Validation of performance measures for AMERIGROUP Community Care: measurement period: calendar year 2010; validation period: state fiscal year 2011

Georgia Department of Community Health
Validation of Performance Measures for
AMERIGROUP Community Care
Measurement Period: Calendar Year 2010 Validation Period: State Fiscal Year 2011
Publish Date: July 15, 2011
3133 East Camelback Road, Suite 300 Phoenix, AZ 85016 Phone 602.264.6382 Fax 602.241.0757

CONTENTS
for AMERIGROUP Community Care
Validation of Performance Measures ................................................................................................... 1 Validation Overview ............................................................................................................................. 1 Care Management Organization (CMO) Information ........................................................................... 1 Performance Measures Validated........................................................................................................ 2 Description of Validation Activities ....................................................................................................... 3 Pre-audit Strategy.............................................................................................................................. 3 Validation Team................................................................................................................................. 3 Technical Methods of Data Collection and Analysis.......................................................................... 4 On-site Activities................................................................................................................................ 4 Data Integration, Data Control, and Performance Measure Documentation ....................................... 7 Data Integration ................................................................................................................................. 7 Data Control ...................................................................................................................................... 7 Performance Measure Documentation.............................................................................................. 7 Validation Results ................................................................................................................................ 8 Medical Service Data (Claims/Encounters) ....................................................................................... 8 Enrollment Data................................................................................................................................. 8 Provider Data..................................................................................................................................... 8 Medical Record Review Process....................................................................................................... 8 Supplemental Data ............................................................................................................................ 8 Data Integration ................................................................................................................................. 9 Performance Measure Specific Findings........................................................................................... 9 Validation Findings ............................................................................................................................ 10
Appendix A--Data Integration and Control Findings ..................................................................... A-1 Appendix B--Denominator and Numerator Validation Findings ................................................... B-1 Appendix C--Performance Measure Results .................................................................................. C-1
Appendix D--Final Audited HEDIS Results ..................................................................................... D-1
Appendix E--Audited CY 2010 HEDIS Utilization Measure Results ...............................................E-1

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Validation of Performance Measures
for AMERIGROUP Community Care

Validation Overview
Validation of performance measures is one of three mandatory external quality review (EQR) activities that the Balanced Budget Act of 1997 (BBA) requires state Medicaid agencies to perform. Health Services Advisory Group, Inc. (HSAG), the external quality review organization (EQRO) for the Department of Community Health (DCH), conducted the validation activities. DCH contracts with three care management organizations (CMOs) to provide services to Medicaid managed care enrollees and PeachCare for Kids enrollees. DCH identified a set of performance measures that were calculated and reported by the CMOs for validation. HSAG conducted the validation activities as outlined in the Centers for Medicare & Medicaid Services (CMS) publication, Validating Performance Measures: A Protocol for Use in Conducting External Quality Review Activities, Final Protocol, Version 1.0, May 1, 2002 (CMS performance measure validation protocol).

Care Management Organization (CMO) Information
HSAG validated performance measures calculated and reported by AMERIGROUP Community Care (AMERIGROUP). Information about AMERIGROUP appears in Table 1.

CMO Name: CMO Location: CMO Contact: Contact Telephone Number: Contact E-mail Address: Site Visit Date:

Table 1--AMERIGROUP Information AMERIGROUP Community Care 303 Perimeter Center North, Suite 400 Atlanta, GA 30346 Joanne Soublis, Risk Control and Compliance Officer
(678) 587-4876
JSoubli@amerigroupcorp.com
May 3 and 4, 2011

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Performance Measures Validated
HSAG validated performance measures identified and selected by DCH for validation. Four performance measures were selected from the Agency for Healthcare Research and Quality (AHRQ) Quality Indicator set and one performance measure was developed by DCH. The measurement period was identified by DCH as calendar year (CY) 2010. Table 2 lists the performance measures validated and who calculated the performance measure.

Table 2--List of CY 2010 Performance Measures for AMERIGROUP

Performance Measure

Calculation by:

1. Cesarean Delivery Rate--AHRQ measure

AMERIGROUP

2. Low Birth Weight Rate--AHRQ measure

AMERIGROUP

3. Asthma ED/Urgent Care Visits--DCH-developed measure

AMERIGROUP

4. Diabetes Short-Term Complications Admission Rate--AHRQ measure

AMERIGROUP

5. Asthma Admission Rate--AHRQ measure

AMERIGROUP

In addition, each CMO was required to report a selected set of Healthcare Effectiveness Data and Information Set (HEDIS) measures to DCH. The CMOs were required to contract with an NCQAlicensed audit organization and undergo a NCQA HEDIS Compliance AuditTM. Final audited HEDIS measure results were submitted to DCH via NCQA's Interactive Data Submission System (IDSS) and provided to HSAG. HSAG will use these results in addition to the measures validated and displayed within this report as data sources for the annual EQR technical report. Appendices D and E display the final audited HEDIS 2010 results for all required measures.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA) HEDIS Compliance AuditTM is a trademark of the National Committee for Quality Assurance (NCQA)

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Description of Validation Activities

Pre-audit Strategy
HSAG conducted the validation activities as outlined in the CMS performance measure validation protocol. In order to complete the validation activities for AMERIGROUP, HSAG obtained a list of the measures that were selected by DCH for validation.
HSAG then prepared a document request letter that was submitted to AMERIGROUP outlining the steps in the performance measure validation process. The document request letter included a request for a completed Information Systems Capabilities Assessment Tool (ISCAT), or Appendix Z of the CMS protocol; source code for each performance measure; portions of the HEDIS 2011 Record of Administration, Data Management, and Processes (Roadmap); and any additional supporting documentation necessary to complete the audit. HSAG responded to ISCAT/Roadmap-related questions directly from AMERIGROUP during the pre-on-site phase.
For the on-site visit, HSAG prepared an agenda describing all visit activities and indicating the type of staffing needed for each session. HSAG provided the agenda to AMERIGROUP approximately one week prior to the on-site visit. HSAG also conducted a pre-on-site conference call with AMERIGROUP to discuss any outstanding ISCAT/Roadmap questions and on-site visit activity expectations.

Validation Team
The HSAG Performance Measure Validation Team was composed of a lead auditor and validation team members. HSAG assembled the team based on the skills required for the validation and requirements of AMERIGROUP. Some team members, including the lead auditor, participated in the on-site meetings at AMERIGROUP; others conducted their work at HSAG's offices. AMERIGROUP's validation team was composed of the following members in the designated positions. Table 3 lists the validation team members, their positions, and their skills and expertise.

