Validation of performance measures for WellCare of Georgia, Inc., measurement period: calendar year 2012; validation period: state fiscal year 2013 [Sept. 20, 2013]

Georgia Department of Community Health
Validation of Performance Measures for
WellCare of Georgia, Inc.
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 WellCare of Georgia, Inc.
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 ....................................... 8 Data Integration ................................................................................................................................. 8 Data Control ...................................................................................................................................... 8 Performance Measure Documentation.............................................................................................. 8 Validation Results ................................................................................................................................ 9 Medical Service Data (Claims/Encounters) ....................................................................................... 9 Enrollment Data............................................................................................................................... 10 Provider Data................................................................................................................................... 10 Medical Record Review Process ..................................................................................................... 10 Supplemental Data .......................................................................................................................... 11 Data Integration ............................................................................................................................... 11 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 WellCare of Georgia, Inc.

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 WellCare of Georgia, Inc. (WellCare). Information about WellCare appears in Table 1.

Table 1--WellCare of Georgia, Inc. Information

CMO Name: CMO Location: CMO Audit Location: CMO Contact:

WellCare of Georgia, Inc. 211 Perimeter Center Parkway, Suite 800 Atlanta, GA 30346 8735 Henderson Rd. Tampa, FL 33634
Jacqueline Collins, RN, CPHQ, Director, Quality Improvement

Contact Telephone Number:

770.913.2175

Contact E-mail Address:

Jacqueline.collins@wellcare.com

Site Visit Date:

April 1516, 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 WellCare

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:
WellCare
WellCare WellCare WellCare WellCare WellCare WellCare WellCare WellCare WellCare WellCare

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 WellCare to report a selected set of Healthcare Effectiveness Data and Information Set (HEDIS) measures to DCH. WellCare 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 WellCare, 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 WellCare 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 WellCare 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 WellCare approximately one week prior to the on-site visit. HSAG also conducted a pre-on-site conference call with WellCare 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 WellCare. Some team members, including the lead auditor, participated in the onsite meetings at WellCare; 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

Allen Iovannisci, MS, CHCA Lead Auditor

Certified HEDIS auditor; performance measure knowledge, data integration, systems review, and analysis.

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

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

Tammy GianFrancisco Project Leader, Audits

Performance measure validation coordination, communication, and scheduling.

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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: WellCare 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: WellCare 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 WellCare on April 15 and 16, 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 WellCare 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 WellCare 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 WellCare staff members who were involved with performance measure reporting. Table 4 lists key WellCare interviewees:

Sharon Nisbet Thomas Clegg Danny Sharpe Gary Chu Tara Katt Chuck Beeman Bob Klopotek KimThao Nguyen Cesar Collazo Patricia Doyle Megan Jagger Candice Duffey Lee Falk Sean Fletcher Susan Swiontek Aaron Hahn Sunmi Janicek Lee Genco Brian Pogue Charlene Rohde Thomas Everett Sandy Hudson Claudius Conner Lissette Salemi

Table 4--List of WellCare of Georgia, Inc. Interviewees

Name

Title

Vice President, Quality and Performance Improvement

Project Analyst

Director, Quality Data Integrity

Manager, Application Development

Quality Improvement Project Manager, Sr.

Sr. Director, Information Technology

Vice President, Information Systems

Director, Corporate Compliance Oversight

Manager, Front End

Director, Provider Service and Vendor Management

Sr. Manager, National Vendor Management

Manager, Claims Reporting Rules

EDI Team Lead

Sr. Manager Encounter Operations

Manager, Delegation and Oversight

Manager, Actuary (Level III)

Director, Health Services Delegation and Oversight

Sr. Director, Pharmacy Benefit Relations

Director, Claims

Sr. Manager, Claims

Sr. Director, Configurations

Director, Claims Audit

Director, Enrollment Operations

Manager, Enrollment

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Andrew Duffen Amy Russo Patricia Strickland Alicia Martin Terri Pokraka Michelle Saulsberry Jackie Collins Tiffany King Beatrice Clebert Brian Donnelly

Table 4--List of WellCare of Georgia, Inc. Interviewees

Name

Title

Director Corporate Network Integrity

Sr. Director, Provider Resolution

Sr. Manager, Configuration

Sr. Manager, Configurations

Director, Field Quality Improvement--IL

Sr. Manager, Network Management

Director, Field Quality Improvement--GA

Claims Audit Specialist, Lead

Hospital Contracting Manager

Supervisor, Enterprise Intake Ops

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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 WellCare, 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 WellCare were:
Acceptable
Not acceptable

Data Control
WellCare'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 WellCare 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 WellCare 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 WellCare. 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 WellCare was:
Acceptable
Not acceptable

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Validation Results
The validation team evaluated WellCare'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)
WellCare was fully compliant with the capture and processing of medical service data. WellCare did not experience any system changes during the measurement year, and only employed industrystandard codes (e.g., ICD-9-CM, CPT, DRG, and HCPCS). System edits ensured that all characters were captured and primary and secondary codes were identified. Nonstandard coding schemes were not employed during the measurement year. The medical claims/encounter system was consistent with industry standards and compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards to date.
Claim submissions were accepted in both paper and electronic format. Paper claims were routed to clearinghouses for scanning and transmitted to WellCare in standard 837 compliant format. This process ensured that 100 percent of all claims were processed electronically. WellCare's policies and procedures included sufficient edit checks and monitoring of all transaction files. All electronic files were logged and monitored by the EDI Operations team. Approximately 99 percent of all clean claims were processed within nine days.
WellCare reimbursed all claims on a fee-for-service (FFS) basis, and therefore, data completeness issues were minimized. WellCare also had a provider incentive payment available for the completion of HEDIS services and submission of the claims for the services. This further ensured data completeness for the measures. Complete and accurate claims were required to be submitted no later than the first week of January for the prior year to receive an incentive payment. Physicians were provided a list of noncompliant members and the needed services, so they could proactively contact, schedule, and provide the services prior to the end of the year.
The pharmacy vendor, Catalyst Rx, was acquired by SXC Health Solutions in July 2012. The new combined organization is known as Catamaran. The acquisition did not result in any system changes for WellCare. Catamaran kept the adjudication platform, and the process remained the same. Catamaran processed all pharmacy claims electronically and provided the invoices to WellCare. The pharmacy claims data were validated weekly with the receipt of every invoice. There were no discrepancies identified in the measurement year, and WellCare had good oversight of the vendor to ensure all submissions were complete and accurate.
The vendor for dental services was DentaQuest. The vendor conducted numerous claim checks on the entry and migration of claims data throughout the system. In addition, audits of claims entry occur on a routine basis, ensuring accurate data for WellCare. Batch counts and total claims entered were matched to control totals to ensure WellCare received 100 percent of all dental claims.

