UCare Minnesota
Plan Name
2004
Reporting Year
General Info
Plan ID
Submission #
Last Refreshed:
9/30/2005 12:39:10 PM
Page
Title
Disclaimers
Effectiveness of
Care Measures
1
17
2
Measure
Page
Use of Services
Measures
Measure
Page
Childhood Immunization Status
3
Well-Child Visits In The First 15 Months of Life
21
Adolescent Immunization Status
4
Well-Child Visits In The Third, Fourth, Fifth And Sixth Year of Life
22
Appropriate Treatment of Children w/ Upper Respiratory Infection
5
Adolescent Well-Care Visits
23
Appropriate Testing for Children with Pharyngitis
6
Frequency of Selected Procedures
24
Colorectal Cancer Screening
7
Inpatient Utilization - General Hospital/Acute Care
25
Breast Cancer Screening
8
Ambulatory Care
27
Cervical Cancer Screening
9
Inpatient Utilization - Nonacute Care
29
Chlamydia Screening in Women
10
Mental Health Utilization - Inpatient Discharges and Average Length of Stay
31
Controlling High Blood Pressure
11
Mental Health Utilization - % of Members Receiving Inpatient and Ambulatory Services
33
Beta Blocker Treatment after a Heart Attack
12
Chemical Dependency Utilization - Inpatient Discharges and Average Length of Stay
35
Cholesterol Management
13
Identification of Alcohol and Other Drug Services
37
Comprehensive Diabetes Care
14
Outpatient Drug Utilization
39
Appropriate Medications for People with Asthma
16
Follow-up After Hospitalization For Mental Illness
17
Antidepressant Medication Management
18
Osteoporosis Management in Women
20
Access /
Availability of
Care
Measure
Measure
Page
Practitioner Turnover
47
Years in Business / Total Membership
48
Page
Adults' Access to Preventive/Ambulatory Health Services
41
Children's Access to Primary Care Practitioners
43
Prenatal and Postpartum Care
44
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
45
HEDIS 2005 (Reporting Year 2004)
Health Plan
Stability
Health Plan
Descriptive
Information
Measure
Enrollment by Product Line (Age & Sex)
Page
49
DISCLAIMERS
-1
0. Disclaimer Query located below
1. The MN Department of Human Services was responsible for collecting and reporting PMAP, GAMC,
MNCare and MSHO product data for the 2004 reporting year.
For information regarding these products, please contact:
Vicki Kunerth, Director - Performance Measurement Quality Improvement
Minnesota Department of Human Services
[email protected]
(651) 431-2618
HEDIS 2005 (Reporting Year 2004)
Page 2
Effectiveness of Care
UCare Minnesota
Childhood Immunization Status
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Data Elements
General
Measure
Data
DTaP/DT
IPV/OPV
MMR
HiB
Hepatitis B
VZV
Combo 1
Combo 2
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 2005 (Reporting Year 2004)
Page 3
Effectiveness of Care
UCare Minnesota
Adolescent Immunization Status
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Data Elements
General
Measure
Data
MMR
Hepatitis B
VZV
Combo 1
Combo 2
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Reported Rate
NR
NR
NR
NR
NR
Lower 95% Confidence Interval
Upper 95% Confidence Interval
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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
HEDIS 2005 (Reporting Year 2004)
Page 4
Effectiveness of Care
UCare Minnesota
Appropriate Treatment for Children with Upper
Respiratory Infection
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Member Months
Age
<1
1-4
5-9
10-14
15-17
NR
Total
Data Elements
General
Measure
Data
Data Collection Methodology
Eligible Member Population
Eligible population by non-ER/Urgent Care
Visits*
Eligible Population by ER/Urgent Care
Visits*
Numerator Events by Admin Data
Numerator by non-ER/Urgent Care Visits*
Numerator by ER/Urgent Care Visits*
Reported Rate
NR
Lower 95% Confidence Interval
NR
Upper 95% Confidence Interval
NR
Data Elements with an Asterisk(*) are OPTIONAL and
are not used in any calculation or total
HEDIS 2005 (Reporting Year 2004)
Page 5
Effectiveness of Care
UCare Minnesota
Appropriate Testing for Children with Pharyngitis
