Validation of performance measures for Peach State Health Plan, measurement period: calendar year 2011; validation period: state fiscal year 2012

Georgia Department of Community Health
Validation of Performance Measures for
Peach State Health Plan
Measurement Period: Calendar Year 2011 Validation Period: State Fiscal Year 2012
Publish Date: August 23, 2012
3133 East Camelback Road, Suite 300 Phoenix, AZ 85016 Phone 602.264.6382 Fax 602.241.0757

CONTENTS
for Peach State Health Plan
Validation of Performance Measures ................................................................................................... 1 Validation Overview ............................................................................................................................. 1 Care Management Organization (CMO) Information ........................................................................... 1 Performance Measures Validated........................................................................................................ 2 Description of Validation Activities ....................................................................................................... 3 Pre-Audit Strategy ............................................................................................................................. 3 Validation Team................................................................................................................................. 3 Technical Methods of Data Collection and Analysis.......................................................................... 4 On-Site Activities ............................................................................................................................... 4 Data Integration, Data Control, and Performance Measure Documentation ....................................... 6 Data Integration ................................................................................................................................. 6 Data Control ...................................................................................................................................... 6 Performance Measure Documentation.............................................................................................. 6 Validation Results ................................................................................................................................ 7 Medical Service Data (Claims/Encounters) ....................................................................................... 7 Enrollment Data................................................................................................................................. 7 Provider Data..................................................................................................................................... 8 Medical Record Review Process....................................................................................................... 8 Supplemental Data ............................................................................................................................ 8 Data Integration ................................................................................................................................. 8 Performance Measure Specific Findings........................................................................................... 9 Validation Findings ............................................................................................................................ 10
Appendix A--Data Integration and Control Findings ..................................................................... A-1 Appendix B--Denominator and Numerator Validation Findings ................................................... B-1
Appendix C--Performance Measure Results .................................................................................. C-1
Appendices D and E--Final Audited HEDIS Results ...................................................................... D-1

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Validation of Performance Measures
for Peach State Health Plan

Validation Overview
Validation of performance measures is one of three mandatory external quality review (EQR) activities that the Balanced Budget Act of 1997 (BBA) requires state Medicaid agencies to perform. Health Services Advisory Group, Inc. (HSAG), the external quality review organization (EQRO) for the Department of Community Health (DCH), conducted the validation activities. DCH contracts with three care management organizations (CMOs) to provide services to Medicaid managed care enrollees and PeachCare for Kids enrollees. PeachCare for Kids is the name of Georgia's stand-alone Children's Health Insurance Program (CHIP). DCH identified a set of performance measures that were calculated and reported by the CMOs for validation. HSAG conducted the validation activities as outlined in the Centers for Medicare & Medicaid Services (CMS) publication, Validating Performance Measures: A Protocol for Use in Conducting External Quality Review Activities, Final Protocol, Version 1.0, May 1, 2002 (CMS performance measure validation protocol).

Care Management Organization (CMO) Information
HSAG validated performance measures calculated and reported by Peach State Health Plan (Peach State). Information about Peach State appears in Table 1.

CMO Name: CMO Location: CMO Contact: Contact Telephone Number: Contact E-mail Address: Site Visit Date:

Table 1--Peach State Information Peach State Health Plan 3200 Highlands Parkway SE, Suite 300 Smyrna, GA 30082 Joyce McElwain, Senior Director, Quality Improvement (QI)
678.556.2344
jmcelwain@centene.com
March 6, 2012

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Performance Measures Validated
HSAG validated performance measures identified and selected by DCH for validation. Two performance measures were selected from the Agency for Healthcare Research and Quality (AHRQ) Quality Indicator set, and five performance measures were selected from the Children's Health Insurance Program Reauthorization Act (CHIPRA) Initial Core Set of Children's Health Care Quality Measures. The measurement period was identified by DCH as calendar year (CY) 2011 for all measures except the two CHIPRA dental measures. They were reported for federal fiscal year (FFY) 2011 per CMS requirements. Table 2 lists the performance measures that HSAG validated and identifies who calculated the performance measure rates.

Table 2--List of CY 2011 Performance Measures for Peach State

Performance Measure

Rate Calculation by:

1. Low Birth Weight Rate (AHRQ)

Peach State

2. Cesarean Delivery Rate (AHRQ)

3.

Percentage of Eligibles That Received Preventive Dental Services (CHIPRA)

4.

Otitis Media With Effusion (OME)--Avoidance of Inappropriate Use of Systemic Antimicrobials (CHIPRA)

5.

Percentage of Eligibles That Received Dental Treatment Services (CHIPRA)

6.

Annual Percentage of Asthma Patients With One or More AsthmaRelated Emergency Room Visits (CHIPRA)

7. Annual Pediatric Hemoglobin (HbA1c) Testing (CHIPRA)

Peach State Peach State Peach State Peach State Peach State Peach State

In addition, Peach State was required to report a selected set of Healthcare Effectiveness Data and Information Set (HEDIS) measures to DCH. Peach State was required to contract with an NCQAlicensed audit organization and undergo a NCQA HEDIS Compliance AuditTM. Final audited HEDIS
measure results were submitted to DCH via NCQA's Interactive Data Submission System (IDSS)
and provided to HSAG. HSAG will use these results in addition to the measures HSAG validated
and displayed within this report as data sources for the annual EQR technical report. Appendices D
and E display the final audited HEDIS 2012 results for all required measures.

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

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Description of Validation Activities

Pre-Audit Strategy
HSAG conducted the validation activities as outlined in the CMS performance measure validation protocol. To complete the validation activities for Peach State, 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 Peach State outlining the steps in the performance measure validation process. The document request letter included a request for source code for each performance measure; a completed HEDIS 2012 Record of Administration, Data Management, and Processes (Roadmap); and any additional supporting documentation necessary to complete the audit. HSAG responded to Roadmap-related questions received directly from Peach State during the pre-on-site phase.
For the on-site visit, HSAG prepared an agenda describing all visit activities and indicating the type of staffing needed for each session. HSAG provided the agenda to Peach State approximately one week prior to the on-site visit. HSAG also conducted a pre-on-site conference call with Peach State to discuss any outstanding Roadmap questions and on-site visit activity expectations.

Validation Team
The HSAG Performance Measure Validation Team was composed of a lead auditor and validation team members. HSAG assembled the team based on the skills required for the validation and requirements of Peach State. Some team members, including the lead auditor, participated in the on-site meetings at Peach State; others conducted their work at HSAG's offices. Peach State's validation team was composed of the following members in the designated positions. Table 3 lists the validation team members, their positions, and their skills and expertise.

Name / Role
Jennifer Lenz, MPH, CHCA Lead Auditor
David Mabb, MS, CHCA Associate Director, Audits
Ron Holcomb, AS Source Code Reviewer Tammy GianFrancisco Project Leader

Table 3--Validation Team Skills and Expertise
Certified HEDIS auditor, performance measure validation knowledge, health care quality expertise, and interviewing skills Certified HEDIS auditor, HEDIS knowledge, source code review manager, and statistics and analysis.
Source code review
Overall project coordination and communications

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Technical Methods of Data Collection and Analysis
The CMS performance measure validation protocol identifies key types of data that should be reviewed as part of the validation process. The following list describes the type of data collected and how HSAG conducted an analysis of these data:
NCQA's HEDIS 2012 Roadmap: Peach State completed and submitted the required and relevant portions of its Roadmap for review by the validation team. The validation team used the responses from the Roadmap to complete the pre-on-site systems assessment.
Source code (programming language) for performance measures: HSAG requested and received source code from Peach State that calculated its performance measure rates using automated computer code. The validation team completed a line-by-line code review and observation of program logic flow to ensure compliance with State measure definitions during the on-site visit. Source code reviewers identified areas of deviation and shared them with the lead auditor to evaluate the impact of the deviation on the measure and assess the degree of bias (if any).
Supporting documentation: HSAG requested any documentation that would provide reviewers with additional information to complete the validation process, including policies and procedures, file layouts, system flow diagrams, system log files, and data collection process descriptions. The validation team reviewed all supporting documentation, identifying issues or clarifications for further follow-up.

