Validation of performance measures for AMERIGROUP Community Care: measurement period: calendar year 2012; validation period: state fiscal year 2013

Georgia Department of Community Health
Validation of Performance Measures for
AMERIGROUP Community Care
Measurement Period: Calendar Year 2012 Validation Period: State Fiscal Year 2013
Publish Date: September 20, 2013
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....................................................................................................... 4 Pre-Audit Strategy ............................................................................................................................. 4 Validation Team ................................................................................................................................ 4 Technical Methods of Data Collection and Analysis ......................................................................... 5 On-Site Activities ............................................................................................................................... 5 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 .................................................................................................................................... 9 Medical Record Review Process ...................................................................................................... 9 Supplemental Data............................................................................................................................ 9 Data Integration............................................................................................................................... 10 Performance Measure Specific Findings ........................................................................................ 10 Validation Findings ............................................................................................................................ 11
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 Rates...........................................................................................D-1 Appendix E. Performance Measure Validation Reporting Spreadsheet ........................................ E-1 Appendix F. HEDIS Interactive Data Submission System Data ...................................................... F-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. The DCH contracts with three care management organizations (CMOs) to provide services to Medicaid managed care enrollees and PeachCare for Kids enrollees. PeachCare for Kids is the name of Georgia's stand-alone Children's Health Insurance Program (CHIP). The 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, EQR Protocol 2: Validation of Performance Measures Reported by the MCO: A Mandatory Protocol for External Quality Review (EQR), Version 2.0, September 2012.

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

Table 1--AMERIGROUP Community Care Information

CMO Name: CMO Location: CMO Audit Location: CMO Contact:

AMERIGROUP Community Care 303 Perimeter Center North, Ste. 400 Atlanta, GA 30346 1300 Amerigroup Way Virginia Beach, VA 23464
Tanya Chambers-Ashford, MPA, MSOC, Regulatory Market Manager

Contact Telephone Number:

678.587.4840, Ext. 74994

Contact E-mail Address:

Tanya.chambers-ashford@amerigroup.com

Site Visit Date:

March 2021, 2013

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Performance Measures Validated
HSAG validated performance measures identified and selected by DCH for validation. All performance measures were selected from the Centers for Medicare & Medicaid Services' (CMS) Initial Core Set of Children's Health Care Quality Measures,1 the Initial Core Set of Health Care Quality Measures for Adults Enrolled in Medicaid,2 or the Agency for Healthcare Research and Quality (AHRQ). The measurement period was identified by DCH as calendar year (CY) 2012 for all measures except the two child core set dental measures. The dental measures were reported for federal fiscal year (FFY) 2012, which covered the time frame of October 1, 2011, through September 30, 2012, per CMS requirements. Table 2 lists the performance measures that HSAG validated and identifies who calculated the performance measure rates.

Table 2--List of CY 2012 Performance Measures for AMERIGROUP

Performance Measure

1.

Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517)

Annual Percentage of Asthma Patients with One 2. or More Asthma-Related Emergency Room
Visit (ages 220)

3. Cesarean Delivery Rate

4. Cesarean Rate for Nulliparous Singleton Vertex

5.

Percentage of Eligibles that Received Dental Treatment Services

6.

Percentage of Eligibles that Received Preventive Dental Services

7.

Percentage of Live Births Weighing Less Than 2,500 Grams

8. Adult Asthma Admission Rate

9.

Chronic Obstructive Pulmonary Disease (COPD) Admission Rate

10. Congestive Heart Failure Admission Rate

11.

Diabetes, Short-Term Complications Admission Rate

Method Hybrid3 Admin
Admin Admin Admin Admin Admin Admin Admin Admin Admin

Specifications
CMS Child Core Set
CMS Child Core Set
AHRQ
CMS Child Core Set4
CMS Child Core Set
CMS Child Core Set
CMS Child Core Set/AHRQ
CMS Adult Core Set
CMS Adult Core Set
CMS Adult Core Set
CMS Adult Core Set

Rate Calculation by: AMERIGROUP
AMERIGROUP AMERIGROUP AMERIGROUP AMERIGROUP AMERIGROUP AMERIGROUP AMERIGROUP AMERIGROUP AMERIGROUP AMERIGROUP

1 The Centers for Medicare & Medicaid Services. Initial Core Set of Children's Health Care Quality Measures, November 2012. 2 The Centers for Medicare & Medicaid Services. Initial Core Set of Health Care Quality Measures for Adults Enrolled in
Medicaid, February 2013. 3 Hybrid measures require both administrative data and medical record review. 4 The CMS measure specifications were modified by HSAG.

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In addition to the AHRQ and the CMS adult and child core set measures audited by HSAG, DCH required AMERIGROUP to report a selected set of Healthcare Effectiveness Data and Information Set (HEDIS) measures to DCH. AMERIGROUP was required to contract with an NCQA-licensed audit organization and undergo an NCQA HEDIS Compliance AuditTM. Final audited HEDIS measure results from NCQA's Interactive Data Submission System (IDSS) were submitted to HSAG and provided to DCH. Appendices D and E display the final audited HEDIS 2013 results for all required measures, covering the 2012 measurement period. HSAG will use these results in addition to the measures HSAG validated and displayed within this report as data sources for the annual EQR technical report.

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. 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 source code for each performance measure; a completed HEDIS 2013 Record of Administration, Data Management, and Processes (Roadmap); and any additional supporting documentation necessary to complete the audit. HSAG responded to Roadmap-related questions received 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 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. Table 3 lists the validation team members, their positions, and their skills and expertise.

Name and Role

Table 3--Validation Team Skills and Expertise

John Couzins, MPH, CHCA Lead Auditor

Certified HEDIS auditor; performance measure knowledge, statistics, and analysis.

Judy Yip, PhD Source Code Review Manager and Audit Specialist, Audits

Auditing experience, HEDIS knowledge, performance measure knowledge, and source code review management.

Tammy GianFrancisco Project Leader, Audits

Performance measure validation coordination, communication, and scheduling.

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Technical Methods of Data Collection and Analysis
The CMS performance measures 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:
NCQA's HEDIS 2013 Roadmap: AMERIGROUP completed and submitted the required and relevant portions of its Roadmap for review by the validation team. The validation team used responses from the Roadmap to complete the pre-on-site assessment of the information systems.
Source code (programming language) for performance measures: AMERIGROUP contracted with Inovalon, an NCQA-Certified software vendor, to calculate rates for both HEDIS and nonHEDIS measures. The source code review was conducted via a Web-assisted session where Inovalon explained the process and source code to HSAG's source code review team.
Supporting documentation: HSAG requested 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 areas needing clarification for further follow-up.
On-Site Activities
HSAG conducted an on-site visit with AMERIGROUP on March 20 and 21, 2013. 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:
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, focusing on the processing of claims and encounter data, provider data, patient data, and inpatient data. Additionally, the review evaluated the processes used to collect and calculate the performance measure rates, 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 Roadmap and supporting documentation: The review included processes used for collecting, storing, validating, and reporting performance measure rates. 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 measure rates. The goal of the session was to obtain a confidence level as to the degree of compliance with written documentation compared to the actual process. HSAG conducted interviews to confirm findings from the

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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 measure rates. 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 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:

Pauline Tukey Stacy M. Williams Jiong Huang Tawonna Ingram Joanne Soublis Michelle Rush Monica Lester William Alexander Angela Evans Gail Brown Bing Zhu

Table 4--List of AMERIGROUP Community Care Interviewees

Name

Title

Business Analyst, Clinical Quality Management

Manager, Clinical Quality Management

Vice President, Quality Management

Director, HEDIS/Health Promotions

Director, Plan Compliance

Associate Vice President, Provider Relations

Director, Contracting

Chief Medical Officer

Manager, Performance Reporting

Manager, Performance Reporting

Business Analyst

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Data Integration, Data Control, and Performance Measure Documentation
There are several aspects crucial to the calculation of performance measure rates. 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 for calculating valid performance measure rates. 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
AMERIGROUP's organizational infrastructure must support all necessary information systems; and its 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 AMERIGROUP used 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 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 Results
The validation team evaluated AMERIGROUP's data systems for processing of each type of data used for reporting DCH performance measure rates. General findings are indicated below:

Medical Service Data (Claims/Encounters)
AMERIGROUP used Facets for processing medical claims. Both paper and electronic claims were received daily. Paper claims were received by the Document Management Group, scanned, and sent to a vendor for data entry. Two data entry vendors were used during the measurement year, and all files were transmitted back to AMERIGROUP in a standard electronic HIPAA 837 format. The low volume of paper claims (5 percent) helped to minimize errors.
Electronic claims accounted for approximately 95 percent of all claims and were received from three data clearinghouses (Emdeon, Capario, and Availity) or via the provider Web portal, where providers could directly enter the claims for processing by AMERIGROUP. Prior to processing, all claims were loaded into a central repository, where they received automated system edit checks, and then, if passed, were loaded into Facets on a nightly basis where they underwent the adjudication process. The auto-adjudication rate during the measurement year was approximately 75 percent, and pended claims were worked daily by examiners to ensure no backlogs occurred. Appropriate controls, reconciliation processes, and tracking mechanisms were in place to monitor accurate and complete transmission for both paper and electronic claims. AMERIGROUP's Quality Assurance staff conducted random, statistically valid, monthly audits with a sample of 204 claims to evaluate the financial, payment, and statistical accuracy of claims processing. No significant deficiencies were detected during the measurement year.
Vendor data included pharmacy and dental claims. Pharmacy claims were received from Caremark during 2012. These data were received and processed according to established timelines between AMERIGROUP and Caremark. Dental claims were received from Scion Dental. Claim volumes and receipt dates were also monitored closely to ensure claims were processed and audited. As in prior years, the vendor team had good oversight of all data received and worked closely with the vendors to ensure data were received timely and completely. There were no concerns with the vendor data processing.

Enrollment Data
AMERIGROUP's enrollment data processing was the same as the previous year. Monthly enrollment files and daily files, which included demographic changes, terminations, additions, and voids, were received from DCH's enrollment broker. These files were downloaded daily by the information systems department and submitted through a compliance checker and EDINET. The Membership Enrollment and Editing Tool (MEET) was used to identify and correct errors. The State's fiscal agent also provided an end-of-month adjustment file that included voided transactions (e.g., the member was not or never was eligible). AMERIGROUP performed a monthly reconciliation of their enrollment data with the State's data. To further ensure accuracy,

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AMERIGROUP compared the total number of records downloaded with the number loaded into an MS Access database, as well as the claims processing system, Facets. There were no issues receiving enrollment data from the State during 2012, and there were no backlogs in processing the files. The auditor had no concerns with AMERIGROUP's enrollment data.
Provider Data
AMERIGROUP was compliant with provider data processing. The providers' specialties were used in two of the 11 audited measures. AMERIGROUP used two systems for housing the provider data: Cactus for credentialing and Facets for billing and payment. Initial credentialing applications were received by AMERIGROUP. All provider information was loaded into Cactus (AMERIGROUP's current credentialing data system). Standard primary source verification was conducted by AMERIGROUP on all credentialing information. As credentialing decisions were rendered, notification was sent to the Provider Management Department and the information was also used to update Facets. Auditing of the credentialing process was performed monthly using a sample-based methodology. Through an automated feed, practitioner data were loaded into Facets, which eliminated the possibility of manual data entry errors into Facets. Provider validation of claims occurred at the time of receipt prior to entry within the adjudication system. AMERIGROUP implemented different levels (daily, weekly, and monthly) of edit checks on practitioner data submitted via claims. AMERIGROUP used a common practitioner ID to identify unique practitioners. For providers that could not be identified on a claim submission, the claim was pended to a manual work flow process. To further ensure accuracy and completeness, AMERIGROUP's audit team manually reviewed 25 percent of all completed practitioner records on a monthly basis. Overall, there were no concerns with the practitioner data used for performance measure reporting.
Medical Record Review Process
AMERIGROUP was fully compliant with the medical record review reporting requirements. AMERIGROUP's health plan review staff procured and collected the medical record documentation into the Quality Spectrum Hybrid Reporter (QSHR) hybrid tool. HSAG reviewed the QSHR hybrid tool and corresponding instructions. Reviewer qualifications, training, and oversight were appropriate. Due to reporting a new State-required hybrid measure, a convenience sample was required and subsequently passed. AMERIGROUP passed the medical record review validation process for the Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517) measure.
Supplemental Data
AMERIGROUP did not use any supplemental data that contributed to the production of the selected performance measures.

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Data Integration
AMERIGROUP had a thorough and detailed process in place to ensure no data were lost during the data integration process. AMERIGROUP contracted with Inovalon, an NCQA-Certified software vendor, for calculating the 2013 performance measure rates. A uniform format was created for each data type to avoid data integration issues during the compilation process. All data were provided to Inovalon, and there were communications with Inovalon to ensure that all data elements needed for deriving the rates for the measures were provided. Throughout the process of data integration, internal benchmarks were created, and ongoing rate review was conducted by AMERIGROUP to ensure data integrity and accuracy. For security and backup, data from Facets were stored in the CMO's corporate data warehouse. AMERIGROUP appropriately backed up its data, and no data were lost during the measurement year.
Primary source verification by HSAG was also performed for all performance measures, and no issues were identified through this review. HSAG also reviewed and approved Inovalon's programming code for these measures.

Performance Measure Specific Findings

Based on all validation activities, the HSAG Performance Measure Validation Team determined validation results for each performance measure rate. Table 5 displays the key review results. For detailed information, see Appendix B of this report.

Table 5--Key Review Results for AMERIGROUP Community Care

Performance Measures

Key Review Findings

1. Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517)

No concerns were identified.

2.

Annual Percentage of Asthma Patients with One or More AsthmaRelated Emergency Room Visit (ages 220)

No concerns were identified.

3. Cesarean Delivery Rate

No concerns were identified.

4. Cesarean Rate for Nulliparous Singleton Vertex

No concerns were identified.

5. Percentage of Eligibles that Received Dental Treatment Services

No concerns were identified.

6. Percentage of Eligibles that Received Preventive Dental Services

No concerns were identified.

7. Percentage of Live Births Weighing Less Than 2,500 Grams

No concerns were identified.

8. Adult Asthma Admission Rate

No concerns were identified.

9. Chronic Obstructive Pulmonary Disease (COPD) Admission Rate No concerns were identified.

10. Congestive Heart Failure Admission Rate

No concerns were identified.

11. Diabetes, Short-Term Complications Admission Rate

No concerns were identified.

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Validation Findings

HSAG provided an audit designation for each performance measure as defined in Table 6:

Report (R)

Table 6--Validation Findings Definitions
The organization followed the specifications and produced a reportable rate or result for the measure.

Not Reportable (NR)

The calculated rate was materially biased, or the organization chose not to report the measure, or the organization was not required to report the measure.

According to the CMS 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 Reportable." Consequently, it is possible that an error for a single audit element may result in a designation of "NR" because the impact of the error biased the reported performance measure rate 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 "R."

Table 7 shows the final validation findings for AMERIGROUP for each performance measure rate. For additional information regarding performance measure rates, see Appendix C of this report.

Table 7--Key Review Results for AMERIGROUP Community Care

Performance Measures

Validation Finding

1. Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517)

R

2.

Annual Percentage of Asthma Patients with One or More AsthmaRelated Emergency Room Visit (ages 220)

R

3. Cesarean Delivery Rate

R

4. Cesarean Rate for Nulliparous Singleton Vertex

R

5. Percentage of Eligibles that Received Dental Treatment Services

R

6. Percentage of Eligibles that Received Preventive Dental Services

R

7. Percentage of Live Births Weighing Less Than 2,500 Grams

R

8. Adult Asthma Admission Rate

R

9. Chronic Obstructive Pulmonary Disease (COPD) Admission Rate

R

10. Congestive Heart Failure Admission Rate

R

11. Diabetes, Short-Term Complications Admission Rate

R

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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 March 2021, 2013 John Couzins, MPH, CHCA

Table A-1--Data Integration and Control Findings for AMERIGROUP Community Care

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

Table A-1--Data Integration and Control Findings for AMERIGROUP Community Care

Data Integration and Control Element

Not Met Met N/A

Comments

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.

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

Reviewer Worksheets

CMO Name: On-Site Visit Date: Reviewers:

AMERIGROUP Community Care March 2021, 2013 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.

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).

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.

Population estimates were not necessary.

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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.

Nonstandard codes were not used or reported.

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).

