Validation of performance measures for Peach State Health Plan, measurement period: calendar year 2012; validation period: state fiscal year 2013

Georgia Department of Community Health
Validation of Performance Measures for
Peach State Health Plan
Measurement Period: Calendar Year 2012 Validation Period: State Fiscal Year 2013
Publish Date: September 20, 2013
3133 East Camelback Road, Suite 300 Phoenix, AZ 85016 Phone 602.264.6382 Fax 602.241.0757

CONTENTS
for 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 ....................................................................................................... 4 Pre-Audit Strategy ............................................................................................................................. 4 Validation Team................................................................................................................................. 4 Technical Methods of Data Collection and Analysis.......................................................................... 5 On-Site Activities ............................................................................................................................... 5 Data Integration, Data Control, and Performance Measure Documentation ....................................... 7 Data Integration ................................................................................................................................. 7 Data Control ...................................................................................................................................... 7 Performance Measure Documentation.............................................................................................. 7 Validation Results ................................................................................................................................ 8 Medical Service Data (Claims/Encounters) ....................................................................................... 8 Enrollment Data................................................................................................................................. 9 Provider Data..................................................................................................................................... 9 Medical Record Review Process ....................................................................................................... 9 Supplemental Data .......................................................................................................................... 10 Data Integration ............................................................................................................................... 10 Performance Measure Specific Findings......................................................................................... 11 Validation Findings ............................................................................................................................ 12
Appendix A. Data Integration and Control Findings ....................................................................... A-1 Appendix B. Denominator and Numerator Validation Findings..................................................... B-1 Appendix C. Performance Measure Results .................................................................................... C-1 Appendix D. Final Audited HEDIS Rates .......................................................................................... D-1 Appendix E. Performance Measure Validation Reporting Spreadsheet.........................................E-1 Appendix F. HEDIS Interactive Data Submission System Data ...................................................... F-1

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Validation of Performance Measures
for 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. The DCH contracts with three care management organizations (CMOs) to provide services to Medicaid managed care enrollees and PeachCare for Kids enrollees. PeachCare for Kids is the name of Georgia's stand-alone Children's Health Insurance Program (CHIP). The DCH identified a set of performance measures that were calculated and reported by the CMOs for validation. HSAG conducted the validation activities as outlined in the Centers for Medicare & Medicaid Services (CMS) publication, EQR Protocol 2: Validation of Performance Measures Reported by the MCO: A Mandatory Protocol for External Quality Review (EQR), Version 2.0, September 2012.

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

Table 1--Peach State Health Plan Information

CMO Name: CMO Location: CMO Contact:

Peach State Health Plan 3200 Highlands Parkway SE, Suite 300 Smyrna, GA 30082 Joyce McElwain, Senior Director, Quality Improvement

Contact Telephone Number:

678.556.2344

Contact E-mail Address:

jmcelwain@centene.com

Site Visit Date:

April 18, 2013

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

Table 2--List of CY 2012 Performance Measures for Peach State

Performance Measure

1.

Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517)

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

3. Cesarean Delivery Rate

4. Cesarean Rate for Nulliparous Singleton Vertex

5.

Percentage of Eligibles that Received Dental Treatment Services

6.

Percentage of Eligibles that Received Preventive Dental Services

7.

Percentage of Live Births Weighing Less Than 2,500 Grams

8. Adult Asthma Admission Rate

9.

Chronic Obstructive Pulmonary Disease (COPD) Admission Rate

10. Congestive Heart Failure Admission Rate

11.

Diabetes, Short-Term Complications Admission Rate

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

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

Rate Calculation by:
Peach State
Peach State Peach State Peach State Peach State Peach State Peach State Peach State Peach State Peach State Peach State

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

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

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

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Description of Validation Activities

Pre-Audit Strategy
HSAG conducted the validation activities as outlined in the CMS performance measure validation protocol. To complete the validation activities for 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 2013 Record of Administration, Data Management, and Processes (Roadmap); and any additional supporting documentation necessary to complete the audit. HSAG responded to Roadmap-related questions received directly from 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 onsite meetings at Peach State; others conducted their work at HSAG's offices. Table 3 lists the validation team members, their positions, and their skills and expertise.

Table 3--Validation Team

Name and Role

Skills and Expertise

Patience Hoag, RHIT, CHCA, CHDA, CCS, CCS-P, Certified HEDIS auditor, certified coder; HEDIS

CPHQ

knowledge, interviewing skills, data analysis,

Lead Auditor

abstraction, tool development, and quality improvement.

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

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

Tammy GianFrancisco Project Leader, Audits

Performance measure validation coordination, communication, and scheduling.

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Technical Methods of Data Collection and Analysis
The CMS performance measures validation protocol identifies key types of data that should be reviewed as part of the validation process. The following list describes the type of data collected and how HSAG conducted an analysis of these data:
NCQA's HEDIS 2013 Roadmap: Peach State completed and submitted the required and relevant portions of its Roadmap for review by the validation team. The validation team used responses from the Roadmap to complete the pre-on-site assessment of information systems.
Source code (programming language) for performance measures: Peach State contracted with Inovalon, an NCQA-Certified software vendor, to calculate rates for both HEDIS and nonHEDIS measures. The source code review was conducted via a Web-assisted session where Inovalon explained the process and source code to HSAG's source code review team.
Supporting documentation: HSAG requested documentation that would provide reviewers with additional information to complete the validation process, including policies and procedures, file layouts, system flow diagrams, system log files, and data collection process descriptions. The validation team reviewed all supporting documentation, identifying issues or areas needing clarification for further follow-up.
On-Site Activities
HSAG conducted an on-site visit with Peach State on April 18, 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 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, focusing on the processing of claims and encounter data, provider data, patient data, and inpatient data. Additionally, the review evaluated the processes used to collect and calculate the performance measure rates, including accurate numerator and denominator identification and algorithmic compliance (which evaluated whether rate calculations were performed correctly, all data were combined appropriately, and numerator events were counted accurately).
Review of Roadmap and supporting documentation: The review included processes used for collecting, storing, validating, and reporting performance measure rates. This session was designed to be interactive with key 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 from the documentation review, expand or clarify outstanding issues, and ascertain that written policies and procedures were used and followed in daily practice.

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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:

Alfred Miller

Table 4--List of Peach State Health Plan Interviewees

Name

Title

Data Analyst III

Detra Friley-Clark

Director, Provider Data and Credentialing

Joyce McElwain

Senior Director, Quality Improvement

Ron Purisima

Manager, Quality Analytics

Dean Greeson

Senior Vice President, Medical Director

Donna McIntosh

Senior Director, Compliance

Shaywen Hawkins

Quality Improvement Manager

Andrea Stuckey-Hendley

Project Manager, Compliance

Chevron Cardenas

Senior Director, Member and Provider Services

Heather House

Farmington Claims Supervisor

Jessica Silver

Corporate Director, Encounters

Kimberly Weakley

Vice President, Provider Solutions

Debra Peterson-Smith

Senior Vice President, Operations

Luke Ferguson

Encounters Analyst

Tonnette Tucker

Supervisor, Provider Data Management

Inez Sarves

Contract Management

Wanda Lee

Member Service Manager

Jason Rosen

Senior Health Economics Analyst

Brian Daming

Information Technology QSI Technician

Valerie Liserio-Eike

Quality Improvement Specialist--HEDIS

Yolanda Spivey

Senior Director, Data Analytics

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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 DCH performance measure rates. General findings are indicated below:
Medical Service Data (Claims/Encounters)
There were no concerns with Peach State's medical service data system or processes. The plan continued to use Amisys as its transactional system, which had sufficient edits in place to ensure data were complete and accurate upon entry/loading into the system. All data elements needed for reporting the performance measures were captured. All providers submitted data in standard formats, using industry standard codes. Over 90 percent of Peach State's providers and facilities submitted claims data electronically, which instilled additional confidence in data accuracy. Paper claims were received at the corporate office in Farmington, Missouri; scanned via optical character recognition (OCR) technology; and loaded into Amisys for processing. Minimal data were manually entered into Amisys. The plan's reimbursement structure is fee-for-service (FFS), which serves as a built-in incentive for providers to submit data to the plan. Peach State's claims processors are audited on an ongoing basis, and all processors met standards for the measurement year for payment, financial, and processing accuracy. The entire process from data submission to claims processing is highly automated, with very little manual intervention.
The plan successfully transitioned to the 5010 format, and most of its providers had also transitioned during 2012. Claims submitted by providers using the 4010 format were rejected for reimbursement, which encouraged providers to submit claims with the updated format. The plan was also proactively planning for ICD-10 implementation, having begun mapping and other preparations for the transition in the code set in 2014.
Although the plan's reimbursement structure helps ensure that providers are submitting complete data, the plan also ran various monitoring reports to track providers' claim submission volumes. If a high-volume provider were to suspend submission of claims to the plan, this action would be quickly identified.
Peach State used DentaQuest to process its dental claims. Although DentaQuest underwent a system transition during late 2011, the transition went smoothly, and there were no issues related to data loss. Thorough testing prior to implementation included running dual systems and comparing results to historical data. DentaQuest sent encounter files to Peach State twice each month, and the encounters were then loaded to the data warehouse. There were no issues or concerns with the completeness or integrity of the data in 2012, as ongoing monitoring of volume occurs as a part of data receipt and loading.
Peach State contracted with US Script to serve as its pharmacy vendor. Data were submitted to Peach State at least weekly and included paid, denied, and reversal claims data. These data were loaded to the plan's data warehouse for use in measure reporting. There were no issues with data format, timeliness, or completeness in 2012.

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A recommendation for more formal documentation of vendor monitoring was made during the previous performance measure validation review and discussed during the on-site review. Peach State conducted meetings with each of its vendors monthly (weekly for those not meeting performance standards) to discuss any issues or concerns, and maintained documentation of this interaction. The plan's Finance department also performed oversight of pharmacy transactional and payment volumes, which was documented. In addition, the plan submitted a comprehensive document for auditor review, GA CMO Encounter Report. The report was produced by an accounting firm and showed detailed financial information based on data provided by each of the plan's vendors.

Enrollment Data
Peach State had effective processes for acquiring and loading enrollment data from the State's fiscal agent. The plan had a highly electronic, well-coordinated, and long-standing method for acquisition and loading of State enrollment files. Daily 834 changes/addition files were acquired via secure file transfer protocol, processed for edit checks, and then uploaded into Amisys, the transactional system. Error reports were generated identifying discrepancies that needed to be manually worked. The plan also received a full monthly enrollment file, which included demographic changes, terminations, additions, and voids. The State's fiscal agent also provided an end-of-month adjustment file that included voided transactions (e.g., the member was not or never was eligible). Any discrepancies requiring research were identified through automated reports and corrected efficiently, with monthly reporting to the State for any member data discrepancies that had not been corrected. There were no backlogs during 2012. The auditor had no concerns with Peach State's enrollment data.

Provider Data
There were no concerns with the plan's provider data system or processes. The plan used the Portico system to house provider data. This software application interfaces seamlessly with Amisys, which helps to eliminate reconciliation concerns. Peach State conducts 100 percent validation of all data entry of its direct providers and continually monitors delegated entities' data. The number of primary care physicians increased during 2012 due to the plan's expansion initiative, which delayed some provider data entry. The delay was quickly remedied, however, because staffing was immediately increased to accommodate the influx.

Medical Record Review Process
Peach State was fully compliant with the medical record review reporting requirements. Peach State used the vendor, RecordFlow, to procure the medical records, and another vendor, Aqurate Health Data Management, to abstract and enter the medical record data into the Aqurate hybrid tool. HSAG reviewed the Aqurate hybrid tool and corresponding instructions. Aqurate's reviewer qualifications, training, and oversight were appropriate. Peach State's oversight of the medical record abstraction and procurement vendors was appropriate. Due to reporting a new State-required hybrid measure, a convenience sample was required and subsequently passed review. Peach State passed the medical record review validation process for the Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517) measure.

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Supplemental Data
Peach State did not use supplemental data to augment rates for the measures under the scope of the audit; therefore, this standard is not applicable.
Data Integration
Peach State contracted with Inovalon to generate the various non-HEDIS performance measure rates for the measures under the scope of the audit, as well as the plan's HEDIS rates. Staff members at Peach State responsible for measure reporting activities were very experienced and well-versed in all aspects of the performance measure reporting process, and they were very responsive to any and all pre-onsite, on-site, and post-onsite requests.
For data integration, all source data were pulled from Peach State's enterprise data warehouse into a staging database prior to loading into Inovalon's certified software, Quality Spectrum Insight (QSI). There were communications with Inovalon to ensure that all data elements needed for deriving the measures were provided. For each file provided to Inovalon, row counts and other automated reports were run to ensure that data transfers into QSI were completed, and no data were lost or corrupted.
In addition to the certified software for HEDIS measures, Inovalon produced the programming code based on the performance measure specifications for the non-HEDIS measures. HSAG reviewed and approved Inovalon's programming code for the non-HEDIS performance measures. There were no further concerns with Peach State's data integration system or processes to generate its 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 Health Plan

Performance Measures

Key Review Findings

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

No concerns were identified.