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Data Elements
General
Measure
Data
Data Collection Methodology
Eligible Member Population
Eligible population by non-ER/Urgent Care
Visits*
Eligible Population by ER/Urgent Care Visits*
Numerator Events by Admin Data
Numerator by non-ER/Urgent Care Visits*
Numerator by ER/Urgent Care Visits*
Reported Rate
NR
Lower 95% Confidence Interval
NR
Upper 95% Confidence Interval
NR
Data Elements with an Asterisk(*) are OPTIONAL and
are not used in any calculation or total
HEDIS 2005 (Reporting Year 2004)
Page 6
Effectiveness of Care
UCare Minnesota
Colorectal Cancer Screening
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Data Elements
Commercial
Data collection methodology (administrative or hybrid)
HO
Sampling method used (see User's Guide for entry descriptions)
S
Eligible population
13460
Number of numerator events by administrative data in eligible population (before exclusions)
Current year's administrative rate (before exclusions)
Medicare +
Choice
6009
NR
44.64%
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
222
Administrative rate on FSS
NR
49.01%
Number of original sample records excluded because of valid data errors
0
Records Excluded - Contraindications/Admin Data
0
Records Excluded - Contraindications/Medical Record Review
0
Number of employee/dependent medical records excluded
0
Records added from the oversample list
222
Denominator
411
Numerator events by administrative data
202
FOBT by administrative data*
40
Flexible sigmoidoscopy by administrative data*
41
DCBE by administrative data*
12
Colonoscopy by administrative data*
180
Numerator events by medical records
54
FOBT by medical records*
7
Flexible sigmoidoscopy by medical records*
20
DCBE by medical records*
3
Colonoscopy by medical records*
29
Reported rate
NR
62.29%
Lower 95% confidence interval
NR
57.48%
Upper 95% confidence interval
NR
67.09%
Data Elements with an Asterisk(*) are OPTIONAL and are not used in any calculation or total
HEDIS 2005 (Reporting Year 2004)
Page 7
Effectiveness of Care
UCare Minnesota
Breast Cancer Screening
Data Elements
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Medicare + Choice
A
1718
Numerator Events by Admin Data on Eligible
Population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
Records Excluded because of Valid Data Errors
NR
NR
NR
NR
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 Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2005 (Reporting Year 2004)
1309
NR
NR
NR
76.19%
74.15%
78.24%
Page 8
Effectiveness of Care
UCare Minnesota
Cervical Cancer Screening
Data Elements
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Data Collection Methodology
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
NR
NR
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 2005 (Reporting Year 2004)
NR
NR
NR
Page 9
Effectiveness of Care
UCare Minnesota
Chlamydia Screening in Women
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Data Elements
General
Measure
Data
Ages 16-20 Ages 21-25
Total
Data Collection Methodology
Eligible Member Population
NR
Records Excluded - Contraindications/Admin Data
NR
Denominator
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
NR
NR
NR
NR
NR
HEDIS 2005 (Reporting Year 2004)
NR
NR
NR
NR
NR
NR
Page 10
Effectiveness of Care
UCare Minnesota
Controlling High Blood Pressure
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Data Elements
Commercial
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
Medicare + Choice
HO
S
6450
0
NR
0.00%
411
5.00%
432
0
NR
0.00%
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
Number of employee/dependent medical records
excluded
0
0
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 2005 (Reporting Year 2004)
0
NR
NR
NR
411
0
261
63.50%
58.73%
68.28%
Page 11
Effectiveness of Care
UCare Minnesota
Beta Blocker Treatment after Heart Attack
Data Elements
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Data Collection Methodology
Medicare + Choice
HO
Sampling Method Used
S
