Blue Plus
Plan Name
2006
Reporting Year
General Info
Disclaimers
Plan ID
Submission #
1
8
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
9/5/2007 8:35:21 AM
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
30
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
57
31
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory Services
60
32
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
64
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
Breast Cancer Screening
9
Cervical Cancer Screening
13
Chlamydia Screening in Women
14
Osteoporosis Management in Women Who had a Fracture
15
Controlling High Blood Pressure
16
Beta Blocker Treatment after Heart Attack
17
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
( this page left blank intentionally )
0. Disclaimer Query located below
HEDIS 2007 (Reporting Year 2006)
Page 2
Effectiveness of Care
Blue Plus
Childhood Immunization Status
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
HiB
Hepatitis B
VZV
Pneumococcal
Conjugate
Combo 2
Combo 3
928
62.83%
1022
69.19%
1301
88.08%
1020
69.06%
978
66.22%
1248
84.50%
861
58.29%
818
55.38%
728
49.29%
330
76.39%
348
80.56%
382
88.43%
348
80.56%
342
79.17%
367
84.95%
314
72.69%
287
66.44%
262
60.65%
330
40
90.02%
87.01%
93.04%
348
43
95.13%
92.93%
97.34%
382
10
95.38%
93.23%
97.53%
348
43
95.13%
92.93%
97.34%
342
49
95.13%
92.93%
97.34%
367
13
92.46%
89.78%
95.13%
314
31
83.94%
80.27%
87.61%
287
62
84.91%
81.33%
88.50%
262
58
77.86%
73.72%
81.99%
432
0
Number of Records Excluded because of
Contraindications by Admin Data
0
Number of Records Excluded because of
Contraindications by Medical Record
Review
0
Number of employee/dependent records
excluded
9
Records Added from the Oversample List
9
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
1477
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
Blue Plus
Childhood Immunization Status
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Medicaid
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
HiB
Hepatitis B
VZV
Pneumococcal
Conjugate
Combo 2
Combo 3
1253
53.87%
1391
59.80%
1979
85.08%
1465
62.98%
1341
57.65%
1831
78.72%
691
29.71%
969
41.66%
537
23.09%
233
53.94%
251
58.10%
372
86.11%
279
64.58%
239
55.32%
347
80.32%
129
29.86%
183
42.36%
104
24.07%
222
159
92.70%
90.06%
95.34%
237
145
92.94%
90.35%
95.54%
356
23
92.21%
89.50%
94.93%
265
93
87.10%
83.74%
90.47%
226
155
92.70%
90.06%
95.34%
331
24
86.37%
82.94%
89.81%
124
238
88.08%
84.82%
91.33%
173
156
80.05%
76.06%
84.03%
100
215
76.64%
72.43%
80.85%
432
0
Number of Records Excluded because of
Contraindications by Admin Data
0
Number of Records Excluded because of
Contraindications by Medical Record
Review
2
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
2
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
2005
H
2326
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
Blue Plus
Adolescent Immunization Status
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
VZV
Combo 2
1140
55.45%
437
21.25%
453
22.03%
143
6.96%
213
48.41%
81
18.41%
92
20.91%
27
6.14%
213
149
88.08%
84.82%
91.33%
81
246
79.56%
75.54%
83.58%
92
170
63.75%
58.98%
68.52%
27
207
56.93%
52.03%
61.84%
411
7.00%
440
Number of Records Excluded Because of
Valid Data Errors
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
29
Records Added from the Oversample List
29
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
411
HEDIS 2007 (Reporting Year 2006)
Hepatitis B
2006
H
2056
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
Page 5
Effectiveness of Care
Blue Plus
Adolescent Immunization Status
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Medicaid
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
Combo 2
1070
56.55%
366
19.34%
400
21.14%
92
4.86%
242
56.02%
83
19.21%
90
20.83%
23
5.32%
242
125
89.29%
86.18%
92.41%
83
225
74.94%
70.63%
79.25%
90
133
54.26%
49.32%
59.20%
23
165
45.74%
40.80%
50.68%
432
0
Number of Records Excluded because of
Contraindications by Admin Data
0
Number of Records Excluded because of
Contraindications by Medical Record Review
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
HEDIS 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
1892
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
Blue Plus
Appropriate Treatment for Children with Upper
Respiratory Infection
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
General
Measure
Data
2006
A
Eligible Member Population
3154
Numerator Events by Admin Data
562
Reported Rate
82.18%
Lower 95% Confidence Interval
80.83%
Upper 95% Confidence Interval
83.53%
HEDIS 2007 (Reporting Year 2006)
Page 7
Effectiveness of Care
Blue Plus
Colorectal Cancer Screening
Data Elements
Measurement Year
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Medicare
Advantage
MSHO
2006
2006
H
H
Eligible population
32114
2578
Number of numerator events by administrative data in eligible
population (before exclusions)
15865
819
Data collection methodology (administrative or hybrid)
Current year's administrative rate (before exclusions)
49.40%
NR
31.77%
Minimum required sample size (MRSS) or other sample size
411
411
Oversampling rate
0.1
0.1
Final sample size (FSS)
453
453
Number of numerator events by administrative data in FSS
219
133
Administrative rate on FSS
48.34%
NR
29.36%
Number of original sample records excluded because of valid data
errors
0
0
Number of administrative data records excluded
0
0
Number of medical record data records excluded
0
1
Number of employee/dependent medical records excluded
13
0
Records added from the oversample list
12
1
Denominator
411
411
Numerator events by administrative data
219
133
Numerator events by medical records
45
46
Reported rate
64.23%
NR
43.55%
Lower 95% confidence interval
59.48%
NR
38.64%
Upper 95% confidence interval
68.99%
NR
48.47%
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
Blue Plus
Breast Cancer Screening
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
13281
9266
69.77%
68.98%
70.55%
14817
11444
77.24%
76.56%
77.91%
28098
20710
73.71%
73.19%
74.22%
2006
A
Page 9
