Metropolitan Health Plan
Plan Name
2003
Reporting Year
General Info
Submission #
1
Last Refreshed:
7
9/1/2004 3:58:41 PM
Page
Title
Disclaimers
Effectiveness of
Care Measures
Plan ID
2
Access / Availability
of Care
Page
Measure
Page
Childhood Immunization Rate
3
Adults' Access to Preventive/Ambulatory Health Services
55
Adolescent Immunization Rate
6
Children's Access to Primary Care Practitioners
59
Breast Cancer Screening
9
Prenatal and Postpartum Care
61
Cervical Cancer Screening
10
Chlamydia Screening in Women
11
Controlling High Blood Pressure
12
Beta Blocker Treatment after a Heart Attack
13
Cholesterol Management
14
Comprehensive Diabetes Care
15
Practitioner Turnover
63
Appropriate Medications for People with Asthma
20
Years in Business / Total Membership
65
Follow-up After Hospitalization For Mental Illness
22
Antidepressant Medication Management
23
Measure
Use of Services
Measures
Measure
Health Plan Stability
Measure
Page
Health Plan
Descriptive
Information
Measure
Page
Page
Well-Child Visits In The First 15 Months of Life
27
Board Certification / Residency Completion
67
Well-Child Visits In The Third, Fourth, Fifth And Sixth Year of Life
29
Total Enrollment by Percentage
68
Adolescent Well-Care Visits
30
Enrollment by Product Line (Age & Sex)
69
Inpatient Utilization - General Hospital/Acute Care
31
Ambulatory Care
35
Inpatient Utilization - Nonacute Care
38
Mental Health Utilization - Inpatient Discharges and Average Length of Stay
41
Mental Health Utilization - Percentage of Members Receiving Inpatient and Ambulatory Services
44
Chemical Dependency Utilization - Inpatient Discharges and Average Length of Stay
47
Chemical Dependency Utilization - Percentage of Members Receiving Inpatient and Ambulatory Services
50
Outpatient Drug Utilization
53
HEDIS 2004 (Reporting Year 2003)
DISCLAIMERS
-1
0. Disclaimer Query located below
1. For this reporting period, DHS has waived the reporting by all Managed Care Organizations (MCOs)
of all HEDIS measures for the distinct MNCare and GAMC populations.
2. For BCBS, Medica, MHP and UCare (Community Measurement Project "CMP") participants: three
Effectiveness of Care measures (Childhood Immunization Status, Adolescent Immunization Status
and Comprehensive Diabetes Care) are reported under the category "Medicaid." For 2003 data
reported in 2004 only, "Medicaid" results are based on the combined PMAP, MNCare and GAMC
populations but do not include MSHO.
3. Although HealthPartners participates in the CMP, it has reported all 14 Effectiveness of Care
measures for its PMAP population only.
4. All MCOs that do not participate in the CMP reported commercial, PMAP, MSHO and
Medicare+Choice measures.
HEDIS 2004 (Reporting Year 2003)
Page 2
Effectiveness of Care
Metropolitan Health Plan
Childhood Immunization Rate
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Data Elements
General
Measure
Data
DTaP/DT
IPV/OPV
MMR
HiB
Hepatitis B
VZV
Combo 1
Combo 2
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of Records Excluded because of
Contraindications by Admin Data
Number of Records Excluded because of
Contraindications by Medical Record
Review
Number of employee/dependent records
excluded
Additional Records Added from the
Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
Page 3
Effectiveness of Care
Metropolitan Health Plan
Childhood Immunization Rate
Data Last Refreshed:
Sep 1, 2004 3:58 PM
PMAP
Data Elements
General
Measure
Data
DTaP/DT
IPV/OPV
MMR
HiB
Hepatitis B
VZV
Combo 1
Combo 2
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of Records Excluded because of
Contraindications by Admin Data
Number of Records Excluded because of
Contraindications by Medical Record
Review
Number of employee/dependent records
excluded
Additional Records Added from the
Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
Page 4
Effectiveness of Care
Metropolitan Health Plan
Childhood Immunization Rate
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Medicaid
Data Elements
General
Measure
Data
DTaP/DT
IPV/OPV
MMR
HiB
Hepatitis B
VZV
Combo 1
Combo 2
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of Records Excluded because of
Contraindications by Admin Data
Number of Records Excluded because of
Contraindications by Medical Record
Review
Number of employee/dependent records
excluded
Additional Records Added from the
Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
Page 5
Effectiveness of Care
Metropolitan Health Plan
Adolescent Immunization Status
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Data Elements
General
Measure
Data
MMR
Hepatitis B
VZV
Combo 1
Combo 2
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of Records Excluded because of
Contraindications by Admin Data
Number of Records Excluded because of
Contraindications by Medical Record
Review
Number of employee/dependent records
excluded
Additional Records Added from the
Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
Page 6
Effectiveness of Care
Metropolitan Health Plan
Adolescent Immunization Status
Data Last Refreshed:
Sep 1, 2004 3:58 PM
PMAP
Data Elements
General
Measure
Data
MMR
Hepatitis B
VZV
Combo 1
Combo 2