Eligible Member Population
164
Numerator Events by Admin Data on Eligible
Population
118
Current Year's Admin Rate
NR
Minimum Required Sample Size
71.95%
411
Oversampling Rate
5.00%
Final Sample Size (FSS)
164
Numerator events by admin data in FSS
118
Admin rate on FSS
NR
71.95%
Records Excluded because of Valid Data
Errors
4
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
160
Numerator Events by Admin Data
118
Numerator Events by Medical Record
30
Reported Rate
NR
92.50%
Lower 95% Confidence Interval
NR
88.11%
Upper 95% Confidence Interval
NR
96.89%
HEDIS 2005 (Reporting Year 2004)
Page 12
Effectiveness of Care
UCare Minnesota
Cholesterol Management After Acute
Cardiovascular Events
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Medicare + Choice
Data Elements
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 2005 (Reporting Year 2004)
106
6
8
74.65%
4.23%
5.63%
106
6
8
74.65%
4.23%
5.63%
6
58
80
78.87%
71.81%
85.94%
45.07%
36.53%
53.61%
61.97%
53.63%
70.31%
411
5.00%
142
Records Excluded because of Valid Data Errors
Records Added from the Oversample List
Denominator
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
LDL-C Level of LDL-C Level of
<100 mg/dL 60- <130 mg/dL 60365 Days
365 Days
HO
S
142
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 60365 Days
0
142
Page 13
Effectiveness of Care
UCare Minnesota
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Data Elements
General
Measure Data
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
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 2005 (Reporting Year 2004)
Page 14
Effectiveness of Care
UCare Minnesota
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Medicare + Choice
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure Data
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
4
Records Excluded because of
contraindications through Admin Data
0
Records Excluded because of
contraindications through Medical Record
Review
2
Number of employee/dependent records
excluded
0
Additional Records Added from the
Oversample List
6
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2005 (Reporting Year 2004)
LDL-C
Screening
LDL-C Level
<130 mg/dL
LDL-C Level
<100 mg/dL
Monitoring for
Diabetic
Nephropathy
1456
89.82%
1621
100.00%
1164
71.81%
1473
90.87%
30
1.85%
23
1.42%
947
58.42%
404
89.18%
453
100.00%
337
74.39%
418
92.27%
6
1.32%
5
1.10%
276
60.93%
369
10
92.21%
0
83
20.19%
306
16
78.35%
382
7
94.65%
5
290
71.78%
5
197
49.15%
255
15
65.69%
89.50%
94.93%
16.19%
24.20%
74.24%
82.45%
92.35%
96.94%
67.30%
76.25%
44.19%
54.10%
60.98%
70.40%
453
Number of Records Excluded Because of
Valid Data Errors
Numerator Events by Admin Data
Eye Exam
411
10.00%
Admin rate on FSS
Denominator
Poor HbA1c
Control
HO
S
1621
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
HbA1c
Testing
411
Page 15
Effectiveness of Care
UCare Minnesota
Appropriate Medications for People with Asthma
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Data Elements
Data Collection Methodology
Eligible Member Population
Total Exclusions
Denominator
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2005 (Reporting Year 2004)
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
NR
NR
Page 16
Effectiveness of Care
UCare Minnesota
Follow-Up After Hospitalization for Mental Illness
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Data Elements
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2005 (Reporting Year 2004)
General
Measure
Data
Medicare + Choice
W/in 7 Days of W/in 30 Days of
Discharge
Discharge
General
Measure
Data
W/in 7 Days of W/in 30 Days of
Discharge
Discharge
A
26
NR
NR
NR
NR
NR
NR
5
NA
NA
NA
13
NA
NA
NA
Page 17
Effectiveness of Care
UCare Minnesota
Antidepressant Medication Management
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Data Elements
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2005 (Reporting Year 2004)
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 18
Effectiveness of Care
UCare Minnesota
Antidepressant Medication Management