Effectiveness of Care
Blue Plus
Breast Cancer Screening
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
Blue Plus
Breast Cancer Screening
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
403
207
51.36%
46.36%
56.37%
403
207
51.36%
46.36%
56.37%
2006
A
Page 11
Effectiveness of Care
Blue Plus
Breast Cancer Screening
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
3254
1871
57.50%
55.78%
59.21%
2266
1356
59.84%
57.80%
61.88%
5520
3227
58.46%
57.15%
59.77%
2006
A
Page 12
Effectiveness of Care
Blue Plus
Cervical Cancer Screening
Data Elements
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Medicaid
Measurement Year
Data Collection Methodology
Eligible Member Population
2006
H
34783
2006
H
15326
Numerator Events by Admin Data on Eligible
Population (before exclusions)
26666
11003
Records Excluded because of Valid Data Errors
76.66%
411
10.00%
453
352
77.70%
0
71.79%
411
10.00%
453
313
69.09%
0
Number of administrative data records excluded
0
0
Number of medical record data records excluded
16
13
Number of employee/dependent medical records
excluded
4
0
18
411
352
11
88.32%
85.09%
91.55%
13
411
313
24
82.00%
78.16%
85.83%
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
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
Blue Plus
Chlamydia Screening in Women
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
2585
829
32.07%
30.25%
33.89%
2452
858
34.99%
33.08%
36.90%
5037
1687
33.49%
32.18%
34.81%
1884
758
40.23%
37.99%
42.47%
2492
989
39.69%
37.75%
41.63%
4376
1747
39.92%
38.46%
41.38%
Page 14
Effectiveness of Care
Blue Plus
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:
Sep 5, 2007 8:35 AM
Medicare
Advantage
NR
NR
NR
MSHO
2006
A
282
39
13.83%
9.62%
18.04%
Page 15
Effectiveness of Care
Blue Plus
Controlling High Blood Pressure
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology (Hybrid)
General Measure
Data
Current Year's Admin Rate
Final Sample Size (FSS)
1333
7650
8983
0
0
0
0.00%
0.00%
0.00%
0
0
0
0.00%
0.00%
0.00%
55
356
411
411
10.00%
453
Numerator events by admin data in FSS
Admin rate on FSS
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
19
Records Added from the OverSample List
38
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
27
225
252
Reported Rate
49.09%
63.20%
61.31%
Lower 95% Confidence Interval
34.97%
58.05%
56.48%
Upper 95% Confidence Interval
63.21%
68.35%
66.14%
HEDIS 2007 (Reporting Year 2006)
Page 16
Effectiveness of Care
Blue Plus
Beta Blocker Treatment after Heart Attack
Data Elements
Measurement Year
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Medicare Advantage
MSHO
2006
2006
H
H
Eligible Member Population
125
103
Numerator Events by Admin Data on
Eligible Population
103
75
Data Collection Methodology
Current Year's Admin Rate
Minimum Required Sample Size
82.40%
NR
72.82%
114
81
10.00%
10.00%
Final Sample Size (FSS)
114
81
Numerator events by admin data in FSS
103
74
Oversampling Rate
Admin rate on FSS
90.35%
NR
91.36%
Records Excluded because of Valid Data
Errors
0
3
Number of administrative data records
excluded
0
0
Number of medical record data records
excluded
0
1
Number of employee/dependent medical
records excluded
0
0
Records Added from the Oversample List
0
0
Denominator
114
77
Numerator Events by Admin Data
103
74
4
2
Numerator Events by Medical Record
Reported Rate
93.86%
NR
98.70%
Lower 95% Confidence Interval
89.01%
NR
95.52%
Upper 95% Confidence Interval
98.71%
NR
100.00%
HEDIS 2007 (Reporting Year 2006)
Page 17
Effectiveness of Care
Blue Plus
Persistence of Beta Blocker Treatment After Hearth Attack
Data Elements
Measurement Year
Data Collection Methodology
Commercial
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Medicare Advantage
MSHO
2006
A
Eligible Member Population
112
Numerator Events by Admin Data on
Eligible Population
91
Reported Rate
81.25%
NR
NR
Lower 95% Confidence Interval
73.57%
NR
NR
Upper 95% Confidence Interval
88.93%
NR
NR
HEDIS 2007 (Reporting Year 2006)
Page 18
Effectiveness of Care
Blue Plus
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
General
Measure
Data
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
0
Number of administrative data records excluded
0
Number of medical record data records excluded
0
Number of employee/dependent medical records
excluded
12
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006)
1025
0
87.76%
0.00%
361
0
76.32%
0.00%
361
16
0
253
91.73%
88.94%
94.51%
61.56%
56.73%
66.38%
411
15.00%
473
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
LDL-C Level of
<100 mg/dL
2006
H
1168
Numerator Events by Admin Data on Eligible
Population
Current Year's Admin Rate
Minimum Required Sample Size
LDL-C
screening
12
411
Page 19
Effectiveness of Care
Blue Plus
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Medicare Advantage
General
Measure
Data
LDL-C
screening
LDL-C Level of
<100 mg/dL
Current Year's Admin Rate
NR
NR
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
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on Eligible
Population
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
Blue Plus
Cholesterol Management for Patients with Cardiovascular
Conditions
Data Last Refreshed:
Sep 5, 2007 8:35 AM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
0
72.67%
0.00%
116
0
72.05%
0.00%
116
7
0
86
78.34%
71.58%
85.11%
54.78%
46.67%
62.88%
161
15.00%
161
4
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)
117
161
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
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
157
Page 21
Effectiveness of Care
Blue Plus
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
5012
2006
H
5012
2006
H
5012
2006
H
5012
2006
H
5012
2006
H
5012
2006
H
5012
2006
H
5012
2006
H
5012
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
4397
87.73%
411
10%
453
359
79.25%
5012
100.00%
411
10%
453
453
100.00%
0
0.00%
411
10%
453
0
0.00%
2897
57.80%
411
10%
453
231
50.99%
4098
81.76%
411
10%
453
333
73.51%
0
0.00%
411
10%
453
0
0.00%
4051
80.83%
411
10%
453
342
75.50%
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
