Group Health Plan, Inc.
Plan Name
2003
Reporting Year
General Info
Submission #
1
Last Refreshed:
5
9/1/2004 3:42:49 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
Group Health Plan, Inc.
Childhood Immunization Rate
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Childhood Immunization Rate
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Childhood Immunization Rate
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Adolescent Immunization Status
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Adolescent Immunization Status
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Adolescent Immunization Status
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Breast Cancer Screening
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Commercial
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
Medicare + Choice
HO
S
1721
1419
NR
NR
82.45%
250
5.00%
263
222
84.41%
0
Records Excluded because of contraindications
through Admin data
0
Records Excluded because of contraindications
through Medical Record Review
2
Number of employee/dependent medical records
excluded
0
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)
NR
NR
NR
2
250
213
1
85.60%
81.05%
90.15%
Page 9
Effectiveness of Care
Group Health Plan, Inc.
Cervical Cancer Screening
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Commercial
PMAP
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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
Group Health Plan, Inc.
Chlamydia Screening in Women
Data Last Refreshed:
Sep 1, 2004 3:42 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
NR
NR
PMAP
Total
NR
NR
General
Measure Ages 16-20 Ages 21-25
Data
NR
NR
Total
NR
NR
Records Excluded - Contraindications/Admin
Data
NR
NR
Denominator
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
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
Page 11
Effectiveness of Care
Group Health Plan, Inc.
Controlling High Blood Pressure
Data Last Refreshed:
Sep 1, 2004 3:42 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
HO
S
3700
392
5.00%
412
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
4
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
4
392
270
68.88%
64.17%
73.59%
MSHO
NR
NR
NR
Page 12
Effectiveness of Care
Group Health Plan, Inc.
Beta Blocker Treatment after Heart Attack
Data Elements
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Commercial
Data Collection Methodology
Medicare + Choice
HO
Sampling Method Used
N
Eligible Member Population
58
Numerator Events by Admin Data on
Eligible Population
33
Current Year's Admin Rate
NR
Minimum Required Sample Size
58
Oversampling Rate
0.00%
Final Sample Size (FSS)
58
Numerator events by admin data in FSS
Admin rate on FSS
56.90%
33
NR
56.90%
Records Excluded because of Valid Data
Errors
0
Records Excluded Contraindications/Admin Data
0
Records Excluded Contraindications/Medical Record Review
3
Number of employee/dependent medical
records excluded
0
Records Added from Auxiliary List
0
Denominator
55
Numerator Events by Admin Data
33
Numerator Events by Medical Record
21
Reported Rate
NR
Lower 95% Confidence Interval
Upper 95% Confidence Interval
NR
93.74%
NR
100.00%
HEDIS 2004 (Reporting Year 2003)
98.18%
Page 13
Effectiveness of Care
Group Health Plan, Inc.
Cholesterol Management After Acute Cardiovascular Events
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Commercial
Data Elements
General
Measure
Data
Medicare + Choice
LDL-C
LDL-C Level of
screening 60- <130 mg/dL 60365 Days
365 Days
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
HO
S
126
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
8
Number of employee/dependent medical
records excluded
0
HEDIS 2004 (Reporting Year 2003)
104
92
82.54%
73.02%
104
92
82.54%
73.02%
102
1
92
7
87.29%
80.85%
93.72%
83.90%
76.84%
90.95%
126
0.00%
126
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
0
118
NR
NR
NR
NR
NR
NR
Page 14
Effectiveness of Care
Group Health Plan, Inc.
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Medicare + Choice
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
1219
92.56%
301
22.85%
953
72.36%
1214
92.18%
912
69.25%
590
44.80%
920
69.86%
416
91.83%
110
24.28%
319
70.42%
418
92.27%
319
70.42%
217
47.90%
318
70.20%
382
4
93.92%
91.48%
96.35%
22
25
11.44%
8.24%
14.63%
294
9
73.72%
69.35%
78.10%
382
0
92.94%
90.35%
95.54%
292
22
76.40%
72.17%
80.63%
201
16
52.80%
47.85%
57.75%
294
17
75.67%
71.40%
79.94%
453
6
Number of employee/dependent records
excluded
0
Additional Records Added from the
Auxiliary List
6
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
1317
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 16
Effectiveness of Care
Group Health Plan, Inc.
