Preferred One Community Health Plan
Plan Name
2004
Reporting Year
General Info
Submission #
1
Last Refreshed:
23
9/30/2005 11:44:02 AM
Page
Title
Disclaimers
Effectiveness of
Care Measures
Plan ID
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
Preferred One Community Health Plan
Childhood Immunization Status
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
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
Admin rate on FSS
Number of Records Excluded because of
Contraindications by Admin Data
0
Number of Records Excluded because of
Contraindications by Medical Record
Review
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
Upper 95% Confidence Interval
HEDIS 2005 (Reporting Year 2004)
HiB
Hepatitis B
VZV
Combo 1
Combo 2
148
38.24%
163
42.12%
330
85.27%
164
42.38%
162
41.86%
290
74.94%
126
32.56%
114
29.46%
148
38.24%
163
42.12%
330
85.27%
164
42.38%
162
41.86%
290
74.94%
126
32.56%
114
29.46%
148
163
330
164
162
290
126
114
192
194
21
163
185
27
177
167
88.54%
85.23%
91.86%
92.97%
90.28%
95.66%
91.41%
88.47%
94.34%
85.16%
81.47%
88.84%
90.36%
87.28%
93.45%
82.55%
78.63%
86.48%
78.91%
74.70%
83.12%
73.18%
68.62%
77.74%
387
3
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
MMR
387
0.00%
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
IPV/OPV
HO
N
387
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
DTaP/DT
384
Page 3
Effectiveness of Care
Preferred One Community Health Plan
Adolescent Immunization Status
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
Data Elements
General
Measure
Data
MMR
Hepatitis B
VZV
Combo 1
Combo 2
213
75
19
63
1
44.19%
15.56%
3.94%
13.07%
0.21%
NR
NR
NR
NR
NR
Numerator Events by Admin Data
187
65
14
54
0
Numerator Events by Medical Record
Data Collection Methodology
HO
Sampling Method Used
CS
Eligible Member Population
482
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
411
10.00%
411
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
1
Number of Records Excluded because of
Contraindications by Admin Data
0
Number of Records Excluded because of
Contraindications by Medical Record
Review
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
1
Denominator
411
132
207
159
208
145
Reported Rate
77.62%
66.18%
42.09%
63.75%
35.28%
Lower 95% Confidence Interval
Upper 95% Confidence Interval
73.46%
81.77%
61.48%
70.88%
37.20%
46.99%
58.98%
68.52%
30.54%
40.02%
HEDIS 2005 (Reporting Year 2004)
Page 4
Effectiveness of Care
Preferred One Community Health Plan
Appropriate Treatment for Children with Upper
Respiratory Infection
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
Member Months
Age
<1
8540
1-4
31510
5-9
40779
10-14
43748
15-17
26868
151445
Total
Data Elements
Data Collection Methodology
Eligible Member Population
General
Measure
Data
A
721
Eligible population by non-ER/Urgent Care
Visits*
Eligible Population by ER/Urgent Care
Visits*
Numerator Events by Admin Data
108
Numerator by non-ER/Urgent Care Visits*
Numerator by ER/Urgent Care Visits*
Reported Rate
85.02%
Lower 95% Confidence Interval
82.35%
Upper 95% Confidence Interval
87.70%
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
Preferred One Community Health Plan
Appropriate Testing for Children with Pharyngitis
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
Data Elements
Data Collection Methodology
Eligible Member Population
General
Measure
Data
A
775
Eligible population by non-ER/Urgent Care
Visits*
Eligible Population by ER/Urgent Care Visits*
Numerator Events by Admin Data
665
Numerator by non-ER/Urgent Care Visits*
Numerator by ER/Urgent Care Visits*
Reported Rate
85.81%
Lower 95% Confidence Interval
83.28%
Upper 95% Confidence Interval
88.33%
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
Preferred One Community Health Plan
Colorectal Cancer Screening
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Data Elements
Data collection methodology (administrative or hybrid)
Commercial
Medicare +
Choice
A
Sampling method used (see User's Guide for entry descriptions)
Eligible population
4332
Number of numerator events by administrative data in eligible population (before exclusions)
Current year's administrative rate (before exclusions)
NR
NR
NR
NR
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
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 administrative data
1681
FOBT by administrative data*
252
Flexible sigmoidoscopy by administrative data*
335
DCBE by administrative data*
Colonoscopy by administrative data*
57
1423
Numerator events by medical records
FOBT by medical records*
Flexible sigmoidoscopy by medical records*
DCBE by medical records*
Colonoscopy by medical records*
Reported rate
NR
NR
Lower 95% confidence interval
NR
NR
Upper 95% confidence interval
NR
NR
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
Preferred One Community Health Plan
Breast Cancer Screening
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
A
Medicare + Choice
2019
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)
1513
74.94%
73.02%
76.85%
NR
NR
NR
Page 8
Effectiveness of CarePreferred One Community Health Plan
Cervical Cancer Screening
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
A
2811
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
73.03%
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)
2053
#VALUE!
