Medica Health Plans
Plan Name
2006
Reporting Year
General Info
Disclaimers
Submission #
Plan ID
1
18
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 1:17:18 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
Medica Health Plans
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:17 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
2649
69.49%
2817
73.90%
3442
90.29%
2829
74.21%
2764
72.51%
3274
85.89%
2451
64.30%
2294
60.18%
2069
54.28%
303
70.14%
315
72.92%
393
90.97%
323
74.77%
312
72.22%
379
87.73%
282
65.28%
265
61.34%
237
54.86%
292
79
90.27%
87.28%
93.25%
301
88
94.65%
92.35%
96.94%
374
16
94.89%
92.64%
97.14%
308
78
93.92%
91.48%
96.35%
297
89
93.92%
91.48%
96.35%
360
19
92.21%
89.50%
94.93%
272
69
82.97%
79.21%
86.72%
256
98
86.13%
82.67%
89.59%
229
91
77.86%
73.72%
81.99%
432
0
Number of Records Excluded because of
Contraindications by Admin Data
2
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)
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
2006
H
3812
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
DTaP/DT
411
Page 3
Effectiveness of Care
Medica Health Plans
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:17 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
2081
71.54%
2262
77.76%
2586
88.90%
2145
73.74%
2171
74.63%
2474
85.05%
1931
66.38%
1651
56.75%
1469
50.50%
311
71.99%
330
76.39%
389
90.05%
315
72.92%
330
76.39%
374
86.57%
282
65.28%
252
58.33%
222
51.39%
301
50
85.40%
81.87%
88.94%
319
67
93.92%
91.48%
96.35%
372
15
94.16%
91.77%
96.55%
304
60
88.56%
85.37%
91.76%
320
67
94.16%
91.77%
96.55%
358
17
91.24%
88.39%
94.10%
272
40
75.91%
71.66%
80.17%
245
83
79.81%
75.80%
83.81%
215
70
69.34%
64.76%
73.92%
432
0
Number of Records Excluded because of
Contraindications by Admin Data
6
Number of Records Excluded because of
Contraindications by Medical Record
Review
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
HEDIS 2007 (Reporting Year 2006)
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
2006
H
2909
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
DTaP/DT
411
Page 4
Effectiveness of Care
Medica Health Plans
Adolescent Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
Combo 2
1912
46.57%
690
16.80%
836
20.36%
256
6.23%
207
47.92%
73
16.90%
95
21.99%
24
5.56%
198
159
86.86%
83.47%
90.25%
71
241
75.91%
71.66%
80.17%
88
176
64.23%
59.48%
68.99%
23
208
56.20%
51.29%
61.12%
432
0
Number of Records Excluded because of
Contraindications by Admin Data
12
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
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
Hepatitis B
2006
H
4106
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
411
Page 5
Effectiveness of Care
Medica Health Plans
Adolescent Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Medicaid
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
Combo 2
1143
62.29%
386
21.04%
578
31.50%
158
8.61%
262
60.65%
88
20.37%
149
34.49%
40
9.26%
250
111
87.83%
84.55%
91.12%
86
218
73.97%
69.60%
78.33%
143
129
66.18%
61.48%
70.88%
40
188
55.47%
50.55%
60.40%
432
0
Number of Records Excluded because of
Contraindications by Admin Data
4
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
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
Hepatitis B
2006
H
1835
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
411
Page 6
Effectiveness of Care
Medica Health Plans
Appropriate Treatment for Children with Upper
Respiratory Infection
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
General
Measure
Data
2006
A
Eligible Member Population
7568
Numerator Events by Admin Data
1158
Reported Rate
84.70%
Lower 95% Confidence Interval
83.88%
Upper 95% Confidence Interval
85.52%
HEDIS 2007 (Reporting Year 2006)
Page 7
Effectiveness of Care
Medica Health Plans
Colorectal Cancer Screening
Data Elements
Measurement Year
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
Medicare
Advantage
MSHO
2006
2006
H
H
Eligible population
42644
3506
Number of numerator events by administrative data in eligible
population (before exclusions)
15941
862
Data collection methodology (administrative or hybrid)
Current year's administrative rate (before exclusions)
37.38%
NR
24.59%
Minimum required sample size (MRSS) or other sample size
411
411
Oversampling rate
0.05
0
Final sample size (FSS)
432
411
Number of numerator events by administrative data in FSS
146
106
Administrative rate on FSS
33.80%
NR
25.79%
Number of original sample records excluded because of valid data
errors
0
0
Number of administrative data records excluded
48
20
Number of medical record data records excluded
0
0
Number of employee/dependent medical records excluded
0
0
Records added from the oversample list
0
0
Denominator
411
411
Numerator events by administrative data
135
112
Numerator events by medical records
80
30
Reported rate
52.31%
NR
34.55%
Lower 95% confidence interval
47.36%
NR
29.83%
Upper 95% confidence interval
57.26%
NR
39.27%
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
Medica Health Plans
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:17 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
20414
13926
68.22%
67.58%
68.86%
19255
14201
73.75%
73.13%
74.38%
39669
28127
70.90%
70.46%
71.35%
2006
A
Page 9
Effectiveness of Care
Medica Health Plans
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:17 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
Ages 52-69
Total
0
0
NA
NA
NA
492
256
52.03%
47.52%
56.55%
492
256
52.03%
47.52%
56.55%
2006
A
Page 11
Effectiveness of Care
Medica Health Plans
Breast Cancer Screening
Data Last Refreshed:
Oct 7, 2009 1:17 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 42-51
Ages 52-69
Total
2102
1070
50.90%
48.74%
53.06%
1477
852
57.68%
55.13%
60.24%
3579
1922
53.70%
52.05%
55.35%
2006
A
Page 12
Effectiveness of Care
Medica Health Plans
Cervical Cancer Screening
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
Medicaid
2006
A
48961
2006
A
13752
78.97%
73.38%
NR
NR
38665
10091
78.97%
78.61%
79.33%
73.38%
72.64%
74.12%
Numerator Events by Admin Data on Eligible
Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
Records Excluded because of Valid Data Errors
Number of administrative data records excluded
Number of medical record data records excluded
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
Page 13
Effectiveness of Care
Medica Health Plans
Chlamydia Screening in Women
Data Last Refreshed:
Oct 7, 2009 1:17 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
2006
A
General
Measure Ages 16-20 Ages 21-25
Data
Total
2006
A
4241
1268
29.90%
28.51%
31.29%
6352
2047
32.23%
31.07%
33.38%
10593
3315
31.29%
30.41%
32.18%
1887
802
42.50%
40.24%
44.76%
2450
1049
42.82%
40.84%
44.80%
4337
1851
42.68%
41.20%
44.16%
Page 14
Effectiveness of Care
Medica Health Plans
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 1:17 PM
Medicare
Advantage
NR
NR
NR
MSHO
2006
A
354
57
16.10%
12.13%
20.07%
Page 15
Effectiveness of Care
Medica Health Plans
Controlling High Blood Pressure
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology (Hybrid)
General Measure
Data
Current Year's Admin Rate
Final Sample Size (FSS)
13943
17381
0
0
0
0.00%
0.00%
0.00%
0
0
0
0.00%
0.00%
0.00%
75
336
411
20.00%
494
Admin rate on FSS
0
Number of administrative data records
excluded
303
Number of medical record data records
excluded
16
Number of employee/dependent medical
records excluded
0
Records Added from the OverSample List
16
Denominator
3438
411
Numerator events by admin data in FSS
Records Excluded because of Valid Data
Errors
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
33
213
246
Reported Rate
44.00%
63.39%
59.85%
Lower 95% Confidence Interval
32.10%
58.09%
54.99%
Upper 95% Confidence Interval
55.90%
68.69%
64.71%
HEDIS 2007 (Reporting Year 2006)
Page 16
Effectiveness of Care
Medica Health Plans
Beta Blocker Treatment after Heart Attack
Data Elements
Measurement Year
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
Medicare Advantage
MSHO
2006
2006
H
A
Eligible Member Population
284
82
Numerator Events by Admin Data on
Eligible Population
240
Data Collection Methodology
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
84.51%
NR
NR
NR
253
0.00%
Final Sample Size (FSS)
253
Numerator events by admin data in FSS
224
Admin rate on FSS
NR
88.54%
Records Excluded because of Valid Data
Errors
0
Number of administrative data records
excluded
14
Number of medical record data records
excluded
3
Number of employee/dependent medical
records excluded
0
Records Added from the Oversample List
0
Denominator
250
Numerator Events by Admin Data
224
Numerator Events by Medical Record
14
72
Reported Rate
95.20%
NR
87.80%
Lower 95% Confidence Interval
92.35%
NR
80.11%
Upper 95% Confidence Interval
98.05%
NR
95.50%
HEDIS 2007 (Reporting Year 2006)
Page 17
Effectiveness of Care
Medica Health Plans
Persistence of Beta Blocker Treatment After Hearth Attack
Data Elements
Measurement Year
Data Collection Methodology
Commercial
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Medicare Advantage
MSHO
2006
A
Eligible Member Population
263
Numerator Events by Admin Data on
Eligible Population
201
Reported Rate
76.43%
NR
NR
Lower 95% Confidence Interval
71.11%
NR
NR
Upper 95% Confidence Interval
81.75%
NR
NR
HEDIS 2007 (Reporting Year 2006)
Page 18
Effectiveness of Care
Medica Health Plans
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:17 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 2007 (Reporting Year 2006)
1196
23
71.40%
1.37%
310
7
71.76%
1.62%
296
60
7
236
86.62%
83.20%
90.03%
59.12%
54.25%
64.00%
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
2006
H
1675
Numerator Events by Admin Data on Eligible
Population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
LDL-C
screening
0
411
Page 19
Effectiveness of Care
Medica Health Plans
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Oct 7, 2009 1:17 PM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
Number of administrative data records excluded
0
Number of medical record data records excluded
0
Number of employee/dependent medical records
excluded
0
HEDIS 2007 (Reporting Year 2006)
7
53.05%
2.67%
138
7
52.67%
2.67%
138
50
7
119
71.76%
66.11%
77.40%
48.09%
41.85%
54.33%
262
0.00%
262
0
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
139
262
Records Excluded because of Valid Data Errors
Records Added from the Oversample List
Denominator
LDL-C Level of
<100 mg/dL
2006
H
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
262
Page 21
Effectiveness of Care
Medica Health Plans
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:17 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
9049
2006
H
9049
2006
H
9049
2006
H
9049
2006
H
9049
2006
H
9049
2006
H
9049
2006
H
9049
2006
H
9049
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
6912
76.38%
411
10%
453
359
79.25%
8970
99.13%
411
10%
453
450
99.34%
46
0.51%
411
10%
453
3
0.66%
4724
52.20%
411
10%
453
240
52.98%
6328
69.93%
411
10%
453
325
71.74%
120
1.33%
411
10%
453
5
1.10%
7045
77.85%
411
10%
453
353
77.92%
0
0.00%
411
10%
453
0
0.00%
0
0.00%
411
10%
453
0
0.00%
Number of Records Excluded Because of
Valid Data Errors
0
0
0
0
0
0
0
0
0
105
105
105
105
105
105
105
105
105
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
411
324
43
89.29%
86.18%
92.41%
0
411
17
104
29.44%
24.91%
33.97%
0
411
3
182
45.01%
40.08%
49.94%
0
411
220
25
59.61%
54.75%
64.48%
0
411
293
37
80.29%
76.32%
84.26%
0
411
5
176
44.04%
39.12%
48.96%
0
411
320
18
82.24%
78.42%
86.06%
0
411
0
304
73.97%
69.60%
78.33%
0
411
0
187
45.50%
40.56%
50.43%
Numerator events by admin data in eligible
population
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 22
Effectiveness of Care
Medica Health Plans
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:17 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
2006
H
946
2006
H
946
2006
H
946
2006
H
946
2006
H
946
2006
H
946
2006
H
946
2006
H
946
2006
H
946
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
594
62.79%
411
10%
453
275
60.71%
925
97.78%
411
10%
453
444
98.01%
15
1.59%
411
10%
453
5
1.10%
598
63.21%
411
10%
453
281
62.03%
487
51.48%
411
10%
453
220
48.57%
19