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Appendix C. Performance Measure Results
for AMERIGROUP Community Care

Performance Measure 1--Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517)

Table C-1--Performance Measure 1 for AMERIGROUP Community Care
Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517)

Rate 84.02%

Performance Measure 2--Annual Percentage of Asthma Patients with One or More Asthma-Related Emergency Room Visit (ages 220)

Table C-2--Performance Measure 2 for AMERIGROUP Community Care
Annual Percentage of Asthma Patients with One or More Asthma-Related Emergency Room Visit (ages 220)

Rate 12.88%

Performance Measure 3--Cesarean Delivery Rate
Table C-3--Performance Measure 3 for AMERIGROUP Community Care
Cesarean Delivery Rate

Rate 29.76%

Performance Measure 4--Cesarean Rate for Nulliparous Singleton Vertex

Table C-4--Performance Measure 4 for AMERIGROUP Community Care
Cesarean Rate for Nulliparous Singleton Vertex

Rate 18.14%

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Performance Measure 5--Percentage of Eligibles that Received Dental Treatment Services

Table C-5--Performance Measure 5 for AMERIGROUP Community Care
Percentage of Eligibles that Received Dental Treatment Services

Rate 24.11%

Performance Measure 6--Percentage of Eligibles that Received Preventive Dental Services

Table C-6--Performance Measure 6 for AMERIGROUP Community Care
Percentage of Eligibles that Received Preventive Dental Services

Rate 50.75%

Performance Measure 7--Percentage of Live Births Weighing Less Than 2,500 Grams

Table C-7--Performance Measure 7 for AMERIGROUP Community Care
Percentage of Live Births Weighing Less Than 2,500 Grams

Rate 8.45%

Performance Measure 8--Adult Asthma Admission Rate
Table C-8--Performance Measure 8 for AMERIGROUP Community Care
Adult Asthma Admission Rate

Rate (Per 100,000)
61.74

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PERFORMANCE MEASURE RESULTS

Performance Measure 9--Chronic Obstructive Pulmonary Disease (COPD) Admission Rate

Table C-9--Performance Measure 9 for AMERIGROUP Community Care
Chronic Obstructive Pulmonary Disease (COPD) Admission Rate

Rate (Per 100,000)
76.56

Performance Measure 10--Congestive Heart Failure Admission Rate

Table C-10--Performance Measure 10 for AMERIGROUP Community Care
Congestive Heart Failure Admission Rate

Rate (Per 100,000)
29.64

Performance Measure 11--Diabetes, Short-Term Complications Admission Rate

Table C-11--Performance Measure 11 for AMERIGROUP Community Care
Diabetes, Short-Term Complications Admission Rate

Rate (Per 100,000)
27.62

AMERIGROUP Community Care Validation of Performance Measures State of Georgia

Page C-3 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913

Appendix D. Final Audited HEDIS Rates
for AMERIGROUP Community Care

Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for AMERIGROUP Community Care

Measure

CMO Rate

Adolescent Well-Care Visits

46.58%

Adults' Access to Preventive/Ambulatory Health Services-- Ages 2044 Years
Adults' Access to Preventive/Ambulatory Health Services-- Ages 4564 Years
Adults' Access to Preventive/Ambulatory Health Services-- Ages 65+ Years

83.84% 90.25% Denominator fewer than 30

Adults' Access to Preventive/Ambulatory Health Services--Total

84.79%

Adult BMI Assessment

62.70%

Annual Dental Visit--Ages 23 Years

48.50%

Annual Dental Visit--Ages 46 Years

77.44%

Annual Dental Visit--Ages 710 Years

79.64%

Annual Dental Visit--Ages 1114 Years

72.39%

Annual Dental Visit--Ages 1518 Years

61.55%

Annual Dental Visit--Ages 1921 Years

35.70%

Annual Dental Visit--Total
Annual Monitoring for Patients on Persistent Medications-- ACE Inhibitors or ARBs Annual Monitoring for Patients on Persistent Medications-- Anticonvulsants
Annual Monitoring for Patients on Persistent Medications--Digoxin

69.92% 90.93% 61.43% Denominator fewer than 30

Annual Monitoring for Patients on Persistent Medications--Diuretics

89.80%

Annual Monitoring for Patients on Persistent Medications--Total
Antibiotic Utilization--Percent of Antibiotics of Concern of All Antibiotic Scrips--Total Antidepressant Medication Management--Effective Acute Phase Treatment Antidepressant Medication Management--Effective Continuation Phase Treatment
Appropriate Testing for Children with Pharyngitis

89.32% 41.48% 54.16% 36.81% 77.44%

AMERIGROUP Community Care Validation of Performance Measures State of Georgia

Page D-1 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913

FINAL AUDITED HEDIS RATES

Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for AMERIGROUP Community Care

Measure

CMO Rate

Appropriate Treatment for Children with Upper Respiratory Infection (URI)*

82.66%

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis*

17.83%

Breast Cancer Screening

59.22%

Call Answer Timeliness

85.71%

Cervical Cancer Screening
Cholesterol Management for Patients with Cardiovascular Conditions-- LDL-C Screening Cholesterol Management for Patients with Cardiovascular Conditions-- LDL-C Control
Childhood Immunization Status--Combo 3

72.09% 87.50% 27.50% 82.64%

Childhood Immunization Status--Combo 6

40.97%

Childhood Immunization Status--Combo 10
Children's and Adolescents' Access to Primary Care Practitioners-- Ages 1224 Months Children's and Adolescents' Access to Primary Care Practitioners-- Ages 25 Months6 Years Children's and Adolescents' Access to Primary Care Practitioners-- Ages 711 Years Children's and Adolescents' Access to Primary Care Practitioners-- Ages 1219 Years
Chlamydia Screening in Women

31.94% 97.55% 91.44% 92.26% 90.08% 56.98%

Comprehensive Diabetes Care--Blood Pressure Control <140/80

32.61%

Comprehensive Diabetes Care--Blood Pressure Control <140/90

55.07%

Comprehensive Diabetes Care--Eye Exam

48.25%

Comprehensive Diabetes Care--HbA1c Control <7.0

30.56%

Comprehensive Diabetes Care--HbA1c Control <8.0

38.94%

Comprehensive Diabetes Care--HbA1c Poor Control >9.0 **

53.58%

Comprehensive Diabetes Care--HbA1c Testing

79.37%

Comprehensive Diabetes Care--LDL-C Screening

73.21%

Comprehensive Diabetes Care--LDL-C Control

27.29%

Comprehensive Diabetes Care--Medical Attention to Nephropathy

74.38%

AMERIGROUP Community Care Validation of Performance Measures State of Georgia

Page D-2 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913

FINAL AUDITED HEDIS RATES

Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for AMERIGROUP Community Care

Measure

CMO Rate

Controlling High Blood Pressure
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis
Follow-Up After Hospitalization for Mental Illness--30 Day Follow-Up

38.72% 65.00% 67.29%

Follow-Up After Hospitalization for Mental Illness--7 Day Follow-Up
Follow-Up Care for Children Prescribed ADHD Medication--Initiation Phase Follow-Up Care for Children Prescribed ADHD Medication-- Continuation and Maintenance Phase
Frequency of Ongoing Prenatal Care--< 21 Percent

45.80% 42.32% 58.15% 10.65%

Frequency of Ongoing Prenatal Care--2140 Percent

4.17%

Frequency of Ongoing Prenatal Care--4160 Percent

7.64%

Frequency of Ongoing Prenatal Care--6180 Percent

11.11%

Frequency of Ongoing Prenatal Care--81+ Percent
Human Papillomavirus Vaccine for Female Adolescents
Immunizations for Adolescents--Combo 1 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment--Initiation of Treatment Initiation and Engagement of Alcohol and Other Drug Dependence Treatment--Engagement of Treatment Inpatient Utilization--General Hospital/Acute Care--Total
Lead Screening in Children
Asthma Medication Ratio--Total: 564 Years Medication Management for People with Asthma-- Total-Medication Compliance 50% Medication Management for People with Asthma-- Total-Medication Compliance 75%
Persistence of Beta-Blocker Treatment After a Heart Attack
Pharmacotherapy Management of COPD Exacerbation-- Systemic Corticosteroid Pharmacotherapy Management of COPD Exacerbation--Bronchodilator
Prenatal and Postpartum Care--Postpartum Care
Prenatal and Postpartum Care--Timeliness of Prenatal Care

66.44% 16.71% 71.43% 41.87% 10.01% Rates reported in Appendix E 74.06% 62.40% 43.64% 20.07% Denominator fewer than 30 63.27% 83.67% 59.49% 84.72%

AMERIGROUP Community Care Validation of Performance Measures State of Georgia

Page D-3 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913

FINAL AUDITED HEDIS RATES

Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for AMERIGROUP Community Care

Measure

CMO Rate

Use of Appropriate Medications for People with Asthma-- Ages 511 Years Use of Appropriate Medications for People with Asthma-- Ages 1218 Years Use of Appropriate Medications for People with Asthma-- Ages 1950 Years Use of Appropriate Medications for People with Asthma-- Ages 5164 Years

90.32% 88.69% 69.17% Denominator fewer than 30

Use of Appropriate Medications for People with Asthma--Total

89.03%

Use of Imaging Studies for Low Back Pain*

74.22%

Use of Spirometry Testing in the Assessment and Diagnosis of COPD
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--Total BMI Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--Total Nutrition Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--Total Physical Activity
Well-Child Visits in the First 15 Months of Life--Zero Visits

23.26% 40.74% 52.31% 39.81% 1.49%

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

1.74%

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

3.97%

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

3.47%

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

7.94%

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

18.36%

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

63.03%

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

68.21%

Ambulatory Care

Rates reported in Appendix F

Board Certification

Rates reported in Appendix F

Enrollment by Product Line--Total

Rates reported in Appendix F

Enrollment by State

Rates reported in Appendix F

Frequency of Selected Procedures

Rates reported in Appendix F

Identification of Alcohol and Other Drug Services--Total

Rates reported in Appendix F

Language Diversity of Membership

Rates reported in Appendix F

Mental Health Utilization

Rates reported in Appendix F

AMERIGROUP Community Care Validation of Performance Measures State of Georgia

Page D-4 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913

FINAL AUDITED HEDIS RATES

Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for AMERIGROUP Community Care

Measure

CMO Rate

Race/Ethnicity Diversity of Membership

Rates reported in Appendix F

Total Membership

Rates reported in Appendix F

Weeks of Pregnancy at Time of Enrollment

Rates reported in Appendix F

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

AMERIGROUP Community Care Validation of Performance Measures State of Georgia

Page D-5 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913

Appendix E. Performance Measure Validation Reporting Spreadsheet
for AMERIGROUP Community Care
Appendix E contains AMERIGROUP Community Care's performance measure validation reporting spreadsheet.

AMERIGROUP Community Care Validation of Performance Measures State of Georgia

Page E-1 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913

Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for AMERIGROUP
2013 Validation of Performance Measures Rate Reporting Template

CMO Name:

Amerigroup Community Care

CMO Contact Name and Title: Tawonna Ingram - Director Health Promotions/HEDIS

CMO Contact Email:

tawonna.ingram@amerigroup.com

Comments:

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Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for AMERIGROUP

Cesarean Delivery Rate

Data Element Reporting Year Data collection methodology (administrative)

General Measure Data 2013 A

Eligible population

12661

Numerator events by administrative data

3768

Reported rate

29.76

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September 2013

Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for AMERIGROUP

Percentage of Eligibles that Received Preventive Dental Services

Data Element Reporting Year Data collection methodology (administrative) Eligible population
Numerator events by administrative data
Reported rate

General Measure Data 2013 A
284617 144455 50.75%

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Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for AMERIGROUP

Percentage of Eligibles that Received Dental Treatment Services

Data Element

General Measure Data

Reporting Year

2013

Data collection methodology (administrative) Eligible population Numerator events by administrative data Reported rate

A 284617 68629 24.11%

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Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for AMERIGROUP

Cesarean Rate for Nulliparous Singleton Vertex

Data Element Reporting Year

General Measure Data
2013

Data collection methodology (administrative)

A

Eligible population

4305

Numerator events by administrative data

781

Reported rate

18.14%

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Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for AMERIGROUP

Percentage of Live Births Weighing Less Than 2,500 Grams

Data Element

General Measure Data

Reporting Year Data collection methodology (administrative)
Eligible population

2013 A
13544

Numerator events by administrative data

1144

Reported rate

8.45

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Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for AMERIGROUP

Annual Percentage of Asthma Patients with One or More Asthma-Related Emergency Room Visit (ages 2-20)

Data Element

General Measure Data

Reporting Year
Data collection methodology (administrative)

2013 A

Eligible population

30442

Numerator events by administrative data

3921

Reported rate

12.88%

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Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for AMERIGROUP

Annual Pediatric Hemoglobin (HbA1c) Testing (ages 5-17)

Data Element Reporting Year

General Measure Data 2013

Data collection methodology (hybrid)

H

Eligible population

339

Denominator

338

Numerator events by administrative data

276

Numerator events by medical records

8

Numerator Total

284

Reported rate

84.02%

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Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for AMERIGROUP

Diabetes, Short-Term Complications Admission Rate

Data Element

General Measure Data

Reporting Year

2013

Data collection methodology (administrative)

A

Eligible population

184663

Numerator events by administrative data

51

Reported rate (Per 100,000 Members)

28

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Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for AMERIGROUP

Chronic Obstructive Pulmonary Disease (COPD) Admission Rate

Data Element

General Measure Data

Reporting Year

2013

Data collection methodology (administrative)

A

Eligible population

80982

Numerator events by administrative data

62

Reported rate (Per 100,000 Members)

77

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Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for AMERIGROUP

Congestive Heart Failure (CHF) Admission Rate

Data Element

General Measure Data

Reporting Year

2013

Data collection methodology (administrative)

A

Eligible population

80982

Numerator events by administrative data

24

Reported rate (Per 100,000 Members)

30

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Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for AMERIGROUP

Adult Asthma Admission Rate

Data Element Reporting Year

General Measure Data
2013

Data collection methodology (administrative)

A

Eligible population

80982

Numerator events by administrative data

50

Reported rate (Per 100,000 Members)

62

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September 2013

Appendix F. HEDIS Interactive Data Submission System Data
for AMERIGROUP Community Care
Appendix F contains AMERIGROUP Community Care's reported IDSS data.

AMERIGROUP Community Care Validation of Performance Measures State of Georgia

Page F-1 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Audit Review Table

AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None); Measurement Year - 2012

The Auditor lock has been applied to this submission.

Pharmacy Reversal - Pharmacy Reversals Included

Measure/Data Element

Report Measure

Benefit Offered

Rotated Measure

Rate

Reportable

Comment

Effectiveness of Care: Prevention and Screening

Adult BMI Assessment (aba)

Y

N

62.70%

R

Reportable

Weight Assessment and Counseling for Nutrition

and Physical Activity for Children/Adolescents

Y

N

(wcc)

BMI Percentile

40.74%

R

Reportable

Counseling for Nutrition

52.31%

R

Reportable

Counseling for Physical Activity

39.81%

R

Reportable

Childhood Immunization Status (cis)

Y

N

DTaP

88.66%

R

Reportable

IPV

96.30%

R

Reportable

MMR

94.21%

R

Reportable

HiB

95.83%

R

Reportable

Hepatitis B

93.98%

R

Reportable

VZV

95.60%

R

Reportable

Pneumococcal Conjugate

88.43%

R

Reportable

Hepatitis A

93.98%

R

Reportable

Rotavirus

71.53%

R

Reportable

Influenza

45.37%

R

Reportable

Combination #2

85.42%

R

Reportable

Combination #3

82.64%

R

Reportable

Combination #4

81.94%

R

Reportable

Combination #5

63.43%

R

Reportable

Combination #6

40.97%

R

Reportable

Combination #7

62.96%

R

Reportable

Combination #8

40.97%

R

Reportable

Combination #9

31.94%

R

Reportable

Combination #10

31.94%

R

Reportable

Immunizations for Adolescents (ima)

Y

Meningococcal

73.51%

R

Reportable

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Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Tdap/Td

84.68%

R

Combination #1

71.43%

R

Human Papillomavirus Vaccine for Female Adolescents (hpv)

Y

16.71%

R

Lead Screening in Children (lsc)

Y

N

74.06%

R

Breast Cancer Screening (bcs)

Y

59.22%

R

Cervical Cancer Screening (ccs)

Y

72.09%

R

Chlamydia Screening in Women (chl)

Y

16-20 Years

53.93%

R

21-24 Years

68.86%

R

Total

56.98%

R

Effectiveness of Care: Respiratory Conditions

Appropriate Testing for Children with Pharyngitis (cwp)

Y

Y

77.44%

R

Appropriate Treatment for Children With URI (uri)

Y

Y

82.66%

R

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (aab)

Y

Y

17.83%

R

Use of Spirometry Testing in the Assessment and Diagnosis of COPD (spr)

Y

Pharmacotherapy Management of COPD Exacerbation (pce)

Y

Y

Systemic Corticosteroid

Bronchodilator

Use of Appropriate Medications for People With Asthma (asm)

Y

Y

5-11 Years

12-18 Years

19-50 Years

51-64 Years

Total

Medication Management for People With Asthma (mma)

Y

Y

5-11 Years - Medication Compliance 50%

23.26%

R

63.27%

R

83.67%

R

90.32%

R

88.69%

R

69.17%

R

NA

R

89.03%

R

44.00%

R

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Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable
Reportable Reportable
Reportable
Reportable
Reportable Reportable
Reportable Reportable Reportable Denominator fewer than 30 Reportable
Reportable
September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

5-11 Years - Medication Compliance 75%

20.62%

R

12-18 Years - Medication Compliance 50%

42.50%

R

12-18 Years - Medication Compliance 75%

18.97%

R

19-50 Years - Medication Compliance 50%

44.58%

R

19-50 Years - Medication Compliance 75%

15.66%

R

51-64 Years - Medication Compliance 50%

NA

R

51-64 Years - Medication Compliance 75%

NA

R

Total - Medication Compliance 50%

43.64%

R

Total - Medication Compliance 75%

20.07%

R

Asthma Medication Ratio (amr)

Y

Y

5-11 Years

62.42%

R

12-18 Years

64.26%

R

19-50 Years

40.34%

R

51-64 Years

NA

R

Total

62.40%

R

Effectiveness of Care: Cardiovascular

Cholesterol Management for Patients With Cardiovascular Conditions (cmc)

Y

Y

LDL-C Screening Performed

87.50%

R

LDL-C Control (<100 mg/dL)

27.50%

R

Controlling High Blood Pressure (cbp)

Y

38.72%

R

Persistence of Beta-Blocker Treatment After a Heart Attack (pbh)

Y

Y

NA

R

Effectiveness of Care: Diabetes

Comprehensive Diabetes Care (cdc)

Y

N

Hemoglobin A1c (HbA1c) Testing

79.37%

R

HbA1c Poor Control (>9.0%)

53.58%

R

HbA1c Control (<8.0%)

38.94%

R

HbA1c Control (<7.0%)

30.56%

R

Eye Exam (Retinal) Performed

48.25%

R

LDL-C Screening Performed

73.21%

R

LDL-C Control (<100 mg/dL)

27.29%

R

Medical Attention for Nephropathy

74.38%

R

Blood Pressure Control (<140/80 mm Hg)

32.61%

R

Blood Pressure Control (<140/90 mm Hg)

55.07%

R

Effectiveness of Care: Musculoskeletal

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Reportable Reportable Reportable Reportable Reportable Denominator fewer than 30 Denominator fewer than 30 Reportable Reportable
Reportable Reportable Reportable Denominator fewer than 30 Reportable
Reportable Reportable Reportable Denominator fewer than 30
Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable
September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis (art)

Y

Y

Use of Imaging Studies for Low Back Pain (lbp)

Y

Effectiveness of Care: Behavioral Health

Antidepressant Medication Management (amm)

Y

Y

Effective Acute Phase Treatment

Effective Continuation Phase Treatment

Follow-Up Care for Children Prescribed ADHD Medication (add)

Y

Y

Initiation Phase

Continuation and Maintenance (C&M) Phase

Follow-Up After Hospitalization for Mental Illness (fuh)

Y

Y

30-Day Follow-Up

7-Day Follow-Up

Diabetes Screening for People With Schizophrenia

or Bipolar Disorder Who Are Using Antipsychotic

Y

Y

Medication (ssd)

Diabetes Monitoring for People With Diabetes and Schizophrenia (smd)

Y

Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (smc)

Y

Adherence to Antipsychotic Medications for Individuals With Schizophrenia (saa)

Y

Y

Effectiveness of Care: Medication Management

Annual Monitoring for Patients on Persistent Medications (mpm)

Y

Y

ACE Inhibitors or ARBs

Digoxin

Diuretics

Anticonvulsants

Total

Access/Availability of Care

Adults' Access to Preventive/Ambulatory Health Services (aap)