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WellCare's staff also incorporated a new process during the measurement year to track encounter submissions from vendors on a monthly basis. This process was an additional edit check to ensure data completeness. There were no concerns with WellCare's medical service data.
Enrollment Data
There were no concerns with the processing of enrollment files received from DCH. Monthly files were received and loaded into WellCare's enrollment system. WellCare's system contained sufficient data elements to capture multiple enrollment spans and identification numbers as well as a file to capture the unique member identifier. WellCare's policies and procedures provided sufficient edit checks to ensure enrollment files were accurately loaded and free of errors. The enrollment files were reconciled monthly against the capitation file as an additional validation to ensure all eligible members were being captured for service and payment. WellCare did not have any issues with membership data during 2012. There were no backlogs of applications since DCH provided the eligibility files. There were minimal retroactive enrollments during the year. PeachCare for Kids enrollment data were submitted in standard 834 format, and updates were validated against internal applications.
Provider Data
WellCare used Cactus for the provider credentialing system and Xcelys to store the practitioner specialty data for claims payments. Monthly audits were conducted for accuracy of the provider information entered into the Cactus database. WellCare's provider data system, Xcelys, contained appropriate mappings for all provider specialties. WellCare's policies, procedures, log forms, and training manuals for data submission ensured accuracy and completeness and verified that the organization has mechanisms for transferring information to the appropriate location within Xcelys. There were appropriate procedures in place for processing provider additions, deletions, and changes. All relevant fields were captured and mapped to ensure measure-appropriate measure reporting. The organization effectively monitored the quality and accuracy of its electronic submissions daily. Transmissions of provider data were properly controlled by logs, verification of record counts, and edit checking. There were no concerns with WellCare's processing of provider data.
Medical Record Review Process
WellCare was fully compliant with the medical record review reporting requirements. WellCare used Outcomes Health Information Systems, Inc., a medical record vendor, to procure medical records and abstract medical record data. HSAG reviewed the hybrid tools and corresponding instructions of this vendor's system. Reviewer qualifications, training, and oversight were appropriate. WellCare's oversight of the medical record vendor was appropriate. Due to reporting a new State-required hybrid measure, a convenience sample was required and subsequently passed review. WellCare passed the medical record review validation process for the Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517) measure.

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Supplemental Data
WellCare did not use any supplemental data sources for reporting the selected performance measures under review; therefore, this standard is not applicable.

Data Integration
WellCare contracted with Inovalon, an NCQA-Certified software vendor, for calculating the 2013 performance measure rates. WellCare had a thorough and detailed process in place to ensure no data were lost during the data integration process. A uniform format was created for each data type to avoid data integration issues during the compilation process. WellCare consolidated data from several different data sources and platforms, and provided sufficient documentation ensuring that appropriate fields were mapped to Inovalon's specifications for the data file submissions. In addition, Inovalon maintained sufficient processes to integrate these data sources for reporting. Communication between WellCare and Inovalon allowed the teams to work out any issues prior to final submission and calculation of the rates.
The audit team conducted primary source verification on every measure to ensure the Inovalon source code was accurately calculating the information relevant to the measures under review. All primary source data were found to be compliant. In addition, Inovalon's source code was reviewed by HSAG's source code review team and found to be compliant with the measure specifications. There were no concerns with WellCare's data integration process.

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 WellCare of Georgia, Inc.

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 WellCare for each performance measure rate. For additional information regarding performance measure rates, see Appendix C of this report.

Table 7--Key Review Results for WellCare of Georgia, Inc.

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 WellCare of Georgia, Inc.

Documentation Worksheet

CMO Name: On-Site Visit Date: Reviewers:

WellCare of Georgia, Inc. April 1516, 2013 Allen Iovannisci, MS, CHCA

Table A-1--Data Integration and Control Findings for WellCare of Georgia, Inc.

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 WellCare of Georgia, Inc.

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 WellCare of Georgia, Inc.

Reviewer Worksheets

CMO Name: On-Site Visit Date: Reviewers:

WellCare of Georgia, Inc. April 1516, 2013 Allen Iovannisci, MS, CHCA

Table B-1--Denominator Validation Findings for WellCare of Georgia, Inc.

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 used.

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DENOMINATOR AND NUMERATOR VALIDATION FINDINGS

Table B-2--Numerator Validation Findings for WellCare of Georgia, Inc.

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.

WellCare did not use any nonstandard codes.

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

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Appendix C. Performance Measure Results
for WellCare of Georgia, Inc.

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

Table C-1--Performance Measure 1 for WellCare of Georgia, Inc.
Annual Pediatric Hemoglobin (HbA1c) Testing (ages 517)

Rate 82.97%

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 WellCare of Georgia, Inc.
Annual Percentage of Asthma Patients with One or More Asthma-Related Emergency Room Visit (ages 220)

Rate 12.23%

Performance Measure 3--Cesarean Delivery Rate
Table C-3--Performance Measure 3 for WellCare of Georgia, Inc.
Cesarean Delivery Rate

Rate 29.10%

Performance Measure 4--Cesarean Rate for Nulliparous Singleton Vertex

Table C-4--Performance Measure 4 for WellCare of Georgia, Inc.
Cesarean Rate for Nulliparous Singleton Vertex

Rate 16.86%

WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia

Page C-1 WellCare_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 WellCare of Georgia, Inc.
Percentage of Eligibles that Received Dental Treatment Services

Rate 24.32%

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

Table C-6--Performance Measure 6 for WellCare of Georgia, Inc.
Percentage of Eligibles that Received Preventive Dental Services

Rate 52.52%

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

Table C-7--Performance Measure 7 for WellCare of Georgia, Inc.
Percentage of Live Births Weighing Less Than 2,500 Grams

Rate 8.02%

Performance Measure 8--Adult Asthma Admission Rate
Table C-8--Performance Measure 8 for WellCare of Georgia, Inc.
Adult Asthma Admission Rate

Rate (Per 100,000)
71.17

WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia

Page C-2 WellCare_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 WellCare of Georgia, Inc.
Chronic Obstructive Pulmonary Disease (COPD) Admission Rate

Rate (Per 100,000)
19.24

Performance Measure 10--Congestive Heart Failure Admission Rate

Table C-10--Performance Measure 10 for WellCare of Georgia, Inc.
Congestive Heart Failure Admission Rate

Rate (Per 100,000)
41.04

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

Table C-11--Performance Measure 11 for WellCare of Georgia, Inc.
Diabetes, Short-Term Complications Admission Rate

Rate (Per 100,000)
27.82

WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia

Page C-3 WellCare_GA2012-13_CMO_PMV_F1_0913

Appendix D. Final Audited HEDIS Rates
for WellCare of Georgia, Inc.

Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for WellCare of Georgia, Inc.

