Validation of performance measures for Georgia Department of Community Health: measurement period: calendar year 2012; validation period: state fiscal year 2013 [Nov. 26, 2013]

Georgia Department of Community Health
Validation of Performance Measures for
Georgia Department of Community Health
Measurement Period: Calendar Year 2012 Validation Period: State Fiscal Year 2013
Publish Date: November 26, 2013
3133 East Camelback Road, Suite 300 Phoenix, AZ 85016 Phone 602.264.6382 Fax 602.241.0757

CONTENTS
for Georgia Department of Community Health
Validation of Performance Measures ................................................................................................... 1 Validation Overview .............................................................................................................................. 1 Georgia Department of Community Health Information........................................................................ 2 Audited Populations.............................................................................................................................. 2 Performance Measures Validated ........................................................................................................ 3 Description of Validation Activities........................................................................................................ 6 Pre-audit Strategy ............................................................................................................................. 6 Validation Team ................................................................................................................................ 7 On-site Activities ............................................................................................................................... 7 Technical Methods of Data Collection and Analysis ......................................................................... 9 Data Integration, Data Control, and Performance Measure Documentation ...................................... 10 Data Integration .............................................................................................................................. 10 Data Control.................................................................................................................................... 10 Performance Measure Documentation ........................................................................................... 10 Validation Results ............................................................................................................................... 11 Medical Service Data (Encounters) ................................................................................................ 11 Medical Service Data (Claims) ....................................................................................................... 11 Enrollment Data .............................................................................................................................. 13 Provider Data .................................................................................................................................. 13 Medical Record Review Process .................................................................................................... 14 Data Integration .............................................................................................................................. 17 Performance Measure Specific Findings ............................................................................................ 19 Validation Findings ............................................................................................................................. 22
Appendix A--Data Integration and Control Findings...................................................................... A-1
Appendix B--Denominator and Numerator Validation Findings ................................................... B-1
Appendix C--Performance Measure Validation Reporting Spreadsheet...................................... C-1

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for Georgia Department of Community Health
Validation Overview
The Centers for Medicare & Medicaid Services (CMS) requires that states, through their contracts with managed care organizations (MCOs), measure and report on performance to assess the quality and appropriateness of care and services provided to members. Validation of performance measures is one of three mandatory external quality review (EQR) activities required by the Balanced Budget Act of 1997 (BBA) described at 42 CFR 438.358(b)(2). The purpose of performance measure validation is to ensure that MCOs have sufficient systems and processes in place to provide accurate and complete information for calculating valid performance measure rates according to specifications required by the state. The state, its agent that is not an MCO, or an external quality review organization (EQRO) can perform this validation.
During state fiscal year (SFY) 2013, the Georgia Department of Community Health (DCH) required its MCOs, known as care management organizations (CMOs), to report performance measure data using calendar year (CY) 2012 as the measurement period. To facilitate rate comparisons and to prepare for voluntary reporting of data to CMS for the Children's Health Insurance Program Reauthorization Act (CHIPRA) core set measures (Core Set), DCH contracted with HewlettPackard Enterprise Services (HP), its Medicaid Management Information System (MMIS) vendor, to calculate performance measure rates for the Medicaid and PeachCare for Kids1 programs for the following populations:
Fee-for-Service (FFS) Georgia Families Medicaid and PeachCare for Kids managed care members (GF) All Medicaid and PeachCare for Kids (ALL) Medicaid Adult Only (MAO) Community Care Services Program (CCSP)
The DCH contracted with Health Services Advisory Group, Inc. (HSAG), as its EQRO to conduct performance measure validation (PMV) on a list of performance measure rates calculated and reported by HP. HSAG conducted the validation activities as outlined in the 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 1, 2012.2

1 PeachCare for Kids is the name of Georgia's stand-alone Children's Health Insurance Program (CHIP). 2 Department of Health and Human Services, Centers for Medicare & Medicaid Services. EQR Protocol 2: Validation of
Performance Measures Reported by the MCO: A Mandatory Protocol for External Quality Review (EQR), Version 2.0, September 2012. Available at: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Quality-ofCare/Quality-of-Care-External-Quality-Review.html. Accessed on: Feb 19, 2013.

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Georgia Department of Community Health Information
HSAG validated performance measure rates calculated and reported by HP on behalf of DCH. Information about DCH appears in Table 1.

DCH Location: DCH Contact: Site Visit Location: HP Contact: Site Visit Date:

Table 1--Georgia Department of Community Health
2 Peachtree Street, NW Atlanta, GA 30303
Janice M. Carson, MD, MSA Deputy Director, Performance, Quality and Outcomes 404.463.2832 jcarson@dch.ga.gov
Hewlett-Packard Enterprise Services 100 Crescent Centre, Ste. 1100 Tucker, GA 30084
Michele Hunter Services Information Developer III 972.605.8853 Michele.hunter@hp.com
June 2526, 2013

Audited Populations
Georgia Families Managed Care (GF)--the GF population consisted of Medicaid and PeachCare for Kids members enrolled in the three contracted CMOs:3 AMERIGROUP Community Care, Peach State Health Plan, and WellCare of Georgia, Inc. To be included in the GF rates, a member had to be continuously enrolled in any one CMO or could have switched CMOs during the measurement period. The GF rates excluded dual eligible members.
Fee-for-Service (FFS)--the FFS population included Medicaid and PeachCare for Kids members not enrolled in the GF managed care program. To be included in the FFS rates, a member had to be continuously enrolled in the FFS population for the entire measurement period. The FFS rates excluded dual eligible members.
Total Population (ALL)--the ALL population consisted of all members covered under the Georgia Medicaid and PeachCare for Kids programs during the measurement period. The ALL population consisted of the members included in the FFS and GF populations, as well as members who may have switched between managed care and FFS during the measurement period. The ALL population rates excluded dual eligible members.

3 The DCH required its CMOs to contract with an NCQA-licensed audit organization and undergo an NCQA HEDIS Compliance AuditTM. To validate the rates calculated for the non-HEDIS measures, DCH contracted HSAG to perform an independent performance measure validation for each CMO. Results for these validations are presented in each CMO-specific PMV report.

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Medicaid Adult Only (MAO)--the MAO population is composed of the members included in the ALL population during the measurement period, excluding the PeachCare for Kids population. The MAO rates excluded dual eligible members.
Community Care Services Program (CCSP)--the CCSP is a Medicaid waiver program that provides community-based social, health, and support services to eligible members as an alternative to institutional placement in a nursing facility. The DCH's Division of Medical Assistance Plans partners with the Division of Aging Services (DAS) within the Department of Human Services (DHS) for the operational management of the program. Approximately 70 percent of the CCSP population is composed of dual eligible members (i.e., members eligible for Medicare and Medicaid). The CCSP population includes all members covered under the CCSP waiver program, including dual eligible members.

Performance Measures Validated
Table 2 lists the performance measures that HSAG validated for each of the audited populations and identifies the methodology and specifications that were used for calculating the rates. In addition to the Healthcare Effectiveness Data and Information Set (HEDIS)4 measures developed by the National Committee for Quality Assurance (NCQA), performance measures were also selected by DCH from CMS' Initial Core Set of Children's Health Care Quality Measures, CMS' Initial Core Set of Health Care Quality Measures for Adults Enrolled in Medicaid, and the Agency for Healthcare Research and Quality (AHRQ). The measurement period was identified by DCH as CY 2012.

Table 2--List of Performance Measures for CY 2012

Population(s) Required for Reporting

Performance Measures

Measure Set

GF* FFS All MAO CCSP

Well-Child Visits in the First 15 Months of Life--6 or HEDIS and

1 More Visits (Hybrid)

Core Set**





2

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

HEDIS and Core Set**





3 Adolescent Well-Care Visits (Hybrid)

HEDIS and Core Set**





Children and Adolescents' Access to Primary Care 4 Practitioners (12 months19 years of age)

HEDIS and Core Set**





Adults' Access to Preventive/Ambulatory Health 5 Services (2044 years of age)

HEDIS





6

Childhood Immunization Status--Combos 3, 6, and 10 (Hybrid)

HEDIS and Core Set**





7 Lead Screening in Children (Hybrid)

HEDIS



Weight Assessment and Counseling for Nutrition and 8 Physical Activity for Children/Adolescents (Hybrid)

HEDIS and Core Set**





4 HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

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Table 2--List of Performance Measures for CY 2012

Performance Measures 9 Annual Dental Visit

Measure Set
HEDIS

Population(s) Required for Reporting
GF* FFS All MAO CCSP





Cervical Cancer Screening (Hybrid) 10

HEDIS and Core Set**









11 Breast Cancer Screening

HEDIS and Core Set**









12 Prenatal and Postpartum Care (Hybrid)

HEDIS and Core Set**







Frequency of Ongoing Prenatal Care--81 percent of 13 expected visits (Hybrid)

HEDIS and Core Set**







14 Chlamydia Screening in Women

HEDIS and Core Set**









15 Immunizations for Adolescents--Combo 1 (Hybrid)

HEDIS and Core Set**





16 Appropriate Testing for Children With Pharyngitis

HEDIS and Core Set**





Use of Appropriate Medications for People With 17 Asthma

HEDIS





18 Comprehensive Diabetes Care (Hybrid)

HEDIS and Core Set**









Follow-Up Care for Children Prescribed ADHD 19 Medication

HEDIS and Core Set**





20 Follow-Up After Hospitalization for Mental Illness

HEDIS and Core Set**









21 Ambulatory Care

HEDIS and Core Set**









22 Inpatient Utilization--General Hospital/Acute Care

HEDIS





23 Weeks of Pregnancy at Time of Enrollment

HEDIS



24 Race/Ethnicity Diversity of Membership 25 Cesarean Delivery Rate

HEDIS





AHRQ



26 Cesarean Rate for Nulliparous Singleton Vertex Low Birth Weight Rate--Percentage of Live Births
27 Weighing Less Than 2,500 Grams Annual Percentage of Asthma Patients with One or
28 More Asthma-Related ER Visit 220 years of age

Core Set

Core Set and AHRQ



Core Set



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Table 2--List of Performance Measures for CY 2012

Performance Measures 29 Antidepressant Medication Management
Annual Pediatric Hemoglobin (HbA1c) Testing 517 30 years of age (Hybrid) 31 Diabetes, Short-term Complications Admission Rate
Chronic Obstructive Pulmonary Disease (COPD) 32 Admission Rate 33 Congestive Heart Failure Admission Rate
34 Adult Asthma Admission Rate Antibiotic Utilization--Percentage of antibiotics of
35 concern for all antibiotic prescriptions (Total)

Measure Set
HEDIS and Core Set**
HEDIS and Core Set**
Core Set and AHRQ
Core Set and AHRQ
Core Set and AHRQ
Core Set and AHRQ
HEDIS

Population(s) Required for Reporting
GF* FFS All MAO CCSP



























36 Controlling High Blood Pressure (Hybrid)

HEDIS and Core Set**

NA







Initiation and Engagement of Alcohol and Other Drug 37 Dependence Treatment

HEDIS and Core Set**









Annual Monitoring for Patients on Persistent 38 Medications

HEDIS and Core Set**









39 Mental Health Utilization

HEDIS





40 Plan All-Cause Readmissions

Core Set



Appropriate Treatment for Children with Upper 41 Respiratory Infection

HEDIS



Screening for Clinical Depression and Follow-Up Plan 42 (Hybrid for CCSP population only)

Core Set







43 Annual HIV/AIDS Medical Visit

Core Set



44 Adult BMI Assessment (Hybrid)

HEDIS and Core Set**









Developmental Screening in the First Three Years of 45 Life

Core Set

46 Elective Delivery

Core Set

47 Antenatal Steroids

Core Set

Adherence to Antipsychotics for Individuals with 48 Schizophrenia
Adherence to Antipsychotics for Individuals with 49 Schizophrenia***

HEDIS





Core Set

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Table 2--List of Performance Measures for CY 2012

Performance Measures
Care Transition--Transition Record Transmitted to 50 Health Care Professional
Persistence of Beta-Blocker Treatment After a Heart 51 Attack

Measure Set
Core Set
HEDIS

Population(s) Required for Reporting
GF* FFS All MAO CCSP









52 Colorectal Cancer Screening (Hybrid)

Custom





53 Pharmacotherapy Management of COPD Exacerbation HEDIS





Human Papillomavirus Vaccine for Female 54 Adolescents (Hybrid)

HEDIS and Core Set**





55 Medication Management for People With Asthma

HEDIS and Core Set**









* The Georgia Families measures were calculated using only the administrative method.

** The required reporting age groups were modified from HEDIS by CMS for some of the Core Set measures. *** This measure was removed from Core Set reporting for this year.

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, 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 DCH outlining the steps in the performance measure validation process. The document request letter included a request for a completed Record of Administration, Data Management and Processes (Roadmap), source code for each performance measure (unless the source code was produced by NCQA-Certified software), and any additional supporting documentation necessary to complete the audit. HSAG responded to Roadmap-related questions during the pre-on-site phase.
HSAG conducted a pre-on-site conference call with HP, DCH's performance measure rate calculation vendor, and the Georgia Medical Care Foundation (GMCF), the medical record review vendor, to discuss the medical record review procurement and abstraction processes.
For the on-site visit, HSAG prepared an agenda describing all visit activities and indicating the type of staff needed for each session. HSAG provided the agenda to DCH and HP several weeks prior to the onsite visit. HSAG also frequently communicated with DCH and HP to discuss on-site visit expectations.

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Validation Team
The HSAG performance measure validation team's members were selected because they possessed the full complement of skills required for the validation and met the requirements of DCH. Some team members, including the lead auditor, participated in the on-site meetings at DCH; others conducted their work at HSAG's offices. Table 3 describes each team member's role and expertise.

Table 3--Validation Team

Name / Role
David Mabb, MS, CHCA Lead Auditor; Director, Audits/State & Corporate Services
Jennifer Lenz, MPH, CHCA Secondary Auditor; Executive Director, State & Corporate Services Marilea Rose, RN, BA Associate Director, State & Corporate Services; Medical Record Review, Over-read Process Supervisor
Maricris Kueny Project Coordinator, Medical Record Review
Judy Yip-Reyes, PhD Source Code Review Manager; Audit Specialist Ron Holcomb, AS Source Code Reviewer Tammy GianFrancisco Project Leader, Audits

Skills and Expertise
Management of audit department; Certified HEDIS Compliance Auditor; HEDIS knowledge; performance measure knowledge; statistics, analysis, and source code programming knowledge.
Certified HEDIS Compliance Auditor, HEDIS knowledge, statistics and analysis knowledge.
Medical record review, clinical consulting and expertise, abstraction, tool development, HEDIS knowledge, and supervision of nurse reviewers.
Coordinator for the medical record review process, liaison between the audit team and clients, maintains record tracking database, and manages deliverables and timelines. Auditing experience, HEDIS knowledge, performance measure knowledge, and source code review management.
Statistics, analysis, and source code programming knowledge.
Project coordination, communication, and scheduling.

On-site Activities
HSAG conducted an on-site visit with DCH and HP on June 2526, 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 DCH and HP staff members involved in the performance measure activities. The review purpose, required documentation, basic meeting logistics, and session topics 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

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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 DCH and HP 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 actual processes. HSAG conducted interviews to confirm findings from the documentation review, expand or clarify outstanding issues, and ascertain that written policies and procedures were used and followed in daily practice.
Overview of data integration and control procedures: The overview included discussion and observation of source code logic, a review of how all data sources were combined, and a review of how the analytic file was produced for the reporting of selected performance measure rates. HSAG performed primary source verification to further validate the accuracy of the data from the original source to 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 requested for any post-visit activities.
HSAG conducted several interviews with key individuals who were involved in performance measure reporting. Table 4 displays a list of key interviewees:

Name Trina Jackson Tatum Anita Mills Jennifer Bass Sandy Choate Yvonne Greene Michele Hunter Turkesia Robertson-Jones Debra Stone Donna Johnson Theresa Harris David Burnett
Melinda Ford-Williams
Dophamia Williams Pam White

Table 4--List of Interviewees Title
Compliance Auditor II Compliance Auditor II Project Director, DCH Deputy Director, Alliant/GMCF Eligibility Program Director Services Information Developer III--HEDIS Lead Pharmacy Operations Manager Clinical Quality Manager Program Specialist 2, Eligibility Policy Systems Analyst Systems Architect Early Periodic Screening, Diagnosis, and Treatment (EPSDT), DCH Eligibility Program Consultant Claims Operations Manager, HP

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Technical Methods of Data Collection and Analysis
The CMS performance measure validation protocol identifies key types of data that should be reviewed as part of the validation process. The following list describes the type of data collected and how HSAG conducted an analysis of these data:
Roadmap: The DCH and HP were required to submit a completed Roadmap to HSAG. Upon receipt by HSAG, the Roadmap underwent a cursory review to ensure each section was complete and all applicable attachments were present. HSAG then thoroughly reviewed all documentation, noting any potential issues, concerns, and items that needed additional clarification. Where applicable, HSAG used the information provided in the Roadmap to begin completion of the review tools.
Medical record documentation: HP and its contracted medical record review vendor, GMCF, were responsible for completing the medical record review section within the Roadmap. In addition, the following attachments were requested and reviewed by HSAG: medical record hybrid tools and instructions, training materials for medical record review staff members, and policies and procedures outlining the processes for monitoring the accuracy of the reviews performed by the review staff members.
Source code (programming language) for performance measures: HP was required to submit source code (computer programming language) for each performance measure being validated, except for the HEDIS measures that were generated by an NCQA-Certified software vendor. HSAG completed line-by-line review and evaluation of program logic flow on the supplied source code to ensure compliance with the measure specifications required by the State. HSAG identified areas of deviation from the specifications, evaluating the impact to the measure and assessing the degree of bias (if any). HSAG shared these findings with HP, and HP was required to revise the code and re-submit for review and approval.
Supporting documentation: HP submitted documentation to HSAG that provided additional information to complete the validation process, including policies and procedures, file layouts, system flow diagrams, system log files, and data collection process descriptions. HSAG reviewed all supporting documentation, with issues or clarifications flagged for follow-up.
Rate Review: Upon receiving the calculated rates from HP, HSAG conducted a review on the reasonableness and integrity of the rates for all of the audited populations. Since HP used the encounter data submitted monthly by the CMOs to calculate the Georgia Families rates, HSAG also used the final audited HEDIS measure results (obtained from NCQA's Interactive Data Submission System [IDSS]) submitted by the CMOs to further test for reasonability of the calculated Georgia Families rates.

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Data Integration, Data Control, and Performance Measure Documentation
There are several aspects crucial to the calculation of performance measure rates. These include data integration, data control, and documentation of performance measure calculations. Each of the following sections describes the validation processes used and the validation findings. For more detailed information, see Appendix A of this report.

Data Integration
Accurate data integration is essential to 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 DCH and its vendor, HP, 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, HSAG determined that the data integration processes in place were:
Acceptable
Not acceptable

Data Control
The organizational infrastructure must support all necessary information systems. The quality assurance practices and backup procedures must be sound to ensure timely and accurate processing of data, and to provide data protection in the event of a disaster. HSAG validated the data control processes used by DCH and its vendors, which included a review of disaster recovery procedures, data backup protocols, and related policies and procedures. Overall, HSAG determined that the data control processes in place 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 DCH and HP. 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 rate calculations, and other related documentation. Overall, HSAG determined that the documentation of performance measure calculations was:
Acceptable
Not acceptable

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Validation Results
Through the validation process, the audit team evaluated HP's data systems for the processing of each type of data used for reporting the performance measure rates. General findings are indicated below.

Medical Service Data (Encounters)
HP received encounter data from the three contracted CMOs monthly, at a minimum. The CMOs transmitted all encounter data to HP using the standard 837 file format through a secure data transfer site. There were appropriate transfer protocols in place to ensure all data transfers were securely received and completed, with no loss of data.
The encounter data from the CMOs were used in the calculation of the Georgia Families performance measure rates. Along with standard International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes, if diagnosis-related group (DRG) codes were submitted by the CMOs, then HP used the DRGs in measures that used DRG coding. However, HP did not use a DRG grouper for CMO-submitted encounter data that did not contain DRGs; therefore, some measures that rely on DRGs, such as the inpatient utilization measures, may be underreported for the Georgia Families and ALL populations.
HSAG also reviewed encounter data rejection reports from HP. These reports showed two of the CMOs had approximately 2.5 percent of the encounter data rejected by HP, while the third CMO had a 9.6 percent error rejection rate. Overall, the error rejection rate was approximately 6.0 percent. The CMOs were required by DCH to meet a 99 percent pass rate, so currently this standard has not been met. The high error rejection rate for the one specific CMO should be explored to determine the reasons for data rejection, and corrected by the CMO. Incomplete encounter data can negatively impact the rates for the GF and the ALL populations.