2.

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

No concerns were identified.

3. Cesarean Delivery Rate

No concerns were identified.

4. Cesarean Rate for Nulliparous Singleton Vertex

No concerns were identified.

5. Percentage of Eligibles that Received Dental Treatment Services

No concerns were identified.

6. Percentage of Eligibles that Received Preventive Dental Services

No concerns were identified.

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

No concerns were identified.

8. Adult Asthma Admission Rate

No concerns were identified.

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

10. Congestive Heart Failure Admission Rate

No concerns were identified.

11. Diabetes, Short-Term Complications Admission Rate

No concerns were identified.

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Validation Findings

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

Report (R)

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

Not Reportable (NR)

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

According to the CMS protocol, the validation finding for each measure is determined by the magnitude of the errors detected for the audit elements, not by the number of audit elements determined to be "Not Reportable." Consequently, it is possible that an error for a single audit element may result in a designation of "NR" because the impact of the error biased the reported performance measure rate by more than 5 percentage points. Conversely, it is also possible that several audit element errors may have little impact on the reported rate, resulting in a measure designation of "R."

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

Table 7--Key Review Results for Peach State Health Plan

Performance Measures

Validation Finding

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

R

2.

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

R

3. Cesarean Delivery Rate

R

4. Cesarean Rate for Nulliparous Singleton Vertex

R

5. Percentage of Eligibles that Received Dental Treatment Services

R

6. Percentage of Eligibles that Received Preventive Dental Services

R

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

R

8. Adult Asthma Admission Rate

R

9. Chronic Obstructive Pulmonary Disease (COPD) Admission Rate

R

10. Congestive Heart Failure Admission Rate

R

11. Diabetes, Short-Term Complications Admission Rate

R

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

Documentation Worksheet

CMO Name: On-Site Visit Date: Reviewers:

Peach State Health Plan April 18, 2013 Patience Hoag, RHIT, CHCA, CHDA, CCS, CCS-P, CPHQ

Table A-1--Data Integration and Control Findings for Peach State Health Plan

Data Integration and Control Element

Not Met Met N/A

Comments

Accuracy of data transfers to assigned performance measure data repository.

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

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

Accuracy of file consolidations, extracts, and derivations.

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

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

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

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

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

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

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

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DATA INTEGRATION AND CONTROL FINDINGS

Table A-1--Data Integration and Control Findings for Peach State Health Plan

Data Integration and Control Element

Not Met Met N/A

Comments

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

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

Prescribed data cutoff dates are followed.

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

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

Reviewer Worksheets

CMO Name: On-Site Visit Date: Reviewers:

Peach State Health Plan April 18, 2013 Patience Hoag, RHIT, CHCA, CHDA, CCS, CCS-P, CPHQ

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.

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

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

Exclusion criteria included in the performance measure specifications are followed.

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

Population estimates were not necessary.

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DENOMINATOR AND NUMERATOR VALIDATION FINDINGS

Table B-2--Numerator Validation Findings for 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.

Nonstandard codes were not used or reported.

If any time parameters are required by the specifications of the performance measure, they are followed (i.e., the measured event occurred during the time period specified or defined in the performance measure).

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Appendix C. Performance Measure Results
for Peach State Health Plan

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

Table C-1--Performance Measure 1 for Peach State Health Plan
Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517)

Rate 83.38%

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

Table C-2--Performance Measure 2 for Peach State Health Plan
Annual Percentage of Asthma Patients with One or More Asthma-Related Emergency Room Visit (ages 220)

Rate 12.64%

Performance Measure 3--Cesarean Delivery Rate
Table C-3--Performance Measure 3 for Peach State Health Plan
Cesarean Delivery Rate

Rate 30.01%

Performance Measure 4--Cesarean Rate for Nulliparous Singleton Vertex

Table C-4--Performance Measure 4 for Peach State Health Plan
Cesarean Rate for Nulliparous Singleton Vertex

Rate 19.63%

Peach State Health Plan Validation of Performance Measures State of Georgia

Page C-1 Peach State_GA2012-13_CMO_PMV_F1_0913

PERFORMANCE MEASURE RESULTS

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

Table C-5--Performance Measure 5 for Peach State Health Plan
Percentage of Eligibles that Received Dental Treatment Services

Rate 23.14%

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

Table C-6--Performance Measure 6 for Peach State Health Plan
Percentage of Eligibles that Received Preventive Dental Services

Rate 48.06%

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

Table C-7--Performance Measure 7 for Peach State Health Plan
Percentage of Live Births Weighing Less Than 2,500 Grams

Rate 8.53%

Performance Measure 8--Adult Asthma Admission Rate
Table C-8--Performance Measure 8 for Peach State Health Plan
Adult Asthma Admission Rate

Rate (Per 100,000)
52.17

Peach State Health Plan Validation of Performance Measures State of Georgia

Page C-2 Peach State_GA2012-13_CMO_PMV_F1_0913

PERFORMANCE MEASURE RESULTS

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

Table C-9--Performance Measure 9 for Peach State Health Plan
Chronic Obstructive Pulmonary Disease (COPD) Admission Rate

Rate (Per 100,000)
18.87

Performance Measure 10--Congestive Heart Failure Admission Rate

Table C-10--Performance Measure 10 for Peach State Health Plan
Congestive Heart Failure Admission Rate

Rate (Per 100,000)
25.53

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

Table C-11--Performance Measure 11 for Peach State Health Plan
Diabetes, Short-Term Complications Admission Rate

Rate (Per 100,000)
25.52

Peach State Health Plan Validation of Performance Measures State of Georgia

Page C-3 Peach State_GA2012-13_CMO_PMV_F1_0913

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

Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for Peach State Health Plan

Measure

CMO Rate

Adolescent Well-Care Visits

43.98%

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

84.94% 89.36% Denominator fewer than 30

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

85.46%

Adult BMI Assessment

66.59%

Annual Dental Visit--Ages 23 Years

43.96%

Annual Dental Visit--Ages 46 Years

76.01%

Annual Dental Visit--Ages 710 Years

78.32%

Annual Dental Visit--Ages 1114 Years

70.02%

Annual Dental Visit--Ages 1518 Years

59.42%

Annual Dental Visit--Ages 1921 Years

38.85%

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

67.92% 87.92% 63.41% Denominator fewer than 30

Annual Monitoring for Patients on Persistent Medications--Diuretics

87.90%

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

86.87% 40.84% 43.92% 28.13% 73.80%

Peach State Health Plan Validation of Performance Measures State of Georgia

Page D-1 Peach State_GA2012-13_CMO_PMV_F1_0913

FINAL AUDITED HEDIS RATES

Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for Peach State Health Plan

Measure

CMO Rate

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

80.47%

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis*

17.31%

Breast Cancer Screening

56.46%

Call Answer Timeliness

82.84%

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

73.54% 74.55% 23.64% 76.74%

Childhood Immunization Status--Combo 6

33.26%

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

27.91% 96.98% 90.43% 90.81% 87.97% 59.60%

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

27.30%

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

53.74%

Comprehensive Diabetes Care--Eye Exam

57.22%

Comprehensive Diabetes Care--HbA1c Control <7.0

27.61%

Comprehensive Diabetes Care--HbA1c Control <8.0

39.13%

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

55.48%

Comprehensive Diabetes Care--HbA1c Testing

79.83%

Comprehensive Diabetes Care--LDL-C Screening

67.83%

Comprehensive Diabetes Care--LDL-C Control

20.35%

Comprehensive Diabetes Care--Medical Attention to Nephropathy

73.39%

Peach State Health Plan Validation of Performance Measures State of Georgia

Page D-2 Peach State_GA2012-13_CMO_PMV_F1_0913

FINAL AUDITED HEDIS RATES

Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for Peach State Health Plan

Measure

CMO Rate

Controlling High Blood Pressure

49.78%

Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis

68.42%

Follow-Up After Hospitalization for Mental Illness--30 Day Follow-Up

70.79%

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

52.52% 43.73% 58.60% 8.62%

Frequency of Ongoing Prenatal Care--2140 Percent

4.43%

Frequency of Ongoing Prenatal Care--4160 Percent

6.99%

Frequency of Ongoing Prenatal Care--6180 Percent

14.92%

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

65.03% 17.82% 71.30% 39.74% 8.27% Rates reported in Appendix F 74.19% 60.77% 40.08% 18.44% Denominator fewer than 30 63.64% 78.18% 71.56% 86.71%

Peach State Health Plan Validation of Performance Measures State of Georgia

Page D-3 Peach State_GA2012-13_CMO_PMV_F1_0913

FINAL AUDITED HEDIS RATES

Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for Peach State Health Plan

Measure

CMO Rate

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

90.58% 88.40%

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

72.39% Denominator fewer than 30

Use of Appropriate Medications for People with Asthma--Total

89.22%

Use of Imaging Studies for Low Back Pain*

78.26%

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

40.82% 47.69% 56.02% 47.69%
4.63%

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

3.24%

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

4.86%

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

4.63%

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

11.34%

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

15.97%

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

55.32%

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

67.59%

Ambulatory Care

Rates reported in Appendix F

Board Certification

Rates reported in Appendix F

Enrollment by Product Line--Total

Rates reported in Appendix F

Enrollment by State

Rates reported in Appendix F

Frequency of Selected Procedures

Rates reported in Appendix F

Identification of Alcohol and Other Drug Services--Total

Rates reported in Appendix F

Language Diversity of Membership

Rates reported in Appendix F

Mental Health Utilization

Rates reported in Appendix F

Peach State Health Plan Validation of Performance Measures State of Georgia

Page D-4 Peach State_GA2012-13_CMO_PMV_F1_0913

FINAL AUDITED HEDIS RATES

Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for Peach State Health Plan

Measure

CMO Rate

Race/Ethnicity Diversity of Membership

Rates reported in Appendix F

Total Membership

Rates reported in Appendix F

Weeks of Pregnancy at Time of Enrollment

Rates reported in Appendix F

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

Peach State Health Plan Validation of Performance Measures State of Georgia

Page D-5 Peach State_GA2012-13_CMO_PMV_F1_0913

Appendix E. Performance Measure Validation Reporting Spreadsheet
for Peach State Health Plan
Appendix E contains Peach State Health Plan's performance measure validation reporting spreadsheet.

Peach State Health Plan Validation of Performance Measures State of Georgia

Page E-1 Peach State_GA2012-13_CMO_PMV_F1_0913

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

2013 Validation of Performance Measures Rate Reporting Template

CMO Name:

Peach State Health Plan

CMO Contact Name and Title: Joyce McElwain, Senior Director of QI

CMO Contact Email: Comments:

jmcelwain@centene.com
FINAL Rates for 5/24/2013

1 of 12

September 2013

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

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

General Measure Data 2013 A 14830 4451 30.01

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September 2013

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

Percentage of Eligibles that Received Preventive Dental Services

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

General Measure Data 2013 A
318356 153003 48.06%

3 of 12

September 2013

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

Percentage of Eligibles that Received Dental Treatment Services

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

General Measure Data 2013 A
318356 73680 23.14%

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September 2013

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

Cesarean Rate for Nulliparous Singleton Vertex

Data Element Reporting Year

General Measure Data
2013

Data collection methodology (administrative)

A

Eligible population

5410

Numerator events by administrative data

1062

Reported rate

19.63%

5 of 12

September 2013

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

Percentage of Live Births Weighing Less Than 2,500 Grams

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

General Measure Data 2013 A 16875 1440 8.53

6 of 12

September 2013

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

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

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

General Measure Data
2013 A
34088 4309 12.64%

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September 2013

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

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

Data Element
Reporting Year Data collection methodology (hybrid) Eligible population Denominator Numerator events by administrative data Numerator events by medical records Numerator Total Reported rate

General Measure Data
2013 H 368 361 295 6 301
83.38%

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September 2013

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

Diabetes, Short-Term Complications Admission Rate

Data Element

General Measure Data

Reporting Year

2013

Data collection methodology (administrative)

A

Eligible population

199874

Numerator events by administrative data

51

Reported rate (Per 100,000 Members)

26

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September 2013

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

Chronic Obstructive Pulmonary Disease (COPD) Admission Rate

Data Element

General Measure Data

Reporting Year

2013

Data collection methodology (administrative)

A

Eligible population

90097

Numerator events by administrative data

17

Reported rate (Per 100,000 Members)

19

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September 2013

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

Congestive Heart Failure (CHF) Admission Rate

Data Element

General Measure Data

Reporting Year

2013

Data collection methodology (administrative)

A

Eligible population

90097

Numerator events by administrative data

23

Reported rate (Per 100,000 Members)

26

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September 2013

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

Adult Asthma Admission Rate

Data Element Reporting Year

General Measure Data
2013

Data collection methodology (administrative)

A

Eligible population

90097

Numerator events by administrative data

47

Reported rate (Per 100,000 Members)

52

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September 2013

Appendix F. HEDIS Interactive Data Submission System Data
for Peach State Health Plan
Appendix F contains Peach State Health Plan's reported IDSS data.