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of Records Excluded because of
Contraindications by Admin Data
Number of Records Excluded because of
Contraindications by Medical Record
Review
Number of employee/dependent records
excluded
Additional Records Added from the
Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
Page 7
Effectiveness of Care
Metropolitan Health Plan
Adolescent Immunization Status
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Medicaid
Data Elements
General
Measure
Data
MMR
Hepatitis B
VZV
Combo 1
Combo 2
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of Records Excluded because of
Contraindications by Admin Data
Number of Records Excluded because of
Contraindications by Medical Record
Review
Number of employee/dependent records
excluded
Additional Records Added from the
Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
Page 8
Effectiveness of Care
Metropolitan Health Plan
Breast Cancer Screening
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Medicare + Choice
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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
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 Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
Page 9
Effectiveness of Care
Metropolitan Health Plan
Cervical Cancer Screening
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
PMAP
A
963
Numerator Events by Admin Data on Eligible
Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
Records Excluded because of Valid Data Errors
NR
64.59%
NR
NR
Records Excluded because of contraindications
through Admin data
1
Records Excluded because of contraindications
through Medical Record Review
Number of employee/dependent medical records
excluded
Records Added from Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
962
622
NR
NR
NR
64.66%
61.58%
67.73%
Page 10
Effectiveness of Care
Metropolitan Health Plan
Chlamydia Screening in Women
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Data Elements
Data Collection Methodology
Eligible Member Population
Current Year's Admin Rate (before exclusions)
General
Measure Ages 16-20 Ages 21-25
Data
PMAP
Total
General
Measure Ages 16-20 Ages 21-25
Data
Total
A
NR
NR
258
78.29%
209
80.86%
467
79.44%
Records Excluded - Contraindications/Admin
Data
NR
0
0
0
Denominator
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
NR
NR
NR
NR
NR
258
202
78.29%
73.07%
83.52%
209
169
80.86%
75.29%
86.43%
467
371
79.44%
75.67%
83.22%
HEDIS 2004 (Reporting Year 2003)
NR
NR
NR
NR
NR
NR
NR
NR
Page 11
Effectiveness of Care
Metropolitan Health Plan
Controlling High Blood Pressure
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Data Elements
Data Collection Methodology (Hybrid)
Sampling Method Used
Eligible Member Population
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Records Excluded because of Valid Data Errors
Records Excluded - False positive diagnosis
Commercial
Medicare + Choice
MSHO
HO
S
184
0
0.00%
157
0
0
Records Excluded because of ESRD or non-acute
admission identified by Admin Data
0
Records Excluded because of ESRD or non-acute
admission identified by Medical Record
0
Number of employee/dependent medical records
excluded
0
Records Added from Auxiliary List
Denominator
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
NR
NR
NR
NR
NR
NR
0
157
93
59.24%
51.23%
67.24%
Page 12
Effectiveness of Care
Metropolitan Health Plan
Beta Blocker Treatment after Heart Attack
Data Elements
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Medicare + Choice
NR
NR
NR
NR
Reported Rate
NR
NR
Lower 95% Confidence Interval
Upper 95% Confidence Interval
NR
NR
NR
NR
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
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 Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
HEDIS 2004 (Reporting Year 2003)
Page 13
Effectiveness of Care
Metropolitan Health Plan
Cholesterol Management After Acute Cardiovascular Events
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Data Elements
General
Measure
Data
Medicare + Choice
LDL-C
LDL-C Level of
screening 60- <130 mg/dL 60365 Days
365 Days
General
Measure
Data
LDL-C
LDL-C Level of
screening 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
NR
NR
NR
NR
NR
Records Excluded because of Valid Data
Errors
Number of employee/dependent medical
records excluded
Records Added from Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
Page 14
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Data Elements
General
Measure Data
HbA1c
Testing
Poor HbA1c
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<130 mg/dL
LDL-C Level
<100 mg/dL
Monitoring for
Diabetic
Nephropathy
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in
eligible population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because
of Valid Data Errors
Number of employee/dependent records
excluded
Additional Records Added from the
Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
Page 15
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
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
Number of employee/dependent records
excluded
Additional Records Added from the
Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
Page 16
