Medica Health Plans
Plan Name
2004
Reporting Year
General Info
Submission #
1
Last Refreshed:
18
9/30/2005 11:40:14 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
Medica Health Plans
Childhood Immunization Status
Data Last Refreshed:
Sep 30, 2005 11:40 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
3639
56.90%
3852
60.23%
5542
86.66%
3809
59.56%
3647
57.03%
4948
77.37%
2979
46.58%
2689
42.05%
193
51.88%
215
57.80%
323
86.83%
212
56.99%
210
56.45%
284
76.34%
168
45.16%
157
42.20%
188
208
308
207
205
273
163
152
132
121
28
100
109
22
127
108
90.40%
87.18%
93.61%
92.94%
90.13%
95.75%
94.92%
92.49%
97.35%
86.72%
83.05%
90.40%
88.70%
85.26%
92.14%
83.33%
79.31%
87.36%
81.92%
77.77%
86.07%
73.45%
68.70%
78.19%
372
1
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
MMR
354
5.00%
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
IPV/OPV
HO
S
6395
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
DTaP/DT
354
Page 3
Effectiveness of Care
Medica Health Plans
Adolescent Immunization Status
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Commercial
Data Elements
General
Measure
Data
MMR
Hepatitis B
VZV
Combo 1
Combo 2
3394
1264
192
1028
38
44.69%
16.64%
2.53%
13.54%
0.50%
186
59
7
54
1
43.06%
13.66%
1.62%
12.50%
0.23%
Numerator Events by Admin Data
178
57
7
52
1
Numerator Events by Medical Record
Data Collection Methodology
Sampling Method Used
Eligible Member Population
HO
S
7595
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
411
5.00%
432
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
0
Number of Records Excluded because of
Contraindications by Admin Data
0
Number of Records Excluded because of
Contraindications by Medical Record
Review
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
Denominator
411
169
203
158
201
142
Reported Rate
84.43%
63.26%
40.15%
61.56%
34.79%
Lower 95% Confidence Interval
Upper 95% Confidence Interval
80.80%
88.06%
58.48%
68.04%
35.29%
45.01%
56.73%
66.38%
30.07%
39.52%
HEDIS 2005 (Reporting Year 2004)
Page 4
Effectiveness of Care
Medica Health Plans
Appropriate Treatment for Children with Upper
Respiratory Infection
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Commercial
Member Months
Age
<1
8107
1-4
33047
5-9
42356
10-14
45917
15-17
27759
157186
Total
Data Elements
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*
General
Measure
Data
A
10336
10098
238
1160
1134
26
Reported Rate
88.78%
Lower 95% Confidence Interval
88.16%
Upper 95% Confidence Interval
89.39%
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
Medica Health Plans
Appropriate Testing for Children with Pharyngitis
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Commercial
Data Elements
Data Collection Methodology
General
Measure
Data
A
Eligible Member Population
8901
Eligible population by non-ER/Urgent Care
Visits*
8723
Eligible Population by ER/Urgent Care Visits*
178
Numerator Events by Admin Data
Numerator by non-ER/Urgent Care Visits*
Numerator by ER/Urgent Care Visits*
7545
7535
10
Reported Rate
84.77%
Lower 95% Confidence Interval
84.01%
Upper 95% Confidence Interval
85.52%
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
Medica Health Plans
Colorectal Cancer Screening
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Data Elements
Data collection methodology (administrative or hybrid)
Sampling method used (see User's Guide for entry descriptions)
Commercial
HO
S
Eligible population
72581
Number of numerator events by administrative data in eligible population (before exclusions)
28733
Current year's administrative rate (before exclusions)
39.59%
Minimum required sample size (MRSS) or other sample size
411
Oversampling rate
0.1
Final sample size (FSS)
432
Number of numerator events by administrative data in FSS
181
Administrative rate on FSS
Medicare +
Choice
41.90%
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
181
Denominator
411
Numerator events by administrative data
174
FOBT by administrative data*
29
Flexible sigmoidoscopy by administrative data*
39
DCBE by administrative data*
6
Colonoscopy by administrative data*
152
Numerator events by medical records
46
FOBT by medical records*
0
Flexible sigmoidoscopy by medical records*
9
DCBE by medical records*
0
Colonoscopy by medical records*
37
NR
NR
Reported rate
53.53%
NR
Lower 95% confidence interval
48.58%
NR
Upper 95% confidence interval
58.47%
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
Medica Health Plans
Breast Cancer Screening
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Commercial
A
Medicare + Choice
33527
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)
25015
74.61%
74.14%
75.08%
NR
NR
NR
Page 8
Effectiveness of Care
Medica Health Plans
Cervical Cancer Screening
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Commercial
A
96197
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
79.95%
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)
76909
#VALUE!