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Medicare + Choice
Data Elements
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2005 (Reporting Year 2004)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
17
10.76%
5.61%
15.91%
86
54.43%
46.35%
62.51%
72
45.57%
37.49%
53.65%
A
158
Page 19
Effectiveness of Care
UCare Minnesota
Osteoporosis Management in Women Who
had a Fracture
Data Elements
Data Collection Methodology
Eligible Member Population
Nonduplicated prior to bone mineral density
exclusions*
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Medicare +
Choice
A
626
Nonduplicated prior to prescription exclusions*
Nonduplicated other exclusions*
Total nonduplicated exclusions
Numerator events for bone mineral density by
administrative data*
Numerator events for precription by administrative
data*
Numerator events for both bone density and
prescription by administrative data*
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2005 (Reporting Year 2004)
39
115
154
154
24.60%
21.15%
28.05%
Page 20
Use of Services
UCare Minnesota
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Sep 30, 2005 12:39 PM
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
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 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 2005 (Reporting Year 2004)
Page 21
Use of Services
UCare Minnesota
Well Child Visits in the 3rd, 4th, 5th and 6th Years
of Life
Data Elements
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Data Collection Methodology
Sampling Method Used
Eligible Member Population
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
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 2005 (Reporting Year 2004)
NR
NR
NR
Page 22
Use of Services
UCare Minnesota
Adolescent Well-Care Visits
Data Elements
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Data Collection Methodology
Sampling Method Used
Eligible Member Population
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
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 2005 (Reporting Year 2004)
NR
NR
NR
Page 23
Use of Services
UCare Minnesota
Frequency of Selected Procedures
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Age
0-4
0-9
5-19
10-19
15-44
20-64
30-64
45-64
65+
Male
Procedure
Myringotomy
Age
0-4
5-19
Tonsillectomy
0-9
10-19
Dilation &
15-44
Curettage
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+
65+
Cholecystectomy, 30-64
Closed
15-44
45-64
65+
65+
Laminectomy /
20-64
Diskectomy
20-64
Angioplasty (PTCA) 45-64
45-64
65+
65+
Cardiac
45-64
Catheterization
45-64
65+
65+
CABG
45-64
45-64
65+
65+
Prostatectomy
45-64
65+
HEDIS 2005 (Reporting Year 2004)
Member Months
Female
Sex
Total
Total
Total
Total
F
F
F
F
F
F
F
F
M
F
F
M
F
M
F
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
M
Total
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
Page 24
Use of Services
UCare Minnesota
Inpatient Utilization - General Hospital/Acute Care
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
65+
Unknown
Total
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Member Months
NR
Discharges
Discharges /
1,000 Member
Months
Days
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2005 (Reporting Year 2004)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 25
Use of Services
UCare Minnesota
Inpatient Utilization - General Hospital/Acute Care
Medicare + Choice
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
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Member Months
0
0
0
426
5737
124177
127581
62289
0
320210
Discharges
Discharges /
1,000 Member
Months
0
0
0
3
135
2149
3784
2475
0
8546
NA
NA
NA
7.04
23.53
17.31
29.66
39.73
0
0
0
2
79
1182
2453
1853
0
5569
NA
NA
NA
4.69
13.77
9.52
19.23
29.75
0
0
0
1
56
967
1331
622
0
2977
NA
NA
NA
2.35
9.76
7.79
10.43
9.99
HEDIS 2005 (Reporting Year 2004)
26.69
17.39
9.30
Days
Days / 1,000
Member
Months
0
0
0
6
578
8964
16627
10792
0
36967
NA
NA
NA
14.08
100.75
72.19
130.33
173.26
0
0
0
3
312
4172
9419
7276
0
21182