On-Site Activities
HSAG conducted an on-site visit with Peach State on March 6, 2012. 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 Peach State staff members involved in the performance measure activities. The review purpose, the required documentation, basic meeting logistics, and queries to be performed were discussed.
Evaluation of system compliance: The evaluation included a review of the information systems assessment, focusing on the processing of claims and encounter data, patient data, and inpatient data. Additionally, the review evaluated the processes used to collect and calculate the performance measure rates, including accurate numerator and denominator identification and algorithmic compliance (which evaluated whether rate calculations were performed correctly, all data were combined appropriately, and numerator events were counted accurately).
Review of Roadmap and supporting documentation: The review included processes used for collecting, storing, validating, and reporting performance measure rates. This session was designed to be interactive with key Peach State staff members so that the validation team could obtain a complete picture of all the steps taken to generate the performance measure rates. The goal of the session was to obtain a confidence level as to the degree of compliance with written documentation compared to the actual process. HSAG conducted interviews to confirm findings

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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 output files and reviewed backup documentation on data integration. HSAG also addressed data control and security procedures during this session.
Closing conference: The closing conference included a summation of preliminary findings based on the review of the Roadmap and the on-site visit, and revisited the documentation requirements for any post-visit activities.
HSAG conducted several interviews with key Peach State staff members who were involved with performance measure reporting. Table 4 lists key Peach State interviewees:

Chevron Cardenas Donna McIntosh Clyde White Ron Purisma Vandana Pandita Joyce McElwain Dean Greeson Mark Smith Tony Ward Loni Eaton Heather House Yolanda Spivey Vicki Pitlajk Dana Sulton Luke Ferguson Kimberly Weakley Detra Friley Wanda Lee Jason Rosen Tony Masgio Janet Johnson

Name

Table 4--List of Peach State Interviewees Title
Sr. Director, Member and Provider Services Director, Compliance VP, Compliance Manager, QI Analytics Director, Accreditation Sr. Director, QI Senior Medical Director Manager, Corporate Encounters (Georgia) Director, Claims Manager, Claims Support Services Supervisor, Claims Senior Director, Data Analytics Director, Claims (Farmington) Encounters Specialist EPO (Georgia) Encounters Analyst (Georgia) Senior Director, Provider Operations Manager, Provider Data Manager HEDIS Analyst IT Integration, Corporate IT Integration, Corporate

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Data Integration, Data Control, and Performance Measure Documentation
There are several aspects crucial to the calculation of performance measure rates. These include data integration, data control, and documentation of performance measure calculations. Each of the following sections describes the validation processes used and the validation findings. For more detailed information, see Appendix A of this report.
Data Integration
Accurate data integration is essential for calculating valid performance measure rates. The steps used to combine various data sources (including claims/encounter data, eligibility data, and other administrative data) must be carefully controlled and validated. HSAG validated the data integration process used by Peach State, which included a review of file consolidations or extracts, a comparison of source data to warehouse files, data integration documentation, source code, production activity logs, and linking mechanisms. Overall, the validation team determined that the data integration processes in place at Peach State were:
Acceptable Not acceptable
Data Control
Peach State's organizational infrastructure must support all necessary information systems; and its quality assurance practices and backup procedures must be sound to ensure timely and accurate processing of data, and to provide data protection in the event of a disaster. HSAG validated the data control processes Peach State used which included a review of disaster recovery procedures, data backup protocols, and related policies and procedures. Overall, the validation team determined that the data control processes in place at Peach State 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 Peach State. HSAG reviewed all related documentation, which included the completed Roadmap, job logs, computer programming code, output files, work flow diagrams, narrative descriptions of performance measure calculations, and other related documentation. Overall, the validation team determined that the documentation of performance measure calculations by Peach State was:
Acceptable Not acceptable

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Validation Results
The validation team evaluated Peach State's data systems for processing of each type of data used for reporting the DCH performance measure rates. General findings are indicated below:

Medical Service Data (Claims/Encounters)
Peach State uses AMISYS to process claims and has no capitated providers. Therefore, all providers must submit a claim for the purpose of payment. Peach State receives a high percentage of claims electronically, approximately 90 percent, which leaves a small number of claims for manual processing. There were sufficient edit checks in place for the processing of electronic claims and electronic data interchange (EDI) files. Paper claims are processed at Peach State's claims processing center in Farmington, New Mexico. Peach State conducts monthly audits of its claims processors and provides feedback to the claims processors regarding keying errors. While there was sufficient training and oversight of the manual claims process, the auditor recommends that Peach State formally document data entry results in addition to the financial accuracy results. Peach State had sufficient edit checks in place to detect invalid codes, only accepts industry standard codes, and does not use any homegrown codes. Peach State primarily receives delivery claims through a global bill, receives inpatient revenue codes, and uses a DRG grouper.
Peach State delegates claims processing functions for pharmacy and dental services. The pharmacy vendor, US Script, provided pharmacy data to Peach State at least weekly. Paid, denied, and reversal information was included on the file. The data are loaded into a separate table in the data warehouse for the purposes of HEDIS reporting. Peach State indicated it conducts financial reconciliation of pharmacy data for the purposes of vendor oversight; however, this information could not be produced for the auditor. Peach State did provide claims information by month for the 2011 calendar year. The volume was consistent; therefore, there were no concerns with complete data.
Peach State uses DentaQuest for dental claims processing. Data are received every two weeks on a flat file, and the files are loaded into Peach State's data warehouse as medical claims. Both paid and denied claims are included in the DentaQuest files. All dental providers are paid fee-for-service.
The auditor identified no concerns with Peach State's ability to capture complete and accurate data; however, the auditor encourages Peach State to formally implement and document a process that monitors vendor volume.

Enrollment Data
Peach State receives three types of enrollment files from Hewlett Packard (HP), DCH's Medicaid Management Information System (MMIS) vendor. The files include a daily change file, a monthly full file, and the end-of-month adjustment file. All files are posted to the FTP site from HP and retrieved and processed by Peach State. Peach State had sufficient procedures in place to systematically identify discrepancies for local enrollment processors to update. Enrollment information is housed in AMISYS. Peach State indicated that there were some issues with

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processing data in April 2011 for newborns that had not been included on the daily file since March 25, 2011. To resolve the issue, the DCH provided Peach State with an ad hoc file; and members were manually loaded in the system, which took approximately three-to-four days to process. Peach State had very good processes in place to ensure monthly oversight of manually entered data.
Newborns are assigned a Medicaid ID at the time of enrollment and are sometimes passed from DCH to Peach State as "baby boy," etc. The newborns are not linked to their mothers, and Peach State is dependent on DCH's files to show the member as a duplicate or member merge. Peach State has a process to forward potential duplicates to the DCH for research and resolution.
There were no concerns identified with Peach State's ability to process eligibility data.
Provider Data
Peach State used a CACTUS database for provider data through July 2011. Beginning in August 2011, Peach State implemented Portico to house all provider data. Portico interfaces electronically with the AMISYS system for the purposes of claims payment. Dental provider information is received through a file feed at the corporate location and uploaded into the Portico system monthly. The system is able to capture provider specialties at the individual level; however, federally qualified health centers (FQHCs) are built on a facility number; therefore, the rendering provider and associated provider type are not captured on these claims. This can result in under/over reporting for measures that require a provider type. There were no issues identified with the conversion from CACTUS to Portico.
Peach State should work toward requiring FQHCs to submit the rendering provider for all claims to capture the provider type.
Medical Record Review Process
Peach State was only required to submit administrative rates for the HSAG validated performance measure rates; therefore, no HSAG validated measures used the hybrid method, and medical record review was not required.
Supplemental Data
The auditor verified that Peach State did not use any sources of supplemental data.
Data Integration
Peach State produced its own rates for the two AHRQ measures (Cesarean Delivery Rate, and Low Birth Weight Rate), and used its vendor, MedAssurant, to calculate the CMS CHIPRA measures. Peach State loaded data into its data warehouse for the purposes of producing the measures. As part of the data integration review, the auditor reviewed a MedAssurant data load report showing that all data files were processed completely and accurately. Overall, there were no concerns with Peach State's integration of data to produce valid rates.

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

Table 5--Key Review Results for Peach State

Performance Measures

Key Review Findings

1. Low Birth Weight Rate (AHRQ)

No concerns identified

2. Cesarean Delivery Rate (AHRQ)

No concerns identified

3.

Percentage of Eligibles That Received Preventive Dental Services (CHIPRA)

No concerns identified

4.

Otitis Media With Effusion (OME)--Avoidance of Inappropriate Use of Systemic Antimicrobials (CHIPRA)

The specifications were followed to calculate this measure; however, Georgia providers do not submit CPT Category II codes so rates could not be calculated.

5.

Percentage of Eligibles That Received Dental Treatment Services (CHIPRA)

No concerns identified

6.

Annual Percentage of Asthma Patients With One or More Asthma-Related Emergency Room Visits (CHIPRA)

No concerns identified

7. Annual Pediatric Hemoglobin (HbA1c) Testing (CHIPRA)

No concerns identified

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

Report (R)
Not Report (NR)

Table 6--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 measure is determined by the magnitude of the errors detected for the audit elements, not by the number of audit elements determined to be "Not Reportable." Consequently, it is possible that an error for a single audit element may result in a designation of "NR" because the impact of the error biased the reported performance measure rate by more than 5 percentage points. Conversely, it is also possible that several audit element errors may have little impact on the reported rate, resulting in a measure designation of "R."
Table 7 shows the final validation findings for Peach State for each performance measure. For additional information regarding performance measure rates, see Appendix C of this report.

Table 7--Validation Findings for Peach State

Performance Measures

Validation Finding

1. Low Birth Weight Rate (AHRQ)

Report

2. Cesarean Delivery Rate (AHRQ)

Report

3. Percentage of Eligibles That Received Preventive Dental Services (CHIPRA)

Report

4.