#VALUE!
#VALUE!
Page 9
Effectiveness of Care
Medica Health Plans
Chlamydia Screening in Women
Data Last Refreshed:
Sep 30, 2005 11:40 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
7026
10201
17227
71
29
100
7026
1899
27.03%
25.98%
28.07%
10201
2547
24.97%
24.12%
25.81%
17227
4446
25.81%
25.15%
26.46%
Page 10
Effectiveness of Care
Medica Health Plans
Controlling High Blood Pressure
Data Last Refreshed:
Sep 30, 2005 11:40 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
S
21674
0
0.00%
411
15.00%
494
0.00%
0
Records Excluded because of contraindications
through Admin Data
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)
NR
0
Records Excluded because of Valid Data Errors
Records Excluded because of contraindications
through Medical Record Review
Number of employee/dependent medical records
excluded
Medicare + Choice
NR
21
0
21
413
0
244
59.08%
54.22%
63.94%
NR
NR
NR
Page 11
Effectiveness of Care
Medica Health Plans
Beta Blocker Treatment after Heart Attack
Data Elements
Data Collection Methodology
Sampling Method Used
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Commercial
HO
N
Eligible Member Population
387
Numerator Events by Admin Data on Eligible
Population
299
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
77.26%
NR
387
0.00%
Final Sample Size (FSS)
387
Numerator events by admin data in FSS
279
Admin rate on FSS
Medicare + Choice
72.09%
Records Excluded because of Valid Data
Errors
7
Records Excluded because of
contraindications through Admin Data
24
Records Excluded because of
contraindications through Medical Record
Review
2
Number of employee/dependent medical
records excluded
0
Records Added from the Oversample List
0
Denominator
354
Numerator Events by Admin Data
279
Numerator Events by Medical Record
45
NR
Reported Rate
91.53%
NR
Lower 95% Confidence Interval
88.48%
NR
Upper 95% Confidence Interval
94.57%
NR
HEDIS 2005 (Reporting Year 2004)
Page 12
Effectiveness of Care
Medica Health Plans
Cholesterol Management After Acute
Cardiovascular Events
Data Last Refreshed:
Sep 30, 2005 11:40 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
Medica Health Plans
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Commercial
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
2
Number of employee/dependent medical
records excluded
0
Additional Records Added from the
Oversample List
2
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
12116
73.31%
16528
100.00%
9215
55.75%
12489
75.56%
46
0.28%
33
0.20%
8329
50.39%
326
71.96%
453
100.00%
256
56.51%
342
75.50%
1
0.22%
0
0.00%
224
49.45%
299
44
83.45%
0
119
28.95%
231
7
57.91%
314
42
86.62%
0
239
58.15%
0
150
36.50%
207
0
50.36%
79.74%
87.17%
24.45%
33.46%
53.01%
62.80%
83.20%
90.03%
53.26%
63.04%
31.72%
41.27%
45.41%
55.32%
453
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
S
16528
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
Medica Health Plans
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 30, 2005 11:40 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
Medica Health Plans
Appropriate Medications for People with Asthma
Data Last Refreshed:
Sep 30, 2005 11:40 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
740
2
740
585
79.05%
76.05%
82.05%
1309
5
1309
1019
77.85%
75.56%
80.13%
5195
115
5195
4014
77.27%
76.12%
78.42%
7244
122
7244
5618
77.55%
76.59%
78.52%
A
Page 16
Effectiveness of Care
Medica Health Plans
Follow-Up After Hospitalization for Mental Illness
Data Last Refreshed:
Sep 30, 2005 11:40 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
1357
645
47.53%
44.84%
50.23%
1020
75.17%
72.83%
77.50%
NR
NR
NR
NR
NR
NR
Page 17
Effectiveness of Care
Medica Health Plans
Antidepressant Medication Management