Name / Role
Melissa C. Brashears, CPA, MBA Executive Director, Audits
Wendy Talbot, MPH, CHCA Lead Auditor
John Couzins, MPH, CHCA Secondary Auditor
David Mabb, MS, CHCA Associate Director/Audits

Table 3--Validation Team Skills and Expertise
Management of Audit Department, HEDIS knowledge, interviewing skills, financial data analysis, and certified public accountant Auditing expertise, project management, performance measure development, managed care operations
Audit knowledge and experience, performance measure development, and statistical analysis
Source code review management

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VALIDATION OF PERFORMANCE MEASURES

Name / Role Ron Holcomb, AS Source Code Reviewer
Kelly Stewart, BA, HCSA Project Coordinator

Table 3--Validation Team Skills and Expertise
Source code review
Overall project coordination and communications

Technical Methods of Data Collection and Analysis
The CMS performance measure validation protocol identifies key types of data that should be reviewed as part of the validation process. The following list describes the type of data collected and how HSAG conducted an analysis of these data:
Information Systems Capabilities Assessment Tool (ISCAT): A modified version of the ISCAT was requested and received from AMERIGROUP. In preparing the ISCAT document, HSAG removed questions that were already addressed in AMERIGROUP's National Committee for Quality Assurance (NCQA) Roadmap. Upon receipt by HSAG, the ISCAT underwent a cursory review to ensure all sections were completed and all attachments were present. The validation team then reviewed all ISCAT documents, noting issues or items that needed further follow-up. The validation team used information included in the ISCAT to complete the review tools, as applicable.
NCQA's HEDIS 2011 Roadmap: AMERIGROUP completed and submitted portions of its Roadmap for review by the validation team. The validation team combined the responses from the ISCAT review and Roadmap to complete the pre-on-site systems assessment.
Source code (programming language) for performance measures: HSAG requested source code from CMOs that calculate their performance measures by using automated computer code. HSAG requested and received source code from AMERIGROUP. The validation team completed a line-by-line code review and observation of program logic flow to ensure compliance with State measure definitions during the on-site visit. Source code reviewers identified areas of deviation and shared them with the lead auditor to evaluate the impact of the deviation on the measure and assess the degree of bias (if any).
Supporting documentation: HSAG requested any documentation that would provide reviewers with additional information to complete the validation process, including policies and procedures, file layouts, system flow diagrams, system log files, and data collection process descriptions. The validation team reviewed all supporting documentation, identifying issues or clarifications for further follow-up.
On-site Activities
HSAG conducted an on-site visit with AMERIGROUP on May 3 and 4, 2011. HSAG collected information using several methods, including interviews, system demonstration, review of data output files, primary source verification, observation of data processing, and review of data reports. The on-site visit activities are described as follows:

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Opening meeting: The opening meeting included an introduction of the validation team and key AMERIGROUP staff members involved in the performance measure activities. The review purpose, the required documentation, basic meeting logistics, and queries to be performed were discussed.
Evaluation of system compliance: The evaluation included a review of the information systems assessment, focusing on the processing of claims and encounter data, patient data, and inpatient data.
Additionally, the review evaluated the processes used to collect and calculate the performance measures, including accurate numerator and denominator identification and algorithmic compliance (which evaluated whether rate calculations were performed correctly, all data were combined appropriately, and numerator events were counted accurately).
Review of ISCAT/Roadmap and supporting documentation: The review included processes used for collecting, storing, validating, and reporting performance measure data. This session was designed to be interactive with key AMERIGROUP staff members so that the validation team could obtain a complete picture of all the steps taken to generate the performance measures. The goal of the session was to obtain a confidence level as to the degree of compliance with written documentation compared to actual process. HSAG conducted interviews to confirm findings from the documentation review, expand or clarify outstanding issues, and ascertain that written policies and procedures were used and followed in daily practice.
Overview of data integration and control procedures: The overview included discussion and observation of source code logic, a review of how all data sources were combined, and a review of how the analytic file was produced for the reporting of selected performance measures. HSAG performed primary source verification to further validate the output files and reviewed backup documentation on data integration. HSAG also addressed data control and security procedures during this session.
Closing conference: The closing conference included a summation of preliminary findings based on the review of the ISCAT/Roadmap and the on-site visit, and revisited the documentation requirements for any post-visit activities.
HSAG conducted several interviews with key AMERIGROUP staff members who were involved with performance measure reporting. Table 4 lists key AMERIGROUP interviewees:

Lee Root Russ Esposito Diana Cleary Jill Heine Rachelle Whitacre Joanne Soublis Tawonna Ingram Angela Evans

Name

Table 4--List of AMERIGROUP Interviewees Title
Chief Information Officer Senior Vice President Director of Security and Compliance Plan Compliance Officer, New Mexico Regulatory Market Manager Plan Compliance Officer, Georgia Director, HEDIS Manager, Performance Reporting

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VALIDATION OF PERFORMANCE MEASURES

Gail Brown Kim Turner Leslie Langslow Andre Payne Fran Gary Bridget McKenzie Ester Mays

Name

Table 4--List of AMERIGROUP Interviewees Title
Manager, Performance Reporting Assistant Vice President, Claims Operations Assistant Vice President, Claims Operations Vice President, Provider Relations Chief Operating Officer Vice President, Healthcare Management Systems Director, Finance

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Data Integration, Data Control, and Performance Measure Documentation
There are several aspects crucial to the calculation of performance measures. These include data integration, data control, and documentation of performance measure calculations. Each of the following sections describes the validation processes used and the validation findings. For more detailed information, see Appendix A of this report.
Data Integration
Accurate data integration is essential to calculate valid performance measures. The steps used to combine various data sources (including claims/encounter data, eligibility data, and other administrative data) must be carefully controlled and validated. HSAG validated the data integration process used by AMERIGROUP, which included a review of file consolidations or extracts, a comparison of source data to warehouse files, data integration documentation, source code, production activity logs, and linking mechanisms. Overall, the validation team determined that the data integration processes in place at AMERIGROUP were:
Acceptable Not acceptable
Data Control
The organizational infrastructure of a CMO must support all necessary information systems. Each CMO's quality assurance practices and backup procedures must be sound to ensure timely and accurate processing of data, and to provide data protection in the event of a disaster. HSAG validated the data control processes used by AMERIGROUP, which included a review of disaster recovery procedures, data backup protocols, and related policies and procedures. Overall, the validation team determined that the data control processes in place at AMERIGROUP were:
Acceptable Not acceptable
Performance Measure Documentation
Sufficient, complete documentation is necessary to support validation activities. While interviews and system demonstrations provided supplementary information, the majority of the validation review findings were based on documentation provided by AMERIGROUP. HSAG reviewed all related documentation, which included the completed ISCAT/Roadmap, job logs, computer programming code, output files, work flow diagrams, narrative descriptions of performance measure calculations, and other related documentation. Overall, the validation team determined that the documentation of performance measure calculations by AMERIGROUP was:
Acceptable Not acceptable

