Medica Health Plans
Plan Name
2003
Reporting Year
General Info
Submission #
1
Last Refreshed:
18
9/1/2004 3:57:28 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
Medica Health Plans
Childhood Immunization Rate
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Commercial
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
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
132
90.40%
87.18%
93.61%
208
121
92.94%
90.13%
95.75%
308
28
94.92%
92.49%
97.35%
207
100
86.72%
83.05%
90.40%
205
109
88.70%
85.26%
92.14%
273
22
83.33%
79.31%
87.36%
163
127
81.92%
77.77%
86.07%
152
108
73.45%
68.70%
78.19%
372
1
Number of Records Excluded because of
Contraindications by Admin Data
0
Number of Records Excluded because of
Contraindications by Medical Record
Review
0
Number of employee/dependent records
excluded
0
Additional Records Added from the
Auxiliary List
1
HEDIS 2004 (Reporting Year 2003)
MMR
354
5.00%
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
IPV/OPV
HO
S
6395
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
DTaP/DT
354
Page 3
Effectiveness of Care
Medica Health Plans
Childhood Immunization Rate
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Childhood Immunization Rate
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Adolescent Immunization Status
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Commercial
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
Combo 1
Combo 2
3394
44.69%
1264
16.64%
192
2.53%
1028
13.54%
38
0.50%
186
43.06%
59
13.66%
7
1.62%
54
12.50%
1
0.23%
178
169
84.43%
80.80%
88.06%
57
203
63.26%
58.48%
68.04%
7
158
40.15%
35.29%
45.01%
52
201
61.56%
56.73%
66.38%
1
142
34.79%
30.07%
39.52%
432
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
Additional Records Added from the
Auxiliary List
0
HEDIS 2004 (Reporting Year 2003)
VZV
411
5.00%
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
Hepatitis B
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)
Numerator events by admin data in FSS
Admin rate on FSS
MMR
411
Page 6
Effectiveness of Care
Medica Health Plans
Adolescent Immunization Status
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Adolescent Immunization Status
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Breast Cancer Screening
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Commercial
A
Medicare + Choice
32901
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
75.34%
NR
NR
NR
0
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)
32901
24789
75.34%
74.88%
75.81%
NR
NR
NR
Page 9
Effectiveness of Care
Medica Health Plans
Cervical Cancer Screening
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Commercial
A
PMAP
A
104552
8086
75.17%
68.28%
NR
NR
0
0
104552
78587
8086
5521
75.17%
74.90%
75.43%
68.28%
67.26%
69.30%
Numerator Events by Admin Data on Eligible
Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
Records Excluded because of Valid Data Errors
Records Excluded because of contraindications
through Admin data
Records Excluded because of contraindications
through Medical Record Review
Number of employee/dependent medical records
excluded
Records Added from 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 10
Effectiveness of Care
Medica Health Plans
Chlamydia Screening in Women
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Commercial
Data Elements
Data Collection Methodology
Eligible Member Population
Current Year's Admin Rate (before exclusions)
Records Excluded - Contraindications/Admin
Data
Denominator
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2004 (Reporting Year 2003)
General
Measure Ages 16-20 Ages 21-25
Data
PMAP
Total
A
General
Measure Ages 16-20 Ages 21-25
Data
Total
A
6620
22.46%
10441
21.54%
17061
21.90%
1477
37.31%
2015
35.38%
3492
36.20%
0
0
0
0
0
0
6620
1487
22.46%
21.45%
23.48%
10441
2249
21.54%
20.75%
22.33%
17061
3736
21.90%
21.27%
22.52%
1477
551
37.31%
34.81%
39.81%
2015
713
35.38%
33.27%
37.50%
3492
1264
36.20%
34.59%
37.81%
Page 11
Effectiveness of Care
Medica Health Plans
Controlling High Blood Pressure
Data Last Refreshed:
Sep 1, 2004 3:57 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
HO
S
16455
411
20.00%
493
0
25
Medicare + Choice
MSHO
HO
N
152
152
0.00%
151
4
7
Records Excluded because of ESRD or non-acute
admission identified by Admin Data
0
1
Records Excluded because of ESRD or non-acute
admission identified by Medical Record
0
1
Number of employee/dependent medical records
excluded
0
0
25
411
197
47.93%
42.98%
52.88%
0
139
92
66.19%
57.96%
74.41%
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
Page 12
Effectiveness of Care
Medica Health Plans