Data Last Refreshed:
Sep 30, 2005 11:40 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
593
15.85%
14.67%
17.04%
2544
68.00%
66.50%
69.51%
1972
52.71%
51.10%
54.33%
A
3741
Page 18
Effectiveness of Care
Medica Health Plans
Antidepressant Medication Management
Data Last Refreshed:
Sep 30, 2005 11:40 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
Medica Health Plans
Osteoporosis Management in Women Who
had a Fracture
Data Elements
Data Last Refreshed:
Sep 30, 2005 11:40 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
Medica Health Plans
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Sep 30, 2005 11:40 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
60
51
78
104
327
1044
3944
1.07%
0.79%
1.35%
0.91%
0.65%
1.17%
1.39%
1.08%
1.71%
1.85%
1.49%
2.22%
5.83%
5.21%
6.45%
18.62%
17.59%
19.64%
70.33%
69.12%
71.53%
A
5608
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
Medica Health Plans
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 11:40 AM
Commercial
A
26863
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)
16213
60.35%
59.77%
60.94%
Page 22
Use of Services
Medica Health Plans
Adolescent Well-Care Visits
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Commercial
A
70225
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)
22667
32.28%
31.93%
32.62%
Page 23
Use of Services
Medica Health Plans
Frequency of Selected Procedures
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Commercial
Age
0-4
0-9
5-19
10-19
15-44
20-64
30-64
45-64
65+
Male
2416954
1953972
998967
51094
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
493837
1002114
1590102
1081825
1760789
2593025
1094534
43112
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
2550
691
810
345
265
270
412
495
6
421
397
7
80
140
134
9
3
337
687
526
13
18
796
666
760
239
71
31
843
527
101
44
174
36
38
4
266
44
Procedures /
1,000 Member
Months
5.16
0.43
0.81
0.32
0.15
0.25
0.23
0.45
0.14
0.24
0.36
0.16
0.04
0.08
0.12
0.18
0.07
0.17
0.39
0.48
0.25
0.42
0.33
0.26
0.76
0.22
1.39
0.72
0.84
0.48
1.98
1.02
0.17
0.03
0.74
0.09
0.27
0.86
Page 24
Use of Services
Medica Health Plans
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 11:40 AM
Member Months
97276
904838
1081825
2916478
2093501
79574
12370
2262
0
7188124
Discharges
Discharges /
1,000 Member
Months
811
1284
1588
16567
14378
1163
242
78
0
36111
8.34
1.42
1.47
5.68
6.87
14.62
19.56
34.48
683
1001
715
3339
6477
603
146
55
0
13019
7.02
1.11
0.66
1.14
3.09
7.58
11.80
24.31
117
276
622
4184
7766
552
94
22
0
13633
1.20
0.31
0.57
1.43
3.71
6.94
7.60
9.73
232
8952
16
0
0
9200
0.21
3.07
0.01
0.00
HEDIS 2005 (Reporting Year 2004)
5.02
1.81
1.90
1.49
Days
Days / 1,000
Member
Months
5110
4329
6171
51239
55758
4958
1236
349
0
129150
52.53
4.78
5.70
17.57
26.63
62.31
99.92
154.29
4175
2997
2816
11752
24568
2336
713
256
0
49613
42.92
3.31
2.60
4.03
11.74
29.36
57.64
113.17
904
1304
2442
14536
30633
2592
517
89
0
53017
9.29
1.44
2.26
4.98
14.63
32.57
41.79
39.35
568
24663
51
0
0
25282
0.53
8.46
0.02
0.00
17.97
6.90
7.38
4.09
Average
Length of Stay
6.30
3.37
3.89
3.09
3.88
4.26
5.11
4.47
NA
3.58
6.11
2.99
3.94
3.52
3.79
3.87
4.88
4.65
NA
3.81
7.73
4.72
3.93
3.47
3.94
4.70
5.50
4.05
NA
3.89
2.45
2.76
3.19
NA
NA
2.75
Page 25
Use of Services
Medica Health Plans
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 11:40 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
Medica Health Plans
Ambulatory Care
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
97276
904838
1081825
2916478
2093501
79574
12370
2262
0
7188124
Outpatient Visits
(Excludes MH/CD)
Emergency Room Visits
Ambulatory
Surgery/Procedures
Observation Room Stays
Resulting in Discharge
