Sanford Health Plan
Plan Name
2006
Reporting Year
General Info
Disclaimers
Submission #
Plan ID
1
38
Last Refreshed:
23
Use of Services Measures
Well Child Visits in the First 15 Months of Life
24
Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life
43
44
Page
2
10/7/2009 1:21:32 PM
Page
41
Page
25
Adolescent Well-Care Visits
Childhood Immunization Status
3
26
Frequency of Selected Procedures
45
Adolescent Immunization Status
5
27
Inpatient Utilization - General Hospital/Acute Care
48
Appropriate Treatment for Children with Upper Respiratory Infection
7
28
Ambulatory Care
51
Colorectal Cancer Screening
8
29
Inpatient Utilization - Nonacute Care
54
Breast Cancer Screening
9
30
13
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
57
Cervical Cancer Screening
Chlamydia Screening in Women
14
31
15
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory Services
60
Osteoporosis Management in Women Who had a Fracture
Controlling High Blood Pressure
16
32
17
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
64
Beta Blocker Treatment after Heart Attack
33
Identification of Alcohol and Other Drug Services
67
34
Outpatient Drug Utilization
71
35
Adult's Access to Preventive/Ambulatory Health Services
75
36
Children's and Adolescents' Access to Primary Care Practitioners
79
37
Prenatal and Postpartum Care
81
38
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
83
Health Plan Stability Measures
Years in Business / Total Membership
Page
39
Health Plan Descriptive Information Measures
Enrollment by Product Line (Age & Sex)
Page
40
Effectiveness of Care Measures
Persistence of Beta Blocker Treatment After Hearth Attack
18
Cholesterol Management for Patients with Cardiovascular Conditions
19
Comprehensive Diabetes Care
22
Use of Appropriate Medications for People with Asthma
26
Antidepressant Medication Management
28
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
32
Glaucoma Screening in Older Adults
33
Annual Monitoring for Patients on Persistent Medications
34
Drugs to Be Avoided in the Elderly
38
Potentially Harmful Drug-Disease Interactions in the Elderly
39
HEDIS 2007 (Reporting Year 2006)
Access / Availability of Care Measures
Page
87
91
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 2007 (Reporting Year 2006)
Page 2
Effectiveness of Care
Sanford Health Plan
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:21 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
45
18.29%
114
46.34%
108
43.90%
123
50.00%
117
47.56%
90
36.59%
69
28.05%
31
12.60%
20
8.13%
45
18.29%
114
46.34%
108
43.90%
123
50.00%
117
47.56%
90
36.59%
69
28.05%
31
12.60%
20
8.13%
45
165
87.14%
82.70%
91.57%
114
120
97.10%
94.77%
99.42%
108
125
96.68%
94.21%
99.15%
123
111
97.10%
94.77%
99.42%
117
116
96.68%
94.21%
99.15%
90
123
88.38%
84.13%
92.63%
69
58
52.70%
46.19%
59.21%
31
162
80.08%
74.83%
85.33%
20
89
45.23%
38.74%
51.72%
246
3
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
2
Records Added from the Oversample List
0
HEDIS 2007 (Reporting Year 2006)
MMR
246
0.00%
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
IPV
2006
H
246
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
241
Page 3
Effectiveness of Care
Sanford Health Plan
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
Data Elements
General
Measure
Data
DTaP/DT
IPV
MMR
HiB
Hepatitis B
VZV
Pneumococcal
Conjugate
Combo 2
Combo 3
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of Records Excluded because of
Contraindications by Admin Data
Number of Records Excluded because of
Contraindications by Medical Record
Review
Number of employee/dependent records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
Page 4
Effectiveness of Care
Sanford Health Plan
Adolescent Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
Combo 2
33
11.34%
19
6.53%
9
3.09%
2
0.69%
33
11.34%
19
6.53%
9
3.09%
2
0.69%
33
199
79.73%
74.93%
84.52%
19
125
49.48%
43.57%
55.40%
9
63
24.74%
19.61%
29.87%
2
46
16.49%
12.06%
20.93%
291
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 2007 (Reporting Year 2006)
VZV
291
0.00%
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
Hepatitis B
2006
H
291
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
Admin rate on FSS
MMR
291
Page 5
Effectiveness of Care
Sanford Health Plan
Adolescent Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
Data Elements
General
Measure
Data
MMR
Hepatitis B
VZV
Combo 2
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of Records Excluded because of
Contraindications by Admin Data
Number of Records Excluded because of
Contraindications by Medical Record Review
Number of employee/dependent records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
Page 6
Effectiveness of Care
Sanford Health Plan
Appropriate Treatment for Children with Upper
Respiratory Infection
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
General
Measure
Data
2006
A
Eligible Member Population
546
Numerator Events by Admin Data
43
Reported Rate
92.12%
Lower 95% Confidence Interval
89.77%
Upper 95% Confidence Interval
94.48%
HEDIS 2007 (Reporting Year 2006)
Page 7
Effectiveness of Care
Sanford Health Plan
Colorectal Cancer Screening
Data Elements
Measurement Year
Data collection methodology (administrative or hybrid)
Eligible population
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare
Advantage
MSHO
NR
NR
NR
NR
NR
NR
Commercial
2006
A
3737
Number of numerator events by administrative data in eligible