Beta Blocker Treatment after Heart Attack
Data Elements
Data Collection Methodology
Sampling Method Used
Data Last Refreshed:
Sep 1, 2004 3:57 PM
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
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Medicare + Choice
77.26%
NR
387
0.00%
387
279
72.09%
Records Excluded because of Valid Data
Errors
7
Records Excluded Contraindications/Admin Data
24
Records Excluded Contraindications/Medical Record Review
2
Number of employee/dependent medical
records excluded
0
Records Added from Auxiliary 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
Upper 95% Confidence Interval
88.48%
NR
94.57%
NR
HEDIS 2004 (Reporting Year 2003)
Page 13
Effectiveness of Care
Medica Health Plans
Cholesterol Management After Acute Cardiovascular Events
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Commercial
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
21
Number of employee/dependent medical
records excluded
0
HEDIS 2004 (Reporting Year 2003)
General
Measure
Data
LDL-C
LDL-C Level of
screening 60- <130 mg/dL 60365 Days
365 Days
640
12
63.12%
1.18%
269
2
62.27%
0.46%
264
60
2
256
78.83%
74.76%
82.90%
62.77%
57.98%
67.57%
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
411
5.00%
432
Records Excluded because of Valid Data
Errors
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
LDL-C
LDL-C Level of
screening 60- <130 mg/dL 60365 Days
365 Days
HO
S
1014
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
Medicare + Choice
21
411
Page 14
Effectiveness of Care
Medica Health Plans
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Commercial
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
9444
70.11%
13470
100.00%
6952
51.61%
9939
73.79%
245
1.82%
0
0.00%
6369
47.28%
331
73.07%
453
100.00%
238
52.54%
345
76.16%
5
1.10%
0
0.00%
220
48.57%
305
40
83.94%
80.27%
87.61%
0
122
29.68%
25.15%
34.22%
222
3
54.74%
49.81%
59.68%
315
32
84.43%
80.80%
88.06%
4
220
54.50%
49.57%
59.44%
0
126
30.66%
26.08%
35.24%
201
2
49.39%
44.44%
54.35%
453
7
Number of employee/dependent records
excluded
0
Additional Records Added from the
Auxiliary List
7
HEDIS 2004 (Reporting Year 2003)
Eye Exam
411
10.00%
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
13470
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
411
Page 15
Effectiveness of Care
Medica Health Plans
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 1, 2004 3:57 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
37
32.74%
113
100.00%
74
65.49%
55
48.67%
25
22.12%
0
0.00%
45
39.82%
37
32.74%
113
100.00%
74
65.49%
55
48.67%
25
22.12%
0
0.00%
45
39.82%
37
22
53.15%
43.42%
62.89%
0
63
56.76%
47.09%
66.42%
72
1
65.77%
56.49%
75.04%
55
3
52.25%
42.51%
62.00%
25
17
37.84%
28.37%
47.31%
0
28
25.23%
16.70%
33.76%
44
6
45.05%
35.34%
54.75%
113
2
Number of employee/dependent records
excluded
0
Additional Records Added from the
Auxiliary List
0
HEDIS 2004 (Reporting Year 2003)
Eye Exam
113
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
N
113
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
111
Page 17
Effectiveness of Care
Medica Health Plans
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Appropriate Medications for People with Asthma
Data Last Refreshed:
Sep 1, 2004 3:57 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
Total
704
79.69%
0
704
561
79.69%
76.64%
82.73%
1292
72.29%
0
1292
934
72.29%
69.81%
74.77%
5018
76.92%
0
5018
3860
76.92%
75.75%
78.10%
7014
76.35%
0
7014
5355
76.35%
75.35%
77.35%
A
Page 20
Effectiveness of Care
Medica Health Plans
Appropriate Medications for People with Asthma
Data Last Refreshed:
Sep 1, 2004 3:57 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
247
65.18%
0
247
161
65.18%
59.04%
71.33%
380
69.21%
0
380
263
69.21%
64.44%
73.98%
378
61.64%
0
378
233
61.64%
56.61%
66.67%
1005
65.37%
0
1005
657
65.37%
62.38%
68.36%
A
Page 21
Effectiveness of Care
Medica Health Plans
Follow-Up After Hospitalization for Mental Illness
Data Last Refreshed:
Sep 1, 2004 3:57 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
General
Measure
Data
Medicare + Choice
General
W/in 7 Days of W/in 30 Days of
Measure
Discharge
Discharge
Data
A
1074
491
45.72%
42.69%
48.74%
782
72.81%
70.10%
75.52%
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)
W/in 7 Days of W/in 30 Days of
Discharge
Discharge
General
Measure
Data
NR
NR
NR
PMAP
General
W/in 7 Days of W/in 30 Days of
Measure
Discharge
Discharge
Data
A
10
W/in 7 Days of W/in 30 Days of
Discharge
Discharge
A
476
1
NA
NA
NA
2
NA
NA
NA
150
31.51%
27.23%
35.79%
289
60.71%
56.22%
65.21%
Page 22
Effectiveness of Care
Medica Health Plans
