Preferred One Community Health Plan
Plan Name
2005
Reporting Year
Submission #
Title
General Info
1
Last Refreshed:
23
10/7/2009 1:48:22 PM
Page
Disclaimers
Effectiveness of
Care Measures
Plan ID
2
Measure
Page
Use of Services
Measures
Page
Measure
Childhood Immunization Status
3
Well-Child Visits In The First 15 Months of Life
28
Adolescent Immunization Status
5
Well-Child Visits In The Third, Fourth, Fifth And Sixth Year of Life
30
Appropriate Treatment of Children w/ Upper Respiratory Infection
7
Adolescent Well-Care Visits
31
Colorectal Cancer Screening
9
Frequency of Selected Procedures
32
Breast Cancer Screening
10
Inpatient Utilization - General Hospital/Acute Care
34
Cervical Cancer Screening
11
Ambulatory Care
37
Chlamydia Screening in Women
12
Inpatient Utilization - Nonacute Care
39
Controlling High Blood Pressure
13
Mental Health Utilization - Inpatient Discharges and Average Length of Stay
42
Beta Blocker Treatment after a Heart Attack
14
Mental Health Utilization - % of Members Receiving Inpatient and Ambulatory Services
45
Persistence of Beta Blocker Treatment after a Heart Attack
14
Chemical Dependency Utilization - Inpatient Discharges and Average Length of Stay
49
Cholesterol Management for Patients with Cardiovascular Conditions
15
Identification of Alcohol and Other Drug Services
52
Comprehensive Diabetes Care
16
Outpatient Drug Utilization
56
Use of Appropriate Medications for People with Asthma
20
Antidepressant Medication Management
26
Osteoporosis Management in Women who had a Fracture
27
Glaucoma Screening in Older Adults
27
Access /
Availability of
Care
Measure
Measure
Page
Practitioner Turnover
69
Years in Business / Total Membership
70
Page
Adults' Access to Preventive/Ambulatory Health Services
58
Children's Access to Primary Care Practitioners
62
Prenatal and Postpartum Care
64
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
66
HEDIS 2006 (Reporting Year 2005)
Health Plan
Stability
Health Plan
Descriptive
Information
Measure
Enrollment by Product Line (Age & Sex)
Page
71
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 2006 (Reporting Year 2005)
Page 2
Effectiveness of Care
Preferred One Community Health Plan
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
HiB
Hepatitis B
VZV
Combo 3
199
45.85%
211
48.62%
363
83.64%
218
50.23%
197
45.39%
332
76.50%
117
26.96%
156
35.94%
93
21.43%
199
45.85%
211
48.62%
363
83.64%
218
50.23%
197
45.39%
332
76.50%
117
26.96%
156
35.94%
93
21.43%
188
152
82.73%
78.95%
86.50%
200
160
87.59%
84.28%
90.90%
342
39
92.70%
90.06%
95.34%
206
155
87.83%
84.55%
91.12%
187
172
87.35%
84.01%
90.68%
315
42
86.86%
83.47%
90.25%
112
110
54.01%
49.07%
58.95%
148
157
74.21%
69.86%
78.56%
89
105
47.20%
42.25%
52.15%
434
1
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
1
HEDIS 2006 (Reporting Year 2005)
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
HO
S
434
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
Pneumococcal
Combo 2
Conjugate
DTaP/DT
411
Page 3
Effectiveness of Care
Preferred One Community Health Plan
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicaid
Data Elements
General
Measure
Data
Pneumococcal
Combo 2
Conjugate
DTaP/DT
IPV
MMR
HiB
Hepatitis B
VZV
Combo 3
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of Records Excluded because of
Contraindications by Admin Data
Number of Records Excluded because of
Contraindications by Medical Record
Review
Number of employee/dependent records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 4
Effectiveness of Care
Preferred One Community Health Plan
Adolescent Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
Combo 2
186
36.69%
64
12.62%
26
5.13%
4
0.79%
167
36.87%
57
12.58%
22
4.86%
2
0.44%
150
179
80.05%
76.06%
84.03%
52
222
66.67%
61.99%
71.35%
20
145
40.15%
35.29%
45.01%
2
136
33.58%
28.89%
38.26%
453
2
Number of Records Excluded because of
Contraindications by Admin Data
0
Number of Records Excluded because of
Contraindications by Medical Record Review
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
2
HEDIS 2006 (Reporting Year 2005)
VZV
411
10.00%
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
Hepatitis B
2005
HO
S
507
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
Preferred One Community Health Plan
Adolescent Immunization Status
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicaid
Data Elements
General
Measure
Data
MMR
Hepatitis B
VZV
Combo 2
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of Records Excluded because of
Contraindications by Admin Data
Number of Records Excluded because of
Contraindications by Medical Record Review
Number of employee/dependent records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 6
Effectiveness of Care
Preferred One Community Health Plan
Appropriate Treatment for Children with Upper
Respiratory Infection
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
General
Measure
Data
2005
A
Eligible Member Population
893
Numerator Events by Admin Data
133
Reported Rate
85.11%
Lower 95% Confidence Interval
82.72%
Upper 95% Confidence Interval
87.50%
HEDIS 2006 (Reporting Year 2005)
Page 7
Effectiveness of Care
Preferred One Community Health Plan
Colorectal Cancer Screening
Data Elements
Measurement Year
Data collection methodology (administrative or hybrid)
Sampling method used (see User's Guide for entry descriptions)
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
NR
NR
NR
S
Number of numerator events by administrative data in eligible