Medical Service Data (Claims)
All FFS contracted providers and facilities submitted claims data to HP. The process for HP has not changed since the last audit. Paper claims were received at the HP facility, and then batched, scanned, and given an internal control number. Following this process, the claims were routed to an optical character recognition (OCR) system where claim operators reviewed the OCR claims to ensure the claims were read correctly, and then routed the claims for processing. There were sufficient quality checks in place for the oversight of the scanning of claims, the data entry, and the processing of claims. HP confirmed that it did not use or accept nonstandard codes. As with last year, electronic claims processing accounted for the bulk of data processing, with approximately 95 percent of the claims received via electronic data interchange (EDI) submissions, which left very few claims for manual processing.
HSAG confirmed the appropriate use of standard code sets, and HP indicated that it had claim edits in place to accurately capture 4th and 5th digit specificity for ICD-9 codes. This was an issue for last year, and the audit team requested a query to determine if a significant number of paid claims

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had invalid ICD-9 codes (i.e., missing 4th and 5th digit specificity when required). Accepting ICD9 codes without a required 4th or 5th digit specificity has the ability to impact the following HEDIS measures: Comprehensive Diabetes Care, Follow-up After Hospitalization for Mental Illness,
Prenatal and Postpartum Care, Frequency of Ongoing Prenatal Care, Ambulatory Care, Weight
Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents,
Chlamydia Screening for Women, Appropriate Treatment for Children with Upper Respiratory
Infection, Use of Appropriate Medications for People with Asthma, Follow-up Care for Children Prescribed ADHD Medication, and Persistence of Beta-Blocker Treatment After a Heart Attack. In addition, the non-HEDIS Low Birth Weight measure could potentially be impacted, since this measure also requires 5th digit specificity. HSAG acknowledged that DCH's policy does not require 4th or 5th digit specificity for payment of claims, but HSAG's findings are specific to those measures where a 4th or 5th digit is required for accurate HEDIS reporting. Although the specificity issue was not completely eliminated, HSAG determined there was significant improvement in the capture of 4th and 5th digit specificity, and determined the final rates would not be biased for reporting these measures.
HSAG evaluated the use of DRG and MS-DRG codes for inpatient hospitalizations. This was also an issue in the prior year since the Georgia hospitals typically did not submit MS-DRGs, and the CMOs often did not submit DRGs or MS-DRGs to HP. HSAG confirmed this was still an issue. Therefore, the CMOs and HP were required to use a DRG grouper on inpatient claims in order to calculate many of the AHRQ measures. HP used a DRG grouper for its FFS claims data; however, HP did not apply the DRG grouper to the encounter data submitted by the three CMOs. Not using the DRG grouper on the CMO encounter data could result in missing or underreported data when calculating the Georgia Families and the ALL performance measure rates for AHRQ measures that require DRGs.
The State contracted with a pharmacy vendor, Catamaran, to administer pharmacy benefits to its FFS population. HP was able to demonstrate adequate reconciliation between pharmacy data and financial payments. However, pharmacy reversals were included in the extracted files sent to ViPS, the NCQA-Certified software vendor, for rate calculation. Reversed pharmacy claims usually occur when a member presents a prescription to the pharmacy but then fails to return to pick up the filled prescription. After seven days, the pharmacy must return the prescription to stock and submit a reversed claim to HP. Including these reversed pharmacy claims, therefore, may inflate rates, since members who did not pick up the prescription will appear to have received the medication. For this year, NCQA allowed this process; therefore, the auditors did not assess bias to any rates. HSAG recommends that HP explore options to reconcile pharmacy reversals to ensure the pharmacy data are not overstated, and rates are reportable.
Similar to last year, a significant portion of claims for maternity deliveries were paid through global billing. Global billing is the submission of a single claim for a fixed fee that covers all care related to a particular condition over a particular period of time, such as the billing for the prenatal and postpartum care visits in conjunction with the delivery. HSAG conducted primary source verification on measures impacted by global billing and identified that global bills include the date of delivery, which is important for the calculation of the Prenatal and Postpartum Care and Frequency of Ongoing Prenatal Care measures. HSAG again confirmed that postpartum care visits were not allowable for payment outside of the global bill rate; however, DCH noted that providers may be billing for office visit services within the first 21 days after delivery and receiving payment

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outside of the global billing rate. While this does not have an impact on the calculation of performance measure rates for the prenatal and postpartum care measures, DCH may consider investigating its reimbursement policy and this billing practice further. HSAG did not find any discrepancies with the global billing data, and determined the only real impact was a need for increased medical record review for the measures related to maternity care.
Enrollment Data
The DCH staff described its process for providing HP eligibility data file feeds daily, which included a file from the Division of Family and Children Services within the Department of Human Services, data from the PeachCare for Kids program, and a data interface file from the Social Security Administration. There were appropriate edits to detect errors with loading enrollment data, obtaining complete files, and identifying potential duplicate members. HSAG did not identify any issues related to the processing of enrollment files for use in performance measure rate reporting.
Approximately 30 percent of the FFS population were dual eligible members for Medicare and Medicaid. Because Medicare was the primary payer for these members and there was a potential for missing data, HSAG determined that the FFS and ALL population rates could be impacted, resulting in lower rates since Medicare (CMS) was not required to share data. Based on recommendations from the 2012 audit, and consistent with NCQA technical specifications for HEDIS reporting, the dual-eligible population was excluded from the performance measure rate calculations this year for all populations with the exception of the CCSP population, for which HP appropriately included dual-eligible members based on direction from DCH.
The DCH allows its providers to enter newborn data into the system, assigning each newborn a unique member ID at birth, then linking the newborn's ID to the mother's Medicaid ID. Once the baby is assigned its own Medicaid ID, a reconciliation process is conducted to identify potential duplicates when merging enrollment data for reporting. During the previous audit process, HSAG determined that the process for assigning an ID at birth was advantageous for the purposes of ensuring complete data for the newborn. HP also provided information on how it avoids duplicates via the newborn list and various data checks (e.g., multiple births on the same day are reviewed).
HSAG verified the buckets of reporting for the GF, FFS, ALL, MAO, and CCSP populations and identified no concerns with the identification according to DCH specifications. However, HSAG recommends that DCH evaluate and clarify the MAO population to ensure this population does not include children in future reporting years.
Provider Data
There were no significant changes from the prior year's audit. The State-contracted providers continued to be enrolled via a paper-based or Web-based application submission. Each provider was assigned a provider type and/or specialty based on the provider's license. HSAG reviewed the provider mapping crosswalk used by HP's subcontractor, ViPS, to produce the HEDIS performance measure rates and found the mapping to be appropriate for the measures being audited.

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As identified last year, DCH did not require the capture of a rendering provider type on all claims. This impacts measures that require a specific provider type to perform the service, such as the wellchild visit measures and mental health follow-up measures. For hybrid measures, this typically results in increased medical record review, but the rate should not be biased. However, for administrative only measures, the missing rendering provider information may cause a significantly biased, underreported rate. This issue is especially important for group providers such as Federally Qualified Health Centers (FQHCs). The FQHCs often submit the facility identification as the rendering provider. HP confirmed that the issue with obtaining the rendering provider's identification from the FQHCs had not changed. HSAG recommends that DCH and HP continue to work toward requiring that the appropriate rendering provider's identification be completed for all claims. HSAG recognizes the challenge for DCH given that states are not currently required to have FQHCs submit a rendering provider on claims since the FQHC receives prospective payments.
Medical Record Review Process
Several of the required performance measure rates were reported using the hybrid method--a combination of administrative claims, encounter data, and medical record abstracted data. The hybrid approach was conducted across four populations: FFS, ALL, MAO, and CCSP. HP contracted with GMCF to perform the medical record abstractions. GMCF used the ViPS/MedCapture hybrid reporting tools to collect the hybrid data. HSAG reviewed the MedCapture hybrid tool screen prints and corresponding instructions. The hybrid tools contained all of the required measure-specific data elements and appropriate edits. To ensure accuracy of the hybrid data being abstracted by the GMCF staff, and because new hybrid measures were being reported, HSAG requested that GMCF participate in a convenience sample of selected hybrid measures. No critical abstraction errors were detected during HSAG's validation of the convenience sample.
HSAG reviewed HP's and GMCF's processes for medical record review performance for all reported hybrid measures. This review included evaluating the GMCF medical record review staff qualifications, training, data collection instruments/tools, accuracy of data collection, vendor oversight, and the method used for combining medical record review data with administrative data. Additionally, HSAG also validated GMCF's abstraction accuracy for a sample of cases across the NCQA-designated measure groups by comparing its validation results to GMCF's abstraction results.
HSAG also completed the medical record review validation process and reabstracted sample records across the appropriate measure groups and compared the results to GMCF's findings for the same medical records. For each of the validated measures, HSAG randomly selected 16 cases from each measure group of medical record review numerator positives as identified by GMCF. If fewer than 16 medical records were found to meet numerator requirements, all records were reviewed. If an abstraction discrepancy was noted, only critical errors were considered errors. A critical error is defined as an abstraction error that affects the final outcome of the numerator event (i.e., changes a positive event to a negative one). The medical record review validation process completed the medical record portion of the audit and provided an assessment of GMCF's medical record abstraction accuracy.

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Using the results of the medical record review validation process, the audit team determined if findings impacted the audit designation. The goal of the medical record review validation was to determine whether GMCF made abstraction errors that significantly biased its final reported rate. HSAG used the standardized protocol developed by NCQA to validate the integrity of the medical record review processes of audited organizations. The NCQA process was employed, and one error required the auditor to retest a second sample of 16 records that did not include the original sampled records. If the second sample was free of errors, the measure and measure group passed. If one or more errors were detected, the measure and measure group did not pass validation and could not be reported until all errors were corrected and reviewed by the auditor. Testing the exclusion group followed the same validation methodology.
The following tables identify the measure group and validated measure name, the number of records validated, and a final pass/fail determination.

Group Group A Group B
Group B Group B Group B Group B Group C Group D Group D

Table 5--First Sample
Measure
Controlling High Blood Pressure (FFS/ALL/MAO/CCSP)
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--Nutrition ages 311 (FFS/ALL) Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--Physical ages 311 (FFS/ALL) Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (FFS/ALL)
Well-Child Visits in the First 15 Months of Life (6+ Visits) (FFS/ALL)
Adolescent Well-Care Visits (FFS/ALL)
Cervical Cancer Screening (FFS/ALL)
Human Papillomavirus Vaccine for Female Adolescents (FFS/ALL)
Childhood Immunization Status--Combo 3 (FFS/ALL)

Number of Records
16 16
16
16 16 16 16 14* 16

Validation Results Passed Failed
Failed
Failed Passed Failed Passed Passed Passed

Group D

Immunizations for Adolescents--Combo 1 (FFS/ALL)

16

Passed

Group E

Exclusions (FFS/ALL/MAO/CCSP)

20

*HPV only had 14 positive cases from medical record review; all 14 cases were reviewed.

Passed

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Group Group B
Group B Group B Group B

Table 6--Second Sample Measure
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--Nutrition ages 311 (FFS/ALL)
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--Physical ages 311 (FFS/ALL)
Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (FFS/ALL)
Adolescent Well-Care Visits (FFS/ALL)

Number of Records
HSAG reabstracted
all numerator positive
cases
HSAG reabstracted
all numerator positive
cases
7
HSAG reabstracted
all numerator positive
cases

Validation Results Passed
Passed Passed Passed

During the medical record review process, HSAG noted that the above volume of errors could be attributed to GMCF's procurement and abstraction practices that were not presented in the GMCF Roadmap responses. The factors are detailed below:

Incomplete Roadmap Submission: HP and GMCF did not adequately identify the changes to their medical record review process in their Roadmap submission to HSAG. GMCF notified HSAG of the addition of 11 new reviewers at the conclusion of the medical record review process. Had this factor been known to HSAG at the onset of the medical record reviews, a convenience sample would have been requested across all reported hybrid measures, not just the new hybrid measures.
Potential Medical Record Procurement Process Concerns: GMCF procured medical record data from calendar years 2010 through 2012 regardless of the measure review period. This resulted in a large volume of unusable data that the GMCF reviewers were required to review. This fact could potentially have resulted in a higher number of abstraction errors.
Abstraction Practices Not in Alignment with the NCQA Technical Specifications for the Measures: HSAG identified trends related to the errors found for the Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) and Adolescent Well-Care Visits (AWC) measures which were not in alignment with the NCQA Technical Specifications. This may have been attributed to the volume of new staff hired by GMCF for the current year.

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Insufficient Oversight of Medical Record Review Staff: The GMCF Quality Assurance/Interrater Reliability (IRR) Policy contained the requirement that GMCF conduct IRR review of five percent of the total review volume of sample cases per abstractor. IRR reports submitted to HSAG demonstrated that GMCF did not consistently adhere to the requirement. GMCF cited issues with the automated IRR calculation in the vendor database. In addition, a 5 percent oversight may not have been sufficient for the volume of new reviewers.
While the GMCF abstraction procedures were approved and the measures passed medical record review validation, HSAG reabstracted all numerator positive cases for the following measures due to the volume of critical errors noted during the first sample:
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/ Adolescents--Nutrition ages 311 (FFS/ALL)
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/ Adolescents--Physical ages 311 (FFS/ALL)
Adolescent Well-Care Visits (FFS/ALL)
HSAG recommends that prior to future hybrid reporting, GMCF and HP provide complete responses in the Roadmap that accurately reflect the medical record review process (i.e., addition of new review staff). To identify abstraction errors early in the medical record review process, IRR should begin immediately and continue throughout the project at a minimum of 5 percent. IRR should be conducted at a higher percentage for all new review staff. Regarding vendor oversight, HP should enhance its vendor oversight above the weekly review of GMCF IRR reports. As in prior years, HSAG recommends that GMCF request additional training by ViPS to better understand the software as it pertains to the tracking, storing, and consolidation of records.
Data Integration
HP followed the same process as last year with load data from the MMIS to ViPS, the software vendor. Weekly, HP pulled data from the MMIS into the data warehouse (ad-hoc system). HP used data stored within the ad-hoc system to provide the data extract files to ViPS. HP worked with ViPS on data issues identified throughout the data import process until all issues were resolved. HP used test files to ensure mapping back to the ad-hoc system prior to the submission. HP retained its change order and technical/testing documents. Data were reconciled between HP and ViPS data to ensure no data were lost during transfer procedures. ViPS also provided data analysis reports for reconciliation. HP conducted a refresh of the paid claims from MMIS data in March, 2013. HSAG did not identify any areas of concern with the data integration process.
The preliminary rates for the Breast Cancer Screening measure were lower than expected. NCQA changed the specifications last year to exclude certain v-codes from this measure, along with the Cervical Cancer Screening and Chlamydia Screening in Women measures. A limited query performed on-site found that v-codes were submitted in conjunction with CPT or ICD-9 codes, giving confidence that the rates were valid. However, HSAG recommended HP perform additional queries to determine if providers were submitting claims with just the v-codes and therefore not receiving credit for the services provided due to the change in the technical specifications.

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HP also obtained a supplemental database for immunization data. For this year, as a one-time update, the Georgia Registry of Immunization Transactions and Services (GRITS) provided a match of immunizations to all members in the MMIS. This allowed HP to include additional immunizations to ViPS that were not originally obtained from claims or encounter data. There was no mapping of these data since appropriate CPT codes were provided. In the future, HP intends to begin receiving these data from GRITS on a weekly or monthly basis. HSAG did not identify any areas of concern with the supplemental database for immunizations. However, the audit team did query Hepatitis B (Hep B) shots to determine why this rate appeared low, especially with the additional supplemental immunization data. It appeared the birthing hospitals, which provide the first Hep B immunization, were not billing for the Hep B immunization on the baby's or the mother's claim; therefore, this information was not included in the administrative data, nor was it submitted to GRITS. HSAG recommended that the State examine numerator-compliant Hep B shots from the CMOs and compare those to the Hep B negative cases within the MMIS to determine whether discrepancies exist with DCH receiving these data. This comparison would help drive appropriate interventions for DCH to implement.
As mentioned earlier, the dual-eligible population was excluded from the performance measure rate calculations this year for all populations with the exception of the CCSP population, for which HP appropriately included dual-eligible members based on direction from DCH. However, during the rate review validation process, it appeared that the eligible populations contained more members than expected since dual-eligible members were excluded. HSAG discussed this potential issue with HP and determined that dual-eligible members were only excluded if they were dual-eligible members for the entire measurement year; partial-year dual-eligible members remained in the measure calculations. In future reporting years, HSAG recommends the State and HP consider treating dual-eligible enrollment spans similar to a break in enrollment to appropriately remove all dual-eligible members who should be excluded from the measures.
For future reporting, the auditors discussed the potential impact of using ICD-10 codes rather than ICD-9 codes. HP has been working on this change and indicated ViPS is ready for ICD-10 as well. In addition, DCH and HP have been working together on testing to ensure the transition goes smoothly. HP also has some indicators to determine if submitted codes are ICD-9 or ICD-10 codes, since there may be some overlap initially in accepted codes. Both DCH and HP indicated they will be ready to fully accept ICD-10 codes by the October 1, 2014, timeline.

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Performance Measure Specific Findings

Based on all validation activities, HSAG determined results for each performance measure. Table 7 displays the key review results. For more detailed information, see Appendix B.

Table 7--Key Review Results for DCH (GF, FFS, ALL, MAO, and CCSP Populations)

Performance Measures

Key Review Findings

1

Well-Child Visits in the First 15 Months of Life--6 or More Visits (Hybrid)

No concerns were identified.

2

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

No concerns were identified.

3 Adolescent Well-Care Visits (Hybrid)

No concerns were identified.

Children and Adolescents' Access to Primary Care 4 Practitioners (12 months19 years of age)

No concerns were identified.

5

Adults' Access to Preventive/Ambulatory Health Services (2044 years of age)

No concerns were identified.

6

Childhood Immunization Status--Combos 3, 6, and 10 (Hybrid)

No concerns were identified.

7 Lead Screening in Children (Hybrid)

8

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

9 Annual Dental Visit

10 Cervical Cancer Screening (Hybrid)

11 Breast Cancer Screening

No concerns were identified.
No concerns were identified.
No concerns were identified.
No concerns were identified. However, changes in technical specifications no longer allow v-codes to be used for this measure. HP and DCH should ensure providers are submitting full, appropriate coding for this measure.
No concerns were identified. However, changes in technical specifications no longer allow v-codes to be used for this measure. HP and DCH should ensure providers are submitting full, appropriate coding for this measure.

12 Prenatal and Postpartum Care (Hybrid)

13

Frequency of Ongoing Prenatal Care--81 percent of expected visits (Hybrid)

14 Chlamydia Screening in Women

No concerns were identified.
No concerns were identified.
No concerns were identified. However, changes in technical specifications no longer allow v-codes to be used for this measure. HP and DCH should ensure providers are submitting full, appropriate coding for this measure.

15 Immunizations for Adolescents--Combo 1 (Hybrid) No concerns were identified.

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Table 7--Key Review Results for DCH (GF, FFS, ALL, MAO, and CCSP Populations)

Performance Measures

16 Appropriate Testing for Children with Pharyngitis

17

Use of Appropriate Medications for People with Asthma

18 Comprehensive Diabetes Care (Hybrid)

19

Follow-Up Care for Children Prescribed ADHD Medication

20 Follow-Up After Hospitalization for Mental Illness

21 Ambulatory Care

22 Inpatient Utilization--General Hospital/Acute Care

23 Weeks of Pregnancy at Time of Enrollment

24 Race/Ethnicity Diversity of Membership

25 Cesarean Delivery Rate

26 Cesarean Rate for Nulliparous Singleton Vertex

27

Low Birth Weight Rate--Percentage of Live Births Weighing Less Than 2,500 Grams

Annual Percentage of Asthma Patients with One or 28 More Asthma-Related ER Visit 220 years of age

29 Antidepressant Medication Management

30

Annual Pediatric Hemoglobin (HbA1c) Testing 517 years of age (Hybrid)

31 Diabetes, Short-term Complications Admission Rate

32

Chronic Obstructive Pulmonary Disease (COPD) Admission Rate

Key Review Findings No concerns were identified.
No concerns were identified.
No concerns were identified.
No concerns were identified.
The rendering provider for FQHCs is not always submitted, which may result in lower rates since the provider type is required for this measure. However, the audit team determined that there was not a significant bias. No concerns were identified. HP does not use a DRG grouper for CMOsubmitted encounter data, which may result in underreporting of inpatient utilization data for the GF and ALL population rates. No concerns were identified. No concerns were identified. No concerns were identified. No concerns were identified.
No concerns were identified.
No concerns were identified.
No concerns were identified.
No concerns were identified.
No concerns were identified.
No concerns were identified.