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 1, 2004 3:42 PM
MSHO
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 17
Effectiveness of Care
Group Health Plan, Inc.
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Comprehensive Diabetes Care
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Appropriate Medications for People with Asthma
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Appropriate Medications for People with Asthma
Data Last Refreshed:
Sep 1, 2004 3:42 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
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Page 21
Effectiveness of Care
Group Health Plan, Inc.
Follow-Up After Hospitalization for Mental Illness
Data Last Refreshed:
Sep 1, 2004 3:42 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
A
35
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)
W/in 7 Days of W/in 30 Days of
Discharge
Discharge
General
Measure
Data
27
77.14%
61.80%
92.48%
PMAP
General
W/in 7 Days of W/in 30 Days of
Measure
Discharge
Discharge
Data
NR
NR
NR
11
31.43%
14.62%
48.24%
NR
NR
NR
W/in 7 Days of W/in 30 Days of
Discharge
Discharge
NR
NR
NR
NR
NR
NR
Page 22
Effectiveness of Care
Group Health Plan, Inc.
Antidepressant Medication Management
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Antidepressant Medication Management
Data Last Refreshed:
Sep 1, 2004 3:42 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
19
16.10%
9.05%
23.16%
82
69.49%
60.76%
78.22%
72
61.02%
51.79%
70.24%
A
118
Page 24
Effectiveness of Care
Group Health Plan, Inc.
Antidepressant Medication Management
Data Last Refreshed:
Sep 1, 2004 3:42 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
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 25
Effectiveness of Care
Group Health Plan, Inc.
Antidepressant Medication Management
Data Last Refreshed:
Sep 1, 2004 3:42 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
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 26
Use of Services
Group Health Plan, Inc.
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Sep 1, 2004 3:42 PM
PMAP
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 28
Use of Services
Group Health Plan, Inc.
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 3:42 PM
Commercial
PMAP
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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
Group Health Plan, Inc.
Adolescent Well-Care Visits
Data Elements
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Commercial
PMAP
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
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
Group Health Plan, Inc.
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Sep 1, 2004 3:42 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
0
0
0
316
2676
83660
91124
23533
0
201309
Discharges
0
0
0
8
62
1662
2661
890
0
5283
Discharges /
1,000 Member
Months
NA
NA
NA
25.32
23.17
19.87
29.20
37.82
26.24
0
0
0
4
40
960
1744
683
0
3431
NA
NA
NA
12.66
14.95
11.48
19.14
29.02
0
0
0
4
22
695
910
207
0
1838
NA
NA
NA
12.66
8.22
8.31
9.99
8.80
HEDIS 2004 (Reporting Year 2003)
17.04
9.13
Days
0
0
0
42
209
6874
10844
3587
0
21556
Days / 1,000
Member
Months
NA
NA
NA
132.91
78.10
82.17
119.00
152.42
107.08
0
0
0
36
103
3251
6047
2334
0
11771
NA
NA
NA
113.92
38.49
38.86
66.36
99.18
0
0
0
6
106
3596
4777
1253
0
9738
NA
NA
NA
18.99
39.61
42.98
52.42
53.24
58.47
48.37
Average Length
of Stay
NA
NA
NA
5.25
3.37
4.14
4.08
4.03
NA
4.08
NA
NA
NA
9.00
2.58
3.39
3.47
3.42
NA
3.43
NA
NA
NA
1.50
4.82
5.17
5.25
6.05
NA
5.30
Page 32
Use of Services
Group Health Plan, Inc.
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Sep 1, 2004 3:42 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
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 33
Use of Services
Group Health Plan, Inc.
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Sep 1, 2004 3:42 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
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 34
Use of Services
Group Health Plan, Inc.