population (before exclusions)
1792
39.47%
Minimum required sample size (MRSS) or other sample size
411
Oversampling rate
0.1
Final sample size (FSS)
453
Number of numerator events by administrative data in FSS
172
Number of original sample records excluded because of valid data
errors
Records Excluded because of contraindications through Admin
Data
Records Excluded because of contraindications through Medical
Record Review
NR
HO
4540
Administrative rate on FSS
MSHO
2005
Eligible population
Current year's administrative rate (before exclusions)
Medicare
Advantage
37.97%
0
0
0
Number of employee/dependent medical records excluded
0
Records added from the oversample list
0
Denominator
411
Numerator events by administrative data
152
FOBT by administrative data*
23
DCBE by administrative data*
4
Numerator events by medical records
37
Flexible sigmoidoscopy by medical records*
5
DCBE by medical records*
0
Colonoscopy by medical records*
32
Reported rate
45.99%
NR
NR
Lower 95% confidence interval
41.05%
NR
NR
Upper 95% confidence interval
50.93%
NR
NR
Data Elements with an Asterisk(*) are OPTIONAL and are not used in any calculation or total
HEDIS 2006 (Reporting Year 2005)
Page 8
Effectiveness of Care
Preferred One Community Health Plan
Breast Cancer Screening
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 2006 (Reporting Year 2005)
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
2005
A
2085
1485
71.22%
69.26%
73.19%
Medicare
Advantage
Medicaid
NR
NR
NR
NR
NR
NR
Page 9
Effectiveness of Care
Preferred One Community Health Plan
Cervical Cancer Screening
Data Elements
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
Measurement Year
Data Collection Methodology
2005
A
Sampling Method Used
Eligible Member Population
4014
Medicaid
Numerator Events by Admin Data on Eligible
Population (before exclusions)
Current Year's Admin Rate
75.04%
NR
NR
NR
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
Records Excluded because of contraindications
through Admin Data
Records Excluded because of contraindications
through 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 2006 (Reporting Year 2005)
3012
#VALUE!
#VALUE!
#VALUE!
NR
NR
NR
Page 10
Effectiveness of Care
Preferred One Community Health Plan
Chlamydia Screening in Women
Data Last Refreshed:
Oct 7, 2009 1:48 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 2006 (Reporting Year 2005)
General
Measure Ages 16-20 Ages 21-25
Data
Medicaid
Total
General
Measure Ages 16-20 Ages 21-25
Data
Total
2005
A
486
154
31.69%
27.45%
35.93%
673
181
26.89%
23.47%
30.32%
1159
335
28.90%
26.25%
31.56%
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 11
Effectiveness of Care
Preferred One Community Health Plan
Controlling High Blood Pressure
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Data Elements
Measurement Year
Data Collection Methodology (Hybrid)
Sampling Method Used
Eligible Member Population
Numerator Events by Admin Data on
Eligible Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Commercial
2005
HO
S
1271
0
0.00%
15.00%
473
0
0.00%
41
Records Excluded because of
contraindications through Admin Data
0
Records Excluded because of
contraindications through Medical Record
Review
0
Number of employee/dependent medical
records excluded
0
Records Added from the OverSample List
41
Denominator
411
Numerator Events by Medical Record
NR
411
Records Excluded because of Valid Data
Errors
Numerator Events by Admin Data
Medicare Advantage
NR
0
220
Reported Rate
53.53%
NR
Lower 95% Confidence Interval
48.58%
NR
Upper 95% Confidence Interval
58.47%
NR
HEDIS 2006 (Reporting Year 2005)
Page 12
Effectiveness of Care
Preferred One Community Health Plan
Beta Blocker Treatment after Heart Attack
Data Elements
Measurement Year
Data Collection Methodology
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
Eligible Member Population
26
Numerator Events by Admin Data on
Eligible Population
22
Oversampling Rate
84.62%
NR
NR
NR
16
0.00%
Final Sample Size (FSS)
16
Numerator events by admin data in FSS
13
Admin rate on FSS
NR
HO
S
Minimum Required Sample Size
MSHO
2005
Sampling Method Used
Current Year's Admin Rate
Medicare Advantage
81.25%
Records Excluded because of Valid Data
Errors
0
Records Excluded because of
contraindications through Admin Data
0
Records Excluded because of
contraindications through Medical Record
Review
0
Number of employee/dependent medical
records excluded
0
Records Added from the Oversample List
0
Denominator
16
Numerator Events by Admin Data
13
Numerator Events by Medical Record
3
Reported Rate
NA
NR
NR
Lower 95% Confidence Interval
NA
NR
NR
Upper 95% Confidence Interval
NA
NR
NR
HEDIS 2006 (Reporting Year 2005)
Page 13
Effectiveness of Care
Preferred One Community Health Plan
Persistence of Beta Blocker Treatment After Hearth Attack
Data Elements
Measurement Year
Commercial
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare Advantage
MSHO
2005
Data Collection Methodology
A
Eligible Member Population
23
Numerator Events by Admin Data on
Eligible Population
19
Reported Rate
NA
NR
NR
Lower 95% Confidence Interval
NA
NR
NR
Upper 95% Confidence Interval
NA
NR
NR
HEDIS 2006 (Reporting Year 2005)
Page 14
Effectiveness of Care
Preferred One Community Health Plan
Cholesterol Management for
Patients with Cardiovascular
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare Advantage
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
0
Records Excluded because of contraindications