Peach State Health Plan Validation of Performance Measures State of Georgia

Page F-1 Peach State_GA2012-13_CMO_PMV_F1_0913

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 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 - 2012

The Auditor lock has been applied to this submission.

Pharmacy Reversal - Pharmacy Reversals NOT Included

Measure/Data Element

Report Measure

Benefit Offered

Rotated Measure

Rate

Reportable

Effectiveness of Care: Prevention and Screening

Adult BMI Assessment (aba)

Y

N

66.59%

R

Weight Assessment and Counseling for Nutrition

and Physical Activity for Children/Adolescents

Y

N

(wcc)

BMI Percentile

47.69%

R

Counseling for Nutrition

56.02%

R

Counseling for Physical Activity

47.69%

R

Childhood Immunization Status (cis)

Y DTaP

N

81.86%

R

IPV

94.65%

R

MMR

95.12%

R

HiB

94.19%

R

Hepatitis B

96.05%

R

VZV

94.42%

R

Pneumococcal Conjugate

82.79%

R

Hepatitis A

90.23%

R

Rotavirus

70.23%

R

Influenza

38.14%

R

Combination #2

80.47%

R

Combination #3

76.74%

R

Combination #4

74.88%

R

Combination #5

60.00%

R

Combination #6

33.26%

R

Combination #7

58.60%

R

Combination #8

32.79%

R

Combination #9

28.37%

R

Combination #10

27.91%

R

Immunizations for Adolescents (ima)

Y

Meningococcal

72.92%

R

1 of 143

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
September 2013

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

Tdap/Td

85.19%

R

Combination #1

71.30%

R

Human Papillomavirus Vaccine for Female Adolescents (hpv)

Y

17.82%

R

Lead Screening in Children (lsc)

Y

N

74.19%

R

Breast Cancer Screening (bcs)

Y

56.46%

R

Cervical Cancer Screening (ccs)

Y

73.54%

R

Chlamydia Screening in Women (chl)

Y

16-20 Years

54.68%

R

21-24 Years

72.93%

R

Total

59.60%

R

Effectiveness of Care: Respiratory Conditions

Appropriate Testing for Children with Pharyngitis (cwp)

Y

Y

73.80%

R

Appropriate Treatment for Children With URI (uri)

Y

Y

80.47%

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 Asthma (asm)

Y

Y

5-11 Years

12-18 Years

19-50 Years

51-64 Years

Total

Medication Management for People With Asthma (mma)

Y

Y

5-11 Years - Medication Compliance 50%

5-11 Years - Medication Compliance 75%

12-18 Years - Medication Compliance 50%

17.31%

R

40.82%

R

63.64%

R

78.18%

R

90.58%

R

88.40%

R

72.39%

R

NA

R

89.22%

R

40.43%

R

19.27%

R

38.32%

R

2 of 143

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
September 2013

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

12-18 Years - Medication Compliance 75%

16.75%

R

19-50 Years - Medication Compliance 50%

50.00%

R

19-50 Years - Medication Compliance 75%

16.67%

R

51-64 Years - Medication Compliance 50%

NA

R

51-64 Years - Medication Compliance 75%

NA

R

Total - Medication Compliance 50%

40.08%

R

Total - Medication Compliance 75%

18.44%

R

Asthma Medication Ratio (amr)

Y

Y

5-11 Years

62.68%

R

12-18 Years

58.92%

R

19-50 Years

40.60%

R

51-64 Years

NA

R

Total

60.77%

R

Effectiveness of Care: Cardiovascular

Cholesterol Management for Patients With Cardiovascular Conditions (cmc)

Y

N

LDL-C Screening Performed

74.55%

R

LDL-C Control (<100 mg/dL)

23.64%

R

Controlling High Blood Pressure (cbp)

Y

49.78%

R

Persistence of Beta-Blocker Treatment After a

Y

Y

Heart Attack (pbh)

NA

R

Effectiveness of Care: Diabetes

Comprehensive Diabetes Care (cdc)

Y

N

Hemoglobin A1c (HbA1c) Testing

79.83%

R

HbA1c Poor Control (>9.0%)

55.48%

R

HbA1c Control (<8.0%)

39.13%

R

HbA1c Control (<7.0%)

27.61%

R

Eye Exam (Retinal) Performed

57.22%

R

LDL-C Screening Performed

67.83%

R

LDL-C Control (<100 mg/dL)

20.35%

R

Medical Attention for Nephropathy

73.39%

R

Blood Pressure Control (<140/80 mm Hg)

27.30%

R

Blood Pressure Control (<140/90 mm Hg)

53.74%

R

Effectiveness of Care: Musculoskeletal

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

Y

Y

68.42%

R

3 of 143

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

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

Use of Imaging Studies for Low Back Pain (lbp)

Y

Effectiveness of Care: Behavioral Health

Antidepressant Medication Management (amm)

Y

Y

Effective Acute Phase Treatment

Effective Continuation Phase Treatment

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

Y

Y

Initiation Phase

Continuation and Maintenance (C&M) Phase

Follow-Up After Hospitalization for Mental Illness (fuh)

Y

Y

30-Day Follow-Up

7-Day Follow-Up

Diabetes Screening for People With Schizophrenia

or Bipolar Disorder Who Are Using Antipsychotic

Y

Y

Medication (ssd)

Diabetes Monitoring for People With Diabetes and Schizophrenia (smd)

Y

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

Y

Adherence to Antipsychotic Medications for Individuals With Schizophrenia (saa)

Y

Y

Effectiveness of Care: Medication Management

Annual Monitoring for Patients on Persistent Medications (mpm)

Y

Y

ACE Inhibitors or ARBs

Digoxin

Diuretics

Anticonvulsants

Total

Access/Availability of Care

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

Y

20-44 Years

45-64 Years

65+ Years

78.26%

R

43.92%

R

28.13%

R

43.73%

R

58.60%

R

70.79%

R

52.52%

R

82.79%

R

NA

R

NA

R

30.43%

R

87.92%

R

NA

R

87.90%

R

63.41%

R

86.87%

R

84.94%

R

89.36%

R

NA

R

4 of 143

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

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

Total

85.46%

R

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

Y

12-24 Months

96.98%

R

25 Months - 6 Years

90.43%

R

7-11 Years

90.81%

R

12-19 Years

87.97%

R

Annual Dental Visit (adv)

Y

Y

2-3 Years

43.96%

R

4-6 Years

76.01%

R

7-10 Years

78.32%

R

11-14 Years

70.02%

R

15-18 Years

59.42%

R

19-21 Years

38.85%

R

Total

67.92%

R

Initiation and Engagement of AOD Dependence Treatment (iet)

Y

Y

Initiation of AOD Treatment: 13-17 Years

34.86%

R

Engagement of AOD Treatment: 13-17 Years

14.79%

R

Initiation of AOD Treatment: 18+ Years

41.00%

R

Engagement of AOD Treatment: 18+ Years

6.58%

R

Initiation of AOD Treatment: Total

39.74%

R

Engagement of AOD Treatment: Total

8.27%

R

Prenatal and Postpartum Care (ppc)

Y

Timeliness of Prenatal Care

86.71%

R

Postpartum Care

71.56%

R

Call Answer Timeliness (cat)

Y

82.84%

R

Utilization

Frequency of Ongoing Prenatal Care (fpc)

Y

<21 Percent

8.62%

R

21-40 Percent

4.43%

R

41-60 Percent

6.99%

R

61-80 Percent

14.92%

R

81+ Percent

65.03%

R

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

Y

N

5 of 143

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
September 2013

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

0 Visits

4.63%

R

1 Visit

3.24%

R

2 Visits

4.86%

R

3 Visits

4.63%

R

4 Visits

11.34%

R

5 Visits

15.97%

R

6+ Visits

55.32%

R

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

Y

N

67.59%

R

Adolescent Well-Care Visits (awc)

Y

N

43.98%

R

Frequency of Selected Procedures (fsp)

Y

R

Ambulatory Care: Total (amba)

Y

R

Ambulatory Care: Dual Eligibles (ambb)

N

NR

Ambulatory Care: Disabled (ambc)

N

NR

Ambulatory Care: Other (ambd)

N

NR

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

Y

R

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

N

NR

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

N

NR

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

N

NR

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

Y

Y

R

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

N

N

NR

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

N

N

NR

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

N

N

NR

Mental Health Utilization: Total (mpta)

Y

Y

R

Mental Health Utilization: Dual Eligibles (mptb)

N

N

NR

Mental Health Utilization: Disabled (mptc)

N

N

NR

Mental Health Utilization: Other (mptd)

N

N

NR

Antibiotic Utilization: Total (abxa)

Y

Y

R

Antibiotic Utilization: Dual Eligibles (abxb)

N

N

NR

6 of 143

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
September 2013

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

Antibiotic Utilization: Disabled (abxc)

N

N

NR

Antibiotic Utilization: Other (abxd)

N

N

NR

Relative Resource Use

Relative Resource Use for People With Diabetes (rdi)

Y

R

Relative Resource Use for People With Asthma (ras)

Y

Y

R

Relative Resource Use for People With Cardiovascular Conditions (rca)

Y

R

Relative Resource Use for People With Hypertension (rhy)

Y

R

Relative Resource Use for People With COPD (rco)

Y

R

Health Plan Descriptive Information

Board Certification (bcr)

N

NR

Total Membership (tlm)

Y

R

Enrollment by Product Line: Total (enpa)

Y

R

Enrollment by Product Line: Dual Eligibles (enpb)

N

NR

Enrollment by Product Line: Disabled (enpc)

N

NR

Enrollment by Product Line: Other (enpd)

N

NR

Enrollment by State (ebs)

Y

R

Race/Ethnicity Diversity of Membership (rdm)

Y

R

Language Diversity of Membership (ldm)

Y

R

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

Y

R

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

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September 2013

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

Adult BMI Assessment (ABA)

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

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

Measure Data 2012 H 7401
370
5.00% 411 0.05 432 29
6.71% 0 0 1 0 0
431 29 258 66.59% 62.02% 71.16%

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September 2013

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

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

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

Data Element

BMI Percentile 3-11 years 12-17 years Total

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

Measurement year

2012

2012

Data collection methodology (administrative or hybrid)

H

H

Eligible population

77173

34466

111,639

77173

34466

111,639

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

7682

3119

10,801

2587

1286

3,873

Current year's administrative rate (before exclusions)

9.95%

9.05%

9.67%

3.35%

3.73%

3.47%

Minimum required sample size (MRSS) or other sample size

411

411

Oversampling rate

0.05

0.05

Final sample size

432

432

Number of numerator events by administrative data in FSS

43

28

71

9

10

19

Administrative rate on FSS

9.95%

6.48%

16.44%

2.08%

2.31%

4.40%

Number of original sample records excluded because of valid

0

0

data errors

Number of administrative data records excluded

0

0

Number of medical records excluded

0

0

Number of employee/dependent medical records excluded

0

0

Records added from the oversample list

0

0

Denominator

303

129

432

303

129

432

Numerator events by administrative data

43

28

71

9

10

19

Numerator events by medical records

101

34

135

165

58

223

Reported rate

47.52%

48.06%

47.69%

57.43%

52.71%

56.02%

Lower 95% confidence interval

41.74%

39.05%

42.86%

51.69%

43.71%

51.22%

Upper 95% confidence interval

53.31%

57.07%

52.51%

63.16%

61.72%

60.82%

Counselin 3-11 years
77173 2114 2.74%
8 1.85%
303 8
129 45.21% 39.45% 50.98%

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September 2013

ng for Physical Activity

12-17 years Total

2012

H

34466

111,639

1060

3,174

3.08% 411 0.05 432 7
1.62%

2.84%
15 3.47%

0

0 0 0 0 129 7 62 53.49% 44.49% 62.48%

432 15 191 47.69% 42.86% 52.51%

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

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September 2013

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

Childhood Immunization Status (CIS)

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

Data Element

General

Measure

DTaP

IPV

Data

Measurement year Data collection methodology (administrative or hybrid)
Eligible population Number of numerator events by admin data in eligible population
(before exclusions) Current year's administrative rate (before exclusions)

2012 H
7800

6290 80.64%

7189 92.17%

Minimum required sample size (MRSS) or other sample Size

411

Oversampling rate Final sample size Number of numerator events by admin data in FSS Administrative rate on FSS