33 Congestive Heart Failure Admission Rate

No concerns were identified.

34 Adult Asthma Admission Rate Antibiotic Utilization--Percentage of antibiotics of
35 concerns for all antibiotic prescriptions (Total)

No concerns were identified.
No concerns were identified. Impact from pharmacy reversals will be minimal due to population size.

36 Controlling High Blood Pressure (Hybrid)

37

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Annual Monitoring for Patients on Persistent 38 Medications

No concerns were identified. No concerns were identified. No concerns were identified.

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Table 7--Key Review Results for DCH (GF, FFS, ALL, MAO, and CCSP Populations)

Performance Measures 39 Mental Health Utilization

Key Review Findings No concerns were identified.

40 Plan All Cause Readmissions

41

Appropriate Treatment for Children with Upper Respiratory Infection

42

Screening for Clinical Depression and Follow-Up Plan (Hybrid for CCSP population only)

No concerns were identified. No concerns were identified. No concerns were identified.

43 Annual HIV/AIDS Medical Visit

No concerns were identified.

44 Adult BMI Assessment (Hybrid) Developmental Screening in the First Three Years of
45 Life 46 Elective Delivery

No concerns were identified. No concerns were identified. No concerns were identified.

47 Antenatal Steroids

No concerns were identified.

Adherence to Antipsychotics for Individuals with 48 Schizophrenia (HEDIS)

49

Adherence to Antipsychotics for Individuals with Schizophrenia

Care Transition--Transition Record Transmitted to 50 Health Care Professional

Persistence of Beta-Blocker Treatment After a Heart 51 Attack

No concerns were identified.
This measure was removed from Core Set reporting for this year. HP only calculated the denominator for this measure since the measure set specifications for the numerator did not provide CPT or ICD9 codes for calculation.
No concerns were identified.

52 Colorectal Cancer Screening (Hybrid)

No concerns were identified.

53 Pharmacotherapy Management of COPD Exacerbation No concerns were identified.

54

Human Papillomavirus Vaccine for Female Adolescents (Hybrid)

No concerns were identified.

55 Medication Management for People With Asthma

No concerns were identified.

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Validation Findings
HSAG provided an audit designation for each performance measure rate as defined in Table 8:

Report (R)
Not Reportable (NR)

Table 8--Validation Findings Definitions
The organization followed the specifications and produced a reportable rate or result for the measure.
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 performance measure rate 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." For measures that DCH did not require reporting of a specific population, HSAG includes a "Not Applicable," "NA" designation.
Table 9 displays the final validation findings for DCH for each performance measure rate. Performance on hybrid measure rate reporting varied across measures and populations. The hybrid measure rates required medical record data in addition to claims data; the GF rates were calculated using only administrative data.

Table 9--Validation Findings for DCH Performance Measures

Measures

GF* FFS ALL

Well-Child Visits in the First 15 Months of Life--6 1 or More Visits (Hybrid)

R

R

R

2

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

R

R

R

3 Adolescent Well-Care Visits (Hybrid)

R

R

R

Children and Adolescents' Access to Primary Care 4 Practitioners (12 months19 years of age)

R

R

R

5

Adults' Access to Preventive/Ambulatory Health Services (2044 years of age)

R

R

R

Childhood Immunization Status--Combos 3, 6, 6 and 10 (Hybrid)

R

R

R

7 Lead Screening in Children (Hybrid)

R

R

R

Weight Assessment and Counseling for Nutrition

8 and Physical Activity for Children/Adolescents

R

R

R

(Hybrid)

9 Annual Dental Visit

R

R

R

MAO NA NA NA NA R NA NA NA R

CCSP NA NA NA NA R NA NA NA R

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Table 9--Validation Findings for DCH Performance Measures

Measures

GF* FFS ALL

10 Cervical Cancer Screening (Hybrid)

R

R

R

11 Breast Cancer Screening

R

R

R

12 Prenatal and Postpartum Care (Hybrid)

R

R

R

Frequency of Ongoing Prenatal Care--81 percent 13 of expected visits (Hybrid)

R

R

R

14 Chlamydia Screening in Women

R

R

R

15

Immunizations for Adolescents--Combo 1 (Hybrid)

R

R

R

16 Appropriate Testing for Children With Pharyngitis

R

R

R

17

Use of Appropriate Medications for People with Asthma

R

R

R

18 Comprehensive Diabetes Care (Hybrid)

R

R

R

Follow-Up Care for Children Prescribed ADHD 19 Medication

R

R

R

20 Follow-Up After Hospitalization for Mental Illness

R

R

R

21 Ambulatory Care

R

R

R

22 Inpatient Utilization--General Hospital/Acute Care R

R

R

23 Weeks of Pregnancy at Time of Enrollment

R

R

R

24 Race/Ethnicity Diversity of Membership

R

R

R

25 Cesarean Delivery Rate

R

R

R

26 Cesarean Rate for Nulliparous Singleton Vertex

R

R

R

27

Low Birth Weight Rate--Percentage of Live Births Weighing Less Than 2,500 Grams

R

R

R

28

Annual Percentage of Asthma Patients with One or More Asthma-Related ER Visit 220 years of age

R

R

R

29 Antidepressant Medication Management

R

R

R

30

Annual Pediatric Hemoglobin (HbA1c) Testing 5 17 years of age (Hybrid)

R

R

R

Diabetes, Short-term Complications Admission 31 Rate

R

R

R

32

Chronic Obstructive Pulmonary Disease (COPD) Admission Rate

R

R

R

33 Congestive Heart Failure Admission Rate

R

R

R

34 Adult Asthma Admission Rate

R

R

R

35

Antibiotic Utilization--Percentage of antibiotics of concern for all antibiotic prescriptions (Total)

R

R

R

36 Controlling High Blood Pressure (Hybrid)

NA

R

R

Initiation and Engagement of Alcohol and Other 37 Drug Dependence Treatment

R

R

R

MAO R R R R R NA NA R R NA R R R R R R R R
NA R NA
R
R R R R R R

CCSP R R NA NA R NA NA R R NA R R R NA R NA NA NA
NA R NA
R
R R R R R R

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Table 9--Validation Findings for DCH Performance Measures

Measures

GF* FFS ALL MAO CCSP

38

Annual Monitoring for Patients on Persistent Medications

R

R

R

R

R

39 Mental Health Utilization

R

R

R

R

R

40 Plan All-Cause Readmissions

R

R

R

R

R

Appropriate Treatment for Children with Upper 41 Respiratory Infection

R

R

R

NA

NA

42

Screening for Clinical Depression and Follow- Up Plan (Hybrid for CCSP population only)

R

R

R

R

R

43 Annual HIV/AIDS Medical Visit

R

R

R

R

R

44 Adult BMI Assessment (Hybrid)

R

R

R

R

R

45

Developmental Screening in the First Three Years of Life

R

R

R

NA

NA

46 Elective Delivery

R

R

R

R

NA

47 Antenatal Steroids

R

R

R

R

NA

48

Adherence to Antipsychotics for Individuals with Schizophrenia (HEDIS)

R

R

R

R

R

Adherence to Antipsychotics for Individuals with 49 Schizophrenia**

NA NA NA

NA

NA

50

Care Transition--Transition Record Transmitted to Health Care Professional ***

NR

NR

NR

NR

NR

Persistence of Beta-Blocker Treatment After a 51 Heart Attack

NA

R

R

R

R

52 Colorectal Cancer Screening (Hybrid)

NA

R

R

R

R

Pharmacotherapy Management of COPD 53 Exacerbation

NA

R

R

R

R

54

Human Papillomavirus Vaccine for Female Adolescents (Hybrid)

R

R

R

NA

NA

55 Medication Management for People With Asthma

R

R

R

R

R

*The Georgia Families measures were calculated using only the administrative method. **This measure was removed from Core Set reporting for this year. ***HP only calculated the denominator for this measure since the measure set specifications for the numerator did not
provide CPT or ICD-9 codes for calculation.

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Appendix A. Data Integration and Control Findings
for Georgia Department of Community Health

Documentation Worksheet

Name: On-Site Visit Date: Reviewers:

Georgia Department of Community Health and Hewlett-Packard Enterprise Services June 2526, 2013 David Mabb, MS, CHCA; Jennifer Lenz, MPH, CHCA

Data Integration and Control Element

Not Met Met N/A

Accuracy of data transfers to assigned performance measure data repository.

Comments

The State 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 measure rates 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 State'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 State uses a performance measure data repository, its structure and format facilitates any required
programming necessary to calculate and report required performance measures.
The performance measure data repository's design, program flow charts, and source codes enable analyses and reports.
Proper linkage mechanisms are employed to join data from all necessary sources (e.g., identifying a member with a given disease/condition).

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Data Integration and Control Element

Not Met Met N/A

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

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

Prescribed data cutoff dates are followed.

The State 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 State's processes and documentation comply with the State standards associated with reporting program specifications, code review, and testing.

Comments

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Appendix B. Denominator and Numerator Validation
for Georgia Department of Community Health

Reviewer Worksheets

Name: On-Site Visit Date: Reviewers:

Georgia Department of Community Health and Hewlett-Packard Enterprise Services June 2526, 2013 David Mabb, MS, CHCA; Jennifer Lenz, MPH, CHCA

Table B-1--Denominator Validation Findings for Georgia Department of Community Health

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.

HSAG confirmed that HP appropriately included members within the GF, FFS, ALL, MAO, and CCSP populations according to DCH's specifications.

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

The State 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.

HP appropriately captured data as provided, and ICD-9 specificity appeared to be enforced for submission of claims.

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.

HP did not program for any exclusion that did not have specific CPT or ICD-9 codes available in the measure set specifications. The DCH approved this method for this year. Exclusion criteria are used to remove members from a measure due to circumstances that would prevent the member from receiving the service under

Georgia Department of Community Health Validation of Performance Measures State of Georgia

Page B-1 DCH_GA2012-13_FFS_GF_PMV_F1_1113

DENOMINATOR AND NUMERATOR VALIDATION FINDINGS

Table B-1--Denominator Validation Findings for Georgia Department of Community Health

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

Not

Met Met N/A

Comments

measurement. The reported rate is

usually higher when valid

exclusions are removed.

No population estimates were used.

Table B-2--Numerator Validation Findings for Georgia Department of Community Health

Audit Element

Not Met Met N/A

Comments

The State uses the appropriate data, including linked data from separate data sets, to identify the entire atrisk population.

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

The State avoids or eliminates all double-counted members or numerator events.

The pharmacy data included reversals (i.e., prescriptions that were entered by the pharmacy but subsequently not received by the member). This can result in numerator compliance for members who did not receive the medication.

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.

The DCH and HP do not accept or use any nonstandard codes.

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).

Georgia Department of Community Health Validation of Performance Measures State of Georgia

Page B-2 DCH_GA2012-13_FFS_GF_PMV_F1_1113

Appendix C. Performance Measure Validation Reporting Spreadsheet
for Georgia Department of Community Health
Appendix C contains DCH's audited CY 2012 performance measure results.

Georgia Department of Community Health Validation of Performance Measures State of Georgia

Page C-1 DCH_GA2012-13_FFS_GF_PMV_F1_1113

Measures Adherence to Antipsychotics for Individuals with Schizophrenia (HEDIS) Adolescent Well-Care Visits Adult Asthma Admission Rate--Per 100,000 Members (Ages 18-64) Adult Asthma Admission Rate--Per 100,000 Members (Ages 65+) Adult Asthma Admission Rate--Per 100,000 Members (Total) Adult BMI Assessment (Ages 18-64) Adult BMI Assessment (Ages 65-74) Adult BMI Assessment (Total) Adults' Access to Preventive/Ambulatory Health Services(Ages 20-44) Adults' Access to Preventive/Ambulatory Health Services(Ages 45-64) Adults' Access to Preventive/Ambulatory Health Services(Ages 65+) Adults' Access to Preventive/Ambulatory Health Services(Total) Ambulatory Care--ED Visits (Total Visits/1,000 Member Months) Ambulatory Care--ED Visits (Total Visits) Ambulatory Care--Outpatient Visits (Total Visits/1,000 Member Months) Ambulatory Care--Outpatient Visits (Total Visits) Annual Dental Visit (Ages 2-3) Annual Dental Visit (Ages 4-6) Annual Dental Visit (Ages 7-10) Annual Dental Visit (Ages 11-14) Annual Dental Visit (Ages 15-18) Annual Dental Visit (Ages 19-21) Annual Dental Visit (Total) Annual HIV/AIDS Medical Visit--90 days between (Ages 18-64) Annual HIV/AIDS Medical Visit--90 days between (Ages 65+)
1 of 47

DCH Audited Calendar Year 2012 Performance Measure Results

Georgia Families (GF)

Fee-for-Service (FFS)

ALL

Medicaid Adult Only (MAO)

CCSP

Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate

43.88%

65.36%

64.45%

64.44%

NA

40.83%

24.95%

30.66%

35.70%

39.90%

59.17

387.37

311.30

322.57

344.53

0.00

1,244.28

1,245.25

1,244.15

895.41

59.16

545.98

441.15

454.74

726.46

NR

NR

NR

NR

NR

NR

NR

NR

6.69%

7.64%

39.90%

7.54%

38.20%

7.54%

39.66%

10.33%

46.72%

84.75%

74.69%

80.57%

80.56%

92.89%

90.27%

87.82%

88.07%

88.07%

91.95%

NA

86.23%

86.23%

86.23%

85.69%

85.50%

83.62%

84.34%

84.34%

87.63%

58.12

92.95

70.20

76.19

99.30

559,229

530,612

1,348,846

1,263,265

7,614

343.01

462.91

382.10

394.30

659.49

3,300,572

2,642,617

7,342,130

6,537,888

50,566

48.03%

41.47%

46.69%

46.34%

NA

77.08%

64.69%

74.53%

73.50%

NA

79.49%

65.49%

76.78%

74.36%

NA

71.95%

59.43%

69.33%

66.02%

NA

61.11%

50.34%

58.57%

54.32%

45.16%

38.92%

30.04%

33.33%

32.04%

NA

69.77%

54.52%

66.64%

64.09%

42.50%

43.79%

56.25%

53.87%

53.91%

63.33%

NA

57.14%

57.14%

57.14%

NA

November 2013

Measures Annual HIV/AIDS Medical Visit--90 days between (Total)

DCH Audited Calendar Year 2012 Performance Measure Results

Georgia Families (GF)

Fee-for-Service (FFS)

ALL

Medicaid Adult Only (MAO)

CCSP

Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate

43.79%

56.29%

54.01%

54.04%

59.46%

Annual HIV/AIDS Medical Visit--180 days between (Ages 18-64)

25.18%

42.98%

40.64%

40.65%

56.67%

Annual HIV/AIDS Medical Visit--180 days between (Ages 65+)

NA

44.52%

44.52%

44.52%

NA

Annual HIV/AIDS Medical Visit--180 days between (Total)
Annual Monitoring for Patients on Persistent Medications--ACE Inhibitors or ARBs (Ages 18-64) Annual Monitoring for Patients on Persistent Medications--ACE Inhibitors or ARBs (Ages 65+) Annual Monitoring for Patients on Persistent Medications--ACE Inhibitors or ARBs (Total)
Annual Monitoring for Patients on Persistent Medications--Digoxin (Ages 18-64)

25.18% 89.02%

43.05% 89.00%

40.79% 88.88%

40.81% 89.78% 78.57% 88.90% 90.38%

51.35% 87.27% 67.86%* 80.72% 100.00%*

Annual Monitoring for Patients on Persistent Medications--Digoxin (Ages 65+)

84.34%

100.00%*

Annual Monitoring for Patients on Persistent Medications--Digoxin (Total)

NA

89.72%

89.85%

89.84%

NA

Annual Monitoring for Patients on Persistent Medications--Diuretics (Ages 18-64)

89.76%

93.75%

Annual Monitoring for Patients on Persistent Medications--Diuretics (Ages 65+)

76.34%

65.52%*

Annual Monitoring for Patients on Persistent Medications--Diuretics (Total)
Annual Monitoring for Patients on Persistent Medications--Anti-convulsants (Ages 18-64) Annual Monitoring for Patients on Persistent Medications--Anti-convulsants (Ages 65+) Annual Monitoring for Patients on Persistent Medications--Anti-convulsants (Total)
Annual Monitoring for Patients on Persistent Medications--Total (Ages 18-64)

88.35% 60.92%

89.09% 65.62%

88.79% 65.54%

88.79% 65.74% 60.85% 65.55% 86.19%

83.12% 51.85%* 38.89%* 46.67% 82.84%

Annual Monitoring for Patients on Persistent Medications--Total (Ages 65+)

76.36%

61.54%

Annual Monitoring for Patients on Persistent Medications (Total, Ages 18+)

87.52%

85.25%

85.48%

85.50%

75.00%

Annual Pediatric Hemoglobin (HbA1c) Testing (Ages 5-17)
Annual Percentage of Asthma Patients with One or More Asthma-Related ER Visit (Ages 2-20)
Antenatal Steroids
Antibiotic Utilization--Percent of antibiotics of concern for all antibiotic prescriptions (Total) Antidepressant Medication Management--Effective Continuation Phase Treatment (Ages 18-64) Antidepressant Medication Management--Effective Continuation Phase Treatment (Ages 65+)

74.14% 13.51% 4.70% 40.93%

63.35% 17.01% 4.11% 43.55%

75.52%

71.68% 12.81% 4.00% 42.31%

77.49%

4.02% 41.69% 44.43% 18.48%

49.56% 35.71%* 16.67%*

2 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Measures
Antidepressant Medication Management--Effective Continuation Phase Treatment (Total) Antidepressant Medication Management--Effective Acute Phase Treatment (Ages 18-64) Antidepressant Medication Management--Effective Acute Phase Treatment (Ages 65+)

Georgia Families (GF) Admin Rate Hybrid Rate
35.73%

Fee-for-Service (FFS) Admin Rate Hybrid Rate
47.19%

ALL

Medicaid Adult Only (MAO)

CCSP

Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate

43.43%

43.50%

NA

60.00%

71.43%*

37.50%

33.33%*

Antidepressant Medication Management--Effective Acute Phase Treatment (Total) 53.36%

60.26%

59.19%

59.26%

NA

Appropriate Testing for Children With Pharyngitis
Appropriate Treatment for Children With Upper Respiratory Infection (Note: Inverted rate)
Breast Cancer Screening (Ages 42-64)

77.47% 82.79%

71.24% 79.26%

74.91% 80.73%

36.74%

19.75%

Breast Cancer Screening (Ages 65-69)

21.53%

16.29%

Breast Cancer Screening (Total)
Care Transition--Transition Record Transmitted to Health Care Professional (Ages 18-64) Care Transition--Transition Record Transmitted to Health Care Professional (Ages 65+)
Cervical Cancer Screening

56.49% NR NR
70.86%

31.98% NR NR
33.23%

40.39%

34.53% NR NR
49.42%

50.85%

34.53% NR NR
49.41%

50.61%

18.64% NR NR
13.21%

17.27%

Cesarean Delivery Rate

31.25%

27.48%

29.58%

29.59%

Cesarean Rate for Nulliparous Singleton Vertex

19.07%

12.72%

16.68%

16.68%

Childhood Immunization Status--Combo 2

13.13%

11.75%

56.45%

12.51%

60.83%

Childhood Immunization Status--Combo 3

11.71%

10.41%

52.80%

11.27%

58.39%

Childhood Immunization Status--Combo 4

11.47%

10.36%

52.55%

11.04%

57.18%

Childhood Immunization Status--Combo 5

8.10%

5.56%

28.95%

7.87%

42.82%

Childhood Immunization Status--Combo 6

5.13%

5.92%

30.41%

4.89%

30.66%

Childhood Immunization Status--Combo 7

7.94%

5.56%

28.71%

7.72%

42.09%

Childhood Immunization Status--Combo 8

5.08%

5.92%

30.17%

4.84%

30.17%

Childhood Immunization Status--Combo 9

3.76%

2.99%

17.76%

3.57%

23.36%

Childhood Immunization Status--Combo 10
Childhood Immunization Status--Diphtheria, Tetanus, and Acellular Pertussis (DTaP)
Childhood Immunization Status--Polio (IPV)