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VALIDATION OF PERFORMANCE MEASURES
Validation Results
The validation team evaluated AMERIGROUP's data systems for processing of each type of data used for reporting the DCH performance measures. General findings are indicated below:
Medical Service Data (Claims/Encounters)
AMERIGROUP required the submission of all data using standard codes and forms. Most data (90 percent) were submitted electronically. AMERIGROUP scanned paper claims. A keying vendor, Affiliated Computer Services (ACS), then processed the files. AMERIGROUP had good control procedures in place for monitoring data flow to and from ACS and between AMERIGROUP and the three clearinghouses. There were sufficient edit checks in place, and ongoing audits were performed to verify the completeness and accuracy of submitted and processed data. The validation team determined that inpatient facility claims data (which are used for the measures under validation) were complete and that AMERIGROUP was fully compliant with the processing of claims and encounter data. Hospitals in Georgia were paid based on fee for service, which mitigated the concern about incomplete facility data.
Enrollment Data
AMERIGROUP received electronic enrollment data monthly from the State's enrollment broker. These data were processed, reconciled, and loaded into Facets. AMERIGROUP performed validation checks to remove duplicate members and to ensure data were complete and accurate. AMERIGROUP received and processed all data in a timely manner, with no issues identified during the measurement period.
Provider Data
Provider data processing and identification were not relevant to the measures under review.
Medical Record Review Process
AMERIGROUP reported all measures using administrative data only. Medical record review was not performed and, therefore, was not evaluated under the scope of this review.
Supplemental Data
AMERIGROUP did not use any supplemental data sources for reporting the selected performance measures.

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VALIDATION OF PERFORMANCE MEASURES

Data Integration
All of the performance measures were generated using data from Reporting MedFin, a data warehouse updated on the second day of each month with data from Facets. A team of AMERIGROUP staff members was responsible for generating the source code to run the measures. The code was internally reviewed and approved, and version control was monitored through a numbering system. The source code was still under review at the time of the on-site visit and was approved post-on-site. Primary source verification was performed on all of the measures during the on-site visit, and no issues were identified.
Performance Measure Specific Findings
Based on all validation activities, the HSAG Validation Team determined validation results for each performance measure. Table 5 displays the key review results. For detailed information, see Appendix B of this report.

Table 5--Key Review Results for AMERIGROUP Performance Measures 1. Cesarean Delivery Rate--AHRQ measure 2. Low Birth Weight Rate--AHRQ measure 3. Asthma ED/Urgent Care Visits--DCH-developed measure 4. Diabetes Short-Term Complications Admission Rate--AHRQ measure 5. Asthma Admission Rate--AHRQ measure

Key Review Findings No concerns identified No concerns identified No concerns identified No concerns identified No concerns identified

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Validation Findings
The CMS performance measure validation protocol identifies four validation findings for each performance measure, which are defined in Table 6.

Table 6--Validation Findings Definitions

Fully Compliant (FC)

Indicates that the performance measure was fully compliant with DCH specifications.

Substantially Compliant (SC)

Indicates that the performance measure was substantially compliant with DCH specifications and had only minor deviations that did not significantly bias the reported rate.

Not Valid (NV)

Indicates that the performance measure deviated from DCH specifications such that the reported rate was significantly biased. This designation is also assigned to measures for which no rate was reported, although reporting of the rate was required.

Not Applicable (NA)

Indicates that the performance measure was not reported because the CMO did not have any Medicaid consumers who qualified for that denominator.

According to the Protocol, the validation finding for each measure is determined by the magnitude of the errors detected for the audit elements, not by the number of audit elements determined to be not met. Consequently, it is possible that an error for a single audit element may result in a designation of Not Valid (NV) because the impact of the error biased the reported performance measure by more than 5 percentage points. Conversely, it is also possible that several audit element errors may have little impact on the reported rate, resulting in a measure designation of Substantially Compliant (SC).
Table 7 shows the final validation findings for AMERIGROUP for each performance measure. For additional information regarding performance measure results, see Appendix C of this report.

Table 7--Validation Findings for AMERIGROUP Performance Measures
1. Cesarean Delivery Rate--AHRQ measure 2. Low Birth Weight Rate--AHRQ measure 3. Asthma ED/Urgent Care Visits--DCH-developed measure 4. Diabetes Short-Term Complications Admission Rate--AHRQ measure 5. Asthma Admission Rate--AHRQ measure

Validation Finding Fully Compliant Fully Compliant Fully Compliant Fully Compliant Fully Compliant

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Appendix A. Data Integration and Control Findings
for AMERIGROUP Community Care
Appendix A, which follows this page, contains the data integration and control findings for AMERIGROUP.

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Appendix A. Data Integration and Control Findings
for AMERIGROUP Community Care

Documentation Worksheet

CMO Name: On-Site Visit Date: Reviewers:

AMERIGROUP Community Care May 3 and 4, 2011 Wendy Talbot, MPH, CHCA, and John Couzins, MPH, CHCA

Data Integration and Control Element

Not Met Met N/A

Comments

Accuracy of data transfers to assigned performance measure data repository

The CMO accurately and completely processes transfer data from the transaction files (e.g., membership, provider, encounter/claims) into the performance measure data repository used to keep the data until the calculations of the performance measures have been completed and validated.

Samples of data from the performance measure data repository are complete and accurate.

Accuracy of file consolidations, extracts, and derivations

The CMO's processes to consolidate diversified files and to extract required information from the performance measure data repository are appropriate.

Actual results of file consolidations or extracts are consistent with those that should have resulted according to documented algorithms or specifications.

Procedures for coordinating the activities of multiple subcontractors ensure the accurate, timely, and complete integration of data into the performance measure database.

Computer program reports or documentation reflect vendor coordination activities, and no data necessary to performance measure reporting are lost or inappropriately modified during transfer.

If the CMO uses a performance measure data repository, its structure and format facilitates any required programming necessary to calculate and report required performance measures.

The performance measure data repository's design, program flow charts, and source codes enable analyses and reports.

Proper linkage mechanisms are employed to join data from all necessary sources (e.g., identifying a member with a given disease/condition).

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DATA INTEGRATION AND CONTROL FINDINGS

Data Integration and Control Element

Not Met Met N/A

Assurance of effective management of report production and of the reporting software.

Documentation governing the production process, including CMO production activity logs and the CMO staff review of report runs, is adequate.

Prescribed data cutoff dates are followed.

Comments

The CMO retains copies of files or databases used for performance measure reporting in case results need to be reproduced.
The reporting software program is properly documented with respect to every aspect of the performance measure data repository, including building, maintaining, managing, testing, and report production.
The CMO's processes and documentation comply with the CMO standards associated with reporting program specifications, code review, and testing.

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Appendix B. Denominator and Numerator Validation Findings
for AMERIGROUP Community Care
Appendix B, which follows this page, contains the denominator and numerator validation findings for AMERIGROUP.

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Appendix B. Denominator and Numerator Validation Findings
for AMERIGROUP Community Care

Reviewer Worksheets

CMO Name: On-Site Visit Date: Reviewers:

AMERIGROUP Community Care May 34, 2011 Wendy Talbot, MPH, CHCA, and John Couzins, MPH, CHCA

Table B-1--Denominator Validation Findings for AMERIGROUP Community Care

Audit Element

Not Met Met N/A

Comments

For each of the performance measures, all members of the relevant populations identified in the performance measure specifications are included in the population from which the denominator is produced.

Adequate programming logic or source code exists to appropriately identify all relevant members of the specified denominator population for each of the performance measures.