through Admin Data
0
Records Excluded because of contraindications
through Medical Record Review
0
Number of employee/dependent medical
records excluded
0
HEDIS 2006 (Reporting Year 2005)
LDL-C
screening
LDL-C Level of LDL-C Level of
<100 mg/dL
<130 mg/dL
170
0
0
65.38%
0.00%
0.00%
170
0
0
65.38%
0.00%
0.00%
170
21
0
94
0
134
73.46%
67.90%
79.02%
36.15%
30.12%
42.19%
51.54%
45.27%
57.81%
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
260
0.00%
260
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
General
LDL-C Level of LDL-C Level of
Measure
<100 mg/dL
<130 mg/dL
Data
2005
HO
S
260
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
260
Page 15
Effectiveness of Care
Preferred One Community Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
HbA1c
Testing
Poor HbA1c
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<130 mg/dL
LDL-C Level
<100 mg/dL
Monitoring for
Diabetic
Nephropathy
2005
HO
S
981
2005
HO
S
981
2005
HO
S
981
2005
HO
S
981
2005
HO
S
981
2005
HO
S
981
2005
HO
S
981
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
755
76.96%
411
10%
453
351
77.48%
953
97.15%
411
10%
453
453
100.00%
491
50.05%
411
10%
453
238
52.54%
768
78.29%
411
10%
453
359
79.25%
0
0.00%
411
10%
453
0
0.00%
0
0.00%
411
10%
453
0
0.00%
539
54.94%
411
10%
453
251
55.41%
Number of Records Excluded Because of
Valid Data Errors
3
3
3
3
3
3
3
Records Excluded because of
contraindications through Admin Data
0
0
0
0
0
0
0
Records Excluded because of
contraindications through Medical Record
Review
0
0
0
0
0
0
0
Number of employee/dependent medical
records excluded
0
0
0
0
0
0
0
3
411
322
41
88.32%
85.09%
91.55%
3
411
20
130
36.50%
31.72%
41.27%
3
411
209
23
56.45%
51.53%
61.36%
3
411
330
42
90.51%
87.56%
93.47%
3
411
0
230
55.96%
51.04%
60.88%
3
411
0
162
39.42%
34.57%
44.26%
3
411
233
25
62.77%
57.98%
67.57%
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
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 2006 (Reporting Year 2005)
Page 16
Effectiveness of Care
Preferred One Community Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare Advantage
Data Elements
HbA1c
Testing
Poor HbA1c
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<130 mg/dL
LDL-C Level
<100 mg/dL
Monitoring for
Diabetic
Nephropathy
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Records Excluded because of
contraindications through Admin Data
Records Excluded because of
contraindications 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 2006 (Reporting Year 2005)
Page 17
Effectiveness of Care
Preferred One Community Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:48 PM
MSHO
Data Elements
HbA1c
Testing
Poor HbA1c
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<130 mg/dL
LDL-C Level
<100 mg/dL
Monitoring for
Diabetic
Nephropathy
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Records Excluded because of
contraindications through Admin Data
Records Excluded because of
contraindications 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 2006 (Reporting Year 2005)
Page 18
Effectiveness of Care
Preferred One Community Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicaid
Data Elements
HbA1c
Testing
Poor HbA1c
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<130 mg/dL
LDL-C Level
<100 mg/dL
Monitoring for
Diabetic
Nephropathy
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Records Excluded because of
contraindications through Admin Data
Records Excluded because of
contraindications 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 2006 (Reporting Year 2005)
Page 19
Effectiveness of Care
Preferred One Community Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 1:48 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 2006 (Reporting Year 2005)
General
Measure Data
Ages 5-9
Ages 10-17
Ages 18-56
Total
41
40
97.56%
91.62%
100.00%
59
57
96.61%
91.14%
100.00%
235
211
89.79%
85.70%
93.87%
335
308
91.94%
88.88%
95.00%
2005
A
Page 20
Effectiveness of Care
Preferred One Community Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 1:48 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 2006 (Reporting Year 2005)
General
Measure Data
Ages 5-9
NR
NR
NR
Ages 10-17
NR
NR
NR
Ages 18-56
Total
NR
NR
NR
NR
NR
NR
NR
NR
Page 21
Effectiveness of Care
Preferred One Community Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:48 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 2006 (Reporting Year 2005)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
34
16.92%
11.48%
22.35%
137
68.16%
61.47%
74.85%
119
59.20%
52.16%
66.25%
2005
A
201
Page 22
Effectiveness of Care
Preferred One Community Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:48 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 2006 (Reporting Year 2005)
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 23
Effectiveness of Care
Preferred One Community Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:48 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 2006 (Reporting Year 2005)
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 24
Effectiveness of Care
Preferred One Community Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 1:48 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 2006 (Reporting Year 2005)
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 25
Effectiveness of Care
Preferred One Community Health Plan
Osteoporosis Management in
Women Who had a Fracture
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interva
HEDIS 2006 (Reporting Year 2005)