0.05

432

334

393

77.31%

90.97%

Number of original records excluded because of valid data errors

1

Number of administrative data records excluded

0

Number of medical data records excluded

1

Number of employee/dependent medical records excluded

0

Records added from the oversample list

0

Denominator

430

Numerator events by administrative data

334

393

Number of numerator events by medical records

18

14

Reported rate

81.86%

94.65%

Lower 95% confidence interval

78.10%

92.41%

Upper 95% confidence interval

85.62%

96.89%

MMR
7159 91.78%
406 93.98%
406 3
95.12% 92.96% 97.27%

HiB

Hepatitis B

VZV

7237 92.78%

7081 90.78%

7213 92.47%

397 91.90%

385 89.12%

401 92.82%

397 8
94.19% 91.86% 96.51%

385 28 96.05% 94.09% 98.00%

401 5
94.42% 92.13% 96.70%

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September 2013

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

Pneumococcal
Conjugate

Hepatitis A

Rotavirus

Influenza

Combination Combination Combination Combination Combination Combination Combination Combination

2

3

4

5

6

7

8

9

6304 80.82%

7124 91.33%

5115 65.58%

2971 38.09%

5950 76.28%

5637 72.27%

5556 71.23%

4239 54.35%

2524 32.36%

4177 53.55%

2497 32.01%

2042 26.18%

338 78.24%

388 89.81%

268 62.04%

161 37.27%

325 75.23%

307 71.06%

301 69.68%

225 52.08%

132 30.56%

220 50.93%

130 30.09%

107 24.77%

338 18 82.79% 79.11% 86.47%

388 0
90.23% 87.31% 93.15%

268 34 70.23% 65.79% 74.67%

161 3
38.14% 33.43% 42.85%

325 21 80.47% 76.60% 84.33%

307 23 76.74% 72.63% 80.85%

301 21 74.88% 70.67% 79.10%

225 33 60.00% 55.25% 64.75%

132 11 33.26% 28.69% 37.83%

220 32 58.60% 53.83% 63.38%

130 11 32.79% 28.24% 37.34%

107 15 28.37% 23.99% 32.75%

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September 2013

Combination 10
2018 25.87%
105 24.31%
105 15 27.91% 23.55% 32.26%
13 of 143

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State
September 2013

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

Immunizations for Adolescents (IMA)

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

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

General Measure
Data 2012
H 8264
411 0.05 432
0 0 0 0 0 432

Meningococcal
6084 73.62%
310 71.76%
310 5
72.92% 68.61% 77.22%

Tdap/Td
6894 83.42%
363 84.03%
363 5
85.19% 81.72% 88.65%

Combination 1
5971 72.25%
303 70.14%
303 5
71.30% 66.91% 75.68%

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September 2013

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

Human Papillomavirus Vaccine for Female Adolescents (HPV)

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

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

Measure Data 2012 H 4063

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

755

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

18.58% 411 0.05 432 76
17.59% 0 0 0 0 0
432 76 1 17.82% 14.10% 21.55%

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September 2013

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

Lead Screening in Children (LSC)

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

Lead Screening in Children
Data Elements which do not apply to the selected data collection methodology will not appear
Measurement year Data collection methodology (administrative or hybrid)
Eligible population Number of numerator events by admin data in eligible population (before exclusions)
Current year's administrative rate (before exclusions) Minimum required sample size (MRSS) or other sample size
Oversampling rate Final sample size (FSS) Number of numerator events by administrative data in FSS Administrative rate on FSS Number of original sample records excluded because of valid data errors Number of administrative data records excluded Number of medical data records excluded Number of employee/dependent medical records excluded Records added from the oversample list
Denominator Numerator events by administrative data
Numerator events by medical records Reported rate
Lower 95% confidence interval Upper 95% confidence interval

General Measure
Data 2012
H 7800 5618 72.03% 411 0.05 432 310 71.76%
1 0 1 0 0 430 310 9 74.19% 69.93% 78.44%

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September 2013

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

Breast Cancer Screening (BCS)

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

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

General Measure
Data 2012
A 1371 774 56.46% 53.79% 59.12%

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September 2013

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

Cervical Cancer Screening (CCS)

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

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

Measure Data 2012 H 12187
8091
66.39% 411 0.05 432 296
68.52% 0 1 4 0 0
427 296 18 73.54% 69.23% 77.84%

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September 2013

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

Chlamydia Screening in Women (CHL)

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

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

General Measure
Data
2012 A

16-20 years 21-24 years

5139 2810 54.68% 53.31% 56.05%

1895 1382 72.93% 70.90% 74.96%

Total
7,034 4,192 59.60% 58.44% 60.75%

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September 2013

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

Appropriate Testing for Children with Pharyngitis (CWP)

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

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

Measure Data 2012 A 11779 8693
73.80% 73.00% 74.60%

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September 2013

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

Appropriate Treatment for Children With URI (URI)

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

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

Measure Data 2012 A 19042 3719
80.47% 79.90% 81.04%

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September 2013

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

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

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

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

Measure Data 2012 A 595 492
17.31% 14.19% 20.44%

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September 2013

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

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

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

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

Measure Data 2012 A 49 20
40.82% 26.03% 55.60%

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September 2013

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

Pharmacotherapy Management of COPD Exacerbation (PCE)

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

Pharmacotherapy Management of COPD Exacerbation

Data Elements

Measure Data

Systemic corticosteroid

Bronchodilator

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

2012 A 55

35 63.64% 50.01% 77.26%

43 78.18% 66.36% 90.01%

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September 2013

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

Use of Appropriate Medications for People With Asthma (ASM)

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

Data Element

General Measure
Data

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

Measurement year

2012

Data collection methodology (administrative)

A

Eligible population

2644

1319

134

12

Number of required exclusions

240

133

90

24

Numerator events by administrative data

2395

1166

97

8

Reported rate

90.58%

88.40%

72.39%

NA

Lower 95% confidence interval

89.45%

86.63%

64.45%

NA

Upper 95% confidence interval

91.71%

90.17%

80.33%

NA

Total
4,109 487 3,666 89.22% 88.26% 90.18%

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September 2013

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

Medication Management for People With Asthma (MMA)

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

5-11 years

12-18 years

19-50 years

51-64 years

Data Element

General Medication Medication Medication Medication Medication Medication Medication Medication

Measure Compliance Compliance Compliance Compliance Compliance Compliance Compliance Compliance

Data

50%

75%

50%

75%

50%

75%

50%

75%

Measurement year

2012

Data collection methodology (administrative)

A

Eligible population

2387

1164

96

8

Number of required exclusions

497

288

128

28

Numerator events by administrative data

965

460

446

195

48

16

6

3

Reported rate Lower 95% confidence interval Upper 95% confidence interval

40.43%

19.27%

38.32%

16.75%

50.00%

16.67%

NA

NA

38.44%

17.67%

35.48%

14.56%

39.48%

8.69%

NA

NA

42.42%

20.87%

41.15%

18.94%

60.52%

24.64%

NA

NA

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September 2013

Total

Medication Medication

Compliance Compliance

50%

75%

3,655 941

1,465

674

40.08% 38.48% 41.68%

18.44% 17.17% 19.71%

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

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September 2013

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

Asthma Medication Ratio (AMR)

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

Data Element

Measure Data

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

Measurement year

2012

51-64 years

Data collection methodology (administrative)

A

Eligible population Number of required exclusions Numerator events by administrative data
Reported rate Lower 95% confidence interval Upper 95% confidence interval

2634

1312

133

12

250

140

91

24

1651

773

54

8

62.68%

58.92%

40.60%

NA

60.81%

56.22%

31.88%

NA

64.55%

61.62%

49.32%

NA

Total
4,091 505 2,486 60.77% 59.26% 62.28%

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September 2013

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

Cholesterol Management for Patients With Cardiovascular Conditions (CMC)

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

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

General Measure
Data 2012
H 55
55 0 55
0 0 0 55

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

40 72.73%

3 5.45%

40 72.73%

3 5.45%

40 1 74.55% 62.12% 86.97%

3 10 23.64% 11.50% 35.77%

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September 2013

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

Controlling High Blood Pressure (CBP)

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

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

General Measure
Data 2012
H 2288
0
0.00% 411 0.1 453 0
0.00% 0 0 0 1 0 0
452 0
225 49.78% 45.06% 54.50%

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September 2013

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

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

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

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

Measure Data 2012 A 9 6 NA NA NA

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September 2013

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

Comprehensive Diabetes Care (CDC)

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

Data Element

HbA1c Testing

HbA1c Poor Control (>9.0%)

HbA1c Control (<8.0%)

HbA1c Control (<7.0%) for a Selected Population

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

2012 H
1286 940
73.09% 548 0.05 576 448
77.78% 0 0 1
0 0 575

2012 H
1286 1055
82.04% 548 0.05 576 472
81.94% 0 0 1
0 0 575

2012 H
1286 199
15.47% 548 0.05 576 91
15.80% 0 0 1
0 0 575

2012 H
1106
126
11.39%
548 0.05 576 55 9.55%
0
0
1
4
82
0 0 489

Eye Exam
2012 H
1286 575
44.71% 548 0.05 576 258
44.79% 0 0 1
0 0 575

LDL-C Screening
2012

LDL-C Level <100 mg/dL

Medical Attention for Nephropathy

Blood Pressure Controlled <140/80 mm
Hg

2012

2012

2012

H

H

H

H

1286

1286

1286

1286

809

134

877

0

62.91%
548 0.05 576 382 66.32%
0
0
1

10.42%
548 0.05 576 58 10.07%
0
0
1

68.20%
548 0.05 576 402 69.79%
0
0
1

0.00%
548 0.05 576
0 0.00%
0
0
1

0

0

0

0

0

0

0

0

575

575

575

575

32 of 143

September 2013

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

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

448 11 79.83% 76.46% 83.19%

256 63 55.48% 51.33% 59.63%

91 134 39.13% 35.05% 43.21%

55 80 27.61% 23.54% 31.67%

258 71 57.22% 53.09% 61.35%

382 8
67.83% 63.92% 71.73%

58 59 20.35% 16.97% 23.73%

402 20 73.39% 69.69% 77.09%

0 157 27.30% 23.58% 31.03%

33 of 143

September 2013

Blood Pressure Controlled <140/90 mm
Hg 2012
H 1286
1
0.08% 548 0.05 576 0
0.00% 0 0 1
0 0 575
34 of 143

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State
September 2013

0 309 53.74% 49.58% 57.90%

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

35 of 143

September 2013

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

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

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

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

Measure Data 2012 A 38 26
68.42% 52.33% 84.52%

36 of 143

September 2013

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

Use of Imaging Studies for Low Back Pain (LBP)

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

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

Measure Data 2012 A 943 205
78.26% 75.58% 80.95%

37 of 143

September 2013

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

Antidepressant Medication Management (AMM)

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

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

General Measure
Data
2012 A 551

Effective Acute Phase
Treatment

Effective Continuation
Phase Treatment

242 43.92% 39.69% 48.15%

155 28.13% 24.29% 31.98%

38 of 143

September 2013

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

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

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

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

General Measure
Data
2012 A

Initiation Phase

Continuation and
Maintenance Phase

3126 1367 43.73% 41.98% 45.48%

500 293 58.60% 54.18% 63.02%

39 of 143

September 2013

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

Follow-Up After Hospitalization for Mental Illness (FUH)

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

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

General Measure
Data
2012 A
1051

30-day 7-day follow-

follow-up

up

744 70.79% 67.99% 73.59%

552 52.52% 49.45% 55.59%

40 of 143

September 2013

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

Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication (SSD)

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

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

Measure Data 2012 A 215 174 178
82.79% 77.51% 88.07%

41 of 143

September 2013

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

Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)

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

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

Measure Data 2012 A 14 0 12 NA NA NA

42 of 143

September 2013

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

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

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

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

Measure Data 2012 A 0 0 NA NA NA

43 of 143

September 2013

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

Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA)

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

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

Measure Data 2012 A 46 27 14
30.43% 16.05% 44.82%

44 of 143

September 2013

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

Annual Monitoring for Patients on Persistent Medications (MPM)

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

Data Element

General Measure
Data

ACE Inhibitors or
ARBs

Digoxin

Diuretics

Measurement year

2012

Data collection methodology (administrative)

A

Eligible population

960

6

909

Numerator events by administrative data

844

5

799

Reported rate

87.92%

NA

87.90%

Lower 95% confidence interval

85.80%

NA

85.72%

Upper 95% confidence interval

90.03%

NA

90.07%

Anticonvulsants
82 52 63.41% 52.38% 74.45%

Total
1,957 1,700 86.87% 85.35% 88.39%

45 of 143

September 2013

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

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

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

Data Element

General Measure
Data

20-44 years 45-64 years 65+ years

Measurement year

2012

Data collection methodology (administrative)