The CMO correctly calculates member months and member years if applicable to the performance measure.

Calculations of member months and years were not required for the measures under review.

The CMO properly evaluates the completeness and accuracy of any codes used to identify medical events, such as diagnoses, procedures, or prescriptions, and these codes are appropriately identified and applied as specified in each performance measure.

If any time parameters are required by the specifications of the performance measure, they are followed (e.g., cutoff dates for data collection, counting 30 calendar days after discharge from a hospital, etc.).

Exclusion criteria included in the performance measure specifications are followed.

Systems or methods used by the CMO to estimate populations when they cannot be accurately or completely counted (e.g., newborns) are valid.

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DENOMINATOR AND NUMERATOR VALIDATION FINDINGS

Table B-2--Numerator Validation Findings for AMERIGROUP Community Care

Audit Element

Not Met Met N/A

Comments

The CMO uses the appropriate data, including linked data from separate data sets, to identify the entire at-risk population.

Qualifying medical events (such as diagnoses, procedures, prescriptions, etc.) are properly identified and confirmed for inclusion in terms of time and services.

The CMO avoids or eliminates all double-counted members or numerator events.
Any nonstandard codes used in determining the numerator are mapped to a standard coding scheme in a manner that is consistent, complete, and reproducible, as evidenced by a review of the programming logic or a demonstration of the program.
If any time parameters are required by the specifications of the performance measure, they are followed (i.e., the measured event occurred during the time period specified or defined in the performance measure).

AMERIGROUP did not use any nonstandard codes.

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Appendix C. Performance Measure Results
for AMERIGROUP Community Care
Appendix C, which follows this page, contains AMERIGROUP's performance measure results.

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Appendix C. Performance Measure Results
for AMERIGROUP Community Care

Indicator 1--Cesarean Delivery Rate

Cesarean Delivery Rate

Table C-1--Indicator 1 for AMERIGROUP Community Care

Denominator

Numerator

13,706

4,508

Rate (per 100) 32.89

The Cesarean Delivery rate remained relatively stable, with only a 0.36 percentage point drop from 2009 to 2010. The 2009 rate was 33.25, and there were 11,264 total deliveries.

Indicator 2--Low Birth Weight Rate

Low Birth Weight Rate

Table C-2--Indicator 2

for AMERIGROUP Community Care

Denominator

Numerator

15,000

1,172

Rate (per 100) 7.81

The Low Birth Weight rate increased from 7.66 in 2009 to 7.81 in 2010, a total increase of 0.15 percentage points. This slight increase could be related to the increase in the number of newborns from 12,445 in 2009 to 15,000 in 2010.

Indicator 3--Asthma Emergency Department/Urgent Care Visits

Table C-3--Indicator 3 for AMERIGROUP Community Care

Denominator

Numerator

Asthma ED/Urgent Care Visits

258,265

5,713

Rate 2.21%

The rate for the Asthma Emergency Department/Urgent Care Visit measure increased from 1.62% in 2009 to 2.21% in 2010. The increase in this rate was due to the clarification of the measure specifications and reporting timeframe. The denominator for this measure dropped from 340,876 in 2009 to 258,265 in 2010.

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PERFORMANCE MEASURE RESULTS

Indicator 4--Diabetes Short-Term Complications Admission Rate

Table C-4--Indicator 4 for AMERIGROUP Community Care

Denominator

Numerator

Diabetes Short-Term Complications Admission Rate

130,624

21

Rate (per 100,000) 16.08

The Diabetes Short-Term Complications Admission rate increased from 14.02 admissions per 100,000 members for 2009 to 16.08 admissions per 100,000 members in 2010. This increase may be attributed to the clarification of the specifications and reporting requirements. The denominator for this measure dropped from 171,126 in 2009 to 130,624 in 2010, which would lead to an increase in the rate.

Indicator 5--Asthma Admission Rate

Asthma Admission Rate

Table C-5--Indicator 5 for AMERIGROUP Community Care

Denominator

Numerator

186,522

143

Rate (per 100,000) 76.67

The Asthma Admission rate increased from 68.43 admissions per 100,000 members in 2009 to 76.67 admissions per 100,000 members in 2010. This increase may be attributed to the clarification of the specifications and reporting requirements. The denominator for this measure dropped from 249,887 members in 2009 to 186,522 members in 2010, which would lead to an increase in the rate.

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Appendix D. Final Audited HEDIS Results
for AMERIGROUP Community Care
Appendix D, which follows this page, contains the final audited HEDIS results for AMERIGROUP.

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Appendix D. Final Audited HEDIS Results
for AMERIGROUP Community Care

CMO Audited Calendar Year 2010 HEDIS Performance Measure Report--AMERIGROUP Community Care

Measure

Numerator Denominator

CMO Rate

Well-Child Visits in the First 15 Months of Life--Zero Visits1

8

428

1.87% Hybrid

Well-Child Visits in the First 15 Months of Life--One Visit

6

428

1.40% Hybrid

Well-Child Visits in the First 15 Months of Life--Two Visits

22

428

5.14% Hybrid

Well-Child Visits in the First 15 Months of Life--Three Visits

29

428

6.78% Hybrid

Well-Child Visits in the First 15 Months of Life--Four Visits

50

428

11.68% Hybrid

Well-Child Visits in the First 15 Months of Life--Five Visits

56

428

13.08% Hybrid

Well-Child Visits in the First 15 Months of Life--Six or More Visits

257

428

60.05% Hybrid

Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life

316

450

70.22% Hybrid

Adolescent Well-Care Visits
Children's and Adolescents' Access to Primary Care Providers--Ages 1224
Months Children's and Adolescents' Access to Primary Care Providers--Ages 25 Months6
Years
Children's and Adolescents' Access to Primary Care Providers--Ages 711 Years

197 9,490 39,382 24,224

432 9,807 42,976 26,110

45.60% Hybrid 96.77% 91.64% 92.78%

Children's and Adolescents' Access to Primary Care Providers--Ages 1219 Years

26,321

29,269

89.93%

Adults' Access to Preventive/Ambulatory Health Services--Ages 2044 Years

8,739

10,250

85.26%

Childhood Immunization Status--Combo 3

324

432

75.00% Hybrid

Lead Screening in Children

284

432

65.74% Hybrid

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FINAL AUDITED HEDIS RESULTS

CMO Audited Calendar Year 2010 HEDIS Performance Measure Report--AMERIGROUP Community Care

Measure

Numerator Denominator

CMO Rate

Weight Assessment and Counseling for

Nutrition and Physical Activity for Children/Adolescents--BMI Percentile

121

424

(Total)

Weight Assessment and Counseling for

Nutrition and Physical Activity for Children/Adolescents--Counseling for

207

424

Nutrition (Total)

28.54% Hybrid 48.82% Hybrid

Weight Assessment and Counseling for

Nutrition and Physical Activity for Children/Adolescents--Counseling for

131

424

Physical Activity (Total)