#VALUE!
#VALUE!
Page 9
Effectiveness of Care
Preferred One Community Health Plan
Chlamydia Screening in Women
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
Data Elements
Data Collection Methodology
Eligible Member Population
Records Excluded - Contraindications/Admin Data
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 16-20 Ages 21-25
Total
A
452
722
1174
0
0
0
452
109
24.12%
20.06%
28.17%
722
201
27.84%
24.50%
31.18%
1174
310
26.41%
23.84%
28.97%
Page 10
Effectiveness of Care
Preferred One Community Health Plan
Controlling High Blood Pressure
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Data Elements
Data Collection Methodology (Hybrid)
Sampling Method Used
Eligible Member Population
Numerator Events by Admin Data on Eligible
Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Commercial
HO
CS
1327
0
0.00%
411
15.00%
411
NR
NR
NR
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
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)
Medicare + Choice
18
0
13
406
0
234
57.64%
52.71%
62.57%
NR
NR
NR
Page 11
Effectiveness of Care
Preferred One Community Health Plan
Beta Blocker Treatment after Heart Attack
Data Elements
Data Collection Methodology
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
HO
Sampling Method Used
N
Eligible Member Population
35
Numerator Events by Admin Data on Eligible
Population
31
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
88.57%
NR
35
0.00%
Final Sample Size (FSS)
35
Numerator events by admin data in FSS
31
Admin rate on FSS
Medicare + Choice
88.57%
Records Excluded because of Valid Data
Errors
0
Records Excluded because of
contraindications through Admin Data
0
Records Excluded because of
contraindications through Medical Record
Review
0
Number of employee/dependent medical
records excluded
0
Records Added from the Oversample List
0
Denominator
35
Numerator Events by Admin Data
31
Numerator Events by Medical Record
3
NR
Reported Rate
97.14%
NR
Lower 95% Confidence Interval
90.19%
NR
Upper 95% Confidence Interval
100.00%
NR
HEDIS 2005 (Reporting Year 2004)
Page 12
Effectiveness of Care
Preferred One Community Health Plan
Cholesterol Management After Acute
Cardiovascular Events
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Medicare + Choice
Data Elements
General
Measure
Data
LDL-C
screening 60365 Days
LDL-C Level of LDL-C Level of
<100 mg/dL 60- <130 mg/dL 60365 Days
365 Days
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
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 Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2005 (Reporting Year 2004)
Page 13
Effectiveness of Care
Preferred One Community Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure Data
1
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
Additional Records Added from the
Oversample List
1
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
768
86.20%
891
100.00%
435
48.82%
762
85.52%
0
0.00%
0
0.00%
498
55.89%
NR
NR
NR
NR
NR
NR
NR
360
16
91.48%
0
123
29.93%
221
5
54.99%
364
15
92.21%
0
264
64.23%
0
171
41.61%
225
23
60.34%
88.66%
94.30%
25.38%
34.48%
50.06%
59.92%
89.50%
94.93%
59.48%
68.99%
36.72%
46.49%
55.49%
65.19%
411
Number of Records Excluded Because of
Valid Data Errors
Reported Rate
Lower 95% Confidence Interval
Eye Exam
411
10.00%
Numerator events by admin data in FSS
Admin rate on FSS
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Poor HbA1c
Control
HO
CS
891