2.01%
411
10%
453
5
1.10%
766
80.97%
411
10%
453
363
80.13%
0
0.00%
411
10%
453
0
0.00%
0
0.00%
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
1
1
1
1
1
1
1
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
411
248
79
79.56%
75.54%
83.58%
0
411
17
119
33.09%
28.42%
37.76%
0
411
4
173
43.07%
38.16%
47.97%
0
411
257
10
64.96%
60.23%
69.70%
0
411
201
73
66.67%
61.99%
71.35%
0
411
4
163
40.63%
35.76%
45.50%
0
411
329
21
85.16%
81.60%
88.72%
0
411
0
267
64.96%
60.23%
69.70%
0
411
0
182
44.28%
39.36%
49.21%
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 24
Effectiveness of Care
Medica Health Plans
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:17 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
2006
H
1991
2006
H
1991
2006
H
1991
2006
H
1991
2006
H
1991
2006
H
1991
2006
H
1991
2006
H
1991
2006
H
1991
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
1314
66.00%
411
10%
453
282
62.25%
1938
97.34%
411
10%
453
449
99.12%
10
0.50%
411
10%
453
3
0.66%
1072
53.84%
411
10%
453
235
51.88%
1124
56.45%
411
10%
453
242
53.42%
18
0.90%
411
10%
453
3
0.66%
1312
65.90%
411
10%
453
296
65.34%
0
0.00%
411
10%
453
0
0.00%
0
0.00%
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
38
38
38
38
38
38
38
38
38
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
411
260
86
84.18%
80.54%
87.83%
0
411
17
143
38.93%
34.09%
43.77%
0
411
3
163
40.39%
35.52%
45.25%
0
411
214
13
55.23%
50.30%
60.16%
0
411
224
73
72.26%
67.81%
76.71%
0
411
3
139
34.55%
29.83%
39.27%
0
411
272
43
76.64%
72.43%
80.85%
0
411
0
270
65.69%
60.98%
70.40%
0
411
0
166
40.39%
35.52%
45.25%
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 25
Effectiveness of Care
Medica Health Plans
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 1:17 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
343
334
97.38%
95.54%
99.21%
563
540
95.91%
94.19%
97.64%
2376
2160
90.91%
89.73%
92.09%
3282
3034
92.44%
91.52%
93.36%
2006
A
Page 26
Effectiveness of Care
Medica Health Plans
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 1:17 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
Ages 10-17
Ages 18-56
Total
303
288
95.05%
92.44%
97.66%
392
348
88.78%
85.52%
92.03%
587
490
83.48%
80.39%
86.57%
1282
1126
87.83%
86.00%
89.66%
2006
A
Page 27
Effectiveness of Care
Medica Health Plans
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:17 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
404
15.94%
14.50%
17.39%
1728
68.19%
66.36%
70.03%
1291
50.95%
48.98%
52.91%
2006
A
2534
Page 28
Effectiveness of Care
Medica Health Plans
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:17 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
4
4.04%
0.00%
8.42%
67
67.68%
57.96%
77.40%
60
60.61%
50.48%
70.74%
2006
A
99
Page 30
Effectiveness of Care
Medica Health Plans
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:17 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
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
191
22.29%
19.44%
25.13%
432
50.41%
47.00%
53.81%
298
34.77%
31.53%
38.02%
2006
A
857
Page 31
Effectiveness of Care
Medica Health Plans
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Oct 7, 2009 1:17 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
Initiation
Phase
Medicaid
Continuation
and
Maintenance
Phase
2006
A
General
Measure
Data
Initiation
Phase
Continuation
and
Maintenance
Phase
636
1
219
34.43%
30.66%
38.21%
165
0
60
36.36%
28.72%
44.01%
2006
A
906
1
301
33.22%
30.10%
36.35%
226
0
86
38.05%
31.50%
44.60%
Page 32
Effectiveness of Care
Medica Health Plans
Glaucoma Screening in Older Adults
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interva
HEDIS 2007 (Reporting Year 2006)
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Medicare
Advantage
NR
NR
NR
MSHO
2006
A
6650
4744
71.34%
70.24%
72.43%
Page 33
Effectiveness of Care
Medica Health Plans
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:17 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
16413
520
10943
66.67%
65.95%
67.40%
330
21
210
63.64%
58.29%
68.98%
12673
365
8481
66.92%
66.10%
67.74%
1059
0
512
48.35%
45.29%
51.40%
30475
906
20146
66.11%
65.57%
66.64%
2006
A
Page 34
Effectiveness of Care
Medica Health Plans
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:17 PM
MSHO
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
2313
706
1578
68.22%
66.30%
70.14%
302
147
201
66.56%
61.07%
72.04%
2488
919
1678
67.44%
65.58%
69.31%
Anticonvulsants
Total
2006
A
328
144
43.90%
38.38%
49.43%
5431
1772
3601
66.30%
65.04%
67.57%
Page 36
Effectiveness of Care
Medica Health Plans
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Medicaid
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
1511
109
1017
67.31%
64.91%
69.70%
35
4
24
68.57%
51.76%
85.38%
1287
104
872
67.75%
65.16%
70.35%
Anticonvulsants
Total
2006
A
237
136
57.38%
50.88%
63.89%
3070
217
2049
66.74%
65.06%
68.43%
Page 37
Effectiveness of Care
Medica Health Plans
Drugs to Be Avoided in the Elderly
Data Last Refreshed:
Oct 7, 2009 1:17 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
1 or More
Prescriptions
NR
NR
NR
MSHO
2 or More
Prescriptions
NR
NR
NR
General
Measure
Data
2006
A
8128
1 or More
Prescriptions
2 or More
Prescriptions
2117
26.05%
25.09%
27.01%
495
6.09%
5.56%
6.62%
Page 38
Effectiveness of Care
Medica Health Plans
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Oct 7, 2009 1:17 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
Total
2006
A
533
141
26.45%
22.62%
30.29%
2278
677
29.72%
27.82%
31.62%
112
10
8.93%
3.20%
14.66%
2923
828
28.33%
26.68%
29.98%
Page 40
Use of Services
Medica Health Plans
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 1:17 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
31
22
42
56
182
572
2437
0.93%
0.59%
1.27%
0.66%
0.37%
0.95%
1.26%
0.86%
1.65%
1.68%
1.23%
2.13%
5.45%
4.66%
6.23%
17.12%
15.82%
18.41%
72.92%
71.40%
74.44%
2006
A
3342
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
Medica Health Plans
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 1:17 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
33
66