Antidepressant Medication Management
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Antidepressant Medication Management
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Antidepressant Medication Management
Data Last Refreshed:
Sep 1, 2004 3:57 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
10
NA
NA
NA
10
NA
NA
NA
A
11
Page 25
Effectiveness of Care
Medica Health Plans
Antidepressant Medication Management
Data Last Refreshed:
Sep 1, 2004 3:57 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
84
14.05%
11.18%
16.92%
306
51.17%
47.08%
55.26%
206
34.45%
30.56%
38.34%
A
598
Page 26
Use of Services
Medica Health Plans
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Sep 1, 2004 3:57 PM
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
2.99%
1.78%
1.25%
2.92%
7.15%
23.90%
60.00%
NR
NR
NR
NR
NR
NR
NR
168
100
70
164
401
1341
3366
2.99%
2.54%
3.45%
1.78%
1.43%
2.14%
1.25%
0.95%
1.55%
2.92%
2.47%
3.37%
7.15%
6.46%
7.83%
23.90%
22.78%
25.03%
60.00%
58.71%
61.29%
A
5610
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)
5610
Page 27
Use of Services
Medica Health Plans
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Sep 1, 2004 3:57 PM
PMAP
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
3.72%
3.61%
5.81%
8.07%
15.27%
25.02%
38.50%
NR
NR
NR
NR
NR
NR
NR
135
131
211
293
554
908
1397
3.72%
3.09%
4.35%
3.61%
2.99%
4.23%
5.81%
5.04%
6.59%
8.07%
7.17%
8.97%
15.27%
14.08%
16.45%
25.02%
23.60%
26.44%
38.50%
36.90%
40.09%
A
3629
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)
3629
Page 28
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 1, 2004 3:57 PM
Commercial
A
PMAP
A
27500
7137
56.45%
57.01%
NR
NR
27500
15523
7137
4069
56.45%
55.86%
57.04%
57.01%
55.86%
58.17%
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
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 29
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 1, 2004 3:57 PM
Commercial
A
PMAP
A
70264
10428
30.97%
32.75%
NR
NR
70264
21761
10428
3415
30.97%
30.63%
31.31%
32.75%
31.84%
33.65%
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
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 30
Use of Services
Medica Health Plans
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Sep 1, 2004 3:57 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
99362
939316
1096437
3003357
1855805
74982
10749
1815
0
7081823
Discharges
Discharges /
1,000 Member
Months
8643
1376
1695
17052
11882
1077
217
50
0
41992
86.98
1.46
1.55
5.68
6.40
14.36
20.19
27.55
8501
1012
771
3401
5437
569
127
37
0
19855
85.56
1.08
0.70
1.13
2.93
7.59
11.82
20.39
119
348
663
4197
6295
498
88
13
0
12221
1.20
0.37
0.60
1.40
3.39
6.64
8.19
7.16
246
9298
16
0
0
9560
HEDIS 2004 (Reporting Year 2003)
5.93
2.80
1.73
0.22
3.10
0.01
0.00
1.58
Days
Days / 1,000
Member
Months
30317
4627
6456
52857
48567
4872
935
342
0
148973
305.12
4.93
5.89
17.60
26.17
64.98
86.98
188.43
29075
3039
3469
12321
21989
2431
509
281
0
73114
292.62
3.24
3.16
4.10
11.85
32.42
47.35
154.82
1171
1508
2318
13486
26045
2406
415
61
0
47410
11.79
1.61
2.11
4.49
14.03
32.09
38.61
33.61
606
26510
74
0
0
27190
0.55
8.83
0.04
0.00
21.04
10.32
6.69
4.50
Average Length
of Stay
3.51
3.36
3.81
3.10
4.09
4.52
4.31
6.84
NA
3.55
3.42
3.00
4.50
3.62
4.04
4.27
4.01
7.59
NA
3.68
9.84
4.33
3.50
3.21
4.14
4.83
4.72
4.69
NA
3.88
2.46
2.85
4.63
NA
NA
2.84
Page 31
Use of Services
Medica Health Plans
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Sep 1, 2004 3:57 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
6072
9190
12648
0
27910
Discharges
0
0
0
0
0
208
226
176
0
610
Discharges /
1,000 Member
Months
NA
NA
NA
NA
NA
34.26
24.59
13.92
21.86
0
0
0
0
0
145
168
106
0
419
NA
NA
NA
NA
NA
23.88
18.28
8.38
0
0
0
0
0
53
47
59
0
159
NA
NA
NA
NA
NA
8.73
5.11
4.66
HEDIS 2004 (Reporting Year 2003)
15.01
5.70
Days
0
0
0
0
0
1234
1129
795
0
3158
Days / 1,000
Member
Months
NA
NA
NA
NA
NA
203.23
122.85
62.86
113.15
0
0
0
0
0
759
737
429
0
1925
NA
NA
NA
NA
NA
125.00
80.20
33.92
0
0
0
0
0
433
337
330
0
1100
NA
NA
NA
NA
NA
71.31
36.67
26.09
68.97
39.41
Average Length
of Stay
NA
NA
NA
NA
NA
5.93
5.00
4.52
NA
5.18
NA
NA
NA
NA
NA
5.23
4.39
4.05
NA
4.59
NA
NA
NA
NA
NA
8.17
7.17
5.59
NA
6.92
Page 33
Use of Services
Medica Health Plans
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Sep 1, 2004 3:57 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
69878
346696
244018
229911
20201
42814
40241
31433
0
1025192
Discharges
4303
907
1318
6087
277
1158
1222
856
0
16128
Discharges /
1,000 Member
Months
61.58
2.62
5.40
26.48
13.71
27.05
30.37
27.23
15.73
4202
771
318
747
173
871
937
736
0
8755
60.13
2.22
1.30
3.25