NA
NA
NA
7.04
54.38
33.60
73.83
116.81
0
0
0
3
266
4792
7208
3516
0
15785
NA
NA
NA
7.04
46.37
38.59
56.50
56.45
115.45
66.15
49.30
Average
Length of Stay
NA
NA
NA
2.00
4.28
4.17
4.39
4.36
NA
4.33
NA
NA
NA
1.50
3.95
3.53
3.84
3.93
NA
3.80
NA
NA
NA
3.00
4.75
4.96
5.42
5.65
NA
5.30
Page 26
Use of Services
UCare Minnesota
Ambulatory Care
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Member
Months
NR
Total
Outpatient Visits
(Excludes MH/CD)
Age
Visits
<1
1-9
Visits/ 1,000
Member
Months
NR
NR
Emergency Room Visits
Visits
Visits/ 1,000
Member
Months
NR
NR
Ambulatory
Surgery/Procedures
Procedures
Procedures/
1,000 Member
Months
NR
NR
Observation Room Stays
Resulting in Discharge
Stays
Stays/ 1,000
Member
Months
NR
NR
10-19
NR
NR
NR
NR
20-44
45-64
65-74
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
75-84
NR
NR
NR
NR
85+
Unknown
NR
NR
NR
NR
Total
NR
HEDIS 2005 (Reporting Year 2004)
NR
NR
NR
NR
NR
NR
NR
Page 27
Use of Services
UCare Minnesota
Ambulatory Care
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Medicare + Choice
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
0
0
0
426
5737
124177
127581
62289
0
320210
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
Visits
0
0
Visits/ 1,000
Member
Months
NA
NA
Emergency Room Visits
Visits
0
0
Ambulatory
Surgery/Procedures
Visits/ 1,000
Member
Months
NA
NA
Procedures
0
0
Observation Room Stays
Resulting in Discharge
Procedures/
1,000 Member
Months
NA
NA
Stays
0
0
Stays/ 1,000
Member
Months
NA
NA
10-19
0
NA
0
NA
0
NA
0
NA
20-44
45-64
65-74
214
4275
66713
502.35
745.16
537.24
21
148
1468
49.30
25.80
11.82
2
204
3785
4.69
35.56
30.48
0
10
179
0.00
1.74
1.44
75-84
85734
672.00
2204
17.28
4271
33.48
336
2.63
85+
Unknown
42001
0
198937
674.29
1329
0
5170
21.34
1326
0
9588
21.29
189
0
714
3.03
Total
HEDIS 2005 (Reporting Year 2004)
621.27
16.15
29.94
2.23
Page 28
Use of Services
UCare Minnesota
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
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 Average Length
Member Months
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
HEDIS 2005 (Reporting Year 2004)
NR
NR
NR
Page 29
Use of Services
UCare Minnesota
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Medicare + Choice
Age
Member Months
<1
0
1-9
0
10-19
0
20-44
426
45-64
5737
65-74
124177
75-84
127581
85+
62289
Unknown
0
320210
Total
Discharges
Discharges /
1,000 Member
Months
<1
0
NA
0
NA
NA
1-9
0
NA
0
NA
NA
10-19
0
NA
0
NA
NA
20-44
0
0.00
0
0.00
NA
45-64
36
6.28
511
89.07
14.19
65-74
298
2.40
4202
33.84
14.10
75-84
1183
9.27
18718
146.71
15.82
85+
1462
23.47
22910
367.80
15.67
Unknown
0
2979
9.30
0
46341
144.72
NA
15.56
Age
Total
HEDIS 2005 (Reporting Year 2004)
Days
Days / 1,000 Average Length
Member Months
of Stay
Page 30
Use of Services
UCare Minnesota
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
Member Months
Female
Total
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
M
65+
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
Unknown
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 2005 (Reporting Year 2004)
Page 31
Use of Services
UCare Minnesota
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Medicare + Choice
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
Male
Member Months
Female
Total
0
0
2696
114914
0
117610
0
0
3467
199133
0
202600
0
0
6163
314047
0
320210
Discharges
Discharges /
1,000 Member
Months
Days*
Average Length
of Stay
M
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
13-17
M
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
18-64
M
5
1.85
48
9.60
F
10
2.88
139
13.90
Total
15
2.43
187
12.47
65+
M
61
0.53
765
12.54
F
116
0.58
1418
12.22
Total
177
0.56
2183
12.33
Unknown
M
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
66
0.56
813
12.32
F
126
0.62
1557
12.36
TOTAL
192
0.60
2370
12.34
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2005 (Reporting Year 2004)
Page 32
Use of Services
UCare Minnesota
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Member Months (Any)
Age
Male
Female