30.90% Hybrid

Follow-Up Care for Children Prescribed ADHD Medication--Initiation Phase

943

2,069

45.58%

Follow-Up Care for Children Prescribed

ADHD Medication--Continuation and

212

363

Maintenance Phase

58.40%

Annual Dental Visit--Ages 23 Years

8,294

17,536

47.30%

Annual Dental Visit--Ages 46 Years

20,040

26,031

76.99%

Annual Dental Visit--Ages 710 Years

26,113

32,978

79.18%

Annual Dental Visit--Ages 1114 Years

20,797

29,131

71.39%

Annual Dental Visit--Ages 1518 Years Annual Dental Visit--Ages 1921 Years
Annual Dental Visit--Total Cervical Cancer Screening Breast Cancer Screening Comprehensive Diabetes Care--HbA1c
Testing

13,661 394
89,299 256 484
469

22,629 952
129,257 364 914
573

60.37% 41.39% 69.09% 70.33% Hybrid 52.95%
81.85% Hybrid

Comprehensive Diabetes Care--HbA1c Poor Control1

301

573

52.53% Hybrid

Comprehensive Diabetes Care--HbA1c Good Control <8.0

219

573

Comprehensive Diabetes Care--HbA1c Good Control <7.0

146

489

38.22% Hybrid 29.86% Hybrid

AMERIGROUP Community Care Validation of Performance Measures State of Georgia

Page D-2 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711

FINAL AUDITED HEDIS RESULTS

CMO Audited Calendar Year 2010 HEDIS Performance Measure Report--AMERIGROUP Community Care

Measure

Numerator Denominator

CMO Rate

Comprehensive Diabetes Care--Eye Exam

270

573

47.12% Hybrid

Comprehensive Diabetes Care--LDL-C Screening
Comprehensive Diabetes Care--LDL-C Level
Comprehensive Diabetes Care--Medical Attention to Nephropathy
Comprehensive Diabetes Care--Blood Pressure Control <140/80
Comprehensive Diabetes Care--Blood Pressure Control <140/90
Use of Appropriate Medications for People with Asthma--Ages 5-11 Years
Use of Appropriate Medications for People with Asthma--Ages 12-50 Years
Use of Appropriate Medications for People with Asthma--Total
Follow-Up After Hospitalization for Mental Illness--30-Day Follow-Up
Follow-Up After Hospitalization for Mental Illness--7-Day Follow-Up
Inpatient Utilization--General Hospital/Acute Care
Prenatal and Postpartum Care--Timeliness of Prenatal Care
Prenatal and Postpartum Care--Postpartum Care
Frequency of Ongoing Prenatal Care--< 21 Percent
Frequency of Ongoing Prenatal Care--2140 Percent
Frequency of Ongoing Prenatal Care--4160 Percent
Frequency of Ongoing Prenatal Care--6180 Percent

405 163 406 193 321 2,020 1,188 3,208 769 506
390 283 26 18 26 48

573

70.68% Hybrid

573

28.45% Hybrid

573

70.86% Hybrid

573

33.68% Hybrid

573

56.02% Hybrid

2,189

92.28%

1,324

89.73%

3,513

91.32%

1,085

70.88%

1,085

46.64%

Rates reported in Appendix E

431

90.49% Hybrid

431

65.66% Hybrid

431

6.03% Hybrid

431

4.18% Hybrid

431

6.03% Hybrid

431

11.14% Hybrid

AMERIGROUP Community Care Validation of Performance Measures State of Georgia

Page D-3 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711

FINAL AUDITED HEDIS RESULTS

CMO Audited Calendar Year 2010 HEDIS Performance Measure Report--AMERIGROUP Community Care

Measure

Numerator Denominator

CMO Rate

Frequency of Ongoing Prenatal Care--81+ Percent

313

431

72.62% Hybrid

Weeks of Pregnancy at Time of Enrollment-- < 0 Weeks
Weeks of Pregnancy at Time of Enrollment-- < 112 Weeks
Weeks of Pregnancy at Time of Enrollment-- < 1327 Weeks

1,217 1,114 9,472

15,607 15,607 15,607

7.80% 7.14% 60.69%

Weeks of Pregnancy at Time of Enrollment-- < 28 or More Weeks
Weeks of Pregnancy at Time of Enrollment--Unknown
Weeks of Pregnancy at Time of Enrollment--Total

2,544 1,260 15,607

15,607 15,607 15,607

16.30% 8.07% 100.00%

Appropriate Treatment For Children With Upper Respiratory Infection (URI)2

3,959

20,208

80.41%

Mental Health Utilization Call Abandonment1 Antibiotic Utilization
Race/Ethnicity Diversity of Membership

1,415

Rates reported in Appendix E

162,680

0.87%

Rates reported in Appendix E

Rates reported in Appendix E

Language Diversity of Membership

Rates reported in Appendix E

Ambulatory Care--Outpatient

1,117,323

361.48

Ambulatory Care--ED Visits

179,563

58.09

1 Note: Lower rate is better
2 Note: The measure is reported as an inverted rate. A higher rate indicates appropriate treatment of children with URI (i.e., the proportion for whom antibiotics were not prescribed). The rate is calculated as 1 minus the numerator divided by the eligible population.

AMERIGROUP Community Care Validation of Performance Measures State of Georgia

Page D-4 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711

Appendix E. Audited CY 2010 HEDIS Utilization Measure Results
for AMERIGROUP Community Care
Appendix E, which follows this page, contains AMERIGROUP's audited CY 2010 HEDIS utilization measure results.

AMERIGROUP Community Care Validation of Performance Measures State of Georgia

Page E-i AMERIGROUP_GA2010-11_CMO_PMV_F1_0711

Department of Community Health, State of Georgia Audited CY 2010 HEDIS Utilization Measure Results for AMERIGROUP
Inpatient Utilization - General Hospital/Acute Care: Total (IPUA)

Inpatient Utilization--General Hospital/Acute Care: Total (IPUA)

AMERIGROUP Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Age

Member Months

<1

240,494

1-9 1,403,044

10-19 1,053,196

20-44 359,422

45-64 34,688

65-74

104

75-84

13

85+

5

Unknown

0

Total 3,090,966

Total Inpatient

Age

Discharge

Discharge s / 1,000

s

Member

Months

Days

Days / 1,000 Members Months

Average Length of
Stay

<1

1464

6.09 10789 44.86

7.37

1-9

1177

0.84

4275

3.05

3.63

10-19

3523

3.35 10876 10.33

3.09

20-44

14612

40.65 43233 120.28

2.96

45-64

448

12.92 2324 67.00

5.19

65-74

3

28.85

10

96.15

3.33

75-84

0

0.00

0

0.00

NA

85+

0

0.00

0

0.00

NA

Unknown

0

0

NA

Total

21,227

6.87 71,507 23.13

3.37

Medicine

Age

Discharge

Discharge s / 1,000

s

Member

Months

Days

Days / 1,000 Members Months

Average Length of
Stay

<1

1132

4.71

5169 21.49

4.57

1-9

905

0.65

2655

1.89

2.93

10-19

462

0.44

1641

1.56

3.55

20-44

615

1.71

2461

6.85

4.00

45-64

252

7.26

1131 32.60

4.49

65-74

2

19.23

7

67.31

3.50

75-84

0

0.00

0

0.00

NA

85+

0

0.00

0

0.00

NA

Unknown

0

0

NA

Total

3,368

1.09 13,064 4.23

3.88

1 of 2

July 2011

Department of Community Health, State of Georgia Audited CY 2010 HEDIS Utilization Measure Results for AMERIGROUP
Inpatient Utilization - General Hospital/Acute Care: Total (IPUA)