3.73% 62.33% 73.73%

2.99% 38.33% 50.08%

17.52% 64.96% 76.16%

3.53% 59.98% 72.38%

22.87% 75.43% 87.10%

3 of 47

November 2013

Measures Childhood Immunization Status--Measles, Mumps, and Rubella (MMR)

DCH Audited Calendar Year 2012 Performance Measure Results

Georgia Families (GF)

Fee-for-Service (FFS)

ALL

Medicaid Adult Only (MAO)

CCSP

Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate

87.34%

76.56%

85.40%

85.29%

91.48%

Childhood Immunization Status--H Influenza Type B (HiB)

80.65%

61.67%

80.29%

78.61%

91.73%

Childhood Immunization Status--Hepatitis B

17.33%

16.59%

65.45%

16.81%

71.05%

Childhood Immunization Status--Chicken Pox (VZV)

87.99%

76.51%

84.67%

85.81%

92.70%

Childhood Immunization Status--Pneumococcal Conjugate (PCV)

60.57%

36.84%

64.23%

58.53%

76.89%

Childhood Immunization Status--Hepatitis A

87.85%

79.03%

85.89%

87.01%

91.24%

Childhood Immunization Status--Rotavirus (RV)

48.03%

28.08%

37.47%

46.88%

59.37%

Childhood Immunization Status--Influenza (Flu)
Children and Adolescents' Access to Primary Care Practitioners(Ages 12-24 Months) Children and Adolescents' Access to Primary Care Practitioners(Ages 25 Months-6 Years)
Children and Adolescents' Access to Primary Care Practitioners(Ages 7-11 Years)
Children and Adolescents' Access to Primary Care Practitioners(Ages 12-19 Years)
Children and Adolescents' Access to Primary Care Practitioners(Total)

36.10% 94.17% 86.27% 88.52% 85.42% 87.20%

36.37% 92.38% 84.60% 84.51% 77.31% 81.32%

42.09%

34.85% 94.34% 85.29% 87.51% 83.71% 86.10%

41.36%

Chlamydia Screening in Women (Ages 16-20)

46.98%

42.27%

46.20%

47.96%

NA

Chlamydia Screening in Women (Ages 21-24)

66.17%

39.96%

60.26%

60.26%

0.00%*

Chlamydia Screening in Women (Total)
Chronic Obstructive Pulmonary Disease (COPD) Admission Rate--Per 100,000 Members (Ages 18-64) Chronic Obstructive Pulmonary Disease (COPD) Admission Rate--Per 100,000 Members (Ages 65+) Chronic Obstructive Pulmonary Disease (COPD) Admission Rate--Per 100,000 Members (Total)
Colorectal Cancer Screening (Custom measure)

51.56% 75.54 0.00 75.52

41.34% 1,480.15 19,871.07 4,884.12 26.21%

31.63%

50.59% 1,099.84 19,886.58 3,711.77 26.52%

32.12%

52.50% 1,139.94 19,892.07 3,829.24 26.52%

32.12%

NA 2,024.12 6,896.55 5,402.19 26.99%

33.82%

Comprehensive Diabetes Care--Blood Pressure Control (<140/80 mm Hg)

0.33%

0.91%

26.46%

0.84%

23.18%

0.84%

29.20%

1.80%

33.03%

Comprehensive Diabetes Care--Blood Pressure Control (<140/90 mm Hg)

0.60%

1.19%

39.96%

1.11%

34.49%

1.11%

39.60%

1.95%

41.24%

Comprehensive Diabetes Care--Eye Exam

41.63%

36.96%

42.70%

35.42%

40.69%

35.40%

39.05%

35.81%

41.61%

Comprehensive Diabetes Care--HbA1c Control (<7.0% for a Selected Population) 0.24%

0.51%

23.98%

0.46%

20.17%

0.46%

20.73%

0.97%

31.88%

Comprehensive Diabetes Care--HbA1c Control (<8.0%)

0.21%

0.64%

27.55%

0.59%

24.64%

0.59%

28.47%

0.90%

29.93%

4 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Measures
Comprehensive Diabetes Care--HbA1c Poor Control (>9.0%) (Note: Lower rate is better)
Comprehensive Diabetes Care--HbA1c Testing (Ages 18-64)

Georgia Families (GF)

Fee-for-Service (FFS)

ALL

Medicaid Adult Only (MAO)

CCSP

Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate

99.70%

98.99%

67.88%

99.07%

70.80%

99.07%

68.61%

98.73%

64.78%

NR

NR

NR

NR

Comprehensive Diabetes Care--HbA1c Testing (Ages 65-75)

NR

NR

NR

NR

Comprehensive Diabetes Care--HbA1c Testing (Total)

73.77%

54.04%

60.22%

56.33%

64.78%

56.29%

64.42%

37.00%

55.84%

Comprehensive Diabetes Care--LDL-C Level (<100 mg/dL)

0.24%

0.89%

21.17%

0.81%

16.24%

0.81%

20.62%

1.27%

25.18%

Comprehensive Diabetes Care--LDL-C Screening (Ages 18-64)

NR

NR

NR

NR

Comprehensive Diabetes Care--LDL-C Screening (Ages 65-75)

NR

NR

NR

NR

Comprehensive Diabetes Care--LDL-C Screening (Total)

66.48%

46.51%

57.66%

48.56%

53.28%

48.55%

57.85%

26.14%

46.35%

Comprehensive Diabetes Care--Medical Attention for Nephropathy

68.01%

61.31%

69.53%

61.98%

67.88%

61.98%

70.26%

52.81%

72.26%

Congestive Heart Failure Admission Rate--Per 100,000 Members (Ages 18-64)

26.44

991.51

721.45

748.19

2,196.38

Congestive Heart Failure Admission Rate--Per 100,000 Members (Ages 65+)

0.00

24,096.99

24,115.80

24,114.70

4,400.84

Congestive Heart Failure Admission Rate--Per 100,000 Members (Total)

26.43

5,268.09

3,973.98

4,099.24

3,724.74

Controlling High Blood Pressure (Ages 18-64)

NR

NR

Controlling High Blood Pressure (Ages 65-85)

NR

NR

Controlling High Blood Pressure (Total)

38.93%

35.04%

32.36%

44.04%

Developmental Screening in the First Three Years of Life (Age 1)

23.04%

20.34%

22.01%

Developmental Screening in the First Three Years of Life (Age 2)

24.63%

21.84%

23.73%

Developmental Screening in the First Three Years of Life (Age 3)

19.82%

19.58%

19.07%

Developmental Screening in the First Three Years of Life (Total)
Diabetes, Short-term Complications Admission Rate--Per 100,000 Members (Ages 18-64) Diabetes, Short-term Complications Admission Rate--Per 100,000 Members (Ages 65+) Diabetes, Short-term Complications Admission Rate--Per 100,000 Members (Total)
Elective Delivery

22.40% 95.26 0.00 95.24 34.29%

20.58% 335.24 383.28 344.13 28.47%

21.58% 297.10 383.58 309.12 33.79%

305.83 383.58 316.98 33.81%

559.86 133.36 264.17

Follow-Up After Hospitalization for Mental Illness--7-Day Follow-Up (Ages 6+)

47.04%

40.17%

42.81%

41.93%

35.90%

Follow-Up After Hospitalization for Mental Illness--7-Day Follow-Up (Ages 21+)

37.95%

35.90%

5 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Measures
Follow-Up After Hospitalization for Mental Illness--7-Day Follow-Up (Ages 2164)

Georgia Families (GF)

Fee-for-Service (FFS)

ALL

Medicaid Adult Only (MAO)

CCSP

Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate

38.61%

42.86%*

Follow-Up After Hospitalization for Mental Illness--7-Day Follow-Up (Ages 65+)

18.67%

27.78%*

Follow-Up After Hospitalization for Mental Illness--30-Day Follow-Up (Ages 6+)
Follow-Up After Hospitalization for Mental Illness--30-Day Follow-Up (Ages 21+) Follow-Up After Hospitalization for Mental Illness--30-Day Follow-Up (Ages 2164) Follow-Up After Hospitalization for Mental Illness--30-Day Follow-Up (Ages 65+) Follow-Up Care for Children Prescribed ADHD Medication--Continuation and Maintenance Phase
Follow-Up Care for Children Prescribed ADHD Medication--Initiation Phase

65.11%
48.32% 35.73%

61.26%
42.30% 31.68%

63.00%
45.64% 34.60%

62.05% 58.60% 59.36% 36.44%

53.85% 53.85% 66.67%* 38.89%*

Frequency of Ongoing Prenatal Care--(<21 Percent)

58.23%

44.41%

36.50%

56.38%

35.77%

46.72%

36.25%

Frequency of Ongoing Prenatal Care (21-40 Percent)

22.67%

31.97%

5.84%

25.02%

2.68%

34.49%

2.43%

Frequency of Ongoing Prenatal Care (41-60 Percent)

8.88%

14.24%

10.22%

8.23%

5.60%

10.10%

4.38%

Frequency of Ongoing Prenatal Care (61-80 Percent)

4.40%

5.41%

9.25%

3.72%

12.90%

4.65%

9.49%

Frequency of Ongoing Prenatal Care (81+ Percent)

5.82%

3.97%

38.20%

6.65%

43.07%

4.05%

47.45%

Human Papillomavirus Vaccine for Female Adolescents

16.08%

11.44%

11.68%

15.11%

16.30%

Immunizations for Adolescents--Combo 1

69.96%

56.83%

66.18%

66.27%

69.23%

Immunizations for Adolescents--Meningococcal

72.19%

59.00%

66.67%

68.51%

71.22%

Immunizations for Adolescents--Tdap/Td Total
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment--Engagement (Ages 13-17) Initiation and Engagement of Alcohol and Other Drug Dependence Treatment--Engagement (Ages 18-64) Initiation and Engagement of Alcohol and Other Drug Dependence Treatment--Engagement (Ages 18+) Initiation and Engagement of Alcohol and Other Drug Dependence Treatment--Engagement (Ages 65+) Initiation and Engagement of Alcohol and Other Drug Dependence Treatment--Engagement (Total, Ages 13+) Initiation and Engagement of Alcohol and Other Drug Dependence Treatment--Initiation (Ages 13-17) Initiation and Engagement of Alcohol and Other Drug Dependence Treatment--Initiation (Ages 18-64) Initiation and Engagement of Alcohol and Other Drug Dependence Treatment--Initiation (Ages 18+)

80.63% 11.74%
6.07%
7.31% 34.51%
39.58%

67.39% 13.10%
6.10%
6.27% 39.29%
43.45%

76.64%

77.52% 11.15%
6.08%
6.49% 36.87%
41.89%

78.16%

10.97% 6.11% 6.15% 6.64% 6.47% 36.37% 40.77% 41.95%

NA 1.19% 0.65% 0.00% 0.65%
NA 41.67% 42.58%

6 of 47

November 2013

Measures Initiation and Engagement of Alcohol and Other Drug Dependence Treatment--Initiation (Ages 65+) Initiation and Engagement of Alcohol and Other Drug Dependence Treatment--Initiation (Total, Ages 13+)
Inpatient Utilization--General Hospital/Acute Care
Lead Screening in Children

DCH Audited Calendar Year 2012 Performance Measure Results

Georgia Families (GF)

Fee-for-Service (FFS)

ALL

Medicaid Adult Only (MAO)

CCSP

Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate

56.37%

43.66%

38.48% Rates reported
in separate table
71.97%

43.36% Rates reported
in separate table
60.67%

65.45%

41.49% Rates reported
in separate table
68.76%

72.02%

41.58% Rates reported
in separate table

42.58% Rates reported
in separate table

Low Birth Weight--Percentage of Live Births Weighing Less Than 2,500 Grams

8.59%

8.52%

8.44%

8.45%

Medication Management for People With Asthma--50% Compliance (Ages 5-11) 49.66%

67.47%

53.85%

53.07%

NA

Medication Management for People With Asthma--50% Compliance (Ages 12-18) 47.06%

67.98%

52.56%

52.65%

NA

Medication Management for People With Asthma--50% Compliance (Ages 19-50) 53.36%

68.17%

62.55%

62.40%

NA

Medication Management for People With Asthma--50% Compliance (Ages 51-64)

NA

73.68%

73.13%

73.13%

NA

Medication Management for People With Asthma--50% Compliance (Total)

48.97%

68.47%

54.68%

54.61%

NA

Medication Management for People With Asthma--75% Compliance (Ages 5-11) 27.43%

48.24%

31.74%

31.46%

NA

Medication Management for People With Asthma--75% Compliance (Ages 12-18) 26.47%

47.52%

31.73%

31.91%

NA

Medication Management for People With Asthma--75% Compliance (Ages 19-50) 26.87%

49.88%

43.07%

42.94%

NA

Medication Management for People With Asthma--75% Compliance (Ages 51-64)

NA

55.06%

54.48%

54.48%

NA

Medication Management for People With Asthma--75% Compliance (Total) Mental Health Utilization Persistence of Beta-Blocker Treatment After a Heart Attack

27.18% Rates reported
in separate table

49.21% Rates reported
in separate table
58.68%

33.27% Rates reported
in separate table
59.86%

33.58% Rates reported
in separate table
59.86%

NA Rates reported
in separate table NA

Pharmacotherapy Management of COPD Exacerbation--Bronchodilator

49.85%

51.00%

51.01%

16.98%

Pharmacotherapy Management of COPD Exacerbation--Systemic Corticosteroid Plan All-Cause Readmissions Prenatal and Postpartum Care--Postpartum Care

Rates reported in separate table 39.16%

36.24% Rates reported
in separate table
25.96%

48.18%

37.37% Rates reported
in separate table
37.72%

56.45%

37.37% Rates reported
in separate table
37.71%

64.96%

7.55% Rates reported
in separate table

Prenatal and Postpartum Care--Timeliness of Prenatal Care Race/Ethnicity Diversity of Membership Screening for Clinical Depression and Follow-Up Plan (Ages 18-64)

37.54% Rates reported
in separate table 0.00%

53.06% Rates reported
in separate table 0.01%

64.72%

44.46% Rates reported
in separate table 0.01%

68.61%

52.69% Rates reported
in separate table 0.01%

72.02%

Rates reported in separate table 0.00%

0.00%

Screening for Clinical Depression and Follow-Up Plan (Ages 65+)

0.00%

0.02%

0.02%

0.02%

0.00%

0.00%

7 of 47

November 2013

Measures Screening for Clinical Depression and Follow-Up Plan (Total)

DCH Audited Calendar Year 2012 Performance Measure Results

Georgia Families (GF)

Fee-for-Service (FFS)

ALL

Medicaid Adult Only (MAO)

CCSP

Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate

0.00%

0.01%

0.01%

0.01%

0.00%

0.00%

Use of Appropriate Medications for People with Asthma (Ages 5-11)

89.54%

90.51%

89.69%

88.74%

NA

Use of Appropriate Medications for People with Asthma (Ages 12-18)

87.36%

85.41%

86.76%

85.40%

NA

Use of Appropriate Medications for People with Asthma (Ages 19-50)

70.71%

68.50%

69.28%

69.17%

NA

Use of Appropriate Medications for People with Asthma (Ages 51-64)

68.42%

64.90%

65.36%

65.36%

NA

Use of Appropriate Medications for People with Asthma (Total)

88.11%

79.68%

85.89%

84.29%

NA

Weeks of Pregnancy at Time of Enrollment (<0 Weeks)

9.71%

7.80%

10.57%

17.57%

Weeks of Pregnancy at Time of Enrollment (1-12 Weeks)

9.46%

0.82%

17.92%

42.61%

Weeks of Pregnancy at Time of Enrollment (13-27 Weeks)

57.19%

2.60%

36.59%

14.10%

Weeks of Pregnancy at Time of Enrollment (28+ Weeks)

15.49%

80.50%

26.71%

18.25%

Weeks of Pregnancy at Time of Enrollment (Unknown)
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--BMI Percentile (Ages 3-11) Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--BMI Percentile (Ages 12-17) Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--BMI Percentile (Total) Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--Counseling for Nutrition (Ages 3-11) Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--Counseling for Nutrition (Ages 12-17) Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--Counseling for Nutrition (Total) Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--Counseling for Physical Activity (Ages 3-11) Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--Counseling for Physical Activity (Ages 12-17) Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--Counseling for Physical Activity (Total) Well-Child Visits in the First 15 Months of Life--Zero Visits ( Note: For zero visits, a lower rate is better)
Well-Child Visits in the First 15 Months of Life--One Visit

8.14% 7.19% 7.05% 7.15% 2.90% 3.44% 3.07% 2.31% 2.66% 2.42% 6.54% 4.18%

8.28% 5.04% 4.73% 4.92% 1.96% 1.98% 1.97% 1.28% 1.35% 1.31% 22.22% 7.56%

24.46% 30.90% 27.25% 39.91% 34.27% 37.47% 24.46% 32.02% 27.74% 19.95% 5.84%

8.22% 7.11% 6.74% 6.99% 2.75% 3.14% 2.87% 2.23% 2.45% 2.30% 6.58% 4.35%

29.00% 26.13% 28.22% 45.67% 36.04% 43.07% 29.33% 36.04% 31.14% 6.08% 2.68%

7.48%

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

5.49%

4.78%

5.35%

5.85%

5.60%

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

7.91%

9.56%

9.49%

8.59%

7.54%

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

11.79%

14.56%

16.55%

12.82%

9.25%

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November 2013

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

DCH Audited Calendar Year 2012 Performance Measure Results

Georgia Families (GF)

Fee-for-Service (FFS)

ALL

Medicaid Adult Only (MAO)

CCSP

Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate Admin Rate Hybrid Rate

17.36%

18.11%

18.49%

18.63%

11.92%

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

46.71%

23.22%

24.33%

43.18%

56.93%

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

61.31%

53.20%

57.80%

57.86%

57.32%

*The denominator for these rates consisted of fewer than 30 cases. Although NCQA requires HEDIS rates based on less than 30 cases to be denoted as "NA," CMS allows the rate to be reported.

9 of 47

November 2013

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

DCH Audited Calendar Year 2012 Performance Measure Results

Georgia Families Inpatient Utilization--General Hospital/Acute Care
Total Inpatient

Discharges

Discharges / 1,000 Member Months

Days

Days / 1,000 Average Length of

Members Months

Stay

3,941

4,334 8,529 40,048 1,340
2 0 0 0 58,194
Discharges
3,057 3,228

Medicine
Discharges / 1,000 Member Months

1,512

2,114 727
1 0 0 0 10,639

23,234
13,773 26,625 116,393 6,626
11 0 0 0 186,662
Days
12,473 8,606
5,102
7,619 2,778
4 0 0 0 36,582

34.33

5.90

3.07

3.18

8.09

3.12

109.32

2.91

62.38

4.94

52.63

5.50

0.00

0.00

0.00

0.00

0.00

0.00

19.40

3.21

Days / 1,000 Average Length of

Members Months

Stay

18.43

4.08

1.92

2.67

1.55

3.37

7.16

3.60

26.15

3.82

19.14

4.00

0.00

0.00

0.00

0.00

0.00

0.00

3.80

3.44

10 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Surgery

Age

Discharges

Discharges / 1,000 Member Months

Days

Days / 1,000 Average Length of

Members Months

Stay

<1

884

1-9

1,106

10,761 5,167

15.90 1.15

12.17 4.67

10-19

1,093

5,523

1.68

5.05

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

1,594 569
1 0 0 0 5,247
Discharges
5,924 36,340

Maternity*
Discharges / 1,000 Member Months

8,701 3,730
7 0 0 0 33,889
Days
16,000 100,073

8.17

5.46

35.12

6.56

33.49

7.00

0.00

0.00

0.00

0.00

0.00

0.00

3.52

6.46

Days / 1,000 Average Length of

Members Months

Stay

4.86

2.70

93.99

2.75

45-64

44

118

1.11

2.68

Unknown

0

0

0.00

0.00

Total

42,308

116,191

26.04

2.75

*For discharges, only discharges per 1000 member years were reported, not discharges per 1000 member months.