Total
Member Months (Inpatient)
Male
Female
Total
Member Months (Day/Night)
Member Months (Ambulatory)
Male
Male
Female
Total
Female
Total
0-12
NR
NR
NR
NR
13-17
NR
NR
NR
NR
18-64
NR
NR
NR
NR
65+
NR
NR
NR
NR
Unknown
Total
Age
0-12
NR
NR
NR
NR
NR
NR
NR
NR
NR
Day/Night Mental Health Services
Ambulatory Mental Health Services
Number
Number
NR
Percent
Percent
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
F
NR
NR
NR
NR
NR
NR
NR
NR
NR
M
NR
NR
NR
F
NR
NR
NR
NR
M
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
M
F
Total
NR
Number
Total
Unknown
NR
NR
Inpatient Mental Health Services
Total
65+
NR
Number
Sex
M
Total
18-64
NR
Any Mental Health Services
F
13-17
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
M
NR
NR
NR
NR
F
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
M
NR
NR
NR
NR
NR
NR
NR
NR
F
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Total
HEDIS 2005 (Reporting Year 2004)
Page 33
Use of Services
UCare Minnesota
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Medicare + Choice
Member Months (Day/Night)
Member Months (Ambulatory)
Male
Member Months (Any)
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
0-12
0
0
0
0
0
0
0
0
0
0
0
0
13-17
0
0
0
0
0
0
0
0
0
0
0
0
18-64
2696
3467
6163
2696
3467
6163
2696
3467
6163
2696
3467
6163
65+
114914
199133
314047
114914
199133
314047
114914
199133
314047
114914
199133
314047
Unknown
0
117610
0
202600
0
320210
0
117610
0
202600
0
320210
0
117610
0
202600
0
320210
0
117610
0
202600
0
320210
Age
Total
Age
0-12
Any Mental Health Services
Inpatient Mental Health Services
Day/Night Mental Health Services
Ambulatory Mental Health Services
Number
Percent
Number
Percent
Number
Percent
Number
Percent
0
NA
0
NA
0
NA
0
NA
0
NA
0
NA
0
NA
0
NA
Sex
M
F
13-17
18-64
65+
Unknown
Total
0
NA
0
NA
0
NA
0
NA
M
0
NA
0
NA
0
NA
0
NA
F
0
NA
0
NA
0
NA
0
NA
Total
0
NA
0
NA
0
NA
0
NA
M
37
16.47%
4
1.78%
0
0.00%
34
15.13%
F
80
27.69%
6
2.08%
0
0.00%
79
27.34%
Total
117
22.78%
10
1.95%
0
0.00%
113
22.00%
M
191
1.99%
50
0.52%
0
0.00%
149
1.56%
F
461
2.78%
98
0.59%
0
0.00%
389
2.34%
Total
652
2.49%
148
0.57%
0
0.00%
538
2.06%
M
0
NA
0
NA
0
NA
0
NA
F
0
NA
0
NA
0
NA
0
NA
Total
Total
Member Months (Inpatient)
0
NA
0
NA
0
NA
0
NA
M
228
2.33%
54
0.55%
0
0.00%
183
1.87%
F
541
769
3.20%
2.88%
104
158
0.62%
0.59%
0
0
0.00%
0.00%
468
651
2.77%
2.44%
Total
HEDIS 2005 (Reporting Year 2004)
Page 34
Use of Services
UCare Minnesota
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
Member Months
Female
Total
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
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 2005 (Reporting Year 2004)
Page 35
Use of Services
UCare Minnesota
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Medicare + Choice
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
Male
Member Months
Female
Total
0
0
2696
114914
0
117610
0
0
3467
199133
0
202600
0
0
6163
314047
0
320210
Discharges
Discharges /
1,000 Member
Months
Days
Average Length
of Stay
M
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
13-17
M
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
18-64
M
2
0.74
4
2.00
F
0
0.00
0
NA
Total
2
0.32
4
2.00
65+
M
11
0.10
51
4.64
F
15
0.08
78
5.20
Total
26
0.08
129
4.96
Unknown
M
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
13
0.11
55
4.23
F
15
0.07
78
5.20
TOTAL
28
0.09
133
4.75
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2005 (Reporting Year 2004)
Page 36
Use of Services
UCare Minnesota
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Member Months (Any)
Age
Male
Female
Member Months (Inpatient)
Male
Female
Member Months (Ambulatory)
Male
Male
Female
Total
NR
Female
0-12
Total
NR
13-17
NR
NR
NR
NR
18-64
NR
NR
NR
NR
65+
NR
NR
NR
NR
Unknown
NR
NR
NR
NR
NR
NR
Total
Age
0-12
NR
NR
NR
NR
NR
NR
NR
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
Number
Number
Number
Sex
M
Total
M
Total
M
F
Total
65+
NR
Inpatient Chemical Dependency
Services
NR
F
18-64
NR
Total
NR
Any Chemical Dependency
Services
F
13-17
NR
Total
NR
Member Months (Day/Night)