Measure

CMO Rate

Adolescent Well-Care Visits

51.58%

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

85.81% 91.21% Denominator fewer than 30

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

86.49%

Adult BMI Assessment

67.88%

Annual Dental Visit--Ages 23 Years

52.22%

Annual Dental Visit--Ages 46 Years

77.61%

Annual Dental Visit--Ages 710 Years

80.37%

Annual Dental Visit--Ages 1114 Years

73.72%

Annual Dental Visit--Ages 1518 Years

63.06%

Annual Dental Visit--Ages 1921 Years

41.88%

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

71.48% 88.51% 63.68% Denominator fewer than 30

Annual Monitoring for Patients on Persistent Medications--Diuretics

87.85%

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

87.06% 42.78% 50.00% 32.74% 75.70%

WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia

Page D-1 WellCare_GA2012-13_CMO_PMV_F1_0913

FINAL AUDITED HEDIS RATES

Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for WellCare of Georgia, Inc.

Measure

CMO Rate

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

79.95%

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis*

16.30%

Breast Cancer Screening

55.78%

Call Answer Timeliness

85.10%

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

72.51% 89.39% 34.85% 78.83%

Childhood Immunization Status--Combo 6

42.82%

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

38.44% 97.56% 91.63% 91.80% 89.57% 48.66%

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

28.47%

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

51.64%

Comprehensive Diabetes Care--Eye Exam

40.51%

Comprehensive Diabetes Care--HbA1c Control <7.0

32.36%

Comprehensive Diabetes Care--HbA1c Control <8.0

39.05%

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

54.01%

Comprehensive Diabetes Care--HbA1c Testing

78.47%

Comprehensive Diabetes Care--LDL-C Screening

69.71%

Comprehensive Diabetes Care--LDL-C Control

28.10%

Comprehensive Diabetes Care--Medical Attention to Nephropathy

72.81%

WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia

Page D-2 WellCare_GA2012-13_CMO_PMV_F1_0913

FINAL AUDITED HEDIS RATES

Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for WellCare of Georgia, Inc.

Measure

CMO Rate

Controlling High Blood Pressure

49.64%

Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis

62.20%

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

77.16%

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

60.37% 39.39% 53.10% 12.90%

Frequency of Ongoing Prenatal Care--2140 Percent

5.11%

Frequency of Ongoing Prenatal Care--4160 Percent

5.60%

Frequency of Ongoing Prenatal Care--6180 Percent

13.87%

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

62.53% 19.95% 70.98% 48.28% 12.27% Rates reported in Appendix F 75.34% 63.72% 43.85% 20.55% Denominator fewer than 30 73.28% 84.73% 62.53% 84.18%

WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia

Page D-3 WellCare_GA2012-13_CMO_PMV_F1_0913

FINAL AUDITED HEDIS RATES

Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for WellCare of Georgia, Inc.

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

90.56% 88.16%

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

75.65% Denominator fewer than 30

Use of Appropriate Medications for People with Asthma--Total

89.12%

Use of Imaging Studies for Low Back Pain*

73.93%

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

39.62% 38.69% 55.47% 42.09%
3.06%

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

3.32%

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

2.55%

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

6.12%

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

7.65%

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

10.71%

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

66.58%

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

68.46%

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

WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia

Page D-4 WellCare_GA2012-13_CMO_PMV_F1_0913

FINAL AUDITED HEDIS RATES

Table D-1--CMO Audited Calendar Year 2012 HEDIS Performance Measure Report for WellCare of Georgia, Inc.

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.

WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia

Page D-5 WellCare_GA2012-13_CMO_PMV_F1_0913

Appendix E. Performance Measure Validation Reporting Spreadsheet
for WellCare of Georgia, Inc.
Appendix E contains WellCare of Georgia, Inc.'s performance measure validation reporting spreadsheet.

WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia

Page E-1 WellCare_GA2012-13_CMO_PMV_F1_0913

Appendix E: Department of Community Health, State of Georgia Validated CY 2012 Performance Measures for WellCare
2013 Validation of Performance Measures Rate Reporting Template

CMO Name:

WellCare of Georgia, Inc.

CMO Contact Name and Title: Jacqueline Collins - Director , Field Quality Improvement

CMO Contact Email:

Jacqueline.Collins@wellcare.com

Comments:

1 of 12

September 2013

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

Cesarean Delivery Rate

Data Element Reporting Year

General Measure Data
2013

Data collection methodology (administrative)

A

Eligible population

26388

Numerator events by administrative data

7679

Reported rate

29.10

2 of 12

September 2013

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

Percentage of Eligibles that Received Preventive Dental Services

Data Element Reporting Year

General Measure Data
2013

Data collection methodology (administrative)

A

Eligible population

594174

Numerator events by administrative data

312073

Reported rate

52.52%

3 of 12

September 2013

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

Percentage of Eligibles that Received Dental Treatment Services

Data Element

General Measure Data

Reporting Year

2013

Data collection methodology (administrative) Eligible population

A 594174

Numerator events by administrative data

144531

Reported rate

24.32%

4 of 12

September 2013

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

Cesarean Rate for Nulliparous Singleton Vertex

Data Element Reporting Year

General Measure Data
2013

Data collection methodology (administrative)

A

Eligible population

9627

Numerator events by administrative data

1623

Reported rate

16.86%

5 of 12

September 2013

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

Percentage of Live Births Weighing Less Than 2,500 Grams

Data Element

General Measure Data

Reporting Year

2013

Data collection methodology (administrative)

A

Eligible population

27680

Numerator events by administrative data

2220

Reported rate

8.02

6 of 12

September 2013

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

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

Data Element

General Measure Data

Reporting Year
Data collection methodology (administrative)

2013 A

Eligible population

60122

Numerator events by administrative data

7354

Reported rate

12.23%

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September 2013

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

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

Data Element Reporting Year

General Measure Data 2013

Data collection methodology (hybrid)

H

Eligible population

778

Denominator

411

Numerator events by administrative data

331

Numerator events by medical records

10

Numerator Total

341

Reported rate

82.97%

8 of 12

September 2013

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

Diabetes, Short-Term Complications Admission Rate

Data Element

General Measure Data

Reporting Year

2013

Data collection methodology (administrative)

A

Eligible population

366644

Numerator events by administrative data

102

Reported rate (Per 100,000 Members)

28

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September 2013

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

Chronic Obstructive Pulmonary Disease (COPD) Admission Rate

Data Element

General Measure Data

Reporting Year

2013

Data collection methodology (administrative)

A

Eligible population

155958

Numerator events by administrative data

30

Reported rate (Per 100,000 Members)

19

10 of 12

September 2013

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

Congestive Heart Failure (CHF) Admission Rate

Data Element

General Measure Data

Reporting Year

2013

Data collection methodology (administrative)

A

Eligible population

155958

Numerator events by administrative data

64

Reported rate (Per 100,000 Members)

41

11 of 12

September 2013

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

Adult Asthma Admission Rate

Data Element Reporting Year

General Measure Data
2013

Data collection methodology (administrative)

A

Eligible population

155958

Numerator events by administrative data

111

Reported rate (Per 100,000 Members)

71

12 of 12

September 2013

Appendix F. HEDIS Interactive Data Submission System Data
for WellCare of Georgia, Inc.
Appendix F contains WellCare of Georgia, Inc.'s reported IDSS data.

WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia

Page F-1 WellCare_GA2012-13_CMO_PMV_F1_0913

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

Audit Review Table

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None); Measurement Year - 2012

The Plan 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

67.88%

R

Weight Assessment and Counseling for Nutrition

and Physical Activity for Children/Adolescents

Y

N

(wcc)

BMI Percentile

38.69%

R

Counseling for Nutrition

55.47%

R

Counseling for Physical Activity

42.09%

R

Childhood Immunization Status (cis)

Y

N

DTaP

88.56%

R

IPV

96.11%

R

MMR

94.16%

R

HiB

95.13%

R

Hepatitis B

94.65%

R

VZV

94.16%

R

Pneumococcal Conjugate

85.40%

R

Hepatitis A

94.40%

R

Rotavirus

74.21%

R

Influenza

47.20%

R

Combination #2

84.43%

R

Combination #3

78.83%

R

Combination #4

78.35%

R

Combination #5

64.72%

R

Combination #6

42.82%

R

Combination #7

64.48%

R

Combination #8

42.58%

R

Combination #9

38.69%

R

Combination #10

38.44%

R

Immunizations for Adolescents (ima)

Y

Meningococcal

72.99%

R

1 of 139

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 WellCare

Tdap/Td

80.75%

R

Combination #1

70.98%

R

Human Papillomavirus Vaccine for Female Adolescents (hpv)

Y

19.95%

R

Lead Screening in Children (lsc)

Y

N

75.34%

R

Breast Cancer Screening (bcs)

Y

55.78%

R

Cervical Cancer Screening (ccs)

Y

72.51%

R

Chlamydia Screening in Women (chl)

Y

16-20 Years

44.26%

R

21-24 Years

62.42%

R

Total

48.66%

R

Effectiveness of Care: Respiratory Conditions

Appropriate Testing for Children with Pharyngitis (cwp)

Y

Y

75.70%

R

Appropriate Treatment for Children With URI (uri)

Y

Y

79.95%

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%

16.30%

R

39.62%

R

73.28%

R

84.73%

R

90.56%

R

88.16%

R

75.65%

R

NA

R

89.12%

R

44.39%

R

20.41%

R

41.40%

R

2 of 139

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 WellCare

12-18 Years - Medication Compliance 75%

19.20%

R

19-50 Years - Medication Compliance 50%

54.15%

R

19-50 Years - Medication Compliance 75%

33.17%

R

51-64 Years - Medication Compliance 50%

NA

R

51-64 Years - Medication Compliance 75%

NA

R

Total - Medication Compliance 50%

43.85%

R

Total - Medication Compliance 75%

20.55%

R

Asthma Medication Ratio (amr)

Y

Y

5-11 Years

65.62%

R

12-18 Years

62.25%

R

19-50 Years

45.90%

R

51-64 Years

NA

R

Total

63.72%

R

Effectiveness of Care: Cardiovascular

Cholesterol Management for Patients With Cardiovascular Conditions (cmc)

Y

N

LDL-C Screening Performed

89.39%

R

LDL-C Control (<100 mg/dL)

34.85%

R

Controlling High Blood Pressure (cbp)

Y

49.64%

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

78.47%

R

HbA1c Poor Control (>9.0%)

54.01%

R

HbA1c Control (<8.0%)

39.05%

R

HbA1c Control (<7.0%)

32.36%

R

Eye Exam (Retinal) Performed

40.51%

R

LDL-C Screening Performed

69.71%

R

LDL-C Control (<100 mg/dL)

28.10%

R

Medical Attention for Nephropathy

72.81%

R

Blood Pressure Control (<140/80 mm Hg)

28.47%

R

Blood Pressure Control (<140/90 mm Hg)

51.64%

R

Effectiveness of Care: Musculoskeletal

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

Y

Y

62.20%

R

3 of 139

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 WellCare

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

Y

Y

(fuh)

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

73.93%

R

50.00%

R

32.74%

R

39.39%

R

53.10%

R

77.16%

R

60.37%

R

84.93%

R

NA

R

NA

R

39.80%

R

88.51%

R

NA

R

87.85%

R

63.68%

R

87.06%

R

4 of 139

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
September 2013

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

20-44 Years

45-64 Years

65+ Years

Total

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

Y

12-24 Months

25 Months - 6 Years

7-11 Years

12-19 Years

Annual Dental Visit (adv)

Y

Y

2-3 Years

4-6 Years

7-10 Years

11-14 Years

15-18 Years

19-21 Years

Total

Initiation and Engagement of AOD Dependence Treatment (iet)

Y

Y

Initiation of AOD Treatment: 13-17 Years

Engagement of AOD Treatment: 13-17 Years

Initiation of AOD Treatment: 18+ Years

Engagement of AOD Treatment: 18+ Years

Initiation of AOD Treatment: Total

Engagement of AOD Treatment: Total

Prenatal and Postpartum Care (ppc)

Y

Timeliness of Prenatal Care

Postpartum Care

Call Answer Timeliness (cat)

Y

Utilization

Frequency of Ongoing Prenatal Care (fpc)

Y

<21 Percent

21-40 Percent

41-60 Percent

61-80 Percent

85.81%

R

91.21%

R

NA

R

86.49%

R

97.56%

R

91.63%

R

91.80%

R

89.57%

R

52.22%

R

77.61%

R

80.37%

R

73.72%

R

63.06%

R

41.88%

R

71.48%

R

49.07%

R

17.44%

R

48.07%

R

10.93%

R

48.28%

R

12.27%

R

84.18%

R

62.53%

R

85.10%

R

12.90%

R

5.11%

R

5.60%

R

13.87%

R

5 of 139

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

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

81+ Percent

62.53%

R

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

Y

N

0 Visits

3.06%

R

1 Visit

3.32%

R

2 Visits

2.55%

R

3 Visits

6.12%

R

4 Visits

7.65%

R

5 Visits

10.71%

R

6+ Visits

66.58%

R

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

Y

Adolescent Well-Care Visits (awc)

Y

Frequency of Selected Procedures (fsp)

Y

Ambulatory Care: Total (amba)

Y

N

68.46%

R

N

51.58%

R

R

R

Ambulatory Care: Dual Eligibles (ambb)

N

NR

Ambulatory Care: Disabled (ambc)

N

NR

Ambulatory Care: Other (ambd)