population (before exclusions)
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of valid data
errors
Number of administrative data records excluded
Number of medical record data records excluded
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
1586
Numerator events by medical records
Reported rate
42.44%
NR
NR
Lower 95% confidence interval
40.84%
NR
NR
Upper 95% confidence interval
44.04%
NR
NR
Data Elements with an Asterisk(*) are OPTIONAL and are not used in any calculation or total
HEDIS 2007 (Reporting Year 2006)
Page 8
Effectiveness of Care
Sanford Health Plan
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
General Measure
Data
Ages 42-51
Ages 52-69
Total
1664
1112
66.83%
64.53%
69.12%
1791
1353
75.54%
73.53%
77.56%
3455
2465
71.35%
69.82%
72.87%
2006
A
Page 9
Effectiveness of Care
Sanford Health Plan
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
General Measure
Data
Ages 42-51
NR
NR
NR
Ages 52-69
Total
NR
NR
NR
NR
NR
NR
NR
NR
Page 10
Effectiveness of Care
Sanford Health Plan
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
General Measure
Data
Ages 42-51
NR
NR
NR
Ages 52-69
Total
NR
NR
NR
NR
NR
NR
NR
NR
Page 11
Effectiveness of Care
Sanford Health Plan
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
Data Elements
General Measure
Data
Ages 42-51
Ages 52-69
Total
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
NR
NR
NR
Page 12
Effectiveness of Care
Sanford Health Plan
Cervical Cancer Screening
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Medicaid
2006
A
3957
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
78.59%
NR
NR
NR
Number of administrative data records excluded
Number of medical record data records excluded
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
3110
78.59%
77.30%
79.89%
NR
NR
NR
Page 13
Effectiveness of Care
Sanford Health Plan
Chlamydia Screening in Women
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
General
Measure Ages 16-20 Ages 21-25
Data
Medicaid
Total
General
Measure Ages 16-20 Ages 21-25
Data
Total
2006
A
338
92
27.22%
22.33%
32.11%
411
113
27.49%
23.06%
31.93%
749
205
27.37%
24.11%
30.63%
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 14
Effectiveness of Care
Sanford Health Plan
Osteoporosis Management in Women Who
had a Fracture
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interva
HEDIS 2007 (Reporting Year 2006)
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare
Advantage
MSHO
NR
NR
NR
NR
NR
NR
Page 15
Effectiveness of Care
Sanford Health Plan
Controlling High Blood Pressure
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology (Hybrid)
General Measure
Data
Current Year's Admin Rate
Final Sample Size (FSS)
265
1008
1273
0
0
0
0.00%
0.00%
0.00%
0
0
0
0.00%
0.00%
0.00%
91
320
411
411
15.00%
411
Numerator events by admin data in FSS
Admin rate on FSS
Records Excluded because of Valid Data
Errors
10
Number of administrative data records
excluded
0
Number of medical record data records
excluded
1
Number of employee/dependent medical
records excluded
0
Records Added from the OverSample List
11
Denominator
Total
H
Numerator Events by Admin Data on
Eligible Population (before exclusions)
Oversampling Rate
Ages 46-85
2006
Eligible Member Population
Minimum Required Sample Size
Ages 18-45
Numerator Events by Admin Data
0
0
0
Numerator Events by Medical Record
40
199
239
Reported Rate
43.96%
62.19%
58.15%
Lower 95% Confidence Interval
33.21%
56.72%
53.26%
Upper 95% Confidence Interval
54.70%
67.66%
63.04%
HEDIS 2007 (Reporting Year 2006)
Page 16
Effectiveness of Care
Sanford Health Plan
Beta Blocker Treatment after Heart Attack
Data Elements
Measurement Year
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
H
Eligible Member Population
21
Numerator Events by Admin Data on
Eligible Population
18
Minimum Required Sample Size
Oversampling Rate
85.71%
NR
NR
NR
NR
21
0.00%
Final Sample Size (FSS)
21
Numerator events by admin data in FSS
18
Admin rate on FSS
MSHO
2006
Data Collection Methodology
Current Year's Admin Rate
Medicare Advantage
85.71%
Records Excluded because of Valid Data
Errors
0
Number of administrative data records
excluded
0
Number of medical record data records
excluded
0
Number of employee/dependent medical
records excluded
0
Records Added from the Oversample List
0
Denominator
21
Numerator Events by Admin Data
18
Numerator Events by Medical Record
2
Reported Rate
NA
NR
NR
Lower 95% Confidence Interval
NA
NR
NR
Upper 95% Confidence Interval
NA
NR
NR
HEDIS 2007 (Reporting Year 2006)
Page 17
Effectiveness of Care
Sanford Health Plan
Persistence of Beta Blocker Treatment After Hearth Attack
Data Elements
Measurement Year
Commercial
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage
MSHO
2006
Data Collection Methodology
A
Eligible Member Population
18
Numerator Events by Admin Data on
Eligible Population
10
Reported Rate
NA
NR
NR
Lower 95% Confidence Interval
NA
NR
NR
Upper 95% Confidence Interval
NA
NR
NR
HEDIS 2007 (Reporting Year 2006)
Page 18
Effectiveness of Care
Sanford Health Plan
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
4
Number of administrative data records excluded
2
Number of medical record data records excluded
0
Number of employee/dependent medical records
excluded
0
HEDIS 2007 (Reporting Year 2006)
91
17
75.83%
14.17%
91
17
75.83%
14.17%
91
8
17
52
86.84%
80.20%
93.49%
60.53%
51.11%
69.94%
120
0.00%
120
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