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare
Advantage
MSHO
NR
NR
NR
NR
NR
NR
Page 26
Effectiveness of Care
Preferred One Community Health Plan
Glaucoma Screening in Older Adults
Data Elements
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare
Advantage
MSHO
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 Interva
HEDIS 2006 (Reporting Year 2005)
Page 27
Use of Services
Preferred One Community Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
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
9
4
5
12
26
75
266
2.27%
0.68%
3.86%
1.01%
0.00%
2.12%
1.26%
0.04%
2.48%
3.02%
1.21%
4.83%
6.55%
3.99%
9.11%
18.89%
14.92%
22.87%
67.00%
62.25%
71.75%
2005
A
397
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 2006 (Reporting Year 2005)
Page 28
Use of Services
Preferred One Community Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicaid
Data Elements
General
Measure
Data
Zero Visits
1 visit
2 visits
3 visits
4 visits
5 visits
6 or more
visits
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of records excluded because of
contraindications identified through
administrative data
Number of records excluded because of
contraindications identified through medical
record review
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 29
Use of Services
Preferred One Community Health Plan
Well Child Visits in the 3rd, 4th,
5th and 6th Years of Life
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
Medicaid
2005
A
1934
Numerator events by admin data in eligible
population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Records Excluded because of Valid Data Errors
NR
NR
NR
NR
Records Excluded - Contraindications/Admin Data
Records Excluded - Contraindications/Medical
Record Review
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
1092
56.46%
54.23%
58.70%
NR
NR
NR
Page 30
Use of Services
Preferred One Community Health Plan
Adolescent Well-Care Visits
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
Medicaid
2005
A
5151
Numerator events by admin data in eligible
population
Current Year's Admin Rate
NR
NR
NR
NR
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 2006 (Reporting Year 2005)
1473
28.60%
27.35%
29.84%
NR
NR
NR
Page 31
Use of Services
Preferred One Community Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
Measurement Year
2005
Member Months
Total
Age
0-4
0-9
5-19
10-19
39532
79774
126503
86261
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
224
68
48
31
Procedures /
1,000 Member
Months
5.67
0.54
0.60
0.36
Member Months
Male
Female
135439
120917
114340
155594
79420
80230
2842
2506
Female
Male
Procedure
Age
Dilation & Curettage 15-44
45-64
Hysterectomy,
15-44
Abdominal
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
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 2006 (Reporting Year 2005)
Number of
Procedures
3
0
18
0
76
142
32
3
48
7
12
4
15
2
Procedures /
1,000 Member
Months
Number of
Procedures
11
8
20
46
0
30
28
0
Procedures /
1,000 Member
Months
0.08
0.10
0.15
0.57
0.00
0.22
0.35
0.00
0.02
0.00
0.12
0.00
0.63
1.79
0.40
1.06
0.60
2.46
0.15
1.41
0.19
0.70
3
3
0
0.02
0.04
0.00
53
30
1
138
150
12
0
33
3
3
1
0.39
0.37
0.40
1.21
1.87
0.15
0.00
0.41
1.20
0.04
0.40
4
21
0
25
42
3
0.03
0.26
0.00
0.18
0.52
1.20
Page 32
Use of Services
Preferred One Community Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare Advantage
Measurement Year
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)
Hysterectomy
Abdominal
Hysterectomy,
Vaginal
Prostatectomy
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 2006 (Reporting Year 2005)
Number of
Procedures
Female
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
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 33
Use of Services
Preferred One Community Health Plan
Inpatient Utilization - General Hospital/Acute Care
Commercial
Measurement
Year
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
65-74
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 1:48 PM
2005
Member Months
7856
71918
86261
235257
159650
5053
273
22
0
566290
Discharges
Discharges /
1,000 Member
Months
91
110
123
1235
1067
62
11
2
0
2701
11.58
1.53
1.43
5.25
6.68
12.27
40.29
90.91
89
96
68
267
524
38
8
2
0
1092
11.33
1.33
0.79
1.13
3.28
7.52
29.30
90.91
2
14
33
269
541
24
3
0
0
886
0.25
0.19
0.38
1.14
3.39
4.75
10.99
0.00
22
699
2
0
0
723
0.26
2.97
0.01
0.00
HEDIS 2006 (Reporting Year 2005)
4.77
1.93
1.56
1.49
Days
Days / 1,000
Member
Months
607
235
370
3305
4014
298
48
6
0
8883
77.27
3.27
4.29
14.05
25.14
58.97
175.82
272.73
604
201
206
728
1949
173
33
6
0
3900
76.88
2.79
2.39
3.09
12.21
34.24
120.88
272.73
3
34
108
786
2060
125
15
0
0
3131
0.38
0.47
1.25
3.34
12.90
24.74
54.95
0.00
56
1791
5
0
0
1852
0.65
7.61
0.03
0.00
15.69
6.89
5.53
3.81
Average
Length of Stay
6.67
2.14
3.01
2.68
3.76
4.81
4.36
3.00
NA
3.29
6.79
2.09
3.03
2.73
3.72
4.55
4.13
3.00
NA
3.57
1.50
2.43
3.27
2.92
3.81
5.21
5.00
NA
NA
3.53
2.55
2.56
2.50
NA
NA
2.56
Page 34
Use of Services
Preferred One Community Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare Advantage
Measurement
Year
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
65-74
Unknown
Total
Member Months
NR
Discharges
Discharges /
1,000 Member
Months
Days
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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
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
NR
Page 35
Use of Services
Preferred One Community Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 7, 2009 1:48 PM
