Metropolitan Health Plan
Plan Name
2005
Reporting Year
Submission #
Title
General Info
1
Last Refreshed:
7
10/7/2009 11:35:35 AM
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
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
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 3
Effectiveness of Care
Metropolitan Health Plan
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Medicaid
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
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
250
272
295
261
258
292
196
216
167
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
2005
A
309
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
Metropolitan Health Plan
Adolescent Immunization Status
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
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 5
Effectiveness of Care
Metropolitan Health Plan
Adolescent Immunization Status
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Medicaid
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
Combo 2
190
81.20%
25
10.68%
100
42.74%
17
7.26%
189
81.12%
25
10.73%
100
42.92%
17
7.30%
188
25
91.81%
88.07%
95.55%
25
139
70.69%
64.62%
76.76%
100
75
75.43%
69.68%
81.19%
17
118
58.19%
51.63%
64.75%
233
0
Number of Records Excluded because of
Contraindications by Admin Data
1
Number of Records Excluded because of
Contraindications by Medical Record Review
1
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
HEDIS 2006 (Reporting Year 2005)
VZV
233
0.00%
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
Hepatitis B
2005
HO
S
234
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
232
Page 6
Effectiveness of Care
Metropolitan Health Plan
Appropriate Treatment for Children with Upper
Respiratory Infection
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
Data Elements
General
Measure
Data
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
NR
Lower 95% Confidence Interval
NR
Upper 95% Confidence Interval
NR
HEDIS 2006 (Reporting Year 2005)
Page 7
Effectiveness of Care
Metropolitan Health Plan
Colorectal Cancer Screening
Data Elements
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
Medicare
Advantage
Measurement Year
MSHO
2005
Data collection methodology (administrative or hybrid)
HO
Sampling method used (see User's Guide for entry descriptions)
S
Eligible population
258
Number of numerator events by administrative data in eligible
population (before exclusions)
94
Current year's administrative rate (before exclusions)
NR
NR
Minimum required sample size (MRSS) or other sample size
36.43%
256
Oversampling rate
0
Final sample size (FSS)
256
Number of numerator events by administrative data in FSS
94
Administrative rate on FSS
NR
NR
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
36.72%
0
2
0
Number of employee/dependent medical records excluded
0
Records added from the oversample list
0
Denominator
256
Numerator events by administrative data
94
FOBT by administrative data*
2
DCBE by administrative data*
0
Numerator events by medical records
44
Flexible sigmoidoscopy by medical records*
2
DCBE by medical records*
0
Colonoscopy by medical records*
28
Reported rate
NR
NR
53.91%
Lower 95% confidence interval
NR
NR
47.60%
Upper 95% confidence interval
NR
NR
60.21%
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
Metropolitan 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 11:35 AM
Commercial
NR
NR
NR
Medicare
Advantage
NR
NR
NR
Medicaid
2005
A
103
54
52.43%
42.30%
62.56%
Page 9
Effectiveness of Care
Metropolitan Health Plan
Cervical Cancer Screening
Data Elements
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
Medicaid
Measurement Year
Data Collection Methodology
Sampling Method Used
2005
A
Eligible Member Population
839
Numerator Events by Admin Data on Eligible
Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
NR
66.15%
NR
NR
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)
555
NR
NR
NR
#VALUE!
#VALUE!
#VALUE!