Unknown
M
F
Total
M
Total
F
Total
M
F
Total
NR
NR
Percent
NR
NR
NR
NR
Percent
NR
NR
NR
NR
Percent
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
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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 2005 (Reporting Year 2004)
Page 37
Use of Services
UCare Minnesota
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Medicare + Choice
Member Months (Any)
Age
Male
Female
0
0
0-12
Member Months (Inpatient)
Total
0
Male
Female
0
0
Total
0
Member Months (Day/Night)
Member Months (Ambulatory)
Male
Female
Male
Female
0
0
0
0
Total
0
Total
0
13-17
0
0
0
0
0
0
0
0
0
0
0
0
18-64
2696
3467
6163
2696
3467
6163
2696
3467
6163
2696
3467
6163
65+
114914
199133
314047
114914
199133
314047
114914
199133
314047
114914
199133
314047
Unknown
0
117610
0
202600
0
320210
0
117610
0
202600
0
320210
0
117610
0
202600
0
320210
0
117610
0
202600
0
320210
Total
Any Chemical Dependency
Services
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
Number
0
Percent
NA
Number
0
Percent
NA
Number
0
Percent
NA
0
Percent
NA
0
0
NA
NA
0
0
NA
NA
0
0
NA
NA
0
0
NA
NA
0
NA
0
NA
0
NA
0
NA
Total
M
0
0
NA
NA
0
0
NA
NA
0
0
NA
NA
0
0
NA
NA
15
6.68%
8
3.56%
0
0.00%
11
4.90%
F
Total
14
29
4.85%
5.65%
6
14
2.08%
2.73%
0
0
0.00%
0.00%
11
22
3.81%
4.28%
65+
M
F
Total
168
131
1.75%
0.79%
103
84
1.08%
0.51%
0
0
0.00%
0.00%
87
57
0.91%
0.34%
Unknown
M
299
0
0
1.14%
NA
NA
187
0
0
0.71%
NA
NA
0
0
0
0.00%
NA
NA
144
0
0
0.55%
NA
NA
0
183
145
328
NA
1.87%
0.86%
1.23%
0
111
90
201
NA
1.13%
0.53%
0.75%
0
0
0
0
NA
0.00%
0.00%
0.00%
0
98
68
166
NA
1.00%
0.40%
0.62%
Age
0-12
Sex
M
F
13-17
Total
M
F
18-64
F
Total
Total
M
F
Total
HEDIS 2005 (Reporting Year 2004)
Page 38
Use of Services
UCare Minnesota
Outpatient Drug Utilization
Commercial
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Member Months
NR
Specification Documentation:
Prescription is defined as (Enter "A"
or "B"):
Age
Total Cost of
Prescriptions
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
HEDIS 2005 (Reporting Year 2004)
NR
Avg. Cost of
Prescriptions /
Per Member Per
Month
NR
NR
NR
NR
NR
NR
NR
NR
Total Number of
Prescriptions
NR
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NR
NR
NR
NR
NR
NR
NR
NR
Page 39
Use of Services
UCare Minnesota
Outpatient Drug Utilization
Medicare + Choice
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Member Months
0
0
426
5737
124177
127581
62289
0
320210
Specification Documentation:
Prescription is defined as (Enter "A"
or "B"):
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
HEDIS 2005 (Reporting Year 2004)
Total Cost of
Prescriptions
$0.00
$0.00
$27,917.98
$540,491.59
$8,276,411.68
$9,902,373.17
$5,028,349.14
$0.00
$23,775,543.56
A
Avg. Cost of
Prescriptions /
Per Member Per
Month
NA
NA
$65.54
$94.21
$66.65
$77.62
$80.73
$74.25
Total Number of
Prescriptions
0
0
673
11742
185827
262888
152024
0
613154
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NA
NA
18.96
24.56
17.96
24.73
29.29
22.98
Page 40
Access/Availability of Care
UCare Minnesota
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
Data Elements
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
NR
NR
NR
NR
NR
NR
NR
NR
NR
Data collection methodology
(Administrative 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 2005 (Reporting Year 2004)
Page 41
Access/Availability of Care
UCare Minnesota
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Medicare + Choice
Data Elements
Data collection methodology
(Administrative 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 2005 (Reporting Year 2004)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
24
392
24023
19
367
23007
NA
NA
NA
93.62%
91.08%
96.17%
95.77%
95.51%
96.03%
A
Page 42
Access/Availability of Care
UCare Minnesota
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Sep 30, 2005 12:39 PM
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
Data collection methodology (Administrative
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 2005 (Reporting Year 2004)