Otitis Media With Effusion (OME)--Avoidance of Inappropriate Use of Systemic Antimicrobials (CHIPRA)

Not Report

5. Percentage of Eligibles That Received Dental Treatment Services (CHIPRA)

Report

6.

Annual Percentage of Asthma Patients With One or More Asthma-Related Emergency Room Visits (CHIPRA)

Report

7. Annual Pediatric Hemoglobin (HbA1c) Testing (CHIPRA)

Report

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Appendix A. Data Integration and Control Findings
for Peach State Health Plan
Appendix A, which follows this page, contains the data integration and control findings for Peach State.

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Appendix A. Data Integration and Control Findings
for Peach State Health Plan

Documentation Worksheet

CMO Name: On-Site Visit Date: Reviewers:

Peach State Health Plan March 6, 2012 Jennifer Lenz, MPH, CHCA

Data Integration and Control Element

Not Met Met N/A

Comments

Accuracy of data transfers to assigned performance measure data repository

The CMO accurately and completely processes transfer data from the transaction files (e.g., membership, provider, encounter/claims) into the performance measure data repository used to keep the data until the calculations of the performance measures have been completed and validated.

Samples of data from the performance measure data repository are complete and accurate.

All measures were administrative; therefore, no samples were drawn.

Accuracy of file consolidations, extracts, and derivations

The CMO's processes to consolidate diversified files and to extract required information from the performance measure data repository are appropriate.

Actual results of file consolidations or extracts are consistent with those that should have resulted according to documented algorithms or specifications.

Procedures for coordinating the activities of multiple subcontractors ensure the accurate, timely, and complete integration of data into the performance measure database.

Computer program reports or documentation reflect vendor coordination activities, and no data necessary to performance measure reporting are lost or inappropriately modified during transfer.

If the CMO uses a performance measure data repository, its structure and format facilitates any required programming necessary to calculate and report required performance measures.

The performance measure data repository's design, program flow charts, and source codes enable analyses and reports.

Proper linkage mechanisms are employed to join data from all necessary sources (e.g., identifying a member with a given disease/condition).

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DATA INTEGRATION AND CONTROL FINDINGS

Data Integration and Control Element

Not Met Met N/A

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

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

Prescribed data cutoff dates are followed.

Comments

The CMO retains copies of files or databases used for performance measure reporting in case results need to be reproduced.
The reporting software program is properly documented with respect to every aspect of the performance measure data repository, including building, maintaining, managing, testing, and report production.
The CMO's processes and documentation comply with the CMO standards associated with reporting program specifications, code review, and testing.

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Appendix B. Denominator and Numerator Validation Findings
for Peach State Health Plan
Appendix B, which follows this page, contains the denominator and numerator validation findings for Peach State.

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Appendix B. Denominator and Numerator Validation Findings
for Peach State Health Plan

Reviewer Worksheets

CMO Name: On-Site Visit Date: Reviewers:

Peach State Health Plan March 6, 2012 Jennifer Lenz, MPH, CHCA

Table B-1--Denominator Validation Findings for Peach State Health Plan

Audit Element

Not Met Met N/A

Comments

For each of the performance measures, all members of the relevant populations identified in the performance measure specifications are included in the population from which the denominator is produced.

Adequate programming logic or source code exists to appropriately identify all relevant members of the specified denominator population for each of the performance measures.

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

Not applicable to the measures being reported.

The CMO properly evaluates the completeness and accuracy of any codes used to identify medical events, such as diagnoses, procedures, or prescriptions, and these codes are appropriately identified and applied as specified in each performance measure.

If any time parameters are required by the specifications of the performance measure, they are followed (e.g., cutoff dates for data collection, counting 30 calendar days after discharge from a hospital, etc.).

Exclusion criteria included in the performance measure specifications are followed.

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

Population estimates were not used.

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DENOMINATOR AND NUMERATOR VALIDATION FINDINGS

Table B-2--Numerator Validation Findings for Peach State Health Plan

Audit Element

Not Met Met N/A

Comments

The CMO uses the appropriate data, including linked data from separate data sets, to identify the entire at-risk population.

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

The CMO avoids or eliminates all double-counted members or numerator events.
Any nonstandard codes used in determining the numerator are mapped to a standard coding scheme in a manner that is consistent, complete, and reproducible, as evidenced by a review of the programming logic or a demonstration of the program.
If any time parameters are required by the specifications of the performance measure, they are followed (i.e., the measured event occurred during the time period specified or defined in the performance measure).

The CMO did not use nonstandard codes.

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Appendix C. Performance Measure Results
for Peach State Health Plan
Appendix C, which follows this page, contains Peach State's performance measure results.

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Appendix C. Performance Measure Results
for Peach State Health Plan

Indicator 1--Low Birth Weight Rate
Table C-1--Indicator 1 for Peach State Health Plan
Low Birth Weight Rate

Rate (per 100) 7.0

Indicator 2--Cesarean Delivery Rate
Table C-2--Indicator 2 for Peach State Health Plan
Cesarean Delivery Rate

Rate (per 100) 31.9

Indicator 3--Percentage of Eligibles that Received Preventive Dental Services

Table C-3--Indicator 3 for Peach State Health Plan
Preventive Dental Services

Rate 45.9%

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PERFORMANCE MEASURE RESULTS

Indicator 4--Otitis Media with Effusion (OME)--Avoidance of Inappropriate Use of Systemic Antimicrobials

Table C-4--Indicator 4 for Peach State Health Plan
Otitis Media with Effusion

Rate 37.9%

Indicator 5--Percentage of Eligibles that Received Dental Treatment Services

Table C-5--Indicator 5 for Peach State Health Plan
Dental Treatment Services

Rate 22.1%

Indicator 6--Annual Percentage of Asthma Patients with One or More Asthma-Related Emergency Room Visit

Table C-6--Indicator 6 for Peach State Health Plan
Asthma ER

Rate 11.8%

Indicator 7--Annual Pediatric Hemoglobin (HbA1c) Testing

Table C-7--Indicator 7 for Peach State Health Plan
Pediatric HbA1c Testing

Rate 82.0%

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Appendix D. Final Audited HEDIS Results
for Peach State Health Plan
Appendices D and E, which follow this page, contain Peach State's final audited HEDIS results.

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Appendix D. Final Audited HEDIS Results
for Peach State Health Plan

CMO Audited Calendar Year 2011 HEDIS Performance Measure Report--Peach State Health Plan

Measure

CMO Rate

Adolescent Well-Care Visits

38.5%

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

84.8% 88.6%

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

NA

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

85.2%

Adult BMI Assessment Annual Dental Visit--Ages 23 Years

48.0% Hybrid 43.9%

Annual Dental Visit--Ages 46 Years

75.6%

Annual Dental Visit--Ages 710 Years
Annual Dental Visit--Ages 1114 Years
Annual Dental Visit--Ages 1518 Years
Annual Dental Visit--Ages 1921 Years
Annual Dental Visit--Total
Annual Monitoring for Patients on Persistent Medications--Total Antidepressant Medication Management--Effective Acute Phase
Treatment Antidepressant Medication Management--Effective Continuation Phase
Treatment Appropriate Testing for Children with Pharyngitis Appropriate Treatment for Children with Upper Repertory Infection (URI) 2 Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2
Breast Cancer Screening
Call Abandonment

78.6% 70.5% 58.9% 39.2% 67.5% 83.8% 38.4% 23.4% 68.8% 77.8% 20.6% 52.9% 1.6%

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FINAL AUDITED HEDIS RESULTS

CMO Audited Calendar Year 2011 HEDIS Performance Measure Report--Peach State Health Plan

Measure

CMO Rate

Call Answer Timeliness

87.4%

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

70.0% Hybrid 77.6% Hybrid 19.0% Hybrid 76.6% Hybrid

Childhood Immunization Status--Combo 10

17.6% Hybrid

Children's and Adolescents' Access to Primary Care Providers--Ages 12 24 Months

95.7%

Children's and Adolescents' Access to Primary Care Providers--Ages 25 Months6 Years
Children's and Adolescents' Access to Primary Care Providers--Ages 7 11 Years
Children's and Adolescents' Access to Primary Care Providers--Ages 12 19 Years
Chlamydia Screening in Women--Total

90.5% 90.3% 87.2% 60.2%

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

36.1% Hybrid

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

58.0% Hybrid

Comprehensive Diabetes Care--Eye Exam

53.7% Hybrid

Comprehensive Diabetes Care--HbA1c Good Control <7.0

28.8% Hybrid

Comprehensive Diabetes Care--HbA1c Good Control <8.0 Comprehensive Diabetes Care--HbA1c Poor Control1

37.4% Hybrid 54.5% Hybrid

Comprehensive Diabetes Care--HbA1c Testing

77.4% Hybrid

Comprehensive Diabetes Care--LDL-C Level

27.5% Hybrid

Peach State Health Plan Validation of Performance Measures State of Georgia

Page D-2 PeachState_GA2011-12_CMO_PMV_F6_0812

FINAL AUDITED HEDIS RESULTS

CMO Audited Calendar Year 2011 HEDIS Performance Measure Report--Peach State Health Plan

