68522
444094
137006
547170
6791
0
1135061
197803
2378
0
494297
349367
4413
0
640764
547170
6791
0
1135061
Intensive Outpatient/Partial
Hospitalization
Inpatient
Member Months
(Outpatient/ED)
Outpatient/ED
Number
Percent
Number
Percent
Number
Percent
Number
Percent
2165
1449
3614
1207
1301
2508
2877
6340
9217
25
37
62
0
0
0
6274
9127
15401
11.51%
7.96%
9.77%
21.15%
22.78%
21.97%
17.45%
21.78%
20.21%
12.62%
10.06%
10.96%
NA
NA
NA
15.23%
17.09%
16.28%
44
22
66
66
129
195
246
383
629
5
6
11
0
0
0
361
540
901
0.23%
0.12%
0.18%
1.16%
2.26%
1.71%
1.49%
1.32%
1.38%
2.52%
1.63%
1.94%
NA
NA
NA
0.88%
1.01%
0.95%
39
11
50
45
23
68
38
133
171
1
0
1
0
0
0
123
167
290
0.21%
0.06%
0.14%
0.79%
0.40%
0.60%
0.23%
0.46%
0.38%
0.50%
0.00%
0.18%
NA
NA
NA
0.30%
0.31%
0.31%
2161
1446
3607
1201
1291
2492
2844
6307
9151
20
31
51
0
0
0
6226
9075
15301
11.49%
7.94%
9.75%
21.04%
22.61%
21.83%
17.25%
21.66%
20.07%
10.09%
8.43%
9.01%
NA
NA
NA
15.11%
17.00%
16.18%
HEDIS 2008 (Reporting Year 2007)
Page 62
Blue Plus
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Commercial
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
145417
72070
71636
80194
408116
12510
0
789943
Female
137177
68729
79192
102903
465665
7595
0
861261
Member Months
(Inpatient)
Total
282594
140799
150828
183097
873781
20105
0
1651204
Any Services
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
1
4
5
147
95
242
206
105
311
144
91
235
604
337
941
16
3
19
0
0
0
1118
635
1753
HEDIS 2008 (Reporting Year 2007)
Male
145417
72070
71636
80194
408116
12510
0
789943
Female
137177
68729
79192
102903
465665
7595
0
861261
Total
282594
140799
150828
183097
873781
20105
0
1651204
Inpatient
Percent
0.01%
0.03%
0.02%
2.45%
1.66%
2.06%
3.45%
1.59%
2.47%
2.15%
1.06%
1.54%
1.78%
0.87%
1.29%
1.53%
0.47%
1.13%
NA
NA
NA
1.70%
0.88%
1.27%
Number
1
0
1
49
37
86
50
27
77
28
17
45
180
100
280
3
3
6
0
0
0
311
184
495
Percent
0.01%
0.00%
0.00%
0.82%
0.65%
0.73%
0.84%
0.41%
0.61%
0.42%
0.20%
0.29%
0.53%
0.26%
0.38%
0.29%
0.47%
0.36%
NA
NA
NA
0.47%
0.26%
0.36%
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
145417
137177
282594
72070
68729
140799
71636
79192
150828
80194
102903
183097
408116
465665
873781
12510
7595
20105
0
0
0
789943
861261
1651204
Member Months
(Outpatient/ED)
Male
145417
72070
71636
80194
408116
12510
0
789943
Female
137177
68729
79192
102903
465665
7595
0
861261
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
0
0
0
11
3
14
11
6
17
6
7
13
21
15
36
0
0
0
0
0
0
49
31
80
Number
0
4
4
143
91
234
197
94
291
141
87
228
568
323
891
15
1
16
0
0
0
1064
600
1664
Percent
0.00%
0.00%
0.00%
0.18%
0.05%
0.12%
0.18%
0.09%
0.14%
0.09%
0.08%
0.09%
0.06%
0.04%
0.05%
0.00%
0.00%
0.00%
NA
NA
NA
0.07%
0.04%
0.06%
Total
282594
140799
150828
183097
873781
20105
0
1651204
Percent
0.00%
0.03%
0.02%
2.38%
1.59%
1.99%
3.30%
1.42%
2.32%
2.11%
1.01%
1.49%
1.67%
0.83%
1.22%
1.44%
0.16%
0.95%
NA
NA
NA
1.62%
0.84%
1.21%
Page 63
Blue Plus
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:26 PM
MSHO
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
0
0
0
0
3
30159
0
30162
Female
0
0
0
0
0
84876
0
84876
Member Months
(Inpatient)
Total
0
0
0
0
3
115035
0
115038
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
68
84
152
0
0
0
68
84
152
HEDIS 2008 (Reporting Year 2007)
Male
0
0
0
0
3
30159
0
30162
Female
0
0
0
0
0
84876
0
84876
Total
0
0
0
0
3
115035
0
115038
Inpatient
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
2.71%
1.19%
1.59%
NA
NA
NA
2.71%
1.19%
1.59%
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
37
45
82
0
0
0
37
45
82
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
1.47%
0.64%
0.86%
NA
NA
NA
1.47%
0.64%
0.86%
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Male
Female
Total
0
0
0
0
0
0
0
0
0
0
0
0
3
0
3
30159
84876
115035
0
0
0
30162
84876
115038
Member Months
(Outpatient/ED)
Male
0
0
0
0
3
30159
0
30162