Ambulatory Care
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Ambulatory Care
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Medicare + Choice
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
0
0
0
316
2676
83660
91124
23533
0
201309
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
161
1915
48323
63681
19162
0
133242
HEDIS 2004 (Reporting Year 2003)
Visits/ 1,000
Member
Months
NA
NA
NA
509.49
715.62
577.61
698.84
814.26
661.88
Emergency Room Visits
Visits
0
0
0
15
61
941
1428
431
0
2876
Visits/ 1,000
Member
Months
NA
NA
NA
47.47
22.80
11.25
15.67
18.31
14.29
Ambulatory
Surgery/Procedures
Procedures
0
0
0
7
99
1469
1827
356
0
3758
Procedures/
1,000 Member
Months
NA
NA
NA
22.15
37.00
17.56
20.05
15.13
18.67
Observation Room Stays
Resulting in Discharge
Stays
0
0
0
0
0
4
1
0
0
5
Stays/ 1,000
Member
Months
NA
NA
NA
0.00
0.00
0.05
0.01
0.00
0.02
Page 36
Use of Services
Group Health Plan, Inc.
Ambulatory Care
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Minnesota Senior Health Options
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 37
Use of Services
Group Health Plan, Inc.
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Medicare + Choice
Member
Months
Age
<1
0
1-9
0
10-19
0
20-44
316
45-64
2676
65-74
83660
75-84
91124
85+
23533
Unknown
0
201309
Total
Days
Days / 1,000
Member
Months
Average Length
of Stay
NA
0
NA
NA
0
NA
0
NA
NA
0
NA
0
NA
NA
Discharges
Discharges /
1,000 Member
Months
<1
0
1-9
10-19
Age
20-44
0
0.00
0
0.00
NA
45-64
17
6.35
116
43.35
6.82
65-74
378
4.52
4776
57.09
12.63
75-84
1032
11.33
12793
140.39
12.40
85+
617
26.22
7396
314.28
11.99
Unknown
0
2044
10.15
0
25081
124.59
NA
12.27
Total
HEDIS 2004 (Reporting Year 2003)
Page 39
Use of Services
Group Health Plan, Inc.
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Minnesota Senior Health Options
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 40
Use of Services
Group Health Plan, Inc.
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Medicare + Choice
Member Months
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
Male
Female
Total
0
0
1435
77963
0
79398
0
0
1557
120354
0
121911
0
0
2992
198317
0
201309
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
M
13-17
0
NA
0
NA
F
0
NA
0
NA
Total
0
NA
0
NA
M
18-64
7
4.88
38
5.43
F
4
2.57
32
8.00
Total
11
3.68
70
6.36
M
65+
43
0.55
358
8.33
F
90
0.75
807
8.97
Total
133
0.67
1165
8.76
M
Unknown
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
50
0.63
396
7.92
F
94
0.77
839
8.93
TOTAL
144
0.72
1235
8.58
* 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
Group Health Plan, Inc.
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Minnesota Senior Health Options
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 43
Use of Services
Group Health Plan, Inc.
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:42 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
0
0
1435
77963
65
79463
Female
0
0
1557
120354
0
121911
Member Months (Inpatient)
Total
0
0
2992
198317
65
201374
Male
0
0
1435
77963
65
79463
Female
0
0
1557
120354
0
121911
Total
0
0
2992
198317
65
201374
Any Mental Health Services
Inpatient Mental Health Services
Number
0
0
0
0
0
0
33
46
79
245
523
768
0
0
0
278
569
847
Number
0
0
0
0
0
0
5
4
9
40
71
111
0
0
0
45
75
120
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
27.60%
35.45%
31.68%
3.77%
5.21%
4.65%
0.00%
NA
0.00%
4.20%
5.60%
5.05%
Percent
NA
NA
NA
NA
NA
NA
4.18%
3.08%
3.61%
0.62%
0.71%
0.67%
0.00%
NA
0.00%
0.68%
0.74%
0.72%
Member Months (Day/Night)
Male
0
0
1435
77963
65
79463
Female
0
0
1557
120354
0
121911
Total
0
0
2992
198317
65
201374
Day/Night Mental Health Services
Number
0
0
0
0
0
0
0
0
0
0
2
2
0
0
0
0
2
2
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
0.00%
0.02%
0.01%
0.00%
NA
0.00%
0.00%
0.02%
0.01%
Member Months (Ambulatory)
Male
0
0
1435
77963
65
79463
Female
0
0
1557
120354
0
121911
Total
0
0
2992
198317
65
201374
Ambulatory Mental Health Services
Number
0
0
0
0
0
0
32
46
78
214
476
690
0
0
0
246
522
768
Percent
NA
NA
NA
NA
NA
NA
26.76%
35.45%
31.28%
3.29%
4.75%
4.18%
0.00%
NA
0.00%
3.71%
5.14%
4.58%
Page 45
Use of Services
Group Health Plan, Inc.