Y

65.00%

R

74.22%

R

54.16%

R

36.81%

R

42.32%

R

58.15%

R

67.29%

R

45.80%

R

84.04%

R

NA

R

NA

R

46.30%

R

90.93%

R

NA

R

89.80%

R

61.43%

R

89.32%

R

Reportable Reportable
Reportable Reportable
Reportable Reportable
Reportable Reportable Reportable
Denominator fewer than 30
Denominator fewer than 30
Reportable
Reportable Denominator fewer than 30
Reportable Reportable Reportable

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

20-44 Years

45-64 Years

65+ Years

Total

Children and Adolescents' Access to Primary Care Practitioners (cap)

Y

12-24 Months

25 Months - 6 Years

7-11 Years

12-19 Years

Annual Dental Visit (adv)

Y

Y

2-3 Years

4-6 Years

7-10 Years

11-14 Years

15-18 Years

19-21 Years

Total

Initiation and Engagement of AOD Dependence Treatment (iet)

Y

Y

Initiation of AOD Treatment: 13-17 Years

Engagement of AOD Treatment: 13-17 Years

Initiation of AOD Treatment: 18+ Years

Engagement of AOD Treatment: 18+ Years

Initiation of AOD Treatment: Total

Engagement of AOD Treatment: Total

Prenatal and Postpartum Care (ppc)

Y

Timeliness of Prenatal Care

Postpartum Care

Call Answer Timeliness (cat)

Y

Utilization

Frequency of Ongoing Prenatal Care (fpc)

Y

<21 Percent

21-40 Percent

41-60 Percent

61-80 Percent

83.84%

R

90.25%

R

NA

R

84.79%

R

97.55%

R

91.44%

R

92.26%

R

90.08%

R

48.50%

R

77.44%

R

79.64%

R

72.39%

R

61.55%

R

35.70%

R

69.92%

R

39.37%

R

15.24%

R

42.60%

R

8.50%

R

41.87%

R

10.01%

R

84.72%

R

59.49%

R

85.71%

R

10.65%

R

4.17%

R

7.64%

R

11.11%

R

5 of 146

Reportable Reportable Denominator fewer than 30 Reportable
Reportable Reportable Reportable Reportable
Reportable Reportable Reportable Reportable Reportable Reportable Reportable
Reportable Reportable Reportable Reportable Reportable Reportable
Reportable Reportable Reportable
Reportable Reportable Reportable Reportable
September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

81+ Percent

66.44%

R

Well-Child Visits in the First 15 Months of Life (w15)

Y

N

0 Visits

1.49%

R

1 Visit

1.74%

R

2 Visits

3.97%

R

3 Visits

3.47%

R

4 Visits

7.94%

R

5 Visits

18.36%

R

6+ Visits

63.03%

R

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (w34)

Y

Adolescent Well-Care Visits (awc)

Y

Frequency of Selected Procedures (fsp)

Y

Ambulatory Care: Total (amba)

Y

N

68.21%

R

N

46.58%

R

R

R

Ambulatory Care: Dual Eligibles (ambb)

N

NR

Ambulatory Care: Disabled (ambc)

N

NR

Ambulatory Care: Other (ambd)

N

NR

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

Y

R

Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (ipub)

N

NR

Inpatient Utilization--General Hospital/Acute Care: Disabled (ipuc)

N

NR

Inpatient Utilization--General Hospital/Acute Care: Other (ipud)

N

NR

Identification of Alcohol and Other Drug Services: Total (iada)

Y

Y

R

Identification of Alcohol and Other Drug Services: Dual Eligibles (iadb)

N

N

NR

Identification of Alcohol and Other Drug Services: Disabled (iadc)

N

N

NR

Identification of Alcohol and Other Drug Services: Other (iadd)

N

N

NR

Mental Health Utilization: Total (mpta)

Y

Y

R

Mental Health Utilization: Dual Eligibles (mptb)

N

N

NR

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Reportable
Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Measure Unselected Measure Unselected Measure Unselected Reportable
Measure Unselected
Measure Unselected
Measure Unselected
Reportable
Measure Unselected
Measure Unselected
Measure Unselected Reportable
Measure Unselected
September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Mental Health Utilization: Disabled (mptc)

N

N

NR

Mental Health Utilization: Other (mptd)

N

N

NR

Antibiotic Utilization: Total (abxa)

Y

Y

R

Antibiotic Utilization: Dual Eligibles (abxb)

N

N

NR

Antibiotic Utilization: Disabled (abxc)

N

N

NR

Antibiotic Utilization: Other (abxd)

N

N

NR

Relative Resource Use

Relative Resource Use for People With Diabetes (rdi)

Y

R

Relative Resource Use for People With Asthma (ras)

Y

Y

R

Relative Resource Use for People With Cardiovascular Conditions (rca)

Y

R

Relative Resource Use for People With Hypertension (rhy)

Y

R

Relative Resource Use for People With COPD (rco)

Y

R

Health Plan Descriptive Information

Board Certification (bcr)

Y

R

Total Membership (tlm)

Y

R

Enrollment by Product Line: Total (enpa)

Y

R

Enrollment by Product Line: Dual Eligibles (enpb)

N

NR

Enrollment by Product Line: Disabled (enpc)

N

NR

Enrollment by Product Line: Other (enpd)

N

NR

Enrollment by State (ebs)

Y

R

Race/Ethnicity Diversity of Membership (rdm)

Y

R

Language Diversity of Membership (ldm)

Y

R

Weeks of Pregnancy at Time of Enrollment in MCO (wop)

Y

R

Measure Unselected Measure Unselected
Reportable Measure Unselected Measure Unselected Measure Unselected
Reportable
Reportable
Reportable
Reportable
Reportable
Reportable Reportable Reportable Measure Unselected Measure Unselected Measure Unselected Reportable Reportable Reportable Reportable

7 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Adult BMI Assessment (ABA)

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

Data Element
Measurement year Data collection methodology (administrative or hybrid)
Eligible population

Measure Data 2012 H 5838

Number of numerator events by administrative data in eligible population (before exclusions) 311

Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size
Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of administrative data records excluded Number of medical records excluded Number of employee/dependent medical records excluded Records added from the oversample list
Denominator Numerator events by administrative data
Numerator events by medical records Reported rate
Lower 95% confidence interval Upper 95% confidence interval

5.33% 411 0.05 432 30
6.94% 0 1 2 0 0
429 30 239 62.70% 58.01% 67.40%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)

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

Data Element

BMI Percentile

3-11 years 12-17 years

Total

Counseling for Nutrition 3-11 years 12-17 years Total

Counseling for Physical Activity 3-11 years 12-17 years Total

Measurement year

2012

2012

2012

Data collection methodology (administrative or

H

H

H

hybrid)

Eligible population

65481

32453

97,934

65481

32453

97,934

65481

32453

97,934

Number of numerator events by administrative data in eligible population (before exclusions)

3580

1778

5,358

2243

1315

3,558

1769

998

2,767

Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample size
Oversampling rate Final sample size Number of numerator events by administrative
data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors

5.47%
16 3.70%

5.48%
411 0.05 432 13 3.01%
0

5.47%
29 6.71%

3.43%
7 1.62%

4.05%
411 0.05 432
6 1.39%
0

3.63%
13 3.01%

2.70%
6 1.39%

3.08%
411 0.05 432
4 0.93%
0

2.83%
10 2.31%

Number of administrative data records excluded

0

0

0

Number of medical records excluded

0

0

0

Number of employee/dependent medical records

0

0

0

excluded

Records added from the oversample list

0

0

0

Denominator

294

138

432

294

138

432

294

138

432

Numerator events by administrative data

16

13

29

7

6

13

6

4

10

Numerator events by medical records Reported rate
Lower 95% confidence interval Upper 95% confidence interval

95 37.76% 32.04% 43.47%

52 47.10% 38.41% 55.79%

147 40.74% 35.99% 45.49%

155 55.10% 49.25% 60.96%

58 46.38% 37.69% 55.06%

213 52.31% 47.49% 57.14%

108 38.78% 33.04% 44.52%

54 42.03% 33.43% 50.63%

162 39.81% 35.08% 44.55%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Childhood Immunization Status (CIS)

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

Data Element

General

Measure

DTaP

IPV

MMR

HiB

Data

Measurement year

2012

Data collection methodology (administrative or hybrid)

H

Eligible population

6961

Number of numerator events by admin data in eligible population (before exclusions)

5149

5859

6418

6440

Current year's administrative rate (before exclusions)

73.97%

84.17%

92.20%

92.52%

Minimum required sample size (MRSS) or other sample Size 411

Oversampling rate

0.05

Final sample size

432

Number of numerator events by admin data in FSS

Administrative rate on FSS

Number of original records excluded because of valid data errors

0

Number of administrative data records excluded

0

Number of medical data records excluded

0

346 80.09%

379 87.73%

402 93.06%

407 94.21%

Number of employee/dependent medical records excluded

0

Records added from the oversample list Denominator
Numerator events by administrative data Number of numerator events by medical records
Reported rate Lower 95% confidence interval Upper 95% confidence interval

0

432

346

379

402

407

37

37

5

7

88.66%

96.30%

94.21%

95.83%

85.55%

94.40%

91.90%

93.83%

91.76%

98.19%

96.53%

97.83%

Hepatitis B
5845 83.97%
367 84.95%
367 39 93.98% 91.62% 96.34%

VZV
6474 93.00%
406 93.98%
406 7
95.60% 93.55% 97.65%

Pneumococcal
Conjugate
5569 80.00%
360 83.33%
360 22 88.43% 85.29% 91.56%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Hepatitis A Rotavirus

Influenza

Combination Combination Combination Combination Combination Combination Combination Combination Combination

2

3

4

5

6

7

8

9

10

6354 91.28%

3633 52.19%

2953 42.42%

4476 64.30%

4240 60.91%

4182 60.08%

2615 37.57%

2100 30.17%

2587 37.16%

2084 29.94%

1376 19.77%

1369 19.67%

402 93.06%

241 55.79%

191 44.21%

299 69.21%

286 66.20%

283 65.51%

175 40.51%

144 33.33%

173 40.05%

144 33.33%

91 21.06%

91 21.06%

402 4
93.98% 91.62% 96.34%

241 68 71.53% 67.16% 75.90%

191 5
45.37% 40.56% 50.18%

299 70 85.42% 81.97% 88.86%

286 71 82.64% 78.95% 86.33%

283 71 81.94% 78.20% 85.69%

175 99 63.43% 58.77% 68.08%

144 33 40.97% 36.22% 45.73%

173 99 62.96% 58.29% 67.63%

144 33 40.97% 36.22% 45.73%

91 47 31.94% 27.43% 36.46%

91 47 31.94% 27.43% 36.46%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Immunizations for Adolescents (IMA)

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

Data Element

General Measure
Data

Meningococcal

Measurement year

2012

Data collection methodology (administrative or hybrid)

H

Eligible population

7538

Number of numerator events by admin data in eligible population (before exclusions)

5475

Current year's administrative rate (before exclusions)

72.63%

Minimum required sample size (MRSS) or other sample Size

366

Oversampling rate

0.05

Final sample size

385

Number of numerator events by admin data in FSS

274

Administrative rate on FSS

71.17%

Number of original records excluded because of valid data errors

0

Number of administrative data records excluded

0

Number of medical data records excluded

0

Number of employee/dependent medical records excluded

0

Records added from the oversample list

0

Denominator

385

Numerator events by administrative data

274

Number of numerator events by medical records

9

Reported rate

73.51%

Lower 95% confidence interval

68.97%

Upper 95% confidence interval

78.04%

Tdap/Td
6230 82.65%
316 82.08%
316 10 84.68% 80.95% 88.40%

Combination 1
5356 71.05%
267 69.35%
267 8
71.43% 66.79% 76.07%

12 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Human Papillomavirus Vaccine for Female Adolescents (HPV)

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

Data Element
Measurement year Data collection methodology (administrative or hybrid)
Eligible population

Measure Data 2012 H 3642

Number of numerator events by administrative data in eligible population (before exclusions)

469

Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size
Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of administrative data records excluded Number of medical data records excluded Number of employee/dependent medical records excluded Records added from the oversample list
Denominator Numerator events by administrative data
Numerator events by medical records Reported rate
Lower 95% confidence interval Upper 95% confidence interval

12.88% 411 0.05 432 58
13.43% 0 1 0 0 0
431 58 14 16.71% 13.07% 20.34%

13 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Lead Screening in Children (LSC)

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

Lead Screening in Children

Data Elements which do not apply to the selected data collection methodology will not appear Measurement year

General Measure
Data 2012

Data collection methodology (administrative or hybrid)

H

Eligible population

6961

Number of numerator events by admin data in eligible population (before exclusions)

5168

Current year's administrative rate (before exclusions)

74.24%

Minimum required sample size (MRSS) or other sample size

305

Oversampling rate

0.05

Final sample size (FSS)

321

Number of numerator events by administrative data in FSS

225

Administrative rate on FSS

70.09%

Number of original sample records excluded because of valid data errors

1

Number of administrative data records excluded

0

Number of medical data records excluded

0

Number of employee/dependent medical records excluded

0

Records added from the oversample list

0

Denominator

320

Numerator events by administrative data

225

Numerator events by medical records

12

Reported rate

74.06%

Lower 95% confidence interval

69.10%

Upper 95% confidence interval

79.02%

14 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Breast Cancer Screening (BCS)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

General Measure
Data 2012
A 1285 761 59.22% 56.50% 61.95%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Cervical Cancer Screening (CCS)

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

Data Element
Measurement year Data collection methodology (administrative or hybrid)
Eligible population

Measure Data 2012 H 9966

Number of numerator events by administrative data in eligible population (before exclusions)

6542

Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size
Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of administrative data records excluded Number of medical data records excluded Number of employee/dependent medical records excluded Records added from the oversample list
Denominator Numerator events by administrative data
Numerator events by medical records Reported rate
Lower 95% confidence interval Upper 95% confidence interval

65.64% 411 0.05 432 293
67.82% 0 1 1 0 0
430 293 17 72.09% 67.74% 76.45%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Chlamydia Screening in Women (CHL)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

General Measure
Data
2012 A

16-20 years 21-24 years

4387 2366 53.93% 52.45% 55.42%

1127 776 68.86% 66.11% 71.60%

Total
5,514 3,142 56.98% 55.67% 58.30%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Appropriate Testing for Children with Pharyngitis (CWP)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

Measure Data 2012 A 9581 7420
77.44% 76.60% 78.29%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Appropriate Treatment for Children With URI (URI)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

Measure Data 2012 A 15072 2614
82.66% 82.05% 83.26%

19 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Total numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

Measure Data 2012 A 561 461
17.83% 14.57% 21.08%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

Measure Data 2012 A 43 10
23.26% 9.47% 37.05%

21 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Pharmacotherapy Management of COPD Exacerbation (PCE)
AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)
Pharmacotherapy Management of COPD Exacerbation

Data Elements

Measure Data

Systemic corticosteroid

Bronchodilator

Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

2012 A 49

31 63.27% 48.75% 77.78%

41 83.67% 72.30% 95.04%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Use of Appropriate Medications for People With Asthma (ASM)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Number of required exclusions Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

General Measure
Data
2012 A

5-11 years 12-18 years 19-50 years 51-64 years

2169

1308

120

12

240

139

117

18

1959

1160

83

11

90.32%

88.69%

69.17%

NA

89.05%

86.93%

60.49%

NA

91.59%

90.44%

77.85%

NA

Total
3,609 514 3,213 89.03% 87.99% 90.06%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Medication Management for People With Asthma (MMA)

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

5-11 years

12-18 years

19-50 years

51-64 years

Data Element

General Measure
Data

Medication Medication Medication Medication Medication Medication Medication Medication

Compliance Compliance Compliance Compliance Compliance Compliance Compliance Compliance

50%

75%

50%

75%

50%

75%

50%

75%

Measurement year

2012

Data collection methodology (administrative)

A

Eligible population

1959

1160

83

11

Number of required exclusions

450

287

154

19

Numerator events by administrative data

862

404

493

220

37

13

10

8

Reported rate

44.00%

20.62%

42.50%

18.97%

44.58%

15.66%

NA

NA

Lower 95% confidence interval

41.78%

18.81%

39.61%

16.67%

33.28%

7.24%

NA

NA

Upper 95% confidence interval

46.23%

22.44%

45.39%

21.26%

55.87%

24.08%

NA

NA

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September 2013

Total

Medication Medication

Compliance Compliance

50%

75%

3,213 910

1,402

645

43.64% 41.90% 45.37%

20.07% 18.67% 21.48%

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

25 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Asthma Medication Ratio (AMR)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Number of required exclusions Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

Measure Data 2012 A

5-11 years 12-18 years 19-50 years 51-64 years

2166

1304

119

12

243

143

118

18

1352

838

48

9

62.42%

64.26%

40.34%

NA

60.36%

61.62%

31.10%

NA

64.48%

66.90%

49.57%

NA

Total
3,601 522 2,247 62.40% 60.80% 64.00%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Cholesterol Management for Patients With Cardiovascular Conditions (CMC)

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

Data Element
Measurement year Data collection methodology (administrative or hybrid)
Eligible population

General Measure
Data 2011
H 40

LDL-C LDL-C level Screening <100 mg/dL

Number of numerator events by administrative data in eligible population (before exclusions)

33

7

Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size
Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of employee/dependent medical records excluded Records added from the oversample list
Denominator Numerator events by administrative data
Numerator events by medical records Reported rate
Lower 95% confidence interval Upper 95% confidence interval

82.50%

17.50%

40

0.05

40

33

6

82.50%

15.00%

0

0

0

40

33

6

2

5

87.50%

27.50%

76.00%

12.41%

99.00%

42.59%

27 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Controlling High Blood Pressure (CBP)
AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Data Element
Measurement year Data collection methodology (hybrid)
Eligible population

General Measure
Data
2012 H
2029

Number of numerator events by administrative data in eligible population (before exclusions)

0

Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size
Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of records excluded because of false positive diagnoses Number of administrative data records excluded Number of medical data records excluded Number of employee/dependent medical records excluded Records added from the oversample list
Denominator Numerator events by administrative data
Numerator events by medical records Reported rate
Lower 95% confidence interval Upper 95% confidence interval

0.00% 411 0.1 453 0
0.00% 0 0 1 0 0 0
452 0
175 38.72% 34.12% 43.32%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Persistence of Beta-Blocker Treatment After a Heart Attack (PBH)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

Measure Data 2012 A 9 8 NA NA NA

29 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Comprehensive Diabetes Care (CDC)

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

Data Element

HbA1c Testing

HbA1c Poor Control (>9.0%)