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
MSHO
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure Data
LDL-C
Screening
LDL-C Level
<130 mg/dL
LDL-C Level
<100 mg/dL
Monitoring for
Diabetic
Nephropathy
72
88.89%
81
100.00%
15
18.52%
55
67.90%
0
0.00%
0
0.00%
41
50.62%
71
87.65%
24
29.63%
11
13.58%
45
55.56%
0
0.00%
0
0.00%
41
50.62%
71
3
92.50%
86.10%
98.90%
23
0
28.75%
18.21%
39.29%
10
42
65.00%
53.92%
76.08%
45
23
85.00%
76.55%
93.45%
0
45
56.25%
44.75%
67.75%
0
36
45.00%
33.47%
56.53%
41
8
61.25%
49.95%
72.55%
81
1
Number of employee/dependent records
excluded
0
Additional Records Added from the
Auxiliary List
0
HEDIS 2004 (Reporting Year 2003)
Eye Exam
0
0.00%
Number of Records Excluded Because
of Valid Data Errors
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
Poor HbA1c
Control
HO
S
81
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
HbA1c
Testing
80
Page 17
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
PMAP
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
Number of employee/dependent records
excluded
Additional Records Added from the
Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
Page 18
Effectiveness of Care
Metropolitan Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Medicaid
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
Number of employee/dependent records
excluded
Additional Records Added from the
Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
Page 19
Effectiveness of Care
Metropolitan Health Plan
Appropriate Medications for People with Asthma
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Data Elements
Data Collection Methodology
Eligible Member Population
Current Year's Admin Rate
Total Exclusions
Denominator
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
General
Measure Data
Ages 5-9
Ages 10-17
Ages 18-56
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Page 20
Effectiveness of Care
Metropolitan Health Plan
Appropriate Medications for People with Asthma
Data Last Refreshed:
Sep 1, 2004 3:58 PM
PMAP
Data Elements
Data Collection Methodology
Eligible Member Population
Current Year's Admin Rate
Total Exclusions
Denominator
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
General
Measure Data
Ages 5-9
Ages 10-17
Ages 18-56
Total
61
62.30%
0
61
38
62.30%
49.31%
75.28%
102
61.76%
0
102
63
61.76%
51.84%
71.69%
56
51.79%
5
51
29
56.86%
42.29%
71.44%
219
59.36%
5
214
130
60.75%
53.97%
67.52%
A
Page 21
Effectiveness of Care
Metropolitan Health Plan
Follow-Up After Hospitalization for Mental Illness
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Data Elements
General
Measure
Data
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
Medicare + Choice
General
W/in 7 Days of W/in 30 Days of
Measure
Discharge
Discharge
Data
NR
NR
NR
NR
NR
NR
NR
NR
NR
MSHO
Data Elements
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
General
Measure
Data
W/in 7 Days of W/in 30 Days of
Discharge
Discharge
NR
NR
NR
PMAP
General
W/in 7 Days of W/in 30 Days of
Measure
Discharge
Discharge
Data
A
2
W/in 7 Days of W/in 30 Days of
Discharge
Discharge
A
48
0
NA
NA
NA
1
NA
NA
NA
4
8.33%
0.00%
17.19%
15
31.25%
17.10%
45.40%
Page 22
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Data Elements
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 23
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Medicare + Choice
Data Elements
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 24
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Sep 1, 2004 3:58 PM
MSHO
Data Elements
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
0
NA
NA
NA
3
NA
NA
NA
3
NA
NA
NA
A
4
Page 25
Effectiveness of Care
Metropolitan Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Sep 1, 2004 3:58 PM
PMAP
Data Elements
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
11
18.64%
7.86%
29.43%
34
57.63%
44.17%
71.08%
18
30.51%
17.91%
43.11%
A
59
Page 26
Use of Services
Metropolitan Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Data Elements
General
Measure
Data
Zero Visits
1 visit
2 visits
3 visits
4 visits
5 visits
6 or more
visits
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of employee/dependent medical
records excluded
Additional Records Added from the
Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
Page 27
Use of Services
Metropolitan Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Sep 1, 2004 3:58 PM
PMAP
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
0
Number of employee/dependent medical
records excluded
0
Additional Records Added from the
Auxiliary List
0
HEDIS 2004 (Reporting Year 2003)
2 visits
3 visits
4 visits
5 visits
6 or more
visits
3
0.39%
8
1.03%
23
2.98%
62
8.02%
91
11.77%
202
26.13%
384
49.68%
4
0.88%
8
1.77%
11
2.43%
33
7.28%
51
11.26%
111
24.50%
235
51.88%
1
0
0.24%
0.00%
0.84%
3
0
0.73%
0.00%
1.67%
4
1
1.22%
0.04%
2.40%
17
5
5.35%
3.06%
7.65%
35
12
11.44%
8.24%
14.63%
68
7
18.25%
14.39%
22.10%
218
40
62.77%
57.98%
67.57%
411
10.00%
453
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
1 visit
HO
S
773
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
Zero Visits
411
Page 28
Use of Services
Metropolitan 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
Commercial