8
8
8
8
8
8
8
8
8
Number of administrative data records
excluded
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
24
24
24
24
24
24
24
24
24
26
411
359
16
91.24%
88.39%
94.10%
26
411
58
33
22.14%
18.01%
26.28%
26
411
0
202
49.15%
44.19%
54.10%
26
411
231
56
69.83%
65.27%
74.39%
26
411
333
21
86.13%
82.67%
89.59%
26
411
0
211
51.34%
46.38%
56.29%
26
411
342
2
83.70%
80.01%
87.39%
26
411
0
306
74.45%
70.11%
78.79%
26
411
0
187
45.50%
40.56%
50.43%
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
Blue Plus
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
Blue Plus
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
898
2006
H
898
2006
H
898
2006
H
898
2006
H
898
2006
H
898
2006
H
898
2006
H
898
2006
H
898
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
804
89.53%
411
10%
453
372
82.12%
898
100.00%
411
10%
453
453
100.00%
0
0.00%
411
10%
453
0
0.00%
602
67.04%
411
10%
453
284
62.69%
669
74.50%
411
10%
453
313
69.09%
0
0.00%
411
10%
453
0
0.00%
776
86.41%
411
10%
453
356
78.59%
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
4
4
4
4
4
4
4
4
4
Number of administrative data records
excluded
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
411
372
9
92.70%
90.06%
95.34%
4
411
80
20
24.33%
20.06%
28.60%
4
411
0
212
51.58%
46.63%
56.53%
4
411
284
26
75.43%
71.14%
79.71%
4
411
313
15
79.81%
75.80%
83.81%
4
411
0
208
50.61%
45.65%
55.56%
4
411
356
0
86.62%
83.20%
90.03%
4
411
0
261
63.50%
58.73%
68.28%
4
411
0
163
39.66%
34.81%
44.51%
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
Blue Plus
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
1800
2006
H
1800
2006
H
1800
2006
H
1800
2006
H
1800
2006
H
1800
2006
H
1800
2006
H
1800
2006
H
1800
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
1555
86.39%
411
10%
453
355
78.37%
1800
100.00%
411
10%
453
453
100.00%
0
0.00%
411
10%
453
0
0.00%
962
53.44%
411
10%
453
237
52.32%
1350
75.00%
411
10%
453
317
69.98%
0
0.00%
411
10%
453
0
0.00%
1391
77.28%
411
10%
453
331
73.07%
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
2
2
2
2
2
2
2
2
2
Number of administrative data records
excluded
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
411
355
9
88.56%
85.37%
91.76%
2
411
88
44
32.12%
27.48%
36.75%
2
411
0
168
40.88%
36.00%
45.75%
2
411
237
38
66.91%
62.24%
71.58%
2
411
317
7
78.83%
74.76%
82.90%
2
411
0
166
40.39%
35.52%
45.25%
2
411
331
0
80.54%
76.59%
84.48%
2
411
0
266
64.72%
59.98%
69.46%
2
411
0
163
39.66%
34.81%
44.51%
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
Blue Plus
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
190
185
97.37%
94.83%
99.91%
302
287
95.03%
92.42%
97.65%
1392
1295
93.03%
91.66%
94.41%
1884
1767
93.79%
92.67%
94.91%
2006
A
Page 26
Effectiveness of Care
Blue Plus
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
201
199
99.00%
97.38%
100.00%
308
282
91.56%
88.29%
94.83%
623
536
86.04%
83.23%
88.84%
1132
1017
89.84%
88.04%
91.65%
2006
A
Page 27
Effectiveness of Care
Blue Plus
Antidepressant Medication Management
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
192
16.33%
14.17%
18.48%
766
65.14%
62.37%
67.90%
574
48.81%
45.91%
51.71%
2006
A
1176
Page 28
Effectiveness of Care
Blue Plus
Antidepressant Medication Management
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
Blue Plus
Antidepressant Medication Management
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
8
7.08%
1.91%
12.25%
86
76.11%
67.80%
84.41%
81
71.68%
62.93%
80.43%
2006
A
113
Page 30
Effectiveness of Care
Blue Plus
Antidepressant Medication Management
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
142
16.92%
14.33%
19.52%
417
49.70%
46.26%
53.14%
290
34.56%
31.29%
37.84%
2006
A
839
Page 31
Effectiveness of Care
Blue Plus
Follow-Up Care for Children Prescribed
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Medicaid
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
Continuation
and
Maintenance
Phase
2006
A
General
Measure
Data
Initiation
Phase
Continuation
and
Maintenance
Phase
465
0
149
32.04%
27.69%
36.39%
141
0
43
30.50%
22.54%
38.45%
2006
A
344
0
106
30.81%
25.79%
35.84%
101
0
34
33.66%
23.95%
43.37%
Page 32
Effectiveness of Care
Blue Plus
Glaucoma Screening in Older Adults
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interva
HEDIS 2007 (Reporting Year 2006)
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Medicare
Advantage
NR
NR
NR
MSHO
2006
A
5358
3608
67.34%
66.07%
68.60%
Page 33
Effectiveness of Care
Blue Plus
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
9322
128
7214
77.39%
76.53%
78.24%
165
3
130
78.79%
72.25%
85.33%
7451
99
5797
77.80%
76.85%
78.75%
577
17
397
68.80%
64.94%
72.67%
17515
247
13538
77.29%
76.67%
77.92%
2006
A
Page 34
Effectiveness of Care
Blue Plus
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Medicare Advantage
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
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 35
Effectiveness of Care
Blue Plus
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
Anticonvulsants
Total
3622
88
3282
90.61%
89.65%
91.58%
680
20
628
92.35%
90.28%
94.42%
4521
105
4106
90.82%
89.97%
91.67%
543
48
469
86.37%
83.39%
89.35%
9366
261
8485
90.59%
90.00%
91.19%
2006
A
Page 36
Effectiveness of Care
Blue Plus
Annual Monitoring for Patients on Persisten
Medications
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
Anticonvulsants
Total
2121
30
1644
77.51%
75.71%
79.31%
47
0
39
82.98%
71.17%
94.79%
1698
24
1324
77.97%
75.97%
79.97%
272
7
198
72.79%
67.32%
78.27%
4138
61
3205
77.45%
76.17%
78.74%
2006
A
Page 37
Effectiveness of Care
Blue Plus
Drugs to Be Avoided in the Elderly
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
9353
1 or More
Prescriptions
2 or More
Prescriptions
2432
26.00%
25.11%
26.90%
476
5.09%
4.64%
5.54%
Page 38
Effectiveness of Care
Blue Plus
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
Blue Plus
Potentially Harmful Drug-Disease Interactions in the Elderly
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
487
108
22.18%
18.38%
25.97%
1588
429
27.02%
24.80%