2006
H
120
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
114
Page 19
Effectiveness of Care
Sanford Health Plan
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
Page 20
Effectiveness of Care
Sanford Health Plan
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
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
Sampling Method Used
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 2007 (Reporting Year 2006)
Page 21
Effectiveness of Care
Sanford Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:21 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
2006
H
730
2006
H
730
2006
H
730
2006
H
730
2006
H
730
2006
H
730
2006
H
730
2006
H
730
2006
H
730
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
341
46.71%
411
15%
411
341
82.97%
730
100.00%
411
15%
411
411
100.00%
21
2.88%
411
15%
411
21
5.11%
202
27.67%
411
15%
411
202
49.15%
294
40.27%
411
15%
411
294
71.53%
47
6.44%
411
15%
411
47
11.44%
4
0.55%
411
15%
411
4
0.97%
0
0.00%
411
15%
411
0
0.00%
0
0.00%
411
15%
411
0
0.00%
Number of Records Excluded Because of
Valid Data Errors
17
17
17
17
17
17
17
17
17
Number of administrative data records
excluded
0
0
0
0
0
0
0
0
0
11
11
11
11
11
11
11
11
11
0
0
0
0
0
0
0
0
0
28
411
341
32
90.75%
87.83%
93.68%
28
411
1
87
21.41%
17.32%
25.50%
28
411
21
169
46.23%
41.29%
51.17%
28
411
202
34
57.42%
52.52%
62.32%
28
411
294
29
78.59%
74.50%
82.68%
28
411
47
115
39.42%
34.57%
44.26%
28
411
4
334
82.24%
78.42%
86.06%
28
411
0
266
64.72%
59.98%
69.46%
28
411
0
144
35.04%
30.30%
39.77%
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 2007 (Reporting Year 2006)
Page 22
Effectiveness of Care
Sanford Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:21 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
Admin rate on FSS
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number of Records Excluded Because of
Valid Data Errors
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
Page 23
Effectiveness of Care
Sanford Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
Data Elements
HbA1c
Testing
Poor HbA1c Good HbA1c
Control
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
Blood
Monitoring
Pressure
for Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<130/80 mm
Hg
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number of Records Excluded Because of
Valid Data Errors
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
Page 24
Effectiveness of Care
Sanford Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
Data Elements
HbA1c
Testing
Poor HbA1c Good HbA1c
Control
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<100 mg/dL
Blood
Monitoring
Pressure
for Diabetic
<140/90 mm
Nephropathy
Hg
Blood
Pressure
<130/80 mm
Hg
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number of Records Excluded Because of
Valid Data Errors
Number of administrative data records
excluded
Number of medical record data records
excluded
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
Page 25
Effectiveness of Care
Sanford Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
General
Measure Data
Ages 5-9
Ages 10-17
Ages 18-56
Total
28
28
NA
NA
NA
40
37
92.50%
83.09%
100.00%
143
120
83.92%
77.54%
90.29%
211
185
87.68%
83.01%
92.35%
2006
A
Page 26
Effectiveness of Care
Sanford Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
General
Measure Data
Ages 5-9
NR
NR
NR
Ages 10-17
NR
NR
NR
Ages 18-56
Total
NR
NR
NR
NR
NR
NR
NR
NR
Page 27
Effectiveness of Care
Sanford Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
11
17.46%
7.29%
27.63%
49
77.78%
66.72%
88.84%
38
60.32%
47.44%
73.19%
2006
A
63
Page 28
Effectiveness of Care
Sanford Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
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 29
Effectiveness of Care
Sanford Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
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 30
Effectiveness of Care
Sanford Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
Data Elements
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
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
Page 31
Effectiveness of Care
Sanford Health Plan
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Total Exclusions
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interva
HEDIS 2007 (Reporting Year 2006)
General
Measure
Data
Medicaid
Initiation
Phase
Continuation
and
Maintenance
Phase
35
1
10
28.57%
12.18%
44.97%
5
0
3
NA
NA
NA
General
Measure
Data
Initiation
Phase
Continuation
and
Maintenance
Phase
NR
NR
NR
NR
NR
NR
2006
A
Page 32
Effectiveness of Care
Sanford Health Plan
Glaucoma Screening in Older Adults
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interva
HEDIS 2007 (Reporting Year 2006)
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare
Advantage
MSHO
NR
NR
NR
NR
NR
NR
Page 33
Effectiveness of Care
Sanford Health Plan
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Total Exclusions
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
General
Measure
Data
Annual Monitoring for Members on
ACE Inhibitors
or ARBs
Digoxin
Diuretics
Anticonvulsants
Total
1211
0
821
67.80%
65.12%
70.47%
23
0
14
NA
NA
NA
823
0
586
71.20%
68.05%
74.36%
56
0
36
64.29%
50.84%
77.73%
2113
0
1457
68.95%
66.96%
70.95%
2006
A
Page 34
Effectiveness of Care
Sanford Health Plan
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage
Data Elements
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