Page 10
Effectiveness of Care
Metropolitan Health Plan
Chlamydia Screening in Women
Data Last Refreshed:
Oct 7, 2009 11:35 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 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
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
244
185
75.82%
70.24%
81.40%
150
110
73.33%
65.92%
80.74%
394
295
74.87%
70.46%
79.28%
Page 11
Effectiveness of Care
Metropolitan Health Plan
Controlling High Blood Pressure
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Data Elements
Commercial
Medicare Advantage
NR
NR
NR
NR
Reported Rate
NR
NR
Lower 95% Confidence Interval
NR
NR
Upper 95% Confidence Interval
NR
NR
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
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
HEDIS 2006 (Reporting Year 2005)
Page 12
Effectiveness of Care
Metropolitan Health Plan
Beta Blocker Treatment after Heart Attack
Data Elements
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
Medicare Advantage
Measurement Year
MSHO
2005
Data Collection Methodology
A
Sampling Method Used
Eligible Member Population
4
Numerator Events by Admin Data on
Eligible Population
Current Year's Admin Rate
NR
NR
NR
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
3
Numerator Events by Medical Record
Reported Rate
NR
NR
NR
Lower 95% Confidence Interval
NR
NR
NR
Upper 95% Confidence Interval
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
Page 13
Effectiveness of Care
Metropolitan Health Plan
Persistence of Beta Blocker Treatment After Hearth Attack
Data Elements
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
Medicare Advantage
MSHO
Reported Rate
NR
NR
NR
Lower 95% Confidence Interval
NR
NR
NR
Upper 95% Confidence Interval
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data on
Eligible Population
HEDIS 2006 (Reporting Year 2005)
Page 14
Effectiveness of Care
Metropolitan Health Plan
Cholesterol Management for
Patients with Cardiovascular
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
Data Elements
General
Measure
Data
LDL-C
screening
Medicare Advantage
General
LDL-C Level of LDL-C Level of
Measure
<100 mg/dL
<130 mg/dL
Data
LDL-C
screening
LDL-C Level of LDL-C Level of
<100 mg/dL
<130 mg/dL
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator Events by Admin Data on Eligible
Population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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)
Page 15
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
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 16
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 11:35 AM
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
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 11:35 AM
MSHO
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
80
HO
S
80
HO
S
80
HO
S
80
HO
S
80
HO
S
80
HO
S
80
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
64
80.00%
80
0%
80
64
80.00%
18
22.50%
80
0%
80
18
22.50%
22
27.50%
80
0%
80
22
27.50%
49
61.25%
80
0%
80
49
61.25%
0
0.00%
80
0%
80
0
0.00%
0
0.00%
80
0%
80
0
0.00%
73
91.25%
80
0%
80
73
91.25%
Number of Records Excluded Because of
Valid Data Errors
0
0
0
0
0
0
0
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
0
80
64
12
95.00%
89.60%
100.00%
0
80
18
1
23.75%
13.80%
33.70%
0
80
22
33
68.75%
57.97%
79.53%
0
80
49
17
82.50%
73.55%
91.45%
0
80
0
46
57.50%
46.04%
68.96%
0
80
0
34
42.50%
31.04%
53.96%
0
80
73
0
91.25%
84.43%
98.07%
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 18
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Medicaid
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
216
2005
HO
S
216
2005
HO
S
216
2005
HO
S
216
2005
HO
S
216
2005
HO
S
216
2005
HO
S
216
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
134
62.04%
216
0%
216
134
62.04%
76
35.19%
216
0%
216
76
35.19%
56
25.93%
216
0%
216
56
25.93%
99
45.83%
216
0%
216
99
45.83%
0
0.00%
216
0%
216
0
0.00%
0
0.00%
216
0%
216
0
0.00%
148
68.52%
216
0%
216
148
68.52%
Number of Records Excluded Because of
Valid Data Errors
15
15
15
15
15
15
15
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
0
201
133
42
87.06%
82.18%
91.95%
0
201
64
11
37.31%
30.38%
44.25%
0
201
53
73
62.69%
55.75%
69.62%
0
201
97
71
83.58%
78.21%
88.95%
0
201
0
121
60.20%
53.18%
67.21%
0
201
0
87
43.28%
36.19%
50.38%
0
201
143
10
76.12%
69.98%
82.26%
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 19
Effectiveness of Care
Metropolitan Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 11:35 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 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 20
Effectiveness of Care
Metropolitan Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 11:35 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 2006 (Reporting Year 2005)
General
Measure Data
Ages 5-9
Ages 10-17
Ages 18-56
Total
35
34
97.14%
90.19%
100.00%
56
49
87.50%
77.95%
97.05%
34
26
76.47%
60.74%
92.20%
125
109
87.20%
80.94%
93.46%
2005
A
Page 21
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 11:35 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 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 22