29.23%
78
7
8.97%
1.99%
15.96%
2153
544
25.27%
23.41%
27.13%
Page 40
Use of Services
Blue Plus
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
35
9
12
20
55
185
978
2.70%
1.78%
3.63%
0.70%
0.20%
1.19%
0.93%
0.37%
1.49%
1.55%
0.83%
2.26%
4.25%
3.11%
5.39%
14.30%
12.35%
16.24%
75.58%
73.20%
77.96%
2006
A
1294
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
Blue Plus
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
25
53
74
136
316
669
1438
0.92%
0.54%
1.30%
1.95%
1.42%
2.49%
2.73%
2.10%
3.36%
5.02%
4.18%
5.86%
11.66%
10.43%
12.88%
24.68%
23.04%
26.32%
53.04%
51.15%
54.94%
2006
A
2711
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
Blue Plus
Well Child Visits in the 3rd, 4th,
5th and 6th Years of Life
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Medicaid
2006
A
6623
2006
A
7272
NR
NR
NR
NR
4019
4452
60.68%
59.50%
61.87%
61.22%
60.09%
62.35%
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
Blue Plus
Adolescent Well-Care Visits
Data Elements
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Medicaid
2006
A
21292
2006
A
14770
Current Year's Admin Rate
NR
NR
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
NR
NR
6756
4637
31.73%
31.10%
32.36%
31.39%
30.64%
32.15%
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator events by admin data in eligible
population
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
Blue Plus
Frequency of Selected Procedures
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Member Months
Total
108018
228983
415821
294856
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
773
226
266
107
Procedures /
1,000 Member
Months
7.16
0.54
1.16
0.36
Member Months
Male
Female
401477
270435
324132
487203
305546
336472
12692
8000
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)
Female
Number of
Procedures
Procedures /
1,000 Member
Months
21
0.04
0
93
3
220
588
56
189
15
191
16
46
9
95
13
0.00
0.19
0.24
0.81
1.92
4.41
0.62
1.18
0.63
1.26
0.15
0.71
0.31
1.02
Number of
Procedures
30
51
87
135
1
92
109
2
Procedures /
1,000 Member
Months
0.07
0.15
0.22
0.40
0.13
0.23
0.32
0.25
11
14
0
0.03
0.04
0.00
140
177
6
450
654
19
47
2
140
4
19
2
0.35
0.53
0.75
1.39
1.94
2.38
0.14
0.25
0.42
0.50
0.06
0.25
29
70
4
76
196
8
0.07
0.21
0.50
0.19
0.58
1.00
Page 45
Use of Services
Blue Plus
Frequency of Selected Procedures
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
Blue Plus
Frequency of Selected Procedures
Data Last Refreshed:
Sep 5, 2007 8:35 AM
MSHO
Age
< 65
65-74
75-84
85+
Member Months
Male
Female
3
0
12867
21463
12419
32112
9262
43058
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
8
0
0
0
6
7
2
0
17
12
4
0
6
3
0
0
10
16
17
0
0
3
0
0
5
7
1
0
3
4
0
0
5
2
0
0
7
4
1
0
17
25
7
Procedures /
1,000 Member
Months
0.00
0.62
0.00
0.00
0.00
0.47
0.56
0.22
0.00
1.32
0.97
0.43
0.00
0.47
0.24
0.00
0.00
0.78
1.29
1.84
0.00
0.00
0.24
0.00
0.00
0.39
0.56
0.11
0.00
0.23
0.32
0.00
0.00
0.39
0.16
0.00
0.00
0.54
0.32
0.11
0.00
1.32
2.01
0.76
Female
Number of
Procedures
0
9
7
0
0
15
19
12
0
29
22
10
0
1
1
1
0
11
52
96
0
11
14
8
0
14
29
4
0
4
13
7
0
2
3
1
0
15
10
12
0
112
111
71
0
3
4
1
0
3
2
1
0
5
7
3
0
9
9
5
Procedures /
1,000 Member
Months
NA
0.42
0.22
0.00
NA
0.70
0.59
0.28
NA
1.35
0.69
0.23
NA
0.05
0.03
0.02
NA
0.51
1.62
2.23
NA
0.51
0.44
0.19
NA
0.65
0.90
0.09
NA
0.19
0.40
0.16
NA
0.09
0.09
0.02
NA
0.70
0.31
0.28
NA
5.22
3.46
1.65
NA
0.14
0.12
0.02
NA
0.14
0.06
0.02
NA
0.23
0.22
0.07
NA
0.42
0.28
0.12
Page 47
Use of Services
Blue Plus
Inpatient Utilization - General Hospital/Acute Care
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Member Months
19931
209052
294856
594567
642018
19522
1093
77
0
1781116
Discharges
Discharges /
1,000 Member
Months
144
388
484
3604
4496
271
40
7
0
9434
7.22
1.86
1.64
6.06
7.00
13.88
36.60
90.91
115
262
210
653
1734
112
23
7
0
3116
5.77
1.25
0.71
1.10
2.70
5.74
21.04
90.91
28
119
206
1056
2725
157
17
0
0
4308
1.40
0.57
0.70
1.78
4.24
8.04
15.55
0.00
67
1884
28
0
1979
0.23
3.17
0.04
HEDIS 2007 (Reporting Year 2006)
5.30
1.75
2.42
1.28
Days
Days / 1,000
Member
Months
443
1101
1616
10423
15523
1617
133
20
0
30876
22.23
5.27
5.48
17.53
24.18
82.83
121.68
259.74
256
549
516
1789
4794
416
80
20
0
8420
12.84
2.63
1.75
3.01
7.47
21.31
73.19
259.74
176
516
910
3286
10586
1168
53
0
0
16695
8.83
2.47
3.09
5.53
16.49
59.83
48.49
0.00
189
5328
66
0
5583
0.64
8.96
0.10
17.34
4.73
9.37
3.60
Average
Length of Stay
3.08
2.84
3.34
2.89
3.45
5.97
3.33
2.86
NA
3.27
2.23
2.10
2.46
2.74
2.76
3.71
3.48
2.86
NA
2.70
6.29
4.34
4.42
3.11
3.88
7.44
3.12
NA
NA
3.88
2.82
2.83
2.36
NA
2.82
Page 48
Use of Services
Blue Plus
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
Blue Plus
Inpatient Utilization - General Hospital/Acute Care
MSHO
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
Unknown
Total
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Member Months
0
0
0
3
0
34330
44531
52320
0
131184
Discharges
Discharges /
1,000 Member
Months
0
0
0
0
0
1391
2030
2148
0
5569
NA
NA
NA
0.00
NA
40.52
45.59
41.06
0
0
0
0
0
916
1498
1763
0
4177
NA
NA
NA
0.00
NA
26.68
33.64
33.70
0
0
0
0
0
461
517
360
0
1338
NA
NA
NA
0.00
NA
13.43
11.61
6.88
0
0
0
0
0
HEDIS 2007 (Reporting Year 2006)
42.45
31.84
10.20
NA
0.00
NA
0.00
Days
0
0
0
0
0
7379
9062
8987
0
25428
0
0
0
0
0
3545
5639
6766
0
15950
Days / 1,000
Member
Months
NA
NA
NA
0.00
NA
214.94
203.50
171.77
193.83
NA
NA
NA
0.00
NA
103.26
126.63
129.32
121.58
0
0
0
0
0
3722
3276
2103
0
9101
NA
NA
NA
0.00
NA
108.42
73.57
40.19
0
0
0
0
0
NA
0.00
NA
69.38
0.00
Average
Length of Stay
NA
NA
NA
NA
NA
5.30
4.46
4.18
NA
4.57
NA
NA
NA
NA
NA
3.87
3.76
3.84
NA
3.82
NA
NA
NA
NA
NA
8.07
6.34
5.84
NA
6.80
NA
NA
NA
NA
NA
Page 50
Use of Services
Blue Plus
Ambulatory Care
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
19931
209052
294856
594567
642018
19522
1093
77
0
1781116
Outpatient Visits
(Excludes MH/CD)
Age
Visits
17053
61772
10-19
20-44
45-64
65-74
75-84
85+
Unknown
65793
156612
226439
10123
836
50
0
538678
<1
1-9
Total
HEDIS 2007 (Reporting Year 2006)
Visits/ 1,000
Member
Months
855.60
295.49
223.14
263.41
352.70