Female
0
0
0
0
0
84876
0
84876
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
51
56
107
0
0
0
51
56
107
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
0.04%
0.00%
0.01%
NA
NA
NA
0.04%
0.00%
0.01%
Total
0
0
0
0
3
115035
0
115038
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
2.03%
0.79%
1.12%
NA
NA
NA
2.03%
0.79%
1.12%
Page 65
Blue Plus
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Medicaid
Member Months
(Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
225632
68484
45733
44407
107663
2378
0
494297
Female
218462
68522
90663
98529
160175
4413
0
640764
Member Months
(Inpatient)
Total
444094
137006
136396
142936
267838
6791
0
1135061
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
8
6
14
287
228
515
432
419
851
514
638
1152
1020
892
1912
6
5
11
0
0
0
2267
2188
4455
HEDIS 2008 (Reporting Year 2007)
Male
225632
68484
45733
44407
107663
2378
0
494297
Female
218462
68522
90663
98529
160175
4413
0
640764
Total
444094
137006
136396
142936
267838
6791
0
1135061
Inpatient
Percent
0.04%
0.03%
0.04%
5.03%
3.99%
4.51%
11.34%
5.55%
7.49%
13.89%
7.77%
9.67%
11.37%
6.68%
8.57%
3.03%
1.36%
1.94%
NA
NA
NA
5.50%
4.10%
4.71%
Number
0
0
0
96
83
179
128
126
254
138
178
316
351
312
663
5
3
8
0
0
0
718
702
1420
Percent
0.00%
0.00%
0.00%
1.68%
1.45%
1.57%
3.36%
1.67%
2.23%
3.73%
2.17%
2.65%
3.91%
2.34%
2.97%
2.52%
0.82%
1.41%
NA
NA
NA
1.74%
1.31%
1.50%
Member Months
(Intensive Outpatient/Partial
Hospitalization)
Total
Male
Female
225632
68484
45733
44407
107663
2378
0
494297
218462
68522
90663
98529
160175
4413
0
640764
444094
137006
136396
142936
267838
6791
0
1135061
Member Months
(Outpatient/ED)
Male
225632
68484
45733
44407
107663
2378
0
494297
Female
218462
68522
90663
98529
160175
4413
0
640764
Intensive Outpatient/Partial
Hospitalization
Outpatient/ED
Number
0
1
1
36
14
50
20
26
46
23
36
59
36
41
77
0
0
0
0
0
0
115
118
233
Number
8
6
14
276
209
485
405
379
784
490
604
1094
964
834
1798
4
4
8
0
0
0
2147
2036
4183
Percent
0.00%
0.01%
0.00%
0.63%
0.25%
0.44%
0.52%
0.34%
0.40%
0.62%
0.44%
0.50%
0.40%
0.31%
0.34%
0.00%
0.00%
0.00%
NA
NA
NA
0.28%
0.22%
0.25%
Total
444094
137006
136396
142936
267838
6791
0
1135061
Percent
0.04%
0.03%
0.04%
4.84%
3.66%
4.25%
10.63%
5.02%
6.90%
13.24%
7.36%
9.18%
10.74%
6.25%
8.06%
2.02%
1.09%
1.41%
NA
NA
NA
5.21%
3.81%
4.42%
Page 66
Use of Services
Blue Plus
Outpatient Drug Utilization
Commercial
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
209452
267267
540370
607906
19034
985
42
0
1645056
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 1:26 PM
$3,831,920.00
$8,361,808.00
$25,303,532.00
$60,602,436.00
$2,616,840.00
$174,322.00
$1,664.00
$0.00
$100,892,522.00
HEDIS 2008 (Reporting Year 2007)
Avg. Cost of
Prescriptions /
Per Member Per
Month
$18.29
$31.29
$46.83
$99.69
$137.48
$176.98
$39.62
$61.33
Total Number of
Prescriptions
63274
119590
464278
1183613
59073
4645
78
0
1894551
Avg. Num. Of
Prescriptions /
Per Member Per
Year
3.63
5.37
10.31
23.36
37.24
56.59
22.29
13.82
Page 67
Use of Services
Blue Plus
Outpatient Drug Utilization
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
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
3
0
30485
38769
45781
0
115038
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 1:26 PM
$0.00
$0.00
$0.00
$60,800.00
$8,892,556.00
$10,784,794.00
$11,432,102.00
$0.00
$31,170,252.00
HEDIS 2008 (Reporting Year 2007)
Avg. Cost of
Prescriptions /
Per Member Per
Month
NA
NA
$0.00
NA
$291.70
$278.18
$249.71
$270.96
Total Number of
Prescriptions
0
0
0
1406
233610
338238
410333
0
983587
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NA
NA
0.00
NA
91.96
104.69
107.56
102.60
Page 69
Use of Services
Blue Plus
Outpatient Drug Utilization
Medicaid
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
361160
264537
353084
149489
3398
1782
1611
0
1135061