MSHO
Measurement
Year
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
65-74
Unknown
Total
Member Months
NR
Discharges
Discharges /
1,000 Member
Months
Days
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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
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
NR
Page 36
Use of Services
Preferred One Community Health Plan
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
Measurement
Year
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
2005
Member
Months
7856
71918
86261
235257
159650
5053
273
22
0
566290
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
6639
20985
17233
52952
49908
2326
171
6
0
150220
HEDIS 2006 (Reporting Year 2005)
Visits/ 1,000
Member
Months
845.09
291.79
199.78
225.08
312.61
460.32
626.37
272.73
265.27
Emergency Room Visits
Visits
227
1088
896
2463
1412
56
7
1
0
6150
Visits/ 1,000
Member
Months
28.90
15.13
10.39
10.47
8.84
11.08
25.64
45.45
10.86
Ambulatory
Surgery/Procedures
Procedures
59
282
247
1413
2732
120
8
0
0
4861
Procedures/
1,000 Member
Months
7.51
3.92
2.86
6.01
17.11
23.75
29.30
0.00
8.58
Observation Room Stays
Resulting in Discharge
Stays
14
15
10
211
66
2
0
1
0
319
Stays/ 1,000
Member
Months
1.78
0.21
0.12
0.90
0.41
0.40
0.00
45.45
0.56
Page 37
Use of Services
Preferred One Community Health Plan
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare Advantage
Measurement
Year
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
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
NR
HEDIS 2006 (Reporting Year 2005)
Visits/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Emergency Room Visits
Visits
NR
Visits/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Ambulatory
Surgery/Procedures
Procedures
NR
Procedures/
1,000 Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Observation Room Stays
Resulting in Discharge
Stays
NR
Stays/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 38
Use of Services
Preferred One Community Health Plan
Inpatient Utilization - Nonacute Care
Commercial
Measurement
Year
Age
2005
Member
Months
<1
7856
1-9
71918
10-19
86261
20-44
235257
45-64
159650
65-74
5053
75-84
273
85+
22
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 1:48 PM
0
566290
Discharges
Discharges /
1,000 Member
Months
Days
Days / 1,000
Member
Months
Average Length
of Stay
<1
0
1-9
0
0.00
0
0.00
NA
0.00
0
0.00
NA
10-19
1
0.01
14
0.16
14.00
20-44
4
0.02
32
0.14
8.00
45-64
36
0.23
338
2.12
9.39
65-74
4
0.79
24
4.75
6.00
75-84
1
3.66
7
25.64
7.00
85+
0
0.00
0
0.00
NA
Unknown
0
46
0.08
0
415
0.73
NA
9.02
Age
Total
HEDIS 2006 (Reporting Year 2005)
Page 39
Use of Services
Preferred One Community Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare Advantage
Measurement
Year
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 2006 (Reporting Year 2005)
NR
NR
Page 40
Use of Services
Preferred One Community Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 1:48 PM
MSHO
Measurement
Year
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 2006 (Reporting Year 2005)
NR
NR
Page 41
Use of Services
Preferred One Community Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Commercial
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 1:48 PM
2005
Male
Member Months
Female
Total
52611
23308
208211
2842
0
286972
52438
22183
202191
2506
0
279318
105049
45491
410402
5348
0
566290
Discharges
Discharges /
1,000 Member
Months
Age
0-12
Days*
Average
Length of Stay
Gender
M
3
0.06
115
38.33
F
3
0.06
120
40.00
Total
6
0.06
235
39.17
13-17
M
9
0.39
27
3.00
F
17
0.77
125
7.35
Total
26
0.57
152
5.85
18-64
M
35
0.17
187
5.34
F
54
0.27
356
6.59
Total
89
0.22
543
6.10
M
65+
0
0.00
0
NA
F
0
0.00
0
NA
Total
0
0.00
0
NA
M
Unknown
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
47
0.16
329
7.00
F
74
0.26
601
8.12
TOTAL
121
0.21
930
7.69
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 42
Use of Services
Preferred One Community Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare Advantage
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
Discharges
Age
0-12
Discharges /
1,000 Member
Months
Days*
Average
Length of Stay
Gender
M
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
13-17
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
18-64
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
65+
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
Unknown
NR
F
NR
Total
NR
NR
NR
Total
M
NR
NR
NR
NR
F
NR
NR
NR
NR
TOTAL
NR
NR
NR
NR
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 43
Use of Services
Preferred One Community Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Oct 7, 2009 1:48 PM
MSHO
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
Discharges
Age
0-12
Discharges /
1,000 Member
Months
Days*
Average
Length of Stay
Gender
M
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
13-17
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
18-64
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
65+
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
Unknown
NR
F
NR
Total
NR
NR
NR
Total
M
NR
NR
NR
NR
F
NR
NR
NR
NR
TOTAL
NR
NR
NR
NR
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 44
Use of Services
Preferred One Community Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
Measurement Year
2005
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
0-12
Member Months (Ambulatory)
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
52611
23308
52438
22183
105049
45491
52611
23308
52438
22183
105049
45491
52611