518.54
764.87
649.35
302.44
Emergency Room Visits
Visits
590
3606
4025
8108
6966
252
23
1
0
23571
Visits/ 1,000
Member
Months
29.60
17.25
13.65
13.64
10.85
12.91
21.04
12.99
13.23
Ambulatory
Surgery/Procedures
Procedures
259
1172
1028
5082
13827
668
55
0
0
22091
Procedures/
1,000 Member
Months
12.99
5.61
3.49
8.55
21.54
34.22
50.32
0.00
12.40
Observation Room Stays
Resulting in Discharge
Stays
22
48
83
643
283
19
4
0
0
1102
Stays/ 1,000
Member
Months
1.10
0.23
0.28
1.08
0.44
0.97
3.66
0.00
0.62
Page 51
Use of Services
Blue Plus
Ambulatory Care
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Medicare Advantage
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 52
Use of Services
Blue Plus
Ambulatory Care
Data Last Refreshed:
Sep 5, 2007 8:35 AM
MSHO
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
0
0
0
3
0
34330
44531
52320
0
131184
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
23956
28602
22677
0
75235
HEDIS 2007 (Reporting Year 2006)
Visits/ 1,000
Member
Months
NA
NA
NA
0.00
NA
697.82
642.29
433.43
573.51
Emergency Room Visits
Visits
0
0
0
0
0
1221
1563
1577
0
4361
Visits/ 1,000
Member
Months
NA
NA
NA
0.00
NA
35.57
35.10
30.14
33.24
Ambulatory
Surgery/Procedures
Procedures
0
0
0
0
0
1302
1471
898
0
3671
Procedures/
1,000 Member
Months
NA
NA
NA
0.00
NA
37.93
33.03
17.16
27.98
Observation Room Stays
Resulting in Discharge
Stays
0
0
0
0
0
60
101
124
0
285
Stays/ 1,000
Member
Months
NA
NA
NA
0.00
NA
1.75
2.27
2.37
2.17
Page 53
Use of Services
Blue Plus
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Age
Member
Months
<1
19931
1-9
209052
10-19
294856
20-44
594567
45-64
642018
65-74
19522
75-84
1093
85+
Unknown
Total
77
0
1781116
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
2
0.01
59
0.20
29.50
20-44
15
0.03
143
0.24
9.53
45-64
149
0.23
2022
3.15
13.57
65-74
18
0.92
229
11.73
12.72
75-84
6
5.49
55
50.32
9.17
85+
0
0.00
0
0.00
NA
0.11
0
2508
1.41
NA
13.20
Discharges
Discharges /
1,000 Member
Months
<1
0
1-9
Age
Unknown
Total
0
190
HEDIS 2007 (Reporting Year 2006)
Page 54
Use of Services
Blue Plus
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
Blue Plus
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 5, 2007 8:35 AM
MSHO
Age
Member
Months
<1
0
1-9
0
10-19
0
20-44
3
45-64
0
65-74
34330
75-84
44531
85+
52320
Unknown
0
131184
Total
Discharges
Discharges /
1,000 Member
Months
<1
0
1-9
Days
Days / 1,000
Member
Months
Average Length
of Stay
NA
0
NA
NA
0
NA
0
NA
NA
10-19
0
NA
0
NA
NA
20-44
0
0.00
0
0.00
NA
45-64
0
NA
0
NA
NA
65-74
434
12.64
11489
334.66
26.47
75-84
1075
24.14
30670
688.73
28.53
85+
1804
34.48
52226
998.20
28.95
Unknown
0
3313
25.25
0
94385
719.49
NA
28.49
Age
Total
HEDIS 2007 (Reporting Year 2006)
Page 56
Use of Services
Blue Plus
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Member Months
Male
Female
Total
159038
149461
308499
79539
605342
12692
0
856611
76060
690984
8000
0
924505
155599
1296326
20692
0
1781116
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
17
10
27
0.11
0.07
0.09
347
175
522
20.41
17.50
19.33
13-17
M
F
Total
92
128
220
1.16
1.68
1.41
3673
3801
7474
39.92
29.70
33.97
18-64
M
F
Total
M
F
Total
M
F
Total
M
F
TOTAL
126
264
390
0.21
0.38
0.30
1053
2760
3813
8.36
10.45
9.78
1
0
1
0.08
0.00
0.05
22
0
22
22.00
NA
22.00
0
0
0
NA
NA
NA
5095
6736
11831
21.59
16.76
18.54
65+
Unknown
Total
HEDIS 2007 (Reporting Year 2006)
0
0
0
236
402
638
0.28
0.43
0.36
Page 57
Use of Services
Blue Plus
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
Blue Plus
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 5, 2007 8:35 AM
MSHO
Member Months
Age
Male
Female
Total
0-12
13-17
18-64
65+
Unknown
Total
0
0
3
34548
0
34551
0
0
0
96633
0
96633
0
0
3
131181
0
131184
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
0.00
NA
0.00
0
0
0
NA
NA
NA
155
370
525
4.49
3.83
4.00
4131
10032
14163
26.65
27.11
26.98
0
0
0
NA
NA
NA
4131
10032
14163
26.65
27.11
26.98
65+
Unknown
Total
HEDIS 2007 (Reporting Year 2006)
0
0
0
155
370
525
4.49
3.83
4.00
Page 59
Use of Services
Blue Plus
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
Member Months (Ambulatory)
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
149461
76060
308499
155599
159038
79539
149461
76060
308499
155599
159038
79539
149461
76060
308499
155599
159038
79539
149461
76060
308499
155599
605342
12692
0
856611
690984
8000
0
924505
1296326
20692
0
1781116
605342
12692
0
856611
690984
8000
0
924505
1296326
20692
0
1781116
605342
12692
0
856611
690984
8000
0
924505
1296326
20692
0
1781116
605342
12692
0
856611
690984
8000
0
924505
1296326
20692
0
1781116
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)
159038
79539
Any Mental Health Services
0-12
Member Months (Inpatient)
Inpatient Mental Health Services
Number
Percent
Number
Percent
Day/Night Mental Health Services
Percent
Number
948
550
1498
819
905
1724
3343
6566
9909
36
28
64
0
0
0
5146
8049
13195
7.15%
4.42%
5.83%
12.36%
14.28%
13.30%
6.63%
11.40%
9.17%
3.40%
4.20%
3.71%
NA
NA
NA
7.21%
10.45%
8.89%
14
9
23
68
91
159
104
185
289
1
0
1
0
0
0
187
285
472
0.11%
0.07%
0.09%
1.03%
1.44%
1.23%
0.21%
0.32%
0.27%
0.09%
0.00%
0.06%
NA
NA
NA
0.26%
0.37%
0.32%
1
1
2
8
10
18
5
33
38
0
0
0
0
0
0
14
44
58
HEDIS 2007 (Reporting Year 2006)
0.01%
0.01%
0.01%
0.12%
0.16%
0.14%
0.01%
0.06%
0.04%
0.00%
0.00%
0.00%
NA
NA
NA
0.02%
0.06%
0.04%
Ambulatory Mental Health Services
Percent
Number
946
549
1495
808
900
1708
3328
6547
9875
36
28
64
0
0
0
5118
8024
13142
7.14%
4.41%
5.82%
12.19%
14.20%
13.17%
6.60%
11.37%
9.14%
3.40%
4.20%
3.71%
NA
NA
NA
7.17%
10.42%
8.85%
Page 60
Use of Services
Blue Plus
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
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
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 61
Use of Services
Blue Plus
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
3
34548
0
34551
0
96633
0
96633
3
131181
0
131184
3
34548
0
34551
0
96633
0
96633
3
131181
0
131184
3
34548
0
34551
0
96633
0
96633
3
131181
0
131184
3
34548
0
34551
0
96633
0
96633
3
131181
0
131184
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