8.56
20.34
23.28
23.41
95
120
152
603
92
285
281
120
0
1748
1.36
0.35
0.62
2.62
4.55
6.66
6.98
3.82
820
4604
10
0
0
5434
HEDIS 2004 (Reporting Year 2003)
8.54
1.71
3.36
20.03
0.50
0.00
8.93
Days
Days / 1,000
Member
Months
16659
2697
4384
16759
1035
5644
6301
4001
0
57480
238.40
7.78
17.97
72.89
51.24
131.83
156.58
127.29
15966
2043
1172
2326
593
3914
4531
3375
0
33920
228.48
5.89
4.80
10.12
29.35
91.42
112.60
107.37
622
576
721
2065
404
1722
1757
626
0
8493
8.90
1.66
2.95
8.98
20.00
40.22
43.66
19.92
2405
11970
32
0
0
14407
9.86
52.06
1.58
0.00
56.07
33.09
8.28
23.67
Average Length
of Stay
3.87
2.97
3.33
2.75
3.74
4.87
5.16
4.67
NA
3.56
3.80
2.65
3.69
3.11
3.43
4.49
4.84
4.59
NA
3.87
6.55
4.80
4.74
3.42
4.39
6.04
6.25
5.22
NA
4.86
2.93
2.60
3.20
NA
NA
2.65
Page 34
Use of Services
Medica Health Plans
Ambulatory Care
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Commercial
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
99362
939316
1096437
3003357
1855805
74982
10749
1815
0
7081823
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
87522
281765
226933
728942
599340
33666
5937
917
0
1965022
HEDIS 2004 (Reporting Year 2003)
Visits/ 1,000
Member
Months
880.84
299.97
206.97
242.71
322.95
448.99
552.33
505.23
277.47
Emergency Room Visits
Visits
3265
15200
12836
35926
18760
1087
231
63
0
87368
Visits/ 1,000
Member
Months
32.86
16.18
11.71
11.96
10.11
14.50
21.49
34.71
12.34
Ambulatory
Surgery/Procedures
Procedures
651
4564
3554
22231
32704
2221
380
44
0
66349
Procedures/
1,000 Member
Months
6.55
4.86
3.24
7.40
17.62
29.62
35.35
24.24
9.37
Observation Room Stays
Resulting in Discharge
Stays
55
188
197
2562
432
39
4
3
0
3480
Stays/ 1,000
Member
Months
0.55
0.20
0.18
0.85
0.23
0.52
0.37
1.65
0.49
Page 35
Use of Services
Medica Health Plans
Ambulatory Care
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Ambulatory Care
Data Last Refreshed:
Sep 1, 2004 3:57 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
6072
9190
12648
0
27910
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
4420
7528
10735
0
22683
HEDIS 2004 (Reporting Year 2003)
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
727.93
819.15
848.75
812.72
Emergency Room Visits
Visits
0
0
0
0
0
168
153
117
0
438
Visits/ 1,000
Member
Months
NA
NA
NA
NA
NA
27.67
16.65
9.25
15.69
Ambulatory
Surgery/Procedures
Procedures
0
0
0
0
0
146
146
81
0
373
Procedures/
1,000 Member
Months
NA
NA
NA
NA
NA
24.04
15.89
6.40
13.36
Observation Room Stays
Resulting in Discharge
Stays
0
0
0
0
0
4
4
3
0
11
Stays/ 1,000
Member
Months
NA
NA
NA
NA
NA
0.66
0.44
0.24
0.39
Page 37
Use of Services
Medica Health Plans
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Commercial
Member
Months
Age
<1
99362
1-9
939316
10-19
1096437
20-44
3003357
45-64
1855805
65-74
74982
75-84
10749
85+
1815
Unknown
0
7081823
Total
Days
Days / 1,000
Member
Months
Average Length
of Stay
0.00
0
0.00
NA
1
0.00
2
0.00
2.00
12
0.01
285
0.26
23.75
Discharges
Discharges /
1,000 Member
Months
<1
0
1-9
10-19
Age
20-44
46
0.02
645
0.21
14.02
45-64
145
0.08
1829
0.99
12.61
65-74
23
0.31
251
3.35
10.91
75-84
2
0.19
37
3.44
18.50
85+
3
1.65
62
34.16
20.67
0
232
0.03
0
3111
0.44
NA
13.41
Unknown
Total
HEDIS 2004 (Reporting Year 2003)
Page 38
Use of Services
Medica Health Plans
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Minnesota Senior Health Options
Member
Months
Age
<1
0
1-9
0
10-19
0
20-44
0
45-64
0
65-74
6072
75-84
9190
85+
12648
Unknown
0
27910
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
5
0.82
130
21.41
26.00
75-84
13
1.41
233
25.35
17.92
85+
15
1.19
363
28.70
24.20
Unknown
0
33
1.18
0
726
26.01
NA
22.00
Discharges
Discharges /
1,000 Member
Months
<1
0
1-9
Age
Total
HEDIS 2004 (Reporting Year 2003)
Page 40
Use of Services
Medica Health Plans
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Commercial
Member Months
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Female
Total
587704
237147
2050107
37302
0
2912260
562825
227647
2129534
30952
0
2950958
1150529
464794
4179641
68254
0
5863218
Discharges
Discharges /
1,000 Member
Months
Age
0-12
Days*
Average Length
of Stay
M
61
0.10
1532
25.11
F
29
0.05
437
15.07
Total
90
0.08
1969
21.88
13-17
M
207
0.87
5491
26.53
F
272
1.19
4851
17.83
Total
479
1.03
10342
21.59
18-64
M
435
0.21
3023
6.95
F
673
0.32
4849
7.21
Total
1108
0.27
7872
7.10
65+
M
6
0.16
43
7.17
F
4
0.13
34
8.50
Total
10
0.15
77
7.70
M
Unknown
0
0
NA
F
0
0
NA
Total
0
0
NA
M
Total
709
0.24
10089
14.23
F
978
0.33
10171
10.40
TOTAL
1687
0.29
20260
12.01
* 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
Medica Health Plans