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 11:35 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 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
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 11:35 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 2006 (Reporting Year 2005)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
1
NA
NA
NA
4
NA
NA
NA
4
NA
NA
NA
2005
A
5
Page 24
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 11:35 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 2006 (Reporting Year 2005)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
7
NA
NA
NA
11
NA
NA
NA
5
NA
NA
NA
2005
A
29
Page 25
Effectiveness of Care
Metropolitan 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 11:35 AM
Medicare
Advantage
NR
NR
NR
MSHO
2005
A
10
1
NA
NA
NA
Page 26
Effectiveness of Care
Metropolitan Health Plan
Glaucoma Screening in Older Adults
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 2006 (Reporting Year 2005)
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Medicare
Advantage
NR
NR
NR
MSHO
2005
A
334
36
122
36.53%
31.21%
41.84%
Page 27
Use of Services
Metropolitan Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
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 28
Use of Services
Metropolitan Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Medicaid
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
1
1
10
22
47
73
132
0.35%
0.00%
1.21%
0.35%
0.00%
1.21%
3.50%
1.19%
5.80%
7.69%
4.43%
10.96%
16.43%
11.96%
20.90%
25.52%
20.30%
30.75%
46.15%
40.20%
52.11%
2005
A
286
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
Metropolitan Health Plan
Well Child Visits in the 3rd, 4th,
5th and 6th Years of Life
Data Elements
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Medicaid
2005
A
1038
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)
685
NR
NR
NR
65.99%
63.06%
68.92%
Page 30
Use of Services
Metropolitan Health Plan
Adolescent Well-Care Visits
Data Elements
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Medicaid
2005
A
1616
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)
553
NR
NR
NR
34.22%
31.88%
36.56%
Page 31
Use of Services
Metropolitan Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
Measurement Year
Member Months
Total
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
Procedures /
1,000 Member
Months
NR
NR
NR
NR
Member Months
Male
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+
Cardiac
45-64
Catheterization
65+
CABG
45-64
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
Female
Procedures /
1,000 Member
Months
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
Page 32
Use of Services
Metropolitan Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 11:35 AM
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
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 7, 2009 11:35 AM
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
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 34
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 7, 2009 11:35 AM
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
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
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
Data Last Refreshed:
Oct 7, 2009 11:35 AM
2005
Member Months
0
0
0
0
0
2290
1822
568
0
4680
Discharges
Discharges /
1,000 Member
Months
0
0
0
0
0
143
122
22
0
287
NA
NA
NA
NA
NA
62.45
66.96
38.73
0
0
0
0
0
105
96
20
0
221
NA
NA
NA
NA
NA
45.85
52.69
35.21
0
0
0
0
0
37
26
2
0
65
NA
NA
NA
NA
NA
16.16
14.27
3.52
0
0
0
1
0
1
NA
NA
NA
0.44
HEDIS 2006 (Reporting Year 2005)
61.32
47.22
13.89
0.44
Days
0
0
0
0
0
651
617
91
0
1359
Days / 1,000
Member
Months
NA
NA
NA
NA
NA
284.28
338.64
160.21
290.38
0
0
0
0
0
446
436
84
0
966
NA
NA
NA
NA
NA
194.76
239.30
147.89
0
0
0
0
0
204
181
7
0
392
NA
NA
NA
NA
NA
89.08
99.34
12.32
0
0
0
1
0
1
NA
NA
NA
0.44
206.41
83.76
0.44
Average
Length of Stay
NA
NA
NA
NA
NA
4.55
5.06
4.14
NA
4.74
NA
NA
NA
NA
NA
4.25
4.54
4.20
NA
4.37
NA
NA
NA
NA
NA
5.51
6.96
3.50
NA
6.03
NA
NA
NA
1.00
NA
1.00
Page 36
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
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 37
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 11:35 AM
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
Metropolitan Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
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 39
Use of Services
Metropolitan Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 11:35 AM
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
Metropolitan Health Plan
Inpatient Utilization - Nonacute Care
MSHO
Measurement
Year
Age
Data Last Refreshed:
Oct 7, 2009 11:35 AM
2005
Member
Months
<1
0
1-9
0
10-19
0
20-44
0
45-64
0
65-74
2290
75-84
1822
85+
568
Unknown
Total
0
4680
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
NA
0
NA
NA
45-64
0
NA
0
NA
NA
65-74
70
30.57
843
368.12
12.04
75-84
119
65.31
1334
732.16
11.21
85+
22
38.73
213
375.00
9.68
Unknown
Total
0
211
45.09
0
2390
510.68
NA
11.33
Age
HEDIS 2006 (Reporting Year 2005)
Page 41
Use of Services
Metropolitan Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
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