Surgery

Age

Discharge

Discharge s / 1,000

s

Member

Months

Days

Days / 1,000 Members Months

Average Length of
Stay

<1

332

1.38

5620 23.37

16.93

1-9

272

0.19

1620

1.15

5.96

10-19

285

0.27

1800

1.71

6.32

20-44

538

1.50

3173

8.83

5.90

45-64

185

5.33

1171 33.76

6.33

65-74

1

9.62

3

28.85

3.00

75-84

0

0.00

0

0.00

NA

85+

0

0.00

0

0.00

NA

Unknown

0

0

NA

Total

1,613

0.52 13,387 4.33

8.30

Maternity*

Age 10-19

Discharge

Discharge s / 1,000

s

Member

Months

2776

2.64

Days 7435

Days / 1,000 Members Months

Average Length of
Stay

7.06

2.68

20-44

13459

37.45 37599 104.61

2.79

45-64

11

0.32

22

0.63

2.00

Unknown

0

0

NA

Total

16,246

11.22 45,056 31.13

2.77

*The maternity category is calculated using member months for members 10-64 years.

2 of 2

July 2011

Department of Community Health, State of Georgia Audited CY 2010 HEDIS Utilization Measure Results for AMERIGROUP
Mental Health Utilization: Total (MPTA)

Mental Health Utilization: Total (MPTA)

AMERIGROUP Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Member Months (Any) Age

Member Months (Inpatient)

Member Months (Intensive Outpatient/Partial Hospitalization)

Member Months (Outpatient/ED)

Male

Female

Total

Male

Female

Total

Male

Female

Total

Male

Female

Total

0-12

1039599 1006024 2,045,623 1039599 1006024 2,045,623 1039599 1006024 2,045,623 1039599 1006024 2,045,623

13-17

276831 276230 553,061 276831 276230 553,061 276831 276230 553,061 276831 276230 553,061

18-64

80879

411257 492,136

80879

411257 492,136

80879

411257 492,136

80879

411257 492,136

65+

26

96

122

26

96

122

26

96

122

26

96

122

Unknown

0

0

0

0

0

0

0

0

0

0

0

0

Total Age

1,397,335 Sex

1,693,607 3,090,942 Any Services
Number Percent

1,397,335 1,693,607 Inpatient
Number Percent

3,090,942 1,397,335 Intensive
Outpatient/Partial Number Percent

1,693,607 3,090,942 Outpatient/ED
Number Percent

1,397,335

1,693,607

3,090,942

M

6658

7.69%

151

0.17%

50

0.06%

6642

7.67%

0-12

F

3715

4.43%

71

0.08%

16

0.02%

3705

4.42%

Total

10,373

6.08%

222

0.13%

66

0.04%

10,347

6.07%

M

2944

12.76%

213

0.92%

61

0.26%

2902

12.58%

13-17

F

2537

11.02%

274

1.19%

55

0.24%

2490

10.82%

Total

5,481

11.89%

487

1.06%

116

0.25%

5,392

11.70%

M

533

7.91%

88

1.31%

12

0.18%

505

7.49%

18-64

F

3360

9.80%

383

1.12%

75

0.22%

3228

9.42%

Total

3,893

9.49%

471

1.15%

87

0.21%

3,733

9.10%

M

0

0.00%

0

0.00%

0

0.00%

0

0.00%

65+

F

0

0.00%

0

0.00%

0

0.00%

0

0.00%

Total

0

0.00%

0

0.00%

0

0.00%

0

0.00%

M

0

NA

0

NA

0

NA

0

NA

Unknown

F

0

NA

0

NA

0

NA

0

NA

Total

0

NA

0

NA

0

NA

0

NA

M

10,135

8.70%

452

0.39%

123

0.11%

10,049

8.63%

Total

F

9,612

6.81%

728

0.52%

146

0.10%

9,423

6.68%

Total

19,747

7.67%

1,180

0.46%

269

0.10%

19,472

7.56%

1 of 1

July 2011

Department of Community Health, State of Georgia Audited CY 2010 HEDIS Utilization Measure Results for AMERIGROUP
Antibiotic Utilization: Total (ABXA)

Antibiotic Utilization: Total (ABXA)
AMERIGROUP Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Pharmacy Benefit Member Months

Age 0-9 10-17 18-34 35-49 50-64 65-74 75-84 85+ Unknown Total
Age
0-9
10-17
18-34
35-49
50-64
65-74
75-84
85+
Unknown
Total

Male 835101 481329 59047 18270
3562 8 13 5 0
1,397,335
Sex
M F Total M F Total M F Total M F Total M F Total M F Total M F Total M F Total M F Total M F Total

Female

Total

808413 1,643,514

473841 955,170

313117 372,164

85208 103,478

12932

16,494

96

104

0

13

0

5

0

0

1,693,607 3,090,942

Antibiotic Utilization

Percentag

Total Antibiotic
Scrips

Average Scrips PMPY for Antibiotics

Total Days Supplied
for All Antibiotic
Scrips

Average Days
Supplied per
Antibiotic Scrip

Total Average

e of

Number of Scrips Antibiotics

Scrips for PMPY for

of

Antibiotics Anitbiotics Concern

of

of

of all

Concern Concern Antibiotic

Scrips

99864

1.43

944769

9.46

45178

0.65

45.24%

95293

1.41

908880

9.54

39648

0.59

41.61%

195,157

1.42 1,853,649 9.50

84,826

0.62

43.47%

27806

0.69

280776

10.10

12212

0.30

43.92%

36254

0.92

347833

9.59

14907

0.38

41.12%

64,060

0.80

628,609

9.81

27,119

0.34

42.33%

3943

0.80

39192

9.94

1532

0.31

38.85%

53175

2.04

418035

7.86

17797

0.68

33.47%

57,118

1.84

457,227

8.00

19,329

0.62

33.84%

2010

1.32

18677

9.29

874

0.57

43.48%

14470

2.04

120357

8.32

6009

0.85

41.53%

16,480

1.91

139,034

8.44

6,883

0.80

41.77%

382

1.29

3792

9.93

153

0.52

40.05%

1996

1.85

17194

8.61

1036

0.96

51.90%

2,378

1.73

20,986

8.83

1,189

0.87

50.00%

1

1.50

7

7.00

1

1.50

100.00%

24

3.00

321

13.38

7

0.88

29.17%

25

2.88

328

13.12

8

0.92

32.00%

1

0.92

10

10.00

1

0.92

100.00%

0

NA

0

NA

0

NA

NA

1

0.92

10

10.00

1

0.92

100.00%

0

0.00

0

NA

0

0.00

NA

0

NA

0

NA

0

NA

NA

0

0.00

0

NA

0

0.00

NA

0

NA

0

NA

0

NA

NA

0

NA

0

NA

0

NA

NA

0

NA

0

NA

0

NA

NA

134,007

1.15 1,287,223 9.61

59,951

0.51

44.74%

201,212

1.43 1,812,620 9.01

79,404

0.56

39.46%

335,219

1.30 3,099,843 9.25

139,355

0.54

41.57%

1 of 3

July 2011

Department of Community Health, State of Georgia Audited CY 2010 HEDIS Utilization Measure Results for AMERIGROUP
Antibiotic Utilization: Total (ABXA)