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

11 of 47

November 2013

12 of 47

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
Age

DCH Audited Calendar Year 2012 Performance Measure Results

Fee-for-Service Inpatient Utilization--General Hospital/Acute Care
Total Inpatient

Discharges

Discharges / 1,000 Member Months

Days

Days / 1,000 Average Length of

Members Months

Stay

1,861

5,415 5,867 31,829 41,290 10,235 8,098 5,476
0 110,071
Discharges
1,263
3,901

Medicine
Discharges / 1,000 Member Months

19,645
26,737 27,625 151,907 253,233 59,600 45,768 28,275
0 612,790
Days
6,323
13,615

194.24

10.56

23.24

4.94

26.49

4.71

127.23

4.77

202.50

6.13

135.64

5.82

143.15

5.65

134.32

5.16

0.00

0.00

107.34

5.57

Days / 1,000 Average Length of

Members Months

Stay

62.52

5.01

11.83

3.49

2,811

11,520 27,597 7,183 6,066 4,506
0 64,847
Discharges

Surgery
Discharges / 1,000 Member Months

11,796
53,441 125,146 33,138 28,704 20,664
0 292,827
Days

11.31

4.20

44.76

4.64

100.08

4.53

75.42

4.61

89.78

4.73

98.16

4.59

0.00

0.00

51.29

4.52

Days / 1,000 Average Length of

Members Months

Stay

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

<1

598

13,322

131.72

22.28

1-9

1,514

13,122

11.40

8.67

10-19

1,330

11,130

10.67

8.37

20-44 45-64
65-74
75-84 85+

5,890 13,626
3,052
2,032 970

60,115 127,772
26,462
17,064 7,611

50.35 102.18
60.22
53.37 36.15

10.21 9.38
8.67
8.40 7.85

Unknown

0

0

0.00

0.00

Total
Age
10-19 20-44 45-64 Unknown Total

29,012
Discharges
1,726 14,419
67 0 16,212

Maternity*
Discharges / 1,000 Member Months

276,598
Days
4,699 38,351
315 0
43,365

48.45

9.53

Days / 1,000 Average Length of

Members Months

Stay

4.51

2.72

32.12

2.66

0.25

4.70

0.00

0.00

12.44

2.67

*For discharges, only discharges per 1000 member years were reported, not discharges per 1000 member months. **The maternity category is calculated using member months for members 10-64 years.

13 of 47

November 2013

14 of 47

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

DCH Audited Calendar Year 2012 Performance Measure Results

ALL Inpatient Utilization--General Hospital/Acute Care
Total Inpatient

Discharges

Discharges / 1,000 Member Months

Days

Days / 1,000 Average Length of

Members Months

Stay

7,976 12,093 18,765 88,949 43,238 10,237 8,098 5,476
0 194,832
Discharges
6,124

Medicine
Discharges / 1,000 Member Months

52,925 47,311 67,051 313,927 262,385 59,611 45,768 28,275
0 877,253
Days
24,945

50.82

6.64

6.35

3.91

11.86

3.57

116.12

3.53

188.06

6.07

135.58

5.82

143.14

5.65

134.31

5.16

0.00

0.00

45.65

4.50

Days / 1,000 Average Length of

Members Months

Stay

23.95

4.07

8,941

26,783

3.59

3.00

5,081 14,731 28,664 7,184 6,066 4,506
0 81,297
Discharges
1,852

Surgery
Discharges / 1,000 Member Months

3,152

19,200 64,971 129,166 33,142 28,704 20,664
0 347,575
Days
27,980
20,528

3.40

3.78

24.03

4.41

92.58

4.51

75.38

4.61

89.77

4.73

98.16

4.59

0.00

0.00

18.09

4.28

Days / 1,000 Average Length of

Members Months

Stay

26.87

15.11

2.75

6.51

2,942 8,380 14,448 3,053 2,032 970
0 36,829
Discharges
10,742 65,838

Maternity*
Discharges / 1,000 Member Months

18,872 72,824 132,752 26,469 17,064 7,611
0 324,100
Days
28,979 176,132

3.34

6.41

26.94

8.69

95.15

9.19

60.20

8.67

53.37

8.40

36.15

7.85

0.00

0.00

16.87

8.80

Days / 1,000 Average Length of

Members Months

Stay

5.13

2.70

65.15

2.68

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

45-64 Unknown
Total

126 0
76,706

467

0.33

3.71

0

0.00

0.00

205,578

21.08

2.68

*For discharges, only discharges per 1000 member years were reported, not discharges per 1000 member months. **The maternity category is calculated using member months for members 10-64 years.

15 of 47

November 2013

16 of 47

DCH Audited Calendar Year 2012 Performance Measure Results

Medicaid Adult Only

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

Inpatient Utilization--General Hospital/Acute Care

Total Inpatient

Discharges

Discharges / 1,000 Member Months

Days

Days / 1,000 Average Length of

Members Months

Stay

7,953

52,851

51.04

6.65

11,091

44,265

7.05

3.99

17,310

61,138

14.58

3.53

88,949

313,927

116.12

3.53

43,238

262,385

188.06

6.07

10,237

59,611

135.58

5.82

8,098

45,768

143.14

5.65

5,476

28,275

134.31

5.16

0

0

0.00

0.00

192,352

868,220

52.36

4.51

Medicine

Discharges

Discharges / 1,000 Member Months

Days

Days / 1,000 Average Length of

Members Months

Stay

6,107 8,195 4,321 14,731 28,664 7,184 6,066 4,506
0 79,774

24,901

24.05

4.08

24,820

3.95

3.03

16,310

3.89

3.77

64,971

24.03

4.41

129,166

92.58

4.51

33,142

75,38

4.61

28,704

89.77

4.73

20,664

98.16

4.59

0

0.00

0.00

342,678

20.67

4.30

Surgery

Discharges

Discharges / 1,000 Member Months

Days

Days / 1,000 Average Length of

Members Months

Stay

1,846 2,896 2,387 8,380 14,448 3,053 2,032 970
0 36,012

Maternity*

27,950 19,445 16,231 72,824 132,752 26,469 17,064 7,611
0 320,346

26.99 3.10 3.87 26.94 95.15 60.20 53.37 36.15 0.00 19.32

15.14 6.71 6.80 8.69 9.19 8.67 8.40 7.85 0.00 8.90

Discharges

Discharges / 1,000 Member Months

Days

Days / 1,000 Average Length of

Members Months

Stay

10,602 65,838
126 0
76,566

28,597

6.82

2.70

176,132

65.15

2.68

467

0.33

3.71

0

0.00

0.00

205,196

24.74

2.68

*For discharges, only discharges per 1000 member years were reported, not discharges per 1000 member months. **The maternity category is calculated using member months for members 10-64 years.

November 2013

17 of 47

DCH Audited Calendar Year 2012 Performance Measure Results

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

CCSP

Inpatient Utilization--General Hospital/Acute Care Total Inpatient

Discharges

Discharges / 1,000 Member Months

Days

Days / 1,000 Average Length of

Members Months

Stay

0 2 11 110 710 691 631 408 0 2,563

0

0.00

0.00

6

20.34

3.00

33

39.76

3.00

765

200.84

6.95

4,320

225.20

6.08

3,774

209.22

5.46

3,582

185.94

5.68

2,055

134.71

5.04

0

0.00

0.00

14,535

189.57

5.67

Medicine

Discharges

Discharges / 1,000 Member Months

Days

Days / 1,000 Average Length of

Members Months

Stay

0 1 6 69 495 521 492 339 0 1,923

0

0.00

0.00

4

13.56

4.00

18

21.69

3.00

354

92.94

5.13

2,318

120.84

4.68

2,351

130.34

4.51

2,393

124.22

4.86

1,579

103.51

4.66

0

0.00

0.00

9,017

117.60

4.69

Surgery

Discharges

Discharges / 1,000 Member Months

Days

Days / 1,000 Average Length of

Members Months

Stay

0

0

0.00

0.00

1

2

6.78

2.00

5

15

18.07

3.00

40

409

107.38

10.23

214

2,001

104.31

9.35

170

1,423

78,89

8.37

139

1,189

61.72

8.55

69

476

31.20

6.90

0

0

0.00

0.00

638

5,515

71.93

8.64

Maternity*

Discharges

Discharges / 1,000 Member Months

Days

Days / 1,000 Average Length of

Members Months

Stay

0

0

0.00

0.00

1

2

0.53

2.00

1

1

0.05

1.00

0

0

0.00

0.00

2

3

0.13

1.50

*For discharges, only discharges per 1000 member years were reported, not discharges per 1000 member months. **The maternity category is calculated using member months for members 10-64 years.

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Georgia Families

Race White

Race/Ethnicity Diversity of Membership

Hispanic or Latino

Not Hispanic or Latino Unknown Ethnicity

Number Percentage Number Percentage Number Percentage

120,454

10.59%

238,745

20.98%

92,050

8.09%

Declined Ethnicity Number Percentage

0

0.00%

Total Number Percentage

451,249

39.66%

Black or African American

2,875

0.25%

425,645

37.41%

120,384

10.58%

0

0.00%

548,904

48.24%

American-Indian and Alaska Native 248

0.02%

566

0.05%

268

0.02%

0

0.00%

1,082

0.10%

Asian

527

0.05%

17,589

1.55%

11,530

1.01%

0

0.00%

29,646

2.61%

Native Hawaiian and Other Pacific Islanders

503

0.04%

442

0.04%

46

0.00%

0

0.00%

991

0.09%

Some Other Race

37,518

3.30%

7,394

0.65%

768

0.07%

0

0.00%

45,680

4.01%

Two or More Races

1

0.00%

2

0.00%

0

0.00%

0

0.00%

3

0.00%

Unknown

199

0.02%

2,401

0.21%

552

0.05%

0

0.00%

3,152

0.28%

Declined

216

0.02%

2,692

0.24%

54,320

4.77%

0

0.00%

57,228

5.03%

Total

1,137,935 100.00%

18 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Race
White
Black or African American American-Indian and Alaska
Native Asian Native Hawaiian and Other Pacific Islanders Some Other Race
Two or More Races
Unknown
Declined
Total

Fee-for-Service

Hispanic or Latino Number 87,556 2,156 177 387 353 17,045 1 1,650 755

Race/Ethnicity Diversity of Membership

Percentage 7.72%

Not Hispanic or Latino Number
268,599

Percentage 23.67%

Unknown Ethnicity Number
55,202

Percentage 4.86%

Declined Ethnicity Number
0

Percentage 0.00%

Total Number 411,357

Percentage 36.25%

0.19%

427,471

37.67%

69,129

6.09%

0

0.00%

498,756 43.95%

0.02%

837

0.07%

186

0.02%

0

0.00%

1,200

0.11%

0.03%

18,621

1.64%

4,342

0.38%

0

0.00%

23,350

2.06%

0.03%

392

0.03%

28

0.00%

0

0.00%

773

0.07%

1.50%

9,516

0.84%

616

0.05%

0

0.00%

27,177

2.39%

0.00%

3

0.00%

2

0.00%

0

0.00%

6

0.00%

0.15%

79,368

6.99%

24,633

2.17%

0

0.00%

105,651

9.31%

0.07%

22,332

1.97%

43,508

3.83%

0

0.00%

66,595

5.87%

1,134,865 100.00%

19 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Race
White
Black or African American American-Indian and Alaska
Native Asian Native Hawaiian and Other Pacific Islanders Some Other Race
Two or More Races
Unknown
Declined
Total

ALL

Race/Ethnicity Diversity of Membership

Hispanic or Latino

Number

Percentage

169,294

8.40%

Not Hispanic or Latino Number Percentage

452,065

22.44%

Unknown Ethnicity Number Percentage

165,932

8.24%

Declined Ethnicity Number Percentage

0

0.00%

Total Number Percentage
787,291 39.08%

3,801

0.19%

707,702

35.13%

191,120

9.49%

0

0.00%

902,623 44.81%

345

0.02%

1,212

0.06%

410

0.02%

0

0.00%

1,967

0.10%

695

0.03%

27,283

1.35%

14,491

0.72%

0

0.00%

42,469

2.11%

656

0.03%

662

0.03%

90

0.00%

0

0.00%

1,408

0.07%

47,415

2.35%

14,412

0.72%

1,643

0.08%

0

0.00%

63,470

3.15%

3

0.00%

7

0.00%

2

0.00%

0

0.00%

12

0.00%

1,678

0.08%

79,879

3.97%

24,768

1.23%

0

0.00%

106,325

5.28%

888

0.04%

24185

1.20%

83,893

4.16%

0

0.00%

108,966

5.41%

2,014,531 100.00%

20 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Race
White Black or African American American-Indian and Alaska Native
Asian Native Hawaiian and Other Pacific
Islanders Some Other Race Two or More Races
Unknown Declined
Total

Medicaid Adult Only

Race/Ethnicity Diversity of Membership

Hispanic or Latino Not Hispanic or Latino Unknown Ethnicity

Declined Ethnicity

Total

Number Percentage Number Percentage Number Percentage Number Percentage Number Percentage

169,140

9.51%

451,382 25.37%

83,251

4.68%

0

0.00%

703,773 39.55%

3,796

0.21%

707,352 39.76% 120,626

6.78%

0

0.00%

831,774 46.75%

345

0.02%

1,212

0.07%

324

0.02%

0

0.00%

1,881

0.11%

694

0.04%

27,225

1.53%

4,838

0.27%

0

0.00%

32,757

1.84%

654

0.04%

662

0.04%

90

0.01%

0

0.00%

1,406

0.08%

15,553

0.87%

14,405

0.81%

1,637

0.09%

0

0.00%

31,595

1.78%

3

0.00%

7

0.00%

2

0.00%

0

0.00%

12

0.00%

1,678

0.09%

79,879

4.49%

24,763

1.39%

0

0.00%

106,320 5.98%

887

0.05%

24,184

1.36%

44,646

2.51%

0

0.00%

69,717

3.92%

1,779,235 100.00%

21 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Race
White Black or African American American-Indian and Alaska Native
Asian Native Hawaiian and Other Pacific
Islanders Some Other Race Two or More Races
Unknown Declined
Total

CCSP

Race/Ethnicity Diversity of Membership

Hispanic or Latino

Not Hispanic or Latino Unknown Ethnicity

Declined Ethnicity

Total

Number Percentage Number Percentage Number Percentage Number Percentage Number Percentage

55

0.71%

3,325

42.94%

1,043

13.47%

0

0.00%

4,423

57.12%

6

0.08%

2,385

30.80%

787

10.16%

0

0.00%

3,178

41.04%

0

0.00%

6

0.08%

0

0.00%

0

0.00%

6

0.08%

0

0.00%

39

0.50%

5

0.06%

0

0.00%

44

0.57%

1

0.01%

2

0.03%

0

0.00%

0

0.00%

3

0.04%

1

0.01%

10

0.13%

1

0.01%

0

0.00%

12

0.15%

0

0.00%

0

0.00%

0

0.00%

0

0.00%

0

0.00%

0

0.00%

51

0.66%

3

0.04%

0

0.00%

54

0.70%

0

0.00%

22

0.28%

1

0.01%

0

0.00%

23

0.30%

7,743

100.00%

22 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Age

Sex

0-12 13-17 18-64 65+ Unknown Total

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

Georgia Families

Any Services

Number 21,276 13,004 34,280 8,641 8,327 16,968 1,614 10,377 11,991
1 1 2 0 0 0 31,532 31,709 63,241

Percent 7.84 4.91 6.39 12.18 11.60 11.89 8.01 10.12 9.77 12.77 8.28 10.04 0.00 0.00 0.00 8.70 7.22 7.89

Mental Health Utilization

Inpatient

Number

Percent

Intensive Outpatient/Partial
Hospitalization

Number

Percent

388

0.14

219

0.08

231

0.09

128

0.05

619

0.12

347

0.06

597

0.84

233

0.33

909

1.27

282

0.39

1,506

1.06

515

0.36

195

0.97

42

0.21

1,000

0.97

193

0.19

1,195

0.97

235

0.19

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

1,180

0.33

494

0.14

2,140

0.49

603

0.14

3,320

0.41

1,097

0.14

Outpatient/ED

Number 21,182 12,934 34,116 8,488 8,123 16,611 1,531 9,952 11,483
1 1 2 0 0 0 31,202 31,010 62,212

Percent 7.80 4.88 6.36 11.96 11.32 11.64 7.60 9.70 9.36 12.77 8.28 10.04 0.00 0.00 0.00 8.61 7.06 7.76

23 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Age

Sex

0-12 13-17 18-64 65+ Unknown Total

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

Fee-for-Service

Mental Health Utilization

Any Services

Number

Percent

Inpatient

Number

Percent

Intensive Outpatient/Partial
Hospitalization

Number

Percent

12,341

17.10

216

0.30

81

0.11

6,844

11.17

128

0.21

21

0.03

19,185

14.38

344

0.26

102

0.08

7,608

30.94

385

1.57

57

0.23

5,031

25.59

379

1.93

41

0.21

12,639

28.56

764

1.73

98

0.22

18,208

20.41

2,712

3.04

56

0.06

24,622

19.35

3,200

2.51

86

0.07

42,830

19.78

5,912

2.73

142

0.07

2,065

9.26

1,346

6.03

1

0.00

5,830

9.97

3,815

6.52

2

0.00

7,895

9.77

5,161

6.39

3

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

40,222

19.31

4,659

2.24

195

0.09

42,327

15.87

7,522

2.82

150

0.06

82,549

13.38

12,181

2.56

345

0.07

Outpatient/ED

Number 12,307 6,821 19,128 7,549 4,975 12,524 17,429 23,783 41,212
838 2,393 3,231
0 0 0 38,123 37,972 76,095

Percent 17.05 11.13 14.33 30.70 25.30 28.30 19.53 18.69 19.04 3.76 4.09 4.00 0.00 0.00 0.00 18.30 14.24 16.02

24 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Age

Sex

0-12 13-17 18-64 65+ Unknown Total

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

ALL

Mental Health Utilization

Any Services

Inpatient

Intensive Outpatient/Partial
Hospitalization

Number

Percent

Number

Percent

Number

Percent

43,318

9.57

781

0.17

318

0.07

25,583

5.91

463

0.11

160

0.04

68,901

7.78

1,244

0.14

478

0.05

19,397

15.70

1,217

0.98

312

0.25

16,451

13.68

1,680

1.94

348

0.29

35,848

14.70

2,897

1.19

660

0.27

20,520

17.40

2,989

2.53

104

0.09

39,232

14.42

4,638

1.71

306

0.13

59,752

15.32

7,627

1.96

410

0.11

2,066

9.26

1,346

6.03

1

0.00

5,831

9.97

3,815

6.52

2

0.00

7,897

9.77

5,161

6.39

3

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

85,301

11.90

6,333

0.88

735

0.10

87,097

9.85

10,596

1.20

816

0.09

172,398

10.77

16,929

1.06

1,551

0.10

Outpatient/ED

Number 43,245 25,513 68,758 19,208 16,197 35,405 19,649 37,939 57,588
839 2,394 3,233
0 0 0 82,941 82,043 164,984

Percent 9.55 5.89 7.76 15.55 13.47 14.52 16.66 13.95 14.77 3.76 4.09 4.00 0.00 0.00 0.00 11.57 9.28 10.31

25 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Age

Sex

0-12 13-17 18-64 65+ Unknown Total

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

Medicaid Adult Only

Mental Health Utilization

Any Services

Number 37,135 22,076 59,211 16,039 13,359 29,398 20,221 38,967 59,188 2,066 5,834 7,900
0 0 0 75,461 80,236 155,697

Percent 9.80 6.08 7.98 17.75 15.20 16.49 17.94 14.60 15.59 9.26 9.97 9.77 0.00 0.00 0.00 12.48 10.33 11.27

Inpatient

Number 688 401 1,089 974 1,361 2,335 2,951 4,606 7,557 1,346 3,819 5,165 0 0 0 5,959
10,187 16,146

Percent 0.18 0.11 0.15 1.18 1.55 1.31 2.62 1.76 1.99 6.03 6.53 6.39 0.00 0.00 0.00 0.99 1.31 1.17

Intensive Outpatient/Partial
Hospitalization

Number

Percent

280

0.07

140

0.04

420

0.06

231

0.26

266

0.30

497

0.28

98

0.09

301

0.11

399

0.11

1

0.00

2

0.00

3

0.00

0

0.00

0

0.00

0

0.00

610

0.10

709

0.90

1,319

0.10

Outpatient/ED

Number 37,069 22,016 59,085 15,884 13,140 29,024 19,365 37,687 57,052
839 2,394 3,233
0 0 0 73,157 75,237 148,394