Page 43
Access/Availability of Care
UCare Minnesota
Prenatal and Postpartum Care
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
General Measure
Data
Timeliness of
Prenatal Care
Postpartum Care
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Data collection methodology (Administrative or Hybrid)
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
Additional 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 2005 (Reporting Year 2004)
Page 44
Access/Availability of Care
UCare Minnesota
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
18-25 Year Olds
Data Elements
General
Measure
Data
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
26-34 Year Olds
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
35-64 Year Olds
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
65+ Year Olds
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
Overall Rate
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
Data collection methodology
(Administrative 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 2005 (Reporting Year 2004)
NR
NR
NR
NR
NR
NR
NR
NR
NR
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
Access/Availability of Care
UCare Minnesota
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Medicare + Choice
18-25 Year Olds
Data Elements
Data collection methodology
(Administrative 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 2005 (Reporting Year 2004)
General
Measure
Data
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
26-34 Year Olds
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
35-64 Year Olds
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
65+ Year Olds
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
Overall Rate
Initiation of
AOD
Treatment
Engagement
of AOD
Treatment
A
0
0
239
21
260
0
0
0
0
10
4
97
5
107
9
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
40.59%
34.15%
47.02%
2.09%
0.07%
4.12%
41.15%
34.98%
47.33%
3.46%
1.05%
5.88%
Page 46
Health Plan Stability
UCare Minnesota
Practitioner Turnover
Medicare + Choice
Practitioner Types
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Number of
Practitioners as of
12/31/2003
Number of
Practitioners who
were not affiliated
with the plan as of
12/31/2004
Practitioner
Turnover Rate
Primary Care Physicians
Non-Physician Primary
Care Practitioners
HEDIS 2005 (Reporting Year 2004)
1561
255
16.34%
563
125
22.20%
Page 47
Health Plan Stability
UCare Minnesota
Years in Business / Total Membership
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Medicare + Choice
Product/Product Line
HMO (Total)
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other (specify)
PPO (Total)
Commercial
Medicare (cost or risk)
Self-insured
Other (specify)
POS (Total)
Commercial
Medicare (cost or risk)
Self-insured
Other (specify)
Total
Years in Business
17.00
17.00
0.00
6.50
0.00
8.00
Members*
112172
82413
0
27122
0
2637
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
112172
* Total number of members in each category as of December 31, 2004
HEDIS 2005 (Reporting Year 2004)
Page 48
Health Plan Descriptive Information
UCare Minnesota
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Commercial
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
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2005 (Reporting Year 2004)
NR
NR
NR
NR
NR
NR
NR
Page 49
Health Plan Descriptive Information
UCare Minnesota
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 30, 2005 12:39 PM
Medicare + Choice
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Male
0
0
0
0
0
0
Member Months
Female
0
0
0
0
0
0
Total
0
0
0
0
0
0
0
0.00%
0
12
24
24
108
0
0.00%
24
12
12
72
144
0
0.00%
168
0.14%
276
396
720
1152
264
0.13%
360
540
792
1512
432
0.13%
2544
2.16%
25524
25464
26076
20412
12492
4944
3204
1.58%
36132
37044
43116
37980
28548
16308
5748
1.80%
114912
97.69%
0
199128
98.29%
0
314040
98.07%
117624
202596
HEDIS 2005 (Reporting Year 2004)
24
24
36
96
252
636
936
1512
2664
61656
62508
69192
58392
41040
21252
0
320220
Page 50