Number
Percent
Inpatient Mental Health Services
Percent
Number
0
0
0
0
0
0
0
0
0
311
810
1121
0
0
0
311
810
1121
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
10.80%
10.06%
10.25%
NA
NA
NA
10.80%
10.06%
10.25%
0
0
0
0
0
0
0
0
0
100
254
354
0
0
0
100
254
354
HEDIS 2007 (Reporting Year 2006)
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
3.47%
3.15%
3.24%
NA
NA
NA
3.47%
3.15%
3.24%
Day/Night Mental Health Services
Percent
Number
Ambulatory Mental Health Services
Percent
Number
0
0
0
0
0
0
0
0
0
0
2
2
0
0
0
0
2
2
0
0
0
0
0
0
0
0
0
239
623
862
0
0
0
239
623
862
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
0.00%
0.02%
0.02%
NA
NA
NA
0.00%
0.02%
0.02%
NA
NA
NA
NA
NA
NA
0.00%
NA
0.00%
8.30%
7.74%
7.89%
NA
NA
NA
8.30%
7.74%
7.89%
Page 62
Use of Services
Blue Plus
Mental Health Utilization % of Members Receiving Inpatient, Day/Night and Ambulatory
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
239701
76416
233111
76529
472812
152945
239701
76416
233111
76529
472812
152945
239701
76416
233111
76529
472812
152945
239701
76416
233111
76529
472812
152945
223152
3758
0
543027
385971
7328
0
702939
609123
11086
0
1245966
223152
3758
0
543027
385971
7328
0
702939
609123
11086
0
1245966
223152
3758
0
543027
385971
7328
0
702939
609123
11086
0
1245966
223152
3758
0
543027
385971
7328
0
702939
609123
11086
0
1245966
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
2201
1419
3620
1239
1278
2517
2878
6608
9486
33
70
103
0
0
0
6351
9375
15726
11.02%
7.30%
9.19%
19.46%
20.04%
19.75%
15.48%
20.54%
18.69%
10.54%
11.46%
11.15%
NA
NA
NA
14.03%
16.00%
15.15%
43
34
77
78
142
220
228
368
596
8
13
21
0
0
0
357
557
914
0.22%
0.18%
0.20%
1.22%
2.23%
1.73%
1.23%
1.14%
1.17%
2.55%
2.13%
2.27%
NA
NA
NA
0.79%
0.95%
0.88%
11
4
15
10
12
22
14
41
55
0
0
0
0
0
0
35
57
92
HEDIS 2007 (Reporting Year 2006)
0.06%
0.02%
0.04%
0.16%
0.19%
0.17%
0.08%
0.13%
0.11%
0.00%
0.00%
0.00%
NA
NA
NA
0.08%
0.10%
0.09%
Ambulatory Mental Health Services
Percent
Number
2197
1417
3614
1229
1260
2489
2841
6567
9408
26
63
89
0
0
0
6293
9307
15600
11.00%
7.29%
9.17%
19.30%
19.76%
19.53%
15.28%
20.42%
18.53%
8.30%
10.32%
9.63%
NA
NA
NA
13.91%
15.89%
15.02%
Page 63
Use of Services
Blue Plus
Chemical Dependency Utilization Inpatient Discharges and Average Length of
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Member Months
Male
Female
Total
159038
79539
605342
12692
0
856611
149461
76060
690984
8000
0
924505
308499
155599
1296326
20692
0
1781116
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
52
34
86
0.65
0.45
0.55
1076
1191
2267
20.69
35.03
26.36
18-64
M
F
Total
M
F
Total
M
F
Total
M
F
TOTAL
235
149
384
0.39
0.22
0.30
2844
2391
5235
12.10
16.05
13.63
1
0
1
0.08
0.00
0.05
1
0
1
1.00
NA
1.00
0
0
0
NA
NA
NA
3921
3582
7503
13.61
19.57
15.93
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
65+
Unknown
Total
HEDIS 2007 (Reporting Year 2006)
0
0
0
288
183
471
0.34
0.20
0.26
Page 64
Use of Services
Blue Plus
Chemical Dependency Utilization Inpatient Discharges and Average Length of
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
Blue Plus
Chemical Dependency Utilization Inpatient Discharges and Average Length of
Data Last Refreshed:
Sep 5, 2007 8:35 AM
MSHO
Member Months
Age
Male
Female
Total
0-12
13-17
18-64
65+
Unknown
Total
0
0
3
34548
0
34551
0
0
0
96633
0
96633
0
0
3
131181
0
131184
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
0.00
NA
0.00
0
0
0
NA
NA
NA
29
19
48
0.84
0.20
0.37
447
345
792
15.41
18.16
16.50
0
0
0
NA
NA
NA
447
345
792
15.41
18.16
16.50
Age
0-12
65+
Unknown
Total
HEDIS 2007 (Reporting Year 2006)
0
0
0
29
19
48
0.84
0.20
0.37
Page 66
Blue Plus
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
159038
79539
78516
86930
439896
12692
0
856611
Female
149461
76060
86991
110014
493979
8000
0
924505
Total
308499
155599
165507
196944
933875
20692
0
1781116
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
4
1
5
151
126
277
213
152
365
164
94
258
673
389
1062
8
2
10
0
0
0
1213
764
1977
HEDIS 2007 (Reporting Year 2006)
Percent
0.03%
0.01%
0.02%
2.28%
1.99%
2.14%
NR
NR
NA
1.24%
0.75%
1.00%
1.84%
0.94%
1.36%
0.76%
0.30%
0.58%
NA
NA
NA
1.70%
0.99%
1.33%
Member Months (Inpatient)
Male
159038
79539
78516
86930
439896
12692
0
856611
Female
149461
76060
86991
110014
493979
8000
0
924505
Total
308499
155599
165507
196944
933875
20692
0
1781116
Member Months (Day/Night)
Male
159038
79539
78516
86930
439896
12692
0
856611
Female
149461
76060
86991
110014
493979
8000
0
924505
Total
308499
155599
165507
196944
933875
20692
0
1781116
Member Months (Ambulatory)
Male
159038
79539
78516
86930
439896
12692
0
856611
Female
149461
76060
86991
110014
493979
8000
0
924505
Total
308499
155599
165507
196944
933875
20692
0
1781116
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
0
0
0
49
50
99
61
31
92
33
26
59
213
121
334
4
1
5
0
0
0
360
229
589
Number
0
0
0
5
10
15
10
5
15
3
3
6
14
6
20
0
0
0
0
0
0
32
24
56
Number
4
1
5
140
100
240
180
136
316
153
84
237
601
341
942
6
2
8
0
0
0
1084
664
1748
Percent
0.00%
0.00%
0.00%
0.74%
0.79%
0.76%
NR
NR
NA
0.25%
0.21%
0.23%
0.58%
0.29%
0.43%
0.38%
0.15%
0.29%
NA
NA
NA
0.50%
0.30%
0.40%
Percent
0.00%
0.00%
0.00%
0.08%
0.16%
0.12%
NR
NR
NA
0.02%
0.02%
0.02%
0.04%
0.01%
0.03%
0.00%
0.00%
0.00%
NA
NA
NA
0.04%
0.03%
0.04%
Percent
0.03%
0.01%
0.02%
2.11%
1.58%
1.85%
NR
NR
NA
1.15%
0.67%
0.92%
1.64%
0.83%
1.21%
0.57%
0.30%
0.46%
NA
NA
NA
1.52%
0.86%
1.18%
Page 67
Blue Plus
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Medicare Advantage
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 68
Blue Plus
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Sep 5, 2007 8:35 AM
MSHO
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
0
0
0
0
3
34548
0
34551
Female
0
0
0
0
0
96633
0
96633
Total
0
0
0
0
3
131181
0
131184
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
93
87
180
0
0
0
93
87
180
HEDIS 2007 (Reporting Year 2006)
Percent
NA
NA
NA
NA
NA
NA
NR
NR
NA
NA
NA
NA
0.00%
NA
0.00%
3.23%
1.08%
1.65%
NA
NA
NA
3.23%
1.08%
1.65%
Member Months (Inpatient)
Male
0
0