Measure

CMO Rate

Comprehensive Diabetes Care--LDL-C Screening

65.5% Hybrid

Comprehensive Diabetes Care--Medical Attention to Nephropathy Controlling High Blood Pressure 3
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis Follow-Up After Hospitalization for Mental Illness--30-Day Follow-Up

71.1% Hybrid NR
47.6% Hybrid 72.5%
74.6%

Follow-Up After Hospitalization for Mental Illness--7-Day Follow-Up
Follow-Up Care for Children Prescribed ADHD Medication--Initiation Phase
Follow-Up Care for Children Prescribed ADHD Medication-- Continuation and Maintenance Phase

51.3% 43.7% 57.4%

Frequency of Ongoing Prenatal Care--< 21 Percent Frequency of Ongoing Prenatal Care--2140 Percent

7.9% Hybrid 3.9% Hybrid

Frequency of Ongoing Prenatal Care--4160 Percent

5.1% Hybrid

Frequency of Ongoing Prenatal Care--6180 Percent

12.5% Hybrid

Frequency of Ongoing Prenatal Care--81+ Percent

70.5% Hybrid

Human Papillomavirus Vaccine for Female Adolescents

17.7%

Immunizations for Adolescents--Combo 1

70.8% Hybrid

Initiation and Engagement of AOD Dependence Treatment--Initiation

34.6%

Initiation and Engagement of AOD Dependence Treatment--Engagement

8.7%

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

Rates reported in Appendix E

Peach State Health Plan Validation of Performance Measures State of Georgia

Page D-3 PeachState_GA2011-12_CMO_PMV_F6_0812

FINAL AUDITED HEDIS RESULTS

CMO Audited Calendar Year 2011 HEDIS Performance Measure Report--Peach State Health Plan

Measure

CMO Rate

Lead Screening in Children

70.8% Hybrid

Medication Management for People with Asthma--Total-Medication Compliance 50%

40.6%

Medication Management for People with Asthma--Total-Medication Compliance 75%

17.1%

Persistence of Beta-Blocker Treatment After a Heart Attack

NA

Pharmacotherapy Management of COPD Exacerbation--Systemic Corticosteroid

69.6%

Pharmacotherapy Management of COPD Exacerbation--Bronchodilator

87.0%

Prenatal and Postpartum Care--Postpartum Care

61.7% Hybrid

Prenatal and Postpartum Care--Timeliness of Prenatal Care
Use of Appropriate Medications for People with Asthma--Ages 511 Years
Use of Appropriate Medications for People with Asthma--Ages 1218 Years
Use of Appropriate Medications for People with Asthma--Ages 1950 Years
Use of Appropriate Medications for People with Asthma--Ages 5164 Years
Use of Appropriate Medications for People with Asthma--Total

85.8% Hybrid 91.3% 90.6% 73.6% NA 90.4%

Use of Imaging Studies for Low Back Pain 2

75.8%

Use of Spirometry Testing in the Assessment and Diagnosis of COPD

43.2%

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents--BMI Percentile (Total)

22.7% Hybrid

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

40.7% Hybrid

Peach State Health Plan Validation of Performance Measures State of Georgia

Page D-4 PeachState_GA2011-12_CMO_PMV_F6_0812

FINAL AUDITED HEDIS RESULTS

CMO Audited Calendar Year 2011 HEDIS Performance Measure Report--Peach State Health Plan

Measure

CMO Rate

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

29.4% Hybrid

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

7.2% Hybrid

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

3.5% Hybrid

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

3.0% Hybrid

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

7.4% Hybrid

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

11.3% Hybrid

Well-Child Visits in the First 15 Months of Life--Five Visits Well-Child Visits in the First 15 Months of Life--Six or More Visits Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life
Frequency of Selected Procedures Mental Health Utilization--Total
Board Certification Total Membership Enrollment by Product Line--Total Enrollment by State Identification of Alcohol and Other Drug Services--Total Weeks of Pregnancy at Time of Enrollment Race/Ethnicity Diversity of Membership

17.1% Hybrid 50.5% Hybrid 67.4% Hybrid Rates reported in Appendix E Rates reported in Appendix E
NR Rates reported in Appendix E Rates reported in Appendix E Rates reported in Appendix E Rates reported in Appendix E Rates reported in Appendix E Rates reported in Appendix E

Peach State Health Plan Validation of Performance Measures State of Georgia

Page D-5 PeachState_GA2011-12_CMO_PMV_F6_0812

FINAL AUDITED HEDIS RESULTS

CMO Audited Calendar Year 2011 HEDIS Performance Measure Report--Peach State Health Plan

Measure

CMO Rate

Language Diversity of Membership

Rates reported in Appendix E

Ambulatory Care--Total

Rates reported in Appendix E

Relative Resource Use for People with Diabetes

NR

Relative Resource Use for People with Asthma

NR

Relative Resource Use for People with Cardiovascular Conditions

NR

Relative Resource Use for People with COPD

NR

Relative Resource Use for People with Hypertension

NR

Antibiotic Utilization--Total

Rates reported in Appendix E

1 Note: Lower rate is better.
2 Note: The measure is reported as an inverted rate. A higher rate indicates appropriate treatment of children with URI (i.e., the proportion for whom antibiotics were not prescribed). The rate is calculated as 1 minus the numerator divided by the eligible population.
3 Note: The plan chose to rotate the measure. Measure rotation allows the health plan to use the audited and reportable rate from the previous year as specified by NCQA in HEDIS 2012 Technical Specifications for Health Plans, Volume 2; however, rotation is not allowed by DCH. Therefore, the rotated rate is not reportable with DCH.

Peach State Health Plan Validation of Performance Measures State of Georgia

Page D-6 PeachState_GA2011-12_CMO_PMV_F6_0812

Appendix E: Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State

Audit Review Table

Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None); Measurement Year - 2011

The Auditor lock has been applied to this submission.

Measure/Data Element

Report Measure

Benefit Offered

Rotated Measure

Rate

Reportable

Effectiveness of Care: Prevention and Screening

Adult BMI Assessment (aba)

Y

48.0%

R

Weight Assessment and Counseling for Nutrition

and Physical Activity for Children/Adolescents

Y

(wcc)

BMI Percentile

22.7%

R

Counseling for Nutrition

40.7%

R

Counseling for Physical Activity

29.4%

R

Childhood Immunization Status (cis)

Y

DTaP

83.8%

R

IPV

96.8%

R

MMR

94.2%

R

HiB

95.6%

R

Hepatitis B

95.6%

R

VZV

95.4%

R

Pneumococcal Conjugate

85.2%

R

Hepatitis A

45.8%

R

Rotavirus

66.7%

R

Influenza

36.3%

R

Combination #2

80.6%

R

Combination #3

76.6%

R

Combination #4

42.6%

R

Combination #5

58.6%

R

Combination #6

34.0%

R

Combination #7

33.3%

R

Combination #8

20.8%

R

Combination #9

28.0%

R

Combination #10

17.6%

R

Immunizations for Adolescents (ima)

Y

Meningococcal

72.7%

R

Tdap/Td

81.9%

R

Combination #1

70.8%

R

Human Papillomavirus Vaccine for Female

Y

Adolescents (hpv)

17.7%

R

Lead Screening in Children (lsc)

Y

70.8%

R

Breast Cancer Screening (bcs)

Y

52.9%

R

Cervical Cancer Screening (ccs)

Y

N

70.0%

R

Chlamydia Screening in Women (chl)

Y

16-20 Years

55.6%

R

21-24 Years

72.3%

R

Total

60.2%

R

Effectiveness of Care: Respiratory Conditions

Appropriate Testing for Children with Pharyngitis

Y

Y

(cwp)

68.8%

R

Appropriate Treatment for Children With URI (uri)

Y

Y

77.8%

R

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

Y

Y

Use of Spirometry Testing in the Assessment and

Diagnosis of COPD (spr)

Y

Pharmacotherapy Management of COPD Exacerbation (pce)

Y

Y

Systemic Corticosteroid

Bronchodilator

Use of Appropriate Medications for People With

Y

Y

Asthma (asm)

5-11 Years

12-18 Years

19-50 Years

51-64 Years

Total

Medication Management for People With Asthma (mma)

Y

Y

5-11 Years - Medication Compliance 50%

5-11 Years - Medication Compliance 75%

12-18 Years - Medication Compliance 50%

12-18 Years - Medication Compliance 75%

19-50 Years - Medication Compliance 50%

19-50 Years - Medication Compliance 75%

20.6%

R

43.2%

R

69.6%

R

87.0%

R

91.3%

R

90.6%

R

73.6%

R

NA

R

90.4%

R

40.8%

R

17.9%

R

39.7%

R

15.2%

R

42.6%

R

19.4%

R

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

1 of 20

August 2012

Appendix E: Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State

51-64 Years - Medication Compliance 50%

NA

R

51-64 Years - Medication Compliance 75%

NA

R

Total - Medication Compliance 50%

40.6%

R

Total - Medication Compliance 75%

17.1%

R

Effectiveness of Care: Cardiovascular

Cholesterol Management for Patients With

Y

Cardiovascular Conditions (cmc)