23308
52438
22183
105049
45491
52611
23308
52438
22183
105049
45491
208211
2842
0
286972
202191
2506
0
279318
410402
5348
0
566290
208211
2842
0
286972
202191
2506
0
279318
410402
5348
0
566290
208211
2842
0
286972
202191
2506
0
279318
410402
5348
0
566290
208211
2842
0
286972
202191
2506
0
279318
410402
5348
0
566290
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
Age
Member Months (Inpatient)
Male
Number
Percent
Inpatient Mental Health Services
Percent
Number
Day/Night Mental Health Services
Percent
Number
Ambulatory Mental Health Services
Percent
Number
247
137
384
196
219
415
944
1614
2558
6
8
14
0
0
0
1393
1978
3371
5.63%
3.14%
4.39%
10.09%
11.85%
10.95%
5.44%
9.58%
7.48%
2.53%
3.83%
3.14%
NA
NA
NA
5.82%
8.50%
7.14%
2
1
3
5
17
22
31
46
77
0
0
0
0
0
0
38
64
102
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
246
137
383
195
218
413
935
1609
2544
6
8
14
0
0
0
1382
1972
3354
HEDIS 2006 (Reporting Year 2005)
0.05%
0.02%
0.03%
0.26%
0.92%
0.58%
0.18%
0.27%
0.23%
0.00%
0.00%
0.00%
NA
NA
NA
0.16%
0.27%
0.22%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
5.61%
3.14%
4.38%
10.04%
11.79%
10.89%
5.39%
9.55%
7.44%
2.53%
3.83%
3.14%
NA
NA
NA
5.78%
8.47%
7.11%
Page 45
Use of Services
Preferred One Community Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare Advantage
Measurement Year
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
Female
NR
Member Months (Inpatient)
Total
0-12
13-17
18-64
65+
Unknown
Total
Sex
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
HEDIS 2006 (Reporting Year 2005)
Female
Total
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
Age
Male
Member Months (Day/Night)
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 46
Use of Services
Preferred One Community Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 7, 2009 1:48 PM
MSHO
Measurement Year
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
Female
NR
Member Months (Inpatient)
Total
0-12
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 2006 (Reporting Year 2005)
Female
Total
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
Age
Male
Member Months (Day/Night)
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 47
Use of Services
Preferred One Community Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicaid
Measurement Year
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
Female
NR
Member Months (Inpatient)
Total
0-12
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 2006 (Reporting Year 2005)
Female
Total
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
Age
Male
Member Months (Day/Night)
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 48
Use of Services
Preferred One Community Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Commercial
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 1:48 PM
2005
Male
Member Months
Female
Total
52611
23308
208211
2842
0
286972
52438
22183
202191
2506
0
279318
105049
45491
410402
5348
0
566290
Discharges
Discharges /
1,000 Member
Months
Age
0-12
Days
Average
Length of Stay
M
0
0.00
0
NA
F
0
0.00
0
NA
Total
0
0.00
0
NA
M
13-17
8
0.34
103
12.88
F
7
0.32
13
1.86
Total
15
0.33
116
7.73
M
18-64
54
0.26
470
8.70
F
45
0.22
361
8.02
Total
99
0.24
831
8.39
M
65+
1
0.35
3
3.00
F
0
0.00
0
NA
Total
1
0.19
3
3.00
M
Unknown
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
63
0.22
576
9.14
F
52
0.19
374
7.19
TOTAL
115
0.20
950
8.26
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 49
Use of Services
Preferred One Community Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare Advantage
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
Discharges
Age
0-12
Discharges /
1,000 Member
Months
Days
Average
Length of Stay
M
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
13-17
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
18-64
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
65+
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
Unknown
NR
F
NR
Total
NR
NR
NR
Total
M
NR
NR
NR
NR
F
NR
NR
NR
NR
TOTAL
NR
NR
NR
NR
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 50
Use of Services
Preferred One Community Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Oct 7, 2009 1:48 PM
MSHO
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
Discharges
Age
0-12
Discharges /
1,000 Member
Months
Days
Average
Length of Stay
M
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
13-17
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
18-64
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
65+
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
Unknown
NR
F
NR
Total
NR
NR
NR
Total
M
NR
NR
NR
NR
F
NR
NR
NR
NR
TOTAL
NR
NR
NR
NR
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 51
Use of Services
Preferred One Community Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
Measurement Year
2005
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
52611
23308
28408
47410
132393
2842
0
286972
Female
52438
22183
25919
44929
131343
2506
0
279318
Total
105049
45491
54327
92339
263736
5348
0
566290
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
33
23
56
38
25
63
53
20
73
173
113
286
2
0
2
0
0
0
299
181
480
HEDIS 2006 (Reporting Year 2005)
Percent
0.00%
0.00%
0.00%
1.70%
1.24%
1.48%
NR
NR
NA
1.21%
0.46%
0.83%
1.57%
1.03%
1.30%
0.84%
0.00%
0.45%
NA
NA
NA
1.25%
0.78%
1.02%
Member Months (Inpatient)
Male
52611
23308
28408
47410
132393
2842
0
286972
Female
52438
22183
25919
44929
131343
2506
0
279318
Total
105049
45491
54327
92339
263736
5348
0
566290
Member Months (Day/Night)