N

NR

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

Y

R

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

N

NR

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

N

NR

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

N

NR

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

Y

Y

R

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

N

N

NR

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

N

N

NR

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

N

N

NR

Mental Health Utilization: Total (mpta)

Y

Y

R

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

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September 2013

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

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

Antibiotic Utilization: Disabled (abxc)

N

N

NR

Antibiotic Utilization: Other (abxd)

N

N

NR

Relative Resource Use

Relative Resource Use for People With Diabetes (rdi)

Y

R

Relative Resource Use for People With Asthma (ras)

Y

Y

R

Relative Resource Use for People With Cardiovascular Conditions (rca)

Y

R

Relative Resource Use for People With Hypertension (rhy)

Y

R

Relative Resource Use for People With COPD (rco)

Y

R

Health Plan Descriptive Information

Board Certification (bcr)

Y

R

Total Membership (tlm)

Y

R

Enrollment by Product Line: Total (enpa)

Y

R

Enrollment by Product Line: Dual Eligibles (enpb)

N

NR

Enrollment by Product Line: Disabled (enpc)

N

NR

Enrollment by Product Line: Other (enpd)

N

NR

Enrollment by State (ebs)

Y

R

Race/Ethnicity Diversity of Membership (rdm)

Y

R

Language Diversity of Membership (ldm)

Y

R

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

Y

R

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

7 of 139

September 2013

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

Adult BMI Assessment (ABA)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 14257
675
4.73% 411 0.05 432 34
7.87% 0 0 0 0 0
411 33 246 67.88% 63.25% 72.52%

8 of 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Data Element

BMI Percentile 3-11 years 12-17 years Total

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

Counseling for Physical Activity 3-11 years 12-17 years Total

Measurement year

2012

2012

2012

Data collection methodology

H

H

H

(administrative or hybrid)

Eligible population

153983

69005

222,988

153983

69005

222,988

153983

69005

222,988

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

8581

3684

12,265

3155

1597

4,752

2418

1130

3,548

Current year's administrative rate (before exclusions)

5.57%

5.34%

5.50%

2.05%

2.31%

2.13%

1.57%

1.64%

1.59%

Minimum required sample size (MRSS) or

411

411

411

other sample size

Oversampling rate

0.05

0.05

0.05

Final sample size

432

432

432

Number of numerator events by

9

6

15

4

2

6

4

1

5

administrative data in FSS

Administrative rate on FSS

2.08%

1.39%

3.47%

0.93%

0.46%

1.39%

0.93%

0.23%

1.16%

Number of original sample records

0

0

0

excluded because of valid data errors

Number of administrative data records

0

0

0

excluded

Number of medical records excluded

0

0

0

Number of employee/dependent medical

0

0

0

records excluded

Records added from the oversample list

0

0

0

Denominator

298

113

411

298

113

411

298

113

411

Numerator events by administrative data

8

6

14

4

2

6

4

1

5

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

101 36.58% 30.94% 42.21%

44 44.25% 34.65% 53.85%

145 38.69% 33.86% 43.52%

161 55.37% 49.56% 61.18%

61 55.75% 46.15% 65.35%

222 55.47% 50.55% 60.40%

105 36.58% 30.94% 42.21%

63 56.64% 47.06% 66.22%

168 42.09% 37.20% 46.99%

9 of 139

September 2013

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

Childhood Immunization Status (CIS)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Data Element

General

Measure

DTaP

IPV

MMR

HiB

Data

Measurement year

2012

Data collection methodology (administrative or hybrid)

H

Eligible population

13946

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

11860

13263

13124

13246

Current year's administrative rate (before exclusions)

85.04%

95.10%

94.11%

94.98%

Minimum required sample size (MRSS) or other sample Size

411

Oversampling rate

0.05

Final sample size

432

Number of numerator events by admin data in FSS

375

411

406

408

Administrative rate on FSS

86.81%

95.14%

93.98%

94.44%

Number of original records excluded because of valid data errors

0

Number of administrative data records excluded

0

Number of medical data records excluded

0

Number of employee/dependent medical records excluded

0

Records added from the oversample list

0

Denominator

411

Numerator events by administrative data

357

391

387

389

Number of numerator events by medical records
Reported rate

7 88.56%

4 96.11%

0 94.16%

2 95.13%

Hepatitis B
12853 92.16%
397 91.90%
377 12 94.65%

VZV
13181 94.51%
406 93.98%
387 0
94.16%

Pneumococcal
Conjugate

Hepatitis A

11747 84.23%

13036 93.47%

364 84.26%

406 93.98%

346 5
85.40%

388 0
94.40%

10 of 139

September 2013

Lower 95% confidence interval Upper 95% confidence interval

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

85.37% 91.76%

94.12% 98.10%

91.77% 96.55%

92.93% 97.34%

92.35% 96.94%

91.77% 96.55%

81.87% 88.94%

92.06% 96.75%

11 of 139

September 2013

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

Rotavirus

Influenza

Combination Combination Combination Combination Combination Combination Combination Combination Combination

2

3

4

5

6

7

8

9

10

9677 69.39%

5934 42.55%

11214 80.41%

10669 76.50%

10550 75.65%

8275 59.34%

5207 37.34%

8197 58.78%

5184 37.17%

4297 30.81%

4277 30.67%

307 71.06%

197 45.60%

350 81.02%

327 75.69%

325 75.23%

262 60.65%

172 39.81%

261 60.42%

171 39.58%

154 35.65%

153 35.42%

294 11 74.21%

191 3
47.20%

334 13 84.43%

312 12 78.83%

310 12 78.35%

251 15 64.72%

167 9
42.82%

250 15 64.48%

166 9
42.58%

149 10 38.69%

148 10 38.44%

12 of 139

September 2013

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

69.86% 78.56%

42.25% 52.15%

80.80% 88.06%

74.76% 82.90%

74.24% 82.45%

59.98% 69.46%

37.92% 47.73%

59.73% 69.23%

37.68% 47.48%

33.86% 43.52%

33.62% 43.27%

13 of 139

September 2013

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

Immunizations for Adolescents (IMA)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

General Measure
Data 2012
H 16045
348 0.05 366
0 0

Meningococcal
11878 74.03%
265 72.40%

Tdap/Td Combination 1

13585 84.67%

11686 72.83%

293 80.05%

258 70.49%

Number of medical data records excluded

0

Number of employee/dependent medical records excluded

0

Records added from the oversample list

0

Denominator

348

Numerator events by administrative data

251

279

244

14 of 139

September 2013

Number of numerator events by medical records
Reported rate Lower 95% confidence interval Upper 95% confidence interval

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

3
72.99% 68.18% 77.80%

2
80.75% 76.46% 85.03%

3
70.98% 66.06% 75.89%

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September 2013

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

Human Papillomavirus Vaccine for Female Adolescents (HPV)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 7965
1390
17.45% 411 0.05 432 83
19.21% 0 0 0 0 0
411 76 6 19.95% 15.97% 23.94%