HbA1c Control (<8.0%)

HbA1c Control (<7.0%) for a Eye Exam Selected Population

LDL-C Screening

Measurement year

2012

2012

2012

2012

2012

2012

LDL-C Level <100 mg/dL

Medical Attention for Nephropathy

2012

2012

Data collection methodology (administrative or hybrid) H

H

H

H

H

H

H

H

Eligible population

1103

1103

1103

953

1103

1103

1103

1103

Number of numerator events by administrative data in eligible population (before optional exclusions)

829

886

186

140

416

736

152

741

Current year's administrative rate (before optional exclusions)
Minimum required sample size (MRSS) or other sample size
Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in
FSS Administrative rate on FSS Number of original sample records excluded because
of valid data errors Number of optional administrative data records
excluded Number of optional medical data records excluded
Number of HbA1c <7 required medical records excluded
Number of HbA1c <7 required administrative data records excluded
Number of employee/dependent medical records excluded
Records added from the oversample list Denominator
Numerator events by administrative data

75.16% 548 0.1 603 469
77.78% 2 0 0
0 0 601 469

80.33% 548 0.1 603 512
84.91% 2 0 0
0 0 601 261

16.86% 548 0.1 603 76
12.60% 2 0 0
0 0 601 76

14.69%
548 0.1 603 56 9.29% 2
0 0 7
90
0 0 504 56

37.72% 548 0.1 603 270
44.78% 2 0 0
0 0 601 270

66.73% 548 0.1 603 429
71.14% 2 0 0
0 0 601 429

13.78% 548 0.1 603 69
11.44% 2 0 0
0 0 601 69

67.18% 548 0.1 603 418
69.32% 2 0 0
0 0 601 418

30 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Numerator events by medical records Reported rate
Lower 95% confidence interval Upper 95% confidence interval

8 79.37% 76.05% 82.69%

61 53.58% 49.51% 57.65%

158 38.94% 34.95% 42.92%

98 30.56% 26.43% 34.68%

20 48.25% 44.17% 52.33%

11 73.21% 69.59% 76.84%

95 27.29% 23.64% 30.93%

29 74.38% 70.80% 77.95%

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September 2013

Blood

Blood

Pressure Pressure

Controlled Controlled

<140/80 mm <140/90 mm

Hg

Hg

2012

2012

H

H

1103

1103

14

20

1.27%
548 0.1 603 6 1.00% 2
0 0

1.81%
548 0.1 603 9 1.49% 2
0 0

0

0

0

0

601

601

6

9

32 of 146

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

September 2013

190 32.61% 28.78% 36.44%

322 55.07% 51.01% 59.13%

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

33 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Disease Modifying Anti-Rheumatic Drug therapy in Rheumatoid Arthritis (ART)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

Measure Data 2012 A 40 26
65.00% 48.97% 81.03%

34 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Use of Imaging Studies for Low Back Pain (LBP)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence Interval Upper 95% confidence Interval

Measure Data 2012 A 799 206
74.22% 71.12% 77.31%

35 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Antidepressant Medication Management (AMM)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

General Measure
Data
2012 A 565

Effective Acute Phase
Treatment

Effective Continuation
Phase Treatment

306 54.16% 49.96% 58.36%

208 36.81% 32.75% 40.88%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Follow-Up Care for Children Prescribed ADHD Medication (ADD)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

General Measure
Data
2012 A

Initiation Phase

Continuation and
Maintenance Phase

2455 1039 42.32% 40.35% 44.30%

411 239 58.15% 53.26% 63.04%

37 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Follow-Up After Hospitalization for Mental Illness (FUH)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

General Measure
Data
2012 A
1168

30-day 7-day follow-

follow-up

up

786 67.29% 64.56% 70.03%

535 45.80% 42.90% 48.70%

38 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Number of required exclusions Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

Measure Data 2012 A 213 173 179
84.04% 78.88% 89.19%

39 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Number of optional exclusions Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

Measure Data 2012 A 12 0 7 NA NA NA

40 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Cardiovascular Monitoring for People With Cardiovascular Disease and

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

Measure Data 2012 A 0 0 NA NA NA

41 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Number of required exclusions Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

Measure Data 2012 A 54 23 25
46.30% 32.07% 60.52%

42 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Annual Monitoring for Patients on Persistent Medications (MPM)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

General Measure
Data
2012 A

ACE Inhibitors or
ARBs
904 822 90.93% 89.00% 92.86%

Digoxin
6 6 NA NA NA

Diuretics
931 836 89.80% 87.80% 91.79%

Anticonvulsants
70 43 61.43% 49.31% 73.55%

Total
1,911 1,707 89.32% 87.91% 90.74%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Adults' Access to Preventive/Ambulatory Health Services (AAP)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

General Measure
Data
2012 A

20-44 years 45-64 years 65+ years

10744

1857

2

9008

1676

2

83.84%

90.25%

NA

83.14%

88.88%

NA

84.54%

91.63%

NA

Total
12,603 10,686 84.79% 84.16% 85.42%

44 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Children and Adolescents' Access to Primary Care Practitioners (CAP)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

General Measure
Data
2012 A

12-24 months

25 months 6 years

7-11 years

12-19 years

9228 9002 97.55% 97.23% 97.87%

43488 39767 91.44% 91.18% 91.71%

29437 27158 92.26% 91.95% 92.57%

34602 31168 90.08% 89.76% 90.39%

45 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Annual Dental Visit (ADV)

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

Data Element

Measure Data

2-3 Years 4-6 Years 7-10 Years

Measurement year

2012

Data collection methodology (administrative)

A

Eligible population

17078

27101

33388

Numerator events by administrative data

8282

20986

26590

Reported rate

48.50%

77.44%

79.64%

Lower 95% confidence interval

47.74%

76.94%

79.21%

Upper 95% confidence interval

49.25%

77.94%

80.07%

11-14 Years 15-18 Years 19-21 Years

31813 23028 72.39% 71.89% 72.88%

23897 14709 61.55% 60.93% 62.17%

1182 422 35.70% 32.93% 38.48%

46 of 146

September 2013

Total
134,459 94,017 69.92% 69.68% 70.17%

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

47 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Initiation and Engagement of AOD Dependence Treatment (IET)

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

Data Elements

General Measure
Data

13-17 years

Initiation of AOD
Treatment

Engagement of AOD
Treatment

18+ years

T

Initiation of Engagement of Initiation of

AOD

AOD

AOD

Treatment Treatment Treatment

Measurement year

2012

Data collection methodology (administrative) Eligible population

A 315

1094

1,

Numerator events by administrative data

124

48

466

93

590

Reported rate

39.37%

15.24%

42.60%

8.50%

41.87%

Lower 95% confidence interval

33.81%

11.11%

39.62%

6.80%

39.26%

Upper 95% confidence interval

44.92%

19.37%

45.57%

10.20%

44.49%

48 of 146

September 2013

otal Engagement of AOD Treatment
,409 141
10.01% 8.40% 11.61%

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

49 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Prenatal and Postpartum Care (PPC)

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

Data Element

Timeliness of Prenatal
Care

Postpartum Care

Measurement year

2012

2012

Data collection methodology (administrative or hybrid) Eligible population
Number of numerator events by administrative data in eligible population (before exclusions)
Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size
Oversampling rate

H 12505
5963
47.68% 411 0.05

H 12505
4838
38.69% 411 0.05

Final sample size (FSS)

432

432

Number of numerator events by administrative data in FSS

205

178

Administrative rate on FSS

47.45%

41.20%

Number of original sample records excluded because of valid data errors

0

0

Number of employee/dependent medical records excluded

0

0

Records added from the oversample list

0

0

Denominator Numerator events by administrative data
Numerator events by medical records

432

432

205

178

161

79

Reported rate

84.72%

59.49%

Lower 95% confidence interval

81.21%

54.75%

Upper 95% confidence interval

88.23%

64.24%

50 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Call Answer Timeliness (CAT)

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

Data Element
Measurement year Data collection methodology (administrative)
Eligible population Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

Measure Data 2012 A
186541 159884 85.71% 85.55% 85.87%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Frequency of Ongoing Prenatal Care (FPC)

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

Data Element
Measurement year Data collection methodology (administrative or hybrid)
Eligible population Number of numerator events by administrative data in eligible population
(before exclusions) Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size
Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS
Number of original sample records excluded because of valid data errors

General Measure
Data 2012
H 12505
411 0.05 432
0

<21 Percent
6312 50.48%
44 10.19%

21-40 Percent
1985 15.87%
14 3.24%

41-60 Percent
1070 8.56%
15 3.47%

Number of employee/dependent medical records excluded Records added from the oversample list Denominator Numerator events by administrative data Numerator events by medical records Reported rate Lower 95% confidence interval Upper 95% confidence interval

0

0

432

44

14

15

2

4

18

10.65%

4.17%

7.64%

7.62%

2.17%

5.02%

13.67%

6.17%

10.26%

61-80 Percent

81+ Percent

864 6.91%

2274 18.18%

10 2.31%

88 20.37%

10 38 11.11% 8.03% 14.19%

88 199 66.44% 61.87% 71.00%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Well-Child Visits in the First 15 Months of Life (W15)

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

Data Element

Measure Data

0 visits

1 visit

2 visits

Measurement year

2012

Data collection methodology (administrative or hybrid)

H

Eligible population

7568

Number of numerator events by administrative data in eligible population (before exclusions)

136

206

304

Current year's administrative rate (before exclusions)

1.80%

2.72%

4.02%

Minimum required sample size (MRSS) or other sample size

384

Oversampling rate

0.05

Final sample size (FSS)

404

Number of numerator events by administrative data in FSS

8

8

24

Administrative rate on FSS

1.98%

1.98%

5.94%

Number of original sample records excluded because of valid data errors

1

Number of employee/dependent medical records excluded

0

Records added from the oversample list

0

Denominator

403

Numerator events by administrative data

6

7

15

Numerator events by medical records

0

0

1

Reported rate

1.49%

1.74%

3.97%

Lower 95% confidence interval

0.18%

0.34%

1.94%

Upper 95% confidence interval

2.80%

3.14%

6.00%

3 visits
466 6.16%
14 3.47%
9 5 3.47% 1.56% 5.39%

4 visits
835 11.03%
47 11.63%
32 0 7.94% 5.18% 10.70%

5 visits
1431 18.91%
84 20.79%
59 15 18.36% 14.46% 22.27%

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September 2013

6 or more visits
4190 55.36%
219 54.21%
222 32 63.03% 58.19% 67.86%

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Adolescent Well-Care Visits (AWC)

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

Data Element
Measurement year Data collection methodology (administrative or hybrid)
Eligible population
Number of numerator events by administrative data in eligible population (before exclusions)
Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size
Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of employee/dependent medical records excluded Records added from the oversample list
Denominator Numerator events by administrative data
Numerator events by medical records Reported rate
Lower 95% confidence interval Upper 95% confidence interval

Measure Data 2012 H 48352
21295
44.04% 411 0.1 453 203
44.81% 0 0 0
453 203
8 46.58% 41.87% 51.28%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34)

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

Data Element
Measurement year Data collection methodology (administrative or hybrid)
Eligible population
Number of numerator events by administrative data in eligible population (before exclusions)
Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size
Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of employee/dependent medical records excluded Records added from the oversample list
Denominator Numerator events by administrative data
Numerator events by medical records Reported rate
Lower 95% confidence interval Upper 95% confidence interval

Measure Data 2012 H 35623
23907
67.11% 411 0.1 453 303
66.89% 0 0 0
453 303
6 68.21% 63.81% 72.61%

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Frequency of Selected Procedures (FSP)

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

Age 0-9 10-19 15-44 20-44 30-64 45-64

Male 853,450 557,165
33,102 30,610 8,454

Female 829,770 568,126 546,711 320,952
29,891

Total 1,683,237 1,125,291

Procedure

Age

Sex

Number of Procedures

Procedures / 1,000 Member
Years

Bariatric weight loss surgery
Tonsillectomy Hysterectomy, Abdominal
Hysterectomy, Vaginal Cholecystectomy, Open Cholecystectomy (laparoscopic)
Back Surgery

0-19

Male

0

0.00

Female

1

0.00

20-44

Male

0

0.00

Female

45

0.14

Male

0

0.00

45-64

Female

6

0.20

0-9

Male &

1246

0.74

10-19

Female

390

0.35

15-44

Female

107

0.20

45-64

28

0.94

15-44

Female

142

0.26

45-64

18

0.60

30-64

Male

1

0.03

15-44

Female

9

0.02

45-64

3

0.10

30-64

Male

7

0.23

15-44

Female

449

0.82

45-64

18

0.60

20-44

Male

29

0.88

Female

52

0.16

57 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Back Surgery
Mastectomy Lumpectomy

45-64

Male

9

1.06

Female

12

0.40

15-44

Female

43

0.08

45-64

63

2.11

15-44

Female

109

0.20

45-64

57

1.91

58 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Ambulatory Care: Total (AMBA)

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

Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

Member Months 240,609 1,442,628 1,125,291 354,054 38,345
67 3 2 0 3,200,999 Outpatient Visits

ED Visits

Age

Visits/ 1,000

Visits/ 1,000

Visits

Member

Visits

Member

Months

Months

<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

188944 490093 270469 159632 28779
44 7 2 0 1,137,970

785.27 339.72 240.35 450.87 750.53 656.72 2,333.33 1,000.00
355.50

23676 74929 44399 45385 3366
4 0 1 0 191,760

98.40 51.94 39.46 128.19 87.78 59.70 0.00 500.00
59.91

59 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Ambulatory Care: Dual Eligibles (AMBB)

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

Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

Member Months
NR NR NR NR NR NR NR NR NR NR Outpatient Visits

Age

Visits/ 1,000

Visits

Member

Months

<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

ED Visits

Visits

Visits/ 1,000 Member Months

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

60 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Ambulatory Care: Disabled (AMBC)

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

Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

Member Months
NR NR NR NR NR NR NR NR NR NR Outpatient Visits

Age

Visits/ 1,000

Visits

Member

Months

<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

ED Visits

Visits

Visits/ 1,000 Member Months

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

61 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Ambulatory Care: Other (AMBD)

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

Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

Member Months
NR NR NR NR NR NR NR NR NR NR Outpatient Visits

Age

Visits/ 1,000

Visits

Member

Months

<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

ED Visits

Visits

Visits/ 1,000 Member Months

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

62 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

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
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

Total Inpatient

Member Months 240,609 1,442,628 1,125,291 354,054 38,345
67 3 2 0 3,200,999

Age

Discharges

Discharges / 1,000
Member Months

Days

Days / 1,000 Members Months

Average Length of
Stay

<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

Medicine

1391

5.78

10170

42.27

7.31

1201

0.83

4032

2.79

3.36

2981

2.65

9218

8.19

3.09

13608

38.43

40009

113.00

2.94

456

11.89

2259

58.91

4.95

3

44.78

17

253.73

5.67

0

0.00

0

0.00

NA

0

0.00

0

0.00

NA

0

0

NA

19,640

6.14

65,705

20.53

3.35

63 of 146

September 2013

64 of 146

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total
Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

Surgery Maternity*

Discharges

Discharges / 1,000
Member Months

Days

Days / 1,000 Members Months

Average Length of
Stay

1046

4.35

4662

19.38

4.46

856

0.59

2327

1.61

2.72

454

0.40

1438

1.28

3.17

627

1.77

2268

6.41

3.62

240

6.26

913

23.81

3.80

2

29.85

10

149.25

5.00

0

0.00

0

0.00

NA

0

0.00

0

0.00

NA

0

0

NA

3,225

1.01

11,618

3.63

3.60

Discharges

Discharges / 1,000
Member Months

Days

Days / 1,000 Members Months

Average Length of
Stay

345 345 373 551 203
1 0 0 0 1,818

1.43 0.24 0.33 1.56 5.29 14.93 0.00 0.00
0.57

5508 1705 1882 3151 1314
7 0 0 0 13,567

22.89 1.18 1.67 8.90 34.27 104.48 0.00 0.00
4.24

15.97 4.94 5.05 5.72 6.47 7.00 NA NA NA 7.46

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Age
10-19 20-44 45-64 Unknown Total *The maternity category is calculated using member months for members 10-64 years.

Discharges

Discharges / 1,000
Member Months

2154 12430
13 0 14,597

1.91 35.11 0.34
9.62

Days
5898 34590
32 0 40,520

Days / 1,000 Members Months

Average Length of
Stay

5.24

2.74

97.70

2.78

0.83

2.46

NA

26.70

2.78

65 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (IPUB)

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

Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total
Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

Total Inpatient Medicine

Member Months
NR NR NR NR NR NR NR NR NR NR

Discharges

Discharges / 1,000
Member Months

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Days
NR NR NR NR NR NR NR NR NR NR

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

66 of 146

September 2013

67 of 146

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total
Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

Surgery Maternity*

Discharges

Discharges / 1,000
Member Months

Days

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Discharges

Discharges / 1,000
Member Months

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Days
NR NR NR NR NR NR NR NR NR NR

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Age
10-19 20-44 45-64 Unknown Total *The maternity category is calculated using member months for members 10-64 years.

Discharges

Discharges / 1,000
Member Months

NR

NR

NR

NR

NR

NR

NR

NR

NR

Days
NR NR NR NR NR

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

68 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Inpatient Utilization--General Hospital/Acute Care: Disabled (IPUC)

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

Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

Total Inpatient

Member Months
NR NR NR NR NR NR NR NR NR NR

Discharges /

Age

Discharges

1,000 Member

Months

<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

Medicine

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Days
NR NR NR NR NR NR NR NR NR NR

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

69 of 146

September 2013

70 of 146

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total
Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

Surgery Maternity*

Discharges

Discharges / 1,000
Member Months

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Days
NR NR NR NR NR NR NR NR NR NR

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Discharges

Discharges / 1,000
Member Months

Days

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Age
10-19 20-44 45-64 Unknown Total *The maternity category is calculated using member months for members 10-64 years.

Discharges

Discharges / 1,000
Member Months

NR

NR

NR

NR

NR

NR

NR

NR

NR

Days
NR NR NR NR NR

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

71 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Inpatient Utilization--General Hospital/Acute Care: Other (IPUD)

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

Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total
Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

Total Inpatient Medicine

Member Months
NR NR NR NR NR NR NR NR NR NR

Discharges

Discharges / 1,000
Member Months

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Days
NR NR NR NR NR NR NR NR NR NR

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

72 of 146

September 2013

73 of 146

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total
Age
<1 1-9 10-19 20-44 45-64 65-74 75-84 85+ Unknown Total

Surgery Maternity*

Discharges

Discharges / 1,000
Member Months

Days

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Discharges

Discharges / 1,000
Member Months

Days

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Age
10-19 20-44 45-64 Unknown Total *The maternity category is calculated using member months for members 10-64 years.