102
231
481
964
2113
0.83%
0.53%
1.12%
1.65%
1.25%
2.06%
2.56%
2.05%
3.06%
5.79%
5.05%
6.53%
12.06%
11.03%
13.08%
24.16%
22.82%
25.50%
52.96%
51.40%
54.52%
2006
A
3990
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
Medica Health Plans
Well Child Visits in the 3rd, 4th,
5th and 6th Years of Life
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
Medicaid
2006
A
15833
2006
A
8786
NR
NR
NR
NR
9953
5760
62.86%
62.11%
63.62%
65.56%
64.56%
66.56%
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 2007 (Reporting Year 2006)
Page 43
Use of Services
Medica Health Plans
Adolescent Well-Care Visits
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
Medicaid
2006
A
40405
2006
A
14185
NR
NR
NR
NR
13120
4952
32.47%
32.01%
32.93%
34.91%
34.12%
35.70%
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 2007 (Reporting Year 2006)
Page 44
Use of Services
Medica Health Plans
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
Member Months
Total
317244
631371
960892
646765
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
1687
403
558
214
Procedures /
1,000 Member
Months
5.32
0.42
0.88
0.33
Member Months
Male
Female
1084049
973461
926432
1258345
644957
651748
30618
24600
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
34
0.03
3
223
12
727
968
66
447
41
449
49
74
14
158
27
0.10
0.18
0.39
0.75
1.50
2.16
0.69
1.34
0.70
1.60
0.11
0.46
0.24
0.88
Number of
Procedures
68
81
261
296
5
248
240
2
Procedures /
1,000 Member
Months
0.06
0.12
0.24
0.45
0.20
0.23
0.37
0.08
27
29
0
0.02
0.04
0.00
483
325
4
988
1188
60
98
16
241
19
12
0
0.45
0.50
0.16
1.07
1.82
2.44
0.15
0.65
0.37
0.77
0.02
0.00
51
141
4
204
275
11
0.05
0.22
0.16
0.19
0.42
0.45
Page 45
Use of Services
Medica Health Plans
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:17 PM
MSHO
Age
< 65
65-74
75-84
85+
Member Months
Male
Female
0
0
12788
23307
10192
28308
5670
31648
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
0
3
3
0
0
22
11
1
0
25
15
1
0
1
2
0
0
7
11
11
0
7
3
0
0
6
11
0
0
3
5
2
0
2
1
1
0
6
2
1
0
31
14
2
Procedures /
1,000 Member
Months
NA
0.23
0.29
0.00
NA
1.72
1.08
0.18
NA
1.95
1.47
0.18
NA
0.08
0.20
0.00
NA
0.55
1.08
1.94
NA
0.55
0.29
0.00
NA
0.47
1.08
0.00
NA
0.23
0.49
0.35
NA
0.16
0.10
0.18
NA
0.47
0.20
0.18
NA
2.42
1.37
0.35
Female
Number of
Procedures
0
4
3
0
0
17
23
6
0
35
33
5
0
3
0
0
0
9
31
77
0
3
10
16
0
26
18
2
0
6
23
5
0
2
1
1
0
11
10
3
0
103
81
24
0
4
3
1
0
2
1
0
0
6
8
6
0
4
6
3
Procedures /
1,000 Member
Months
NA
0.17
0.11
0.00
NA
0.73
0.81
0.19
NA
1.50
1.17
0.16
NA
0.13
0.00
0.00
NA
0.39
1.10
2.43
NA
0.13
0.35
0.51
NA
1.12
0.64
0.06
NA
0.26
0.81
0.16
NA
0.09
0.04
0.03
NA
0.47
0.35
0.09
NA
4.42
2.86
0.76
NA
0.17
0.11
0.03
NA
0.09
0.04
0.00
NA
0.26
0.28
0.19
NA
0.17
0.21
0.09
Page 47
Use of Services
dica Health Plans
Inpatient Utilization - General Hospital/Acute Care
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Member Months
62568
568803
646765
1899893
1296705
47763
6154
1301
0
4529952
Discharges
Discharges /
1,000 Member
Months
606
867
999
10353
7778
583
124
39
0
21349
9.69
1.52
1.54
5.45
6.00
12.21
20.15
29.98
515
656
472
2015
3405
275
73
29
0
7440
8.23
1.15
0.73
1.06
2.63
5.76
11.86
22.29
86
206
398
2462
4332
307
51
10
0
7852
1.37
0.36
0.62
1.30
3.34
6.43
8.29
7.69
124
5849
6
0
5979
0.19
3.08
0.00
HEDIS 2007 (Reporting Year 2006)
4.71
1.64
1.73
1.56
Days
Days / 1,000
Member
Months
2831
2268
2911
27784
24805
2355
534
229
0
63717
45.25
3.99
4.50
14.62
19.13
49.31
86.77
176.02
2290
1496
1134
5284
9988
896
263
147
0
21498
36.60
2.63
1.75
2.78
7.70
18.76
42.74
112.99
530
750
1413
7163
14643
1455
271
82
0
26307
8.47
1.32
2.18
3.77
11.29
30.46
44.04
63.03
351
15240
16
0
15607
0.54
8.02
0.01
14.07
4.75
5.81
4.06
Average
Length of Stay
4.67
2.62
2.91
2.68
3.19
4.04
4.31
5.87
NA
2.98
4.45
2.28
2.40
2.62
2.93
3.26
3.60
5.07
NA
2.89
6.16
3.64
3.55
2.91
3.38
4.74
5.31
8.20
NA
3.35
2.83
2.61
2.67
NA
2.61
Page 48
Use of Services
dica Health Plans
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 7, 2009 1:17 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
dica Health Plans
Inpatient Utilization - General Hospital/Acute Care
MSHO
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Member Months
0
0
0
0
0
36095
38500
37318
0
111913
Discharges
Discharges /
1,000 Member
Months
0
0
0
0
0
1134
1295
928
0
3357
NA
NA
NA
NA
NA
31.42
33.64
24.87
0
0
0
0
0
824
1008
764
0
2596
NA
NA
NA
NA
NA
22.83
26.18
20.47
0
0
0
0
0
276
249
133
0
658
NA
NA
NA
NA
NA
7.65
6.47
3.56
0
0
0
0
0
NA
NA
NA
HEDIS 2007 (Reporting Year 2006)
30.00
23.20
5.88
NA
Days
0
0
0
0
0
5045
5836
3947
0
14828
Days / 1,000
Member
Months
NA
NA
NA
NA
NA
139.77
151.58
105.77
132.50
0
0
0
0
0
3288
4134
3060
0
10482
NA
NA
NA
NA
NA
91.09
107.38
82.00
0
0
0
0
0
1642
1561
772
0
3975
NA
NA
NA
NA
NA
45.49
40.55
20.69
0
0
0
0
0
NA
NA
NA
93.66
35.52
NA
Average
Length of Stay
NA
NA
NA
NA
NA
4.45
4.51
4.25
NA
4.42
NA
NA
NA
NA
NA
3.99
4.10
4.01
NA
4.04
NA
NA
NA
NA
NA
5.95
6.27
5.80
NA
6.04
NA
NA
NA
NA
NA
Page 50
Use of Services
dica Health Plans
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
62568
568803
646765
1899893
1296705
47763
6154
1301
0
4529952
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
Visits
52393
159496
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
129741
427279
402102
22502
3870
873
0
1198256
HEDIS 2007 (Reporting Year 2006)
Visits/ 1,000
Member
Months
837.38
280.41
200.60
224.90
310.10
471.12
628.86
671.02
264.52
Emergency Room Visits
Visits
1938
9833
8304
24751
13688
688
143
54
0
59399
Visits/ 1,000
Member
Months
30.97
17.29
12.84
13.03
10.56
14.40
23.24
41.51
13.11
Ambulatory
Surgery/Procedures
Procedures
411
2479
1976
11839
22378
1264
197
17
0
40561
Procedures/
1,000 Member
Months
6.57
4.36
3.06
6.23
17.26
26.46
32.01
13.07
8.95
Observation Room Stays
Resulting in Discharge
Stays
69
99
121
1416
491
33
4
2
0
2235
Stays/ 1,000
Member
Months
1.10
0.17
0.19
0.75
0.38
0.69
0.65
1.54
0.49
Page 51
Use of Services
dica Health Plans
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:17 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
dica Health Plans
