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 AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page i AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 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 AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 1 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES 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. AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 2 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES 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). AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 3 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES Description of Validation Activities Pre-Audit Strategy HSAG conducted the validation activities as outlined in the CMS performance measure validation protocol. 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. AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 4 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES 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 AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 5 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES 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 AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 6 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES 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 AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 7 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES 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, AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 8 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES 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. AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 9 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES 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. AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 10 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 VALIDATION OF PERFORMANCE MEASURES 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 AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page 11 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 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). AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page A-1 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 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. AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page A-2 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 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. AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page B-1 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 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). AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page B-2 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 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% AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page C-1 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 PERFORMANCE MEASURE RESULTS 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 AMERIGROUP Community Care Validation of Performance Measures State of Georgia Page C-2 AMERIGROUP_GA2012-13_CMO_PMV_F1_0913 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: 1 of 12 September 2013 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 2 of 12 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% 3 of 12 September 2013 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% 4 of 12 September 2013 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% 5 of 12 September 2013 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 6 of 12 September 2013 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% 7 of 12 September 2013 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% 8 of 12 September 2013 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 9 of 12 September 2013 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 10 of 12 September 2013 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 11 of 12 September 2013 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 12 of 12 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 1 of 146 September 2013 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 2 of 146 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 3 of 146 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 4 of 146 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 6 of 146 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% 8 of 146 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% 9 of 146 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% 10 of 146 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% 11 of 146 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% 15 of 146 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% 16 of 146 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% 17 of 146 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% 18 of 146 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% 20 of 146 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% 22 of 146 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% 23 of 146 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 24 of 146 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% 26 of 146 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% 28 of 146 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% 31 of 146 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% 36 of 146 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% 43 of 146 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% 51 of 146 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% 52 of 146 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% 53 of 146 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 54 of 146 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% 55 of 146 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% 56 of 146 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