LDL-C Screening Performed

77.6%

R

LDL-C Control (<100 mg/dL)

Controlling High Blood Pressure (cbp)

Y

19.0%

R

Y1

47.6%

R

Persistence of Beta-Blocker Treatment After a

Y

Y

Heart Attack (pbh)

NA

R

Effectiveness of Care: Diabetes

Comprehensive Diabetes Care (cdc)

Y

Hemoglobin A1c (HbA1c) Testing

77.4%

R

HbA1c Poor Control (>9.0%)

54.5%

R

HbA1c Control (<8.0%)

37.4%

R

HbA1c Control (<7.0%)

28.8%

R

Eye Exam (Retinal) Performed

53.7%

R

LDL-C Screening Performed

65.5%

R

LDL-C Control (<100 mg/dL)

27.5%

R

Medical Attention for Nephropathy

71.1%

R

Blood Pressure Control (<140/80 mm Hg)

36.1%

R

Blood Pressure Control (<140/90 mm Hg)

58.0%

R

Effectiveness of Care: Musculoskeletal

Disease Modifying Anti-Rheumatic Drug Therapy

Y

Y

in Rheumatoid Arthritis (art)

72.5%

R

Use of Imaging Studies for Low Back Pain (lbp)

Y

75.8%

R

Effectiveness of Care: Behavioral Health

Antidepressant Medication Management (amm)

Y

Y

Effective Acute Phase Treatment

38.4%

R

Effective Continuation Phase Treatment

23.4%

R

Follow-Up Care for Children Prescribed ADHD

Y

Y

Medication (add)

Initiation Phase

Continuation and Maintenance (C&M) Phase

Follow-Up After Hospitalization for Mental Illness (fuh)

Y

Y

30-Day Follow-Up

7-Day Follow-Up

Effectiveness of Care: Medication Management

Annual Monitoring for Patients on Persistent Medications (mpm)

Y

Y

ACE Inhibitors or ARBs

Digoxin

Diuretics

Anticonvulsants

Total

Access/Availability of Care

Adults' Access to Preventive/Ambulatory Health

Y

Services (aap)

20-44 Years

45-64 Years

65+ Years

Total

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

Y

12-24 Months

25 Months - 6 Years

7-11 Years

12-19 Years

Annual Dental Visit (adv)

Y

Y

2-3 Years

4-6 Years

7-10 Years

11-14 Years

15-18 Years

19-21 Years

Total

Initiation and Engagement of AOD Dependence

Y

Y

Treatment (iet)

Initiation of AOD Treatment: 13-17 Years

Engagement of AOD Treatment: 13-17 Years

43.7%

R

57.4%

R

74.6%

R

51.3%

R

84.6%

R

NA

R

84.9%

R

65.2%

R

83.8%

R

84.8%

R

88.6%

R

NA

R

85.2%

R

95.7%

R

90.5%

R

90.3%

R

87.2%

R

43.9%

R

75.6%

R

78.6%

R

70.5%

R

58.9%

R

39.2%

R

67.5%

R

28.2%

R

12.2%

R

2 of 20

Denominator fewer than 30 Denominator fewer than 30
Reportable Reportable
Reportable Reportable Reportable Denominator fewer than 30
Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable
Reportable Reportable
Reportable Reportable
Reportable Reportable
Reportable Reportable
Reportable Denominator fewer than 30
Reportable Reportable Reportable
Reportable Reportable Denominator fewer than 30 Reportable
Reportable Reportable Reportable Reportable
Reportable Reportable Reportable Reportable Reportable Reportable Reportable
Reportable Reportable
August 2012

Appendix E: Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State

Initiation of AOD Treatment: 18+ Years

Engagement of AOD Treatment: 18+ Years

Initiation of AOD Treatment: Total

Engagement of AOD Treatment: Total

Prenatal and Postpartum Care (ppc)

Y

Timeliness of Prenatal Care

Postpartum Care

Call Answer Timeliness (cat)

Y

Call Abandonment (cab)

Y

Utilization

Frequency of Ongoing Prenatal Care (fpc)

Y

<21 Percent

21-40 Percent

41-60 Percent

61-80 Percent

81+ Percent

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

Y

0 Visits

1 Visit

2 Visits

3 Visits

4 Visits

5 Visits

6+ Visits

36.6%

R

7.5%

R

34.6%

R

8.7%

R

N

85.8%

R

61.7%

R

87.4%

R

1.6%

R

N

7.9%

R

3.9%

R

5.1%

R

12.5%

R

70.5%

R

7.2%

R

3.5%

R

3.0%

R

7.4%

R

11.3%

R

17.1%

R

50.5%

R

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

Y

67.4%

R

Adolescent Well-Care Visits (awc)

Y

Frequency of Selected Procedures (fsp)

Y

Ambulatory Care: Total (amba)

Y

Ambulatory Care: Dual Eligibles (ambb)

N

Ambulatory Care: Disabled (ambc)

N

Ambulatory Care: Other (ambd)

N

Inpatient Utilization--General Hospital/Acute Care:

Total (ipua)

Y

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

N

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

N

Inpatient Utilization--General Hospital/Acute Care:

N

Other (ipud)

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

Y

Y

Identification of Alcohol and Other Drug Services:

Dual Eligibles (iadb)

N

N

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

N

N

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

N

N

Mental Health Utilization: Total (mpta)

Y

Y

Mental Health Utilization: Dual Eligibles (mptb)

N

N

Mental Health Utilization: Disabled (mptc) Mental Health Utilization: Other (mptd)

N

N

N

N

Antibiotic Utilization: Total (abxa)

Y

Y

Antibiotic Utilization: Dual Eligibles (abxb)

N

N

Antibiotic Utilization: Disabled (abxc)

N

N

Antibiotic Utilization: Other (abxd) Relative Resource Use

N

N

Relative Resource Use for People With Diabetes

(rdi)

N

Relative Resource Use for People With Asthma (ras)

N

N

Relative Resource Use for People With Cardiovascular Conditions (rca)

N

Relative Resource Use for People With

N

Hypertension (rhy)

38.5%

R

R

R

NR

NR

NR

R

NR

NR

NR

R

NR

NR

NR
R NR NR NR R NR NR NR

NR NR NR NR

Relative Resource Use for People With COPD (rco)

N

NR

Health Plan Descriptive Information

Board Certification (bcr)

Y

NR

Total Membership (tlm)

Y

R

Enrollment by Product Line: Total (enpa)

Y

R

Enrollment by Product Line: Dual Eligibles (enpb)

N

NR

Reportable Reportable Reportable Reportable
Reportable Reportable Reportable Reportable
Reportable Reportable Reportable Reportable Reportable
Reportable Reportable Reportable Reportable Reportable Reportable Reportable
Reportable
Reportable Reportable Reportable Measure Unselected Measure Unselected Measure Unselected Reportable
Measure Unselected
Measure Unselected
Measure Unselected
Reportable
Measure Unselected
Measure Unselected
Measure Unselected Reportable
Measure Unselected Measure Unselected Measure Unselected
Reportable Measure Unselected Measure Unselected Measure Unselected
Measure Unselected
Measure Unselected
Measure Unselected
Measure Unselected
Measure Unselected
Calculated rate was materially biased Reportable Reportable
Measure Unselected

3 of 20

August 2012

Appendix E: Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State

Enrollment by Product Line: Disabled (enpc)

N

NR

Measure Unselected

Enrollment by Product Line: Other (enpd)

N

NR

Measure Unselected

Enrollment by State (ebs)

Y

R

Reportable

Race/Ethnicity Diversity of Membership (rdm)

Y

R

Reportable

Language Diversity of Membership (ldm)

Y

R

Reportable

Weeks of Pregnancy at Time of Enrollment in MCO

Y

N

R

Reportable

(wop)

1 Note: Plan chose to rotate the measure. Measure rotation allows the health plan to use the audited and reportable rate from the previous year as specified by NCQA in the HEDIS 2012 Technical Specifications for Health Plans, Volume 2; however, rotation is not allowed by DCH; therefore, the rotated rate is not reportable with DCH.