Stays/ 1,000
Member
Months
0.73
0.17
<1
1-9
Visits
84367
257303
Visits/ 1,000
Member
Months
867.30
284.36
10-19
221600
204.84
12076
11.16
3477
3.21
180
0.17
20-44
45-64
65-74
724186
696791
39792
248.31
332.84
500.06
35886
22440
1238
12.30
10.72
15.56
20652
37538
2323
7.08
17.93
29.19
2435
615
50
0.83
0.29
0.63
75-84
7825
632.58
293
23.69
424
34.28
11
0.89
1228
0
2033092
542.88
67
0
88597
29.62
43
0
68993
19.01
1
0
3519
0.44
Age
85+
Unknown
Total
HEDIS 2005 (Reporting Year 2004)
282.84
Visits
2982
13615
Visits/ 1,000
Member
Months
30.66
15.05
12.33
Procedures
632
3904
Procedures/
1,000 Member
Months
6.50
4.31
9.60
Stays
71
156
0.49
Page 27
Use of Services
Medica Health Plans
Ambulatory Care
Data Last Refreshed:
Sep 30, 2005 11:40 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
Medica Health Plans
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Commercial
Age
Member Months
<1
97276
1-9
904838
10-19
1081825
20-44
2916478
45-64
2093501
65-74
79574
75-84
12370
85+
2262
Unknown
Total
0
7188124
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
4
0.00
58
0.05
14.50
20-44
33
0.01
293
0.10
8.88
45-64
142
0.07
1213
0.58
8.54
65-74
15
0.19
64
0.80
4.27
75-84
6
0.49
28
2.26
4.67
85+
1
0.44
1
0.44
1.00
0.03
0
1657
0.23
NA
8.24
Age
Unknown
Total
HEDIS 2005 (Reporting Year 2004)
0
201
Days
Days / 1,000 Average Length
Member Months
of Stay
Page 29
Use of Services
Medica Health Plans
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 30, 2005 11:40 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
Medica Health Plans
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Commercial
Male
Member Months
Female
Total
670286
282830
2497515
50718
0
3501349
644235
270913
2666244
42733
0
3624125
1314521
553743
5163759
93451
0
7125474
Discharges
Discharges /
1,000 Member
Months
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
Days*
Average Length
of Stay
M
56
0.08
978
17.46
F
40
0.06
505
12.63
Total
96
0.07
1483
15.45
13-17
M
176
0.62
6168
35.05
F
323
1.19
5962
18.46
Total
499
0.90
12130
24.31
18-64
M
592
0.24
4420
7.47
F
991
0.37
8156
8.23
Total
1583
0.31
12576
7.94
M
65+
14
0.28
150
10.71
F
8
0.19
132
16.50
Total
22
0.24
282
12.82
M
Unknown
0
0
NA
F
0
0
NA
Total
0
0
NA
M
Total
838
0.24
11716
13.98
F
1362
0.38
14755
10.83
TOTAL
2200
0.31
26471
12.03
* 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
Medica Health Plans
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 30, 2005 11:40 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
Medica Health Plans
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Sep 30, 2005 11:40 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
670286
644235
1314521
670286
644235
1314521
670286
644235
1314521
670286
644235
1314521
13-17
282830
270913
553743
282830
270913
553743
282830
270913
553743
282830
270913
553743
18-64
2497515
2666244
5163759
2497515
2666244
5163759
2497515
2666244
5163759
2497515
2666244
5163759
50718
42733
93451
50718
42733
93451
50718
42733
93451
50718
42733
93451
0
3501349
0
3624125
0
7125474
0
3501349
0
3624125
0
7125474
0
3501349
0
3624125
0
7125474
0
3501349
0
3624125
0
7125474
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
3248
5.81%
45
0.08%
2
0.00%
3240
5.80%
F
1904
3.55%
32
0.06%
1
0.00%
1901
3.54%
Total
5152
4.70%
77
0.07%
3
0.00%
5141
4.69%
M
2720
11.54%
141
0.60%
5
0.02%
2694
11.43%
Sex
M
F
2941
13.03%
237
1.05%
9
0.04%
2912
12.90%
Total
5661
12.27%
378
0.82%
14
0.03%
5606
12.15%
M
13019
6.26%
473
0.23%
1
0.00%
12890
6.19%
F
23990
10.80%
740
0.33%
8
0.00%
23876
10.75%
Total
37009
8.60%
1213
0.28%
9
0.00%
36766
8.54%
123
2.91%
13
0.31%
0
0.00%
115
2.72%
M
F
115
3.23%
7
0.20%
0
0.00%
112
3.15%
Total
238
3.06%
20
0.26%
0
0.00%
227
2.91%