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
HEDIS 2004 (Reporting Year 2003)
PMAP
HO
S
1255
745
NR
59.36%
411
10.00%
453
282
NR
62.25%
0
Number of employee/dependent medical records
excluded
Records Added from Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
Data Last Refreshed:
Sep 1, 2004 3:58 PM
0
NR
NR
NR
0
411
261
14
66.91%
62.24%
71.58%
Page 29
Use of Services
Metropolitan Health Plan
Adolescent Well-Care Visits
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
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
608
NR
33.54%
411
10.00%
453
147
NR
32.45%
0
Number of employee/dependent medical records
excluded
Records Added from Auxiliary List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
PMAP
HO
S
1813
0
NR
NR
NR
0
411
136
44
43.80%
38.88%
48.71%
Page 30
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
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
Member Months
NR
Discharges
Discharges /
1,000 Member
Months
Days
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2004 (Reporting Year 2003)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Days / 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
Average Length
of Stay
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 31
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
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
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 2004 (Reporting Year 2003)
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 32
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Minnesota Senior Health Options
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
Member Months
0
0
0
0
0
2468
1709
605
0
4782
Discharges
Discharges /
1,000 Member
Months
0
0
0
0
0
120
56
31
0
207
NA
NA
NA
NA
NA
48.62
32.77
51.24
0
0
0
0
0
96
51
30
0
177
NA
NA
NA
NA
NA
38.90
29.84
49.59
0
0
0
0
0
24
5
1
0
30
HEDIS 2004 (Reporting Year 2003)
43.29
37.01
NA
NA
NA
NA
NA
9.72
2.93
1.65
6.27
Days
Days / 1,000
Member
Months
0
0
0
0
0
575
229
97
0
901
NA
NA
NA
NA
NA
232.98
134.00
160.33
0
0
0
0
0
407
203
96
0
706
NA
NA
NA
NA
NA
164.91
118.78
158.68
0
0
0
0
0
168
26
1
0
195
188.41
147.64
NA
NA
NA
NA
NA
68.07
15.21
1.65
40.78
Average Length
of Stay
NA
NA
NA
NA
NA
4.79
4.09
3.13
NA
4.35
NA
NA
NA
NA
NA
4.24
3.98
3.20
NA
3.99
NA
NA
NA
NA
NA
7.00
5.20
1.00
NA
6.50
Page 33
Use of Services
Metropolitan Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
PMAP
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
Member Months
11836
68011
48666
31956
3871
7195
3408
1119
0
176062
Discharges
184
231
259
848
41
184
81
26
0
1854
Discharges /
1,000 Member
Months
15.55
3.40
5.32
26.54
10.59
25.57
23.77
23.24
10.53
167
179
75
93
28
129
61
24
0
756
14.11
2.63
1.54
2.91
7.23
17.93
17.90
21.45
17
52
30
56
9
55
20
2
0
241
1.44
0.76
0.62
1.75
2.32
7.64
5.87
1.79
154
699
4
0
0
857
HEDIS 2004 (Reporting Year 2003)
4.29
1.37
3.16
21.87
1.03
0.00
8.91
Days
Days / 1,000
Member
Months
891
650
710
2203
117
684
370
90
0
5715
75.28
9.56
14.59
68.94
30.22
95.07
108.57
80.43
574
472
222
235
66
411
256
83
0
2319
48.50
6.94
4.56
7.35
17.05
57.12
75.12
74.17
317
178
86
185
37
273
114
7
0
1197
26.78
2.62
1.77
5.79
9.56
37.94
33.45
6.26
402
1783
14
0
0
2199
8.26
55.80
3.62
0.00
32.46
13.17
6.80
22.86
Average Length
of Stay
4.84
2.81
2.74
2.60
2.85
3.72
4.57
3.46
NA
3.08
3.44
2.64
2.96
2.53
2.36
3.19
4.20
3.46
NA
3.07
18.65
3.42
2.87
3.30
4.11
4.96
5.70
3.50
NA
4.97
2.61
2.55
3.50
NA
NA
2.57
Page 34
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
NR
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
NR
HEDIS 2004 (Reporting Year 2003)
Visits/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Emergency Room Visits
Visits
NR
Visits/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Ambulatory
Surgery/Procedures
Procedures
NR
Procedures/
1,000 Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Observation Room Stays
Resulting in Discharge
Stays
NR
Stays/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 35
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Medicare + Choice
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
NR
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
NR
HEDIS 2004 (Reporting Year 2003)
Visits/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Emergency Room Visits
Visits
NR
Visits/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Ambulatory
Surgery/Procedures
Procedures
NR
Procedures/
1,000 Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Observation Room Stays
Resulting in Discharge
Stays
NR
Stays/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 36
Use of Services
Metropolitan Health Plan
Ambulatory Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Minnesota Senior Health Options
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
0
0
0
0
0
2468
1709
605
0
4782
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
0
0
0
0
0
2317
1578
576
0
4471
HEDIS 2004 (Reporting Year 2003)
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
938.82
923.35
952.07
934.96
Emergency Room Visits
Visits
0
0
0
0
0
100
59
16
0
175
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
40.52
34.52
26.45
36.60
Ambulatory
Surgery/Procedures
Procedures
0
0
0
0
0
84
31
14
0
129