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
HbA1c
Testing
411
Page 14
Effectiveness of Care
Preferred One Community Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Medicare + Choice
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 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 15
Effectiveness of Care
Preferred One Community Health Plan
Appropriate Medications for People with Asthma
Data Last Refreshed:
Sep 30, 2005 11:44 AM
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
Ages 10-17
Ages 18-56
Total
41
0
41
33
80.49%
67.14%
93.84%
93
0
93
74
79.57%
70.84%
88.30%
292
0
292
238
81.51%
76.88%
86.13%
426
0
426
345
80.99%
77.14%
84.83%
A
Page 16
Effectiveness of Care
Preferred One Community Health Plan
Follow-Up After Hospitalization for Mental Illness
Data Last Refreshed:
Sep 30, 2005 11:44 AM
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
73
33
45.21%
33.10%
57.31%
50
68.49%
57.15%
79.83%
NR
NR
NR
NR
NR
NR
Page 17
Effectiveness of Care
Preferred One Community Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Sep 30, 2005 11:44 AM
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
40
16.00%
11.26%
20.74%
161
64.40%
58.26%
70.54%
118
47.20%
40.81%
53.59%
A
250
Page 18
Effectiveness of Care
Preferred One Community Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Sep 30, 2005 11:44 AM
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
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 19
Effectiveness of Care
Preferred One Community Health Plan
Osteoporosis Management in Women Who
had a Fracture
Data Elements
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Medicare +
Choice
Data Collection Methodology
Eligible Member Population
Nonduplicated prior to bone mineral density
exclusions*
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)
NR
NR
NR
Page 20
Use of Services
Preferred One Community Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
Data Elements
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
6
4
2
13
27
83
223
1.68%
0.21%
3.15%
1.12%
0.00%
2.35%
0.56%
0.00%
1.47%
3.63%
1.55%
5.71%
7.54%
4.67%
10.42%
23.18%
18.67%
27.70%
62.29%
57.13%
67.45%
A
358
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
Preferred One Community Health Plan
Well Child Visits in the 3rd, 4th, 5th and 6th Years
of Life
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
A
1940
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)
1094
56.39%
54.16%
58.62%
Page 22
Use of Services
Preferred One Community Health Plan
Adolescent Well-Care Visits
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
A
5078
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)
1431
28.18%
26.93%
29.43%
Page 23
Use of Services
Preferred One Community Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
Age
0-4
0-9
5-19
10-19
15-44
20-64
30-64
45-64
65+
Male
195988
152418
75417
2791
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
Total
40050
80829
126672
85893
137362
194410
77647
2357
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
Number of
Procedures
181
44
67
24
10
7
27
27
0
28
26
1
4
3
5
0
0
20
52
36
1
0
38
40
52
11
4
0
52
21
2
1
12
2
0
0
19
5
Procedures /
1,000 Member
Months
4.52
0.35
0.83
0.28
0.07
0.09
0.20
0.35
0.00
0.20
0.33
0.42
0.03
0.02
0.06
0.00
0.00
0.13
0.38
0.46
0.36
0.00
0.19
0.21
0.69
0.14
1.43
0.00
0.69
0.27
0.72
0.42
0.16
0.03
0.00
0.00
0.25
1.79
Page 24
Use of Services
Preferred One Community Health Plan