Measurement Year
Data Collection Methodology
Eligible Member Population
Total Exclusions
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
Page 35
Effectiveness of Care
Sanford Health Plan
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
Data Elements
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
Measurement Year
Data Collection Methodology
Eligible Member Population
Total Exclusions
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
Page 36
Effectiveness of Care
Sanford Health Plan
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
Data Elements
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
Measurement Year
Data Collection Methodology
Eligible Member Population
Total Exclusions
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
Page 37
Effectiveness of Care
Sanford Health Plan
Drugs to Be Avoided in the Elderly
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
General
Measure
Data
MSHO
1 or More
Prescriptions
2 or More
Prescriptions
NR
NR
NR
NR
NR
NR
General
Measure
Data
1 or More
Prescriptions
2 or More
Prescriptions
NR
NR
NR
NR
NR
NR
Page 38
Effectiveness of Care
Sanford Health Plan
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
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 39
Effectiveness of Care
Sanford Health Plan
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
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 40
Use of Services
Sanford Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 1:21 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
3
2
4
8
11
50
132
1.43%
0.00%
3.27%
0.95%
0.00%
2.50%
1.90%
0.00%
3.99%
3.81%
0.98%
6.64%
5.24%
1.99%
8.49%
23.81%
17.81%
29.81%
62.86%
56.08%
69.63%
2006
A
210
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 2007 (Reporting Year 2006)
Page 41
Use of Services
Sanford Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
Data Elements
General
Measure
Data
Zero Visits
1 visit
2 visits
3 visits
4 visits
5 visits
6 or more
visits
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of records excluded because of
contraindications identified through
administrative data
Number of records excluded because of
contraindications identified through medical
record review
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
Page 42
Use of Services
Sanford Health Plan
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 1:21 PM
Commercial
Medicaid
2006
A
1157
Numerator events by admin data in eligible
population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Records Excluded because of Valid Data Errors
NR
NR
NR
NR
Records Excluded - Contraindications/Admin Data
Records Excluded - Contraindications/Medical
Record Review
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
541
46.76%
43.84%
49.68%
NR
NR
NR
Page 43
Use of Services
Sanford Health Plan
Adolescent Well-Care Visits
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Medicaid
2006
A
3280
Numerator events by admin data in eligible
population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
NR
NR
NR
NR
Records Excluded because of Valid Data Errors
Records Excluded - Contraindications/Admin Data
Records Excluded - Contraindications/Medical
Record Review
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
870
26.52%
25.00%
28.05%
NR
NR
NR
Page 44
Use of Services
Sanford Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Member Months
Total
22326
44769
72622
50179
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
154
23
38
24
Procedures /
1,000 Member
Months
6.90
0.32
0.85
0.48
Member Months
Male
Female
76098
61686
63480
86062
47130
49585
1828
1398
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 2007 (Reporting Year 2006)
Number of
Procedures
Procedures /
1,000 Member
Months
1
0.01
0
28
0
52
109
2
41
0
50
7
12
0
13
1
0.00
0.33
0.00
0.84
2.31
1.09
0.87
0.00
1.06
3.83
0.25
0.00
0.28
0.55
Number of
Procedures
19
14
21
23
0
19
32
0
Procedures /
1,000 Member
Months
0.25
0.28
0.28
0.46
0.00
0.25
0.65
0.00
1
6
0
0.01
0.12
0.00
54
26
0
103
131
4
7
0
37
0
0
0
0.71
0.52
0.00
1.62
2.64
2.86
0.14
0.00
0.75
0.00
0.00
0.00
2
7
2
15
24
0
0.03
0.14
1.43
0.20
0.48
0.00
Page 45
Use of Services
Sanford Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
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 46
Use of Services
Sanford Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
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 2007 (Reporting Year 2006)
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 47
Use of Services
nford Health Plan
Inpatient Utilization - General Hospital/Acute Care
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Member Months
4307
40462
50179
125166
96715
3095
119
12
0
320055
Discharges
Discharges /
1,000 Member
Months
53
86
70
756
627
21
3
0
0
1616
12.31
2.13
1.40
6.04
6.48
6.79
25.21
0.00
47
70
29
134
274
12
3
0
0
569
10.91
1.73
0.58
1.07
2.83
3.88
25.21
0.00
6
16
25
151
353
9
0
0
0
560
1.39
0.40
0.50
1.21
3.65
2.91
0.00
0.00
16
471
0
0
487
0.32
3.76
0.00
HEDIS 2007 (Reporting Year 2006)
5.05
1.78
1.75
1.79
Days
195
255
211
2097
2264
60
8
0
0
5090
Days / 1,000
Member
Months
45.28
6.30
4.20
16.75
23.41
19.39
67.23
0.00
15.90
156
185
85
381
971
34
8
0
0
1820
36.22
4.57
1.69
3.04
10.04
10.99
67.23
0.00
39
70
88
526
1293
26
0
0
0
2042
9.06
1.73
1.75
4.20
13.37
8.40
0.00
0.00
38
1190
0
0
1228
0.76
9.51
0.00
5.69
6.38
4.51
Average
Length of Stay
3.68
2.97
3.01
2.77
3.61
2.86
2.67
NA
NA
3.15
3.32