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
19110
6.55%
672
0.23%
8
0.00%
18939
6.49%
F
28950
48060
9.59%
8.09%
1016
1688
0.34%
0.28%
18
26
0.01%
0.00%
28801
47740
9.54%
8.04%
Total
HEDIS 2005 (Reporting Year 2004)
Page 33
Use of Services
Medica Health Plans
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Sep 30, 2005 11:40 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
Medica Health Plans
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Commercial
Male
Member Months
Female
Total
670286
282830
2497515
50718
0
3501349
644235
270913
2666244
42733
0
3624125
1314521
553743
5163759
93451
0
7125474
Discharges
Discharges /
1,000 Member
Months
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
Days
Average Length
of Stay
M
1
0.00
1
1.00
F
2
0.00
4
2.00
Total
3
0.00
5
1.67
13-17
M
110
0.39
1440
13.09
F
78
0.29
994
12.74
Total
188
0.34
2434
12.95
18-64
M
717
0.29
5566
7.76
F
424
0.16
3695
8.71
Total
1141
0.22
9261
8.12
65+
M
4
0.08
20
5.00
F
2
0.05
31
15.50
Total
6
0.06
51
8.50
Unknown
M
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
832
0.24
7027
8.45
F
506
0.14
4724
9.34
TOTAL
1338
0.19
11751
8.78
* 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
Medica Health Plans
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Sep 30, 2005 11:40 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
Medica Health Plans
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Commercial
Member Months (Any)
Age
0-12
Male
Female
670286
644235
Total
1314521
Member Months (Inpatient)
Male
Female
670286
644235
Total
1314521
Member Months (Day/Night)
Male
Female
670286
644235
Total
1314521
Member Months (Ambulatory)
Male
Female
670286
644235
Total
1314521
13-17
282830
270913
553743
282830
270913
553743
282830
270913
553743
282830
270913
553743
18-64
2497515
2666244
5163759
2497515
2666244
5163759
2497515
2666244
5163759
2497515
2666244
5163759
50718
42733
93451
50718
42733
93451
50718
42733
93451
50718
42733
93451
0
3501349
0
3624125
0
7125474
0
3501349
0
3624125
0
7125474
0
3501349
0
3624125
0
7125474
0
3501349
0
3624125
0
7125474
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
2
Percent
0.00%
Number
8
Percent
0.01%
6
Percent
0.01%
6
14
0.01%
0.01%
2
4
0.00%
0.00%
0
0
0.00%
0.00%
5
11
0.01%
0.01%
448
1.90%
127
0.54%
0
0.00%
383
1.63%
Total
M
330
778
1.46%
1.69%
121
248
0.54%
0.54%
0
0
0.00%
0.00%
270
653
1.20%
1.42%
3698
1.78%
1159
0.56%
1
0.00%
3022
1.45%
F
Total
2202
5900
0.99%
1.37%
726
1885
0.33%
0.44%
0
1
0.00%
0.00%
1783
4805
0.80%
1.12%
71
27
1.68%
0.76%
38
14
0.90%
0.39%
0
0
0.00%
0.00%
45
18
1.06%
0.51%
Unknown
M
F
Total
M
1.26%
NA
NA
52
0
0
0.67%
NA
NA
0
0
0
0.00%
NA
NA
63
0
0
0.81%
NA
NA
Total
F
Total
M
98
0
0
0
4225
2565
6790
NA
1.45%
0.85%
1.14%
0
1326
863
2189
NA
0.45%
0.29%
0.37%
0
1
0
1
NA
0.00%
0.00%
0.00%
0
3456
2076
5532
NA
1.18%
0.69%
0.93%
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
Medica Health Plans
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Sep 30, 2005 11:40 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
Medica Health Plans
Outpatient Drug Utilization
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Commercial
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member Months
922710
992531
2725268
1950909
74021
11174
2096
0
6678709
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
Total Cost of
Prescriptions
$11,057,078.00
$24,880,429.00
$117,240,644.00
$185,609,645.00
$10,863,585.00
$1,787,136.00
$245,506.00
$0.00
$351,684,023.00
HEDIS 2005 (Reporting Year 2004)
A
Avg. Cost of
Prescriptions /
Per Member Per
Month
$11.98
$25.07
$43.02
$95.14
$146.76
$159.94
$117.13
$52.66
Total Number of
Prescriptions
208607
304215
1541219
2587635