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 11:44 AM
Member Months
8540
72289
85893
237334
153064
4781
325
42
0
562268
Discharges
Discharges /
1,000 Member
Months
90
120
119
1361
925
67
15
7
0
2704
10.54
1.66
1.39
5.73
6.04
14.01
46.15
166.67
73
97
52
290
434
34
14
6
0
1000
8.55
1.34
0.61
1.22
2.84
7.11
43.08
142.86
17
23
48
340
486
33
1
1
0
949
1.99
0.32
0.56
1.43
3.18
6.90
3.08
23.81
19
729
3
0
0
751
0.22
3.07
0.02
0.00
HEDIS 2005 (Reporting Year 2004)
4.81
1.78
1.69
1.56
Days
Days / 1,000
Member
Months
815
278
308
3796
3054
226
65
21
0
8563
95.43
3.85
3.59
15.99
19.95
47.27
200.00
500.00
610
227
119
721
1282
85
55
18
0
3117
71.43
3.14
1.39
3.04
8.38
17.78
169.23
428.57
205
51
129
1036
1756
141
10
3
0
3331
24.00
0.71
1.50
4.37
11.47
29.49
30.77
71.43
60
2033
10
0
0
2103
0.70
8.57
0.07
0.00
15.23
5.54
5.92
4.37
Average
Length of Stay
9.06
2.32
2.59
2.79
3.30
3.37
4.33
3.00
NA
3.17
8.36
2.34
2.29
2.49
2.95
2.50
3.93
3.00
NA
3.12
12.06
2.22
2.69
3.05
3.61
4.27
10.00
3.00
NA
3.51
3.16
2.79
3.33
NA
NA
2.80
Page 25
Use of Services
Preferred One Community Health Plan
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 11:44 AM
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
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
Days / 1,000
Member
Months
NR
NR
NR
NR
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
Page 26
Use of Services
Preferred One Community Health Plan
Ambulatory Care
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
8540
72289
85893
237334
153064
4781
325
42
0
562268
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
Visits
6911
19234
Visits/ 1,000
Member
Months
809.25
266.07
Emergency Room Visits
Visits
209
1011
Visits/ 1,000
Member
Months
24.47
13.99
Ambulatory
Surgery/Procedures
Procedures
47
253
Procedures/
1,000 Member
Months
5.50
3.50
Observation Room Stays
Resulting in Discharge
Stays
7
35
Stays/ 1,000
Member
Months
0.82
0.48
10-19
16291
189.67
891
10.37
183
2.13
19
0.22
20-44
45-64
65-74
54618
47305
2235
230.13
309.05
467.48
2511
1302
61
10.58
8.51
12.76
1418
2313
113
5.97
15.11
23.64
186
87
5
0.78
0.57
1.05
75-84
191
587.69
8
24.62
13
40.00
0
0.00
26
0
146811
619.05
1
0
5994
23.81
0
0
4340
0.00
0
0
339
0.00
85+
Unknown
Total
HEDIS 2005 (Reporting Year 2004)
261.11
10.66
7.72
0.60
Page 27
Use of Services
Preferred One Community Health Plan
Ambulatory Care
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Medicare + Choice
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 28
Use of Services
Preferred One Community Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
Age
Member Months
<1
8540
1-9
72289
10-19
85893
20-44
237334
45-64
153064
65-74
4781
75-84
325
85+
42
Unknown
Total
0
562268
Discharges
Discharges /
1,000 Member
Months
<1
0
0.00
0
0.00
NA
1-9
0
0.00
0
0.00
NA
10-19
0
0.00
0
0.00
NA
20-44
4
0.02
43
0.18
10.75
45-64
14
0.09
100
0.65
7.14
65-74
4
0.84
26
5.44
6.50
75-84
3
9.23
57
175.38
19.00
85+
1
23.81
5
119.05
5.00
Unknown
0
26
0.05
0
231
0.41
NA
8.88
Age
Total
HEDIS 2005 (Reporting Year 2004)
Days
Days / 1,000 Average Length
Member Months
of Stay
Page 29
Use of Services
Preferred One Community Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Medicare + Choice
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 30
Use of Services
Preferred One Community Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
Male
Member Months
Female
Total
53945
22973
203907
2791
0
283616
52534
21993
201768
2357
0
278652
106479