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:17 PM
MSHO
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
0
0
0
0
0
36095
38500
37318
0
111913
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
Visits
0
0
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
0
0
0
24549
20608
11190
0
56347
HEDIS 2007 (Reporting Year 2006)
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
680.12
535.27
299.86
503.49
Emergency Room Visits
Visits
0
0
0
0
0
1413
1197
913
0
3523
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
39.15
31.09
24.47
31.48
Ambulatory
Surgery/Procedures
Procedures
0
0
0
0
0
1014
947
382
0
2343
Procedures/
1,000 Member
Months
NA
NA
NA
NA
NA
28.09
24.60
10.24
20.94
Observation Room Stays
Resulting in Discharge
Stays
0
0
0
0
0
68
66
70
0
204
Stays/ 1,000
Member
Months
NA
NA
NA
NA
NA
1.88
1.71
1.88
1.82
Page 53
Use of Services
Medica Health Plans
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
Age
Member
Months
<1
62568
1-9
568803
10-19
646765
20-44
1899893
45-64
1296705
65-74
47763
75-84
6154
85+
1301
Unknown
Total
0
4529952
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
0.00
120
0.19
40.00
20-44
37
0.02
723
0.38
19.54
45-64
233
0.18
2523
1.95
10.83
65-74
27
0.57
329
6.89
12.19
75-84
13
2.11
96
15.60
7.38
2
1.54
7
5.38
3.50
0.07
0
3798
0.84
NA
12.06
Age
85+
Unknown
Total
0
315
HEDIS 2007 (Reporting Year 2006)
Page 54
Use of Services
Medica Health Plans
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:17 PM
MSHO
Age
Member
Months
<1
0
1-9
0
10-19
0
20-44
0
45-64
0
65-74
36095
75-84
38500
85+
37318
Unknown
0
111913
Total
Discharges
Discharges /
1,000 Member
Months
Days
Days / 1,000
Member
Months
Average Length
of Stay
<1
0
NA
0
NA
NA
1-9
0
NA
0
NA
NA
10-19
0
NA
0
NA
NA
20-44
0
NA
0
NA
NA
45-64
0
NA
0
NA
NA
65-74
187
5.18
1308
36.24
6.99
75-84
333
8.65
2458
63.84
7.38
85+
305
8.17
1751
46.92
5.74
Unknown
0
825
7.37
0
5517
49.30
NA
6.69
Age
Total
HEDIS 2007 (Reporting Year 2006)
Page 56
Use of Services
Medica Health Plans
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
Member Months
Male
Female
Total
418752
403824
822576
169922
1676155
30606
0
2295435
163735
1632470
24600
0
2224629
333657
3308625
55206
0
4520064
Discharges
Discharges /
1,000 Member
Months
Days*
Average Length
of Stay
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
Gender
M
F
Total
32
14
46
0.08
0.03
0.06
1898
112
2010
59.31
8.00
43.70
13-17
M
F
Total
129
180
309
0.76
1.10
0.93
2792
4008
6800
21.64
22.27
22.01
18-64
M
F
Total
M
F
Total
M
F
Total
M
F
TOTAL
367
573
940
0.22
0.35
0.28
2540
4972
7512
6.92
8.68
7.99
3
4
7
0.10
0.16
0.13
59
7
66
19.67
1.75
9.43
0
0
0
NA
NA
NA
7289
9099
16388
13.73
11.80
12.59
65+
Unknown
Total
HEDIS 2007 (Reporting Year 2006)
0
0
0
531
771
1302
0.23
0.35
0.29
Page 57
Use of Services
Medica Health Plans
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Oct 7, 2009 1:17 PM
MSHO
Member Months
Age
Male
Female
Total
0-12
13-17
18-64
65+
Unknown
Total
0
0
0
26996
0
26996
0
0
0
77821
0
77821
0
0
0
104817
0
104817
Discharges
Discharges /
1,000 Member
Months
Days*
Average Length
of Stay
Age
0-12
Gender
M
F
Total
0
0
0
NA
NA
NA
0
0
0
NA
NA
NA
13-17
M
F
Total
0
0
0
NA
NA
NA
0
0
0
NA
NA
NA
18-64
M
F
Total
M
F
Total
M
F
Total
M
F
TOTAL
0
0
0
NA
NA
NA
0
0
0
NA
NA
NA
29
101
130
1.07
1.30
1.24
311
1105
1416
10.72
10.94
10.89
0
0
0
NA
NA
NA
311
1105
1416
10.72
10.94
10.89
65+
Unknown
Total
HEDIS 2007 (Reporting Year 2006)
0
0
0
29
101
130
1.07
1.30
1.24
Page 59
Use of Services
Medica Health Plans
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory
Data Last Refreshed:
Oct 7, 2009 1:17 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
418752
169922
403824
163735
822576
333657
418752
169922
403824
163735
822576
333657
418752
169922
403824
163735
822576
333657
418752
169922
403824
163735
822576
333657
1676155
30606
0
2295435
1632470
24600
0
2224629
3308625
55206
0
4520064
1676155
30606
0
2295435
1632470
24600
0
2224629
3308625
55206
0
4520064
1676155
30606
0
2295435
1632470
24600
0
2224629
3308625
55206
0
4520064
1676155
30606
0
2295435
1632470
24600
0
2224629
3308625
55206
0
4520064
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
1859
1132
2991
1562
1667
3229
7927
14167
22094
71
82
153
0
0
0
11419
17048
28467
5.33%
3.36%
4.36%
11.03%
12.22%
11.61%
5.68%
10.41%
8.01%
2.78%
4.00%
3.33%
NA
NA
NA
5.97%
9.20%
7.56%
28
13
41
97
141
238
297
432
729
2
4
6
0
0
0
424
590
1014
0.08%
0.04%
0.06%
0.69%
1.03%
0.86%
0.21%
0.32%
0.26%
0.08%
0.20%
0.13%
NA
NA
NA
0.22%
0.32%
0.27%
10
6
16
14
48
62
29
100
129
0
2
2
0
0
0
53
156
209
HEDIS 2007 (Reporting Year 2006)
0.03%
0.02%
0.02%
0.10%
0.35%
0.22%
0.02%
0.07%
0.05%
0.00%
0.10%
0.04%
NA
NA
NA
0.03%
0.08%
0.06%
Ambulatory Mental Health Services
Percent
Number
1854
1130
2984
1544
1645
3189
7845
14094
21939
71
80
151
0
0
0
11314
16949
28263
5.31%
3.36%
4.35%
10.90%
12.06%
11.47%
5.62%
10.36%
7.96%
2.78%
3.90%
3.28%
NA
NA
NA
5.91%
9.14%
7.50%
Page 60
Use of Services
Medica Health Plans
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory
Data Last Refreshed:
Oct 7, 2009 1:17 PM
MSHO
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Member Months (Inpatient)
Age
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
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
26996
0
26996
0
77821
0
77821
0
104817
0
104817
0
26996
0
26996
0
77821
0
77821
0
104817
0
104817
0
26996
0
26996
0
77821
0
77821
0
104817
0
104817
0
26996
0
26996
0
77821
0
77821
0
104817
0
104817
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 (Ambulatory)
Female
Any Mental Health Services
0-12
Member Months (Day/Night)
Male
Inpatient Mental Health Services
Day/Night Mental Health Services
Number
Percent
Number
Percent
Number
Percent
Ambulatory Mental Health Services
Percent
Number
0
0
0
0
0
0
0
0
0
221
563
784
0
0
0
221
563
784
NA
NA
NA
NA
NA
NA
NA
NA
NA
9.82%
8.68%
8.98%
NA
NA
NA
9.82%
8.68%
8.98%
0
0
0
0
0
0
0
0
0
23
78
101
0
0
0
23
78
101
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.02%
1.20%
1.16%
NA
NA
NA
1.02%
1.20%
1.16%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