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September 2013

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

Lead Screening in Children (LSC)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 13946
10524
75.46% 296 0.05 311 225
72.35% 0 0 0 0 0
296 215
8 75.34% 70.26% 80.42%

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September 2013

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

Breast Cancer Screening (BCS)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 2639 1472 55.78% 53.86% 57.69%

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September 2013

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

Cervical Cancer Screening (CCS)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 22195
14847
66.89% 371 0.05 390 257
65.90% 0 0 0 0 0
371 244 25 72.51% 67.83% 77.18%

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September 2013

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

Chlamydia Screening in Women (CHL)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

9879 4372 44.26% 43.27% 45.24%

3164 1975 62.42% 60.72% 64.12%

Total
13,043 6,347 48.66% 47.80% 49.52%

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September 2013

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

Appropriate Testing for Children with Pharyngitis (CWP)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 24721 18714
75.70% 75.16% 76.24%

21 of 139

September 2013

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

Appropriate Treatment for Children With URI (URI)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 35156 7050
79.95% 79.53% 80.37%

22 of 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 1368 1145
16.30% 14.31% 18.30%

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September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 106 42
39.62% 29.84% 49.41%

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September 2013

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

Pharmacotherapy Management of COPD Exacerbation (PCE)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 131

96 73.28% 65.32% 81.24%

111 84.73% 78.19% 91.27%

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September 2013

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

Use of Appropriate Medications for People With Asthma (ASM)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

4398

2263

271

26

Number of required exclusions

324

164

246

57

Numerator events by administrative data

3983

1995

205

18

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

90.56%

88.16%

75.65%

NA

89.69%

86.80%

70.35%

NA

91.44%

89.51%

80.94%

NA

Total
6,958 791 6,201 89.12% 88.38% 89.86%

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September 2013

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

Medication Management for People With Asthma (MMA)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

5-11 years

12-18 years

19-50 years

51-64 years

Data Element

General Measure
Data

Medication Medication Medication Medication Medication Medication Medication Medication

Compliance Compliance Compliance Compliance Compliance Compliance Compliance Compliance

50%

75%

50%

75%

50%

75%

50%

75%

Measurement year

2012

Data collection methodology (administrative)

A

Eligible population

3983

1995

205

18

Number of required exclusions

739

432

312

65

Numerator events by administrative data

1768

813

826

383

111

68

14

10

Reported rate

44.39%

20.41%

41.40%

19.20%

54.15%

33.17%

NA

NA

Lower 95% confidence interval

42.83%

19.15%

39.22%

17.44%

47.08%

26.48%

NA

NA

Upper 95% confidence interval

45.94%

21.68%

43.59%

20.95%

61.21%

39.86%

NA

NA

27 of 139

September 2013

Total

Medication Medication

Compliance Compliance

50%

75%

6,201 1,548

2,719

1,274

43.85% 42.60% 45.09%

20.55% 19.53% 21.56%

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

28 of 139

September 2013

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

Asthma Medication Ratio (AMR)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Data Element

Measure Data

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

Measurement year

2012

Data collection methodology (administrative)

A

Eligible population

4378

2249

268

26

Number of required exclusions

344

178

249

57

Numerator events by administrative data

2873

1400

123

14

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

65.62%

62.25%

45.90%

NA

64.21%

60.22%

39.74%

NA

67.04%

64.28%

52.05%

NA

Total
6,921 828 4,410 63.72% 62.58% 64.86%

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September 2013

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

Cholesterol Management for Patients With Cardiovascular Conditions (CMC)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 132
132 0.05 132
0 0 0 132

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

114 86.36%

20 15.15%

115 87.12%

17 12.88%

115 3
89.39% 83.76% 95.03%

17 29 34.85% 26.34% 43.36%

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September 2013

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

Controlling High Blood Pressure (CBP)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 4625
0
0.00% 411 0.1 453 0
0.00% 24 24 1 0 0 24 411 0 204
49.64% 44.68% 54.59%

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September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 24 17 NA NA NA

32 of 139

September 2013

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

Comprehensive Diabetes Care (CDC)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

Eye Exam

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

2012 H
2487

2012 H
2487

2012 H
2487

2012 H
2154

2012 H
2487

Number of numerator events by

administrative data in eligible population 1870

2047

363

283

846

(before optional exclusions)

Current year's administrative rate (before optional exclusions)

75.19%

82.31%

14.60%

13.14%

34.02%

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

548 0.15 631 484 76.70%

548 0.15 631 556 88.11%

548 0.15 631 64 10.14%

548 0.15 631 44 6.97%

548 0.15 631 231 36.61%

Number of original sample records excluded because of valid data errors

0

0

0

0

0

Number of optional administrative data records excluded

0

0

0

0

0

Number of optional medical data records excluded

0

0

0

0

0

Number of HbA1c <7 required medical records excluded

32

Number of HbA1c <7 required administrative data records excluded

87

Number of employee/dependent medical records excluded

0

0

0

0

0

Records added from the oversample list

0

0

0

0

0

LDL-C Screening
2012

Blood

LDL-C Level <100 mg/dL

Medical Attention for Nephropathy

Pressure Controlled <140/80 mm

Hg

2012

2012

2012

H

H

H

H

2487

2487

2487

2487

1638

326

1643

17

65.86%
548 0.15 631 436 69.10%
0
0
0

13.11%
548 0.15 631 51 8.08%
0
0
0

66.06%
548 0.15 631 437 69.26%
0
0
0

0.68%
548 0.15 631
5 0.79%
0
0
0

0

0

0

0

0

0

0

0

33 of 139

September 2013

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

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

548
418
12 78.47% 74.93% 82.00%

548
215
81 54.01% 49.75% 58.28%

548
55
159 39.05% 34.88% 43.23%

445
37
107 32.36% 27.90% 36.82%

548
205
17 40.51% 36.31% 44.71%

548
376
6 69.71% 65.77% 73.65%

548
46
108 28.10% 24.25% 31.96%

548
381
18 72.81% 68.99% 76.63%

548
5
151 28.47% 24.60% 32.34%

34 of 139

September 2013

Blood Pressure Controlled <140/90 mm
Hg 2012
H 2487
26
1.05% 548 0.15 631 7
1.11% 0 0 0
0 0
35 of 139

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

548
7
276 51.64% 47.37% 55.92%

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

36 of 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 82 51
62.20% 51.09% 73.30%

37 of 139

September 2013

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

Use of Imaging Studies for Low Back Pain (LBP)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 1845 481
73.93% 71.90% 75.96%

38 of 139

September 2013

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

Antidepressant Medication Management (AMM)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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
1234