Procedures/
1,000 Member
Months
NA
NA
NA
NA
NA
34.04
18.14
23.14
26.98
Observation Room Stays
Resulting in Discharge
Stays
0
0
0
0
0
4
0
0
0
4
Stays/ 1,000
Member
Months
NA
NA
NA
NA
NA
1.62
0.00
0.00
0.84
Page 37
Use of Services
Metropolitan Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Member
Months
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
NR
Total
Age
Discharges
Discharges /
1,000 Member
Months
Days
Days / 1,000
Member
Months
Average Length
of Stay
<1
NR
NR
NR
1-9
NR
NR
NR
10-19
NR
NR
NR
20-44
NR
NR
NR
45-64
NR
NR
NR
65-74
NR
NR
NR
75-84
NR
NR
NR
85+
NR
NR
NR
NR
NR
NR
Unknown
Total
HEDIS 2004 (Reporting Year 2003)
NR
NR
NR
Page 38
Use of Services
Metropolitan Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Medicare + Choice
Member
Months
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
NR
Total
Age
Discharges
Discharges /
1,000 Member
Months
Days
Days / 1,000
Member
Months
Average Length
of Stay
<1
NR
NR
NR
1-9
NR
NR
NR
10-19
NR
NR
NR
20-44
NR
NR
NR
45-64
NR
NR
NR
65-74
NR
NR
NR
75-84
NR
NR
NR
85+
NR
NR
NR
NR
NR
NR
Unknown
Total
HEDIS 2004 (Reporting Year 2003)
NR
NR
NR
Page 39
Use of Services
Metropolitan Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Minnesota Senior Health Options
Member
Months
Age
<1
0
1-9
0
10-19
0
20-44
0
45-64
0
65-74
2468
75-84
1709
85+
605
Unknown
0
4782
Total
Days
Days / 1,000
Member
Months
Average Length
of Stay
NA
0
NA
NA
0
NA
0
NA
NA
10-19
0
NA
0
NA
NA
20-44
0
NA
0
NA
NA
45-64
0
NA
0
NA
NA
65-74
34
13.78
210
85.09
6.18
75-84
19
11.12
110
64.37
5.79
85+
6
9.92
51
84.30
8.50
Unknown
0
59
12.34
0
371
77.58
NA
6.29
Discharges
Discharges /
1,000 Member
Months
<1
0
1-9
Age
Total
HEDIS 2004 (Reporting Year 2003)
Page 40
Use of Services
Metropolitan Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Member Months
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
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
M
Unknown
NR
F
NR
Total
NR
NR
NR
M
Total
NR
NR
NR
NR
F
NR
NR
NR
NR
TOTAL
NR
NR
NR
NR
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization should not be included in this table
HEDIS 2004 (Reporting Year 2003)
Page 41
Use of Services
Metropolitan Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Medicare + Choice
Member Months
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
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
M
13-17
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
18-64
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
65+
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
Unknown
NR
F
NR
Total
NR
NR
NR
Total
M
NR
NR
NR
NR
F
NR
NR
NR
NR
TOTAL
NR
NR
NR
NR
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization should not be included in this table
HEDIS 2004 (Reporting Year 2003)
Page 42
Use of Services
Metropolitan Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Minnesota Senior Health Options
Member Months
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
Male
Female
Total
0
0
0
1506
0
1506
0
0
0
3276
0
3276
0
0
0
4782
0
4782
Discharges
Discharges /
1,000 Member
Months
Days*
Average Length
of Stay
M
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
13-17
M
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
18-64
M
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
65+
M
13
8.63
45
3.46
F
27
8.24
150
5.56
Total
40
8.36
195
4.88
Unknown
M
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
13
8.63
45
3.46
F
27
8.24
150
5.56
TOTAL
40
8.36
195
4.88
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization should not be included in this table
HEDIS 2004 (Reporting Year 2003)
Page 43
Use of Services
Metropolitan Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Female
NR
NR
Member Months (Inpatient)
Total
NR
NR
NR
NR
NR
NR
Male
Female
NR
NR
Member Months (Day/Night)
Total
NR
NR
NR
NR
NR
NR
Male
Female
NR
NR
Member Months (Ambulatory)
Total
NR
NR
NR
NR
NR
NR
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
Any Mental Health Services
Inpatient Mental Health Services
Day/Night Mental Health Services
Ambulatory Mental Health Services
Number
Number
Number
Number
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
HEDIS 2004 (Reporting Year 2003)
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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
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
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 44
Use of Services
Metropolitan Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Medicare + Choice
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Female
NR
NR
Member Months (Inpatient)
Total
NR
NR
NR
NR
NR
NR
Male
Female
NR
NR
Member Months (Day/Night)
Total
NR
NR
NR
NR
NR
NR
Any Mental Health Services
Inpatient Mental Health Services
Number
Number
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
HEDIS 2004 (Reporting Year 2003)
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Male
Female
NR
NR
Member Months (Ambulatory)
Total
NR
NR
NR
NR
NR
NR
Day/Night Mental Health Services
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
Ambulatory Mental Health Services
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 45
Use of Services