0
0
0
0
0
0
0
0
0
207
526
733
0
0
0
207
526
733
HEDIS 2007 (Reporting Year 2006)
NA
NA
NA
NA
NA
NA
NA
NA
NA
9.20%
8.11%
8.39%
NA
NA
NA
9.20%
8.11%
8.39%
Page 62
Use of Services
Medica Health Plans
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Medicaid
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
Member Months (Ambulatory)
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
322921
86363
316787
87943
639708
174306
322921
86363
316787
87943
639708
174306
322921
86363
316787
87943
639708
174306
322921
86363
316787
87943
639708
174306
205350
13522
0
628156
411961
27176
0
843867
617311
40698
0
1472023
205350
13522
0
628156
411961
27176
0
843867
617311
40698
0
1472023
205350
13522
0
628156
411961
27176
0
843867
617311
40698
0
1472023
205350
13522
0
628156
411961
27176
0
843867
617311
40698
0
1472023
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 (Day/Night)
Female
Any Mental Health Services
0-12
Member Months (Inpatient)
Male
Inpatient Mental Health Services
Number
Percent
Number
Percent
Day/Night Mental Health Services
Percent
Number
2780
1878
4658
1332
1481
2813
3488
8192
11680
122
281
403
0
0
0
7722
11832
19554
10.33%
7.11%
8.74%
18.51%
20.21%
19.37%
20.38%
23.86%
22.70%
10.83%
12.41%
11.88%
NA
NA
NA
14.75%
16.83%
15.94%
43
30
73
72
124
196
369
553
922
8
12
20
0
0
0
492
719
1211
0.16%
0.11%
0.14%
1.00%
1.69%
1.35%
2.16%
1.61%
1.79%
0.71%
0.53%
0.59%
NA
NA
NA
0.94%
1.02%
0.99%
14
17
31
8
25
33
14
66
80
0
0
0
0
0
0
36
108
144
HEDIS 2007 (Reporting Year 2006)
0.05%
0.06%
0.06%
0.11%
0.34%
0.23%
0.08%
0.19%
0.16%
0.00%
0.00%
0.00%
NA
NA
NA
0.07%
0.15%
0.12%
Ambulatory Mental Health Services
Percent
Number
2775
1875
4650
1315
1456
2771
3365
8072
11437
117
277
394
0
0
0
7572
11680
19252
10.31%
7.10%
8.72%
18.27%
19.87%
19.08%
19.66%
23.51%
22.23%
10.38%
12.23%
11.62%
NA
NA
NA
14.47%
16.61%
15.69%
Page 63
Use of Services
Medica Health Plans
Chemical Dependency Utilization Inpatient Discharges and Average Length of
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
Member Months
Male
Female
Total
418752
169922
1676155
30606
0
2295435
403824
163735
1632470
24600
0
2224629
822576
333657
3308625
55206
0
4520064
Discharges
Discharges /
1,000 Member
Months
Days
Average Length
of Stay
M
F
Total
1
0
1
0.00
0.00
0.00
1
0
1
1.00
NA
1.00
13-17
M
F
Total
49
46
95
0.29
0.28
0.28
653
518
1171
13.33
11.26
12.33
18-64
M
F
Total
M
F
Total
M
F
Total
M
F
TOTAL
419
222
641
0.25
0.14
0.19
2963
1868
4831
7.07
8.41
7.54
1
5
6
0.03
0.20
0.11
12
71
83
12.00
14.20
13.83
0
0
0
NA
NA
NA
3629
2457
6086
7.72
9.00
8.19
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
65+
Unknown
Total
HEDIS 2007 (Reporting Year 2006)
0
0
0
470
273
743
0.20
0.12
0.16
Page 64
Use of Services
Medica Health Plans
Chemical Dependency Utilization Inpatient Discharges and Average Length of
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Chemical Dependency Utilization Inpatient Discharges and Average Length of
Data Last Refreshed:
Oct 7, 2009 1:17 PM
MSHO
Member Months
Age
Male
Female
Total
0-12
13-17
18-64
65+
Unknown
Total
0
0
0
26996
0
26996
0
0
0
77821
0
77821
0
0
0
104817
0
104817
Discharges
Discharges /
1,000 Member
Months
Days
Average Length
of Stay
M
F
Total
0
0
0
NA
NA
NA
0
0
0
NA
NA
NA
13-17
M
F
Total
0
0
0
NA
NA
NA
0
0
0
NA
NA
NA
18-64
M
F
Total
M
F
Total
M
F
Total
M
F
TOTAL
0
0
0
NA
NA
NA
0
0
0
NA
NA
NA
9
10
19
0.33
0.13
0.18
70
29
99
7.78
2.90
5.21
0
0
0
NA
NA
NA
70
29
99
7.78
2.90
5.21
Age
0-12
65+
Unknown
Total
HEDIS 2007 (Reporting Year 2006)
0
0
0
9
10
19
0.33
0.13
0.18
Page 66
Medica Health Plans
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
418752
169922
225749
379082
1071324
30606
0
2295435
Female
403824
163735
213468
357753
1061249
24600
0
2224629
Total
822576
333657
439217
736835
2132573
55206
0
4520064
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
6
1
7
251
242
493
503
286
789
720
353
1073
1779
967
2746
28
18
46
0
0
0
3287
1867
5154
HEDIS 2007 (Reporting Year 2006)
Percent
0.02%
0.00%
0.01%
1.77%
1.77%
1.77%
NR
NR
NA
2.06%
1.05%
1.57%
1.99%
1.09%
1.55%
1.10%
0.88%
1.00%
NA
NA
NA
1.72%
1.01%
1.37%
Member Months (Inpatient)
Male
418752
169922
225749
379082
1071324
30606
0
2295435
Female
403824
163735
213468
357753
1061249
24600
0
2224629
Total
822576
333657
439217
736835
2132573
55206
0
4520064
Member Months (Day/Night)
Male
418752
169922
225749
379082
1071324
30606
0
2295435
Female
403824
163735
213468
357753
1061249
24600
0
2224629
Total
822576
333657
439217
736835
2132573
55206
0
4520064
Member Months (Ambulatory)
Male
418752
169922
225749
379082
1071324
30606
0
2295435
Female
403824
163735
213468
357753
1061249
24600
0
2224629
Total
822576
333657
439217
736835
2132573
55206
0
4520064
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
2
1
3
64
74
138
97
66
163
141
97
238
512
313
825
11
7
18
0
0
0
827
558
1385
Number
0
0
0
9
9
18
12
6
18
11
6
17
24
11
35
0
0
0
0
0
0
56
32
88
Number
4
0
4
222
202
424
448
249
697
636
300
936
1510
822
2332
18
12
30
0
0
0
2838
1585
4423
Percent
0.01%
0.00%
0.00%
0.45%
0.54%
0.50%
NR
NR
NA
0.40%
0.29%
0.35%
0.57%
0.35%
0.46%
0.43%
0.34%
0.39%
NA
NA
NA
0.43%
0.30%
0.37%
Percent
0.00%
0.00%
0.00%
0.06%
0.07%
0.06%
NR
NR
NA
0.03%
0.02%
0.02%
0.03%
0.01%
0.02%
0.00%
0.00%
0.00%
NA
NA
NA
0.03%
0.02%
0.02%
Percent
0.01%
0.00%
0.01%
1.57%
1.48%
1.52%
NR
NR
NA
1.82%
0.89%
1.37%
1.69%
0.93%
1.31%
0.71%
0.59%
0.65%
NA
NA
NA
1.48%
0.85%
1.17%
Page 67
Medica Health Plans
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:17 PM
MSHO
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
0
0
0
0
0
26996
0
26996
Female
0
0
0
0
0
77821
0
77821
Total
0
0
0
0
0
104817
0
104817
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
0
0
0
0
0
0
0
0
0
0
0
0
97
97
194
0
0
0
97
97
194
HEDIS 2007 (Reporting Year 2006)
Percent
NA
NA
NA
NA
NA
NA
NR
NR
NA
NA
NA
NA
NA
NA
NA
4.31%
1.50%
2.22%
NA
NA
NA
4.31%
1.50%
2.22%
Member Months (Inpatient)
Male
0
0
0
0
0
26996
0
26996
Female
0
0
0
0
0
77821
0
77821
Total
0
0
0
0
0
104817
0
104817
Member Months (Day/Night)
Male
0
0
0
0
0
26996
0
26996
Female
0
0
0
0
0
77821