Percent 9.78 6.06 7.96 17.58 14.95 16.28 17.18 14.12 15.03 3.76 4.09 4.00 0.00 0.00 0.00 12.10 9.69 10.75

26 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Age

Sex

0-12 13-17 18-64 65+ Unknown Total

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

CCSP

Mental Health Utilization

Any Services

Inpatient

Intensive Outpatient/Partial
Hospitalization

Number

Percent

Number

Percent

Number

Percent

1

5.36

0

0.00

0

0.00

2

12.57

0

0.00

0

0.00

3

8.67

0

0.00

0

0.00

3

10.78

0

0.00

0

0.00

2

11.48

0

0.00

0

0.00

5

11.05

0

0.00

0

0.00

106

12.71

12

1.44

0

0.00

171

15.60

22

2.01

1

0.09

277

14.35

34

1.76

1

0.05

70

6.51

14

1.30

0

0.00

234

7.08

64

1.94

0

0.00

304

6.91

78

1.78

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

180

9.21

26

1.33

0

0.00

409

9.22

86

1.94

1

0.02

589

9.22

112

1.75

1

0.02

Outpatient/ED

Number 1 2 3 3 2 5 98
159 257 60 180 240
0 0 0 162 343 505

Percent 5.36 12.57 8.67 10.79 11.48 11.05 11.75 14.51 13.32 5.58 5.45 5.48 0.00 0.00 0.00 8.29 7.74 7.90

27 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Age 18-44 45-54 55-64 18-64 65+ Total

Sex
Male Female Total:
Male Female Total:
Male Female Total:
Male Female Total:
Male Female Total:
Male Female Total:

Count of Index Stays
(Denominator)
266 1,664 1,930
77 327 404 11 129 140 354 2,120 2,474
0 1 1 354 2,121 2,475

Georgia Families

Plann All-Cause Readmission Rate

Count of 30-Day Readmissions
(Numerator)
22 156 178
7 42 49 1 17 18 30 215 245 0 0 0 30 215 245

Observed Readmission
(Num/Den)

Average Adjusted Probability

8.27% 9.38% 9.22% 9.09% 12.84% 12.13% 9.09% 13.18% 12.86% 8.47% 10.14% 9.90% 0.00% 0.00% 0.00% 8.47% 10.14% 9.90%

0.1533 0.1293 0.1326 0.1610 0.135 0.1399 0.0800 0.1703 0.1632
NR NR NR 0.0000 0.1233 0.1233 0.1527 0.1327 0.1356

Total Variance
31.4689 172.1504 203.6193
9.2386 34.2590 43.7976 0.8024 16.2502 17.0526
NR NR NR 0.0000 0.1081 0.1081 41.5099 222.7677 264.2776

O/E Ratio (Observed Readmission/Aver age Adjusted Probability)
0.5395 0.7251 0.6955 0.5647 0.9514 0.8670 1.1364 0.7738 0.7878
NR NR NR 0.0000 0.0000 0.0000 0.5550 0.7639 0.7300

28 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Fee-for-Service

Age 18-44 45-54 55-64 18-64 65+ Total

Sex
Male Female Total:
Male Female Total:
Male Female Total:
Male Female Total:
Male Female Total:
Male Female Total:

Count of Index Stays
(Denominator)
5,280 6,306 11,586 4,654 6,908 11,562 5,418 7,869 13,287 15,352 21,083 36,435 4,598 12,083 16,681 19,950 33,166 53,116

Plan All-Cause Readmission Rate

Count of 30-Day Readmissions
(Numerator)
742 854 1,596 590 840 1,430 696 791 1,487 2,028 2,485 4,513 112 303 415 2,140 2,788 4,928

Observed Readmission
(Num/Den)

Average Adjusted Probability

14.05% 13.54% 13.78% 12.68% 12.16% 12.37% 12.85% 10.05% 11.19% 13.21% 11.79% 12.39% 2.44% 2.51% 2.49% 10.73% 8.41% 9.28%

0.2167 0.2023 0.2089 0.2270 0.2002 0.2110 0.2138 0.1839 0.1961
NR NR NR 0.1883 0.1732 0.1773 0.2118 0.1869 0.1962

Total Variance
798.5978 898.3019 1696.8997 706.6172 964.7284 1671.3456 786.9669 1039.7823 1826.7492
NR NR NR 662.7293 1642.3014 2305.0307 2954.9112 4545.1140 7500.0252

O/E Ratio (Observed Readmission/Aver age Adjusted Probability)
0.6485 0.6694 0.6594 0.5585 .06074 0.5862 0.6008 0.5466 0.5707
NR NR NR 0.1294 0.1448 0.1403 0.5065 0.4498 0.4729

29 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

ALL

Age 18-44 45-54 55-64 18-64 65+ Total

Sex
Male Female Total:
Male Female Total:
Male Female Total:
Male Female Total:
Male Female Total:
Male Female Total:

Count of Index Stays
(Denominator)
5,929 10,494 16,423 4,833 7,675 12,508 5,447 8,126 13,573 16,209 26,295 42,504 4,598 12,087 16,685 20,807 38,382 59,189

Plan All-Cause Readmission Rate

Count of 30-Day Readmissions
(Numerator)
799 1,297 2,096 608 928 1,536 699 828 1,527 2,106 3,053 5,159 112 304 416 2,218 3,357 5,575

Observed Readmission
(Num/Den)

Average Adjusted Probability

13.48% 12.36% 12.76% 12.58% 12.09% 12.28% 12.83% 10.19% 11.25% 12.99% 11.61% 12.14% 2.44% 2.52% 2.49% 10.66% 8.75% 9.42%

0.2093 0.1751 0.1874 0.2244 0.1934 0.2054 0.2133 0.1838 0.1956
NR NR NR 0.1883 0.1732 0.1773 0.2092 0.1800 0.1902

Total Variance
872.4920 1341.2717 2213.7638 727.2987 1044.1408 1771.4395 789.6694 1072.5389 1862.2083
NR NR NR 662.7293 1642.8163 2305.5456 3052.1894 5100.7677 8152.9572

O/E Ratio (Observed Readmission/Aver age Adjusted Probability)
0.6439 0.7059 0.6810 0.5606 0.6252 0.5979 0.6016 0.5544 0.5752
NR NR NR 0.1294 0.1452 0.1406 0.5096 0.4859 0.4952

30 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Medicaid Adult Only

Age 18-44 45-54 55-64 18-64 65+ Total

Sex
Male Female Total:
Male Female Total:
Male Female Total:
Male Female Total:
Male Female Total:
Male Female Total:

Count of Index Stays
(Denominator)
5,857 10,405 16,262 4,833 7,675 12,508 5,447 8,126 13,573 16,137 26,206 42,343 4,598 12,087 16,685 20,735 38,293 59,028

Plan All-Cause Readmission Rate

Count of 30-Day Readmissions
(Numerator)
791 1,288 2,079 608 928 1,536 699 828 1,527 2,098 3,044 5,142 112 304 416 2,210 3,348 5,558

Observed Readmission
(Num/Den)

Average Adjusted Probability

13.51% 12.38% 12.78% 12.58% 12.09% 12.28% 12.83% 10.19% 11.25% 13.00% 11.62% 12.14% 2.44% 2.52% 2.49% 10.66% 8.74% 9.42%

0.2103 0.1755 0.1881 0.2244 0.1934 0.2054 0.2133 0.1838 0.1956
NR NR NR 0.1882 0.17362 0.1773 0.2095 0.1801 0.1904

Total Variance
865.0936 1332.2993 2197.3929 727.2987 1044.1522 1771.4509 789.7202 1072.5389 1862.2591
NR NR NR 662.6793 1642.8375 2305.5168 3044.7918 5091.8279 8136.6197

O/E Ratio (Observed Readmission/Aver age Adjusted Probability)
0.6422 0.7053 0.6797 0.5606 0.6252 0.5979 0.6016 0.5544 0.5752
NR NR NR 0.1294 0.1452 0.1406 0.5087 0.4855 0.4945

31 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

CCSP

Age 18-44 45-54 55-64 18-64 65+ Total

Sex
Male Female Total:
Male Female Total:
Male Female Total:
Male Female Total:
Male Female Total:
Male Female Total:

Count of Index Stays
(Denominator)
37 33 70 61 87 148 116 169 285 214 289 503 276 813 1,089 490 1,102 1,592

Plan All-Cause Readmission Rate

Count of 30-Day Readmissions
(Numerator)
2 1 3 2 1 3 3 4 7 7 6 13 4 8 12 11 14 25

Observed Readmission
(Num/Den)

Average Adjusted Probability

5.41% 3.03% 4.29% 3.28% 1.15% 2.03% 2.59% 2.37% 2.46% 3.27% 2.08% 2.58% 1.45% 0.98% 1.10% 2.24% 1.27% 1.57%

0.2257 0.2005 0.2138 0.2878 0.1942 0.2328 0.2540 0.1922 0.2173
NR NR NR 0.2024 0.1878 0.1915 0.2270 0.1894 0.2010

Total Variance
5.6317 4.9076 10.5393 10.5936 12.6262 23.2198 18.7010 23.1701 41.8711
NR NR NR 41.7348 117.9622 159.6970 76.6611 158.6660 235.3271

O/E Ratio (Observed Readmission/Aver age Adjusted Probability)
0.2395 0.1511 0.2005 0.1139 0.0592 0.0871 0.1018 0.1231 0.1130
NR NR NR 0.0716 0.0524 0.0575 0.0989 0.0671 0.0781

32 of 47

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Demographic Stratification by Gender Measures Cervical Cancer Screening (CCS); Controlling High Blood Pressure (CBP); Comprehensive
Diabetes Care (CDC)
CCS--Female CBP--Female CBP--Male CDC/Blood Pressure Level <140/80mm Hg--Female CDC/Blood Pressure Level <140/80mm Hg--Male CDC/Blood Pressure Level <140/90mm Hg--Female CDC/Blood Pressure Level <140/90mm Hg--Male CDC/Eye Exam--Female CDC/Eye Exam--Male CDC/HbA1c <7% for Selected Population--Female CDC/HbA1c <7% for Selected Population--Male CDC/HbA1c <8%--Female CDC/HbA1c <8%--Male CDC/HbA1c Poor Control--Female CDC/HbA1c Poor Control--Male CDC/HbA1c Testing--Female CDC/HbA1c Testing--Male CDC/LDL-C Control <100 mg/dL--Female CDC/LDL-C Control <100 mg/dL--Male CDC/LDL-C Screening--Female CDC/LDL-C Screening--Male CDC/Medical Attention for Nephropathy--Female CDC/Medical Attention for Nephropathy--Male

Medicaid Adult Only (MAO)

CCSP

Admin Rate Hybrid Rate Admin Rate Hybrid Rate

49.41% 0.00% 0.00% 0.85% 0.82% 1.13% 1.08% 37.26% 31.26% 0.48% 0.42% 0.62% 0.53% 99.00% 99.22% 57.62% 53.34% 0.82% 0.80% 49.30% 46.87% 61.80% 62.39%

50.61% 31.18% 31.06% 30.19% 27.12% 39.89% 38.98% 40.43% 36.16% 21.76% 18.18% 28.03% 29.38% 69.27% 67.23% 63.07% 67.80% 18.87% 24.29% 55.53% 64.41% 69.54% 71.75%

13.21% 0.00% 0.00% 1.66% 2.03% 1.66% 2.44% 36.89% 33.94% 0.79% 1.23% 0.83% 1.02% 98.70% 98.78% 35.23% 40.04% 1.07% 1.63% 26.10% 26.22% 52.79% 52.85%

17.03% 36.26% 46.38% 32.97% 33.15% 39.73% 43.82% 43.51% 37.64% 33.33% 29.63% 34.05% 21.35% 61.89% 71.35% 58.65% 51.69% 25.68% 24.16% 48.38% 43.26% 72.97% 70.79%

33 of 47

November 2013

34 of 47

DCH Audited Calendar Year 2012 Performance Measure Results

Demographic Stratification by Race/Ethnicity Measures

Cervical Medicaid Adult Only (MAO)

CCSP

Cancer Screening (CCS); Controlling High Blood Pressure (CBP); Comprehensive Diabetes Care (CDC)

Admin Rate Hybrid Rate Admin Rate Hybrid Rate

CCS--American Indian or Alaskan-Ethnicity Unknown

65.52%

0.00%

CCS--American Indian or Alaskan-Hispanic or Latino

100.00%

0.00%

CCS--American Indian or Alaskan-Not Hispanic or Latino

39.85%

100.00%

CCS--Asian-Ethnicity Unknown

47.65%

0.00%

CCS--Asian-Hispanic or Latino

54.55%

0.00%

CCS--Asian-Not Hispanic or Latino

45.00%

100.00%

0.00%

0.00%

CCS--Asian Pacific American-Not Hispanic or Latino

0.00%

0.00%

CCS--Black-Ethnicity Unknown

57.34%

53.06%

21.70%

32.73%

CCS--Black-Hispanic or Latino

60.40%

0.00%

CCS--Black-Not Hispanic or Latino

53.27%

55.35%

10.17%

13.74%

CCS--Black (Non-Hispanic)-Ethnicity Unknown

73.91%

0.00%

CCS--Black (Non-Hispanic)-Not Hispanic or Latino

56.58%

0.00%

CCS--Caucasian-Ethnicity Unknown

52.76%

30.00%

16.90%

18.06%

CCS--Caucasian-Hispanic or Latino

70.80%

80.00%

0.00%

0.00%

CCS--Caucasian-Not Hispanic or Latino

54.79%

53.75%

11.46%

14.19%

CCS--Hispanic-Ethnicity Unknown

46.51%

0.00%

CCS--Hispanic-Hispanic or Latino

46.43%

100.00%

CCS--Hispanic-Not Hispanic or Latino

40.90%

0.00%

CCS--Not Applicable-Not Hispanic or Latino

29.75%

33.85%

0.00%

0.00%

CCS--Not Applicable-Ethnicity Unknown

37.90%

48.00%

CCS--Not Applicable-Hispanic or Latino

42.11%

0.00%

CCS--Not Provided-Not Hispanic or Latino

34.75%

50.00%

0.00%

0.00%

CCS--Not Provided-Ethnicity Unknown

63.80%

33.33%

CCS--Not Provided-Hispanic or Latino

28.57%

0.00%

CCS--Other-Ethnicity Unknown

50.00%

0.00%

CCS--Other-Hispanic or Latino

75.00%

0.00%

CCS--Other-Not Hispanic or Latino

68.00%

0.00%

CCS--Pacific Islander-Ethnicity Unknown

100.00%

0.00%

CCS--Pacific Islander-Hispanic or Latino

66.67%

0.00%

CCS--Pacific Islander-Not Hispanic or Latino

63.64%

0.00%

CCS--White (Non-Hispanic)-Ethnicity Unknown

76.92%

0.00%

CCS--White (Non-Hispanic)-Hispanic or Latino

0.00%

0.00%

CCS--White (Non-Hispanic)-Not Hispanic or Latino

62.03%

100.00%

CBP--American Indian or Alaskan-Ethnicity Unknown

0.00%

0.00%

CBP--American Indian or Alaskan-Hispanic or Latino

0.00%

0.00%

November 2013

35 of 47

DCH Audited Calendar Year 2012 Performance Measure Results

Demographic Stratification by Race/Ethnicity Measures

Cervical Medicaid Adult Only (MAO)

CCSP

Cancer Screening (CCS); Controlling High Blood Pressure (CBP); Comprehensive Diabetes Care (CDC)

Admin Rate Hybrid Rate Admin Rate Hybrid Rate

CBP--American Indian or Alaskan-Not Hispanic or Latino

0.00%

0.00%

0.00%

50.00%

CBP--Asian-Ethnicity Unknown

0.00%

71.43%

CBP--Asian-Hispanic or Latino

0.00%

0.00%

CBP--Asian-Not Hispanic or Latino

0.00%

54.55%

0.00%

0.00%

CBP--Asian Pacific American-Not Hispanic or Latino

0.00%

0.00%

CBP--Black-Ethnicity Unknown

0.00%

18.75%

0.00%

33.33%

CBP--Black-Hispanic or Latino

0.00%

0.00%

CBP--Black-Not Hispanic or Latino

0.00%

28.28%

0.00%

27.96%

CBP--Black (Non-Hispanic)-Ethnicity Unknown

0.00%

0.00%

CBP--Black (Non-Hispanic)-Not Hispanic or Latino

0.00%

0.00%

CBP--Caucasian-Ethnicity Unknown

0.00%

27.27%

0.00%

43.33%

CBP--Caucasian-Hispanic or Latino

0.00%

100.00%

0.00%

0.00%

CBP--Caucasian-Not Hispanic or Latino

0.00%

30.00%

0.00%

46.79%

CBP--Hispanic-Ethnicity Unknown

0.00%

0.00%

CBP--Hispanic-Hispanic or Latino

0.00%

25.00%

CBP--Hispanic-Not Hispanic or Latino

0.00%

0.00%

0.00%

100.00%

CBP--Not Applicable-Ethnicity Unknown

0.00%

33.33%

CBP--Not Applicable-Hispanic or Latino

0.00%

0.00%

CBP--Not Applicable-Not Hispanic or Latino

0.00%

35.14%

0.00%

100.00%

CBP--Not Provided-Ethnicity Unknown

0.00%

0.00%

CBP--Not Provided-Hispanic or Latino

0.00%

0.00%

CBP--Not Provided-Not Hispanic or Latino

0.00%

27.27%

0.00%

0.00%

CBP--Other-Ethnicity Unknown

0.00%

0.00%

CBP--Other-Hispanic or Latino

0.00%

0.00%

CBP--Other-Not Hispanic or Latino

0.00%

0.00%

0.00%

0.00%

CBP--Pacific Islander-Ethnicity Unknown

0.00%

0.00%

CBP--Pacific Islander-Hispanic or Latino

0.00%

0.00%

CBP--Pacific Islander-Not Hispanic or Latino

0.00%

0.00%

CBP--White (Non-Hispanic)-Ethnicity Unknown

0.00%

0.00%

CBP--White (Non-Hispanic)-Not Hispanic or Latino

0.00%

50.00%

CDC/Blood Pressure Level <140/80mm Hg--American Indian or Alaskan-Ethnicity Unknown

0.00%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--American Indian or Alaskan-Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--American Indian or Alaskan-Not Hispanic or Latino

0.00%

0.00%

0.00%

100.00%

CDC/Blood Pressure Level <140/80 mm Hg--Asian-Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--Asian-Ethnicity Unknown

2.87%

50.00%

November 2013

36 of 47

DCH Audited Calendar Year 2012 Performance Measure Results

Demographic Stratification by Race/Ethnicity Measures

Cervical Medicaid Adult Only (MAO)

CCSP

Cancer Screening (CCS); Controlling High Blood Pressure (CBP); Comprehensive Diabetes Care (CDC)

Admin Rate Hybrid Rate Admin Rate Hybrid Rate

CDC/Blood Pressure Level <140/80 mm Hg--Asian-Not Hispanic or Latino

2.63%

41.67%

0.00%

100.00%

CDC/Blood Pressure Level <140/80 mm Hg--Black-Ethnicity Unknown

0.57%

26.32%

1.49%

25.64%

CDC/Blood Pressure Level <140/80 mm Hg--Black-Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--Black-Not Hispanic or Latino

0.65%

21.96%

1.68%

26.95%

CDC/Blood Pressure Level <140/80 mm Hg--Black (Non-Hispanic)-Ethnicity Unknown

0.00%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--Black (Non-Hispanic)-Not Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--Caucasian-Ethnicity Unknown

0.72%

19.05%

1.36%

39.77%

CDC/Blood Pressure Level <140/80 mm Hg--Caucasian-Hispanic or Latino

0.00%

100.00%

0.00%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--Caucasian-Not Hispanic or Latino

0.79%

29.31%

2.33%

38.16%

CDC/Blood Pressure Level <140/80 mm Hg--Hispanic-Hispanic or Latino

2.44%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--Hispanic-Ethnicity Unknown

3.70%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--Hispanic-Not Hispanic or Latino

1.50%

33.33%

CDC/Blood Pressure Level <140/80 mm Hg--Not Applicable-Ethnicity Unknown

0.78%

56.00%

CDC/Blood Pressure Level <140/80 mm Hg--Not Applicable-Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--Not Applicable-Not Hispanic or Latino