A

Eligible population

13623

1871

2

Numerator events by administrative data

11571

1672

0

Reported rate

84.94%

89.36%

NA

Lower 95% confidence interval

84.33%

87.94%

NA

Upper 95% confidence interval

85.54%

90.79%

NA

Total
15,496 13,243 85.46% 84.90% 86.02%

46 of 143

September 2013

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

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

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

Data Element

General Measure
Data

12-24 months

25 months 6 years

7-11 years

Measurement year

2012

Data collection methodology (administrative)

A

Eligible population

10453

53713

34089

Numerator events by administrative data

10137

48575

30956

Reported rate

96.98%

90.43%

90.81%

Lower 95% confidence interval

96.64%

90.18%

90.50%

Upper 95% confidence interval

97.31%

90.68%

91.12%

12-19 years
38693 34038 87.97% 87.64% 88.29%

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September 2013

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

Annual Dental Visit (ADV)

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

Data Element

Measure Data

2-3 Years

4-6 Years 7-10 Years

Measurement year

2012

Data collection methodology (administrative)

A

Eligible population

20313

34095

37981

Numerator events by administrative data

8929

25917

29748

Reported rate

43.96%

76.01%

78.32%

Lower 95% confidence interval

43.27%

75.56%

77.91%

Upper 95% confidence interval

44.64%

76.47%

78.74%

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

34689 24288 70.02% 69.53% 70.50%

26133 15529 59.42% 58.83% 60.02%

1197 465 38.85% 36.04% 41.65%

Total
154,408 104,876 67.92% 67.69% 68.15%

48 of 143

September 2013

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

Initiation and Engagement of AOD Dependence Treatment (IET)

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

Data Elements

General Measure
Data

13-17 years

Initiation of Engagement

AOD

of AOD

Treatment Treatment

18+ years

Initiation of Engagement

AOD

of AOD

Treatment Treatment

Measurement year

2012

Data collection methodology (administrative)

A

Eligible population

284

1095

Numerator events by administrative data

99

42

449

72

Reported rate

34.86%

14.79%

41.00%

6.58%

Lower 95% confidence interval

29.14%

10.48%

38.05%

5.06%

Upper 95% confidence interval

40.58%

19.09%

43.96%

8.09%

Total

Initiation of Engagement

AOD

of AOD

Treatment Treatment

1,379

548

114

39.74%

8.27%

37.12%

6.78%

42.36%

9.76%

49 of 143

September 2013

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

Prenatal and Postpartum Care (PPC)

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

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

Timeliness of Prenatal
Care 2012
H 14968
5262
35.15% 411 0.05 432 147
34.03% 3 0 0
429 147 225 86.71% 83.38% 90.04%

Postpartum Care
2012 H
14968
5919
39.54% 411 0.05 432 171
39.58% 3 0 0
429 171 136 71.56% 67.18% 75.95%

50 of 143

September 2013

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

Call Answer Timeliness (CAT)

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

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

Measure Data 2012 A
258424 214083 82.84% 82.70% 82.99%

51 of 143

September 2013

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

Frequency of Ongoing Prenatal Care (FPC)

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

Data Element

General Measure
Data

<21 Percent

Measurement year

2012

Data collection methodology (administrative or hybrid)

H

Eligible population

14968

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

10631

Current year's administrative rate (before exclusions)

71.02%

Minimum required sample size (MRSS) or other sample size

411

Oversampling rate

0.05

Final sample size (FSS)

432

Number of numerator events by administrative data in FSS

35

Administrative rate on FSS

8.10%

Number of original sample records excluded because of valid data errors

3

Number of employee/dependent medical records excluded

0

Records added from the oversample list

0

Denominator

429

Numerator events by administrative data

35

Numerator events by medical records

2

Reported rate

8.62%

Lower 95% confidence interval

5.85%

Upper 95% confidence interval

11.40%

21-40 Percent
2354 15.73%
14 3.24%
14 5 4.43% 2.37% 6.49%

41-60 Percent
786 5.25%
10 2.31%
10 20 6.99% 4.46% 9.52%

61-80 Percent

81+ Percent

561 3.75%

636 4.25%

5 1.16%

18 4.17%

5 59 14.92% 11.43% 18.41%

18 261 65.03% 60.41% 69.66%

52 of 143

September 2013

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

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

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

Data Element

Measure Data

0 visits

Measurement year

2012

Data collection methodology (administrative or hybrid)

H

Eligible population

8894

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

530

Current year's administrative rate (before exclusions)

5.96%

Minimum required sample size (MRSS) or other sample size

411

Oversampling rate

0.05

Final sample size (FSS)

432

Number of numerator events by administrative data in FSS

24

Administrative rate on FSS

5.56%

Number of original sample records excluded because of valid data errors

0

Number of employee/dependent medical records excluded

0

Records added from the oversample list

0

Denominator

432

Numerator events by administrative data

20

Numerator events by medical records

0

Reported rate

4.63%

Lower 95% confidence interval

2.53%

Upper 95% confidence interval

6.73%

1 visit
548 6.16%
32 7.41%
14 0 3.24% 1.46% 5.03%

2 visits

3 visits

4 visits

5 visits

711 7.99%

833 9.37%

1173 13.19%

1658 18.64%

42 9.72%

39 9.03%

64 14.81%

68 15.74%

15 6 4.86% 2.72% 7.00%

13 7 4.63% 2.53% 6.73%

28 21 11.34% 8.24% 14.45%

31 38 15.97% 12.40% 19.54%

53 of 143

September 2013

6 or more visits
3441 38.69%
163 37.73%
166 73 55.32% 50.52% 60.13%

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

54 of 143

September 2013

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

Adolescent Well-Care Visits (AWC)

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

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

Measure Data 2012 H 53061
20725
39.06% 411 0.05 432 170
39.35% 0 0 0
432 170 20 43.98% 39.18% 48.78%

55 of 143

September 2013

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

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

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

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

Measure Data 2012 H 45189
28394
62.83% 411 0.05 432 281
65.05% 0 0 0
432 281 11 67.59% 63.06% 72.12%

56 of 143

September 2013

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

Frequency of Selected Procedures (FSP)

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

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

Male 981,633 587,271
35,722 31,171 8,727

Female 959,960 615,903 631,816 386,763
29,486

Total 1,941,593 1,203,174

Procedure

Age

Sex

Number of Procedures

Procedures / 1,000 Member
Years

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

0-19

Male

0

0.00

Female

0

0.00

20-44

Male

0

0.00

Female

15

0.04

45-64

Male

0

0.00

Female

2

0.07

0-9

Male &

1413

0.73

10-19

Female

339

0.28

15-44

Female

124

0.20

45-64

30

1.02

15-44

Female

80

0.13

45-64

6

0.20

30-64

Male

0

0.00

15-44

Female

6

0.01

45-64

3

0.10

30-64

Male

12

0.38

15-44

397

0.63

Female

45-64

22

0.75

20-44

Male

9

0.25

Female

29

0.07

45-64

Male

3

0.34

57 of 143

September 2013

Mastectomy Lumpectomy

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

45-64

Female

11

0.37

15-44

Female

25

0.04

45-64

35

1.19

15-44

Female

130

0.21

45-64

35

1.19

58 of 143

September 2013

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

Ambulatory Care: Total (AMBA)

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

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

Member Months 252,355 1,689,238 1,203,174 422,485 38,213
81 12 3 0 3,605,561 Outpatient Visits

ED Visits

Age

Visits/ 1,000

Visits/ 1,000

Visits

Member

Visits

Member

Months

Months

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

194296 548448 272090 169557 25868
41 17 1 0 1,210,318

769.93 324.67 226.14 401.33 676.94 506.17 1,416.67 333.33
335.68

22354 84939 45547 49842 3226
2 1 0 0 205,911

88.58 50.28 37.86 117.97 84.42 24.69 83.33 0.00
57.11

59 of 143

September 2013

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

Ambulatory Care: Dual Eligibles (AMBB)

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

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

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

ED Visits

Age

Visits/ 1,000

Visits/ 1,000

Visits

Member

Visits

Member

Months

Months

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

60 of 143

September 2013

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

Ambulatory Care: Disabled (AMBC)

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

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

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

ED Visits

Age

Visits/ 1,000

Visits/ 1,000

Visits

Member

Visits

Member

Months

Months

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

61 of 143

September 2013

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

Ambulatory Care: Other (AMBD)

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

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

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

ED Visits

Age

Visits/ 1,000

Visits/ 1,000

Visits

Member

Visits

Member

Months

Months

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

62 of 143

September 2013

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

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

Member Months 252,355 1,689,238 1,203,174 422,485 38,213
81 12 3 0 3,605,561 Total Inpatient

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

Discharges / Discharges 1,000 Member
Months

Days

Days / 1,000 Members Months

Average Length of
Stay

1760

6.97

12680

50.25

7.20

1959

1.16

5721

3.39

2.92

3384

2.81

9793

8.14

2.89

15846

37.51

44671

105.73

2.82

479

12.54

2323

60.79

4.85

1

12.35

1

12.35

1.00

0

0.00

0

0.00

NA

0

0.00

0

0.00

NA

0

0

NA

63 of 143

September 2013

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
64 of 143

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

23,429

6.50

75,189

20.85

3.21

Medicine

Discharges / Discharges 1,000 Member
Months

Days

Days / 1,000 Members Months

Average Length of
Stay

1345

5.33

5634

22.33

4.19

1506

0.89

3892

2.30

2.58

623

0.52

1836

1.53

2.95

750

1.78

2666

6.31

3.55

242

6.33

942

24.65

3.89

1

12.35

1

12.35

1.00

0

0.00

0

0.00

NA

0

0.00

0

0.00

NA

0

0

NA

4,467

1.24

14,971

4.15

3.35

Surgery

Discharges / Discharges 1,000 Member
Months

Days

Days / 1,000 Members Months

Average Length of
Stay

415 453 399 563 215
0 0 0 0 2,045

1.64

7046

27.92

16.98

0.27

1829

1.08

4.04

0.33

1852

1.54

4.64

1.33

2735

6.47

4.86

5.63

1319

34.52

6.13

0.00

0

0.00

NA

0.00

0

0.00

NA

0.00

0

0.00

NA

0

NA

0.57

14,781

4.10

7.23

September 2013

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

Maternity*

Discharges /

Days / 1,000 Average

Age

Discharges 1,000 Member Days

Members Length of

Months

Months

Stay

10-19

2362

1.96

6105

5.07

2.58

20-44

14533

34.40

39270

92.95

2.70

45-64

22

0.58

62

1.62

2.82

Unknown

0

0

NA

Total

16,917

10.17

45,437

27.31

2.69

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

65 of 143

September 2013

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

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

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

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

Member Months
NR NR NR NR NR NR NR NR NR NR Total Inpatient

Discharges /

Days / 1,000 Average

Age

Discharges 1,000 Member Days

Members Length of

Months

Months

Stay

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

66 of 143

September 2013

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
67 of 143

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

NR

NR

Medicine

NR

NR

NR

Discharges / Discharges 1,000 Member
Months

Days

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Surgery

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Discharges / Discharges 1,000 Member
Months

Days

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Maternity*

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

September 2013

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

Discharges /

Days / 1,000 Average

Age

Discharges 1,000 Member Days

Members Length of

Months

Months

Stay

10-19

NR

NR

NR

NR

NR

20-44

NR

NR

NR

NR

NR

45-64

NR

NR

NR

NR

NR

Unknown

NR

NR

NR

Total

NR

NR

NR

NR

NR

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

68 of 143

September 2013

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

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

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

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

Member Months
NR NR NR NR NR NR NR NR NR NR Total Inpatient

Discharges /

Days / 1,000 Average

Age

Discharges 1,000 Member Days

Members Length of

Months

Months

Stay

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

69 of 143

September 2013

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
70 of 143

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

NR

NR

NR

Medicine

NR

NR

NR

NR

NR

Discharges / Discharges 1,000 Member
Months

Days

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Surgery

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Discharges / Discharges 1,000 Member
Months

Days

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

September 2013

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

Maternity*

Discharges /

Days / 1,000 Average

Age

Discharges 1,000 Member Days

Members Length of

Months

Months

Stay

10-19

NR

NR

NR

NR

NR

20-44

NR

NR

NR

NR

NR

45-64

NR

NR

NR

NR

NR

Unknown

NR

NR

NR

Total

NR

NR

NR

NR

NR

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

71 of 143

September 2013

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

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

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

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

Member Months
NR NR NR NR NR NR NR NR NR NR Total Inpatient

Discharges /

Discharges

1,000 Member

Months

Days

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

72 of 143

September 2013

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
73 of 143

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

NR

NR

NR

NR

NR

Medicine

Discharges /

Discharges

1,000 Member

Months

Days

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Surgery

Discharges /

Discharges

1,000 Member

Months

Days

Days / 1,000 Members Months

Average Length of
Stay

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Maternity*

September 2013

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

Age

Discharges /

Discharges

1,000 Member

Months

Days

Days / 1,000 Members Months

10-19

NR

NR

NR

NR

20-44

NR

NR

NR

NR

45-64

NR

NR

NR

NR

Unknown

NR

NR

Total

NR

NR

NR

NR

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

Average Length of
Stay
NR NR NR NR NR

74 of 143

September 2013

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

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 1214384 311821
47851 16997 22300
38 0