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:42 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
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 46
Use of Services
Group Health Plan, Inc.
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Medicare + Choice
Member Months
Age
0-12
13-17
18-64
65+
Unknown
Total
Age
0-12
Male
Female
Total
0
0
1435
77963
0
79398
0
0
1557
120354
0
121911
0
0
2992
198317
0
201309
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
3
2.09
30
10.00
F
1
0.64
1
1.00
Total
4
1.34
31
7.75
65+
M
20
0.26
90
4.50
F
7
0.06
34
4.86
Total
27
0.14
124
4.59
Unknown
M
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
23
0.29
120
5.22
F
8
0.07
35
4.38
TOTAL
31
0.15
155
5.00
* 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 48
Use of Services
Group Health Plan, Inc.
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Minnesota Senior Health Options
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 49
Use of Services
Group Health Plan, Inc.
Chemical Dependency Utilization -Percent of members Receiving inpatient, Day/Night Care, and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Chemical Dependency Utilization -Percent of members Receiving inpatient, Day/Night Care, and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Medicare + Choice
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
0
0
1435
77963
0
79398
Female
0
0
1557
120354
0
121911
Member Months (Inpatient)
Total
0
0
2992
198317
0
201309
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
4
1
5
15
11
26
0
0
0
19
12
31
Percent
NA
NA
NA
NA
NA
NA
3.34%
0.77%
2.01%
0.23%
0.11%
0.16%
NA
NA
NA
0.29%
0.12%
0.18%
Male
0
0
1435
77963
0
79398
Female
0
0
1557
120354
0
121911
Total
0
0
2992
198317
0
201309
Member Months (Day/Night)
Male
0
0
1435
77963
0
79398
Female
0
0
1557
120354
0
121911
Total
0
0
2992
198317
0
201309
Member Months (Ambulatory)
Male
0
0
1435
77963
0
79398
Female
0
0
1557
120354
0
121911
Total
0
0
2992
198317
0
201309
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
0
0
0
0
0
0
2
1
3
11
7
18
0
0
0
13
8
21
Number
0
0
0
0
0
0
0
0
0
1
2
3
0
0
0
1
2
3
Number
0
0
0
0
0
0
3
0
3
7
6
13
0
0
0
10
6
16
Percent
NA
NA
NA
NA
NA
NA
1.67%
0.77%
1.20%
0.17%
0.07%
0.11%
NA
NA
NA
0.20%
0.08%
0.13%
Percent
NA
NA
NA
NA
NA
NA
0.00%
0.00%
0.00%
0.02%
0.02%
0.02%
NA
NA
NA
0.02%
0.02%
0.02%
Percent
NA
NA
NA
NA
NA
NA
2.51%
0.00%
1.20%
0.11%
0.06%
0.08%
NA
NA
NA
0.15%
0.06%
0.10%
Page 51
Use of Services
Group Health Plan, Inc.
Chemical Dependency Utilization -Percent of members Receiving inpatient, Day/Night Care, and Ambulatory Services
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Minnesota Senior Health Options
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 52
Use of Services
Group Health Plan, Inc.
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 3:42 PM
Member Months
0
0
27
849
49830
34381
8508
0
93595
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
$37,270.65
$250,398.33
$6,715,845.87
$4,843,158.29
$1,119,262.64
$0.00
$12,965,935.78
HEDIS 2004 (Reporting Year 2003)
A
Avg. Cost of
Prescriptions /
Per Member Per
Month
NA
NA
$1,380.39
$294.93
$134.78
$140.87
$131.55
$138.53
Total Number of
Prescriptions
0
0
204
4879
178307
146933
40229
0
370552
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NA
NA
90.67
68.96
42.94
51.28
56.74
47.51
Page 53
Use of Services
Group Health Plan, Inc.
Outpatient Drug Utilization
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Minnesota Senior Health Options
Age
Member Months
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
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 54
Access/Availability of Care
Group Health Plan, Inc.