Discharges

Discharges / 1,000
Member Months

NR

NR

NR

NR

NR

NR

NR

NR

NR

Days
NR NR NR NR NR

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

74 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Identification of Alcohol and Other Drug Services: Total (IADA)

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

Age

Member Months (Any)

Member Months (Inpatient)

Member Months (Intensive Outpatient/Partial Hospitalization)

Male

Female

Total

Male

Female

Total

Male

Female

Total

0-12

1073843

1045524 2,119,367 1073843

1045524 2,119,367 1073843

1045524 2,119,367

13-17

294975

292587

587,562

294975

292587

587,562

294975

292587

587,562

18-24

46430

144969

191,399

46430

144969

191,399

46430

144969

191,399

25-34

14463

159399

173,862

14463

159399

173,862

14463

159399

173,862

35-64

22460

106260

128,720

22460

106260

128,720

22460

106260

128,720

65+

19

53

72

19

53

72

19

53

72

Unknown

0

0

0

0

0

0

0

0

0

Total Age 0-12 13-17 18-24 25-34 35-64 65+

1,452,190
Sex
M F Total M F Total M F Total M F Total M F Total M F Total

1,748,792 3,200,982

Any Services

Number 47 23 70 371 213 584 87 375 462 105 813 918 167 608 775 0 0 0

Percent 0.05% 0.03% 0.04% 1.51% 0.87% 1.19% 2.25% 3.10% 2.90% 8.71% 6.12% 6.34% 8.92% 6.87% 7.22% 0.00% 0.00% 0.00%

1,452,190 1,748,792

Inpatient

Number 9 5 14 57 57
114 17 134 151 18 266 284 51 163 214 0 0 0

Percent 0.01% 0.01% 0.01% 0.23% 0.23% 0.23% 0.44% 1.11% 0.95% 1.49% 2.00% 1.96% 2.72% 1.84% 2.00% 0.00% 0.00% 0.00%

3,200,982 1,452,190

Intensive Outpatient/Partial
Hospitalization

Number 1

Percent 0.00%

0

0.00%

1

0.00%

13

0.05%

5

0.02%

18

0.04%

1

0.03%

9

0.07%

10

0.06%

1

0.08%

33

0.25%

34

0.23%

7

0.37%

19

0.21%

26

0.24%

0

0.00%

0

0.00%

0

0.00%

1,748,792 3,200,982

Outpatient/ED

Number 40 21 61 332 175 507 82 287 369 95 668 763 146 532 678 0 0 0

Percent 0.04% 0.02% 0.03% 1.35% 0.72% 1.04% 2.12% 2.38% 2.31% 7.88% 5.03% 5.27% 7.80% 6.01% 6.32% 0.00% 0.00% 0.00%

Member Months (Outpa

Male 1073843 294975
46430 14463 22460
19 0

Female 1045524 292587 144969 159399 106260
53 0

1,452,190 1,748,792

75 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

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

777

0.64%

152

0.13%

23

0.02%

695

0.57%

Total

F

2,032

1.39%

625

0.43%

66

0.05%

1,683

1.15%

Total

2,809

1.05%

777

0.29%

89

0.03%

2,378

0.89%

76 of 146

September 2013

atient/ED)
Total 2,119,367 587,562 191,399 173,862 128,720
72 0
3,200,982

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

77 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

78 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Identification of Alcohol and Other Drug Services: Dual Eligibles (IADB)
AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None)

Age

Member Months (Any)

Member Months (Inpatient)

Member Months (Intensive Outpatient/Partial Hospitalization)

0-12 13-17 18-24 25-34 35-64 65+ Unknown Total

Male NR NR NR NR NR NR NR NR

Female NR NR NR NR NR NR NR NR

Total NR NR NR NR NR NR NR NR

Male NR NR NR NR NR NR NR NR

Female NR NR NR NR NR NR NR NR

Total NR NR NR NR NR NR NR NR

Male NR NR NR NR NR NR NR NR

Female NR NR NR NR NR NR NR NR

Total NR NR NR NR NR NR NR NR

Any Services

Age

Sex

Inpatient

Intensive Outpatient/Partial
Hospitalization

Outpatient/ED

0-12 13-17 18-24 25-34 35-64 65+

M F Total M F Total M F Total M F Total M F Total M F Total

Number NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Percent NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Number NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Percent NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Number NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Percent NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Number NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Percent NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Member Months (Outpa

Male NR NR NR NR NR NR NR NR

Female NR NR NR NR NR NR NR NR

79 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

M

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Total

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

80 of 146

September 2013

atient/ED)
Total NR NR NR NR NR NR NR NR

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

81 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

82 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Identification of Alcohol and Other Drug Services: Disabled (IADC)

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

Age

Member Months (Any)

Member Months (Inpatient)

Member Months (Intensive Outpatient/Partial Hospitalization)

Male

Female

Total

Male

Female

Total

Male

Female

Total

0-12

NR

NR

NR

NR

NR

NR

NR

NR

NR

13-17

NR

NR

NR

NR

NR

NR

NR

NR

NR

18-24

NR

NR

NR

NR

NR

NR

NR

NR

NR

25-34

NR

NR

NR

NR

NR

NR

NR

NR

NR

35-64

NR

NR

NR

NR

NR

NR

NR

NR

NR

65+

NR

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

Any Services

Age

Sex

Inpatient

Intensive Outpatient/Partial
Hospitalization

Outpatient/ED

0-12 13-17 18-24 25-34 35-64 65+

M F Total M F Total M F Total M F Total M F Total M F Total

Number NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Percent NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Number NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Percent NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Number NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Percent NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Number NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Percent NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Member Months (Outpa

Male NR NR NR NR NR NR NR NR

Female NR NR NR NR NR NR NR NR

83 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

M

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Total

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

84 of 146

September 2013

atient/ED)
Total NR NR NR NR NR NR NR NR

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

85 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

86 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Identification of Alcohol and Other Drug Services: Other (IADD)

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

Age

Member Months (Any)

Member Months (Inpatient)

Member Months (Intensive Outpatient/Partial Hospitalization)

Male

Female

Total

Male

Female

Total

Male

Female

Total

0-12

NR

NR

NR

NR

NR

NR

NR

NR

NR

13-17

NR

NR

NR

NR

NR

NR

NR

NR

NR

18-24

NR

NR

NR

NR

NR

NR

NR

NR

NR

25-34

NR

NR

NR

NR

NR

NR

NR

NR

NR

35-64

NR

NR

NR

NR

NR

NR

NR

NR

NR

65+

NR

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

Any Services

Age

Sex

Inpatient

Intensive Outpatient/Partial
Hospitalization

Outpatient/ED

0-12 13-17 18-24 25-34 35-64 65+

M F Total M F Total M F Total M F Total M F Total M F Total

Number NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Percent NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Number NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Percent NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Number NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Percent NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Number NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Percent NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Member Months (Outpa

Male NR NR NR NR NR NR NR NR

Female NR NR NR NR NR NR NR NR

87 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

M

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Total

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

88 of 146

September 2013

atient/ED)
Total NR NR NR NR NR NR NR NR

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

89 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

90 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

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)

Male

Female

Total

Male

Female

Total

Male

Female

Total

0-12

1073843

1045524 2,119,367 1073843

1045524 2,119,367 1073843

1045524 2,119,367

13-17

294975

292587

587,562

294975

292587

587,562

294975

292587

587,562

18-64

83353

410628

493,981

83353

410628

493,981

83353

410628

493,981

65+

19

53

72

19

53

72

19

53

72

Unknown

0

0

0

0

0

0

0

0

0

Total

1,452,190 1,748,792 3,200,982 1,452,190 1,748,792 3,200,982 1,452,190 1,748,792 3,200,982

Age

Sex

Any Services

Inpatient

Intensive Outpatient/Partial
Hospitalization

Outpatient/ED

Number

Percent

Number

Percent

Number

Percent

Number

Percent

M

7119

7.96%

149

0.17%

45

0.05%

7100

7.93%

0-12

F

4350

4.99%

88

0.10%

40

0.05%

4329

4.97%

Total

11,469

6.49%

237

0.13%

85

0.05%

11,429

6.47%

M

3200

13.02%

236

0.96%

69

0.28%

3166

12.88%

13-17

F

3011

12.35%

357

1.46%

80

0.33%

2940

12.06%

Total

6,211

12.68%

593

1.21%

149

0.30%

6,106

12.47%

M

574

8.26%

72

1.04%

16

0.23%

543

7.82%

18-64

F

3669

10.72%

386

1.13%

66

0.19%

3528

10.31%

Total

4,243

10.31%

458

1.11%

82

0.20%

4,071

9.89%

M

0

0.00%

0

0.00%

0

0.00%

0

0.00%

65+

F

1

22.64%

0

0.00%

0

0.00%

1

22.64%

Total

1

16.67%

0

0.00%

0

0.00%

1

16.67%

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

10,893

9.00%

457

0.38%

130

0.11%

10,809

8.93%

Total

F

11,031

7.57%

831

0.57%

186

0.13%

10,798

7.41%

Total

21,924

8.22%

1,288

0.48%

316

0.12%

21,607

8.10%

Member Months (Outpa

Male 1073843 294975
83353 19 0
1,452,190

Female 1045524 292587 410628
53 0 1,748,792

91 of 146

September 2013

atient/ED)
Total 2,119,367 587,562 493,981
72 0 3,200,982

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

92 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Mental Health Utilization: Dual Eligibles (MPTB)

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

Age

Member Months (Any)

Member Months (Inpatient)

Member Months (Intensive Outpatient/Partial Hospitalization)

Male

Female

Total

Male

Female

Total

Male

Female

Total

0-12

NR

NR

NR

NR

NR

NR

NR

NR

NR

13-17

NR

NR

NR

NR

NR

NR

NR

NR

NR

18-64

NR

NR

NR

NR

NR

NR

NR

NR

NR

65+

NR

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

Age

Sex

Any Services

Inpatient

Intensive Outpatient/Partial
Hospitalization

Outpatient/ED

Number

Percent

Number

Percent

Number

Percent

Number

Percent

M

NR

NR

NR

NR

NR

NR

NR

NR

0-12

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

13-17

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

18-64

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

65+

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Total

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

Member Months (Outpa

Male NR NR NR NR NR NR

Female NR NR NR NR NR NR

93 of 146

September 2013

atient/ED)
Total NR NR NR NR NR NR

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

94 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Mental Health Utilization: Disabled (MPTC)

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)

Male

Female

Total

Male

Female

Total

Male

Female

Total

0-12

NR

NR

NR

NR

NR

NR

NR

NR

NR

13-17

NR

NR

NR

NR

NR

NR

NR

NR

NR

18-64

NR

NR

NR

NR

NR

NR

NR

NR

NR

65+

NR

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

Age

Sex

Any Services

Inpatient

Intensive Outpatient/Partial
Hospitalization

Outpatient/ED

Number

Percent

Number

Percent

Number

Percent

Number

Percent

M

NR

NR

NR

NR

NR

NR

NR

NR

0-12

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

13-17

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

18-64

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

65+

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Total

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

Member Months (Outpa

Male NR NR NR NR NR NR

Female NR NR NR NR NR NR

95 of 146

September 2013

atient/ED)
Total NR NR NR NR NR NR

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

96 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Mental Health Utilization: Other (MPTD)

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

Age

Member Months (Any)

Member Months (Inpatient)

Member Months (Intensive Outpatient/Partial Hospitalization)

Male

Female

Total

Male

Female

Total

Male

Female

Total

0-12

NR

NR

NR

NR

NR

NR

NR

NR

NR

13-17

NR

NR

NR

NR

NR

NR

NR

NR

NR

18-64

NR

NR

NR

NR

NR

NR

NR

NR

NR

65+

NR

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

Age

Sex

Any Services

Inpatient

Intensive Outpatient/Partial
Hospitalization

Outpatient/ED

Number

Percent

Number

Percent

Number

Percent

Number

Percent

M

NR

NR

NR

NR

NR

NR

NR

NR

0-12

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

13-17

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

18-64

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

65+

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Total

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

Member Months (Outpa

Male NR NR NR NR NR NR

Female NR NR NR NR NR NR

97 of 146

September 2013

atient/ED)
Total NR NR NR NR NR NR

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

98 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

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

Male

Female

Total

0-9

853450

829770

1,683,220

10-17

515368

508341

1,023,709

18-34

60893

304368

365,261

35-49

18730

91492

110,222

50-64

3730

14768

18,498

65-74

16

51

67

75-84

3

0

3

85+

0

2

2

Unknown

0

0

0

Total

1,452,190 1,748,792 3,200,982

Antibiotic Utilization

Age

Sex

Total Antibiotic
Scrips

Average Scrips PMPY for Antibiotics

Total Days Supplied for All Antibiotic
Scrips

Average Days
Supplied per Antibiotic Scrip

Total Number of Scrips for Antibiotics of Concern

Average Scrips PMPY for
Anitbiotics of Concern

Percentage of Antibiotics of Concern of all
Antibiotic Scrips

0-9 10-17 18-34 35-49 50-64

M

95434

1.34

899895

9.43

42398

0.60

F

92536

1.34

879049

9.50

38881

0.56

Total

187,970

1.34

1,778,944

9.46

81,279

0.58

M

28302

0.66

290865

10.28

12574

0.29

F

36468

0.86

353640

9.70

15006

0.35

Total

64,770

0.76

644,505

9.95

27,580

0.32

M

3896

0.77

40342

10.35

1478

0.29

F

48761

1.92

385005

7.90

16066

0.63

Total

52,657

1.73

425,347

8.08

17,544

0.58

M

1914

1.23

17014

8.89

814

0.52

F

15487

2.03

131552

8.49

6470

0.85

Total

17,401

1.89

148,566

8.54

7,284

0.79

M

397

1.28

3524

8.88

193

0.62

F

2260

1.84

19134

8.47

1117

0.91

44.43% 42.02% 43.24% 44.43% 41.15% 42.58% 37.94% 32.95% 33.32% 42.53% 41.78% 41.86% 48.61% 49.42%

99 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

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

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

2,657 1 9 10 1 0 1 0 0 0 0 0 0
129,945 195,521 325,466
Total Quinolone
Scrips
50 54 104 223 650 873 212 3619 3,831 205 1894 2,099

1.72

22,658

8.53

1,310

0.85

49.30%

0.75

10

10.00

0

0.00

0.00%

2.12

76

8.44

2

0.47

22.22%

1.79

86

8.60

2

0.36

20.00%

4.00

7

7.00

0

0.00

0.00%

NA

0

NA

0

NA

NA

4.00

7

7.00

0

0.00

0.00%

NA

0

NA

0

NA

NA

0.00

0

NA

0

0.00

NA

0.00

0

NA

0

0.00

NA

NA

0

NA

0

NA

NA

NA

0

NA

0

NA

NA

NA

0

NA

0

NA

NA

1.07

1,251,657

9.63

57,457

0.47

44.22%

1.34

1,768,456

9.04

77,542

0.53

39.66%

1.22

3,020,113

9.28

134,999

0.51

41.48%

Antibiotics of Concern Utilization

Average Scrips PMPY for Quinolones

Total Cephalosporin 2nd-
4th Generation
Scrips

Average Scrips PMPY for Cephalosporins 2nd-
4th Generation

Total Azithromyci
n and Clarithro-
mycin Scrips

Average Scrips PMPY for
Azithromycins and Clarithro-
mycins

Total Amoxicillin/ Clavulanate
Scrips

Average Scrips PMPY for
Amoxicillin/ Clavulanates

Total Ketolides
Scrips

0.00

9297

0.13

17101

0.24

14840

0.21

0

0.00

8834

0.13

15622

0.23

13266

0.19

0

0.00

18,131

0.13

32,723

0.23

28,106

0.20

0

0.01

1590

0.04

6507

0.15

3447

0.08

0

0.02

1914

0.05

7878

0.19

3588

0.08

0

0.01

3,504

0.04

14,385

0.17

7,035

0.08

0

0.04

85

0.02

689

0.14

297

0.06

0

0.14

920

0.04

7370

0.29

2339

0.09

0

0.13

1,005

0.03

8,059

0.26

2,636

0.09

0

0.13

41

0.03

321

0.21

135

0.09

0

0.25

337

0.04

2646

0.35

951

0.12

0

0.23

378

0.04

2,967

0.32

1,086

0.12

0

100 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

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

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

55 417 472
0 1 1 0 0 0 0 0 0 0 0 0 745 6,635 7,380

0.18

13

0.04

0.34

54

0.04

0.31

67

0.04

0.00

0

0.00

0.24

0

0.00

0.18

0

0.00

0.00

0

0.00

NA

0

NA

0.00

0

0.00

NA

0

NA

0.00

0

0.00

0.00

0

0.00

NA

0

NA

NA

0

NA

NA

0

NA

0.01

11,026

0.09

0.05

12,059

0.08

0.03

23,085

0.09

Total Absorbable Sulfonamide
Scrips

Average

Scrips PMPY for Absorbable Sulfonamide

Total Aminoglycoside Scrips

s

Average Scrips PMPY for Aminoglycosides

3848

0.05

5

0.00

6036

0.09

1

0.00

9,884

0.07

6

0.00

1936

0.05

5

0.00

3456

0.08

0

0.00

5,392

0.06

5

0.00

397

0.08

0

0.00

4103

0.16

0

0.00

4,500

0.15

0

0.00

207

0.13

1

0.00

1559

0.20

0

0.00

80 412 492
0 0 0 0 0 0 0 0 0 0 0 0 24,698 33,928 58,626

0.26

28

0.09

0

0.33

151

0.12

0

0.32

179

0.12

0

0.00

0

0.00

0

0.00

1

0.24

0

0.00

1

0.18

0

0.00

0

0.00

0

NA

0

NA

0

0.00

0

0.00

0

NA

0

NA

0

0.00

0

0.00

0

0.00

0

0.00

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

0.20

18,747

0.15

0

0.23

20,296

0.14

0

0.22

39,043

0.15

0

All Other Antibiotics Utilization

Total 1st Generation
Cephalosporin Scrips

Average Scrips PMPY for 1st Generation Cephalosporins

Total Lincosamide
Scrips

Total Average Scrips Macrolides
PMPY for (not azith. or Lincosamides clarith.)
Scrips