65+
M
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
Unknown
M
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 42
Use of Services
Metropolitan Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Oct 7, 2009 11:35 AM
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
Metropolitan Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
MSHO
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 11:35 AM
2005
Male
Member Months
Female
Total
0
0
0
1600
0
1600
0
0
0
3080
0
3080
0
0
0
4680
0
4680
Discharges
Discharges /
1,000 Member
Months
Age
0-12
Days*
Average
Length of Stay
Gender
M
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
M
13-17
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
M
18-64
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
M
65+
21
13.13
261
12.43
F
45
14.61
542
12.04
Total
66
14.10
803
12.17
Unknown
M
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
21
13.13
261
12.43
F
45
14.61
542
12.04
TOTAL
66
14.10
803
12.17
* 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
Metropolitan Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
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
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
Age
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 45
Use of Services
Metropolitan Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 7, 2009 11:35 AM
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
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
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Day/Night Mental Health Services
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Ambulatory Mental Health Services
Percent
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 46
Use of Services
Metropolitan Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 7, 2009 11:35 AM
MSHO
Measurement Year
2005
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Member Months (Inpatient)
0-12
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1600
0
1600
0
3080
0
3080
0
4680
0
4680
0
1600
0
1600
0
3080
0
3080
0
4680
0
4680
0
1600
0
1600
0
3080
0
3080
0
4680
0
4680
0
1600
0
1600
0
3080
0
3080
0
4680
0
4680
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)
Male
Any Mental Health Services
Age
Member Months (Day/Night)
Number
Percent
Inpatient Mental Health Services
Percent
Number
Day/Night Mental Health Services
Percent
Number
Ambulatory Mental Health Services
Percent
Number
0
0
0
0
0
0
0
0
0
15
21
36
0
0
0
15
21
36
NA
NA
NA
NA
NA
NA
NA
NA
NA
11.25%
8.18%
9.23%
NA
NA
NA
11.25%
8.18%
9.23%
0
0
0
0
0
0
0
0
0
15
21
36
0
0
0
15
21
36
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
HEDIS 2006 (Reporting Year 2005)
NA
NA
NA
NA
NA
NA
NA
NA
NA
11.25%
8.18%
9.23%
NA
NA
NA
11.25%
8.18%
9.23%
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
Page 47
Use of Services
Metropolitan Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Medicaid
Measurement Year
2005
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
0-12
Member Months (Ambulatory)
Male
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
43340
12150
88007
23208
44667
11058
43340
12150
88007
23208
44667
11058
43340
12150
88007
23208
44667
11058
43340
12150
88007
23208
9267
4635
0
69627
32602
7356
0
95448
41869
11991
0
165075
9267
4635
0
69627
32602
7356
0
95448
41869
11991
0
165075
9267
4635
0
69627
32602
7356
0
95448
41869
11991
0
165075
9267
4635
0
69627
32602
7356
0
95448
41869
11991
0
165075
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)
44667
11058
Any Mental Health Services
Age
Member Months (Inpatient)
Number
Percent
Inpatient Mental Health Services
Percent
Number
Day/Night Mental Health Services
Percent
Number
Ambulatory Mental Health Services
Percent
Number
6
3
9
7
12
19
17
39
56
23
44
67
0
0
0
53
98
151
0.16%
0.08%
0.12%
0.76%
1.19%
0.98%
2.20%
1.44%
1.61%
5.95%
7.18%
6.71%
NA
NA
NA
0.91%
1.23%
1.10%
6
3
9
7
12
19
17
38
55
23
44
67
0
0
0
53
97
150
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
1
1
0
0
0
0
0
0
0
1
1
HEDIS 2006 (Reporting Year 2005)
0.16%
0.08%
0.12%
0.76%
1.19%
0.98%
2.20%
1.40%
1.58%
5.95%
7.18%
6.71%
NA
NA
NA
0.91%
1.22%
1.09%
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%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.04%
0.03%
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.01%
0.01%
Page 48
Use of Services
Metropolitan Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
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
13-17
M
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
18-64
M
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
65+
M
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
Unknown
M
NR
F
NR
Total
NR
NR
NR
M
Total
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 49
Use of Services
Metropolitan Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Oct 7, 2009 11:35 AM
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
Metropolitan Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
MSHO
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 11:35 AM
2005
Male
Member Months
Female
Total
0
0
0
1600
0
1600
0
0
0
3080
0
3080
0
0
0
4680
0