2.64
2.93
2.84
3.54
2.83
2.67
NA
NA
3.20
6.50
4.38
3.52
3.48
3.66
2.89
NA
NA
NA
3.65
2.38
2.53
NA
NA
2.52
Page 48
Use of Services
nford Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 49
Use of Services
nford Health Plan
Inpatient Utilization - General Hospital/Acute Care
MSHO
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Member Months
NR
Discharges
Discharges /
1,000 Member
Months
Days
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2007 (Reporting Year 2006)
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 50
Use of Services
nford Health Plan
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
4307
40462
50179
125166
96715
3095
119
12
0
320055
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
Visits
3969
11475
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
9636
27044
28432
1181
82
0
0
81819
HEDIS 2007 (Reporting Year 2006)
Visits/ 1,000
Member
Months
921.52
283.60
192.03
216.07
293.98
381.58
689.08
0.00
255.64
Emergency Room Visits
Visits
112
569
565
1261
769
34
2
0
0
3312
Visits/ 1,000
Member
Months
26.00
14.06
11.26
10.07
7.95
10.99
16.81
0.00
10.35
Ambulatory
Surgery/Procedures
Procedures
38
166
190
826
1680
68
3
0
0
2971
Procedures/
1,000 Member
Months
8.82
4.10
3.79
6.60
17.37
21.97
25.21
0.00
9.28
Observation Room Stays
Resulting in Discharge
Stays
22
34
42
140
125
9
0
0
0
372
Stays/ 1,000
Member
Months
5.11
0.84
0.84
1.12
1.29
2.91
0.00
0.00
1.16
Page 51
Use of Services
nford Health Plan
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
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
nford Health Plan
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
NR
Outpatient Visits
(Excludes MH/CD)
Age
Visits
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits/ 1,000
Member
Months
NR
NR
Emergency Room Visits
Visits
NR
NR
NR
NR
NR
NR
NR
HEDIS 2007 (Reporting Year 2006)
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 53
Use of Services
Sanford Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Age
Member
Months
<1
4307
1-9
40462
10-19
50179
20-44
125166
45-64
96715
65-74
3095
75-84
119
85+
12
Unknown
Total
0
320055
Discharges
Discharges /
1,000 Member
Months
<1
0
1-9
Days
Days / 1,000
Member
Months
Average Length
of Stay
0.00
0
0.00
NA
0
0.00
0
0.00
NA
10-19
0
0.00
0
0.00
NA
20-44
8
0.06
46
0.37
5.75
45-64
33
0.34
432
4.47
13.09
65-74
0
0.00
0
0.00
NA
75-84
0
0.00
0
0.00
NA
85+
0
0.00
0
0.00
NA
Unknown
0
41
0.13
0
478
1.49
NA
11.66
Age
Total
HEDIS 2007 (Reporting Year 2006)
Page 54
Use of Services
Sanford Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
NR
NR
Page 55
Use of Services
Sanford Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
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 2007 (Reporting Year 2006)
NR
NR
Page 56
Use of Services
Sanford Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Member Months
Age
Male
Female
Total
0-12
13-17
18-64
65+
Unknown
Total
30602
28336
58938
13328
113723
1828
0
159481
12896
117944
1398
0
160574
26224
231667
3226
0
320055
Discharges
Discharges /
1,000 Member
Months
Days*
Average Length
of Stay
Age
0-12
Gender
M
F
Total
6
1
7
0.20
0.04
0.12
48
16
64
8.00
16.00
9.14
13-17
M
F
Total
4
14
18
0.30
1.09
0.69
19
189
208
4.75
13.50
11.56
18-64
M
F
Total
M
F
Total
M
F
Total
M
F
TOTAL
36
46
82
0.32
0.39
0.35
147
243
390
4.08
5.28
4.76
0
0
0
0.00
0.00
0.00
0
0
0
NA
NA
NA
0
0
0
NA
NA
NA
214
448
662
4.65
7.34
6.19
65+
Unknown
Total
HEDIS 2007 (Reporting Year 2006)
0
0
0
46
61
107
0.29
0.38
0.33
Page 57
Use of Services
Sanford Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage
Member Months
Age
Male
0-12
13-17
18-64
65+
Unknown
Total
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
Discharges
Age
0-12
Gender
M
F
Total
13-17
M
F
Total
18-64
65+
Unknown
Total
M
F
Total
M
F
Total
M
F
Total
M
F
TOTAL
HEDIS 2007 (Reporting Year 2006)
Discharges /
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
Days*
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
Page 58
Use of Services
Sanford Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
Member Months
Age
Male
0-12
13-17
18-64
65+
Unknown
Total
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
Discharges
Age
0-12
Gender
M
F
Total
13-17
M
F
Total
18-64
65+
Unknown
Total
M
F
Total
M
F
Total
M
F
Total
M
F
TOTAL
HEDIS 2007 (Reporting Year 2006)
Discharges /
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
Days*
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
Page 59
Use of Services
Sanford Health Plan
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
13-17
18-64
65+
Unknown
Total
Member Months (Day/Night)
Member Months (Ambulatory)
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
30602
13328
28336
12896
58938
26224
30602
13328
28336
12896
58938
26224
30602
13328
28336
12896
58938
26224
30602
13328
28336
12896
58938
26224
113723
1828
0
159481
117944
1398
0
160574
231667
3226
0
320055
113723
1828
0
159481
117944
1398
0
160574
231667
3226
0
320055
113723
1828
0
159481
117944
1398
0
160574
231667
3226
0
320055
113723
1828
0
159481
117944
1398
0
160574
231667
3226
0
320055
Any Mental Health Services
0-12
Member Months (Inpatient)
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Inpatient Mental Health Services
Number
Percent
Number
Percent
Day/Night Mental Health Services
Percent
Number
94
65
159
74
98
172
341
584
925
1
2
3
0
0
0
510
749
1259
3.69%
2.75%
3.24%
6.66%
9.12%
7.87%
3.60%
5.94%
4.79%
0.66%
1.72%
1.12%
NA
NA
NA
3.84%