0
0
3
34548
0
34551
Female
0
0
0
0
0
96633
0
96633
Total
0
0
0
0
3
131181
0
131184
Member Months (Day/Night)
Male
0
0
0
0
3
34548
0
34551
Female
0
0
0
0
0
96633
0
96633
Total
0
0
0
0
3
131181
0
131184
Member Months (Ambulatory)
Male
0
0
0
0
3
34548
0
34551
Female
0
0
0
0
0
96633
0
96633
Total
0
0
0
0
3
131181
0
131184
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
61
52
113
0
0
0
61
52
113
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
54
44
98
0
0
0
54
44
98
Percent
NA
NA
NA
NA
NA
NA
NR
NR
NA
NA
NA
NA
0.00%
NA
0.00%
2.12%
0.65%
1.03%
NA
NA
NA
2.12%
0.65%
1.03%
Percent
NA
NA
NA
NA
NA
NA
NR
NR
NA
NA
NA
NA
0.00%
NA
0.00%
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
0.00%
NA
0.00%
1.88%
0.55%
0.90%
NA
NA
NA
1.88%
0.55%
0.90%
Page 69
Blue Plus
Use of Services
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Medicaid
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
239701
76416
52981
49528
120643
3758
0
543027
Female
233111
76529
104341
104828
176802
7328
0
702939
Total
472812
152945
157322
154356
297445
11086
0
1245966
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
7
2
9
294
215
509
439
482
921
511
614
1125
991
906
1897
14
5
19
0
0
0
2256
2224
4480
HEDIS 2007 (Reporting Year 2006)
Percent
0.04%
0.01%
0.02%
4.62%
3.37%
3.99%
NR
NR
NA
2.56%
3.16%
2.86%
9.86%
6.15%
7.65%
4.47%
0.82%
2.06%
NA
NA
NA
4.99%
3.80%
4.31%
Member Months (Inpatient)
Male
239701
76416
52981
49528
120643
3758
0
543027
Female
233111
76529
104341
104828
176802
7328
0
702939
Total
472812
152945
157322
154356
297445
11086
0
1245966
Member Months (Day/Night)
Male
239701
76416
52981
49528
120643
3758
0
543027
Female
233111
76529
104341
104828
176802
7328
0
702939
Total
472812
152945
157322
154356
297445
11086
0
1245966
Member Months (Ambulatory)
Male
239701
76416
52981
49528
120643
3758
0
543027
Female
233111
76529
104341
104828
176802
7328
0
702939
Total
472812
152945
157322
154356
297445
11086
0
1245966
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
3
0
3
97
87
184
118
137
255
143
171
314
352
310
662
6
1
7
0
0
0
719
706
1425
Number
0
0
0
21
11
32
19
11
30
26
21
47
21
25
46
1
0
1
0
0
0
88
68
156
Number
6
2
8
258
179
437
388
418
806
459
558
1017
875
811
1686
11
4
15
0
0
0
1997
1972
3969
Percent
0.02%
0.00%
0.01%
1.52%
1.36%
1.44%
NR
NR
NA
0.72%
0.88%
0.80%
3.50%
2.10%
2.67%
1.92%
0.16%
0.76%
NA
NA
NA
1.59%
1.21%
1.37%
Percent
0.00%
0.00%
0.00%
0.33%
0.17%
0.25%
NR
NR
NA
0.13%
0.11%
0.12%
0.21%
0.17%
0.19%
0.32%
0.00%
0.11%
NA
NA
NA
0.19%
0.12%
0.15%
Percent
0.03%
0.01%
0.02%
4.05%
2.81%
3.43%
NR
NR
NA
2.30%
2.87%
2.58%
8.70%
5.50%
6.80%
3.51%
0.66%
1.62%
NA
NA
NA
4.41%
3.37%
3.82%
Page 70
Use of Services
Blue Plus
Outpatient Drug Utilization
Commercial
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
227339
289402
589229
630670
19274
1029
77
0
1757020
Total Cost of
Prescriptions
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Data Last Refreshed:
Sep 5, 2007 8:35 AM
$4,306,371.00
$9,515,463.00
$28,643,831.00
$68,411,976.00
$3,221,563.00
$208,582.00
$7,318.00
$0.00
$114,315,104.00
HEDIS 2007 (Reporting Year 2006)
Avg. Cost of
Prescriptions /
Per Member Per
Month
$18.94
$32.88
$48.61
$108.48
$167.15
$202.70
$95.04
$65.06
Total Number of
Prescriptions
69441
125102
491381
1240913
64208
5054
250
0
1996349
Avg. Num. Of
Prescriptions /
Per Member Per
Year
3.67
5.19
10.01
23.61
39.98
58.94
38.96
13.63
Page 71
Use of Services
Blue Plus
Outpatient Drug Utilization
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
Blue Plus
Outpatient Drug Utilization
MSHO
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
0
0
3
0
34330
44531
52320
0
131184
Total Cost of
Prescriptions
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Data Last Refreshed:
Sep 5, 2007 8:35 AM
$0.00
$0.00
$81.00
$0.00
$10,089,436.00
$13,108,055.00
$14,167,385.00
$0.00
$37,364,957.00
HEDIS 2007 (Reporting Year 2006)
Avg. Cost of
Prescriptions /
Per Member Per
Month
NA
NA
$27.00
NA
$293.90
$294.36
$270.78
$284.83
Total Number of
Prescriptions
0
0
5
0
243214
368662
452938
0
1064819
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NA
NA
20.00
NA
85.02
99.35
103.88
97.40
Page 73
Use of Services
Blue Plus
Outpatient Drug Utilization
Medicaid
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
382010
294179
398109
160582
5006
2943
3137
0
1245966
Total Cost of
Prescriptions
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Data Last Refreshed:
Sep 5, 2007 8:35 AM
$6,573,616.84
$8,956,307.50
$26,796,424.62
$20,322,140.41
$329,214.96
$96,562.32
$67,930.30
$0.00
$63,142,196.95
HEDIS 2007 (Reporting Year 2006)
Avg. Cost of
Prescriptions /
Per Member Per
Month
$17.21
$30.45
$67.31
$126.55
$65.76
$32.81
$21.65
$50.68
Total Number of
Prescriptions
147389
150557
510831
413754
9182
4368
5346
0
1241427
Avg. Num. Of
Prescriptions /
Per Member Per
Year
4.63
6.14
15.40
30.92
22.01
17.81
20.45
11.96
Page 74
Access/Availability of Care
Blue Plus
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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+
27040
42141
1607
25862
40878
1574
95.64%
95.40%
95.89%
97.00%
96.84%
97.17%
97.95%
97.22%
98.67%
2006
A
Page 75
Access/Availability of Care
Blue Plus
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
Blue Plus
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
9353
2006
A
0
0
9082
NA
NA
NA
NA
NA
NA
97.10%
96.76%
97.45%
Page 77
Access/Availability of Care
Blue Plus
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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+
17939
9389
466
2006
A
15636
8234
437
87.16%
86.67%
87.65%
87.70%
87.03%
88.37%
93.78%
91.48%
96.08%
Page 78
Access/Availability of Care
Blue Plus
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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.
1590
8047
7973
15899
1560
7235
7140
14654
98.11%
97.41%
98.81%
89.91%
89.24%
90.57%
89.55%
88.87%
90.23%
92.17%
91.75%
92.59%
2006
A
Page 79
Access/Availability of Care
Blue Plus
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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.