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 1, 2004 3:57 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
4950
0
4950
0
0
0
19024
0
19024
0
0
0
23974
0
23974
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
6
1.21
40
6.67
F
18
0.95
150
8.33
Total
24
1.00
190
7.92
Unknown
M
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
6
1.21
40
6.67
F
18
0.95
150
8.33
TOTAL
24
1.00
190
7.92
* 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
Medica Health Plans
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:57 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
587704
237147
2050107
37302
0
2912260
Female
562825
227647
2129534
30952
0
2950958
Member Months (Inpatient)
Total
1150529
464794
4179641
68254
0
5863218
Male
587704
237147
2050107
37302
0
2912260
Female
562825
227647
2129534
30952
0
2950958
Total
1150529
464794
4179641
68254
0
5863218
Member Months (Day/Night)
Male
587704
237147
2050107
37302
0
2912260
Female
562825
227647
2129534
30952
0
2950958
Total
1150529
464794
4179641
68254
0
5863218
Member Months (Ambulatory)
Male
587704
237147
2050107
37302
0
2912260
Female
562825
227647
2129534
30952
0
2950958
Total
1150529
464794
4179641
68254
0
5863218
Any Mental Health Services
Inpatient Mental Health Services
Day/Night Mental Health Services
Ambulatory Mental Health Services
Number
2720
1568
4288
2099
2395
4494
10032
18649
28681
68
74
142
0
0
0
14919
22686
37605
Number
42
23
65
144
208
352
349
521
870
6
4
10
0
0
0
541
756
1297
Number
0
1
1
5
13
18
12
28
40
0
0
0
0
0
0
17
42
59
Number
2706
1562
4268
2060
2340
4400
9935
18537
28472
65
73
138
0
0
0
14766
22512
37278
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
5.55%
3.34%
4.47%
10.62%
12.62%
11.60%
5.87%
10.51%
8.23%
2.19%
2.87%
2.50%
NA
NA
NA
6.15%
9.23%
7.70%
Percent
0.09%
0.05%
0.07%
0.73%
1.10%
0.91%
0.20%
0.29%
0.25%
0.19%
0.16%
0.18%
NA
NA
NA
0.22%
0.31%
0.27%
Percent
0.00%
0.00%
0.00%
0.03%
0.07%
0.05%
0.01%
0.02%
0.01%
0.00%
0.00%
0.00%
NA
NA
NA
0.01%
0.02%
0.01%
Percent
5.53%
3.33%
4.45%
10.42%
12.33%
11.36%
5.82%
10.45%
8.17%
2.09%
2.83%
2.43%
NA
NA
NA
6.08%
9.15%
7.63%
Page 44
Use of Services
Medica Health Plans
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:57 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
4950
0
4950
Female
0
0
0
19024
0
19024
Member Months (Inpatient)
Total
0
0
0
23974
0
23974
Male
0
0
0
4950
0
4950
Female
0
0
0
19024
0
19024
Member Months (Day/Night)
Total
0
0
0
23974
0
23974
Male
0
0
0
4950
0
4950
Female
0
0
0
19024
0
19024
Total
0
0
0
23974
0
23974
Member Months (Ambulatory)
Male
0
0
0
4950
0
4950
Female
0
0
0
19024
0
19024
Total
0
0
0
23974
0
23974
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
21
77
98
0
0
0
21
77
98
Number
0
0
0
0
0
0
0
0
0
3
17
20
0
0
0
3
17
20
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
18
64
82
0
0
0
18
64
82
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
5.09%
4.86%
4.91%
NA
NA
NA
5.09%
4.86%
4.91%
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.73%
1.07%
1.00%
NA
NA
NA
0.73%
1.07%
1.00%
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
4.36%
4.04%
4.10%
NA
NA
NA
4.36%
4.04%
4.10%
Page 46
Use of Services
Medica Health Plans
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Commercial
Member Months
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
Male
Female
Total
587704
237147
2050107
37302
0
2912260
562825
227647
2129534
30952
0
2950958
1150529
464794
4179641
68254
0
5863218
Discharges
Discharges /
1,000 Member
Months
Days
Average Length
of Stay
M
2
0.00
4
2.00
F
1
0.00
2
2.00
Total
3
0.00
6
2.00
M
13-17
93
0.39
1153
12.40
F
54
0.24
618
11.44
Total
147
0.32
1771
12.05
M
18-64
513
0.25
3730
7.27
F
306
0.14
2125
6.94
Total
819
0.20
5855
7.15
M
65+
3
0.08
20
6.67
F
0
0.00
0
NA
Total
3
0.04
20
6.67
M
Unknown
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
611
0.21
4907
8.03
F
361
0.12
2745
7.60
TOTAL
972
0.17
7652
7.87
* 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
Medica Health Plans
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Sep 1, 2004 3:57 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
4950
0
4950
0
0
0
19024
0
19024
0
0
0
23974
0
23974
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
3
0.61
12
4.00
F
1
0.05
4
4.00
Total
4
0.17
16
4.00
Unknown
M
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
3
0.61
12
4.00
F
1
0.05
4
4.00
TOTAL
4
0.17
16
4.00
* 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
Medica Health Plans
Chemical Dependency Utilization -Percent of members Receiving inpatient, Day/Night Care, and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Commercial
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