Male
52611
23308
28408
47410
132393
2842
0
286972
Female
52438
22183
25919
44929
131343
2506
0
279318
Total
105049
45491
54327
92339
263736
5348
0
566290
Member Months (Ambulatory)
Male
52611
23308
28408
47410
132393
2842
0
286972
Female
52438
22183
25919
44929
131343
2506
0
279318
Total
105049
45491
54327
92339
263736
5348
0
566290
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
0
0
0
11
9
20
10
12
22
14
10
24
68
41
109
1
0
1
0
0
0
104
72
176
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
28
19
47
35
17
52
43
15
58
129
91
220
1
0
1
0
0
0
236
142
378
Percent
0.00%
0.00%
0.00%
0.57%
0.49%
0.53%
NR
NR
NA
0.32%
0.23%
0.27%
0.62%
0.37%
0.50%
0.42%
0.00%
0.22%
NA
NA
NA
0.43%
0.31%
0.37%
Percent
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
NR
NR
NA
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
Percent
0.00%
0.00%
0.00%
1.44%
1.03%
1.24%
NR
NR
NA
0.98%
0.34%
0.66%
1.17%
0.83%
1.00%
0.42%
0.00%
0.22%
NA
NA
NA
0.99%
0.61%
0.80%
Page 52
Use of Services
Preferred One Community Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare Advantage
Measurement Year
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 2006 (Reporting Year 2005)
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Inpatient)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Day/Night)
Member Months (Ambulatory)
Male
Female
Male
Female
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
Number
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 53
Use of Services
Preferred One Community Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:48 PM
MSHO
Measurement Year
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 2006 (Reporting Year 2005)
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Inpatient)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Day/Night)
Member Months (Ambulatory)
Male
Female
Male
Female
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
Number
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 54
Use of Services
Preferred One Community Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicaid
Measurement Year
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 2006 (Reporting Year 2005)
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Inpatient)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Day/Night)
Member Months (Ambulatory)
Male
Female
Male
Female
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
Number
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 55
Use of Services
Preferred One Community Health Plan
Outpatient Drug Utilization
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
Measurement
Year
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
2005
Member Months
78447
84884
231826
157581
4980
273
22
0
558013
Age
Total Cost of
Prescriptions
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
$1,010,578.89
$2,007,675.48
$8,319,750.14
$13,610,273.64
$705,621.60
$71,547.91
$1,833.13
$0.00
$25,727,280.79
HEDIS 2006 (Reporting Year 2005)
Avg. Cost of
Prescriptions /
Per Member Per
Month
$12.88
$23.65
$35.89
$86.37
$141.69
$262.08
$83.32
$46.11
Total Number of
Prescriptions
19375
26204
125077
210850
11703
1244
39
0
394492
Avg. Num. Of
Prescriptions /
Per Member Per
Year
2.96
3.70
6.47
16.06
28.20
54.68
21.27
8.48
Page 56
Use of Services
Preferred One Community Health Plan
Outpatient Drug Utilization
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare Advantage
Measurement
Year
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
NR
Age
Total Cost of
Prescriptions
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Avg. Cost of
Prescriptions /
Per Member Per
Month
Total Number of
Prescriptions
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
NR
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 57
Access/Availability of Care
Preferred One Community Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:48 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 2006 (Reporting Year 2005)
Ages 20-44
Ages 45-64
Ages 65+
4255
4207
158
3951
3980
155
92.86%
92.07%
93.64%
94.60%
93.91%
95.30%
98.10%
95.66%
100.00%
2005
A
Page 58
Access/Availability of Care
Preferred One Community Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:48 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 2006 (Reporting Year 2005)
Page 59
Access/Availability of Care
Preferred One Community Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:48 PM
MSHO
Data Elements
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data collection methodology (Administrativ
only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Page 60
Access/Availability of Care
Preferred One Community Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicaid
Data Elements
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data collection methodology (Administrativ
only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Page 61
Access/Availability of Care
Preferred One Community Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 1:48 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 2006 (Reporting Year 2005)
General Measure
Data
12-24 months
25 months - 6
yrs.
7-11 yrs.
12-19 yrs.
518
2343
1647
2934
497
2036
1364
2452
95.95%
94.15%
97.74%
86.90%
85.51%
88.28%
82.82%
80.97%
84.67%
83.57%
82.21%
84.93%
2005
A
Page 62
Access/Availability of Care
Preferred One Community Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicaid
Data Elements
General Measure
Data
12-24 months
25 months - 6
yrs.
7-11 yrs.
12-19 yrs.