44966
405675
5148
0
562268
Discharges
Discharges /
1,000 Member
Months
Days*
Average Length
of Stay
M
3
0.06
15
5.00
F
4
0.08
34
8.50
Total
7
0.07
49
7.00
13-17
M
7
0.30
114
16.29
F
23
1.05
276
12.00
Total
30
0.67
390
13.00
18-64
M
34
0.17
192
5.65
F
57
0.28
608
10.67
Total
91
0.22
800
8.79
M
65+
0
0.00
0
NA
F
1
0.42
11
11.00
Total
1
0.19
11
11.00
M
Unknown
0
0
NA
F
0
0
NA
Total
0
0
NA
M
Total
44
0.16
321
7.30
F
85
0.31
929
10.93
TOTAL
129
0.23
1250
9.69
* 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
Preferred One Community Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Medicare + Choice
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 32
Use of Services
Preferred One Community Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
Member Months (Day/Night)
Member Months (Ambulatory)
Male
Member Months (Any)
Female
Total
Male
Female
Total
Male
Female
Total
Male
Female
Total
0-12
53945
52534
106479
53945
52534
106479
53945
52534
106479
53945
52534
106479
13-17
22973
21993
44966
22973
21993
44966
22973
21993
44966
22973
21993
44966
18-64
203907
201768
405675
203907
201768
405675
203907
201768
405675
203907
201768
405675
2791
2357
5148
2791
2357
5148
2791
2357
5148
2791
2357
5148
0
283616
0
278652
0
562268
0
283616
0
278652
0
562268
0
283616
0
278652
0
562268
0
283616
0
278652
0
562268
Age
65+
Unknown
Total
Age
0-12
13-17
18-64
65+
Unknown
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
235
5.23%
2
0.04%
0
0.00%
234
5.21%
F
152
3.47%
3
0.07%
0
0.00%
152
3.47%
Total
387
4.36%
5
0.06%
0
0.00%
386
4.35%
M
184
9.61%
7
0.37%
1
0.05%
182
9.51%
F
235
12.82%
19
1.04%
0
0.00%
230
12.55%
Total
412
10.99%
Sex
M
419
11.18%
26
0.69%
1
0.03%
M
896
5.27%
27
0.16%
2
0.01%
887
5.22%
F
1517
9.02%
39
0.23%
2
0.01%
1514
9.00%
Total
2413
7.14%
66
0.20%
4
0.01%
2401
7.10%
5
2.15%
0
0.00%
0
0.00%
5
2.15%
M
F
6
3.05%
1
0.51%
0
0.00%
6
3.05%
Total
11
2.56%
1
0.23%
0
0.00%
11
2.56%
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
1320
5.59%
36
0.15%
3
0.01%
1308
5.53%
F
1910
3230
8.23%
6.89%
62
98
0.27%
0.21%
2
5
0.01%
0.01%
1902
3210
8.19%
6.85%
Total
HEDIS 2005 (Reporting Year 2004)
Page 33
Use of Services
Preferred One Community Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Medicare + Choice
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 34
Use of Services
Preferred One Community Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
Male
Member Months
Female
Total
53945
22973
203907
2791
0
283616
52534
21993
201768
2357
0
278652
106479
44966
405675
5148
0
562268
Discharges
Discharges /
1,000 Member
Months
Days
Average Length
of Stay
M
0
0.00
0
NA
F
0
0.00
0
NA
Total
0
0.00
0
NA
13-17
M
7
0.30
62
8.86
F
12
0.55
85
7.08
Total
19
0.42
147
7.74
18-64
M
37
0.18
205
5.54
F
36
0.18
227
6.31
Total
73
0.18
432
5.92
65+
M
1
0.36
6
6.00
F
0
0.00
0
NA
Total
1
0.19
6
6.00
Unknown
M
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
45
0.16
273
6.07
F
48
0.17
312
6.50
TOTAL
93
0.17
585
6.29
* 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
Preferred One Community Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Medicare + Choice
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 36
Use of Services
Preferred One Community Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
Member Months (Any)
Age
0-12
Male
Female
53945
52534
Total
106479
Member Months (Inpatient)
Male
Female
53945
52534
Total
106479
Member Months (Day/Night)
Male
Female
53945