587704
237147
2050107
37302
0
2912260
Female
562825
227647
2129534
30952
0
2950958
Member Months (Inpatient)
Total
1150529
464794
4179641
68254
0
5863218
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
2
2
4
172
95
267
1099
494
1593
4
0
4
0
0
0
1277
591
1868
Percent
0.00%
0.00%
0.00%
0.87%
0.50%
0.69%
0.64%
0.28%
0.46%
0.13%
0.00%
0.07%
NA
NA
NA
0.53%
0.24%
0.38%
Male
587704
237147
2050107
37302
0
2912260
Female
562825
227647
2129534
30952
0
2950958
Total
1150529
464794
4179641
68254
0
5863218
Member Months (Day/Night)
Male
587704
237147
2050107
37302
0
2912260
Female
562825
227647
2129534
30952
0
2950958
Total
1150529
464794
4179641
68254
0
5863218
Member Months (Ambulatory)
Male
587704
237147
2050107
37302
0
2912260
Female
562825
227647
2129534
30952
0
2950958
Total
1150529
464794
4179641
68254
0
5863218
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
1
1
2
71
42
113
395
221
616
3
0
3
0
0
0
470
264
734
Number
0
0
0
1
0
1
1
3
4
0
0
0
0
0
0
2
3
5
Number
1
1
2
108
57
165
763
318
1081
2
0
2
0
0
0
874
376
1250
Percent
0.00%
0.00%
0.00%
0.36%
0.22%
0.29%
0.23%
0.12%
0.18%
0.10%
0.00%
0.05%
NA
NA
NA
0.19%
0.11%
0.15%
Percent
0.00%
0.00%
0.00%
0.01%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
NA
NA
NA
0.00%
0.00%
0.00%
Percent
0.00%
0.00%
0.00%
0.55%
0.30%
0.43%
0.45%
0.18%
0.31%
0.06%
0.00%
0.04%
NA
NA
NA
0.36%
0.15%
0.26%
Page 50
Use of Services
Medica Health Plans
Chemical Dependency Utilization -Percent of members Receiving inpatient, Day/Night Care, and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Chemical Dependency Utilization -Percent of members Receiving inpatient, Day/Night Care, and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Minnesota Senior Health Options
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
0
0
0
4950
0
4950
Female
0
0
0
19024
0
19024
Member Months (Inpatient)
Total
0
0
0
23974
0
23974
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
2
4
0
0
0
2
2
4
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.48%
0.13%
0.20%
NA
NA
NA
0.48%
0.13%
0.20%
Male
0
0
0
4950
0
4950
Female
0
0
0
19024
0
19024
Member Months (Day/Night)
Total
0
0
0
23974
0
23974
Male
0
0
0
4950
0
4950
Female
0
0
0
19024
0
19024
Total
0
0
0
23974
0
23974
Member Months (Ambulatory)
Male
0
0
0
4950
0
4950
Female
0
0
0
19024
0
19024
Total
0
0
0
23974
0
23974
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
0
0
0
0
0
0
0
0
0
1
1
2
0
0
0
1
1
2
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
1
2
0
0
0
1
1
2
Percent
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.24%
0.06%
0.10%
NA
NA
NA
0.24%
0.06%
0.10%
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
0.24%
0.06%
0.10%
NA
NA
NA
0.24%
0.06%
0.10%
Page 52
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 1, 2004 3:57 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
Medica Health Plans
Outpatient Drug Utilization
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Minnesota Senior Health Options
Age
Member Months
0-9
0
10-19
0
20-44
0
45-64
0
65-74
6072
75-84
9190
85+
12648
Unknown
0
Total
27910
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
$1,832,700.00
$2,588,623.00
$2,742,206.00
$0.00
$7,163,529.00
HEDIS 2004 (Reporting Year 2003)
A
Avg. Cost of
Prescriptions /
Per Member Per
Month
NA
NA
NA
NA
$301.83
$281.68
$216.81
$256.67
Total Number of
Prescriptions
0
0
0
0
38954
68577
89271
0
196802
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NA
NA
NA
NA
76.98
89.55
84.70
84.62
Page 54
Access/Availability of Care
Medica Health Plans
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 1, 2004 3:57 PM
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 2004 (Reporting Year 2003)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
98233
84642
5184
93759
81829
5024
95.45%
95.31%
95.58%
96.68%
96.56%
96.80%
96.91%
96.43%
97.39%
A
Page 55
Access/Availability of Care
Medica Health Plans
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 1, 2004 3:57 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
1677
0
0
1634
NA
NA
NA
NA
NA
NA
97.44%
96.65%
98.22%
A
Page 57
Access/Availability of Care
Medica Health Plans
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 1, 2004 3:57 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+
9230
988
7865
8268
894
7540
89.58%
88.95%
90.21%
90.49%
88.61%
92.37%
95.87%
95.42%
96.31%
A
Page 58
Access/Availability of Care
Medica Health Plans
Children's Access to Primary Care Practitioners
Data Last Refreshed:
Sep 1, 2004 3:57 PM
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 2004 (Reporting Year 2003)
General Measure
Data
12-24 months
25 months - 6
yrs.