1.13%

35.88%

0.00%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--Not provided-Ethnicity Unknown

0.85%

25.00%

CDC/Blood Pressure Level <140/80 mm Hg--Not Provided-Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--Not Provided-Not Hispanic or Latino

0.82%

43.75%

CDC/Blood Pressure Level <140/80 mm Hg--Other-Ethnicity Unknown

0.00%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--Other-Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--Other-Not Hispanic or Latino

9.52%

0.00%

0.00%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--Pacific Islander-Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--Pacific Islander-Not Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--White (Non-Hispanic)-Ethnicity Unknown

0.00%

0.00%

CDC/Blood Pressure Level <140/80 mm Hg--White (Non-Hispanic)-Not Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/90mm Hg--American Indian or Alaskan-Ethnicity Unknown

0.00%

0.00%

CDC/Blood Pressure Level <140/90 mm Hg--American Indian or Alaskan-Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/90 mm Hg--American Indian or Alaskan-Not Hispanic or Latino

1.61%

0.00%

0.00%

100.00%

CDC/Blood Pressure Level <140/90 mm Hg--Asian-Ethnicity Unknown

3.35%

50.00%

CDC/Blood Pressure Level <140/90 mm Hg--Asian-Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/90 mm Hg--Asian-Not Hispanic or Latino

3.18%

41.67%

0.00%

100.00%

CDC/Blood Pressure Level <140/90 mm Hg--Black-Ethnicity Unknown

0.79%

36.84%

1.49%

33.33%

CDC/Blood Pressure Level <140/90 mm Hg--Black-Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/90 mm Hg--Black-Not Hispanic or Latino

0.88%

34.11%

1.68%

34.73%

CDC/Blood Pressure Level <140/90 mm Hg--Black (Non-Hispanic)-Ethnicity Unknown

0.00%

0.00%

November 2013

37 of 47

DCH Audited Calendar Year 2012 Performance Measure Results

Demographic Stratification by Race/Ethnicity Measures

Cervical Medicaid Adult Only (MAO)

CCSP

Cancer Screening (CCS); Controlling High Blood Pressure (CBP); Comprehensive Diabetes Care (CDC)

Admin Rate Hybrid Rate Admin Rate Hybrid Rate

CDC/Blood Pressure Level <140/90 mm Hg--Black (Non-Hispanic)-Not Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/90 mm Hg--Caucasian-Ethnicity Unknown

1.02%

28.57%

1.36%

50.00%

CDC/Blood Pressure Level <140/90 mm Hg--Caucasian-Hispanic or Latino

0.00%

100.00%

0.00%

25.00%

CDC/Blood Pressure Level <140/90 mm Hg--Caucasian-Not Hispanic or Latino

1.10%

36.21%

2.75%

45.41%

CDC/Blood Pressure Level <140/90 mm Hg--Hispanic-Hispanic or Latino

2.44%

0.00%

CDC/Blood Pressure Level <140/90 mm Hg--Hispanic-Ethnicity Unknown

7.41%

0.00%

CDC/Blood Pressure Level <140/90 mm Hg--Hispanic-Not Hispanic or Latino

1.66%

33.33%

CDC/Blood Pressure Level <140/90 mm Hg--Not Applicable-Hispanic or Latino

2.17%

0.00%

CDC/Blood Pressure Level <140/90 mm Hg--Not Applicable-Not Hispanic or Latino

1.37%

45.80%

0.00%

0.00%

CDC/Blood Pressure Level <140/90 mm Hg--Not Applicable-Ethnicity Unknown

1.27%

68.00%

CDC/Blood Pressure Level <140/90 mm Hg--Not provided-Ethnicity Unknown

1.70%

25.00%

CDC/Blood Pressure Level <140/90 mm Hg--Not Provided-Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/90 mm Hg--Not Provided-Not Hispanic or Latino

1.02%

62.50%

CDC/Blood Pressure Level <140/90 mm Hg--Other-Ethnicity Unknown

0.00%

0.00%

CDC/Blood Pressure Level <140/90 mm Hg--Other-Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/90 mm Hg--Other-Not Hispanic or Latino

9.52%

0.00%

0.00%

0.00%

CDC/Blood Pressure Level <140/90 mm Hg--Pacific Islander-Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/90 mm Hg--Pacific Islander-Not Hispanic or Latino

0.00%

0.00%

CDC/Blood Pressure Level <140/90 mm Hg--White (Non-Hispanic)-Ethnicity Unknown

0.00%

0.00%

CDC/Blood Pressure Level <140/90 mm Hg--White (Non-Hispanic)-Not Hispanic or Latino

0.00%

0.00%

CDC/Eye Exam--American Indian or Alaskan-Ethnicity Unknown

33.33%

100.00%

CDC/Eye Exam--American Indian or Alaskan-Hispanic or Latino

0.00%

0.00%

CDC/Eye Exam--American Indian or Alaskan-Not Hispanic or Latino

40.32%

100.00%

50.00%

100.00%

CDC/Eye Exam--Asian-Ethnicity Unknown

44.98%

0.00%

CDC/Eye Exam--Asian-Not Hispanic or Latino

46.60%

50.00%

33.33%

100.00%

CDC/Eye Exam--Asian-Hispanic or Latino

20.00%

0.00%

CDC/Eye Exam--Black-Hispanic or Latino

35.29%

0.00%

CDC/Eye Exam--Black-Ethnicity Unknown

38.96%

38.60%

40.30%

47.44%

CDC/Eye Exam--Black-Not Hispanic or Latino

36.93%

41.59%

36.21%

47.90%

CDC/Eye Exam--Black (Non-Hispanic)-Ethnicity Unknown

0.00%

0.00%

CDC/Eye Exam--Black (Non-Hispanic)-Not Hispanic or Latino

70.59%

100.00%

CDC/Eye Exam--Caucasian-Ethnicity Unknown

36.41%

28.57%

36.82%

43.18%

CDC/Eye Exam--Caucasian-Not Hispanic or Latino

32.53%

31.03%

32.77%

32.85%

CDC/Eye Exam--Caucasian-Hispanic or Latino

44.36%

100.00%

45.45%

25.00%

CDC/Eye Exam--Hispanic-Ethnicity Unknown

40.74%

0.00%

November 2013

38 of 47

DCH Audited Calendar Year 2012 Performance Measure Results

Demographic Stratification by Race/Ethnicity Measures

Cervical Medicaid Adult Only (MAO)

CCSP

Cancer Screening (CCS); Controlling High Blood Pressure (CBP); Comprehensive Diabetes Care (CDC)

Admin Rate Hybrid Rate Admin Rate Hybrid Rate

CDC/Eye Exam--Hispanic-Hispanic or Latino

47.56%

100.00%

CDC/Eye Exam--Hispanic-Not Hispanic or Latino

39.43%

66.67%

CDC/Eye Exam--Not Applicable-Not Hispanic or Latino

32.19%

35.88%

42.86%

100.00%

CDC/Eye Exam--Not Applicable-Hispanic or Latino

39.13%

0.00%

CDC/Eye Exam--Not Applicable-Ethnicity Unknown

30.65%

52.00%

CDC/Eye Exam--Not provided-Ethnicity Unknown

35.23%

50.00%

CDC/Eye Exam--Not Provided-Hispanic or Latino

43.75%

0.00%

CDC/Eye Exam--Not Provided-Not Hispanic or Latino

36.56%

25.00%

CDC/Eye Exam--Other-Ethnicity Unknown

60.00%

0.00%

CDC/Eye Exam--Other-Hispanic or Latino

50.00%

0.00%

CDC/Eye Exam--Other-Not Hispanic or Latino

38.10%

0.00%

0.00%

0.00%

CDC/Eye Exam--Pacific Islander-Hispanic or Latino

33.33%

0.00%

CDC/Eye Exam--Pacific Islander-Not Hispanic or Latino

66.67%

0.00%

CDC/Eye Exam--White (Non-Hispanic)-Ethnicity Unknown

75.00%

0.00%

CDC/Eye Exam--White (Non-Hispanic)-Not Hispanic or Latino

36.67%

0.00%

CDC/HbA1c <7% for Selected Populations--American Indian or Alaskan-Ethnicity Unknown

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--American Indian or Alaskan-Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--American Indian or Alaskan-Not Hispanic or Latino

0.00%

0.00%

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Asian-Ethnicity Unknown

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Asian-Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Asian-Not Hispanic or Latino

1.43%

33.33%

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Black-Ethnicity Unknown

0.34%

13.64%

0.00%

33.33%

CDC/HbA1c <7% for Selected Populations--Black-Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Black-Not Hispanic or Latino

0.30%

19.00%

0.00%

40.91%

CDC/HbA1c <7% for Selected Populations--Black (Non-Hispanic)-Ethnicity Unknown

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Black (Non-Hispanic)-Not Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Caucasian-Ethnicity Unknown

1.04%

18.18%

0.00%

7.69%

CDC/HbA1c <7% for Selected Populations--Caucasian-Hispanic or Latino

0.00%

0.00%

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Caucasian-Not Hispanic or Latino

0.62%

7.41%

2.70%

36.00%

CDC/HbA1c <7% for Selected Populations--Hispanic-Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Hispanic-Ethnicity Unknown

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Hispanic-Not Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Not Applicable-Ethnicity Unknown

0.58%

58.33%

CDC/HbA1c <7% for Selected Populations--Not Applicable-Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Not Applicable-Not Hispanic or Latino

0.53%

24.59%

0.00%

0.00%

November 2013

39 of 47

DCH Audited Calendar Year 2012 Performance Measure Results

Demographic Stratification by Race/Ethnicity Measures

Cervical Medicaid Adult Only (MAO)

CCSP

Cancer Screening (CCS); Controlling High Blood Pressure (CBP); Comprehensive Diabetes Care (CDC)

Admin Rate Hybrid Rate Admin Rate Hybrid Rate

CDC/HbA1c <7% for Selected Populations--Not Provided-Ethnicity Unknown

0.95%

50.00%

CDC/HbA1c <7% for Selected Populations--Not Provided-Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Not Provided-Not Hispanic or Latino

0.32%

0.00%

CDC/HbA1c <7% for Selected Populations--Other-Ethnicity Unknown

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Other-Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Other-Not Hispanic or Latino

16.67%

0.00%

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Pacific Islander-Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--Pacific Islander-Not Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--White (Non-Hispanic)-Ethnicity Unknown

0.00%

0.00%

CDC/HbA1c <7% for Selected Populations--White (Non-Hispanic)-Not Hispanic or Latino

4.08%

0.00%

CDC/HbA1c <8%--American Indian or Alaskan-Ethnicity Unknown

0.00%

0.00%

CDC/HbA1c <8%--American Indian or Alaskan-Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <8%--American Indian or Alaskan-Not Hispanic or Latino

1.61%

100.00%

0.00%

0.00%

CDC/HbA1c <8%--Asian-Ethnicity Unknown

2.87%

50.00%

CDC/HbA1c <8%--Asian-Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <8%--Asian-Not Hispanic or Latino

1.43%

33.33%

0.00%

100.00%

CDC/HbA1c <8%--Black-Ethnicity Unknown

0.43%

15.79%

0.50%

32.05%

CDC/HbA1c <8%--Black-Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <8%--Black-Not Hispanic or Latino

0.40%

27.10%

0.48%

23.35%

CDC/HbA1c <8%--Black (Non-Hispanic)-Ethnicity Unknown

0.00%

0.00%

CDC/HbA1c <8%--Black (Non-Hispanic)-Not Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <8%--Caucasian-Ethnicity Unknown

0.56%

28.57%

0.00%

31.82%

CDC/HbA1c <8%--Caucasian-Not Hispanic or Latino

0.59%

27.59%

1.90%

32.85%

CDC/HbA1c <8%--Caucasian-Hispanic or Latino

0.00%

100.00%

0.00%

25.00%

CDC/HbA1c <8%--Hispanic-Ethnicity Unknown

0.00%

0.00%

CDC/HbA1c <8%--Hispanic-Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <8%--Hispanic-Not Hispanic or Latino

1.50%

0.00%

CDC/HbA1c <8%--Not Applicable-Ethnicity Unknown

0.89%

56.00%

CDC/HbA1c <8%--Not Applicable-Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <8%--Not Applicable-Not Hispanic or Latino

0.80%

30.53%

0.00%

100.00%

CDC/HbA1c <8%--Not Provided-Ethnicity Unknown

1.14%

50.00%

CDC/HbA1c <8%--Not Provided-Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <8%--Not Provided-Not Hispanic or Latino

0.34%

25.00%

CDC/HbA1c <8%--Other-Ethnicity Unknown

0.00%

0.00%

CDC/HbA1c <8%--Other-Hispanic or Latino

0.00%

0.00%

November 2013

40 of 47

DCH Audited Calendar Year 2012 Performance Measure Results

Demographic Stratification by Race/Ethnicity Measures

Cervical Medicaid Adult Only (MAO)

CCSP

Cancer Screening (CCS); Controlling High Blood Pressure (CBP); Comprehensive Diabetes Care (CDC)

Admin Rate Hybrid Rate Admin Rate Hybrid Rate

CDC/HbA1c <8%--Other-Not Hispanic or Latino

9.52%

0.00%

0.00%

0.00%

CDC/HbA1c <8%--Pacific Islander-Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <8%--Pacific Islander-Not Hispanic or Latino

0.00%

0.00%

CDC/HbA1c <8%--White (Non-Hispanic)-Ethnicity Unknown

0.00%

0.00%

CDC/HbA1c <8%--White (Non-Hispanic)-Not Hispanic or Latino

3.33%

0.00%

CDC/HbA1c Poor Control--American Indian or Alaskan-Ethnicity Unknown

100.00% 100.00%

CDC/HbA1c Poor Control--American Indian or Alaskan-Hispanic or Latino

100.00%

0.00%

CDC/HbA1c Poor Control--American Indian or Alaskan-Not Hispanic or Latino

98.39%

0.00%

100.00%

0.00%

CDC/HbA1c Poor Control--Asian-Ethnicity Unknown

95.69%

50.00%

CDC/HbA1c Poor Control--Asian-Hispanic or Latino

100.00%

0.00%

CDC/HbA1c Poor Control--Asian-Not Hispanic or Latino

97.70%

66.67%

100.00%

0.00%

CDC/HbA1c Poor Control--Black-Ethnicity Unknown

99.39%

82.46%

99.00%

64.10%

CDC/HbA1c Poor Control--Black-Hispanic or Latino

100.00%

0.00%

CDC/HbA1c Poor Control--Black-Not Hispanic or Latino

99.34%

70.56%

CDC/HbA1c Poor Control--Black (Non-Hispanic)-Ethnicity Unknown

100.00%

0.00%

CDC/HbA1c Poor Control--Black (Non-Hispanic)-Not Hispanic or Latino

100.00% 100.00%

99.28%

71.26%

CDC/HbA1c Poor Control--Caucasian-Ethnicity Unknown

99.13%

66.67%

99.09%

64.77%

CDC/HbA1c Poor Control--Caucasian-Hispanic or Latino

100.00%

0.00%

100.00%

75.00%

CDC/HbA1c Poor Control--Caucasian-Not Hispanic or Latino

99.14%

68.97%

97.89%

61.35%

CDC/HbA1c Poor Control--Hispanic-Not Hispanic or Latino

98.34%

100.00%

CDC/HbA1c Poor Control--Hispanic-Hispanic or Latino

98.78%

100.00%

CDC/HbA1c Poor Control--Hispanic-Ethnicity Unknown

96.30%

0.00%

CDC/HbA1c Poor Control--Not Applicable-Ethnicity Unknown

98.70%

44.00%

CDC/HbA1c Poor Control--Not Applicable-Hispanic or Latino

100.00%

0.00%

CDC/HbA1c Poor Control--Not Applicable-Not Hispanic or Latino

98.70%

64.89%

100.00%

0.00%

CDC/HbA1c Poor Control--Not Provided-Ethnicity Unknown

98.01%

50.00%

CDC/HbA1c Poor Control--Not Provided-Hispanic or Latino

100.00%

0.00%

CDC/HbA1c Poor Control--Not Provided-Not Hispanic or Latino

99.32%

68.75%

CDC/HbA1c Poor Control--Other-Ethnicity Unknown

100.00%

0.00%

CDC/HbA1c Poor Control--Other-Hispanic or Latino

100.00%

0.00%

CDC/HbA1c Poor Control--Other-Not Hispanic or Latino

90.48%

0.00%

100.00%

0.00%

CDC/HbA1c Poor Control--Pacific Islander-Hispanic or Latino

100.00%

0.00%

CDC/HbA1c Poor Control--Pacific Islander-Not Hispanic or Latino

100.00%

0.00%

CDC/HbA1c Poor Control--White (Non-Hispanic)-Ethnicity Unknown

100.00%

0.00%

CDC/HbA1c Poor Control--White (Non-Hispanic)-Not Hispanic or Latino

96.67%

0.00%

November 2013

41 of 47

DCH Audited Calendar Year 2012 Performance Measure Results

Demographic Stratification by Race/Ethnicity Measures

Cervical Medicaid Adult Only (MAO)

CCSP

Cancer Screening (CCS); Controlling High Blood Pressure (CBP); Comprehensive Diabetes Care (CDC)

Admin Rate Hybrid Rate Admin Rate Hybrid Rate

CDC/HbA1c Testing--American Indian or Alaskan-Ethnicity Unknown

33.33%

0.00%

CDC/HbA1c Testing--American Indian or Alaskan-Hispanic or Latino

100.00%

0.00%

CDC/HbA1c Testing--American Indian or Alaskan-Not Hispanic or Latino

54.84%

100.00%

50.00%

100.00%

CDC/HbA1c Testing--Asian-Ethnicity Unknown

54.55%

50.00%

CDC/HbA1c Testing--Asian-Hispanic or Latino

60.00%

0.00%

CDC/HbA1c Testing--Asian-Not Hispanic or Latino

47.70%

50.00%

0.00%

100.00%

CDC/HbA1c Testing--Black-Ethnicity Unknown

54.95%

50.88%

36.82%

50.00%

CDC/HbA1c Testing--Black-Hispanic or Latino

47.06%

0.00%

CDC/HbA1c Testing--Black-Not Hispanic or Latino

58.06%

67.76%

38.13%

56.29%

CDC/HbA1c Testing--Black (Non-Hispanic)-Ethnicity Unknown

0.00%

0.00%

CDC/HbA1c Testing--Black (Non-Hispanic)-Not Hispanic or Latino

94.12%

100.00%

CDC/HbA1c Testing--Caucasian-Ethnicity Unknown

46.63%

61.90%

34.55%

62.50%

CDC/HbA1c Testing--Caucasian-Hispanic or Latino

78.91%

100.00%

36.36%

25.00%

CDC/HbA1c Testing--Caucasian-Not Hispanic or Latino

51.46%

60.34%

37.42%

56.04%

CDC/HbA1c Testing--Hispanic-Ethnicity Unknown

62.96%

0.00%

CDC/HbA1c Testing--Hispanic-Hispanic or Latino

39.63%

100.00%

CDC/HbA1c Testing--Hispanic-Not Hispanic or Latino

49.75%

33.33%

CDC/HbA1c Testing--Not Applicable-Ethnicity Unknown

56.30%

80.00%

CDC/HbA1c Testing--Not Applicable-Hispanic or Latino

50.00%

0.00%

CDC/HbA1c Testing--Not Applicable-Not Hispanic or Latino

57.35%

66.41%

28.57%

100.00%

CDC/HbA1c Testing--Not Provided-Ethnicity Unknown

64.20%

50.00%

CDC/HbA1c Testing--Not Provided-Hispanic or Latino

56.25%

0.00%

CDC/HbA1c Testing--Not Provided-Not Hispanic or Latino

59.48%

68.75%

CDC/HbA1c Testing--Other-Ethnicity Unknown

60.00%

0.00%

CDC/HbA1c Testing--Other-Hispanic or Latino

66.67%

0.00%

CDC/HbA1c Testing--Other-Not Hispanic or Latino

61.90%

0.00%

100.00%

0.00%

CDC/HbA1c Testing--Pacific Islander-Hispanic or Latino

100.00%

0.00%

CDC/HbA1c Testing--Pacific Islander-Not Hispanic or Latino

66.67%

0.00%

CDC/HbA1c Testing--White (Non-Hispanic)-Ethnicity Unknown

50.00%

0.00%

CDC/HbA1c Testing--White (Non-Hispanic)-Not Hispanic or Latino

78.33%

0.00%

CDC/LDL-C Control <100 mg/dL--American Indian or Alaskan-Ethnicity Unknown

0.00%

0.00%

CDC/LDL-C Control <100 mg/dL--American Indian or Alaskan-Hispanic or Latino

0.00%

0.00%

CDC/LDL-C Control <100 mg/dL--American Indian or Alaskan-Not Hispanic or Latino

0.00%

0.00%

0.00%

0.00%

CDC/LDL-C Control <100 mg/dL--Asian-Ethnicity Unknown

1.91%

0.00%

CDC/LDL-C Control <100 mg/dL--Asian-Hispanic or Latino

0.00%

0.00%

November 2013

42 of 47

DCH Audited Calendar Year 2012 Performance Measure Results

Demographic Stratification by Race/Ethnicity Measures

Cervical Medicaid Adult Only (MAO)