4 of 20

August 2012

Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State
Frequency of Selected Procedures (FSP)

Frequency of Selected Procedures (FSP)

Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj:

None)

Age

Male

Female

Total

0-9

997,475

977,039 1,974,514

10-19

564,259

592,582 1,156,841

15-44

618,891

20-44

33,610

378,997

30-64

28,813

45-64

8,063

28,544

Procedures

Procedure

Age

Sex

Number of / 1,000 Procedures Member

Years

0-19

Male

0

0.0

Female

0

0.0

Bariatric weight loss surgery

20-44

Male

1

Female

15

<0.1 <0.1

45-64

Male

0

0.0

Female

0

0.0

Tonsillectomy

0-9

Male &

1541

0.8

10-19

Female

397

0.3

Hysterectomy, Abdominal

15-44

Female

153

0.2

45-64

30

1.1

Hysterectomy, Vaginal

15-44

Female

73

0.1

45-64

5

0.2

30-64

Male

0

0.0

Cholecystectomy, Open

15-44

Female

9

45-64

3

<0.1 0.1

30-64

Male

9

0.3

Cholecystectomy, Closed (laparoscopic) 15-44

Female

429

0.7

45-64

21

0.7

Back Surgery

20-44

Male

10

0.3

Female

53

0.1

45-64

Male

11

1.4

Female

11

0.4

Mastectomy

15-44

Female

31

0.1

45-64

32

1.1

Lumpectomy

15-44

Female

141

0.2

45-64

40

1.4

5 of 20

August 2012

Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State
Ambulatory Care: Total (AMBA)

Ambulatory Care: Total (AMBA)

Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj:

None)

Age

Member Months

<1

281,392

1-9

1,693,122

10-19

1,156,841

20-44

412,607

45-64

36,607

65-74

62

75-84

11

85+

3

Unknown

0

Total

3,580,645

Outpatient Visits

ED Visits

Age

Visits/ 1,000

Visits/ 1,000

Visits

Member

Visits

Member

Months

Months

<1

194908

692.7

20984

74.6

1-9

534110

315.5

76493

45.2

10-19

251830

217.7

41705

36.1

20-44

169619

411.1

45696

110.7

45-64

24748

676.0

2910

79.5

65-74

24

387.1

0

0.0

75-84

15

1363.6

1

90.9

85+

0

0.0

0

0.0

Unknown

0

0

Total

1,175,254

328.2

187,789

52.4

6 of 20

August 2012

Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State Inpatient Utilization--General Hospital/Acute Care: Total (IPUA)

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

Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None)

Age

Member Months

<1 1-9 10-19

281,392 1,693,122 1,156,841

20-44 45-64 65-74

412,607 36,607
62

75-84

11

85+

3

Unknown

0

Total

3,580,645 Total Inpatient

Age

Discharges /

Discharges

1,000 Member

Months

Days

Days / 1,000 Members Months

Average Length of
Stay

<1

1620

5.8

13090

46.5

8.1

1-9

1938

1.1

5798

3.4

3.0

10-19 20-44 45-64 65-74 75-84

3733

3.2

10738

9.3

2.9

16069

38.9

45162

109.5

2.8

443

12.1

2366

64.6

5.3

0

0.0

0

0.0

NA

0

0.0

0

0.0

NA

85+ Unknown
Total

0

0.0

0

0.0

NA

0

0

NA

23,803

6.6

77,154

21.5

3.2

Medicine

Age

Discharges /

Discharges

1,000 Member

Months

Days

Days / 1,000 Members Months

Average Length of
Stay

<1 1-9 10-19

1240

4.4

5869

20.9

4.7

1525

0.9

3853

2.3

2.5

678

0.6

2153

1.9

3.2

20-44 45-64 65-74

780

1.9

2885

7.0

3.7

252

6.9

1152

31.5

4.6

0

0.0

0

0.0

NA

75-84 85+ Unknown

0

0.0

0

0.0

NA

0

0.0

0

0.0

NA

0

0

NA

Total

4,475

1.2

15,912

4.4

3.6

Surgery

Age

Discharges /

Discharges

1,000 Member

Months

Days

Days / 1,000 Members Months

Average Length of
Stay

<1 1-9 10-19 20-44

380

1.4

7221

25.7

19.0

413

0.2

1945

1.1

4.7

382

0.3

1711

1.5

4.5

595

1.4

3123

7.6

5.2

45-64

176

4.8

1174

32.1

6.7

7 of 20

August 2012

Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State Inpatient Utilization--General Hospital/Acute Care: Total (IPUA)

65-74

0

0.0

0

0.0

75-84

0

0.0

0

0.0

85+

0

0.0

0

0.0

Unknown

0

0

Total

1,946

0.5

15,174

4.2

Maternity*

Age

Discharges /

Discharges

1,000 Member

Months

Days

Days / 1,000 Members Months

10-19

2673

2.3

6874

5.9

20-44

14694

35.6

39154

94.9

45-64

15

0.4

40

1.1

Unknown

0

0

Total

17,382

10.8

46,068

28.7

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

NA NA NA NA 7.8
Average Length of
Stay
2.6 2.7 2.7 NA 2.7

8 of 20

August 2012

Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State Identification of Alcohol and Other Drug Services: Total (IADA)

Identification of Alcohol and Other Drug Services: Total (IADA)
Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None)

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

Member Months (Any)

Male 1221894 296804
48402 15488 20819
26 0

Female 1199427 305406 182050 186257 104022
50 0

Total 2,421,321 602,210 230,452 201,745 124,841
76 0

Member Months (Inpatient)

Male 1221894 296804
48402 15488 20819
26 0

Female 1199427 305406 182050 186257 104022
50 0

Total 2,421,321 602,210 230,452 201,745 124,841
76 0

Member Months (Intensive

Outpatient/Partial Hospitalization)

Male

Female

Total

1221894 1199427 2,421,321

296804

305406

602,210

48402

182050

230,452

15488

186257

201,745

20819

104022

124,841

26

50

76

0

0

0

Member Months (Outpatient/ED)

Male 1221894 296804
48402 15488 20819
26 0

Female 1199427 305406 182050 186257 104022
50 0

Total 2,421,321 602,210 230,452 201,745 124,841
76 0

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

1,603,433
Sex
M F Total M F Total M F Total M F Total M F Total M F Total

1,977,212 3,580,645

Any Services

Number 39 23 62 370 186 556 72 376 448 89 682 771 118 450 568 0 0 0

Percent <0.1% <0.1% <0.1% 1.5% 0.7% 1.1% 1.8% 2.5% 2.3% 6.9% 4.4% 4.6% 6.8% 5.2% 5.5% 0.0% 0.0% 0.0%

1,603,433 1,977,212

Inpatient

Number 4 4 8 48 28 76 16
124 140 13 165 178 27 94 121
0 0 0

Percent <0.1% <0.1% <0.1% 0.2% 0.1% 0.2% 0.4% 0.8% 0.7% 1.0% 1.1% 1.1% 1.6% 1.1% 1.2% 0.0% 0.0% 0.0%

3,580,645 1,603,433

Intensive Outpatient/Partial
Hospitalization

Number

Percent

0

0.0%

0

0.0%

0

0.0%

8

<0.1%

5

<0.1%

13

<0.1%

2

<0.1%

11

0.1%

13

0.1%

1

0.1%

33

0.2%

34

0.2%

4

0.2%

10

0.1%

14

0.1%

0

0.0%

0

0.0%

0

0.0%

1,977,212 3,580,645

Outpatient/ED

Number 35 20 55 341 164 505 60 288 348 83 592 675 103 402 505 0 0 0

Percent <0.1% <0.1% <0.1% 1.4% 0.6% 1.0% 1.5% 1.9% 1.8% 6.4% 3.8% 4.0% 5.9% 4.6% 4.9% 0.0% 0.0% 0.0%

1,603,433

1,977,212

3,580,645

9 of 20

August 2012

Unknown Total

M F Total M F Total

0 0 0 688 1,717 2,405

Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State Identification of Alcohol and Other Drug Services: Total (IADA)

NA

0

NA

NA

0

NA

NA

0

NA

0.5%

108

0.1%

1.0%

415

0.3%

0.8%

523

0.2%

0

NA

0

0

NA

0

0

NA

0

15

<0.1%

622

59

<0.1%

1,466

74

<0.1%

2,088

NA NA NA 0.5% 0.9% 0.7%

10 of 20

August 2012

Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State
Mental Health Utilization: Total (MPTA)

Mental Health Utilization: Total (MPTA)

Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None)

Age

Member Months (Any)

Member Months (Inpatient)

Member Months (Intensive Outpatient/Partial Hospitalization)

Male

Female

Total

Male

Female

Total

Male

Female

Total

0-12

1221894 1199427 2,421,321 1221894 1199427 2,421,321 1221894 1199427 2,421,321

13-17

296804

305406

602,210

296804

305406

602,210

296804

305406

602,210

18-64

84709

472329

557,038

84709

472329

557,038

84709

472329

557,038

65+

26

50

76

26

50

76

26

50

76

Unknown

0

0

0

0

0

0

0

0

0

Total

1,603,433 1,977,212 3,580,645 1,603,433 1,977,212 3,580,645 1,603,433 1,977,212 3,580,645