Female 1191808 322183 176261 191628 110232
58 0

Total 2,406,192 634,004 224,112 208,625 132,532
96 0

Member Months (Inpatient)

Male 1214384 311821
47851 16997 22300
38 0

Female 1191808 322183 176261 191628 110232
58 0

Total 2,406,192 634,004 224,112 208,625 132,532
96 0

Member Months (Intensive Outpatient/Partial Hospitalization)

Male

Female

Total

1214384

1191808 2,406,192

311821

322183

634,004

47851

176261

224,112

16997

191628

208,625

22300

110232

132,532

38

58

96

0

0

0

Member M
Male 1214384 311821
47851 16997 22300
38 0

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

1,613,391
Sex
M F Total M F Total M F Total M F Total M F Total M F

1,992,170 3,605,561

Any Services

Number 35 34 69 364 171 535 114 383 497 113 782 895 145 521 666 0 0

Percent 0.03% 0.03% 0.03% 1.40% 0.64% 1.01% 2.86% 2.61% 2.66% 7.98% 4.90% 5.15% 7.80% 5.67% 6.03% 0.00% 0.00%

1,613,391 1,992,170

Inpatient

Number 6 3 9 42 34 76 13
139 152 22 221 243 34 117 151
0 0

Percent 0.01% 0.00% 0.00% 0.16% 0.13% 0.14% 0.33% 0.95% 0.81% 1.55% 1.38% 1.40% 1.83% 1.27% 1.37% 0.00% 0.00%

3,605,561 1,613,391

Intensive Outpatient/Partial
Hospitalization

Number

Percent

0

0.00%

0

0.00%

0

0.00%

21

0.08%

5

0.02%

26

0.05%

3

0.08%

7

0.05%

10

0.05%

4

0.28%

29

0.18%

33

0.19%

4

0.22%

13

0.14%

17

0.15%

0

0.00%

0

0.00%

1,992,170 3,605,561

Outpatient/ED

Number 30 31 61 336 154 490 110 283 393 106 655 761 131 471 602 0 0

Percent 0.03% 0.03% 0.03% 1.29% 0.57% 0.93% 2.76% 1.93% 2.10% 7.48% 4.10% 4.38% 7.05% 5.13% 5.45% 0.00% 0.00%

1,613,391

75 of 143

September 2013

Unknown Total

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

Total

0

0.00%

0

0.00%

0

0.00%

0

0.00%

M

0

NA

0

NA

0

NA

0

NA

F

0

NA

0

NA

0

NA

0

NA

Total

0

NA

0

NA

0

NA

0

NA

M

771

0.57%

117

0.09%

32

0.02%

713

0.53%

F

1,891

1.14%

514

0.31%

54

0.03%

1,594

0.96%

Total

2,662

0.89%

631

0.21%

86

0.03%

2,307

0.77%

76 of 143

September 2013

Months (Outpatient/ED)

Female 1191808 322183 176261 191628 110232
58 0

Total 2,406,192 634,004 224,112 208,625 132,532
96 0

1,992,170 3,605,561

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

77 of 143

September 2013

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

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

13-17

NR

NR

NR

NR

NR

NR

NR

NR

NR

18-24

NR

NR

NR

NR

NR

NR

NR

NR

NR

25-34

NR

NR

NR

NR

NR

NR

NR

NR

NR

35-64

NR

NR

NR

NR

NR

NR

NR

NR

NR

65+

NR

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

Age

Sex

Any Services

Inpatient

Intensive Outpatient/Partial
Hospitalization

Outpatient/ED

Number

Percent

Number

Percent

Number

Percent

Number

Percent

0-12

M

NR

NR

NR

NR

NR

NR

NR

NR

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

13-17

M

NR

NR

NR

NR

NR

NR

NR

NR

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

18-24

M

NR

NR

NR

NR

NR

NR

NR

NR

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

25-34

M

NR

NR

NR

NR

NR

NR

NR

NR

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

35-64

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

65+

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

Member Months (Outpatient/ED)

Male NR NR NR NR NR NR NR NR

Female NR NR NR NR NR NR NR NR

Total NR NR NR NR NR NR NR NR

78 of 143

September 2013

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

M

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Total

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

79 of 143

September 2013

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

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

13-17

NR

NR

NR

NR

NR

NR

NR

NR

NR

18-24

NR

NR

NR

NR

NR

NR

NR

NR

NR

25-34

NR

NR

NR

NR

NR

NR

NR

NR

NR

35-64 65+

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

Any Services

Age

Sex

Inpatient

Intensive Outpatient/Partial
Hospitalization

Outpatient/ED

Number

Percent

Number

Percent

Number

Percent

Number

Percent

0-12

M

NR

NR

NR

NR

NR

NR

NR

NR

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

13-17

M

NR

NR

NR

NR

NR

NR

NR

NR

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

18-24

M

NR

NR

NR

NR

NR

NR

NR

NR

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

25-34

M

NR

NR

NR

NR

NR

NR

NR

NR

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

35-64

M

NR

NR

NR

NR

NR

NR

NR

NR

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

65+

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

Member Months (Outp

Male NR NR NR NR NR NR NR NR

Female NR NR NR NR NR NR NR NR

80 of 143

September 2013

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

Unknown Total

M

NR

NR

NR

NR

NR

NR

NR

NR

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

81 of 143

September 2013

patient/ED)
Total NR NR NR NR NR NR NR NR

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

82 of 143

September 2013

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

83 of 143

September 2013

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

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

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)

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

Male NR NR NR NR NR NR NR NR

Female NR NR NR NR NR NR NR NR

Total NR NR NR NR NR NR NR NR

Male NR NR NR NR NR NR NR NR

Female NR NR NR NR NR NR NR NR

Total NR NR NR NR NR NR NR NR

Male NR NR NR NR NR NR NR NR

Female NR NR NR NR NR NR NR NR

Total NR NR NR NR NR NR NR NR

Any Services

Age

Sex

Inpatient

Intensive Outpatient/Partial
Hospitalization

Outpatient/ED

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

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

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

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

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

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

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

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

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

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

Member Months (Outpa

Male NR NR NR NR NR NR NR NR

Female NR NR NR NR NR NR NR NR

84 of 143

September 2013

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

M

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Total

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

85 of 143

September 2013

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

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

86 of 143

September 2013

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

87 of 143

September 2013

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

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

1214384

1191808 2,406,192 1214384

1191808 2,406,192 1214384

1191808 2,406,192

13-17

311821

322183

634,004

311821

322183

634,004

311821

322183

634,004

18-64

87148

478121

565,269

87148

478121

565,269

87148

478121

565,269

65+

38

58

96

38

58

96

38

58

96

Unknown

0

0

0

0

0

0

0

0

0

Total

1,613,391 1,992,170 3,605,561 1,613,391 1,992,170 3,605,561 1,613,391 1,992,170 3,605,561

Any Services

Age

Sex

Inpatient

Intensive Outpatient/Partial
Hospitalization

Outpatient/ED

Number

Percent

Number

Percent

Number

Percent

Number

Percent

M

8814

8.71%

127

0.13%

90

0.09%

8806

8.70%

0-12

F

5523

5.56%

86

0.09%

40

0.04%

5511

5.55%

Total

14,337

7.15%

213

0.11%

130

0.06%

14,317

7.14%

M

3407

13.11%

202

0.78%

85

0.33%

3380

13.01%

13-17

F

3224

12.01%

309

1.15%

98

0.37%

3188

11.87%

Total

6,631

12.55%

511

0.97%

183

0.35%

6,568

12.43%

M

633

8.72%

66

0.91%

16

0.22%

617

8.50%

18-64

F

4284

10.75%

323

0.81%

72

0.18%

4185

10.50%

Total

4,917

10.44%

389

0.83%

88

0.19%

4,802

10.19%

M

2

63.16%

0

0.00%

0

0.00%

2

63.16%

65+

F

0

0.00%

0

0.00%

0

0.00%

0

0.00%

Total

2

25.00%

0

0.00%

0

0.00%

2

25.00%

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

12,856

9.56%

395

0.29%

191

0.14%

12,805

9.52%

Total

F

13,031

7.85%

718

0.43%

210

0.13%

12,884

7.76%

Total

25,887

8.62%

1,113

0.37%

401

0.13%

25,689

8.55%

Member Months (Outpa

Male 1214384 311821
87148 38 0
1,613,391

Female 1191808 322183 478121
58 0 1,992,170

88 of 143

September 2013

atient/ED)
Total 2,406,192 634,004 565,269
96 0 3,605,561

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

89 of 143

September 2013

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

Mental Health Utilization: Dual Eligibles (MPTB)

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

Member Months (Any) Age

Member Months (Inpatient)

Member Months (Intensive Outpatient/Partial Hospitalization)

Male

Female

Total

Male

Female

Total

Male

Female

Total

0-12

NR

NR

NR

NR

NR

NR

NR

NR

NR

13-17

NR

NR

NR

NR

NR

NR

NR

NR

NR

18-64

NR

NR

NR

NR

NR

NR

NR

NR

NR

65+

NR

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

Age

Sex

Any Services

Inpatient

Intensive Outpatient/Partial
Hospitalization

Outpatient/ED

Number

Percent

Number

Percent

Number

Percent

Number

Percent

M

NR

NR

NR

NR

NR

NR

NR

NR

0-12

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

13-17

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

18-64

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

65+

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Total

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

Member Months (Outpa

Male NR NR NR NR NR NR

Female NR NR NR NR NR NR

90 of 143

September 2013

atient/ED)
Total NR NR NR NR NR NR

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

91 of 143

September 2013

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

Mental Health Utilization: Disabled (MPTC)

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

Member Months (Any) Age

Member Months (Inpatient)

Member Months (Intensive Outpatient/Partial Hospitalization)

Male

Female

Total

Male

Female

Total

Male

Female

Total

0-12

NR

NR

NR

NR

NR

NR

NR

NR

NR

13-17

NR

NR

NR

NR

NR

NR

NR

NR

NR

18-64

NR

NR

NR

NR

NR

NR

NR

NR

NR

65+

NR

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

Age

Sex

Any Services

Inpatient

Intensive Outpatient/Partial
Hospitalization

Outpatient/ED

Number

Percent

Number

Percent

Number

Percent

Number

Percent

M

NR

NR

NR

NR

NR

NR

NR

NR

0-12

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

13-17

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

18-64

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

65+

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Total

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

Member Months (Outpa

Male NR NR NR NR NR NR

Female NR NR NR NR NR NR

92 of 143

September 2013

atient/ED)
Total NR NR NR NR NR NR

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

93 of 143

September 2013

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

Mental Health Utilization: Other (MPTD)

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

Member Months (Any) Age

Member Months (Inpatient)

Member Months (Intensive Outpatient/Partial Hospitalization)

Male

Female

Total

Male

Female

Total

Male

Female

Total

0-12

NR

NR

NR

NR

NR

NR

NR

NR

NR

13-17

NR

NR

NR

NR

NR

NR

NR

NR

NR

18-64

NR

NR

NR

NR

NR

NR

NR

NR

NR

65+

NR

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

Age

Sex

Any Services

Inpatient

Intensive Outpatient/Partial
Hospitalization

Outpatient/ED

Number

Percent

Number

Percent

Number

Percent

Number

Percent

M

NR

NR

NR

NR

NR

NR

NR

NR

0-12

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

13-17

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

18-64

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

65+

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Unknown

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

Total

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

Member Months (Outpa

Male NR NR NR NR NR NR

Female NR NR NR NR NR NR

94 of 143

September 2013

atient/ED)
Total NR NR NR NR NR NR

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

95 of 143

September 2013

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

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

981633

959960

1,941,593

10-17

544572

554031

1,098,603

18-34

64848

367889

432,737

35-49

18172

96185

114,357

50-64

4128

14047

18,175

65-74

30

51

81

75-84

5

7

12

85+

3

0

3

Unknown

0

0

0

Total

1,613,391 1,992,170

3,605,561

Antibiotic Utilization

Age

Sex

Total Antibiotic
Scrips

Average Scrips PMPY for Antibiotics

Total Days Supplied for All Antibiotic
Scrips

Average Days
Supplied per Antibiotic Scrip

Total Number of Scrips for Antibiotics of
Concern

Average Scrips PMPY for
Anitbiotics of Concern

Percentage of Antibiotics of Concern of all
Antibiotic Scrips

M

108170

1.32

993560

9.19

47696

0.58

44.09%

0-9

F

104930

1.31

979072

9.33

42998

0.54

40.98%

Total

213,100

1.32

1,972,632

9.26

90,694

0.56

42.56%

M

28550

0.63

288498

10.11

12923

0.28

45.26%

10-17

F

38727

0.84

371855

9.60

15983

0.35

41.27%

Total

67,277

0.73

660,353

9.82

28,906

0.32

42.97%

M

3998

0.74

39152

9.79

1601

0.30

40.05%

18-34

F

58649

1.91

454899

7.76

18641

0.61

31.78%

Total

62,647

1.74

494,051

7.89

20,242

0.56

32.31%

M

1691

1.12

15085

8.92

766

0.51

45.30%

35-49

F

15660

1.95

129488

8.27

6331

0.79

40.43%

Total

17,351

1.82

144,573

8.33

7,097

0.74

40.90%

M

349

1.01

3156

9.04

177

0.51

50.72%

50-64

F

2144

1.83

17906

8.35

1063

0.91

49.58%

96 of 143

September 2013

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

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

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

2,493 3 1 4 0 3 3 0 0 0 0 0 0
142,761 220,114 362,875
Total Quinolone
Scrips
42 73 115 259 669 928 257 4316 4,573 252 2034 2,286

