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 AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page i AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 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 AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 1 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 VALIDATION OF PERFORMANCE MEASURES 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) AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 2 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 VALIDATION OF PERFORMANCE MEASURES 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 AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 3 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 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: AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 4 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 VALIDATION OF PERFORMANCE MEASURES 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 AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 5 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 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 AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 6 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 VALIDATION OF PERFORMANCE MEASURES 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 AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 7 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 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. AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 8 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 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 AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 9 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 VALIDATION OF PERFORMANCE MEASURES 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 AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 10 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 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. AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page A-i AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 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). AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page A-1 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 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. AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page A-2 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 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. AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page B-i AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 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. AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page B-1 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 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. AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page B-2 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 Appendix C. Performance Measure Results for AMERIGROUP Community Care Appendix C, which follows this page, contains AMERIGROUP's performance measure results. AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page C-i AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 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. AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page C-1 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 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. AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page C-2 AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 Appendix D. Final Audited HEDIS Results for AMERIGROUP Community Care Appendix D, which follows this page, contains the final audited HEDIS results for AMERIGROUP. AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page D-i AMERIGROUP_GA2010-11_CMO_PMV_F1_0711 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 AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page D-1 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 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