Intensive

Age

Sex

Any Services

Inpatient

Outpatient/Partial Hospitalization

Outpatient/ED

Number

Percent

Number

Percent

Number

Percent

Number

Percent

M

7786

7.6%

118

0.1%

81

0.1%

7778

7.6%

0-12

F

4688

4.7%

58

0.1%

36

<0.1%

4680

4.7%

Total

12,474

6.2%

176

0.1%

117

0.1%

12,458

6.2%

M

3277

13.2%

189

0.8%

85

0.3%

3256

13.2%

13-17

F

2928

11.5%

257

1.0%

91

0.4%

2895

11.4%

Total

6,205

12.4%

446

0.9%

176

0.4%

6,151

12.3%

M

531

7.5%

49

0.7%

16

0.2%

519

7.4%

18-64

F

3828

9.7%

296

0.8%

65

0.2%

3749

9.5%

Total

4,359

9.4%

345

0.7%

81

0.2%

4,268

9.2%

M

0

0.0%

0

0.0%

0

0.0%

0

0.0%

65+

F

1

24.0%

0

0.0%

0

0.0%

1

24.0%

Total

1

15.8%

0

0.0%

0

0.0%

1

15.8%

M

0

NA

0

NA

0

NA

0

NA

Unknown

F

0

NA

0

NA

0

NA

0

NA

Total

0

NA

0

NA

0

NA

0

NA

M

11,594

8.7%

356

0.3%

182

0.1%

11,553

8.6%

Total

F

11,445

6.9%

611

0.4%

192

0.1%

11,325

6.9%

Total

23,039

7.7%

967

0.3%

374

0.1%

22,878

7.7%

Member Months (Outpatient/ED)

Male 1221894 296804
84709 26 0
1,603,433

Female 1199427 305406 472329
50 0 1,977,212

Total 2,421,321 602,210 557,038
76 0 3,580,645

11 of 20

August 2012

Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State
Antibiotic Utilization: Total (ABXA)

Antibiotic Utilization: Total (ABXA)

Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None)

Pharmacy Benefit Member Months

Age

Male

Female

Total

0-9

997475

977039

1,974,514

10-17

521223

527794

1,049,017

18-34

63890

368307

432,197

35-49

17018

91019

108,037

50-64

3801

13003

16,804

65-74

15

47

62

75-84

8

3

11

85+

3

0

3

Unknown

0

0

0

Total

1,603,433 1,977,212

3,580,645

Antibiotic Utilization

Age

Sex

Total Antibiotic
Scrips

Total Days Average

Average Scrips Supplied for Days

PMPY for

All

Supplied per

Antibiotics Antibiotic Antibiotic

Scrips

Scrip

Total Number of Scrips for Antibiotics of
Concern

Average Scrips PMPY for
Anitbiotics of Concern

Percentage of Antibiotics of Concern of all Antibiotic
Scrips

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

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

104804 101137 205,941 26186 35789 61,975
3906 57854 61,760 1597 14425 16,022
403 1913 2,316
1 0 1 1 1 2 0 0 0 0 0 0 136,898 211,119 348,017

1.3

943112

9.0

46977

0.6

44.8%

1.2

922633

9.1

42508

0.5

42.0%

1.3

1,865,745

9.1

89,485

0.5

43.5%

0.6

259132

9.9

11720

0.3

44.8%

0.8

327116

9.1

14683

0.3

41.0%

0.7

586,248

9.5

26,403

0.3

42.6%

0.7

38874

10.0

1461

0.3

37.4%

1.9

440153

7.6

17995

0.6

31.1%

1.7

479,027

7.8

19,456

0.5

31.5%

1.1

14103

8.8

711

0.5

44.5%

1.9

118390

8.2

5944

0.8

41.2%

1.8

132,493

8.3

6,655

0.7

41.5%

1.3

3828

9.5

177

0.6

43.9%

1.8

15430

8.1

958

0.9

50.1%

1.7

19,258

8.3

1,135

0.8

49.0%

0.8

15

15.0

1

0.8

100.0%

0.0

0

NA

0

0.0

NA

0.2

15

15.0

1

0.2

100.0%

1.5

5

5.0

1

1.5

0.0%

4.0

7

7.0

0

0.0

50.0%

2.2

12

6.0

1

1.1

50.0%

0.0

0

NA

0

0.0

NA

NA

0

NA

0

NA

NA

0.0

0

NA

0

0.0

NA

NA

0

NA

0

NA

NA

NA

0

NA

0

NA

NA

NA

0

NA

0

NA

NA

1.0

1,259,069

9.2

61,048

0.5

44.6%

1.3

1,823,729

8.6

82,088

0.5

38.9%

1.2

3,082,798

8.9

143,136

0.5

41.1%

Antibiotics of Concern Utilization

12 of 20

August 2012

Age
0-9 10-17 18-34 35-49 50-64 65-74 75-84 85+ Unknown Total
Age
0-9 10-17 18-34 35-49 13 of 20

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

Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State
Antibiotic Utilization: Total (ABXA)

Total Quinolone
Scrips

Total

Average Scrips PMPY for
Quinolones

Cephalosporin 2nd-
4th Generation

Scrips

Average Scrips PMPY for Cephalosporins 2nd-
4th Generation

Total Azithromycin and Clarithromycin Scrips

Average Scrips PMPY for
Azithromycins and Clarithro-
mycins

Total Amoxicillin/ Clavulanate
Scrips

Average Scrips PMPY
for Amoxicillin/ Clavulanates

Total Ketolides
Scrips

Average Scrips PMPY for Ketolides

Total Clindamycin
Scrips

Average Scrips PMPY
for Clindamycins

Total Misc. Antibiotics of
Concern Scrips

Average Scrips PMPY
for Misc. Antibiotics of
Concern

52 81 133 186 599 785 206 4450 4,656 180 1853 2,033 61 334 395 1 0 1 0 0 0 0 0 0 0 0 0 686 7,317 8,003

<0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 0.1 0.1 0.1 0.2 0.2 0.2 0.3 0.3 0.8 0.0 0.2 0.0 0.0 0.0 0.0 NA 0.0 NA NA NA <0.1 <0.1 <0.1

7951 7900 15,851 1049 1286 2,335
52 716 768 23 188 211 10 40 50
0 0 0 0 0 0 0 0 0 0 0 0 9,085 10,130 19,215

0.1 0.1 0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 NA 0.0 NA NA NA 0.1 0.1 0.1

19812

0.2

17599

0.2

17328

0.2

15767

0.2

37,140

0.2

33,366

0.2

5765

0.1

3837

0.1

7633

0.2

4152

0.1

13,398

0.2

7,989

0.1

706

0.1

332

0.1

8289

0.3

2568

0.1

8,995

0.2

2,900

0.1

318

0.2

126

0.1

2425

0.3

885

0.1

2,743

0.3

1,011

0.1

68

0.2

26

0.1

402

0.4

113

0.1

470

0.3

139

0.1

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

1

1.5

0

0.0

0

0.0

0

0.0

1

1.1

0

0.0

0

0.0

0

0.0

0

NA

0

NA

0

0.0

0

0.0

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

26,670

0.2

21,920

0.2

36,077

0.2

23,485

0.1

62,747

0.2

45,405

0.2

All Other Antibiotics Utilization

0

0.0

1560

<0.1

3

<0.1

0

0.0

1423

<0.1

9

<0.1

0

0.0

2,983

<0.1

12

<0.1

0

0.0

881

<0.1

2

<0.1

0

0.0

1011

<0.1

2

<0.1

0

0.0

1,892

<0.1

4

<0.1

0

0.0

165

<0.1

0

0.0

0

0.0

1970

0.1

2

<0.1

0

0.0

2,135

0.1

2

<0.1

0

0.0

64

<0.1

0

0.0

0

0.0

586

0.1

7

<0.1

0

0.0

650

0.1

7

<0.1

0

0.0

11

<0.1

1

<0.1

0

0.0

66

0.1

3

<0.1

0

0.0

77

0.1

4

<0.1

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

NA

0

NA

0

NA

0

0.0

0

0.0

0

0.0

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

0.0

2,681

<0.1

6

<0.1

0

0.0

5,056

<0.1

23

<0.1

0

0.0

7,737

<0.1

29

<0.1

Total Absorbable Sulfonamide
Scrips

Average Scrips PMPY for Absorbable
Sulfonamides

Total Aminoglycoside Scrips

Average Scrips PMPY for Aminoglycosides

Total 1st Generation Cephalosporin Scrips

Average Scrips

PMPY for 1st

Total

Generation Lincosamide

Cephalo-

Scrips

sporins

Average Scrips PMPY
for Lincosamides

Total Macrolides (not azith. or
clarith.) Scrips

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

Total Penicillin
Scrips

Average Scrips PMPY for Penicillins

Total Tetracycline
Scrips

Average Scrips PMPY
for Tetracyclines

Total Misc. Antibiotic
Scrips

5358

0.1

14

<0.1

5693

0.1

0

0.0

133

<0.1

46461

0.6

19

<0.1

149

8064

0.1

5

<0.1

5602

0.1

0

0.0

112

<0.1

44407

0.5

12

<0.1

427

13,422

0.1

19

<0.1

11,295

0.1

0

0.0

245

<0.1

90,868

0.6

31

<0.1

576

1963

<0.1

7

<0.1

2333

0.1

0

0.0

105

<0.1

7763

0.2

2110

<0.1

185

3817

0.1

1

<0.1

2774

0.1

0

0.0

122

<0.1

9798

0.2

2268

0.1

2326

5,780

0.1

8

<0.1

5,107

0.1

0

0.0

227

<0.1

17,561

0.2

4,378

0.1

2,511

385

0.1

3

<0.1

353

0.1

0

0.0

34

<0.1

1072

0.2

483

0.1

115

5145

0.2

3

<0.1

3770

0.1

0

0.0

357

<0.1

10376

0.3

4266

0.1

15942

5,530

0.2

6

<0.1

4,123

0.1

0

0.0

391

<0.1

11,448

0.3

4,749

0.1

16,057

119

0.1

0

0.0

155

0.1

0

0.0

12

<0.1

395

0.3

127

0.1

78

1481

0.2

0

0.0

941

0.1

0

0.0

113

<0.1

2657

0.4

927

0.1

2362

Average Scrips PMPY for Misc. Antibiotics
<0.1 <0.1 <0.1 <0.1 0.1 <0.1 <0.1 0.5 0.4 0.1 0.3