5850

0.08

0

0.00

104

6150

0.09

0

0.00

91

12,000

0.09

0

0.00

195

2910

0.07

0

0.00

93

3063

0.07

0

0.00

109

5,973

0.07

0

0.00

202

337

0.07

0

0.00

27

3275

0.13

0

0.00

248

3,612

0.12

0

0.00

275

181

0.12

0

0.00

16

967

0.13

0

0.00

90

101 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Total

1,766

0.19

1

0.00

1,148

0.12

0

M

29

0.09

0

0.00

29

0.09

0

50-64

F

227

0.18

0

0.00

219

0.18

0

Total

256

0.17

0

0.00

248

0.16

0

M

1

0.75

0

0.00

0

0.00

0

65-74

F

4

0.94

0

0.00

0

0.00

0

Total

5

0.90

0

0.00

0

0.00

0

M

0

0.00

0

0.00

0

0.00

0

75-84

F

0

NA

0

NA

0

NA

0

Total

0

0.00

0

0.00

0

0.00

0

M

0

NA

0

NA

0

NA

0

85+

F

0

0.00

0

0.00

0

0.00

0

Total

0

0.00

0

0.00

0

0.00

0

M

0

NA

0

NA

0

NA

0

Unknown

F

0

NA

0

NA

0

NA

0

Total

0

NA

0

NA

0

NA

0

M

6,418

0.05

11

0.00

9,307

0.08

0

Total

F

15,385

0.11

1

0.00

13,674

0.09

0

Total

21,803

0.08

12

0.00

22,981

0.09

0

0.00

106

0.00

1

0.00

17

0.00

18

0.00

0

0.00

0

0.00

0

0.00

0

NA

0

0.00

0

NA

0

0.00

0

0.00

0

NA

0

NA

0

NA

0

0.00

241

0.00

555

0.00

796

102 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

103 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Average Scrips PMPY for Ketolides

Total Clindamycin
Scrips

Average Scrips PMPY
for Clindamycins

Total Misc. Antibiotics of
Concern Scrips

Average Scrips PMPY for Misc. Antibiotics of
Concern

0.00

1096

0.02

14

0.00

0.00

1093

0.02

12

0.00

0.00

2,189

0.02

26

0.00

0.00

807

0.02

0

0.00

0.00

973

0.02

3

0.00

0.00

1,780

0.02

3

0.00

0.00

192

0.04

3

0.00

0.00

1803

0.07

15

0.00

0.00

1,995

0.07

18

0.00

0.00

107

0.07

5

0.00

0.00

625

0.08

17

0.00

0.00

732

0.08

22

0.00

104 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

0.00

17

0.05

0

0.00

0.00

80

0.07

3

0.00

0.00

97

0.06

3

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

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

NA

0

NA

0

NA

NA

0

NA

0

NA

0.00

2,219

0.02

22

0.00

0.00

4,574

0.03

50

0.00

0.00

6,793

0.03

72

0.00

Average Scrips PMPY for Macrolides (not azith. or clarith.)
0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.01 0.01 0.01 0.01

Total Penicillin
Scrips
43043 40962 84,005 8322 10340 18,662 1085 9367 10,452
486 2807

Average

Total

Average Scrips Total Misc.

Scrips PMPY Tetracycline PMPY for

Antibiotic

for Penicillins Scrips

Tetracyclines Scrips

Average Scrips PMPY for Misc. Antibiotics

0.61

20

0.59

17

0.60

37

0.19

2263

0.24

2637

0.22

4,900

0.21

472

0.37

3253

0.34

3,725

0.31

146

0.37

1143

0.00

166

0.00

0.00

398

0.01

0.00

564

0.00

0.05

199

0.00

0.06

1857

0.04

0.06

2,056

0.02

0.09

100

0.02

0.13

12449

0.49

0.12

12,549

0.41

0.09

63

0.04

0.15

2451

0.32

105 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

0.01

3,293

0.36

0.00

90

0.29

0.01

344

0.28

0.01

434

0.28

0.00

0

0.00

0.00

3

0.71

0.00

3

0.54

0.00

0

0.00

NA

0

NA

0.00

0

0.00

NA

0

NA

0.00

0

0.00

0.00

0

0.00

NA

0

NA

NA

0

NA

NA

0

NA

0.00

53,026

0.44

0.00

63,823

0.44

0.00

116,849

0.44

1,289 41 144 185 0 0 0 1 0 1 0 0 0 0 0 0
2,943 7,194 10,137

0.14

2,514

0.27

0.13

14

0.05

0.12

192

0.16

0.12

206

0.13

0.00

0

0.00

0.00

0

0.00

0.00

0

0.00

4.00

0

0.00

NA

0

NA

4.00

0

0.00

NA

0

NA

0.00

0

0.00

0.00

0

0.00

NA

0

NA

NA

0

NA

NA

0

NA

0.02

542

0.00

0.05

17,347

0.12

0.04

17,889

0.07

106 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Antibiotic Utilization: Dual Eligibles (ABXB)

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

Member Months

Member Months

Age

Male

Female

Total

0-9

NR

NR

NR

10-17

NR

NR

NR

18-34

NR

NR

NR

35-49

NR

NR

NR

50-64

NR

NR

NR

65-74

NR

NR

NR

75-84

NR

NR

NR

85+

NR

NR

NR

Unknown

NR

NR

NR

Total

NR

NR

NR

Antibiotic Utilization

Age

Sex

Total Antibiotic
Scrips

Average Scrips Total Days PMPY for Supplied for All Antibiotics Antibiotic Scrips

Average Days Supplied per Antibiotic Scrip

Total Number of Scrips for Antibiotics of
Concern

Average Scrips PMPY for
Anitbiotics of Concern

Percentage of Antibiotics of Concern of all
Antibiotic Scrips

M

NR

NR

NR

0-9

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

10-17

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

18-34

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

35-49

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

107 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Antibiotics of Concern Utilization

Total Quinolone
Scrips

Average Scrips PMPY for
Quinolones

Total Cephalosporin
2nd-4th Generation
Scrips

Average Scrips PMPY for
Cephalosporins 2nd4th Generation

Total Azithromycin
and Clarithromycin
Scrips

Average Scrips PMPY for
Azithromycins and
Clarithromycins

Total Amoxicillin/ Clavulanate
Scrips

Average Scrips PMPY for
Amoxicillin/ Clavulanates

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

108 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

All Other Antibiotics Utilization

Total Absorbable Sulfonamide
Scrips

Average Scrips PMPY for
Absorbable Sulfonamides

Total Aminoglycoside
Scrips

Average Scrips PMPY for
Aminoglycosides

Total 1st Generation Cephalosporin
Scrips

Average Scrips PMPY for 1st Generation
Cephalosporins

Total

Average Scrips

Lincosamide PMPY for

Scrips Lincosamides

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

109 of 146

September 2013

Total

NR

M

NR

50-64

F

NR

Total

NR

M

NR

65-74

F

NR

Total

NR

M

NR

75-84

F

NR

Total

NR

M

NR

85+

F

NR

Total

NR

M

NR

Unknown

F

NR

Total

NR

M

NR

Total

F

NR

Total

NR

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

110 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

111 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Total Ketolides
Scrips

Average Scrips PMPY for Ketolides

Total Clindamycin
Scrips

Average Scrips PMPY
for Clindamycins

Total Misc. Average Scrips

Antibiotics of PMPY for Misc.

Concern Antibiotics of

Scrips

Concern

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

112 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total Macrolides (not azith. or
clarith.) Scrips

Average Scrips PMPY for Macrolides (not azith. or clarith.)

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total Penicillin
Scrips
NR NR NR NR NR NR NR NR NR NR NR

Average

Total

Average Scrips Total Misc.

Scrips PMPY Tetracycline PMPY for

Antibiotic

for Penicillins Scrips

Tetracyclines Scrips

Average Scrips PMPY for Misc. Antibiotics

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

113 of 146

September 2013

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

114 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Antibiotic Utilization: Disabled (ABXC)

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

Member Months

Member Months

Age

Male

Female

Total

0-9

NR

NR

NR

10-17

NR

NR

NR

18-34

NR

NR

NR

35-49

NR

NR

NR

50-64

NR

NR

NR

65-74

NR

NR

NR

75-84

NR

NR

NR

85+

NR

NR

NR

Unknown

NR

NR

NR

Total

NR

NR

NR

Antibiotic Utilization

Age

Sex

Total Antibiotic
Scrips

Average Scrips Total Days PMPY for Supplied for All Antibiotics Antibiotic Scrips

Average Days Supplied per Antibiotic Scrip

Total Number of Scrips for
Antibiotics of Concern

Average Scrips PMPY for
Anitbiotics of Concern

Percentage of Antibiotics of Concern of all
Antibiotic Scrips

M

NR

NR

NR

0-9

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

10-17

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

18-34

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

35-49

F

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

115 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Antibiotics of Concern Utilization

Total Quinolone
Scrips

Average Scrips PMPY for
Quinolones

Total Cephalosporin
2nd-4th Generation
Scrips

Average Scrips PMPY for
Cephalosporins 2nd-4th
Generation

Total Azithromycin
and Clarithromycin
Scrips

Average Scrips PMPY for
Azithromycins and
Clarithromycins

Total Amoxicillin/ Clavulanate
Scrips

Average Scrips PMPY for
Amoxicillin/ Clavulanates

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

116 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

All Other Antibiotics Utilization

Total Absorbable Sulfonamide
Scrips

Average Scrips PMPY for
Absorbable Sulfonamides

Total Aminoglycoside
Scrips

Average Scrips PMPY for
Aminoglycosides

Total 1st Generation Cephalosporin
Scrips

Average Scrips PMPY for 1st Generation
Cephalosporins

Total

Average Scrips

Lincosamide PMPY for

Scrips

Lincosamides

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

117 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

M

NR

NR

NR

35-49

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

50-64

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

65-74

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

75-84

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

85+

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

Unknown

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

Total

F

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

118 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

119 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Total Ketolides
Scrips

Average Scrips PMPY for Ketolides

Total Clindamycin
Scrips

Total Misc.

Average Scrips PMPY for
Clindamycins

Antibiotics of Concern Scrips

Average Scrips PMPY for Misc. Antibiotics of
Concern

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

120 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total Macrolides (not azith. or
clarith.) Scrips

Average Scrips PMPY for Macrolides (not azith. or clarith.)

Total Penicillin Scrips

Average Scrips PMPY for Penicillins

Total Tetracycline
Scrips

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Average Scrips Total Misc.

PMPY for

Antibiotic

Tetracyclines

Scrips

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Average Scrips PMPY for Misc. Antibiotics
NR NR NR NR NR NR NR NR NR

121 of 146

September 2013

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

122 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Antibiotic Utilization: Other (ABXD)

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

Member Months

Member Months

Age

Male

Female

Total

0-9

NR

NR

NR

10-17

NR

NR

NR

18-34

NR

NR

NR

35-49

NR

NR

NR

50-64

NR

NR

NR

65-74

NR

NR

NR

75-84

NR

NR

NR

85+

NR

NR

NR

Unknown

NR

NR

NR

Total

NR

NR

NR

Antibiotic Utilization

Age

Sex

Total Antibiotic
Scrips

Average Scrips Total Days PMPY for Supplied for All Antibiotics Antibiotic Scrips

Average Days Supplied per Antibiotic Scrip

Total Number of Scrips for
Antibiotics of Concern

Average Scrips PMPY for
Anitbiotics of Concern

Percentage of Antibiotics of Concern of all
Antibiotic Scrips

M

NR

NR

NR

0-9

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

10-17

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

18-34

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

35-49

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

123 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Antibiotics of Concern Utilization

Total Quinolone
Scrips

Average Scrips PMPY for
Quinolones

Total Cephalosporin
2nd-4th Generation Scrips

Average Scrips PMPY for
Cephalosporins 2nd-4th
Generation

Total Azithromycin
and Clarithromycin
Scrips

Average Scrips PMPY for
Azithromycins and
Clarithromycins

Total Amoxicillin/ Clavulanate
Scrips

Average Scrips PMPY for
Amoxicillin/ Clavulanates

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

124 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

All Other Antibiotics Utilization

Total Absorbable Sulfonamide
Scrips

Average Scrips PMPY for
Absorbable Sulfonamides

Total Aminoglycoside
Scrips

Average Scrips PMPY for
Aminoglycosides

Total 1st Generation Cephalosporin
Scrips

Average Scrips PMPY for 1st Generation
Cephalosporins

Total

Average Scrips

Lincosamide PMPY for

Scrips

Lincosamides

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

125 of 146

September 2013

35-49

F

NR

Total

NR

M

NR

50-64

F

NR

Total

NR

M

NR

65-74

F

NR

Total

NR

M

NR

75-84

F

NR

Total

NR

M

NR

85+

F

NR

Total

NR

M

NR

Unknown

F

NR

Total

NR

M

NR

Total

F

NR

Total

NR

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

126 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

127 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Total Ketolides
Scrips

Average Scrips PMPY for Ketolides

Total Clindamycin
Scrips

Average Scrips PMPY for
Clindamycins

Total Misc. Antibiotics of
Concern Scrips

Average Scrips PMPY
for Misc. Antibiotics of
Concern

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

128 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total Macrolides (not azith. or
clarith.) Scrips

Average Scrips PMPY for Macrolides (not azith. or clarith.)

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total Penicillin
Scrips
NR NR NR NR NR NR NR NR NR NR

Average Scrips

Total

PMPY for Tetracycline

Penicillins

Scrips

Average Scrips PMPY
for Tetracyclines

Total Misc. Antibiotic
Scrips

Average Scrips PMPY for Misc. Antibiotics

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

129 of 146

September 2013

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

130 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Board Certification (BCR)

AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area:

None, Spec Proj: None)

Number of

Board Certification

Physicians

Type of Physician

in Each Practice
Area

Number

Percent

Family Medicine Internal Medicine OB/GYN physicians
Pediatricians Geriatricians Other physician specialists

1137 1887 804 1252
18 5077

828 1425 648 977
17 4213

72.82% 75.52% 80.60% 78.04% 94.44% 82.98%

131 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Total Membership (TLM)

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

Product/Product Line
HMO (Total) Medicaid
Commercial Medicare (cost or risk)
Other PPO (Total)
Medicaid Commercial Medicare (cost or risk)
Other POS (Total)
Medicaid Commercial Medicare (cost or risk)
Other FFS (Total) Medicaid Commercial Medicare (cost or risk)
Other Total * Total number of members in each category as of December 31 of the measurement year.

Total Number of Members*
274,262 274177
0 85 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 274,262

132 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Enrollment by Product Line: Total (ENPA)

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

Male

Female

Total

Age

Member

Member

Member

Months

Months

Months

<1

121969

118623

240,592

1-4 5-9 10-14

338478 393003 349433

327876 383271 342367

666,354 776,274 691,800

15-17

165935

165974

331,909

18-19

41797

59785

101,582

0-19 Subtotal

1,410,615 1,397,896 2,808,511

0-19 Subtotal: %

97.14%

79.93%

87.74%

20-24

4633

85184

89,817

25-29

6313

85093

91,406

30-34 35-39 40-44

8150 7596 6410

74306 48646 27723

82,456 56,242 34,133

20-44 Subtotal

33,102

320,952

354,054

20-44 Subtotal: %

2.28%

18.35%

11.06%

45-49

4724

15123

19,847

50-54

2285

8044

10,329

55-59

1096

4123

5,219

60-64

349

2601

2,950

45-64 Subtotal 45-64 Subtotal: %

8,454 0.58%

29,891 1.71%

38,345 1.20%

65-69

2

51

53

70-74

14

0

14

75-79

0

0

0

80-84

3

0

3

85-89

0

2

2

>=90

0

0

0

>=65 Subtotal >=65 Subtotal: %
Age Unknown

19 0.00%
0

53 0.00%
0

72 0.00%
0

133 of 146

September 2013

Total

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP
1,452,190 1,748,792 3,200,982

134 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Enrollment by Product Line: Dual Eligibles (ENPB)

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

Male

Female

Total

Age

Member

Member

Member

Months

Months

Months

<1

NR

NR

NR

1-4 5-9 10-14

NR

NR

NR

NR

NR

NR

NR

NR

NR

15-17

NR

NR

NR

18-19

NR

NR

NR

0-19 Subtotal

NR

NR

NR

0-19 Subtotal: %

NR

NR

NR

20-24

NR

NR

NR

25-29

NR

NR

NR

30-34 35-39 40-44

NR

NR

NR

NR

NR

NR

NR

NR

NR

20-44 Subtotal

NR

NR

NR

20-44 Subtotal: %

NR

NR

NR

45-49

NR

NR

NR

50-54

NR

NR

NR

55-59

NR

NR

NR

60-64

NR

NR

NR

45-64 Subtotal 45-64 Subtotal: %

NR

NR

NR

NR

NR

NR

65-69

NR

NR

NR

70-74

NR

NR

NR

75-79

NR

NR

NR

80-84

NR

NR

NR

85-89

NR

NR

NR

>=90

NR

NR

NR

>=65 Subtotal >=65 Subtotal: %
Age Unknown

NR

NR

NR

NR

NR

NR

NR

NR

NR

135 of 146

September 2013

Total

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

NR

NR

NR

136 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Enrollment by Product Line: Disabled (ENPC)

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

Male

Female

Total

Age

Member

Member

Member

Months

Months

Months

<1

NR

NR

NR

1-4 5-9 10-14

NR

NR

NR

NR

NR

NR

NR

NR

NR

15-17

NR

NR

NR

18-19

NR

NR

NR

0-19 Subtotal

NR

NR

NR

0-19 Subtotal: %

NR

NR

NR

20-24

NR

NR

NR

25-29

NR

NR

NR

30-34 35-39 40-44

NR

NR

NR

NR

NR

NR

NR

NR

NR

20-44 Subtotal

NR

NR

NR

20-44 Subtotal: %

NR

NR

NR

45-49

NR

NR

NR

50-54

NR

NR

NR

55-59

NR

NR

NR

60-64

NR

NR

NR

45-64 Subtotal 45-64 Subtotal: %

NR

NR

NR

NR

NR

NR

65-69

NR

NR

NR

70-74

NR

NR

NR

75-79

NR

NR

NR

80-84

NR

NR

NR

85-89

NR

NR

NR

>=90

NR

NR

NR

>=65 Subtotal >=65 Subtotal: %
Age Unknown

NR

NR

NR

NR

NR

NR

NR

NR

NR

137 of 146

September 2013

Total

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

NR

NR

NR

138 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Enrollment by Product Line: Other (ENPD)

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

Male

Female

Total

Age

Member

Member

Member

Months

Months

Months

<1

NR

NR

NR

1-4 5-9 10-14

NR

NR

NR

NR

NR

NR

NR

NR

NR

15-17

NR

NR

NR

18-19

NR

NR

NR

0-19 Subtotal

NR

NR

NR

0-19 Subtotal: %

NR

NR

NR

20-24

NR

NR

NR

25-29

NR

NR

NR

30-34 35-39 40-44

NR

NR

NR

NR

NR

NR

NR

NR

NR

20-44 Subtotal

NR

NR

NR

20-44 Subtotal: %

NR

NR

NR

45-49

NR

NR

NR

50-54

NR

NR

NR

55-59

NR

NR

NR

60-64

NR

NR

NR

45-64 Subtotal 45-64 Subtotal: %

NR

NR

NR

NR

NR

NR

65-69

NR

NR

NR

70-74

NR

NR

NR

75-79

NR

NR

NR

80-84

NR

NR

NR

85-89

NR

NR

NR

>=90

NR

NR

NR

>=65 Subtotal >=65 Subtotal: %
Age Unknown

NR

NR

NR

NR

NR

NR

NR

NR

NR

139 of 146

September 2013

Total

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

NR

NR

NR

140 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Enrollment by State (EBS)

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

State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii
Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey

Number 0 0 0 0 0 0 0 0 0 0
274177 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

141 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

New Mexico New York
North Carolina North Dakota
Ohio Oklahoma
Oregon Pennsylvania Rhode Island South Carolina South Dakota
Tennessee Texas Utah
Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Commonwealth of Northern Marianas Puerto Rico Virgin Islands Other TOTAL

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 274,177

142 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Race/Ethnicity Diversity of Membership (RDM)

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

Race/Ethnicity Diversity of Membership

Total Unduplicated Membership During the Measurement Year

392695

Percentage of Members for Whom the Organization has Race/Ethnicity Information by Data Collection

Direct Data Collection Method

Indirect Data Collection Method

Direct Total 92.01%

Race

Health Plan Direct*
CMS/State Database*

0.0000 0.9201

Indirect Total*

0.0000

Other*

0.0000

Direct Total 3.15%

Ethnicity

Health Plan Direct*
CMS/State Database*

0.0000 0.0315

Indirect Total*

0.0000

Other*

0.0000

*Enter percentage as a value between 0 and 1.