1.65

21,062

8.45

1,240

0.82

49.74%

1.20

22

7.33

2

0.80

66.67%

0.24

10

10.00

0

0.00

0.00%

0.59

32

8.00

2

0.30

50.00%

0.00

0

NA

0

0.00

NA

5.14

20

6.67

2

3.43

66.67%

3.00

20

6.67

2

2.00

66.67%

0.00

0

NA

0

0.00

NA

NA

0

NA

0

NA

NA

0.00

0

NA

0

0.00

NA

NA

0

NA

0

NA

NA

NA

0

NA

0

NA

NA

NA

0

NA

0

NA

NA

1.06

1,339,473

9.38

63,165

0.47

44.25%

1.33

1,953,250

8.87

85,018

0.51

38.62%

1.21

3,292,723

9.07

148,183

0.49

40.84%

Antibiotics of Concern Utilization

Average Scrips PMPY for Quinolones

Total Cephalosporin 2nd-
4th Generation
Scrips

Average

Scrips PMPY for Cephalosporins 2nd-
4th

Total Azithromycin and Clarithromycin Scrips

Average Scrips PMPY for
Azithromycins and Clarithro-
mycins

Generation

Total Amoxicillin/ Clavulanate
Scrips

Average Scrips PMPY for
Amoxicillin/ Clavulanates

0.00

8072

0.10

20350

0.25

17703

0.22

0.00

7549

0.09

18087

0.23

15900

0.20

0.00

15,621

0.10

38,437

0.24

33,603

0.21

0.01

1006

0.02

6933

0.15

3914

0.09

0.01

1269

0.03

8585

0.19

4440

0.10

0.01

2,275

0.02

15,518

0.17

8,354

0.09

0.05

50

0.01

815

0.15

303

0.06

0.14

620

0.02

9027

0.29

2642

0.09

0.13

670

0.02

9,842

0.27

2,945

0.08

0.17

20

0.01

292

0.19

135

0.09

0.25

168

0.02

2690

0.34

869

0.11

0.24

188

0.02

2,982

0.31

1,004

0.11

Total Ketolides
Scrips
0 0 0 0 0 0 0 0 0 0 0 0

97 of 143

September 2013

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

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

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

54 402 456
1 0 1 0 0 0 0 0 0 0 0 0 865 7,494 8,359

0.16

5

0.01

69

0.34

24

0.02

400

0.30

29

0.02

469

0.40

0

0.00

1

0.00

0

0.00

0

0.15

0

0.00

1

0.00

0

0.00

0

0.00

0

0.00

2

0.00

0

0.00

2

0.00

0

0.00

0

NA

0

NA

0

0.00

0

0.00

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

0.01

9,153

0.07

28,460

0.05

9,630

0.06

38,791

0.03

18,783

0.06

67,251

0.20

35

0.10

0

0.34

168

0.14

0

0.31

203

0.13

0

0.40

0

0.00

0

0.00

0

0.00

0

0.15

0

0.00

0

0.00

0

0.00

0

3.43

0

0.00

0

2.00

0

0.00

0

0.00

0

0.00

0

NA

0

NA

0

0.00

0

0.00

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

0.21

22,090

0.16

0

0.23

24,019

0.14

0

0.22

46,109

0.15

0

All Other Antibiotics Utilization

Total Absorbable Sulfonamide
Scrips

Average Scrips PMPY for Absorbable Sulfonamides

Total Aminoglycoside Scrips

Average Scrips PMPY for Aminoglycosides

Total 1st Generation
Cephalosporin Scrips

Average Scrips PMPY for 1st Generation Cephalosporins

Total Lincosamide
Scrips

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

5181

0.06

5

0.00

5853

0.07

0

0.00

120

7945

0.10

6

0.00

6331

0.08

0

0.00

95

13,126

0.08

11

0.00

12,184

0.08

0

0.00

215

2104

0.05

8

0.00

2461

0.05

0

0.00

85

4071

0.09

2

0.00

2996

0.06

0

0.00

113

6,175

0.07

10

0.00

5,457

0.06

0

0.00

198

385

0.07

0

0.00

317

0.06

0

0.00

25

5185

0.17

0

0.00

3867

0.13

0

0.00

216

5,570

0.15

0

0.00

4,184

0.12

0

0.00

241

176

0.12

0

0.00

124

0.08

0

0.00

4

1620

0.20

0

0.00

1008

0.13

0

0.00

71

98 of 143

September 2013

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

Total

1,796

0.19

0

0.00

1,132

0.12

0

M

32

0.09

0

0.00

21

0.06

0

50-64

F

211

0.18

0

0.00

170

0.15

0

Total

243

0.16

0

0.00

191

0.13

0

M

0

0.00

0

0.00

0

0.00

0

65-74

F

0

0.00

0

0.00

1

0.24

0

Total

0

0.00

0

0.00

1

0.15

0

M

0

0.00

0

0.00

0

0.00

0

75-84

F

0

0.00

0

0.00

0

0.00

0

Total

0

0.00

0

0.00

0

0.00

0

M

0

0.00

0

0.00

0

0.00

0

85+

F

0

NA

0

NA

0

NA

0

Total

0

0.00

0

0.00

0

0.00

0

M

0

NA

0

NA

0

NA

0

Unknown

F

0

NA

0

NA

0

NA

0

Total

0

NA

0

NA

0

NA

0

M

7,878

0.06

13

0.00

8,776

0.07

0

Total

F

19,032

0.11

8

0.00

14,373

0.09

0

Total

26,910

0.09

21

0.00

23,149

0.08

0

0.00

75

0.00

3

0.00

9

0.00

12

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

NA

0

0.00

0

NA

0

NA

0

NA

0

0.00

237

0.00

504

0.00

741

99 of 143

September 2013

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

100 of 143

September 2013

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

Average Scrips PMPY for Ketolides

Total Clindamycin
Scrips

Average Scrips PMPY
for Clindamycins

Total Misc. Antibiotics of
Concern Scrips

Average Scrips PMPY
for Misc. Antibiotics of
Concern

0.00

1527

0.02

2

0.00

0.00

1385

0.02

4

0.00

0.00

2,912

0.02

6

0.00

0.00

809

0.02

2

0.00

0.00

1017

0.02

3

0.00

0.00

1,826

0.02

5

0.00

0.00

175

0.03

1

0.00

0.00

2032

0.07

4

0.00

0.00

2,207

0.06

5

0.00

0.00

67

0.04

0

0.00

0.00

569

0.07

1

0.00

0.00

636

0.07

1

0.00

101 of 143

September 2013

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

0.00

14

0.04

0

0.00

0.00

66

0.06

3

0.00

0.00

80

0.05

3

0.00

0.00

0

0.00

0

0.00

0.00

0

0.00

0

0.00

0.00

0

0.00

0

0.00

0.00

0

0.00

0

0.00

0.00

0

0.00

0

0.00

0.00

0

0.00

0

0.00

0.00

0

0.00

0

0.00

NA

0

NA

0

NA

0.00

0

0.00

0

0.00

NA

0

NA

0

NA

NA

0

NA

0

NA

NA

0

NA

0

NA

0.00

2,592

0.02

5

0.00

0.00

5,069

0.03

15

0.00

0.00

7,661

0.03

20

0.00

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

Total Penicillin
Scrips
49151 47134 96,285 8513 10707 19,220 1045 10663 11,708
398 2825

Average Scrips PMPY for Penicillins

Total Tetracycline
Scrips

Average Scrips PMPY
for Tetracyclines

Total Misc. Antibiotic
Scrips

Average Scrips PMPY for Misc. Antibiotics

0.60

23

0.00

141

0.00

0.59

10

0.00

411

0.01

0.60

33

0.00

552

0.00

0.19

2243

0.05

213

0.00

0.23

2559

0.06

2296

0.05

0.21

4,802

0.05

2,509

0.03

0.19

506

0.09

119

0.02

0.35

3926

0.13

16151

0.53

0.32

4,432

0.12

16,270

0.45

0.26

139

0.09

84

0.06

0.35

1081

0.13

2724

0.34

102 of 143

September 2013

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

0.01

3,223

0.34

0.01

73

0.21

0.01

394

0.34

0.01

467

0.31

0.00

0

0.00

0.00

0

0.00

0.00

0

0.00

0.00

0

0.00

0.00

0

0.00

0.00

0

0.00

0.00

0

0.00

NA

0

NA

0.00

0

0.00

NA

0

NA

NA

0

NA

NA

0

NA

0.00

59,180

0.44

0.00

71,723

0.43

0.00

130,903

0.44

1,220 32 128 160 1 0 1 0 1 1 0 0 0 0 0 0
2,944 7,705 10,649

0.13

2,808

0.29

0.09

11

0.03

0.11

169

0.14

0.11

180

0.12

0.40

0

0.00

0.00

0

0.00

0.15

0

0.00

0.00

0

0.00

1.71

0

0.00

1.00

0

0.00

0.00

0

0.00

NA

0

NA

0.00

0

0.00

NA

0

NA

NA

0

NA

NA

0

NA

0.02

568

0.00

0.05

21,751

0.13

0.04

22,319

0.07

103 of 143

September 2013

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

Antibiotic Utilization: Dual Eligibles (ABXB)

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

Member Months

Member Months

Age

Male

Female

Total

0-9

NR

NR

NR

10-17

NR

NR

NR

18-34

NR

NR

NR

35-49

NR

NR

NR

50-64

NR

NR

NR

65-74

NR

NR

NR

75-84

NR

NR

NR

85+

NR

NR

NR

Unknown

NR

NR

NR

Total

NR

NR

NR

Antibiotic Utilization

Percentage of

Age

Sex

Total Antibiotic
Scrips

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

Average Days Supplied per Antibiotic Scrip

Total Number of Scrips for
Antibiotics of Concern

Average Scrips PMPY for
Anitbiotics of Concern

Antibiotics of Concern of all
Antibiotic Scrips

M

NR

NR

NR

0-9

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

10-17

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

18-34

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

35-49

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

104 of 143

September 2013

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

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Antibiotics of Concern Utilization

Total Quinolone
Scrips

Average Scrips PMPY for
Quinolones

Total Cephalosporin
2nd-4th Generation
Scrips

Average Scrips PMPY for
Cephalosporins 2nd-4th
Generation

Total Azithromycin
and Clarithromycin
Scrips

Average Scrips PMPY for
Azithromycins and
Clarithromycins

Total Amoxicillin/ Clavulanate
Scrips

Average Scrips PMPY for
Amoxicillin/ Clavulanates

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

105 of 143

September 2013

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

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

All Other Antibiotics Utilization

Total Absorbable Sulfonamide
Scrips

Average Scrips PMPY for
Absorbable Sulfonamides

Total Aminoglycoside
Scrips

Average Scrips PMPY for
Aminoglycosides

Total 1st Generation Cephalosporin
Scrips

Average Scrips PMPY for 1st Generation
Cephalosporins

Total

Average Scrips

Lincosamide PMPY for

Scrips

Lincosamides

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

106 of 143

September 2013

35-49

F

NR

Total

NR

M

NR

50-64

F

NR

Total

NR

M

NR

65-74

F

NR

Total

NR

M

NR

75-84

F

NR

Total

NR

M

NR

85+

F

NR

Total

NR

M

NR

Unknown

F

NR

Total

NR

M

NR

Total

F

NR

Total

NR

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

107 of 143

September 2013

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

108 of 143

September 2013

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

Total Ketolides
Scrips

Average Scrips PMPY for Ketolides

Total Clindamycin
Scrips

Average Scrips PMPY for
Clindamycins

Total Misc. Antibiotics of
Concern Scrips

Average Scrips PMPY for Misc. Antibiotics of
Concern

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

109 of 143

September 2013

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total Macrolides (not azith. or
clarith.) Scrips

