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 Georgia Department of Community Health Validation of Performance Measures State of Georgia Page i DCH_GA2012-13_FFS_GF_PMV_F1_1113 Validation of Performance Measures 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. Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 1 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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. Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 2 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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). Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 3 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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 Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 4 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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 Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 5 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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. Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 6 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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 Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 7 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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 Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 8 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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. Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 9 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES Data Integration, Data Control, and Performance Measure Documentation There are several aspects crucial to the calculation of performance measure rates. These include data integration, data control, and documentation of performance measure calculations. Each of the following sections describes the validation processes used and the validation findings. For more detailed information, see Appendix A of this report. Data Integration Accurate data integration is essential 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 Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 10 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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 Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 11 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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 Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 12 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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. Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 13 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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. Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 14 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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 Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 15 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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. Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 16 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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. Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 17 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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. Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 18 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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. Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 19 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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. Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 20 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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. Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 21 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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 Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 22 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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 Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 23 DCH_GA2012-13_FFS_GF_PMV_F1_1113 VALIDATION OF PERFORMANCE MEASURES 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. Georgia Department of Community Health Validation of Performance Measures State of Georgia Page 24 DCH_GA2012-13_FFS_GF_PMV_F1_1113 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). Georgia Department of Community Health Validation of Performance Measures State of Georgia Page A-1 DCH_GA2012-13_FFS_GF_PMV_F1_1113 DATA INTEGRATION AND CONTROL FINDINGS Data Integration and Control Element Not Met Met N/A Assurance of effective management of report production and of the reporting software. Documentation governing the production process, including 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 Georgia Department of Community Health Validation of Performance Measures State of Georgia Page A-2 DCH_GA2012-13_FFS_GF_PMV_F1_1113 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% 8 of 47 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