Race

Hispanic or Latino

Not Hispanic or Latino

Number Percentage Number Percentage

White

0

0.00%

433

100.00%

Black or African American

0

0.00%

0

0.00%

American-Indian and Alaska Native

0

0.00%

0

0.00%

Asian

0

0.00%

0

0.00%

Native Hawaiian and Other Pacific Islanders

0

0.00%

0

0.00%

Some Other Race

0

0.00%

0

0.00%

Two or More Races

0

0.00%

0

0.00%

Unknown

11955

100.00%

0

0.00%

Declined

0

0.00%

0

0.00%

Total

11,955

100.00%

433

100.00%

Unknown

Total*

0.0799

Total*

0.9685

Unknown Ethnicity

Number Percentage

173907

45.73%

172532

45.37%

352

0.09%

7354

1.93%

398

0.10%

6330

1.66%

0

0.00%

19434

5.11%

0

0.00%

380,307

100.00%

Declined Ethnicity

Number Percentage

0

NR

0

NR

0

NR

0

NR

0

NR

0

NR

0

NR

0

NR

0

NR

0

NR

143 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Total

Number Percentage

174,340

44.40%

172,532

43.94%

352

0.09%

7,354

1.87%

398

0.10%

6,330

1.61%

0

0.00%

31,389

7.99%

0

0.00%

392,695

100.00%

144 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

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 ThirdParty Source

Spoken Language Preferred for Health Care*

0.0000

Preferred Language for Written Materials*

0.0000

Other Language Needs*

0.0000

*Enter percentage as a value between 0 and 1.

Spoken Language Preferred for Health Care

1.0000 1.0000 0.0000

0.0000 0.0000 1.0000

English Non-English
Unknown Declined
Total* Language Preferred for Written Materials

Number 212660 28773 151262
0 392,695

Percentage 54.15% 7.33% 38.52% 0.00% 100.00%

English Non-English
Unknown Declined
Total* Other Language Needs

Number 212660 28773 151262
0 392,695

Percentage 54.15% 7.33% 38.52% 0.00% 100.00%

English Non-English
Unknown Declined
Total* *Should sum to 100%

Number 0 0
392695 0
392,695

Percentage 0.00% 0.00%
100.00% 0.00%
100.00%

145 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Weeks of Pregnancy at Time of Enrollment in MCO (WOP)

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

Spec Proj: None)

Measurement Year

Measurement Year

2012

Weeks of Pregnancy

Number Percentage

< 0 weeks

1300

9.04%

1-12 weeks

1091

7.59%

13-27 weeks

8400

58.43%

28 or more weeks

2463

17.13%

Unknown

1121

7.80%

Total

14,375

100.00%

146 of 146

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Audit Review Table

AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None); Measurement Year - 2012 The Auditor lock has been applied to this submission.
Pharmacy Reversal - Pharmacy Reversals Included

Measure/Data Element Effectiveness of Care: Prevention and Screening

Report Measure

Benefit Offered

Rotated Measure

Rate

Reportable

Comment

Adult BMI Assessment (aba)

Y

N

62.70%

R

Reportable

Weight Assessment and Counseling for Nutrition

and Physical Activity for Children/Adolescents

Y

N

(wcc)

BMI Percentile

Counseling for Nutrition

Counseling for Physical Activity

Childhood Immunization Status (cis)

Y

DTaP

IPV

MMR

HiB

40.74%

R

52.31%

R

39.81%

R

N

88.66%

R

96.30%

R

94.21%

R

95.83%

R

Reportable Reportable Reportable
Reportable Reportable Reportable Reportable

Hepatitis B VZV
Pneumococcal Conjugate Hepatitis A Rotavirus Influenza
Combination #2 Combination #3 Combination #4

93.98%

R

95.60%

R

88.43%

R

93.98%

R

71.53%

R

45.37%

R

85.42%

R

82.64%

R

81.94%

R

Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable

Combination #5

Combination #6

Combination #7

Combination #8

Combination #9

Combination #10

Immunizations for Adolescents (ima)

Y

63.43%

R

40.97%

R

62.96%

R

40.97%

R

31.94%

R

31.94%

R

Reportable Reportable Reportable Reportable Reportable Reportable

1 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Audit Review Table

AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None); Measurement Year - 2012

The Auditor lock has been applied to this submission.

Pharmacy Reversal - Pharmacy Reversals Included

Measure/Data Element

Report Measure

Benefit Offered

Rotated Measure

Rate

Reportable

Comment

Meningococcal

73.51%

R

Reportable

Tdap/Td

84.68%

R

Reportable

Combination #1

71.43%

R

Reportable

Human Papillomavirus Vaccine for Female Adolescents (hpv)

Y

16.71%

R

Reportable

Lead Screening in Children (lsc)

Y

N

74.06%

R

Reportable

Breast Cancer Screening (bcs)

Y

59.22%

R

Reportable

Cervical Cancer Screening (ccs)

Y

72.09%

R

Reportable

Chlamydia Screening in Women (chl)

Y

16-20 Years

53.93%

R

Reportable

21-24 Years

68.86%

R

Reportable

Total

56.98%

R

Reportable

Effectiveness of Care: Respiratory Conditions

Appropriate Testing for Children with Pharyngitis (cwp)

Y

Y

77.44%

R

Reportable

Appropriate Treatment for Children With URI (uri)

Y

Y

82.66%

R

Reportable

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (aab)

Y

Y

Use of Spirometry Testing in the Assessment and Diagnosis of COPD (spr)

Y

Pharmacotherapy Management of COPD Exacerbation (pce)

Y

Y

Systemic Corticosteroid

Bronchodilator

Use of Appropriate Medications for People With Asthma (asm)

Y

Y

5-11 Years

12-18 Years

19-50 Years

17.83%

R

23.26%

R

63.27%

R

83.67%

R

90.32%

R

88.69%

R

69.17%

R

Reportable Reportable
Reportable Reportable
Reportable Reportable Reportable

2 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Audit Review Table

AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None); Measurement Year - 2012

The Auditor lock has been applied to this submission.

Pharmacy Reversal - Pharmacy Reversals Included

Measure/Data Element

Report Measure

Benefit Offered

Rotated Measure

Rate

Reportable

Comment

51-64 Years

NA

R

Denominator fewer than 30

Total

89.03%

R

Reportable

Medication Management for People With Asthma (mma)

Y

Y

5-11 Years - Medication Compliance 50%

44.00%

R

Reportable

5-11 Years - Medication Compliance 75%

20.62%

R

Reportable

12-18 Years - Medication Compliance 50%

42.50%

R

Reportable

12-18 Years - Medication Compliance 75%

18.97%

R

Reportable

19-50 Years - Medication Compliance 50%

44.58%

R

Reportable

19-50 Years - Medication Compliance 75%

15.66%

R

Reportable

51-64 Years - Medication Compliance 50%

NA

R

Denominator fewer than 30

51-64 Years - Medication Compliance 75%

NA

R

Denominator fewer than 30

Total - Medication Compliance 50%

43.64%

R

Reportable

Total - Medication Compliance 75%

20.07%

R

Reportable

Asthma Medication Ratio (amr)

Y

Y

5-11 Years

62.42%

R

Reportable

12-18 Years

64.26%

R

Reportable

19-50 Years

40.34%

R

Reportable

51-64 Years

NA

R

Denominator fewer than 30

Total

62.40%

R

Reportable

Effectiveness of Care: Cardiovascular

Cholesterol Management for Patients With Cardiovascular Conditions (cmc)

Y

Y

LDL-C Screening Performed

87.50%

R

Reportable

LDL-C Control (<100 mg/dL)

27.50%

R

Reportable

Controlling High Blood Pressure (cbp)

Y

38.72%

R

Reportable

Persistence of Beta-Blocker Treatment After a Heart Attack (pbh)

Y

Y

NA

R

Denominator fewer than 30

Effectiveness of Care: Diabetes

Comprehensive Diabetes Care (cdc)

Y

N

3 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Audit Review Table

AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None); Measurement Year - 2012

The Auditor lock has been applied to this submission.

Pharmacy Reversal - Pharmacy Reversals Included

Measure/Data Element

Report Measure

Benefit Offered

Rotated Measure

Rate

Reportable

Comment

Hemoglobin A1c (HbA1c) Testing

79.37%

R

Reportable

HbA1c Poor Control (>9.0%)

53.58%

R

Reportable

HbA1c Control (<8.0%)

38.94%

R

Reportable

HbA1c Control (<7.0%)

30.56%

R

Reportable

Eye Exam (Retinal) Performed

48.25%

R

Reportable

LDL-C Screening Performed

73.21%

R

Reportable

LDL-C Control (<100 mg/dL)

27.29%

R

Reportable

Medical Attention for Nephropathy

74.38%

R

Reportable

Blood Pressure Control (<140/80 mm Hg)

32.61%

R

Reportable

Blood Pressure Control (<140/90 mm Hg)

55.07%

R

Reportable

Effectiveness of Care: Musculoskeletal

Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis (art)

Y

Y

65.00%

R

Reportable

Use of Imaging Studies for Low Back Pain (lbp)

Y

74.22%

R

Reportable

Effectiveness of Care: Behavioral Health

Antidepressant Medication Management (amm)

Y

Y

Effective Acute Phase Treatment

Effective Continuation Phase Treatment

Follow-Up Care for Children Prescribed ADHD Medication (add)

Y

Y

Initiation Phase

Continuation and Maintenance (C&M) Phase

Follow-Up After Hospitalization for Mental Illness (fuh)

Y

Y

30-Day Follow-Up

7-Day Follow-Up

54.16%

R

36.81%

R

42.32%

R

58.15%

R

67.29%

R

45.80%

R

Reportable Reportable
Reportable Reportable
Reportable Reportable

4 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Audit Review Table

AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None); Measurement Year - 2012

The Auditor lock has been applied to this submission.

Pharmacy Reversal - Pharmacy Reversals Included

Measure/Data Element

Report Measure

Benefit Offered

Rotated Measure

Rate

Reportable

Comment

Diabetes Screening for People With Schizophrenia

or Bipolar Disorder Who Are Using Antipsychotic

Y

Y

Medication (ssd)

84.04%

R

Reportable

Diabetes Monitoring for People With Diabetes and Schizophrenia (smd)

Y

NA

R

Denominator fewer than 30

Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (smc)

Y

NA

R

Denominator fewer than 30

Adherence to Antipsychotic Medications for Individuals With Schizophrenia (saa)

Y

Y

Effectiveness of Care: Medication Management

Annual Monitoring for Patients on Persistent Medications (mpm)

Y

Y

ACE Inhibitors or ARBs

Digoxin

Diuretics

Anticonvulsants

Total

Access/Availability of Care

Adults' Access to Preventive/Ambulatory Health Services (aap)

Y

20-44 Years

45-64 Years

65+ Years

Total

Children and Adolescents' Access to Primary Care Practitioners (cap)

Y

12-24 Months

25 Months - 6 Years

7-11 Years

46.30%

R

90.93%

R

NA

R

89.80%

R

61.43%

R

89.32%

R

83.84%

R

90.25%

R

NA

R

84.79%

R

97.55%

R

91.44%

R

92.26%

R

Reportable
Reportable Denominator fewer than 30
Reportable Reportable Reportable
Reportable Reportable Denominator fewer than 30 Reportable
Reportable Reportable Reportable

5 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Audit Review Table

AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None); Measurement Year - 2012

The Auditor lock has been applied to this submission.

Pharmacy Reversal - Pharmacy Reversals Included

Measure/Data Element

Report Measure

Benefit Offered

Rotated Measure

Rate

Reportable

Comment

12-19 Years

90.08%

R

Reportable

Annual Dental Visit (adv)

Y

Y

2-3 Years

48.50%

R

Reportable

4-6 Years

77.44%

R

Reportable

7-10 Years

79.64%

R

Reportable

11-14 Years

72.39%

R

Reportable

15-18 Years

61.55%

R

Reportable

19-21 Years

35.70%

R

Reportable

Total

69.92%

R

Reportable

Initiation and Engagement of AOD Dependence Treatment (iet)

Y

Y

Initiation of AOD Treatment: 13-17 Years

39.37%

R

Reportable

Engagement of AOD Treatment: 13-17 Years

15.24%

R

Reportable

Initiation of AOD Treatment: 18+ Years

42.60%

R

Reportable

Engagement of AOD Treatment: 18+ Years

8.50%

R

Reportable

Initiation of AOD Treatment: Total

41.87%

R

Reportable

Engagement of AOD Treatment: Total

10.01%

R

Reportable

Prenatal and Postpartum Care (ppc)

Y

Timeliness of Prenatal Care

84.72%

R

Reportable

Postpartum Care

59.49%

R

Reportable

Call Answer Timeliness (cat)

Y

85.71%

R

Reportable

Utilization

Frequency of Ongoing Prenatal Care (fpc)

Y

<21 Percent

10.65%

R

Reportable

21-40 Percent

4.17%

R

Reportable

41-60 Percent

7.64%

R

Reportable

61-80 Percent

11.11%

R

Reportable

81+ Percent

66.44%

R

Reportable

Well-Child Visits in the First 15 Months of Life (w15)

Y

N

6 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Audit Review Table

AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None); Measurement Year - 2012

The Auditor lock has been applied to this submission.

Pharmacy Reversal - Pharmacy Reversals Included

Measure/Data Element

Report Measure

Benefit Offered

Rotated Measure

Rate

Reportable

Comment

0 Visits

1.49%

R

Reportable

1 Visit

1.74%

R

Reportable

2 Visits

3.97%

R

Reportable

3 Visits

3.47%

R

Reportable

4 Visits

7.94%

R

Reportable

5 Visits

18.36%

R

Reportable

6+ Visits

63.03%

R

Reportable

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (w34)

Y

N

68.21%

R

Reportable

Adolescent Well-Care Visits (awc)

Y

N

46.58%

R

Reportable

Frequency of Selected Procedures (fsp)

Y

R

Reportable

Ambulatory Care: Total (amba)

Y

R

Reportable

Ambulatory Care: Dual Eligibles (ambb)

N

NR

Measure Unselected

Ambulatory Care: Disabled (ambc)

N

NR

Measure Unselected

Ambulatory Care: Other (ambd)

N

NR

Measure Unselected

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

Y

R

Reportable

Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (ipub)

N

NR

Measure Unselected

Inpatient Utilization--General Hospital/Acute Care: Disabled (ipuc)

N

NR

Measure Unselected

Inpatient Utilization--General Hospital/Acute Care: Other (ipud)

N

NR

Measure Unselected

Identification of Alcohol and Other Drug Services: Total (iada)

Y

Y

R

Reportable

Identification of Alcohol and Other Drug Services: Dual Eligibles (iadb)

N

N

NR

Measure Unselected

Identification of Alcohol and Other Drug Services: Disabled (iadc)

N

N

NR

Measure Unselected

7 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Audit Review Table

AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None); Measurement Year - 2012

The Auditor lock has been applied to this submission.

Pharmacy Reversal - Pharmacy Reversals Included

Measure/Data Element

Report Measure

Benefit Offered

Rotated Measure

Rate

Reportable

Comment

Identification of Alcohol and Other Drug Services: Other (iadd)

N

N

NR

Measure Unselected

Mental Health Utilization: Total (mpta)

Y

Y

R

Reportable

Mental Health Utilization: Dual Eligibles (mptb)

N

N

NR

Measure Unselected

Mental Health Utilization: Disabled (mptc)

N

N

Mental Health Utilization: Other (mptd)

N

N

Antibiotic Utilization: Total (abxa)

Y

Y

Antibiotic Utilization: Dual Eligibles (abxb)

N

N

Antibiotic Utilization: Disabled (abxc)

N

N

Antibiotic Utilization: Other (abxd)

N

N

Relative Resource Use

Relative Resource Use for People With Diabetes (rdi)

Y

Relative Resource Use for People With Asthma (ras)

Y

Y

Relative Resource Use for People With Cardiovascular Conditions (rca)

Y

Relative Resource Use for People With Hypertension (rhy)

Y

NR

Measure Unselected

NR

Measure Unselected

R

Reportable

NR

Measure Unselected

NR

Measure Unselected

NR

Measure Unselected

R

Reportable

R

Reportable

R

Reportable

R

Reportable

Relative Resource Use for People With COPD (rco)

Y

R

Reportable

Health Plan Descriptive Information

Board Certification (bcr)

Y

Total Membership (tlm)

Y

Enrollment by Product Line: Total (enpa)

Y

R

Reportable

R

Reportable

R

Reportable

Enrollment by Product Line: Dual Eligibles (enpb)

N

NR

Measure Unselected

Enrollment by Product Line: Disabled (enpc)

N

Enrollment by Product Line: Other (enpd)

N

NR

Measure Unselected

NR

Measure Unselected

8 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Audit Review Table

AmeriGroup Georgia Managed Care Company, Inc. (Org ID: 7359, SubID: 10188, Medicaid, Spec Area: None, Spec Proj: None); Measurement Year - 2012

The Auditor lock has been applied to this submission.