5.60%
4.72%
5
1
6
4
11
15
27
34
61
0
0
0
0
0
0
36
46
82
0.20%
0.04%
0.12%
0.36%
1.02%
0.69%
0.28%
0.35%
0.32%
0.00%
0.00%
0.00%
NA
NA
NA
0.27%
0.34%
0.31%
0
0
0
1
1
2
7
7
14
0
0
0
0
0
0
8
8
16
HEDIS 2007 (Reporting Year 2006)
0.00%
0.00%
0.00%
0.09%
0.09%
0.09%
0.07%
0.07%
0.07%
0.00%
0.00%
0.00%
NA
NA
NA
0.06%
0.06%
0.06%
Ambulatory Mental Health Services
Percent
Number
94
65
159
72
97
169
329
573
902
1
2
3
0
0
0
496
737
1233
3.69%
2.75%
3.24%
6.48%
9.03%
7.73%
3.47%
5.83%
4.67%
0.66%
1.72%
1.12%
NA
NA
NA
3.73%
5.51%
4.62%
Page 60
Use of Services
Sanford Health Plan
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
Female
NR
Member Months (Inpatient)
Total
Age
Sex
M
F
Total
Number
NR
13-17
M
F
Total
NR
18-64
M
F
Total
NR
65+
M
F
Total
NR
Unknown
M
F
Total
M
F
Total
NR
NR
NR
NR
Total
HEDIS 2007 (Reporting Year 2006)
Female
Total
Member Months (Day/Night)
Male
Female
Total
Member Months (Ambulatory)
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 Mental Health Services
0-12
Male
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Mental Health Services
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
Day/Night Mental Health Services
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
Ambulatory Mental Health Services
Percent
Number
NR
NR
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 61
Use of Services
Sanford Health Plan
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory
Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
Female
NR
Member Months (Inpatient)
Total
Age
Sex
M
F
Total
Number
NR
13-17
M
F
Total
NR
18-64
M
F
Total
NR
65+
M
F
Total
NR
Unknown
M
F
Total
M
F
Total
NR
NR
NR
NR
Total
HEDIS 2007 (Reporting Year 2006)
Female
Total
Member Months (Day/Night)
Male
Female
Total
Member Months (Ambulatory)
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 Mental Health Services
0-12
Male
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Mental Health Services
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
Day/Night Mental Health Services
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
Ambulatory Mental Health Services
Percent
Number
NR
NR
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 62
Use of Services
Sanford Health Plan
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
Female
NR
Member Months (Inpatient)
Total
Age
Sex
M
F
Total
Number
NR
13-17
M
F
Total
NR
18-64
M
F
Total
NR
65+
M
F
Total
NR
Unknown
M
F
Total
M
F
Total
NR
NR
NR
NR
Total
HEDIS 2007 (Reporting Year 2006)
Female
Total
Member Months (Day/Night)
Male
Female
Total
Member Months (Ambulatory)
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 Mental Health Services
0-12
Male
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Mental Health Services
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
Day/Night Mental Health Services
Percent
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Ambulatory Mental Health Services
Percent
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 63
Use of Services
Sanford Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Member Months
Male
Female
Total
30602
13328
113723
1828
0
159481
28336
12896
117944
1398
0
160574
58938
26224
231667
3226
0
320055
Discharges
Discharges /
1,000 Member
Months
Days
Average Length
of Stay
M
F
Total
0
0
0
0.00
0.00
0.00
0
0
0
NA
NA
NA
13-17
M
F
Total
3
9
12
0.23
0.70
0.46
56
93
149
18.67
10.33
12.42
18-64
M
F
Total
M
F
Total
M
F
Total
M
F
TOTAL
29
12
41
0.26
0.10
0.18
422
104
526
14.55
8.67
12.83
0
0
0
0.00
0.00
0.00
0
0
0
NA
NA
NA
0
0
0
NA
NA
NA
478
197
675
14.94
9.38
12.74
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
65+
Unknown
Total
HEDIS 2007 (Reporting Year 2006)
0
0
0
32
21
53
0.20
0.13
0.17
Page 64
Use of Services
Sanford Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage
Member Months
Age
Male
0-12
13-17
18-64
65+
Unknown
Total
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
Discharges
Age
0-12
13-17
18-64
65+
Unknown
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
TOTAL
HEDIS 2007 (Reporting Year 2006)
Discharges /
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
Days
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
Page 65
Use of Services
Sanford Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of
Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
Member Months
Age
Male
0-12
13-17
18-64
65+
Unknown
Total
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
Discharges
Age
0-12
13-17
18-64
65+
Unknown
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
TOTAL
HEDIS 2007 (Reporting Year 2006)
Discharges /
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
Days
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
Page 66
Sanford Health Plan
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
30602
13328
15702
23715
74306
1828
0
159481
Female
28336
12896
15725
24495
77724
1398
0
160574
Total
58938
26224
31427
48210
152030
3226
0
320055
Any Chemical Dependency 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
5
10
15
16
7
23
20
3
23
42
14
56
0
0
0
0
0
0
83
34
117
HEDIS 2007 (Reporting Year 2006)
Percent
0.00%
0.00%
0.00%
0.45%
0.93%
0.69%
NR
NR
NA
0.78%
0.13%
0.47%
0.68%
0.22%
0.44%
0.00%
0.00%
0.00%
NA
NA
NA
0.62%
0.25%
0.44%
Member Months (Inpatient)
Male
30602
13328
15702
23715
74306
1828
0
159481
Female
28336
12896
15725
24495
77724
1398
0
160574
Total
58938
26224
31427
48210
152030
3226
0
320055
Member Months (Day/Night)
Male
30602
13328