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Medicare + Choice
Data Elements
Data collection methodology
(Administrative only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2004 (Reporting Year 2003)
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
22
195
16379
18
180
15774
NA
NA
NA
92.31%
88.31%
96.30%
96.31%
96.01%
96.60%
A
Page 56
Access/Availability of Care
Group Health Plan, Inc.
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Minnesota Senior Health Options
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 57
Access/Availability of Care
Group Health Plan, Inc.
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Sep 1, 2004 3:42 PM
PMAP
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 58
Access/Availability of Care
Group Health Plan, Inc.
Children's Access to Primary Care Practitioners
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Children's Access to Primary Care Practitioners
Data Last Refreshed:
Sep 1, 2004 3:42 PM
PMAP
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 60
Access/Availability of Care
Group Health Plan, Inc.
Prenatal and Postpartum Care
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Prenatal and Postpartum Care
Data Last Refreshed:
Sep 1, 2004 3:42 PM
PMAP
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 62
Health Plan Stability
Group Health Plan, Inc.
Practitioner Turnover
Medicare + Choice
Practitioner Types
Data Last Refreshed:
Sep 1, 2004 3:42 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
196
8
4.08%
Non-Physician Primary
Care Practitioners
28
1
3.57%
HEDIS 2004 (Reporting Year 2003)
Page 63
Health Plan Stability
Group Health Plan, Inc.
Practitioner Turnover
Minnesota Senior Health Options
Practitioner Types
Number of
Practitioners as of
12/31/2002
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Years in Business / Total Membership
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Medicare + Choice
Product/Product Line
HMO (Total)
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other (specify)
PPO (Total)
Commercial
Medicare (cost or risk)
Self-insured
Other (specify)
POS (Total)
Commercial
Medicare (cost or risk)
Self-insured
Other (specify)
Total
Years in Business
48.00
18.00
48.00
48.00
16.00
48.00
Members*
427172
49919
106959
33251
232983
4060
0.00
0.00
0.00
0.00
0.00
0
0
0
0
0
20.00
20.00
0.00
0.00
0.00
198869
198869
0
0
0
626041
* Total number of members in each category as of December 31, 2003
HEDIS 2004 (Reporting Year 2003)
Page 65
Health Plan Stability
Group Health Plan, Inc.
Years in Business / Total Membership
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Minnesota Senior Health Options
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 66
Health Plan Descriptive Information
Group Health Plan, Inc.
Board Certification / Residency Completion
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Total Enrollment by Percentage
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
Medicaid
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Commercial
Product Line
Medicare
Other
Total
M
F
M
F
M
F
M
F
M
F
M
F
M
F
Total
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
M
F
M
F
M
F
M
F
M
F
M
F
Total
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
M
F
M
F
M
F
M
F
M
F
Total
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
M
F
M
F
M
F
M
F
M
F
M
F
M
F
Total
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
Age Unknown
Total
0.00%
0.00%
Note: Row entries should add up to 100%.
HEDIS 2004 (Reporting Year 2003)
Page 68
Health Plan Descriptive Information
Group Health Plan, Inc.
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 1, 2004 3:42 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
Group Health Plan, Inc.
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Medicare + Choice
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Male
0
0
0
0
0
0
Member Months
Female
0
0
0
0
0
0
Total
0
0
0
0
0
0
0
0.00%
0
0
24
60
84
0
0.00%
0
0
36
48
72
0
0.00%
168
0.21%
120
240
360
540
156
0.13%
192
228
288
708
324
0.16%
1260
1.59%
14916
20064
20256
15660
5556
1524
1416
1.16%
21036
27648
30816
24396
11244
5220
2676
1.33%
77976
98.20%
0
120360
98.71%
0
198336
98.51%
79404
121932
HEDIS 2004 (Reporting Year 2003)
0
0
60
108
156
312
468
648
1248
35952
47712
51072
40056
16800
6744
0
201336
Page 70
Health Plan Descriptive Information
Group Health Plan, Inc.
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 1, 2004 3:42 PM
Minnesota Senior Health Options
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 71
Health Plan Descriptive Information
Group Health Plan, Inc.
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Sep 1, 2004 3:42 PM
PMAP
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 72