0
77821
Total
0
0
0
0
0
104817
0
104817
Member Months (Ambulatory)
Male
0
0
0
0
0
26996
0
26996
Female
0
0
0
0
0
77821
0
77821
Total
0
0
0
0
0
104817
0
104817
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
46
70
116
0
0
0
46
70
116
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
65
40
105
0
0
0
65
40
105
Percent
NA
NA
NA
NA
NA
NA
NR
NR
NA
NA
NA
NA
NA
NA
NA
2.04%
1.08%
1.33%
NA
NA
NA
2.04%
1.08%
1.33%
Percent
NA
NA
NA
NA
NA
NA
NR
NR
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
Percent
NA
NA
NA
NA
NA
NA
NR
NR
NA
NA
NA
NA
NA
NA
NA
2.89%
0.62%
1.20%
NA
NA
NA
2.89%
0.62%
1.20%
Page 69
Medica Health Plans
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Medicaid
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
322921
86363
48532
49647
107171
13522
0
628156
Female
316787
87943
113769
138419
159773
27176
0
843867
Total
639708
174306
162301
188066
266944
40698
0
1472023
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
26
15
41
351
285
636
489
685
1174
734
1118
1852
1881
1511
3392
27
25
52
0
0
0
3508
3639
7147
HEDIS 2007 (Reporting Year 2006)
Percent
0.10%
0.06%
0.08%
4.88%
3.89%
4.38%
NR
NR
NA
2.73%
4.24%
3.47%
21.06%
11.35%
15.25%
2.40%
1.10%
1.53%
NA
NA
NA
6.70%
5.17%
5.83%
Member Months (Inpatient)
Male
322921
86363
48532
49647
107171
13522
0
628156
Female
316787
87943
113769
138419
159773
27176
0
843867
Total
639708
174306
162301
188066
266944
40698
0
1472023
Member Months (Day/Night)
Male
322921
86363
48532
49647
107171
13522
0
628156
Female
316787
87943
113769
138419
159773
27176
0
843867
Total
639708
174306
162301
188066
266944
40698
0
1472023
Member Months (Ambulatory)
Male
322921
86363
48532
49647
107171
13522
0
628156
Female
316787
87943
113769
138419
159773
27176
0
843867
Total
639708
174306
162301
188066
266944
40698
0
1472023
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
9
3
12
89
91
180
95
210
305
174
308
482
610
470
1080
12
17
29
0
0
0
989
1099
2088
Number
0
0
0
13
13
26
12
17
29
18
35
53
30
34
64
0
0
0
0
0
0
73
99
172
Number
19
14
33
315
236
551
444
573
1017
650
989
1639
1669
1345
3014
21
11
32
0
0
0
3118
3168
6286
Percent
0.03%
0.01%
0.02%
1.24%
1.24%
1.24%
NR
NR
NA
0.65%
1.17%
0.90%
6.83%
3.53%
4.85%
1.06%
0.75%
0.86%
NA
NA
NA
1.89%
1.56%
1.70%
Percent
0.00%
0.00%
0.00%
0.18%
0.18%
0.18%
NR
NR
NA
0.07%
0.13%
0.10%
0.34%
0.26%
0.29%
0.00%
0.00%
0.00%
NA
NA
NA
0.14%
0.14%
0.14%
Percent
0.07%
0.05%
0.06%
4.38%
3.22%
3.79%
NR
NR
NA
2.42%
3.75%
3.07%
18.69%
10.10%
13.55%
1.86%
0.49%
0.94%
NA
NA
NA
5.96%
4.50%
5.12%
Page 70
Use of Services
Medica Health Plans
Outpatient Drug Utilization
Commercial
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
631371
646765
1899893
1296705
47763
6154
1301
0
4529952
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 1:17 PM
$8,673,013.00
$17,598,645.00
$77,412,300.00
$123,698,083.00
$8,230,696.00
$1,301,239.00
$271,885.00
$0.00
$237,185,861.00
HEDIS 2007 (Reporting Year 2006)
Avg. Cost of
Prescriptions /
Per Member Per
Month
$13.74
$27.21
$40.75
$95.39
$172.32
$211.45
$208.98
$52.36
Total Number of
Prescriptions
171296
232425
1141107
1782108
119599
20363
4853
0
3471751
Avg. Num. Of
Prescriptions /
Per Member Per
Year
3.26
4.31
7.21
16.49
30.05
39.71
44.76
9.20
Page 71
Use of Services
Medica Health Plans
Outpatient Drug Utilization
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Outpatient Drug Utilization
MSHO
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
0
0
0
0
36095
38500
37318
0
111913
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 1:17 PM
$0.00
$0.00
$0.00
$0.00
$12,223,715.00
$13,479,418.00
$11,571,130.00
$0.00
$37,274,263.00
HEDIS 2007 (Reporting Year 2006)
Avg. Cost of
Prescriptions /
Per Member Per
Month
NA
NA
NA
NA
$338.65
$350.11
$310.07
$333.06
Total Number of
Prescriptions
0
0
0
0
235845
293926
311196
0
840967
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NA
NA
NA
NA
78.41
91.61
100.07
90.17
Page 73
Use of Services
Medica Health Plans
Outpatient Drug Utilization
Medicaid
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
531922
333919
440873
124611
19808
13526
7364
0
1472023
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 1:17 PM
$7,635,739.00
$9,122,472.00
$31,498,336.00
$17,615,623.00
$1,077,854.00
$431,171.00
$232,582.00
$0.00
$67,613,777.00
HEDIS 2007 (Reporting Year 2006)
Avg. Cost of
Prescriptions /
Per Member Per
Month
$14.35
$27.32
$71.45
$141.36
$54.42
$31.88
$31.58
$45.93
Total Number of
Prescriptions
206858
155323
583412
324820
31829
21349
13935
0
1337526
Avg. Num. Of
Prescriptions /
Per Member Per
Year
4.67
5.58
15.88
31.28
19.28
18.94
22.71
10.90
Page 74
Access/Availability of Care
Medica Health Plans
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:17 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+
50511
52389
2605
48209
50748
2554
95.44%
95.26%
95.63%
96.87%
96.72%
97.02%
98.04%
97.49%
98.59%
2006
A
Page 75
Access/Availability of Care
Medica Health Plans
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:17 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 2007 (Reporting Year 2006)
Ages 20-44
Ages 45-64
Ages 65+
0
0
8128
2006
A
0
0
7867
NA
NA
NA
NA
NA
NA
96.79%
96.40%
97.18%
Page 77
Access/Availability of Care
Medica Health Plans
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:17 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 2007 (Reporting Year 2006)
Ages 20-44
Ages 45-64
Ages 65+
16827
6237
2705
2006
A
14970
5546
2635
88.96%
88.49%
89.44%
88.92%
88.13%
89.71%
97.41%
96.80%
98.03%
Page 78
Access/Availability of Care
Medica Health Plans
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 1:17 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.
4171
19503
13641
23456
4117
17484
12168
21022
98.71%
98.35%
99.06%
89.65%
89.22%
90.08%
89.20%
88.68%
89.73%
89.62%
89.23%
90.02%
2006
A
Page 79
Access/Availability of Care
Medica Health Plans
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 1:17 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 2007 (Reporting Year 2006)
General Measure
Data
12-24 months
25 months - 6
yrs.
7-11 yrs.
12-19 yrs.