4680
Discharges
Discharges /
1,000 Member
Months
Age
0-12
Days
Average
Length of Stay
M
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
M
13-17
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
M
18-64
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
M
65+
3
1.88
14
4.67
F
0
0.00
0
NA
Total
3
0.64
14
4.67
Unknown
M
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
3
1.88
14
4.67
F
0
0.00
0
NA
TOTAL
3
0.64
14
4.67
* 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
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
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 52
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 11:35 AM
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
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 11:35 AM
MSHO
Measurement Year
2005
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
0
0
0
0
0
1600
0
1600
Female
0
0
0
0
0
3080
0
3080
Total
0
0
0
0
0
4680
0
4680
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
5
3
8
0
0
0
5
3
8
HEDIS 2006 (Reporting Year 2005)
Percent
NA
NA
NA
NA
NA
NA
NR
NR
NA
NA
NA
NA
NA
NA
NA
3.75%
1.17%
2.05%
NA
NA
NA
3.75%
1.17%
2.05%
Member Months (Inpatient)
Male
0
0
0
0
0
1600
0
1600
Female
0
0
0
0
0
3080
0
3080
Total
0
0
0
0
0
4680
0
4680
Member Months (Day/Night)
Member Months (Ambulatory)
Male
0
0
0
0
0
1600
0
1600
Male
0
0
0
0
0
1600
0
1600
Female
0
0
0
0
0
3080
0
3080
Total
0
0
0
0
0
4680
0
4680
Female
0
0
0
0
0
3080
0
3080
Total
0
0
0
0
0
4680
0
4680
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
5
3
8
0
0
0
5
3
8
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
0
0
0
0
0
0
0
0
0
Percent
NA
NA
NA
NA
NA
NA
NR
NR
NA
NA
NA
NA
NA
NA
NA
3.75%
1.17%
2.05%
NA
NA
NA
3.75%
1.17%
2.05%
Percent
NA
NA
NA
NA
NA
NA
NR
NR
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
Percent
NA
NA
NA
NA
NA
NA
NR
NR
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
Page 54
Use of Services
Metropolitan Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Medicaid
Measurement Year
2005
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
44667
11058
4493
1636
3138
4635
0
69627
Female
43340
12150
11746
11526
9330
7356
0
95448
Total
88007
23208
16239
13162
12468
11991
0
165075
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
2
6
8
10
12
22
1
18
19
12
26
38
16
7
23
0
0
0
41
69
110
HEDIS 2006 (Reporting Year 2005)
Percent
0.00%
0.00%
0.00%
0.22%
0.59%
0.41%
NR
NR
NA
0.03%
0.50%
0.26%
4.59%
3.34%
3.66%
4.14%
1.14%
2.30%
NA
NA
NA
0.71%
0.87%
0.80%
Member Months (Inpatient)
Male
44667
11058
4493
1636
3138
4635
0
69627
Female
43340
12150
11746
11526
9330
7356
0
95448
Total
88007
23208
16239
13162
12468
11991
0
165075
Member Months (Day/Night)
Male
44667
11058
4493
1636
3138
4635
0
69627
Female
43340
12150
11746
11526
9330
7356
0
95448
Total
88007
23208
16239
13162
12468
11991
0
165075
Member Months (Ambulatory)
Male
44667
11058
4493
1636
3138
4635
0
69627
Female
43340
12150
11746
11526
9330
7356
0
95448
Total
88007
23208
16239
13162
12468
11991
0
165075
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
0
0
0
2
6
8
10
12
22
1
18
19
12
26
38
16
7
23
0
0
0
41
69
110
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
0
0
0
0
0
0
0
0
0
Percent
0.00%
0.00%
0.00%
0.22%
0.59%
0.41%
NR
NR
NA
0.03%
0.50%
0.26%
4.59%
3.34%
3.66%
4.14%
1.14%
2.30%
NA
NA
NA
0.71%
0.87%
0.80%
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%
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%
Page 55
Use of Services
Metropolitan Health Plan
Outpatient Drug Utilization
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
Measurement
Year
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
NR
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 56
Use of Services
Metropolitan Health Plan
Outpatient Drug Utilization
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Medicare Advantage
Measurement
Year
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
NR
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
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
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 58
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 11:35 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 2006 (Reporting Year 2005)
Page 59
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 11:35 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 2006 (Reporting Year 2005)
Ages 20-44
Ages 45-64
Ages 65+
0
0
365
2005
A
0
0
355
NA
NA
NA
NA
NA
NA
97.26%
95.45%
99.07%
Page 60
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 11:35 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 2006 (Reporting Year 2005)
Ages 20-44
Ages 45-64
Ages 65+
894
178
727
2005
A
763
150
672
85.35%
82.97%
87.72%
84.27%
78.64%
89.90%
92.43%
90.44%
94.43%
Page 61
Access/Availability of Care
Metropolitan Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
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 62
Access/Availability of Care
Metropolitan Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 11:35 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 2006 (Reporting Year 2005)
General Measure
Data
12-24 months
25 months - 6
yrs.