3034
9047
6460
10412
2006
A
2996
8229
5848
9541
98.75%
98.34%
99.16%
90.96%
90.36%
91.55%
90.53%
89.80%
91.25%
91.63%
91.10%
92.17%
Page 80
Access/Availability of Care
Blue Plus
Prenatal and Postpartum Care
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
General
Measure Data
Data collection methodology (Administrative or Hybrid)
H
Eligible member population (i.e. members who meet all
denominator criteria)
1661
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
411
Oversampling rate
Final sample size (FSS)
10%
453
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of
valid data errors
5
Number of administrative data records excluded
0
Number of medical records data records excluded
0
Number of employee/dependent medical records excluded
11
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
16
411
HEDIS 2007 (Reporting Year 2006)
Timeliness of
Prenatal Care
Postpartum
Care
1163
1053
70.02%
63.40%
294
277
64.90%
61.15%
295
76
278
57
90.27%
87.28%
93.25%
81.51%
77.63%
85.38%
Page 81
Access/Availability of Care
Blue Plus
Prenatal and Postpartum Care
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Medicaid
General
Measure Data
Data collection methodology (Administrative or Hybrid)
H
Eligible member population (i.e. members who meet all
denominator criteria)
3983
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
411
Oversampling rate
Final sample size (FSS)
10%
453
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of
valid data errors
2
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
2232
2386
56.04%
59.90%
247
265
54.53%
58.50%
247
103
265
37
85.16%
81.60%
88.72%
73.48%
69.09%
77.87%
2
411
Page 82
Access/Availability of Care
Blue Plus
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
13-17 Year Olds
Data Elements
Measurement Year
Data collection methodology
(Administrative only)
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
2006
A
Eligible member population (i.e. members
who meet all denominator criteria)
149
318
136
730
12
1345
61
16
122
23
50
15
301
72
4
2
538
128
Reported rate
40.94%
10.74%
38.36%
7.23%
36.76%
11.03%
41.23%
9.86%
NA
NA
40.00%
9.52%
Lower 95% confidence interval
32.71%
5.43%
32.86%
4.23%
28.29%
5.40%
37.59%
7.63%
NA
NA
37.34%
7.91%
Upper 95% confidence interval
49.17%
16.05%
43.87%
10.24%
45.24%
16.66%
44.87%
12.09%
NA
NA
42.66%
11.12%
Numerator events by administrative data
HEDIS 2007 (Reporting Year 2006)
Page 83
Access/Availability of Care
Blue Plus
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
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 84
Access/Availability of Care
Blue Plus
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Sep 5, 2007 8:35 AM
MSHO
13-17 Year Olds
Data Elements
Measurement Year
Data collection methodology
(Administrative only)
General
Measure
Data
Initiation of
AOD
Treatment
18-25 Year Olds
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)
114
114
0
0
0
0
0
0
0
0
74
3
74
3
Reported rate
NA
NA
NA
NA
NA
NA
NA
NA
64.91%
2.63%
64.91%
2.63%
Lower 95% confidence interval
Upper 95% confidence interval
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
55.71%
74.11%
0.00%
6.01%
55.71%
74.11%
0.00%
6.01%
Numerator events by administrative data
HEDIS 2007 (Reporting Year 2006)
Page 85
Access/Availability of Care
Blue Plus
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
206
472
385
888
15
1966
101
23
190
44
151
29
401
88
5
0
848
184
Reported rate
49.03%
11.17%
40.25%
9.32%
39.22%
7.53%
45.16%
9.91%
NA
NA
43.13%
9.36%
Lower 95% confidence interval
41.96%
6.62%
35.72%
6.59%
34.21%
4.77%
41.83%
7.89%
NA
NA
40.92%
8.05%
Upper 95% confidence interval
56.10%
15.71%
44.78%
12.05%
44.23%
10.30%
48.49%
11.93%
NA
NA
45.35%
10.67%
HEDIS 2007 (Reporting Year 2006)
Page 86
Health Plan Stability
Blue Plus
Years in Business / Total Membership
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
Product/Product Line
Years in Business
Members*
13.00
32.00
0.00
20.00
1.00
32.00
100353
4042
0
72153
11278
187826
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
32.00
0.00
20.00
0.00
32.00
40976
0
30769
0
71745
259571
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
Blue Plus
Years in Business / Total Membership
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
Blue Plus
Years in Business / Total Membership
Data Last Refreshed:
Sep 5, 2007 8:35 AM
MSHO
Product/Product Line
Years in Business
Members*
13.00
32.00
0.00
20.00
1.00
32.00
100353
4042
0
72153
11278
187826
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
32.00
0.00
20.00
0.00
32.00
40976
0
30769
0
71745
259571
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
Blue Plus
Years in Business / Total Membership
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Medicaid
Product/Product Line
Years in Business
Members*
13.00
32.00
0.00
20.00
1.00
32.00
100353
4042
0
72153
11278
187826
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
32.00
0.00
20.00
0.00
32.00
40976
0
30769
0
71745
259571
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
Blue Plus
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 5, 2007 8:35 AM
Commercial
<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
10224
45420
62220
70920
49764
29352
Member Months
Female
9696
42660
58740
67440
46956
30372
Total
19920
88080
120960
138360
96720
59724
267900
31.28%
49152
39612
47304
60072
74256
255864
27.68%
56604
52452
57552
69312
88188
523764
29.41%
270396
31.57%
85128
87984
81204
51216
324108
35.06%
102156
100260
82680
51360
594504
33.38%
305532
35.67%
9936
1884
636
156
24
12
336456
36.40%
6732
948
192
84
12
0
641988
36.05%
12648
1.48%
0
7968
0.86%
0
20616
1.16%
856476
924396
HEDIS 2007 (Reporting Year 2006)
105756
92064
104856
129384
162444
187284
188244
163884
102576
16668
2832
828
240
36
12
0
1780872
Page 91
Health Plan Descriptive Information
Blue Plus
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
Blue Plus
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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%
6420
6444
6396
6012
5472
3780
0
0.00%
10428
11028
14196
17904
19884
23160
0
0.00%
34524
100.00%
0
96600
100.00%
0
131124
100.00%
34524
96600
HEDIS 2007 (Reporting Year 2006)
0
0
0
0
0
0
0
0
0
16848
17472
20592
23916
25356
26940
0
131124
Page 93
Health Plan Descriptive Information
Blue Plus
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 5, 2007 8:35 AM
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
30637
80406
82531
77777
44766
22235
Member Months
Female
29670
77781
80985
75693
45511
28197
Total
60307
158187
163516
153470
90277
50432
338352
62.31%
30746
26683
22845
24040
27421
337837
48.06%
76144
60450
44378
43308
42094
676189
54.27%
131735
24.26%
25857
20683
13722
8920
266374
37.89%
35803
24237
17213
14147
398109
31.95%
69182
12.74%
1417
676
536
428
403
298
91400
13.00%
2107
806
945
1034
1147
1289
160582
12.89%
3758
0.69%
0
7328
1.04%
0
11086
0.89%
543027
702939
HEDIS 2007 (Reporting Year 2006)
106890
87133
67223
67348
69515
61660
44920
30935
23067
3524
1482
1481
1462
1550
1587
0
1245966
Page 94