52534
Total
106479
Member Months (Ambulatory)
Male
Female
53945
52534
Total
106479
13-17
22973
21993
44966
22973
21993
44966
22973
21993
44966
22973
21993
44966
18-64
203907
201768
405675
203907
201768
405675
203907
201768
405675
203907
201768
405675
2791
2357
5148
2791
2357
5148
2791
2357
5148
2791
2357
5148
0
283616
0
278652
0
562268
0
283616
0
278652
0
562268
0
283616
0
278652
0
562268
0
283616
0
278652
0
562268
65+
Unknown
Total
Any Chemical Dependency
Services
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
Number
0
Percent
0.00%
Number
0
Percent
0.00%
Number
0
Percent
0.00%
0
Percent
0.00%
1
1
0.02%
0.01%
1
1
0.02%
0.01%
0
0
0.00%
0.00%
0
0
0.00%
0.00%
38
1.98%
9
0.47%
8
0.42%
32
1.67%
Total
M
38
76
2.07%
2.03%
19
28
1.04%
0.75%
1
9
0.05%
0.24%
29
61
1.58%
1.63%
299
1.76%
65
0.38%
11
0.06%
252
1.48%
F
Total
162
461
0.96%
1.36%
54
119
0.32%
0.35%
1
12
0.01%
0.04%
129
381
0.77%
1.13%
3
0
1.29%
0.00%
1
0
0.43%
0.00%
0
0
0.00%
0.00%
3
0
1.29%
0.00%
Unknown
M
F
Total
M
0.70%
NA
NA
1
0
0
0.23%
NA
NA
0
0
0
0.00%
NA
NA
3
0
0
0.70%
NA
NA
Total
F
Total
M
3
0
0
0
340
201
541
NA
1.44%
0.87%
1.15%
0
75
74
149
NA
0.32%
0.32%
0.32%
0
19
2
21
NA
0.08%
0.01%
0.04%
0
287
158
445
NA
1.21%
0.68%
0.95%
Age
0-12
Sex
M
F
13-17
Total
M
F
18-64
65+
F
Total
HEDIS 2005 (Reporting Year 2004)
Page 37
Use of Services
Preferred One Community Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Medicare + Choice
Member Months (Any)
Age
Male
Female
Member Months (Inpatient)
Male
Female
Member Months (Ambulatory)
Male
Male
Female
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
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+
M
F
Total
Unknown
M
F
Total
Total
NR
Inpatient Chemical Dependency
Services
NR
F
18-64
NR
Total
NR
Any Chemical Dependency
Services
F
13-17
NR
Total
NR
Female
0-12
Total
Total
NR
Member Months (Day/Night)
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 38
Use of Services
Preferred One Community Health Plan
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 11:44 AM
Member Months
80829
85893
237334
153064
4781
325
42
0
562268
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
$927,071.44
$1,880,441.94
$8,795,325.63
$12,768,094.24
$615,766.73
$128,448.10
$3,161.61
$0.00
$25,118,309.69
A
Avg. Cost of
Prescriptions /
Per Member Per
Month
$11.47
$21.89
$37.06
$83.42
$128.79
$395.22
$75.28
$44.67
Total Number of
Prescriptions
18303
27066
133594
206361
10595
1395
96
0
397410
Avg. Num. Of
Prescriptions /
Per Member Per
Year
2.72
3.78
6.75
16.18
26.59
51.51
27.43
8.48
Page 39
Use of Services
Preferred One Community Health Plan
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 11:44 AM
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 40
Access/Availability of Care
Preferred One Community Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
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+
3286
2834
134
3060
2690
128
93.12%
92.24%
94.00%
94.92%
94.09%
95.75%
95.52%
91.65%
99.40%
A
Page 41
Access/Availability of Care
Preferred One Community Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Medicare + Choice
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 42
Access/Availability of Care
Preferred One Community Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
Data Elements
General Measure
Data
Data collection methodology (Administrative
only)
A
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)
12-24 months
25 months - 6
yrs.