15702
23715
74306
1828
0
159481
Female
28336
12896
15725
24495
77724
1398
0
160574
Total
58938
26224
31427
48210
152030
3226
0
320055
Member Months (Ambulatory)
Male
30602
13328
15702
23715
74306
1828
0
159481
Female
28336
12896
15725
24495
77724
1398
0
160574
Total
58938
26224
31427
48210
152030
3226
0
320055
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
0
0
0
3
4
7
5
2
7
7
0
7
15
8
23
0
0
0
0
0
0
30
14
44
Number
0
0
0
1
1
2
5
3
8
4
0
4
11
1
12
0
0
0
0
0
0
21
5
26
Number
0
0
0
4
6
10
9
4
13
13
3
16
27
8
35
0
0
0
0
0
0
53
21
74
Percent
0.00%
0.00%
0.00%
0.27%
0.37%
0.32%
NR
NR
NA
0.27%
0.00%
0.14%
0.24%
0.12%
0.18%
0.00%
0.00%
0.00%
NA
NA
NA
0.23%
0.10%
0.16%
Percent
0.00%
0.00%
0.00%
0.09%
0.09%
0.09%
NR
NR
NA
0.16%
0.00%
0.08%
0.18%
0.02%
0.09%
0.00%
0.00%
0.00%
NA
NA
NA
0.16%
0.04%
0.10%
Percent
0.00%
0.00%
0.00%
0.36%
0.56%
0.46%
NR
NR
NA
0.51%
0.13%
0.33%
0.44%
0.12%
0.28%
0.00%
0.00%
0.00%
NA
NA
NA
0.40%
0.16%
0.28%
Page 67
Sanford Health Plan
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Any Chemical Dependency 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 2007 (Reporting Year 2006)
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 (Inpatient)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Chemical Dependency
Services
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 (Day/Night)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Day/Night Chemical Dependency
Services
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 (Ambulatory)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Ambulatory Chemical Dependency
Services
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 68
Sanford Health Plan
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Any Chemical Dependency 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 2007 (Reporting Year 2006)
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 (Inpatient)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Day/Night)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Ambulatory)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
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
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
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 69
Sanford Health Plan
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
NR
Member Months (Inpatient)
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Any Chemical Dependency 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 2007 (Reporting Year 2006)
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Day/Night)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Ambulatory)
Male
NR
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
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
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
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 70
Use of Services
Sanford Health Plan
Outpatient Drug Utilization
Commercial
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
44769
50179
125166
96715
3095
119
12
0
320055
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 1:21 PM
$678,531.11
$1,064,167.27
$3,817,318.29
$7,067,341.17
$326,369.54
$18,921.29
$392.45
$0.00
$12,973,041.12
HEDIS 2007 (Reporting Year 2006)
Avg. Cost of
Prescriptions /
Per Member Per
Month
$15.16
$21.21
$30.50
$73.07
$105.45
$159.00
$32.70
$40.53
Total Number of
Prescriptions
14476
16356
70860
123011
6021
320
8
0
231052
Avg. Num. Of
Prescriptions /
Per Member Per
Year
3.88
3.91
6.79
15.26
23.34
32.27
8.00
8.66
Page 71
Use of Services
Sanford Health Plan
Outpatient Drug Utilization
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
NR
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 72
Use of Services
Sanford Health Plan
Outpatient Drug Utilization
MSHO
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Member Months
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 2007 (Reporting Year 2006)
NR
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 73
Use of Services
Sanford Health Plan
Outpatient Drug Utilization
Medicaid
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Member Months
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 2007 (Reporting Year 2006)
NR
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 74
Access/Availability of Care
Sanford Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
Ages 20-44
Ages 45-64
Ages 65+
3447
4251
196
3253
4032
192
94.37%
93.59%
95.16%
94.85%
94.17%
95.52%
97.96%
95.72%
100.00%
2006
A
Page 75
Access/Availability of Care
Sanford Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
Page 76
Access/Availability of Care
Sanford Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
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 2007 (Reporting Year 2006)
Page 77
Access/Availability of Care
Sanford Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
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 2007 (Reporting Year 2006)
Page 78
Access/Availability of Care
Sanford Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
General Measure
Data
12-24 months
25 months - 6
yrs.
7-11 yrs.
12-19 yrs.
306
1444
1093
2004
303
1275
944
1762
99.02%
97.75%
100.00%
88.30%
86.60%
89.99%
86.37%
84.29%
88.45%
87.92%
86.47%
89.38%
2006
A
Page 79
Access/Availability of Care
Sanford Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
Data Elements
General Measure
Data
12-24 months
25 months - 6
yrs.
7-11 yrs.
12-19 yrs.