CCSP

Cancer Screening (CCS); Controlling High Blood Pressure (CBP); Comprehensive Diabetes Care (CDC)

Admin Rate Hybrid Rate Admin Rate Hybrid Rate

CDC/LDL-C Control <100 mg/dL--Asian-Not Hispanic or Latino

2.08%

25.00%

0.00%

100.00%

CDC/LDL-C Control <100 mg/dL--Black-Ethnicity Unknown

0.53%

8.77%

1.49%

20.51%

CDC/LDL-C Control <100 mg/dL--Black-Hispanic or Latino

0.00%

0.00%

CDC/LDL-C Control <100 mg/dL--Black-Not Hispanic or Latino

0.63%

21.03%

1.20%

20.96%

CDC/LDL-C Control <100 mg/dL--Black (Non-Hispanic)-Ethnicity Unknown

0.00%

0.00%

CDC/LDL-C Control <100 mg/dL--Black (Non-Hispanic)-Not Hispanic or Latino

0.00%

0.00%

CDC/LDL-C Control <100 mg/dL--Caucasian-Ethnicity Unknown

0.56%

23.81%

0.00%

30.68%

CDC/LDL-C Control <100 mg/dL--Caucasian-Hispanic or Latino

0.36%

0.00%

0.00%

0.00%

CDC/LDL-C Control <100 mg/dL--Caucasian-Not Hispanic or Latino

0.77%

18.97%

1.90%

28.02%

CDC/LDL-C Control <100 mg/dL--Hispanic-Ethnicity Unknown

7.41%

0.00%

CDC/LDL-C Control <100 mg/dL--Hispanic-Hispanic or Latino

1.22%

0.00%

CDC/LDL-C Control <100 mg/dL--Hispanic-Not Hispanic or Latino

1.66%

0.00%

CDC/LDL-C Control <100 mg/dL--Not Applicable-Ethnicity Unknown

1.19%

36.00%

CDC/LDL-C Control <100 mg/dL--Not Applicable-Hispanic or Latino

2.17%

0.00%

CDC/LDL-C Control <100 mg/dL--Not Applicable-Not Hispanic or Latino

1.03%

25.19%

0.00%

50.00%

CDC/LDL-C Control <100 mg/dL--Not Provided-Ethnicity Unknown

0.85%

0.00%

CDC/LDL-C Control <100 mg/dL--Not Provided-Hispanic or Latino

0.00%

0.00%

CDC/LDL-C Control <100 mg/dL--Not Provided-Not Hispanic or Latino

0.89%

12.50%

CDC/LDL-C Control <100 mg/dL--Other-Ethnicity Unknown

0.00%

0.00%

CDC/LDL-C Control <100 mg/dL--Other-Hispanic or Latino

0.00%

0.00%

CDC/LDL-C Control <100 mg/dL--Other-Not Hispanic or Latino

4.76%

0.00%

0.00%

0.00%

CDC/LDL-C Control <100 mg/dL--Pacific Islander-Hispanic or Latino

0.00%

0.00%

CDC/LDL-C Control <100 mg/dL--Pacific Islander-Not Hispanic or Latino

0.00%

0.00%

CDC/LDL-C Control <100 mg/dL--White (Non-Hispanic)-Ethnicity Unknown

0.00%

0.00%

CDC/LDL-C Control <100 mg/dL--White (Non-Hispanic)-Not Hispanic or Latino

3.33%

0.00%

CDC/LDL-C Screening--American Indian or Alaskan-Ethnicity Unknown

44.44%

0.00%

CDC/LDL-C Screening--American Indian or Alaskan-Hispanic or Latino

100.00%

0.00%

CDC/LDL-C Screening--American Indian or Alaskan-Not Hispanic or Latino

56.45%

100.00%

50.00%

100.00%

CDC/LDL-C Screening--Asian-Ethnicity Unknown

45.93%

50.00%

CDC/LDL-C Screening--Asian-Hispanic or Latino

50.00%

0.00%

CDC/LDL-C Screening--Asian-Not Hispanic or Latino

41.78%

33.33%

0.00%

100.00%

CDC/LDL-C Screening--Black-Ethnicity Unknown

46.52%

54.39%

20.90%

42.31%

CDC/LDL-C Screening--Black-Hispanic or Latino

47.06%

0.00%

CDC/LDL-C Screening--Black-Not Hispanic or Latino

49.71%

58.88%

25.42%

42.51%

CDC/LDL-C Screening--Black (Non-Hispanic)-Ethnicity Unknown

0.00%

0.00%

November 2013

43 of 47

DCH Audited Calendar Year 2012 Performance Measure Results

Demographic Stratification by Race/Ethnicity Measures

Cervical Medicaid Adult Only (MAO)

CCSP

Cancer Screening (CCS); Controlling High Blood Pressure (CBP); Comprehensive Diabetes Care (CDC)

Admin Rate Hybrid Rate Admin Rate Hybrid Rate

CDC/LDL-C Screening--Black (Non-Hispanic)-Not Hispanic or Latino

82.35%

100.00%

CDC/LDL-C Screening--Caucasian-Ethnicity Unknown

39.07%

47.62%

26.82%

50.00%

CDC/LDL-C Screening--Caucasian-Hispanic or Latino

66.55%

100.00%

27.27%

75.00%

CDC/LDL-C Screening--Caucasian-Not Hispanic or Latino

45.14%

60.34%

28.54%

48.79%

CDC/LDL-C Screening--Hispanic-Ethnicity Unknown

59.26%

0.00%

CDC/LDL-C Screening--Hispanic-Hispanic or Latino

32.93%

0.00%

CDC/LDL-C Screening--Hispanic-Not Hispanic or Latino

42.60%

33.33%

CDC/LDL-C Screening--Not Applicable-Ethnicity Unknown

48.73%

80.00%

CDC/LDL-C Screening--Not Applicable-Hispanic or Latino

39.13%

0.00%

CDC/LDL-C Screening--Not Applicable-Not Hispanic or Latino

50.50%

61.83%

28.57%

100.00%

CDC/LDL-C Screening--Not Provided-Ethnicity Unknown

44.60%

25.00%

CDC/LDL-C Screening--Not Provided-Hispanic or Latino

18.75%

0.00%

CDC/LDL-C Screening--Not Provided-Not Hispanic or Latino

49.80%

43.75%

CDC/LDL-C Screening--Other-Ethnicity Unknown

60.00%

0.00%

CDC/LDL-C Screening--Other-Hispanic or Latino

66.67%

0.00%

CDC/LDL-C Screening--Other-Not Hispanic or Latino

61.90%

0.00%

100.00%

0.00%

CDC/LDL-C Screening--Pacific Islander-Hispanic or Latino

100.00%

0.00%

CDC/LDL-C Screening--Pacific Islander-Not Hispanic or Latino

66.67%

0.00%

CDC/LDL-C Screening--White (Non-Hispanic)-Ethnicity Unknown

25.00%

0.00%

CDC/LDL-C Screening--White (Non-Hispanic)-Not Hispanic or Latino

75.00%

0.00%

CDC/Medical Attention for Nephropathy--American Indian or Alaskan-Hispanic or Latino

50.00%

0.00%

CDC/Medical Attention for Nephropathy--American Indian or Alaskan-Ethnicity Unknown

11.11%

0.00%

CDC/Medical Attention for Nephropathy--American Indian or Alaskan-Not Hispanic or Latino

75.81%

100.00% 100.00% 100.00%

CDC/Medical Attention for Nephropathy--Asian-Ethnicity Unknown

55.50%

50.00%

CDC/Medical Attention for Nephropathy--Asian-Hispanic or Latino

50.00%

0.00%

CDC/Medical Attention for Nephropathy--Asian-Not Hispanic or Latino

51.21%

50.00%

100.00% 100.00%

CDC/Medical Attention for Nephropathy--Black-Ethnicity Unknown

64.64%

68.42%

54.23%

73.08%

CDC/Medical Attention for Nephropathy--Black-Not Hispanic or Latino

66.29%

74.30%

60.43%

78.44%

CDC/Medical Attention for Nephropathy--Black-Hispanic or Latino

58.82%

0.00%

CDC/Medical Attention for Nephropathy--Black (Non-Hispanic)-Ethnicity Unknown

100.00%

0.00%

CDC/Medical Attention for Nephropathy--Black (Non-Hispanic)-Not Hispanic or Latino

88.24%

100.00%

CDC/Medical Attention for Nephropathy--Caucasian-Ethnicity Unknown

50.05%

47.62%

44.09%

70.45%

CDC/Medical Attention for Nephropathy--Caucasian-Hispanic or Latino

66.55%

0.00%

45.45%

75.00%

CDC/Medical Attention for Nephropathy--Caucasian-Not Hispanic or Latino

55.98%

55.17%

49.05%

67.15%

CDC/Medical Attention for Nephropathy--Hispanic-Ethnicity Unknown

66.67%

0.00%

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Demographic Stratification by Race/Ethnicity Measures

Cervical Medicaid Adult Only (MAO)

CCSP

Cancer Screening (CCS); Controlling High Blood Pressure (CBP); Comprehensive Diabetes Care (CDC)

Admin Rate Hybrid Rate Admin Rate Hybrid Rate

CDC/Medical Attention for Nephropathy--Hispanic-Not Hispanic or Latino

56.41%

100.00%

CDC/Medical Attention for Nephropathy--Hispanic-Hispanic or Latino

46.95%

100.00%

CDC/Medical Attention for Nephropathy--Not Applicable-Ethnicity Unknown

57.12%

72.00%

CDC/Medical Attention for Nephropathy--Not Applicable-Hispanic or Latino

56.52%

0.00%

CDC/Medical Attention for Nephropathy--Not Applicable-Not Hispanic or Latino

60.18%

75.57%

57.14%

100.00%

CDC/Medical Attention for Nephropathy--Not Provided-Ethnicity Unknown

57.10%

50.00%

CDC/Medical Attention for Nephropathy--Not Provided-Hispanic or Latino

62.50%

0.00%

CDC/Medical Attention for Nephropathy--Not Provided-Not Hispanic or Latino

64.80%

81.25%

CDC/Medical Attention for Nephropathy--Other-Ethnicity Unknown

80.00%

0.00%

CDC/Medical Attention for Nephropathy--Other-Hispanic or Latino

33.33%

0.00%

CDC/Medical Attention for Nephropathy--Other-Not Hispanic or Latino

66.67%

0.00%

100.00%

0.00%

CDC/Medical Attention for Nephropathy--Pacific Islander-Hispanic or Latino

100.00%

0.00%

CDC/Medical Attention for Nephropathy--Pacific Islander-Not Hispanic or Latino

100.00%

0.00%

CDC/Medical Attention for Nephropathy--White (Non-Hispanic)-Ethnicity Unknown

25.00%

0.00%

CDC/Medical Attention for Nephropathy--White (Non-Hispanic)-Not Hispanic or Latino

68.33%

0.00%

44 of 47

November 2013

45 of 47

DCH Audited Calendar Year 2012 Performance Measure Results

Demographic Stratification by Region Measures

Medicaid Adult Only (MAO)

CCSP

Cervical Cancer Screening (CCS); Controlling High Blood Pressure (CBP); Comprehensive Diabetes Care (CDC) Admin Rate Hybrid Rate Admin Rate Hybrid Rate

CCS--GF-A-Atlanta

52.06%

53.66%

11.33%

13.70%

CCS--GF-C-Central

47.91%

50.00%

15.32%

26.32%

CCS--GF-E-East

52.15%

53.13%

30.30%

27.27%

CCS--GF-N-North

44.57%

41.07%

12.40%

9.68%

CCS--GF-SE-Southeast

44.90%

50.00%

10.94%

16.67%

CCS--GF-SW-Southwest

49.87%

50.88%

8.57%

18.87%

CCS--UNK

0.00%

0.00%

CBP--GF-A-Atlanta

0.00%

30.72%

0.00%

41.84%

CBP--GF-C-Central

0.00%

31.15%

0.00%

36.84%

CBP--GF-E-East

0.00%

29.17%

0.00%

17.02%

CBP--GF-N-North

0.00%

36.21%

0.00%

51.72%

CBP--GF-SE-Southeast

0.00%

38.10%

0.00%

48.21%

CBP--GF-SW-Southwest

0.00%

24.66%

0.00%

31.82%

CDC/Blood Pressure Level <140/80 mm Hg--GF-A-Atlanta

1.33%

29.69%

4.75%

31.11%

CDC/Blood Pressure Level <140/80 mm Hg--GF-C-Central

0.64%

23.86%

0.54%

29.11%

CDC/Blood Pressure Level <140/80 mm Hg--GF-E-East

0.24%

25.53%

0.00%

29.31%

CDC/Blood Pressure Level <140/80 mm Hg--GF-N-North

0.62%

41.38%

0.81%

45.92%

CDC/Blood Pressure Level <140/80 mm Hg--GF-SE-Southeast

0.61%

21.88%

2.26%

31.87%

CDC/Blood Pressure Level <140/80 mm Hg--GF-SW-Southwest

0.58%

28.57%

0.45%

28.74%

CDC/Blood Pressure Level <140/90 mm Hg--GF-A-Atlanta

1.77%

40.10%

4.75%

41.48%

CDC/Blood Pressure Level <140/90 mm Hg--GF-C-Central

0.78%

32.95%

0.54%

40.51%

CDC/Blood Pressure Level <140/90 mm Hg--GF-E-East

0.28%

40.43%

0.00%

36.21%

CDC/Blood Pressure Level <140/90 mm Hg--GF-N-North

0.91%

50.57%

1.22%

51.02%

CDC/Blood Pressure Level <140/90 mm Hg--GF-SE-Southeast

0.73%

31.25%

2.71%

37.36%

CDC/Blood Pressure Level <140/90 mm Hg--GF-SW-Southwest

0.78%

40.00%

0.45%

36.78%

CDC/Eye Exam--GF-A-Atlanta

33.01%

37.50%

31.33%

34.07%

CDC/Eye Exam--GF-C-Central

36.63%

42.05%

34.05%

44.30%

CDC/Eye Exam--GF-E-East

35.91%

44.68%

36.05%

46.55%

CDC/Eye Exam--GF-N-North

32.56%

34.48%

34.96%

37.76%

CDC/Eye Exam--GF-SE-Southeast

38.06%

40.63%

40.27%

46.15%

CDC/Eye Exam--GF-SW-Southwest

40.65%

40.00%

40.00%

47.13%

CDC/HbA1c <7% for Selected Populations--GF-A-Atlanta

0.67%

20.22%

4.08%

25.00%

CDC/HbA1c <7% for Selected Populations--GF-C-Central

0.30%

22.22%

0.00%

10.00%

CDC/HbA1c <7% for Selected Populations--GF-E-East

0.09%

25.00%

0.00%

50.00%

CDC/HbA1c <7% for Selected Populations--GF-N-North

0.66%

28.21%

0.00%

46.15%

November 2013

46 of 47

DCH Audited Calendar Year 2012 Performance Measure Results

Demographic Stratification by Region Measures

Medicaid Adult Only (MAO)

CCSP

Cervical Cancer Screening (CCS); Controlling High Blood Pressure (CBP); Comprehensive Diabetes Care (CDC) Admin Rate Hybrid Rate Admin Rate Hybrid Rate

CDC/HbA1c <7% for Selected Populations--GF-SE-Southeast

0.21%

20.69%

0.00%

35.71%

CDC/HbA1c <7% for Selected Populations--GF-SW-Southwest

0.33%

8.82%

0.00%

16.67%

CDC/HbA1c <8%--GF-A-Atlanta

0.86%

24.48%

1.90%

28.89%

CDC/HbA1c <8%--GF-C-Central

0.51%

27.27%

0.00%

26.58%

CDC/HbA1c <8%--GF-E-East

0.24%

34.04%

0.68%

25.86%

CDC/HbA1c <8%--GF-N-North

0.68%

37.93%

1.22%

39.80%

CDC/HbA1c <8%--GF-SE-Southeast

0.20%

21.88%

0.45%

26.37%

CDC/HbA1c <8%--GF-SW-Southwest

0.44%

31.43%

0.45%

29.89%

CDC/HbA1c Poor Control--GF-A-Atlanta

98.61%

71.88%

96.84%

68.15%

CDC/HbA1c Poor Control--GF-C-Central

99.22%

72.73%

100.00%

67.09%

CDC/HbA1c Poor Control--GF-E-East

99.67%

63.83%

99.32%

70.69%

CDC/HbA1c Poor Control--GF-N-North

98.94%

56.32%

98.37%

54.08%

CDC/HbA1c Poor Control--GF-SE-Southeast

99.65%

75.00%

99.55%

70.33%

CDC/HbA1c Poor Control--GF-SW-Southwest

99.38%

67.14%

99.55%

60.92%

CDC/HbA1c Testing--GF-A-Atlanta

56.72%

60.94%

34.18%

49.63%

CDC/HbA1c Testing--GF-C-Central

56.90%

62.50%

34.05%

49.37%

CDC/HbA1c Testing--GF-E-East

57.97%

70.21%

37.41%

55.17%

CDC/HbA1c Testing--GF-N-North

55.49%

75.86%

34.15%

65.31%

CDC/HbA1c Testing--GF-SE-Southeast

52.05%

60.94%

37.10%

58.24%

CDC/HbA1c Testing--GF-SW-Southwest

57.76%

62.86%

46.36%

62.07%

CDC/LDL-C Control <100 mg/dL--GF-A-Atlanta

1.42%

19.27%

3.48%

20.00%

CDC/LDL-C Control <100 mg/dL--GF-C-Central

0.60%

22.73%

0.54%

13.92%

CDC/LDL-C Control <100 mg/dL--GF-E-East

0.22%

21.28%

0.00%

29.31%

CDC/LDL-C Control <100 mg/dL--GF-N-North

0.80%

27.59%

2.03%

32.65%

CDC/LDL-C Control <100 mg/dL--GF-SE-Southeast

0.23%

12.50%

0.00%

29.67%

CDC/LDL-C Control <100 mg/dL--GF-SW-Southwest

0.32%

20.00%

0.00%

27.59%

CDC/LDL-C Screening--GF-A-Atlanta

50.82%

54.17%

26.27%

41.48%

CDC/LDL-C Screening--GF-C-Central

48.94%

56.82%

23.24%

36.71%

CDC/LDL-C Screening--GF-E-East

48.44%

59.57%

25.17%

43.10%

CDC/LDL-C Screening--GF-N-North

47.61%

67.82%

29.67%

57.14%

CDC/LDL-C Screening--GF-SE-Southeast

45.21%

59.38%

25.34%

53.85%

CDC/LDL-C Screening--GF-SW-Southwest

45.85%

58.57%

25.91%

47.13%

CDC/Medical Attention for Nephropathy--GF-A-Atlanta

63.17%

64.58%

53.80%

69.63%

CDC/Medical Attention for Nephropathy--GF-C-Central

63.11%

73.86%

52.97%

73.42%

CDC/Medical Attention for Nephropathy--GF-E-East

63.78%

76.60%

53.74%

63.79%

November 2013

DCH Audited Calendar Year 2012 Performance Measure Results

Demographic Stratification by Region Measures

Medicaid Adult Only (MAO)

CCSP

Cervical Cancer Screening (CCS); Controlling High Blood Pressure (CBP); Comprehensive Diabetes Care (CDC) Admin Rate Hybrid Rate Admin Rate Hybrid Rate

CDC/Medical Attention for Nephropathy--GF-N-North

59.31%

73.56%

52.03%

75.51%

CDC/Medical Attention for Nephropathy--GF-SE-Southeast

59.93%

75.00%

52.04%

76.92%

CDC/Medical Attention for Nephropathy--GF-SW-Southwest

60.87%

68.57%

52.27%

72.41%

47 of 47

November 2013