Age
0-9 10-17 18-34 35-49 50-64 65-74 75-84 85+ Unknown Total

Sex
M F Total M F Total M F Total M F Total M F Total M F Total M F Total M F Total M F Total M F Total

Antibiotics of Concern Utilization

Total Quinolone
Scrips

Average

Average Scrips PMPY for Quinolone
s

Total Cephalosporin 2nd-
4th Generatio n Scrips

Scrips PMPY for Cephalosporins 2nd-4th Generatio

n

Total Azithromy
cin and Clarithro-
mycin Scrips

Average

Average

Scrips

Total

Scrips

PMPY for Amoxicilli PMPY for

Azithromy

n/

Amoxicilli

cins and Clavulanat

n/

Clarithro- e Scrips Clavulanat

mycins

es

Total Ketolides
Scrips

43

0.00

10411

0.15

17229

0.25

16397

0.24

0

70

0.00

9394

0.14

15116

0.22

14002

0.21

0

113

0.00

19,805

0.14

32,345

0.24

30,399

0.22

0

260

0.01

1648

0.04

6147

0.15

3416

0.09

0

657

0.02

2113

0.05

7538

0.19

3631

0.09

0

917

0.01

3,761

0.05

13,685

0.17

7,047

0.09

0

220

0.04

92

0.02

737

0.15

318

0.06

1

4101

0.16

1070

0.04

8317

0.32

2588

0.10

0

4,321

0.14

1,162

0.04

9,054

0.29

2,906

0.09

1

249

0.16

30

0.02

319

0.21

165

0.11

0

1791

0.25

304

0.04

2456

0.35

936

0.13

0

2,040

0.24

334

0.04

2,775

0.32

1,101

0.13

0

42

0.14

6

0.02

60

0.20

35

0.12

0

379

0.35

43

0.04

404

0.37

150

0.14

0

421

0.31

49

0.04

464

0.34

185

0.13

0

1

1.50

0

0.00

0

0.00

0

0.00

0

2

0.25

0

0.00

5

0.63

0

0.00

0

3

0.35

0

0.00

5

0.58

0

0.00

0

1

0.92

0

0.00

0

0.00

0

0.00

0

0

NA

0

NA

0

NA

0

NA

0

1

0.92

0

0.00

0

0.00

0

0.00

0

0

0.00

0

0.00

0

0.00

0

0.00

0

0

NA

0

NA

0

NA

0

NA

0

0

0.00

0

0.00

0

0.00

0

0.00

0

0

NA

0

NA

0

NA

0

NA

0

0

NA

0

NA

0

NA

0

NA

0

0

NA

0

NA

0

NA

0

NA

0

816

0.01

12,187

0.10

24,492

0.21

20,331

0.17

1

7,000

0.05

12,924

0.09

33,836

0.24

21,307

0.15

0

7,816

0.03

25,111

0.10

58,328

0.23

41,638

0.16

1

Average Scrips PMPY for Ketolides

Average

Average Total Misc. Scrips

Total

Scrips Antibiotics PMPY for

Clindamyc PMPY for

of

Misc.

in Scrips Clindamyc Concern Antibiotics

ins

Scrips

of

Concern

0.00

1092

0.02

6

0.00

0.00

1051

0.02

15

0.00

0.00

2,143

0.02

21

0.00

0.00

737

0.02

4

0.00

0.00

965

0.02

3

0.00

0.00

1,702

0.02

7

0.00

0.00

160

0.03

4

0.00

0.00

1705

0.07

16

0.00

0.00

1,865

0.06

20

0.00

0.00

108

0.07

3

0.00

0.00

511

0.07

11

0.00

0.00

619

0.07

14

0.00

0.00

10

0.03

0

0.00

0.00

59

0.05

1

0.00

0.00

69

0.05

1

0.00

0.00

0

0.00

0

0.00

0.00

0

0.00

0

0.00

0.00

0

0.00

0

0.00

0.00

0

0.00

0

0.00

NA

0

NA

0

NA

0.00

0

0.00

0

0.00

0.00

0

0.00

0

0.00

NA

0

NA

0

NA

0.00

0

0.00

0

0.00

NA

0

NA

0

NA

NA

0

NA

0

NA

NA

0

NA

0

NA

0.00

2,107

0.02

17

0.00

0.00

4,291

0.03

46

0.00

0.00

6,398

0.02

63

0.00

2 of 3

July 2011

Department of Community Health, State of Georgia Audited CY 2010 HEDIS Utilization Measure Results for AMERIGROUP
Antibiotic Utilization: Total (ABXA)

Age
0-9 10-17 18-34 35-49 50-64 65-74 75-84 85+ Unknown Total

Sex
M F Total M F Total M F Total M F Total M F Total M F Total M F Total M F Total M F Total M F Total

All Other Antibiotics Utilization

Total Absorbabl
e Sulfonami de Scrips

Average Scrips PMPY for Absorbabl
e Sulfonami
des

Total Aminoglycoside Scrips

Average Average Total 1st Scrips Scrips Generatio PMPY for Total PMPY for n Cephalo- 1st Lincosami Amino- sporin Generatio de Scrips glycosides Scrips n Cephalo-
sporins