7-11 yrs.
12-19 yrs.
6716
33613
28104
46585
6601
29736
24699
40962
98.29%
97.97%
98.61%
88.47%
88.12%
88.81%
87.88%
87.50%
88.27%
87.93%
87.63%
88.23%
A
Page 59
Access/Availability of Care
Medica Health Plans
Children's Access to Primary Care Practitioners
Data Last Refreshed:
Sep 1, 2004 3:57 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.
4737
9582
4976
6353
4528
8229
4214
5430
95.59%
94.99%
96.18%
85.88%
85.18%
86.58%
84.69%
83.68%
85.70%
85.47%
84.60%
86.35%
A
Page 60
Access/Availability of Care
Medica Health Plans
Prenatal and Postpartum Care
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Commercial
Timeliness of
Prenatal Care
Postpartum
Care
HO
HO
S
S
8295
8295
6268
5248
75.56%
63.27%
Minimum required sample size (MRSS) or other sample size
288
288
Oversampling rate
Final sample size (FSS)
5%
302
5%
302
Number of numerator events by administrative data in FSS
234
187
77.48%
61.92%
Number of original sample records excluded because of
valid data errors
7
7
Number of employee/dependent medical records excluded
0
0
7
288
222
36
7
288
179
45
89.58%
85.88%
93.29%
77.78%
72.80%
82.75%
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)
Administrative rate on FSS
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
Medica Health Plans
Prenatal and Postpartum Care
Data Last Refreshed:
Sep 1, 2004 3:57 PM
PMAP
Timeliness of
Prenatal Care
Postpartum
Care
HO
HO
S
S
3769
3769
1736
1922
46.06%
50.99%
Minimum required sample size (MRSS) or other sample size
411
411
Oversampling rate
Final sample size (FSS)
5%
429
5%
429
Number of numerator events by administrative data in FSS
190
217
44.29%
50.58%
Number of original sample records excluded because of
valid data errors
0
0
Number of employee/dependent medical records excluded
0
0
4
411
185
147
4
411
209
43
80.78%
76.85%
84.71%
61.31%
56.48%
66.14%
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)
Administrative rate on FSS
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
Medica Health Plans
Practitioner Turnover
Medicare + Choice
Practitioner Types
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Practitioner Turnover
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Minnesota Senior Health Options
Practitioner Types
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
1832
99
5.40%
Non-Physician Primary
Care Practitioners
313
15
4.79%
HEDIS 2004 (Reporting Year 2003)
Page 64
Health Plan Stability
Medica Health Plans
Years in Business / Total Membership
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Years in Business / Total Membership
Data Last Refreshed:
Sep 1, 2004 3:57 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
29.00
29.00
29.00
4.00
0.00
0.00
Members*
196389
121033
72958
2398
0
0
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
29.00
29.00
4.00
29.00
0.00
546988
340762
24219
182007
0
743377
* Total number of members in each category as of December 31, 2003
HEDIS 2004 (Reporting Year 2003)
Page 66
Health Plan Descriptive Information
Medica Health Plans
Board Certification / Residency Completion
Data Last Refreshed:
Sep 1, 2004 3:57 PM
Minnesota Senior Health Options
Type of Practitioner
Primary Care Practitioners
Number of
Practitioners in Each
Practice Area
Number
Percent
2155
113
1769
107
82.09%
94.69%
1122
940
83.78%
Geriatricians
Other practitioner
Specialists
HEDIS 2004 (Reporting Year 2003)
Board Certification
Page 67
Health Plan Descriptive Information
Medica Health Plans
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
42.76%
57.03%
0.00%
0.21%
44.14%
55.60%
0.00%
0.26%
35.17%
64.59%
0.00%
0.24%
35.43%
64.35%
0.00%
0.22%
26.93%
72.80%
0.00%
0.27%
27.67%
72.06%
0.00%
0.27%
23.91%
75.78%
0.00%
0.31%
24.88%
74.81%
0.00%
0.31%
20.54%
79.02%
0.00%