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data collection methodology (Administrativ
only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2007 (Reporting Year 2006)
Page 80
Access/Availability of Care
Sanford Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
General
Measure Data
Data collection methodology (Administrative or Hybrid)
H
Eligible member population (i.e. members who meet all
denominator criteria)
380
Number of numerator events by administrative data in
eligible population (before exclusions)
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample size
260
Oversampling rate
Final sample size (FSS)
5%
260
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of
valid data errors
1
Number of administrative data records excluded
0
Number of medical records data records excluded
1
Number of employee/dependent medical records excluded
0
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 2007 (Reporting Year 2006)
Timeliness of
Prenatal Care
Postpartum
Care
39
190
10.26%
50.00%
39
190
15.00%
73.08%
39
206
190
26
94.23%
91.20%
97.26%
83.08%
78.33%
87.83%
2
260
Page 81
Access/Availability of Care
Sanford Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
General
Measure Data
Timeliness of
Prenatal Care
Postpartum
Care
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Data collection methodology (Administrative or Hybrid)
Eligible member population (i.e. members who meet all
denominator criteria)
Number of numerator events by administrative data in
eligible population (before exclusions)
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of
valid data errors
Number of administrative data records excluded
Number of medical records data records excluded
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2007 (Reporting Year 2006)
Page 82
Access/Availability of Care
Sanford Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
13-17 Year Olds
Data Elements
Measurement Year
Data collection methodology
(Administrative only)
General
Measure
Data
Initiation of
AOD
Treatment
26-34 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
8
6
35-64 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
65+ Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Overall Rate
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement
of AOD
Treatment
2006
A
Eligible member population (i.e. members
who meet all denominator criteria)
Numerator events by administrative data
18-25 Year Olds
12
35
0
61
5
0
3
0
3
0
11
1
0
0
22
1
Reported rate
NA
NA
NA
NA
NA
NA
31.43%
2.86%
NA
NA
36.07%
1.64%
Lower 95% confidence interval
NA
NA
NA
NA
NA
NA
14.62%
0.00%
NA
NA
23.20%
0.00%
Upper 95% confidence interval
NA
NA
NA
NA
NA
NA
48.24%
9.81%
NA
NA
48.94%
5.65%
HEDIS 2007 (Reporting Year 2006)
Page 83
Access/Availability of Care
Sanford Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage
13-17 Year Olds
Data Elements
General
Measure
Data
Initiation of
AOD
Treatment
18-25 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
26-34 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
35-64 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
65+ Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Overall Rate
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement
of AOD
Treatment
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
NR
NR
NR
Reported rate
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Lower 95% confidence interval
Upper 95% confidence interval
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Numerator events by administrative data
HEDIS 2007 (Reporting Year 2006)
Page 84
Access/Availability of Care
Sanford Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
13-17 Year Olds
Data Elements
General
Measure
Data
Initiation of
AOD
Treatment
18-25 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
26-34 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
35-64 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
65+ Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Overall Rate
Engagement Initiation of
of AOD
AOD
Treatment
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
NR
NR
NR
NR
NR
NR
Lower 95% confidence interval
Upper 95% confidence interval
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 2007 (Reporting Year 2006)
Page 85
Access/Availability of Care
Sanford Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
13-17 Year Olds
Data Elements
General
Measure
Data
Initiation of
AOD
Treatment
18-25 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
26-34 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
35-64 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
65+ Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Overall Rate
Engagement Initiation of
of AOD
AOD
Treatment
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
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
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2007 (Reporting Year 2006)
Page 86
Health Plan Stability
Sanford Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Product/Product Line
Years in Business
Members*
0.00
8.00
0.00
8.00
8.00
8.00
0
27086
0
14309
2436
43831
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
43831
HMO
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
Total HMO:
PPO
Commercial
Medicare (cost or risk)
Self-insured
Other
Total PPO:
POS
Commercial
Medicare (cost or risk)
Self-insured
Other
Total POS:
Total:
* Total number of members in each category as of December 31, 2006
HEDIS 2007 (Reporting Year 2006)
Page 87
Health Plan Stability
Sanford Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:21 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
Commercial
Medicare (cost or risk)
Self-insured
Other
Total PPO:
POS
Commercial
Medicare (cost or risk)
Self-insured
Other
Total POS:
Total:
* Total number of members in each category as of December 31, 2006
HEDIS 2007 (Reporting Year 2006)
Page 88
Health Plan Stability
Sanford Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
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
Commercial
Medicare (cost or risk)
Self-insured
Other
Total PPO:
POS
Commercial
Medicare (cost or risk)
Self-insured
Other
Total POS:
Total:
* Total number of members in each category as of December 31, 2006
HEDIS 2007 (Reporting Year 2006)
Page 89
Health Plan Stability
Sanford Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
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
Commercial
Medicare (cost or risk)
Self-insured
Other
Total PPO:
POS
Commercial
Medicare (cost or risk)
Self-insured
Other
Total POS:
Total:
* Total number of members in each category as of December 31, 2006
HEDIS 2007 (Reporting Year 2006)
Page 90
Health Plan Descriptive Information
Sanford Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Member Months
Female
2208
8340
10968
11988
7740
4884
<1
1-4
5-9
10-14
15-17
18-19
Male
2100
9684
11484
12744
7932
4908
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
48852
30.63%
10800
11964
11760
12912
14268
46128
28.73%
10848
12288
12204
13452
14688
94980
29.67%
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
61704
38.68%
15528
14196
10644
6756
63480
39.53%
15852
14256
12036
7440
125184
39.11%
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
47124
29.54%
1428
336
36
24
12
0
49584
30.88%
1068
264
60
0
0
0
96708
30.21%
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
1836
1.15%
0
1392
0.87%
0
3228
1.01%
159516
160584
HEDIS 2007 (Reporting Year 2006)
Total
4308
18024
22452
24732
15672
9792
21648
24252
23964
26364
28956
31380
28452
22680
14196
2496
600
96
24
12
0
0
320100
Page 91
Health Plan Descriptive Information
Sanford Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:21 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 2007 (Reporting Year 2006)
Page 92
Health Plan Descriptive Information
Sanford Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
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 2007 (Reporting Year 2006)
Page 93
Health Plan Descriptive Information
Sanford Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
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 2007 (Reporting Year 2006)
Page 94