Average Scrips PMPY for Lincosami
des

Total Macrolide
s (not azith. or clarith.) Scrips

4152

0.06

6

0.00

6250

0.09

0

0.00

180

6105

0.09

3

0.00

6402

0.10

0

0.00

137

10,257

0.07

9

0.00

12,652

0.09

0

0.00

317

1905

0.05

12

0.00

3008

0.07

0

0.00

153

3588

0.09

3

0.00

3217

0.08

0

0.00

158

5,493

0.07

15

0.00

6,225

0.08

0

0.00

311

377

0.08

1

0.00

363

0.07

0

0.00

39

4599

0.18

1

0.00

3669

0.14

0

0.00

402

4,976

0.16

2

0.00

4,032

0.13

0

0.00

441

231

0.15

0

0.00

160

0.11

0

0.00

26

1434

0.20

0

0.00

1024

0.14

0

0.00

128

1,665

0.19

0

0.00

1,184

0.14

0

0.00

154

39

0.13

0

0.00

48

0.16

0

0.00

4

191

0.18

1

0.00

177

0.16

0

0.00

15

230

0.17

1

0.00

225

0.16

0

0.00

19

0

0.00

0

0.00

0

0.00

0

0.00

0

10

1.25

0

0.00

4

0.50

0

0.00

0

10

1.15

0

0.00

4

0.46

0

0.00

0

0

0.00

0

0.00

0

0.00

0

0.00

0

0

NA

0

NA

0

NA

0

NA

0

0

0.00

0

0.00

0

0.00

0

0.00

0

0

0.00

0

0.00

0

0.00

0

0.00

0

0

NA

0

NA

0

NA

0

NA

0

0

0.00

0

0.00

0

0.00

0

0.00

0

0

NA

0

NA

0

NA

0

NA

0

0

NA

0

NA

0

NA

0

NA

0

0

NA

0

NA

0

NA

0

NA

0

6,704

0.06

19

0.00

9,829

0.08

0

0.00

402

15,927

0.11

8

0.00

14,493

0.10

0

0.00

840

22,631

0.09

27

0.00

24,322

0.09

0

0.00

1,242

Average Scrips PMPY for Macrolide s (not azith. or clarith.)
0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.02 0.01 0.02 0.02 0.02 0.01 0.01 0.01 0.00 0.00 0.00 0.00 NA 0.00 0.00 NA 0.00 NA NA NA 0.00 0.01 0.00

Total Penicillin
Scrips
43915 42541 86,456 8420 9993 18,413 1087 10033 11,120
481 2622 3,103
92 309 401
0 2 2 0 0 0 0 0 0 0 0 0 53,995 65,500 119,495

Average Scrips PMPY for Penicillins

Total Tetracycli ne Scrips

0.63

31

0.63

18

0.63

49

0.21

1943

0.25

2453

0.23

4,396

0.22

472

0.38

3636

0.36

4,108

0.32

172

0.37

1060

0.36

1,232

0.31

35

0.29

101

0.29

136

0.00

0

0.25

1

0.23

1

0.00

0

NA

0

0.00

0

0.00

0

NA

0

0.00

0

NA

0

NA

0

NA

0

0.46

2,653

0.46

7,269

0.46

9,922

Average

Average

Scrips Total Misc. Scrips

PMPY for Antibiotic PMPY for

Tetracycli Scrips

Misc.

nes

Antibiotics

0.00

152

0.00

0.00

439

0.01

0.00

591

0.00

0.05

153

0.00

0.06

1935

0.05

0.06

2,088

0.03

0.10

72

0.01

0.14

13038

0.50

0.13

13,110

0.42

0.11

66

0.04

0.15

2193

0.31

0.14

2,259

0.26

0.12

11

0.04

0.09

166

0.15

0.10

177

0.13

0.00

0

0.00

0.13

0

0.00

0.12

0

0.00

0.00

0

0.00

NA

0

NA

0.00

0

0.00

0.00

0

0.00

NA

0

NA

0.00

0

0.00

NA

0

NA

NA

0

NA

NA

0

NA

0.02

454

0.00

0.05

17,771

0.13

0.04

18,225

0.07

3 of 3

July 2011

Department of Community Health, State of Georgia Audited CY 2010 HEDIS Utilization Measure Results for AMERIGROUP
Race/Ethnicity Diversity of Membership (RDM)

Race/Ethnicity Diversity of Membership (RDM)

AMERIGROUP Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Eligible Population

Race/Ethnicity

Race/Ethnicity

Percentage of Data

Percentage of Data

Collected Using

Collected Using

Direct Data

Indirect Data

Collection Methods

Collection Methods

Direct number of

373232

Indirect number of

0

members

members

Total unduplicated membership during
the measurement year (this number represents the total number of members regardless of data collection method)

373232

Total unduplicated membership during the measurement year
(this number represents the total number of members regardless of data collection method)

373232

Direct number and percentage of members
CMS/State databases percentage of members Other Percentage of Members

100.00%
1 0

Indirect (e.g. surname analysis/geo-coding)
number and percentage of
members

0.00%

1 of 2

July 2011

Department of Community Health, State of Georgia Audited CY 2010 HEDIS Utilization Measure Results for AMERIGROUP
Race/Ethnicity Diversity of Membership (RDM)

Race

Hispanic or Latino

Number

Percentage

White

0

Black or African American

0

American-Indian and Alaska Native

0

Asian

0

Native Hawaiian and

Other Pacific

0

Islanders

Some Other Race

0

0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Two or More Races

0

0.00%

Unknown Declined
Total
Measure

12194

100.00%

0

0.00%

12,194

100.00%

Direct/Indirect Percentage of plan members

Percentage

Measure

Percentage of members for whom the organization has
race information through direct data collection methods

0.936173747159943

Percentage of members for whom the organization has
race information through indirect data collection methods

Not Hispanic or Latino

Number

Percentag e

2350

100.00%

Unknown Ethnicity

Number

Percentag e

166234 46.35%

Declined Ethnicity

Number

Percentag e

0

NR

Total

Number

Percentag e

168,584 45.17%

0

0.00%

169256 47.19%

0

NR

169,256 45.35%

0

0.00%

219

0.06%

0

NR

219

0.06%

0

0.00%

5466

1.52%

0

NR

5,466

1.46%

0

0.00%

365

0.10%

0

NR

365

0.10%

0
0
0 0 2,350

0.00%

5520

1.54%

0

0.00%

0

0.00%

0

0.00%

11628

3.24%

0

0.00%

0

0.00%

0

100.00% 358,688 100.00%

0

NR

5,520

1.48%

NR

0

0.00%

NR

23,822

6.38%

NR

0

0.00%

NR

373,232 100.00%

Percentage

0

Percentage of

Percentage of

members for whom

members for whom

the organization has 0.0389677198096626 the organization has

0

ethnicity information

ethnicity information

through direct data

through indirect data

collection methods

collection methods

2 of 2

July 2011

Department of Community Health, State of Georgia Audited CY 2010 HEDIS Utilization Measure Results for AMERIGROUP
Language Diversity of Membership (LDM)
Language Diversity of Membership (LDM)
AMERIGROUP Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)
Percentage of Members With Known Language Value from Each Data Source

Category

Health Plan Direct

CMS/State Databases

Other Third-Party Source

Spoken

Language Preferred for

0

1

0

Health Care*

Preferred

Language for Written

0

1

0

Materials*

Other Language Needs*

0

0

1

*Enter percentage as a value between 0 and 1.

Spoken Language Preferred for Health Care

Number

Percentage

English

324773

87.02%

Non-English

35763

9.58%

Unknown Declined

12696 0

3.40% 0.00%

Total: this should sum to 100%

373,232

100.00%

Language Preferred for Written Materials

Number

Percentage

English

324773

87.02%

Non-English

35763

9.58%

Unknown Declined

12696 0

3.40% 0.00%

Total: this should sum to 100%

373,232

100.00%

Other Languages Needs

Number

Percentage

English

0

0.00%

Non-English

0

0.00%

Unknown

373232

100.00%

Declined

0

0.00%

Total: this should sum to 100%

373,232

100.00%

1 of 1

July 2011