Pharmacy Reversal - Pharmacy Reversals Included

Measure/Data Element

Report Measure

Benefit Offered

Rotated Measure

Rate

Reportable

Comment

Enrollment by State (ebs)

Y

R

Reportable

Race/Ethnicity Diversity of Membership (rdm)

Y

R

Reportable

Language Diversity of Membership (ldm)

Y

Weeks of Pregnancy at Time of Enrollment in MCO (wop)

Y

R

Reportable

R

Reportable

9 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Relative Resource Use for People With Diabetes (RDI)

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

Data Element
Eligible Population Exclusions
Eligible Population per 1,000 Member Year Medical Eligible Population per 1,000 Member Year Pharmacy
NameBrandOnlyCount(N1) NameBrandGenericExistsCount(N2)
GenericOnlyCount (G1) GenericNameBrandExistsCount (G2) Total Prescriptions (N1+N2+G1+G2) Generic Utilization Rate [(G1 + G2)/(N2+G1+G2)] Generic Substitution Rate [(G2)/(N2+G2)] Overall Generic Utilization [(G1+G2)/(N1+N2+G1+G2)]
Inpatient Facility PMPM E&M Inpatient Services PMPM E&M Outpatient Services PMPM Surgery & Procedure Inpatient Services PMPM Surgery & Procedure Outpatient Services PMPM
Imaging Services PMPM Laboratory Services PMPM
Pharmacy PMPM Inpatient Facility: Acute Inpatient: Medical Days per 1000 MY Inpatient Facility: Acute Inpatient: Medical Discharges per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Days per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Discharges per 1000 MY
Inpatient Facility: Nonacute Days per 1000 MY Inpatient Facility: Nonacute Discharges per 1000 MY
Inpatient Facility Acute Medical ALOS Inpatient Facility Acute Surgery ALOS
Inpatient Facility Nonacute ALOS Total Inpatient Facility Acute ALOS
Total Inpatient Facility ALOS

Measure Data 1051 63
1,011.87 1,011.87
5995 2259 5678 42371 56,303.00 95.51% 94.94% 85.34% 278.11 14.22 89.12 15.26 83.61 72.21 35.94 162.66 1,215.98 256.10 205.07 36.59 30.81 1.93 4.75 5.61 16.00 4.86 4.93

10 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

ED Discharges per 1000 MY Medical Cardiac Catheterization per 1000 MY Medical
PCI per 1000 MY Medical CABG per 1000 MY Medical Carotid Endarterectomy per 1000 MY Medical Carotid Artery Stenosis Diagnostic Test per 1000 MY Medical Cardiac Computed Tomography per 1000 MY Medical CAD Diagnostic Test Using EBCT/Nuclear Imaging Stress Tests per 1000 MY Medical

2,443.52 30.81 3.85 0.00 0.00 0.00 0.00 105.91

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (aab) Use of Spirometry Testing in the Assessment and Diagnosis of COPD (spr)
Use of Appropriate Medications for People With Asthma (asm)

11 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP
Cholesterol Management for Patients With Cardiovascular Conditions (cmc) Persistence of Beta-Blocker Treatment After a Heart Attack (pbh)

Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis (art) Effectiveness of Care: Behavioral Health Follow-Up Care for Children Prescribed ADHD Medication (add)
12 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP
Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication (ssd) Diabetes Monitoring for People With Diabetes and Schizophrenia (smd) Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (smc) Adherence to Antipsychotic Medications for Individuals With Schizophrenia (saa) Effectiveness of Care: Medication Management Annual Monitoring for Patients on Persistent Medications (mpm)
Adults' Access to Preventive/Ambulatory Health Services (aap)
Children and Adolescents' Access to Primary Care Practitioners (cap)

Initiation and Engagement of AOD Dependence Treatment (iet) 13 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (w34)
Inpatient Utilization--General Hospital/Acute Care: Total (ipua) Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (ipub) Inpatient Utilization--General Hospital/Acute Care: Disabled (ipuc) Inpatient Utilization--General Hospital/Acute Care: Other (ipud) Identification of Alcohol and Other Drug Services: Total (iada) Identification of Alcohol and Other Drug Services: Dual Eligibles (iadb) Identification of Alcohol and Other Drug Services: Disabled (iadc) Identification of Alcohol and Other Drug Services: Other (iadd)
14 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP
Relative Resource Use for People With Cardiovascular Conditions (rca)

15 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Relative Resource Use for People With Asthma (RAS)

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

Data Element
Eligible Population Exclusions
Eligible Population per 1,000 Member Year Medical Eligible Population per 1,000 Member Year Pharmacy
NameBrandOnlyCount(N1) NameBrandGenericExistsCount(N2)
GenericOnlyCount (G1) GenericNameBrandExistsCount (G2) Total Prescriptions (N1+N2+G1+G2) Generic Utilization Rate [(G1 + G2)/(N2+G1+G2)] Generic Substitution Rate [(G2)/(N2+G2)] Overall Generic Utilization [(G1+G2)/(N1+N2+G1+G2)]
Inpatient Facility PMPM E&M Inpatient Services PMPM E&M Outpatient Services PMPM Surgery & Procedure Inpatient Services PMPM Surgery & Procedure Outpatient Services PMPM
Imaging Services PMPM Laboratory Services PMPM
Pharmacy PMPM Inpatient Facility: Acute Inpatient: Medical Days per 1000 MY Inpatient Facility: Acute Inpatient: Medical Discharges per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Days per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Discharges per 1000 MY
Inpatient Facility: Nonacute Days per 1000 MY Inpatient Facility: Nonacute Discharges per 1000 MY
Inpatient Facility Acute Medical ALOS Inpatient Facility Acute Surgery ALOS
Inpatient Facility Nonacute ALOS Total Inpatient Facility Acute ALOS
Total Inpatient Facility ALOS

Measure Data 3602 521
1,011.02 1,011.02
20906 14813 7502 42521 85,742.00 77.15% 74.16% 58.34% 21.45 1.30 53.30 0.81 14.79 10.98 5.65 97.36 113.40 27.23 8.42 2.81 23.58 0.84 4.16 3.00 28.00 4.06 4.71

16 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

ED Discharges per 1000 MY Medical

947.58

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (aab) Use of Spirometry Testing in the Assessment and Diagnosis of COPD (spr)
Use of Appropriate Medications for People With Asthma (asm)

17 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP
Cholesterol Management for Patients With Cardiovascular Conditions (cmc) Persistence of Beta-Blocker Treatment After a Heart Attack (pbh)

Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis (art) Effectiveness of Care: Behavioral Health Follow-Up Care for Children Prescribed ADHD Medication (add)
18 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP
Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication (ssd) Diabetes Monitoring for People With Diabetes and Schizophrenia (smd) Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (smc) Adherence to Antipsychotic Medications for Individuals With Schizophrenia (saa) Effectiveness of Care: Medication Management Annual Monitoring for Patients on Persistent Medications (mpm)
Adults' Access to Preventive/Ambulatory Health Services (aap)
Children and Adolescents' Access to Primary Care Practitioners (cap)

Initiation and Engagement of AOD Dependence Treatment (iet) 19 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (w34)
Inpatient Utilization--General Hospital/Acute Care: Total (ipua) Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (ipub) Inpatient Utilization--General Hospital/Acute Care: Disabled (ipuc) Inpatient Utilization--General Hospital/Acute Care: Other (ipud) Identification of Alcohol and Other Drug Services: Total (iada) Identification of Alcohol and Other Drug Services: Dual Eligibles (iadb) Identification of Alcohol and Other Drug Services: Disabled (iadc) Identification of Alcohol and Other Drug Services: Other (iadd)
20 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP
Relative Resource Use for People With Cardiovascular Conditions (rca)

21 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Relative Resource Use for People With Cardiovascular Conditions (RCA)

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

Data Element

Measure Data

Eligible Population

53

Exclusions

3

Eligible Population per 1,000 Member Year Medical

1,007.92

Eligible Population per 1,000 Member Year Pharmacy

1,007.92

NameBrandOnlyCount(N1)

221

NameBrandGenericExistsCount(N2) GenericOnlyCount (G1)
GenericNameBrandExistsCount (G2)

151 334 2430

Total Prescriptions (N1+N2+G1+G2)

3,136.00

Generic Utilization Rate [(G1 + G2)/(N2+G1+G2)]

94.82%

Generic Substitution Rate [(G2)/(N2+G2)]

94.15%

Overall Generic Utilization [(G1+G2)/(N1+N2+G1+G2)]

88.14%

Inpatient Facility PMPM

677.78

E&M Inpatient Services PMPM E&M Outpatient Services PMPM Surgery & Procedure Inpatient Services PMPM

35.99 105.54 64.31

Surgery & Procedure Outpatient Services PMPM

79.68

Imaging Services PMPM

93.60

Laboratory Services PMPM

40.07

Pharmacy PMPM

141.89

Inpatient Facility: Acute Inpatient: Medical Days per 1000 MY

2,510.30

Inpatient Facility: Acute Inpatient: Medical Discharges per 1000 MY

513.47

Inpatient Facility: Acute Inpatient: Surgery Days per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Discharges per 1000 MY
Inpatient Facility: Nonacute Days per 1000 MY

703.65 171.16
0.00

Inpatient Facility: Nonacute Discharges per 1000 MY

0.00

Inpatient Facility Acute Medical ALOS

4.89

Inpatient Facility Acute Surgery ALOS

4.11

Inpatient Facility Nonacute ALOS

NA

Total Inpatient Facility Acute ALOS

4.69

Total Inpatient Facility ALOS

4.69

22 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

ED Discharges per 1000 MY Medical Cardiac Catheterization per 1000 MY Medical
PCI per 1000 MY Medical CABG per 1000 MY Medical Carotid Endarterectomy per 1000 MY Medical Carotid Artery Stenosis Diagnostic Test per 1000 MY Medical Cardiac Computed Tomography per 1000 MY Medical
CAD Diagnostic Test Using EBCT/Nuclear Imaging Stress Tests per 1000 MY Medical

2,491.28 209.19 209.19
0.00 0.00 0.00 0.00
475.44

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (aab) Use of Spirometry Testing in the Assessment and Diagnosis of COPD (spr)
Use of Appropriate Medications for People With Asthma (asm)

23 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP
Cholesterol Management for Patients With Cardiovascular Conditions (cmc) Persistence of Beta-Blocker Treatment After a Heart Attack (pbh)

Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis (art) Effectiveness of Care: Behavioral Health Follow-Up Care for Children Prescribed ADHD Medication (add)
24 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP
Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication (ssd) Diabetes Monitoring for People With Diabetes and Schizophrenia (smd) Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (smc) Adherence to Antipsychotic Medications for Individuals With Schizophrenia (saa) Effectiveness of Care: Medication Management Annual Monitoring for Patients on Persistent Medications (mpm)
Adults' Access to Preventive/Ambulatory Health Services (aap)
Children and Adolescents' Access to Primary Care Practitioners (cap)

Initiation and Engagement of AOD Dependence Treatment (iet) 25 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (w34)
Inpatient Utilization--General Hospital/Acute Care: Total (ipua) Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (ipub) Inpatient Utilization--General Hospital/Acute Care: Disabled (ipuc) Inpatient Utilization--General Hospital/Acute Care: Other (ipud) Identification of Alcohol and Other Drug Services: Total (iada) Identification of Alcohol and Other Drug Services: Dual Eligibles (iadb) Identification of Alcohol and Other Drug Services: Disabled (iadc)
26 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP
Identification of Alcohol and Other Drug Services: Other (iadd)
Relative Resource Use for People With Cardiovascular Conditions (rca)

27 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Relative Resource Use for People With Hypertension (RHY)

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

Data Element
Eligible Population Exclusions
Eligible Population per 1,000 Member Year Medical Eligible Population per 1,000 Member Year Pharmacy
NameBrandOnlyCount(N1) NameBrandGenericExistsCount(N2)
GenericOnlyCount (G1) GenericNameBrandExistsCount (G2) Total Prescriptions (N1+N2+G1+G2) Generic Utilization Rate [(G1 + G2)/(N2+G1+G2)] Generic Substitution Rate [(G2)/(N2+G2)] Overall Generic Utilization [(G1+G2)/(N1+N2+G1+G2)]
Inpatient Facility PMPM E&M Inpatient Services PMPM E&M Outpatient Services PMPM Surgery & Procedure Inpatient Services PMPM Surgery & Procedure Outpatient Services PMPM
Imaging Services PMPM Laboratory Services PMPM
Pharmacy PMPM Inpatient Facility: Acute Inpatient: Medical Days per 1000 MY Inpatient Facility: Acute Inpatient: Medical Discharges per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Days per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Discharges per 1000 MY
Inpatient Facility: Nonacute Days per 1000 MY Inpatient Facility: Nonacute Discharges per 1000 MY
Inpatient Facility Acute Medical ALOS Inpatient Facility Acute Surgery ALOS
Inpatient Facility Nonacute ALOS Total Inpatient Facility Acute ALOS

Measure Data 2076 240
1,014.17 1,014.17
6900 3651 13215 82155 105,921.00 96.31% 95.75% 90.04% 197.67 10.97 89.08 14.70 91.50 70.79 32.30 118.31 791.40 173.91 177.33 35.66 0.00 0.00 4.55 4.97 NA 4.62

28 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Total Inpatient Facility ALOS ED Discharges per 1000 MY Medical

4.62 2,456.77

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (aab) Use of Spirometry Testing in the Assessment and Diagnosis of COPD (spr)
Use of Appropriate Medications for People With Asthma (asm)

29 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP
Cholesterol Management for Patients With Cardiovascular Conditions (cmc) Persistence of Beta-Blocker Treatment After a Heart Attack (pbh)

Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis (art) Effectiveness of Care: Behavioral Health Follow-Up Care for Children Prescribed ADHD Medication (add)
30 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP
Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication (ssd) Diabetes Monitoring for People With Diabetes and Schizophrenia (smd) Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (smc) Adherence to Antipsychotic Medications for Individuals With Schizophrenia (saa) Effectiveness of Care: Medication Management Annual Monitoring for Patients on Persistent Medications (mpm)
Adults' Access to Preventive/Ambulatory Health Services (aap)
Children and Adolescents' Access to Primary Care Practitioners (cap)

Initiation and Engagement of AOD Dependence Treatment (iet) 31 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (w34)
Inpatient Utilization--General Hospital/Acute Care: Total (ipua) Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (ipub) Inpatient Utilization--General Hospital/Acute Care: Disabled (ipuc) Inpatient Utilization--General Hospital/Acute Care: Other (ipud) Identification of Alcohol and Other Drug Services: Total (iada) Identification of Alcohol and Other Drug Services: Dual Eligibles (iadb) Identification of Alcohol and Other Drug Services: Disabled (iadc)
32 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP
Identification of Alcohol and Other Drug Services: Other (iadd)
Relative Resource Use for People With Cardiovascular Conditions (rca)

33 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Relative Resource Use for People With COPD (RCO)

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

Data Element
Eligible Population Exclusions
Eligible Population per 1,000 Member Year Medical Eligible Population per 1,000 Member Year Pharmacy
NameBrandOnlyCount(N1) NameBrandGenericExistsCount(N2)
GenericOnlyCount (G1) GenericNameBrandExistsCount (G2) Total Prescriptions (N1+N2+G1+G2) Generic Utilization Rate [(G1 + G2)/(N2+G1+G2)] Generic Substitution Rate [(G2)/(N2+G2)] Overall Generic Utilization [(G1+G2)/(N1+N2+G1+G2)]
Inpatient Facility PMPM E&M Inpatient Services PMPM E&M Outpatient Services PMPM Surgery & Procedure Inpatient Services PMPM Surgery & Procedure Outpatient Services PMPM
Imaging Services PMPM Laboratory Services PMPM
Pharmacy PMPM Inpatient Facility: Acute Inpatient: Medical Days per 1000 MY Inpatient Facility: Acute Inpatient: Medical Discharges per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Days per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Discharges per 1000 MY
Inpatient Facility: Nonacute Days per 1000 MY Inpatient Facility: Nonacute Discharges per 1000 MY
Inpatient Facility Acute Medical ALOS Inpatient Facility Acute Surgery ALOS
Inpatient Facility Nonacute ALOS Total Inpatient Facility Acute ALOS

Measure Data 252 17
1,014.77 1,014.77
1717 1076 2113 13658 18,564.00 93.61% 92.70% 84.95% 462.68 24.26 107.77 30.34 122.37 102.02 36.27 205.04 1,731.54 350.34 547.65 80.54 0.00 0.00 4.94 6.80 NA 5.29

34 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Total Inpatient Facility ALOS ED Discharges per 1000 MY Medical

5.29 2,484.56

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (aab) Use of Spirometry Testing in the Assessment and Diagnosis of COPD (spr)
Use of Appropriate Medications for People With Asthma (asm)

35 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP
Cholesterol Management for Patients With Cardiovascular Conditions (cmc) Persistence of Beta-Blocker Treatment After a Heart Attack (pbh)

Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis (art) Effectiveness of Care: Behavioral Health Follow-Up Care for Children Prescribed ADHD Medication (add)
36 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP
Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication (ssd) Diabetes Monitoring for People With Diabetes and Schizophrenia (smd) Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (smc) Adherence to Antipsychotic Medications for Individuals With Schizophrenia (saa) Effectiveness of Care: Medication Management Annual Monitoring for Patients on Persistent Medications (mpm)
Adults' Access to Preventive/Ambulatory Health Services (aap)
Children and Adolescents' Access to Primary Care Practitioners (cap)

Initiation and Engagement of AOD Dependence Treatment (iet) 37 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (w34)
Inpatient Utilization--General Hospital/Acute Care: Total (ipua) Inpatient Utilization--General Hospital/Acute Care: Dual Eligibles (ipub) Inpatient Utilization--General Hospital/Acute Care: Disabled (ipuc) Inpatient Utilization--General Hospital/Acute Care: Other (ipud) Identification of Alcohol and Other Drug Services: Total (iada) Identification of Alcohol and Other Drug Services: Dual Eligibles (iadb) Identification of Alcohol and Other Drug Services: Disabled (iadc)
38 of 39

September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for AMERIGROUP
Identification of Alcohol and Other Drug Services: Other (iadd)
Relative Resource Use for People With Cardiovascular Conditions (rca)

39 of 39

September 2013