Metropolitan Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Minnesota Senior Health Options
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
0
0
0
1506
0
1506
Female
0
0
0
3276
0
3276
Member Months (Inpatient)
Total
0
0
0
4782
0
4782
Male
0
0
0
1506
0
1506
Female
0
0
0
3276
0
3276
Member Months (Day/Night)
Total
0
0
0
4782
0
4782
Male
0
0
0
1506
0
1506
Female
0
0
0
3276
0
3276
Member Months (Ambulatory)
Total
0
0
0
4782
0
4782
Male
0
0
0
1506
0
1506
Female
0
0
0
3276
0
3276
Total
0
0
0
4782
0
4782
Any Mental Health Services
Inpatient Mental Health Services
Day/Night Mental Health Services
Ambulatory Mental Health Services
Number
0
0
0
0
0
0
0
0
0
25
52
77
0
0
0
25
52
77
Number
0
0
0
0
0
0
0
0
0
11
18
29
0
0
0
11
18
29
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Number
0
0
0
0
0
0
0
0
0
17
41
58
0
0
0
17
41
58
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
HEDIS 2004 (Reporting Year 2003)
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
19.92%
19.05%
19.32%
NA
NA
NA
19.92%
19.05%
19.32%
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
8.76%
6.59%
7.28%
NA
NA
NA
8.76%
6.59%
7.28%
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
13.55%
15.02%
14.55%
NA
NA
NA
13.55%
15.02%
14.55%
Page 46
Use of Services
Metropolitan Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Member Months
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
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
M
13-17
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
18-64
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
65+
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
Unknown
NR
F
NR
Total
NR
NR
NR
Total
M
NR
NR
NR
NR
F
NR
NR
NR
NR
TOTAL
NR
NR
NR
NR
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization should not be included in this table
HEDIS 2004 (Reporting Year 2003)
Page 47
Use of Services
Metropolitan Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Medicare + Choice
Member Months
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
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 2004 (Reporting Year 2003)
Page 48
Use of Services
Metropolitan Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Minnesota Senior Health Options
Member Months
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
Male
Female
Total
0
0
0
1506
0
1506
0
0
0
3276
0
3276
0
0
0
4782
0
4782
Discharges
Discharges /
1,000 Member
Months
Days
Average Length
of Stay
M
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
13-17
M
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
18-64
M
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
65+
M
2
1.33
6
3.00
F
1
0.31
23
23.00
Total
3
0.63
29
9.67
Unknown
M
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
2
1.33
6
3.00
F
1
0.31
23
23.00
TOTAL
3
0.63
29
9.67
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization should not be included in this table
HEDIS 2004 (Reporting Year 2003)
Page 49
Use of Services
Metropolitan Health Plan
Chemical Dependency Utilization -Percent of members Receiving inpatient, Day/Night Care, and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Female
NR
NR
Member Months (Inpatient)
Total
NR
NR
NR
NR
NR
NR
Any Chemical Dependency Services
Age
0-12
13-17
18-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
HEDIS 2004 (Reporting Year 2003)
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Male
Female
NR
NR
Member Months (Day/Night)
Total
NR
NR
NR
NR
NR
NR
Male
Female
NR
NR
Member Months (Ambulatory)
Total
NR
NR
NR
NR
NR
NR
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
Number
Number
NR
NR
NR
NR
NR
NR
NR
NR
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
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
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 50
Use of Services
Metropolitan Health Plan
Chemical Dependency Utilization -Percent of members Receiving inpatient, Day/Night Care, and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Medicare + Choice
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Female
NR
NR
Member Months (Inpatient)
Total
NR
NR
NR
NR
NR
NR
Any Chemical Dependency Services
Age
0-12
13-17
18-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
HEDIS 2004 (Reporting Year 2003)
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Male
Female
NR
NR
Member Months (Day/Night)
Total
NR
NR
NR
NR
NR
NR
Male
Female
NR
NR
Member Months (Ambulatory)
Total
NR
NR
NR
NR
NR
NR
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
Number
Number
NR
NR
NR
NR
NR
NR
NR
NR
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
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
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 51
Use of Services
Metropolitan Health Plan
Chemical Dependency Utilization -Percent of members Receiving inpatient, Day/Night Care, and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Minnesota Senior Health Options
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
0
0
0
1506
0
1506
Female
0
0
0
3276
0
3276
Member Months (Inpatient)
Total
0
0
0
4782
0
4782
Any Chemical Dependency Services
Age
0-12
13-17
18-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
HEDIS 2004 (Reporting Year 2003)
Number
0
0
0
0
0
0
0
0
0
2
1
3
0
0
0
2
1
3