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 1:26 PM
$5,997,564.00
$8,996,335.00
$24,344,040.00
$18,752,748.00
$223,469.00
$33,504.00
$34,834.00
$0.00
$58,382,494.00
HEDIS 2008 (Reporting Year 2007)
Avg. Cost of
Prescriptions /
Per Member Per
Month
$16.61
$34.01
$68.95
$125.45
$65.76
$18.80
$21.62
$51.44
Total Number of
Prescriptions
137348
141507
487544
413041
6162
2813
2790
0
1191205
Avg. Num. Of
Prescriptions /
Per Member Per
Year
4.56
6.42
16.57
33.16
21.76
18.94
20.78
12.59
Page 70
Access/Availability of Care
Blue Plus
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:26 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+
24039
39895
1601
23081
38714
1573
96.01%
95.77%
96.26%
97.04%
96.87%
97.21%
98.25%
97.58%
98.92%
2007
A
Page 71
Access/Availability of Care
Blue Plus
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:26 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
8279
2007
A
0
0
8097
NA
NA
NA
NA
NA
NA
97.80%
97.48%
98.12%
Page 73
Access/Availability of Care
Blue Plus
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:26 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+
15056
8422
256
2007
A
13267
7439
221
88.12%
87.60%
88.64%
88.33%
87.64%
89.02%
86.33%
81.92%
90.73%
Page 74
Access/Availability of Care
Blue Plus
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 1:26 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.
1427
7381
7207
14284
1389
6760
6507
13145
97.34%
96.47%
98.21%
91.59%
90.95%
92.23%
90.29%
89.60%
90.98%
92.03%
91.58%
92.47%
2007
A
Page 75
Access/Availability of Care
Blue Plus
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 1:26 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.
2965
8323
5810
8946
2007
A
2918
7588
5253
8235
98.41%
97.95%
98.88%
91.17%
90.55%
91.78%
90.41%
89.65%
91.18%
92.05%
91.49%
92.62%
Page 76
Access/Availability of Care
Blue Plus
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 1:26 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)
1550
1661
Number of numerator events by administrative data in
eligible population (before exclusions)
1150
1053
Current year's administrative rate (before exclusions)
74.19%
63.40%
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
354
277
Data Elements
Administrative rate on FSS
78.15%
61.15%
Number of original sample records excluded because of
valid data errors
2
5
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
11
2
451
354
58
16
411
278
57
91.35%
88.65%
94.06%
81.51%
77.63%
85.38%
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
Blue Plus
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 1:26 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)
3983
3983
Number of numerator events by administrative data in
eligible population (before exclusions)
2232
2386
Current year's administrative rate (before exclusions)
56.04%
59.90%
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
247
265
54.53%
58.50%
Number of original sample records excluded because of
valid data errors
2
2
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
2
411
247
103
2
411
265
37
85.16%
81.60%
88.72%
73.48%
69.09%
77.87%
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
Blue Plus
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:26 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
145
1082
1227
66
20
436
117
502
137
Reported rate
45.52%
13.79%
40.30%
10.81%
40.91%
11.17%
Lower 95% confidence interval
37.07%
53.97%
7.84%
19.75%
37.33%
43.26%
8.92%
12.71%
38.12%
43.70%
9.36%
12.97%
Upper 95% confidence interval
HEDIS 2008 (Reporting Year 2007)
Page 79
Access/Availability of Care
Blue Plus
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:26 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
112
112
0
0
73
5
73
5
Reported rate
NA
NA
65.18%
4.46%
65.18%
4.46%
Lower 95% confidence interval
NA
NA
NA
NA
55.91%
74.45%
0.19%
8.74%
55.91%
74.45%