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data collection methodology (Administrativ
only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Page 63
Access/Availability of Care
Preferred One Community Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Commercial
Timeliness of
Prenatal Care
Postpartum
Care
2005
HO
2005
HO
S
S
Eligible member population (i.e. members who meet all
denominator criteria)
591
591
Number of numerator events by administrative data in
eligible population (before exclusions)
419
350
Current year's administrative rate (before exclusions)
Measurement Year
Data collection methodology (Administrative or Hybrid)
Sampling method used (see User's Guide for entry
descriptions)
70.90%
59.22%
Minimum required sample size (MRSS) or other sample
size
411
411
Oversampling rate
Final sample size (FSS)
10%
453
10%
453
Number of numerator events by administrative data in FSS
329
277
72.63%
61.15%
Number of original sample records excluded because of
valid data errors
3
3
Number of employee/dependent medical records
excluded
0
0
3
411
303
59
3
411
253
61
88.08%
84.82%
91.33%
76.40%
72.17%
80.63%
Administrative rate on FSS
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Page 64
Access/Availability of Care
Preferred One Community Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicaid
Timeliness of
Prenatal Care
Postpartum
Care
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data collection methodology (Administrative or Hybrid)
Sampling method used (see User's Guide for entry
descriptions)
Eligible member population (i.e. members who meet all
denominator criteria)
Number of numerator events by administrative data in
eligible population (before exclusions)
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample
size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of
valid data errors
Number of employee/dependent medical records
excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Page 65
Access/Availability of Care
Preferred One Community Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:48 PM
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
2005
A
Eligible member population (i.e. members
who meet all denominator criteria)
42
60
46
202
2
352
16
7
22
6
15
2
60
12
0
0
113
27
Reported rate
38.10%
16.67%
36.67%
10.00%
32.61%
4.35%
29.70%
5.94%
NA
NA
32.10%
7.67%
Lower 95% confidence interval
22.22%
4.21%
23.64%
1.58%
17.97%
0.00%
23.15%
2.43%
NA
NA
27.08%
4.75%
Upper 95% confidence interval
53.97%
29.13%
49.69%
18.42%
47.24%
11.33%
36.25%
9.45%
NA
NA
37.12%
10.59%
Numerator events by administrative data
HEDIS 2006 (Reporting Year 2005)
Page 66
Access/Availability of Care
Preferred One Community Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:48 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
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 2006 (Reporting Year 2005)
Page 67
Access/Availability of Care
Preferred One Community Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 1:48 PM
MSHO
13-17 Year Olds
Data Elements
General
Measure
Data
Initiation of
AOD
Treatment
18-25 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
26-34 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
35-64 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
65+ Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Overall Rate
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement
of AOD
Treatment
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
NR
Numerator events by administrative data
NR
NR
Reported rate
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Lower 95% confidence interval
Upper 95% confidence interval
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
Page 68
Health Plan Stability Preferred One Community Health Plan
Practitioner Turnover
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare Advantage
Measurement Year
Practitioner Types
Number of
Practitioners
as of
12/31/2004
Number of
Practitioners who
were not affiliated
with the plan as of
12/31/2005
Practitioner
Turnover Rate
Practitioner
Retention Rate
Primary Care
Physicians
NR
NR
Non-Physician Primary
Care Practitioners
NR
NR
HEDIS 2006 (Reporting Year 2005)
Page 69
Health Plan Stability
Preferred One Community Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare Advantage
Measurement Year
Product/Product Line
Years in Business
Members*
NR
NR
NR
NR
NR
NR
HMO (Total)
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
PPO (Total)
Commercial
Medicare (cost or risk)
Self-insured
Other
POS (Total)
Commercial
Medicare (cost or risk)
Self-insured
Other
NR
Total
* Total number of members in each category as of December 31, 2005
HEDIS 2006 (Reporting Year 2005)
Page 70
Health Plan Descriptive Information Preferred One Community Health Plan
Enrollment by Product Line (Age & Sex)
Commercial
Measurement Year
<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
Data Last Refreshed:
Oct 7, 2009 1:48 PM
2005
Male
3972
15576
20688
21384
14292
7872
Member Months
Female
3888
16092
19548
21600
13476
7620
83784
29.20%
20532
24204
23196
24780
28200
82224
29.44%
18300
22800
22128
23784
27336
120912
42.14%
28272
23328
16860
10956
114348
40.94%
27000
23376
17868
11988
79416
27.68%
2052
636
120
24
12
0
80232
28.72%
1980
384
120
12
12
0
2844
0.99%
0
2508
0.90%
0
286956
279312
HEDIS 2006 (Reporting Year 2005)
Total
7860
31668
40236
42984
27768
15492
166008
29.32%
38832
47004
45324
48564
55536
235260
41.55%
55272
46704
34728
22944
159648
28.19%
4032
1020
240
36
24
0
5352
0.95%
0
566268
Page 71
Health Plan Descriptive Information Preferred One Community Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicare Advantage
Measurement Year
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: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Member Months
Female
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
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
Page 72
Health Plan Descriptive Information Preferred One Community Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:48 PM
MSHO
Measurement Year
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: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Member Months
Female
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
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
Page 73
Health Plan Descriptive Information Preferred One Community Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 1:48 PM
Medicaid
Measurement Year
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: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Member Months
Female
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
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
Page 74