4422
11142
6762
9311
2006
A
4335
10031
6068
8329
98.03%
97.61%
98.45%
90.03%
89.47%
90.59%
89.74%
89.01%
90.47%
89.45%
88.82%
90.08%
Page 80
Access/Availability of Care
Medica Health Plans
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
General
Measure Data
Data collection methodology (Administrative or Hybrid)
H
Eligible member population (i.e. members who meet all
denominator criteria)
5101
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
395
Oversampling rate
Final sample size (FSS)
5%
415
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of
valid data errors
0
Number of administrative data records excluded
0
Number of medical records data records excluded
0
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
3741
3075
73.34%
60.28%
301
241
72.53%
58.07%
287
71
232
63
90.63%
87.63%
93.63%
74.68%
70.27%
79.10%
0
395
Page 81
Access/Availability of Care
Medica Health Plans
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Medicaid
General
Measure Data
Data collection methodology (Administrative or Hybrid)
H
Eligible member population (i.e. members who meet all
denominator criteria)
5907
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
371
Oversampling rate
Final sample size (FSS)
5%
390
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of
valid data errors
0
Number of administrative data records excluded
0
Number of medical records data records excluded
0
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
3163
3255
53.55%
55.10%
207
220
53.08%
56.41%
197
137
213
49
90.03%
86.84%
93.21%
70.62%
65.85%
75.39%
0
371
Page 82
Access/Availability of Care
Medica Health Plans
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
13-17 Year Olds
Data Elements
Measurement Year
Data collection methodology
(Administrative only)
General
Measure
Data
Initiation of
AOD
Treatment
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
2006
A
Eligible member population (i.e. members
who meet all denominator criteria)
Numerator events by administrative data
18-25 Year Olds
300
744
717
2096
42
3899
107
40
210
70
235
93
723
255
10
1
1285
459
Reported rate
35.67%
13.33%
28.23%
9.41%
32.78%
12.97%
34.49%
12.17%
23.81%
2.38%
32.96%
11.77%
Lower 95% confidence interval
30.08%
9.32%
24.92%
7.24%
29.27%
10.44%
32.44%
10.74%
9.74%
0.00%
31.47%
10.75%
Upper 95% confidence interval
41.25%
17.35%
31.53%
11.57%
36.28%
15.50%
36.55%
13.59%
37.88%
8.18%
34.45%
12.80%
HEDIS 2007 (Reporting Year 2006)
Page 83
Access/Availability of Care
Medica Health Plans
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:17 PM
MSHO
13-17 Year Olds
Data Elements
Measurement Year
Data collection methodology
(Administrative only)
General
Measure
Data
Initiation of
AOD
Treatment
26-34 Year Olds
35-64 Year Olds
65+ Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
0
0
0
0
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
138
138
0
0
0
0
0
0
0
0
57
4
57
4
Reported rate
NA
NA
NA
NA
NA
NA
NA
NA
41.30%
2.90%
41.30%
2.90%
Lower 95% confidence interval
Upper 95% confidence interval
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
32.73%
49.88%
0.00%
6.06%
32.73%
49.88%
0.00%
6.06%
HEDIS 2007 (Reporting Year 2006)
Page 85
Access/Availability of Care
Medica Health Plans
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Medicaid
13-17 Year Olds
Data Elements
Measurement Year
Data collection methodology
(Administrative only)
General
Measure
Data
Initiation of
AOD
Treatment
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
2006
A
Eligible member population (i.e. members
who meet all denominator criteria)
Numerator events by administrative data
18-25 Year Olds
325
630
669
1486
32
3142
91
30
199
56
234
73
540
194
13
0
1077
353
Reported rate
28.00%
9.23%
31.59%
8.89%
34.98%
10.91%
36.34%
13.06%
40.63%
0.00%
34.28%
11.23%
Lower 95% confidence interval
22.96%
5.93%
27.88%
6.59%
31.29%
8.47%
33.86%
11.31%
22.05%
0.00%
32.60%
10.11%
Upper 95% confidence interval
33.04%
12.53%
35.30%
11.19%
38.67%
13.35%
38.82%
14.80%
59.20%
1.56%
35.95%
12.36%
HEDIS 2007 (Reporting Year 2006)
Page 86
Health Plan Stability
Medica Health Plans
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
Product/Product Line
Years in Business
Members*
32.00
32.00
7.00
0.00
0.00
32.00
119984
59409
41508
0
0
220901
32.00
0.00
0.00
0.00
32.00
318090
0
0
0
318090
0.00
0.00
7.00
0.00
7.00
0
0
239773
0
239773
778764
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
Medica Health Plans
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:17 PM
MSHO
Product/Product Line
Years in Business
Members*
32.00
32.00
7.00
0.00
7.00
32.00
119984
59409
43394
0
11235
234022
32.00
0.00
0.00
0.00
32.00
318090
0
0
0
318090
0.00
0.00
7.00
0.00
7.00
0
0
239773
0
239773
791885
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
Medica Health Plans
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Medicaid
Product/Product Line
Years in Business
Members*
32.00
32.00
7.00
0.00
0.00
32.00
119984
59409
41508
0
0
220901
32.00
0.00
0.00
0.00
32.00
318090
0
0
0
318090
0.00
0.00
7.00
0.00
7.00
0
0
239773
0
239773
778764
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
Medica Health Plans
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:17 PM
Commercial
Member Months
Female
30576
125712
153744
159384
99300
58320
<1
1-4
5-9
10-14
15-17
18-19
Male
31992
128976
160392
164184
104160
61416
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
651120
28.31%
165108
194964
185172
204912
223308
627036
28.12%
155808
184896
174192
195336
216216
1278156
28.22%
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
973464
42.32%
220284
190128
146016
88524
926448
41.55%
221088
189036
149832
91800
1899912
41.94%
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
644952
28.04%
20496
6228
2388
924
444
156
651756
29.23%
16572
4476
1776
1068
516
204
1296708
28.62%
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
30636
1.33%
0
24612
1.10%
0
55248
1.22%
2300172
2229852
HEDIS 2007 (Reporting Year 2006)
Total
62568
254688
314136
323568
203460
119736
320916
379860
359364
400248
439524
441372
379164
295848
180324
37068
10704
4164
1992
960
360
0
4530024
Page 91
Health Plan Descriptive Information
Medica Health Plans
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:17 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
Medica Health Plans
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:17 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%
6120
6660
5796
4392
3348
2316
0
0.00%
10416
12888
13176
15132
14844
16812
0
0.00%
28632
100.00%
0
83268
100.00%
0
111900
100.00%
28632
83268
HEDIS 2007 (Reporting Year 2006)
0
0
0
0
0
0
0
0
0
16536
19548
18972
19524
18192
19128
0
111900
Page 93
Health Plan Descriptive Information
Medica Health Plans
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:17 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
47846
115265
106257
89153
50763
21640
Member Months
Female
45031
110612
106911
90806
51370
30187
Total
92877
225877
213168
179959
102133
51827
430924
68.60%
26892
25727
23920
26356
26199
434917
51.54%
83582
78672
59747
49922
39856
865841
58.82%
129094
20.55%
23103
16091
9932
5490
311779
36.95%
30209
18611
13269
7906
440873
29.95%
54616
8.69%
4757
2775
2515
2041
878
556
69995
8.29%
7819
4457
4630
4340
2872
3058
124611
8.47%
13522
2.15%
0
27176
3.22%
0
40698
2.76%
628156
843867
HEDIS 2007 (Reporting Year 2006)
110474
104399
83667
76278
66055
53312
34702
23201
13396
12576
7232
7145
6381
3750
3614
0
1472023
Page 94