Effective Acute Phase
Treatment

Effective Continuation
Phase Treatment

617 50.00% 47.17% 52.83%

404 32.74% 30.08% 35.40%

39 of 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

6639 2615 39.39% 38.21% 40.57%

1241 659 53.10% 50.29% 55.92%

40 of 139

September 2013

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

Follow-Up After Hospitalization for Mental Illness (FUH)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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
2180

30-day 7-day follow-

follow-up

up

1682 77.16% 75.37% 78.94%

1316 60.37% 58.29% 62.44%

41 of 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 491 400 417
84.93% 81.66% 88.20%

42 of 139

September 2013

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

Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 24 0 11 NA NA NA

43 of 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 1 0 NA NA NA

44 of 139

September 2013

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

Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 98 45 39
39.80% 29.59% 50.00%

45 of 139

September 2013

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

Annual Monitoring for Patients on Persistent Medications (MPM)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Data Element

General Measure
Data

ACE Inhibitors or
ARBs

Digoxin

Diuretics

Anticonvulsants

Measurement year

2012

Data collection methodology (administrative)

A

Eligible population

2036

22

1910

190

Numerator events by administrative data

1802

19

1678

121

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

88.51%

NA

87.85%

63.68%

87.10%

NA

86.36%

56.58%

89.92%

NA

89.34%

70.79%

Total
4,158 3,620 87.06% 86.03% 88.09%

46 of 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Data Element

General Measure
Data

20-44 years 45-64 years 65+ years

Total

Measurement year

2012

Data collection methodology (administrative)

A

Eligible population

24969

3606

5

28,580

Numerator events by administrative data

21426

3289

4

24,719

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

85.81%

91.21%

NA

86.49%

85.38%

90.27%

NA

86.09%

86.25%

92.15%

NA

86.89%

47 of 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Data Element

General Measure
Data

12-24 months

25 months 6 years

7-11 years

12-19 years

Measurement year

2012

Data collection methodology (administrative)

A

Eligible population

21341

102928

67330

73563

Numerator events by administrative data

20820

94314

61809

65891

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

97.56% 97.35% 97.77%

91.63% 91.46% 91.80%

91.80% 91.59% 92.01%

89.57% 89.35% 89.79%

48 of 139

September 2013

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

Annual Dental Visit (ADV)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Data Element

Measure Data

2-3 Years 4-6 Years 7-10 Years 11-14 Years 15-18 Years 19-21 Years

Measurement year

2012

Data collection methodology (administrative)

A

Eligible population

38249

65818

76153

67673

49666

2636

Numerator events by administrative data

19972

51084

61202

49887

31320

1104

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

52.22% 51.71% 52.72%

77.61% 77.29% 77.93%

80.37% 80.08% 80.65%

73.72% 73.39% 74.05%

63.06% 62.64% 63.49%

41.88% 39.98% 43.78%

Total
300,195 214,569 71.48% 71.31% 71.64%

49 of 139

September 2013

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

Initiation and Engagement of AOD Dependence Treatment (IET)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

648

2515

Numerator events by administrative data

318

113

1209

275

Reported rate

49.07%

17.44%

48.07%

10.93%

Lower 95% confidence interval

45.15%

14.44%

46.10%

9.69%

Upper 95% confidence interval

53.00%

20.44%

50.04%

12.17%

Total

Initiation of AOD
Treatment

Engagement of AOD
Treatment

3,163

1,527

388

48.28%

12.27%

46.52%

11.11%

50.03%

13.43%

50 of 139

September 2013

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

Prenatal and Postpartum Care (PPC)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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
27243

Postpartum Care
2012 H
27243

10375

10303

38.08% 411 0.05 432 160
37.04% 2 0 2
411 154 192 84.18% 80.54% 87.83%

37.82% 411 0.05 432 144
33.33% 2 0 2
411 138 119 62.53% 57.73% 67.33%

51 of 139

September 2013

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

Call Answer Timeliness (CAT)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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
530463 451448 85.10% 85.01% 85.20%

52 of 139

September 2013

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

Frequency of Ongoing Prenatal Care (FPC)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Data Element

General Measure
Data

<21 Percent

21-40 Percent

41-60 Percent

61-80 Percent

Measurement year

2012

Data collection methodology (administrative or hybrid)

H

Eligible population

27243

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

17913

4689

1851

1119

Current year's administrative rate (before exclusions)

65.75%

17.21%

6.79%

4.11%

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

276

79

27

23

Administrative rate on FSS

63.89%

18.29%

6.25%

5.32%

Number of original sample records excluded because of valid data errors

2

Number of employee/dependent medical records excluded

0

Records added from the oversample list

2

Denominator

411

Numerator events by administrative data

50

14

6

10

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

3 12.90% 9.53% 16.26%

7 5.11% 2.86% 7.36%

17 5.60% 3.25% 7.94%

47 13.87% 10.41% 17.33%

81+ Percent
1671 6.13%
27 6.25%
30 227 62.53% 57.73% 67.33%

53 of 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Data Element

Measure Data

0 visits

1 visit

2 visits

Measurement year

2012

Data collection methodology (administrative or hybrid)

H

Eligible population

15912

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

468

602

822

Current year's administrative rate (before

exclusions)

Minimum required sample size (MRSS) or other sample size

392

Oversampling rate

0.05

Final sample size (FSS)

412

Number of numerator events by administrative

data in FSS

Administrative rate on FSS

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

392

Numerator events by administrative data

Numerator events by medical records

Reported rate

Lower 95% confidence interval

Upper 95% confidence interval

2.94%

3.78%

5.17%

18 4.37%

19 4.61%

21 5.10%

12 0 3.06% 1.23% 4.89%

11 2 3.32% 1.42% 5.22%

10 0 2.55% 0.86% 4.24%

3 visits
1163 7.31%
37 8.98%
21 3 6.12% 3.62% 8.62%

4 visits
1701 10.69%
38 9.22%
19 11 7.65% 4.89% 10.41%

5 visits

6 or more visits

2855 17.94%

8301 52.17%

69 16.75%

210 50.97%

27 15 10.71% 7.52% 13.90%

205 56 66.58% 61.78% 71.38%

54 of 139

September 2013

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

Adolescent Well-Care Visits (AWC)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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
101932
43459
42.64% 411 0.05 432 207
47.92% 0 0 0
411 197 15 51.58% 46.63% 56.53%

55 of 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 86526
56930
65.80% 371 0.05 390 258
66.15% 0 0 0
371 245
9 68.46% 63.60% 73.33%

56 of 139

September 2013

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

Frequency of Selected Procedures (FSP)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