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.59%
0.37%
0.75%
NA
NA
NA
1.59%
0.37%
0.75%
Male
0
0
0
1506
0
1506
Female
0
0
0
3276
0
3276
Member Months (Day/Night)
Total
0
0
0
4782
0
4782
Male
0
0
0
1506
0
1506
Female
0
0
0
3276
0
3276
Member Months (Ambulatory)
Total
0
0
0
4782
0
4782
Male
0
0
0
1506
0
1506
Female
0
0
0
3276
0
3276
Total
0
0
0
4782
0
4782
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
0
0
0
0
0
0
0
0
0
2
1
3
0
0
0
2
1
3
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Number
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
1
0
1
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
1.59%
0.37%
0.75%
NA
NA
NA
1.59%
0.37%
0.75%
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.80%
0.00%
0.25%
NA
NA
NA
0.80%
0.00%
0.25%
Page 52
Use of Services
Metropolitan 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 1, 2004 3:58 PM
Member Months
NR
Specification Documentation:
Prescription is defined as (Enter "A"
or "B"):
Age
Total Cost of
Prescriptions
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
HEDIS 2004 (Reporting Year 2003)
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 53
Use of Services
Metropolitan Health Plan
Outpatient Drug Utilization
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Minnesota Senior Health Options
Age
Member Months
0-9
0
10-19
0
20-44
0
45-64
0
65-74
2468
75-84
1709
85+
605
Unknown
0
Total
4782
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
$0.00
$0.00
$0.00
$0.00
$804,100.30
$557,255.30
$168,017.10
$0.00
$1,529,372.70
HEDIS 2004 (Reporting Year 2003)
A
Avg. Cost of
Prescriptions /
Per Member Per
Month
NA
NA
NA
NA
$325.81
$326.07
$277.71
$319.82
Total Number of
Prescriptions
0
0
0
0
18218
13106
5052
0
36376
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NA
NA
NA
NA
88.58
92.03
100.20
91.28
Page 54
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Data Elements
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
NR
NR
NR
NR
NR
NR
NR
NR
NR
Data collection methodology
(Administrative only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2004 (Reporting Year 2003)
Page 55
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 1, 2004 3:58 PM
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 2004 (Reporting Year 2003)
Page 56
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Minnesota Senior Health Options
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 2004 (Reporting Year 2003)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
0
0
370
0
0
356
NA
NA
NA
NA
NA
NA
96.22%
94.14%
98.30%
A
Page 57
Access/Availability of Care
Metropolitan Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 1, 2004 3:58 PM
PMAP
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 2004 (Reporting Year 2003)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
1022
166
711
880
141
654
86.11%
83.94%
88.28%
84.94%
79.20%
90.68%
91.98%
89.92%
94.05%
A
Page 58
Access/Availability of Care
Metropolitan Health Plan
Children's Access to Primary Care Practitioners
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Data Elements
General Measure
Data
12-24 months
25 months - 6
yrs.
7-11 yrs.
12-19 yrs.
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Data collection methodology
(Administrative only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2004 (Reporting Year 2003)
Page 59
Access/Availability of Care
Metropolitan Health Plan
Children's Access to Primary Care Practitioners
Data Last Refreshed:
Sep 1, 2004 3:58 PM
PMAP
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 2004 (Reporting Year 2003)
General Measure
Data
12-24 months
25 months - 6
yrs.
7-11 yrs.
12-19 yrs.
882
1767
917
1239
848
1527
769
1028
96.15%
94.82%
97.47%
86.42%
84.79%
88.04%
83.86%
81.42%
86.30%
82.97%
80.84%
85.10%
A
Page 60
Access/Availability of Care
Metropolitan Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Timeliness of
Prenatal Care
Postpartum
Care
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Data collection methodology (Administrative or Hybrid)
Sampling method used (see User's Guide for entry
descriptions)
Eligible member population (i.e. members who meet all
denominator criteria)
Number of numerator events by administrative data in
eligible population (before exclusions)
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of
valid data errors
Number of employee/dependent medical records excluded
Additional records added from the auxiliary list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2004 (Reporting Year 2003)
Page 61
Access/Availability of Care
Metropolitan Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Sep 1, 2004 3:58 PM
PMAP
Data collection methodology (Administrative or Hybrid)
Timeliness of
Prenatal Care
Postpartum
Care
A
A
638
638
31.35%
53.76%
NR
NR
638
200
638
343
31.35%
27.67%
35.03%
53.76%
49.81%
57.71%
Sampling method used (see User's Guide for entry
descriptions)
Eligible member population (i.e. members who meet all
denominator criteria)
Number of numerator events by administrative data in
eligible population (before exclusions)
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of
valid data errors
Number of employee/dependent medical records excluded