0.44%
21.12%
78.47%
0.00%
0.41%
17.02%
82.54%
0.00%
0.44%
24.17%
75.38%
0.00%
0.45%
27.19%
72.50%
0.00%
0.31%
28.34%
71.35%
0.00%
0.31%
27.76%
71.94%
0.00%
0.30%
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
11.73%
87.93%
0.00%
0.34%
26.70%
72.98%
0.00%
0.32%
M
F
M
F
M
F
M
F
M
F
Total
M
F
M
F
M
F
M
F
M
F
M
F
M
F
Total
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 3:57 PM
9.04%
90.73%
0.00%
0.23%
20.39%
79.19%
0.00%
0.42%
7.95%
91.77%
0.00%
0.28%
15.65%
83.80%
0.01%
0.54%
7.14%
92.53%
0.02%
0.31%
12.04%
87.42%
0.02%
0.52%
6.71%
92.89%
0.03%
0.37%
9.37%
89.98%
0.04%
0.61%
8.25%
91.43%
0.01%
0.31%
16.33%
83.17%
0.02%
0.48%
12.61%
86.97%
0.01%
0.41%
5.93%
93.49%
0.07%
0.51%
7.20%
91.95%
0.08%
0.77%
5.00%
94.08%
0.15%
0.77%
5.76%
92.79%
0.20%
1.25%
4.59%
93.97%
0.34%
1.10%
5.51%
92.43%
0.45%
1.61%
4.54%
92.75%
1.24%
1.47%
7.01%
89.79%
1.28%
1.92%
5.18%
93.66%
0.32%
0.84%
6.39%
92.00%
0.36%
1.25%
5.82%
92.79%
0.34%
1.05%
13.05%
47.28%
33.24%
6.43%
19.54%
35.95%
36.44%
8.07%
18.27%
26.43%
36.06%
19.24%
26.17%
16.42%
37.73%
19.68%
15.56%
10.16%
55.91%
18.37%
21.20%
4.84%
57.50%
16.46%
12.63%
4.93%
65.59%
16.85%
20.24%
2.18%
62.60%
14.98%
13.64%
2.78%
67.91%
15.67%
21.49%
1.25%
63.26%
14.00%
22.88%
2.04%
60.62%
14.46%
29.63%
0.61%
59.95%
9.81%
15.02%
22.45%
48.28%
14.25%
22.50%
10.74%
52.92%
13.84%
19.77%
15.02%
51.23%
13.98%
0.00%
0.00%
0.00%
0.00%
16.56%
78.65%
3.40%
1.39%
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%
0.00%
100.00%
Note: Row entries should add up to 100%.
HEDIS 2004 (Reporting Year 2003)
Page 68
Health Plan Descriptive Information
Medica Health Plans
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 1, 2004 3:57 PM
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
51204
209136
271116
290028
170916
96804
Member Months
Female
48168
200124
258948
276720
164976
96996
Total
99372
409260
530064
566748
335892
193800
1089204
31.30%
221520
245664
296052
327492
362628
1045932
29.04%
242028
274164
315600
341580
376632
2135136
30.15%
1453356
41.77%
319392
260184
186348
123468
1550004
43.03%
340920
284028
209964
131508
3003360
42.41%
889392
25.56%
30120
11016
4056
1764
588
216
966420
26.83%
25092
8748
3312
1620
732
276
1855812
26.21%
47760
1.37%
0
39780
1.10%
0
87540
1.24%
3479712
3602136
HEDIS 2004 (Reporting Year 2003)
463548
519828
611652
669072
739260
660312
544212
396312
254976
55212
19764
7368
3384
1320
492
0
7081848
Page 69
Health Plan Descriptive Information
Medica Health Plans
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 1, 2004 3:57 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
Medica Health Plans
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 1, 2004 3:57 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%
744
1104
1176
1080
804
636
0
0.00%
1788
2448
3024
3912
4416
6792
0
0.00%
5544
100.00%
0
22380
100.00%
0
27924
100.00%
5544
22380
HEDIS 2004 (Reporting Year 2003)
0
0
0
0
0
0
0
0
0
2532
3552
4200
4992
5220
7428
0
27924
Page 71
Health Plan Descriptive Information
Medica Health Plans
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 1, 2004 3:57 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
35048
97083
77830
69626
33407
13119
Member Months
Female
34830
94329
77454
70448
34148
23270
Total
69878
191412
155284
140074
67555
36389
326113
80.66%
8625
7995
8678
7855
6719
334479
53.87%
59302
48253
37654
26907
17923
660592
64.44%
39872
9.86%
3679
1649
948
447
190039
30.61%
8452
3278
1290
458
229911
22.43%
6723
1.66%
8055
7537
6208
4508
2886
2406
13478
2.17%
13346
13876
14493
15032
12600
13541
20201
1.97%
31600
7.82%
0
82888
13.35%
0
114488
11.17%
404308
620884
HEDIS 2004 (Reporting Year 2003)
67927
56248
46332
34762
24642
12131
4927
2238
905
21401
21413
20701
19540
15486
15947
0
1025192
Page 72