164472
28125
4996
0
4839269
Avg. Num. Of
Prescriptions /
Per Member Per
Year
2.71
3.68
6.79
15.92
26.66
30.20
28.60
8.69
Page 39
Use of Services
Medica Health Plans
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 11:40 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
Medica Health Plans
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 30, 2005 11:40 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+
95899
90714
5446
91495
87751
5281
95.41%
95.27%
95.54%
96.73%
96.62%
96.85%
96.97%
96.51%
97.43%
A
Page 41
Access/Availability of Care
Medica Health Plans
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 30, 2005 11:40 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
Medica Health Plans
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Sep 30, 2005 11:40 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.
6895
32721
26816
45775
6807
28948
23388
40469
98.72%
98.45%
99.00%
88.47%
88.12%
88.82%
87.22%
86.82%
87.62%
88.41%
88.11%
88.70%
Page 43
Access/Availability of Care
Medica Health Plans
Prenatal and Postpartum Care
Data Last Refreshed:
Sep 30, 2005 11:40 AM
Commercial
General Measure
Data
Timeliness of
Prenatal Care
Postpartum Care
Number of numerator events by administrative data in
eligible population (before exclusions)
6394
4982
Current year's administrative rate (before exclusions)
79.69%
62.09%
244
187
80.53%
61.72%
231
32
179
37
91.32%
87.89%
94.74%
75.00%
69.83%
80.17%
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
8024
Minimum required sample size (MRSS) or other sample size
411
Oversampling rate
Final sample size (FSS)
10%
303
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of
valid data errors
0
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)
0
288
Page 44
Access/Availability of Care
Medica Health Plans
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Sep 30, 2005 11:40 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
965
732
3051
85
4833
249
42
176
35
860
139
34
1
1319
217
25.80%
22.99%
28.62%
4.35%
3.01%
5.69%
24.04%
20.88%
27.21%
4.78%
3.17%
6.40%
28.19%
26.57%
29.80%
4.56%
3.80%
5.31%
40.00%
29.00%
51.00%
1.18%
0.00%
4.06%
27.29%
26.03%
28.56%
4.49%
3.90%
5.08%
Page 45
Access/Availability of Care
Medica Health Plans
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Sep 30, 2005 11:40 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
Medica Health Plans
Practitioner Turnover
Medicare + Choice
Practitioner Types
Data Last Refreshed:
Sep 30, 2005 11:40 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
Medica Health Plans
Years in Business / Total Membership
Data Last Refreshed:
Sep 30, 2005 11:40 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 Information
Medica Health Plans
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 30, 2005 11:40 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
50076
201276
260880
279876
170040
98472
Member Months
Female
47208
195288
247392
271128
163068
99240
Total
97284
396564
508272
551004
333108
197712
1060620
30.06%
220512
242472
279228
312780
362988
1023324
27.96%
236976
266412
294204
325656
375252
2083944
28.99%
1417980
40.18%
337668
287904
215100
158304
1498500
40.95%
359688
308232
245892
180732
2916480
40.57%
998976
28.31%
31728
11820
4536
2016
768
240
1094544
29.91%
27072
8964
3864
1956
828
432
2093520
29.12%
51108
1.45%
0
43116
1.18%
0
94224
1.31%
3528684
3659484
HEDIS 2005 (Reporting Year 2004)
457488
508884
573432
638436
738240
697356
596136
460992
339036
58800
20784
8400
3972
1596
672
0
7188168
Page 49
Health Plan Descriptive Information
Medica Health Plans
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 30, 2005 11:40 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