7-11 yrs.
12-19 yrs.
483
1253
594
949
2005
A
474
1119
515
807
98.14%
96.83%
99.45%
89.31%
87.55%
91.06%
86.70%
83.89%
89.52%
85.04%
82.71%
87.36%
Page 63
Access/Availability of Care
Metropolitan Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
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 64
Access/Availability of Care
Metropolitan Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Medicaid
Measurement Year
Data collection methodology (Administrative or Hybrid)
Timeliness of
Prenatal Care
Postpartum
Care
2005
A
2005
A
661
661
NR
NR
NR
NR
518
373
NR
NR
NR
NR
NR
NR
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
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
13-17 Year Olds
Data Elements
General
Measure
Data
Initiation of
AOD
Treatment
18-25 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
26-34 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
35-64 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
65+ Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Overall Rate
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement
of AOD
Treatment
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
NR
Numerator events by administrative data
NR
NR
Reported rate
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Lower 95% confidence interval
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Upper 95% confidence interval
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
Page 66
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 11:35 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
NR
NR
Reported rate
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Lower 95% confidence interval
Upper 95% confidence interval
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Numerator events by administrative data
HEDIS 2006 (Reporting Year 2005)
Page 67
Access/Availability of Care
Metropolitan Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 11:35 AM
MSHO
13-17 Year Olds
Data Elements
Measurement Year
Data collection methodology
(Administrative only)
General
Measure
Data
Initiation of
AOD
Treatment
26-34 Year Olds
35-64 Year Olds
65+ Year Olds
Overall Rate
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
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement
of AOD
Treatment
0
0
0
0
5
5
2005
A
Eligible member population (i.e. members
who meet all denominator criteria)
Numerator events by administrative data
18-25 Year Olds
0
0
0
0
0
0
0
0
1
0
1
0
Reported rate
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Lower 95% confidence interval
Upper 95% confidence interval
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
HEDIS 2006 (Reporting Year 2005)
Page 68
Health Plan Stability
Metropolitan Health Plan
Practitioner Turnover
Data Last Refreshed:
Oct 7, 2009 11:35 AM
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
Metropolitan Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 11:35 AM
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
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 11:35 AM
Commercial
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 71
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 11:35 AM
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
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
MSHO
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 11:35 AM
2005
Male
0
0
0
0
0
0
Member Months
Female
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
0
0
0
0.00%
0
0
0
0
0
0.00%
552
408
420
144
60
36
0
0.00%
564
780
888
384
348
132
1620
100.00%
0
3096
100.00%
0
1620
3096
HEDIS 2006 (Reporting Year 2005)
Total
0
0
0
0
0
0
0
0.00%
0
0
0
0
0
0
0.00%
0
0
0
0
0
0.00%
1116
1188
1308
528
408
168
4716
100.00%
0
4716
Page 73
Health Plan Descriptive Information
Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Medicaid
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 11:35 AM
2005
Male
6412
16547
14329
11993
6444
2861
Member Months
Female
5788
15480
14926
12214
7082
3849
58586
84.14%
1632
772
864
973
895
59339
62.17%
7897
6472
5054
3752
2766
5136
7.38%
596
372
189
113
25941
27.18%
1647
682
331
152
1270
1.82%
1747
1250
853
483
241
61
2812
2.95%
2414
1681
1224
892
609
536
4635
6.66%
0
7356
7.71%
0
69627
95448
HEDIS 2006 (Reporting Year 2005)
Total
12200
32027
29255
24207
13526
6710
117925
71.44%
9529
7244
5918
4725
3661
31077
18.83%
2243
1054
520
265
4082
2.47%
4161
2931
2077
1375
850
597
11991
7.26%
0
165075
Page 74