August 2012

50-64 65-74 75-84 85+ Unknown Total

Total

1,600

0.2

M

54

0.2

F

177

0.2

Total

231

0.2

M

0

0.0

F

0

0.0

Total

0

0.0

M

0

0.0

F

0

0.0

Total

0

0.0

M

0

0.0

F

0

NA

Total

0

0.0

M

0

NA

F

0

NA

Total

0

NA

M

7,879

0.1

F

18,684

0.1

Total

26,563

0.1

Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State
Antibiotic Utilization: Total (ABXA)

0

0.0

1,096

0.1

0

0.0

125

<0.1

3,052

0.3

1,054

0.1

2,440

0.3

0

0.0

33

0.1

0

0.0

2

<0.1

78

0.2

33

0.1

26

0.1

0

0.0

167

0.2

0

0.0

16

<0.1

302

0.3

101

0.1

192

0.2

0

0.0

200

0.1

0

0.0

18

<0.1

380

0.3

134

0.1

218

0.2

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

1

4.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

1

1.1

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

24

<0.1

8,567

0.1

0

0.0

286

<0.1

55,769

0.4

2,772

<0.1

553

<0.1

9

<0.1

13,254

0.1

0

0.0

720

<0.1

67,540

0.4

7,574

<0.1

21,250

0.1

33

<0.1

21,821

0.1

0

0.0

1,006

<0.1

123,309

0.4

10,346

<0.1

21,803

0.1

14 of 20

August 2012

Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State
Total Membership (TLM)

Total Membership (TLM)

Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None)

Product/Product Line

Total Number of Members*

HMO (Total)

296,716

Medicaid

296716

Commercial

0

Medicare (cost or risk)

0

Other

0

PPO (Total)

0

Medicaid

0

Commercial

0

Medicare (cost or risk)

0

Other

0

POS (Total)

0

Medicaid

0

Commercial

0

Medicare (cost or risk)

0

Other

0

FFS (Total)

0

Medicaid

0

Commercial

0

Medicare (cost or risk)

0

Other

0

Total

296,716

* Total number of members in each category as of December 31 of the measurement year.

15 of 20

August 2012

Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State
Enrollment by Product Line: Total (ENPA)

Enrollment by Product Line: Total (ENPA)

Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None)

Male

Female

Total

Age

Member

Member

Member

Months

Months

Months

<1

142613

138779

281,392

1-4

425951

411824

837,775

5-9

428911

426436

855,347

10-14

354649

352688

707,337

15-17

166574

175106

341,680

18-19

43036

64788

107,824

0-19 Subtotal

1,561,734 1,569,621 3,131,355

0-19 Subtotal: %

97.4%

79.4%

87.5%

20-24

5366

117262

122,628

25-29

7494

106397

113,891

30-34

7994

79860

87,854

35-39

7176

49154

56,330

40-44

5580

26324

31,904

20-44 Subtotal

33,610

378,997

412,607

20-44 Subtotal: %

2.1%

19.2%

11.5%

45-49

4262

15541

19,803

50-54

2448

7591

10,039

55-59

956

3606

4,562

60-64

397

1806

2,203

45-64 Subtotal

8,063

28,544

36,607

45-64 Subtotal: %

0.5%

1.4%

1.0%

65-69

14

37

51

70-74

1

10

11

75-79

8

3

11

80-84

0

0

0

85-89

0

0

0

>=90

3

0

3

>=65 Subtotal

26

50

76

>=65 Subtotal: %

<0.1%

<0.1%

<0.1%

Age Unknown

0

0

0

Total

1,603,433 1,977,212 3,580,645

16 of 20

August 2012

Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State
Enrollment by State (EBS)

Enrollment by State (EBS)

Peach State Health Plan (Org ID: 6625, SubID: 9227,

Medicaid, Spec Area: None, Spec Proj: None)

State

Number

Alabama

30

Alaska

2

Arizona

5

Arkansas

0

California

5

Colorado

0

Connecticut

0

Delaware

2

District of Columbia

2

Florida

43

Georgia

295850

Hawaii

0

Idaho

0

Illinois

5

Indiana

2

Iowa

5

Kansas

0

Kentucky

7

Louisiana

4

Maine

0

Maryland

3

Massachusetts

5

Michigan

3

Minnesota

0

Mississippi

2

Missouri

4

Montana

0

Nebraska

1

Nevada

3

New Hampshire

0

New Jersey

2

New Mexico

2

New York

6

North Carolina

14

North Dakota

1

Ohio

4

Oklahoma

0

Oregon

0

Pennsylvania

4

Rhode Island

0

South Carolina

17

South Dakota

0

Tennessee

15

Texas

25

Utah

0

Vermont

0

Virginia

1

Washington

5

West Virginia

0

Wisconsin

1

17 of 20

August 2012

Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State
Enrollment by State (EBS)

Wyoming American Samoa Federated States of Micronesia
Guam Commonwealth of Northern Marianas
Puerto Rico Virgin Islands
Other TOTAL

0 0 0 0 0 0 0 639 296,719

18 of 20

August 2012

Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State
Race/Ethnicity Diversity of Membership (RDM)

Race/Ethnicity Diversity of Membership (RDM)

Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None)

Race/Ethnicity Diversity of Membership

Total Unduplicated Membership During the Measurement Year

425792

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

Direct Data Collection Method

Indirect Data Collection Method

Unknown

Direct Total

48.2%

Race

Health Plan Direct*
CMS/State Database*

0.0000000000 .48151

Indirect 0.000000000

Total*

0

Total*

.51849

Other*

0.0000000000

Direct Total

5.2%

Ethnicity

Health Plan Direct*
CMS/State Database*

0.0000000000 .05158

Indirect 0.000000000

Total*

0

Total*

.94842

Other*

0.0000000000

*Enter percentage as a value between 0 and 1.

Race

Hispanic or Latino

Number

Percentage

Not Hispanic or Latino Number Percentage

Unknown Ethnicity Number Percentage

White

17048

76.6%

59049

30.8%

0

0.0%

Black or African American

484

2.2%

117156

61.1%

0

0.0%

American-Indian and Alaska Native

33

0.1%

161

0.1%

0

0.0%

Asian

134

0.6%

5129

2.7%

0

0.0%

Native Hawaiian and Other Pacific Islanders

75

0.3%

83

<0.1%

0

0.0%

Some Other Race

4188

18.8%

1482

0.8%

0

0.0%

Two or More Races

0

0.0%

0

0.0%

0

0.0%

Unknown

291

1.3%

8590

4.5%

211889

100.0%

Declined

0

0.0%

0

0.0%

0

0.0%

Total

22,253

100.0%

191,650

100.0%

211,889

100.0%

Declined Ethnicity

Number Percentage

0

NR

0

NR

0

NR

0

NR

0

NR

0

NR

0

NR

0

NR

0

NR

0

NR

Total

Number Percentage

76,097

17.9%

117,640

27.6%

194

<0.1%

5,263

1.2%

158

<0.1%

5,670 0
220,770 0
425,792

1.3% 0.0% 51.8% 0.0% 100.0%

19 of 20

August 2012

Department of Community Health, State of Georgia Audited CY 2011 HEDIS Measure Results for Peach State
Language Diversity of Membership (LDM)

Language Diversity of Membership (LDM)

Peach State Health Plan (Org ID: 6625, SubID: 9227, Medicaid, Spec Area: None, Spec Proj: None)

Percentage of Members With Known Language Value from Each Data Source

Category

Health Plan Direct

CMS/State Databases

Other ThirdParty Source

Spoken Language Preferred for Health 0.000000000 1.000000000 0.000000000

Care*

0

0

0

Preferred Language for Written Materials*

0.000000000 1.000000000 0.000000000

0

0

0

Other Language Needs*

0.000000000 1.000000000 0.000000000

0

0

0

*Enter percentage as a value between 0 and 1. Spoken Language Preferred for Health Care

English Non-English

Number 186547 11885

Percentage 43.8% 2.8%

Unknown

227360

53.4%

Declined

0

0.0%

Total*

425,792

100.0%

Language Preferred for Written Materials

Number Percentage

English

0

Non-English

0

Unknown

425792

Declined

0

Total*

425,792

Other Language Needs

0.0% 0.0% 100.0% 0.0% 100.0%

English Non-English
Unknown

Number 0 0
425792

Percentage 0.0% 0.0%
100.0%

Declined

0

Total*

425,792

*Should sum to 100%

0.0% 100.0%

20 of 20

August 2012