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

Total Penicillin Scrips

Average Scrips PMPY for Penicillins

Total Tetracycline
Scrips

Average Scrips Total Misc. PMPY for Antibiotic
Tetracyclines Scrips

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

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

110 of 143

September 2013

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

111 of 143

September 2013

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

Antibiotic Utilization: Disabled (ABXC)

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

Member Months

Member Months

Age

Male

Female

Total

0-9

NR

NR

NR

10-17

NR

NR

NR

18-34

NR

NR

NR

35-49

NR

NR

NR

50-64

NR

NR

NR

65-74

NR

NR

NR

75-84

NR

NR

NR

85+

NR

NR

NR

Unknown

NR

NR

NR

Total

NR

NR

NR

Antibiotic Utilization

Age

Sex

Total Antibiotic
Scrips

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

Average Days Supplied per Antibiotic Scrip

Total Number of Scrips for
Antibiotics of Concern

Average Scrips PMPY for
Anitbiotics of Concern

Percentage of Antibiotics of Concern of all
Antibiotic Scrips

M

NR

NR

NR

0-9

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

10-17

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

18-34

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

35-49

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

112 of 143

September 2013

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

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Antibiotics of Concern Utilization

Total Quinolone
Scrips

Average Scrips PMPY for
Quinolones

Total Cephalosporin
2nd-4th Generation
Scrips

Average Scrips PMPY for
Cephalosporins 2nd-4th
Generation

Total Azithromycin
and Clarithromycin
Scrips

Average Scrips PMPY for
Azithromycins and
Clarithromycins

Total Amoxicillin/ Clavulanate
Scrips

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

113 of 143

September 2013

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

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

All Other Antibiotics Utiliz

Total Absorbable Sulfonamide
Scrips

Average Scrips PMPY for
Absorbable Sulfonamides

Total Aminoglycoside
Scrips

Average Scrips PMPY for
Aminoglycosides

Total 1st Generation Cephalosporin
Scrips

Average Scrips PMPY for 1st Generation
Cephalosporins

Total Lincosamide
Scrips

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

114 of 143

September 2013

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

35-49

F

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

50-64

F

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

65-74

F

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

75-84

F

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

85+

F

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

Unknown

F

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

Total

F

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

115 of 143

September 2013

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

116 of 143

September 2013

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

Average Scrips PMPY for
Amoxicillin/ Clavulanates

Total Ketolides
Scrips

Average Scrips PMPY for Ketolides

Total Clindamycin
Scrips

Average Scrips PMPY for
Clindamycins

Total Misc. Average Scrips

Antibiotics of PMPY for Misc.

Concern Antibiotics of

Scrips

Concern

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

117 of 143

September 2013

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

NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR zation

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Average Scrips PMPY for
Lincosamides

Total Macrolides (not azith. or
clarith.) Scrips

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Average Scrips

Total

Average Scrips Total Misc.

PMPY for

Tetracycline

PMPY for

Antibiotic

Penicillins

Scrips

Tetracyclines Scrips

Average Scrips PMPY for Misc. Antibiotics

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

118 of 143

September 2013

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

119 of 143

September 2013

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

Antibiotic Utilization: Other (ABXD)

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

Member Months

Member Months

Age

Male

Female

Total

0-9

NR

NR

NR

10-17

NR

NR

NR

18-34

NR

NR

NR

35-49

NR

NR

NR

50-64

NR

NR

NR

65-74

NR

NR

NR

75-84

NR

NR

NR

85+

NR

NR

NR

Unknown

NR

NR

NR

Total

NR

NR

NR

Antibiotic Utilization

Age

Sex

Total Antibiotic
Scrips

Average Scrips Total Days

Average Days

PMPY for Supplied for All Supplied per

Antibiotics Antibiotic Scrips Antibiotic Scrip

Total Number of Scrips for Antibiotics of
Concern

Average Scrips PMPY for
Anitbiotics of Concern

Percentage of Antibiotics of Concern of all
Antibiotic Scrips

M

NR

NR

NR

0-9

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

10-17

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

18-34

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

35-49

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

120 of 143

September 2013

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

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Antibiotics of Concern Utilization

Total Quinolone
Scrips

Average Scrips PMPY for
Quinolones

Total Cephalosporin
2nd-4th Generation
Scrips

Average Scrips PMPY for
Cephalosporins 2nd-4th
Generation

Total Azithromycin
and Clarithromycin
Scrips

Average Scrips PMPY for
Azithromycins and
Clarithromycins

Total Amoxicillin/ Clavulanate
Scrips

Average Scrips PMPY for
Amoxicillin/ Clavulanates

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

121 of 143

September 2013

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

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

All Other Antibiotics Utilization

Total Absorbable Sulfonamide
Scrips

Average Scrips PMPY for
Absorbable Sulfonamides

Total Aminoglycoside
Scrips

Average Scrips PMPY for
Aminoglycosides

Total 1st Generation Cephalosporin
Scrips

Average Scrips PMPY for 1st Generation
Cephalosporins

Total Lincosamide
Scrips

Average Scrips PMPY for
Lincosamides

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

122 of 143

September 2013

35-49

F

NR

Total

NR

M

NR

50-64

F

NR

Total

NR

M

NR

65-74

F

NR

Total

NR

M

NR

75-84

F

NR

Total

NR

M

NR

85+

F

NR

Total

NR

M

NR

Unknown

F

NR

Total

NR

M

NR

Total

F

NR

Total

NR

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

123 of 143

September 2013

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

124 of 143

September 2013

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

Total Ketolides
Scrips

Average Scrips PMPY for Ketolides

Total Clindamycin
Scrips

Average Scrips PMPY
for Clindamycins

Total Misc. Average Scrips

Antibiotics of PMPY for Misc.

Concern Antibiotics of

Scrips

Concern

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

125 of 143

September 2013

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total Macrolides (not azith. or
clarith.) Scrips

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

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

Average Scrips PMPY for Penicillins

Total

Average Scrips Total Misc.

Tetracycline PMPY for Antibiotic

Scrips

Tetracyclines Scrips

Average Scrips PMPY for Misc. Antibiotics

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

126 of 143

September 2013

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

127 of 143

September 2013

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

Board Certification (BCR)

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

Type of Physician

Number of Physicians in Each Practice
Area

Board Certification

Number

Percent

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

128 of 143

September 2013

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

Total Membership (TLM)

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

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

Total Number of Members*
313,692 313647
0 45 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 313,692

129 of 143

September 2013

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

Enrollment by Product Line: Total (ENPA)

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

Age
<1 1-4 5-9 10-14 15-17 18-19 0-19 Subtotal 0-19 Subtotal: % 20-24 25-29 30-34 35-39 40-44 20-44 Subtotal 20-44 Subtotal: % 45-49 50-54 55-59 60-64 45-64 Subtotal 45-64 Subtotal: % 65-69 70-74 75-79 80-84 85-89 >=90 >=65 Subtotal >=65 Subtotal: % Age Unknown

Male Member Months 127864 404326 449443 370160 174412
42699 1,568,904
97.24% 5152 8126 8871 7442 6131 35,722 2.21% 4599 2601 1151 376 8,727 0.54% 12 18 3 2 1 2 38 0.00% 0

Female Member Months 124491 391071 444398 370850 183181
61872 1,575,863
79.10% 114389 108026 83602 51597 29149 386,763 19.41% 15439
8146 3914 1987 29,486 1.48%
46 5 7 0 0 0 58 0.00% 0

Total Member Months 252,355 795,397 893,841 741,010 357,593 104,571 3,144,767 87.22% 119,541 116,152 92,473 59,039 35,280 422,485 11.72% 20,038 10,747
5,065 2,363 38,213 1.06%
58 23 10 2 1 2 96 0.00% 0

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Total

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State
1,613,391 1,992,170 3,605,561

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

Enrollment by Product Line: Dual Eligibles (ENPB)

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

Age
<1 1-4 5-9 10-14 15-17 18-19 0-19 Subtotal 0-19 Subtotal: % 20-24 25-29 30-34 35-39 40-44 20-44 Subtotal 20-44 Subtotal: % 45-49 50-54 55-59 60-64 45-64 Subtotal 45-64 Subtotal: % 65-69 70-74 75-79 80-84 85-89 >=90 >=65 Subtotal >=65 Subtotal: % Age Unknown

Male Member Months
NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Female Member Months
NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Total Member Months
NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

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Total

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

NR

NR

NR

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

Enrollment by Product Line: Disabled (ENPC)

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

Age
<1 1-4 5-9 10-14 15-17 18-19 0-19 Subtotal 0-19 Subtotal: % 20-24 25-29 30-34 35-39 40-44 20-44 Subtotal 20-44 Subtotal: % 45-49 50-54 55-59 60-64 45-64 Subtotal 45-64 Subtotal: % 65-69 70-74 75-79 80-84 85-89 >=90 >=65 Subtotal >=65 Subtotal: % Age Unknown

Male Member Months
NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Female Member Months
NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Total Member Months
NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

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Total

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

NR

NR

NR

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

Enrollment by Product Line: Other (ENPD)

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

Age
<1 1-4 5-9 10-14 15-17 18-19 0-19 Subtotal 0-19 Subtotal: % 20-24 25-29 30-34 35-39 40-44 20-44 Subtotal 20-44 Subtotal: % 45-49 50-54 55-59 60-64 45-64 Subtotal 45-64 Subtotal: % 65-69 70-74 75-79 80-84 85-89 >=90 >=65 Subtotal >=65 Subtotal: % Age Unknown

Male Member Months
NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Female Member Months
NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Total Member Months
NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

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Total

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

NR

NR

NR

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September 2013

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

Enrollment by State (EBS)

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

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

Number 16 0 0 0 2 1 0 0 0 22
306046 0 0 3 1 1 0 1 3 0 0 0 0 4 4 1 0 0 1 0 2 0

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

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

2 6 1 3 0 0 2 0 11 0 5 7 0 0 7 2 0 0 0 0 0 0 0 0 0 8 306,162

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

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

433574

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

Direct Data Collection Method

Indirect Data Collection Method

Direct Total 0.00%

Race

Health Plan Direct*
CMS/State Database*

0.0000 0.0000

Indirect Total*

0.0000

Other*

0.0000

Direct Total 0.00%

Ethnicity

Health Plan Direct*
CMS/State Database*

0.0000 0.0000

Indirect Total*

0.0000

Other*

0.0000

*Enter percentage as a value between 0 and 1.

Race

Hispanic or Latino

Not Hispanic or Latino

Number Percentage Number Percentage

White

27198

79.34%

74257

30.71%

Black or African American

766

2.23%

158422

65.52%

American-Indian and Alaska Native

52

0.15%

130

0.05%

Asian

168

0.49%

7375

3.05%

Unknown

Total*

1.0000

Total*

1.0000

Unknown Ethnicity

Number Percentage

66

0.04%

81

0.05%

0

0.00%

5

0.00%

Native Hawaiian and Other Pacific Islanders

94

0.27%

69

0.03%

0

0.00%

Some Other Race Two or More Races
Unknown Declined
Total

6002 0 0 0
34,280

17.51% 0.00% 0.00% 0.00% 100.00%

1528 0 0 0
241,781

0.63% 0.00% 0.00% 0.00% 100.00%

3 0 157358 0 157,513

0.00% 0.00% 99.90% 0.00% 100.00%

Declined Ethnicity

Number Percentage

0

NR

0

NR

0

NR

0

NR

0

NR

0

NR

0

NR

0

NR

0

NR

0

NR

Tot Number 101,521 159,269
182 7,548
163
7,533 0
157,358 0
433,574

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

tal Percentage 23.41% 36.73% 0.04% 1.74% 0.04% 1.74% 0.00% 36.29% 0.00% 100.00%
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Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for Peach State

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 Care*

0.0000

0.0000

1.0000

Preferred Language for Written Materials*

0.0000

0.0000

1.0000

Other Language Needs*

0.0000

0.0000

1.0000

*Enter percentage as a value between 0 and 1.

Spoken Language Preferred for Health Care

Number Percentage

English

253553

58.48%

Non-English

19108

4.41%

Unknown

160913

37.11%

Declined

0

0.00%

Total*

433,574

100.00%

Language Preferred for Written Materials

Number Percentage

English

0

0.00%

Non-English

0

0.00%

Unknown

433574

100.00%

Declined

0

0.00%

Total*

433,574

100.00%

Other Language Needs

Number Percentage

English

0

0.00%

Non-English

0

0.00%

Unknown

433574

100.00%

Declined

0

0.00%

Total* *Should sum to 100%

433,574

100.00%

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

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

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

Measurement Year Measurement Year Weeks of Pregnancy
< 0 weeks 1-12 weeks 13-27 weeks 28 or more weeks Unknown
Total

2012 Number
46 54 252 73 5 430

Percentage 10.70% 12.56% 58.60% 16.98% 1.16% 100.00%

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