7-11 yrs.
12-19 yrs.
543
2357
1555
2534
531
2045
1321
2188
97.79%
96.46%
99.12%
86.76%
85.37%
88.15%
84.95%
83.14%
86.76%
86.35%
84.99%
87.70%
Page 43
Access/Availability of Care
Preferred One Community Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
General Measure
Data
Timeliness of
Prenatal Care
Postpartum Care
Number of numerator events by administrative data in
eligible population (before exclusions)
433
366
Current year's administrative rate (before exclusions)
67.13%
56.74%
282
282
68.61%
68.61%
282
62
230
77
83.70%
80.01%
87.39%
74.70%
70.37%
79.02%
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)
HO
S
645
Minimum required sample size (MRSS) or other sample size
411
Oversampling rate
Final sample size (FSS)
10%
411
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of
valid data errors
10
Number of employee/dependent medical records excluded
0
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)
10
411
Page 44
Access/Availability of Care
Preferred One Community Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
18-25 Year Olds
Data Elements
Data collection methodology
(Administrative only)
General
Measure
Data
Initiation of
AOD
Treatment
HEDIS 2005 (Reporting Year 2004)
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
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
Engagement
of AOD
Treatment
26-34 Year Olds
90
52
191
2
335
22
10
12
8
73
34
1
0
108
52
24.44%
15.01%
33.88%
11.11%
4.06%
18.16%
23.08%
10.66%
35.49%
15.38%
4.62%
26.15%
38.22%
31.07%
45.37%
17.80%
12.11%
23.49%
NA
NA
NA
NA
NA
NA
32.24%
27.08%
37.39%
15.52%
11.50%
19.55%
Page 45
Access/Availability of Care
Preferred One Community Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Medicare + Choice
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 46
Health Plan Stability
Preferred One Community Health Plan
Practitioner Turnover
Medicare + Choice
Practitioner Types
Data Last Refreshed:
Sep 30, 2005 11:44 AM
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
NR
Non-Physician Primary
Care Practitioners
HEDIS 2005 (Reporting Year 2004)
NR
Page 47
Health Plan Stability
Preferred One Community Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Medicare + Choice
Product/Product Line
HMO (Total)
Years in Business
NR
Members*
NR
NR
NR
NR
NR
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
NR
* Total number of members in each category as of December 31, 2004
HEDIS 2005 (Reporting Year 2004)
Page 48
Health Plan Descriptive InformationPreferred One Community Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Commercial
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Male
4200
16020
20892
22176
13632
7920
Member Months
Female
4344
15492
19884
21564
13236
7356
Total
8544
31512
40776
43740
26868
15276
84840
29.91%
20376
23196
23568
25200
28236
81876
29.38%
18732
22668
22716
24384
28272
166716
29.65%
120576
42.51%
26784
21648
15828
11160
116772
41.91%
26088
22548
16872
12132
237348
42.21%
75420
26.59%
2028
552
156
24
12
24
77640
27.86%
1788
420
120
24
0
0
153060
27.22%
2796
0.99%
0
2352
0.84%
0
5148
0.92%
283632
278640
HEDIS 2005 (Reporting Year 2004)
39108
45864
46284
49584
56508
52872
44196
32700
23292
3816
972
276
48
12
24
0
562272
Page 49
Health Plan Descriptive InformationPreferred One Community Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 30, 2005 11:44 AM
Medicare + Choice
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 50