Additional records added from the auxiliary list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2004 (Reporting Year 2003)
Page 62
Health Plan Stability
Metropolitan Health Plan
Practitioner Turnover
Medicare + Choice
Practitioner Types
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Number of
Practitioners as of
12/31/2002
Number of
Practitioners who
were not affiliated
with the plan as of
12/31/2003
Practitioner
Turnover Rate
Primary Care
Physicians
NR
Non-Physician Primary
Care Practitioners
NR
HEDIS 2004 (Reporting Year 2003)
Page 63
Health Plan Stability
Metropolitan Health Plan
Practitioner Turnover
Minnesota Senior Health Options
Practitioner Types
Number of
Practitioners as of
12/31/2002
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Number of
Practitioners who
were not affiliated
with the plan as of
12/31/2003
Practitioner
Turnover Rate
Primary Care
Physicians
NR
Non-Physician Primary
Care Practitioners
NR
HEDIS 2004 (Reporting Year 2003)
Page 64
Health Plan Stability
Metropolitan Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Sep 1, 2004 3:58 PM
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, 2003
HEDIS 2004 (Reporting Year 2003)
Page 65
Health Plan Stability
Metropolitan Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Minnesota Senior Health Options
Product/Product Line
HMO (Total)
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other (specify)
PPO (Total)
Commercial
Medicare (cost or risk)
Self-insured
Other (specify)
POS (Total)
Commercial
Medicare (cost or risk)
Self-insured
Other (specify)
Total
Years in Business
19.00
19.00
0.00
6.00
0.00
0.00
Members*
18548
18148
0
400
0
0
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
18548
* Total number of members in each category as of December 31, 2003
HEDIS 2004 (Reporting Year 2003)
Page 66
Health Plan Descriptive Information
Metropolitan Health Plan
Board Certification / Residency Completion
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Minnesota Senior Health Options
Type of Practitioner
Primary Care Practitioners
Number of
Practitioners in Each
Practice Area
Geriatricians
Other practitioner
Specialists
HEDIS 2004 (Reporting Year 2003)
Board Certification
Number
Percent
NR
NR
NR
Page 67
Health Plan Descriptive Information
Metropolitan Health Plan
Total Enrollment by Percentage
Medicaid
Commercial
Product Line
Medicare
Other
Total
M
F
M
F
M
F
M
F
M
F
M
F
M
F
Total
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
M
F
M
F
M
F
M
F
M
F
M
F
Total
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
M
F
M
F
M
F
M
F
M
F
Total
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
M
F
M
F
M
F
M
F
M
F
M
F
M
F
Total
82.66%
0.00%
17.34%
0.00%
81.21%
0.00%
18.79%
0.00%
72.67%
0.00%
27.33%
0.00%
64.10%
0.00%
35.90%
0.00%
68.36%
0.00%
31.64%
0.00%
64.62%
0.00%
35.38%
0.00%
77.07%
0.00%
22.93%
0.00%
64.55%
0.00%
35.45%
0.00%
62.19%
0.00%
37.81%
0.00%
61.81%
0.00%
38.19%
0.00%
81.68%
0.00%
18.32%
0.00%
67.14%
0.00%
32.86%
0.00%
75.81%
0.00%
24.19%
0.00%
68.94%
0.00%
31.06%
0.00%
71.49%
0.00%
28.51%
0.00%
100.00%
0.00%
0.00%
0.00%
97.99%
0.00%
2.01%
0.00%
Age/Sex
<1
1-4
5-9
10-14
15-17
18-19
Subtotal: 0-19
20-24
25-29
30-34
35-39
40-44
Subtotal: 20-44
45-49
50-54
55-59
60-64
Subtotal: 45-64
65-69
70-74
75-79
80-84
85-89
>=90
Subtotal: >=65
Age Unknown
Total
Data Last Refreshed:
Sep 1, 2004 3:58 PM
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
Note: Row entries should add up to 100%.
HEDIS 2004 (Reporting Year 2003)
Page 68
Health Plan Descriptive Information Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Commercial
Male
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2004 (Reporting Year 2003)
Page 69
Health Plan Descriptive Information Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 1, 2004 3:58 PM
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
NR
NR
NR
NR
NR
NR
NR
HEDIS 2004 (Reporting Year 2003)
Page 70
Health Plan Descriptive Information Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 1, 2004 3:58 PM
Minnesota Senior Health Options
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Male
0
0
0
0
0
0
Member Months
Female
0
0
0
0
0
0
Total
0
0
0
0
0
0
0
0.00%
0
0
0
0
0
0
0.00%
0
0
0
0
0
0
0.00%
0
0.00%
0
0
0
0
0
0.00%
0
0
0
0
0
0.00%
0
0.00%
396
516
372
132
84
24
0
0.00%
540
1008
756
456
324
192
0
0.00%
1524
100.00%
0
3276
100.00%
0
4800
100.00%
1524
3276
HEDIS 2004 (Reporting Year 2003)
0
0
0
0
0
0
0
0
0
936
1524
1128
588
408
216
0
4800
Page 71
Health Plan Descriptive Information Metropolitan Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 1, 2004 3:58 PM
PMAP
<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
6107
19840
14388
13696
6396
3032
Member Months
Female
5729
19927
13856
14108
6961
4473
Total
11836
39767
28244
27804
13357
7505
63459
85.38%
1374
795
967
1017
838
65054
63.94%
7773
6430
5292
4289
3181
128513
72.99%
4991
6.72%
602
384
169
106
26965
26.50%
1412
745
323
130
31956
18.15%
1261
1.70%
1815
1367
763
437
125
107
2610
2.57%
2244
1769
1369
839
509
378
3871
2.20%
4614
6.21%
0
7108
6.99%
0
11722
6.66%
74325
101737
HEDIS 2004 (Reporting Year 2003)
9147
7225
6259
5306
4019
2014
1129
492
236
4059
3136
2132
1276
634
485
0
176062
Page 72