0.19%
8.74%
Upper 95% confidence interval
HEDIS 2008 (Reporting Year 2007)
Page 81
Access/Availability of Care
Blue Plus
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:26 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
209
1660
1869
95
24
759
196
854
220
Reported rate
45.45%
11.48%
45.72%
11.81%
45.69%
11.77%
Lower 95% confidence interval
38.46%
52.44%
6.92%
16.04%
43.30%
48.15%
10.22%
13.39%
43.41%
47.98%
10.28%
13.26%
Upper 95% confidence interval
HEDIS 2008 (Reporting Year 2007)
Page 82
Health Plan Stability
Blue Plus
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Commercial
Product/Product Line
Years in Business
Members*
14.00
33.00
0.00
21.00
2.00
33.00
94504
1988
0
73641
9716
179849
0.00
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
0
0.00
33.00
0.00
21.00
0.00
33.00
0
32021
0
28814
0
60835
240684
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
Blue Plus
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:26 PM
MSHO
Product/Product Line
Years in Business
Members*
14.00
33.00
0.00
21.00
2.00
33.00
94504
1988
0
73641
9716
179849
0.00
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
0
0.00
33.00
0.00
21.00
0.00
33.00
0
32021
0
28814
0
60835
240684
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
Blue Plus
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Medicaid
Product/Product Line
Years in Business
Members*
14.00
33.00
0.00
21.00
2.00
33.00
94504
1988
0
73641
9716
179849
0.00
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
0
0.00
33.00
0.00
21.00
0.00
33.00
0
32021
0
28814
0
60835
240684
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
Blue Plus
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:26 PM
Commercial
Member Months
Female
8724
39156
53880
60492
43632
27768
<1
1-4
5-9
10-14
15-17
18-19
Male
9804
41784
56460
64284
45132
27492
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
244956
31.01%
44136
37116
43068
55212
65484
233652
27.13%
51420
50124
52764
64032
78456
478608
28.99%
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
245016
31.02%
78240
81480
75960
51720
296796
34.46%
95676
94848
80892
51720
541812
32.82%
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
287400
36.39%
9732
1992
588
132
12
12
323136
37.52%
6420
912
168
72
12
0
610536
36.98%
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
12468
1.58%
0
7584
0.88%
0
20052
1.21%
789840
861168
HEDIS 2008 (Reporting Year 2007)
Total
18528
80940
110340
124776
88764
55260
95556
87240
95832
119244
143940
173916
176328
156852
103440
16152
2904
756
204
24
12
0
1651008
Page 87
Health Plan Descriptive Information
Blue Plus
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:26 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
Blue Plus
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:26 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%
5424
5724
5460
5388
4824
3300
0
0.00%
9744
9576
12636
15252
17412
20220
0
0.00%
30120
100.00%
0
84840
100.00%
0
114960
100.00%
30120
84840
HEDIS 2008 (Reporting Year 2007)
0
0
0
0
0
0
0
0
0
15168
15300
18096
20640
22236
23520
0
114960
Page 89
Health Plan Descriptive Information
Blue Plus
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:26 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
30917
76046
76970
69400
40783
19813
Member Months
Female
30089
71200
75938
68218
41539
24784
Total
61006
147246
152908
137618
82322
44597
313929
63.51%
25920
23931
20476
21203
22761
311768
48.66%
65879
58181
40348
38622
35763
625697
55.12%
114291
23.12%
23190
18772
13225
8512
238793
37.27%
32832
23464
16065
13429
353084
31.11%
63699
12.89%
964
454
385
240
203
132
85790
13.39%
1334
646
551
606
676
600
149489
13.17%
2378
0.48%
0
4413
0.69%
0
6791
0.60%
494297
640764
HEDIS 2008 (Reporting Year 2007)
91799
82112
60824
59825
58524
56022
42236
29290
21941
2298
1100
936
846
879
732
0
1135061
Page 90