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

Male 1,840,826 1,107,046
68,158 59,288 15,040

Female 1,790,797 1,149,439 1,109,463 657,657
52,635

Total 3,631,679 2,256,502

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

2

0.00

20-44

Male

4

0.06

Female

55

0.08

45-64

Male

0

0.00

Female

6

0.11

0-9

Male &

3375

0.93

10-19

Female

910

0.40

15-44

Female

343

0.31

45-64

44

0.84

15-44

335

0.30

Female

45-64

47

0.89

30-64

Male

1

0.02

15-44

Female

21

0.02

45-64

1

0.02

30-64

Male

24

0.40

15-44

Female

970

0.87

45-64

36

0.68

20-44

Male

53

0.78

Female

132

0.20

45-64

Male

22

1.46

Female

46

0.87

57 of 139

September 2013

Mastectomy Lumpectomy

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

15-44

Female

49

0.04

45-64

65

1.23

15-44

Female

178

0.16

45-64

69

1.31

58 of 139

September 2013

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

Ambulatory Care: Total (AMBA)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 469,334 3,162,345 2,256,502 725,815 67,675
89 4 1 0 6,681,765 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

431864 1184326 606952 347003
54433 44 1 0 0
2,624,623

920.16 374.51 268.98 478.09 804.33 494.38 250.00
0.00
392.80

47662 169845 97562 104113
7104 4 0 0 0
426,290

101.55 53.71 43.24 143.44 104.97 44.94 0.00 0.00
63.80

59 of 139

September 2013

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

Ambulatory Care: Dual Eligibles (AMBB)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 139

September 2013

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

Ambulatory Care: Disabled (AMBC)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 139

September 2013

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

Ambulatory Care: Other (AMBD)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Age

Member Months

<1

469,334

1-9

3,162,345

10-19

2,256,502

20-44

725,815

45-64

67,675

65-74

89

75-84

4

85+

1

Unknown

0

Total

6,681,765

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 Total

4116

8.77

24722

52.67

6.01

4234

1.34

11991

3.79

2.83

8016

3.55

22390

9.92

2.79

33773

46.53

89604

123.45

2.65

1165

17.21

4626

68.36

3.97

0

0.00

0

0.00

NA

0

0.00

0

0.00

NA

0

0.00

0

0.00

NA

0

0

NA

51,304

7.68

153,333

22.95

2.99

Medicine

Discharges /

Days / 1,000 Average

Age

Discharges 1,000 Member Days

Members Length of

Months

Months

Stay

<1

3284

7.00

11840

25.23

3.61

63 of 139

September 2013

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

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

3299

1.04

7724

2.44

2.34

1479

0.66

4100

1.82

2.77

2305

3.18

7189

9.90

3.12

702

10.37

2233

33.00

3.18

0

0.00

0

0.00

NA

0

0.00

0

0.00

NA

0

0.00

0

0.00

NA

0

0

NA

11,069

1.66

33,086

4.95

2.99

Surgery

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 Total

832

1.77

935

0.30

927

0.41

1492

2.06

434

6.41

0

0.00

0

0.00

0

0.00

0

4,620

0.69

Maternity*

12882 4267 4242 7328 2315
0 0 0 0 31,034

27.45 1.35 1.88 10.10 34.21 0.00 0.00 0.00
4.64

15.48 4.56 4.58 4.91 5.33 NA NA NA NA 6.72

Discharges /

Days / 1,000 Average

Age

Discharges 1,000 Member Days

Members Length of

Months

Months

Stay

10-19

5610

2.49

14048

6.23

2.50

20-44

29976

41.30

75087

103.45

2.50

45-64

29

0.43

78

1.15

2.69

Unknown

0

0

NA

Total

35,615

11.68

89,213

29.25

2.50

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

64 of 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Age

Member Months

<1

NR

1-9

NR

10-19

NR

20-44

NR

45-64

NR

65-74

NR

75-84

NR

85+

NR

Unknown

NR

Total

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 Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Medicine

NR

NR

NR

NR

NR

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 /

Days / 1,000 Average

Age

Discharges 1,000 Member Days

Members Length of

Months

Months

Stay

<1

NR

NR

NR

NR

NR

65 of 139

September 2013

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

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

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

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 Total

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

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.

66 of 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Age

Member Months

<1

NR

1-9

NR

10-19

NR

20-44

NR

45-64

NR

65-74

NR

75-84

NR

85+

NR

Unknown

NR

Total

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 Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Medicine

NR

NR

NR

NR

NR

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 /

Days / 1,000 Average

Age

Discharges 1,000 Member Days

Members Length of

Months

Months

Stay

<1

NR

NR

NR

NR

NR

67 of 139

September 2013

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

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

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

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 Total

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

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 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Age

Member Months

<1

NR

1-9

NR

10-19

NR

20-44

NR

45-64

NR

65-74

NR

75-84

NR

85+

NR

Unknown

NR

Total

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 Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Medicine

NR

NR

NR

NR

NR

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 /

Days / 1,000 Average

Age

Discharges 1,000 Member Days

Members Length of

Months

Months

Stay

<1

NR

NR

NR

NR

NR

69 of 139

September 2013

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

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

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

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 Total

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

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.

70 of 139

September 2013

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

Identification of Alcohol and Other Drug Services: Total (IADA)
WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

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

Member Months (Any)

Male 2286598 578034
93094 30755 42589
42 0

Female 2230569 590990 305536 325383 198050
52 0

Total 4,517,167 1,169,024 398,630 356,138 240,639
94 0

Member Months (Inpatient)

Male 2286598 578034
93094 30755 42589
42 0

Female 2230569 590990 305536 325383 198050
52 0

Total 4,517,167 1,169,024 398,630 356,138 240,639
94 0

Member Months (Intensive Outpatient/Partial Hospitalization)

Male

Female

Total

2286598

2230569 4,517,167

578034

590990

1,169,024

93094

305536

398,630

30755

325383

356,138

42589

198050

240,639

42

52

94

0

0

0

Member Months (Outpa

Male 2286598 578034
93094 30755 42589
42 0

Female 2230569 590990 305536 325383 198050
52 0

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

3,031,112
Sex
M F Total M F Total M F Total M F Total M F Total M F

3,650,580 6,681,692

Any Services

Number 81 62 143 763 411
1,174 236 864 1,100 262 1835 2,097 368 1104 1,472
0 0

Percent 0.04% 0.03% 0.04% 1.58% 0.83% 1.21% 3.04% 3.39% 3.31% 10.22% 6.77% 7.07% 10.37% 6.69% 7.34% 0.00% 0.00%

3,031,112 3,650,580

Inpatient

Number 12 9 21 116 100 216 62 319 381 62 591 653 82 302 384 0 0

Percent 0.01% 0.00% 0.01% 0.24% 0.20% 0.22% 0.80% 1.25% 1.15% 2.42% 2.18% 2.20% 2.31% 1.83% 1.91% 0.00% 0.00%

6,681,692 3,031,112

Intensive Outpatient/Partial
Hospitalization

Number 2 0 2 37 23 60

Percent 0.00% 0.00% 0.00% 0.08% 0.05% 0.06%

9

0.12%

27

0.11%

36

0.11%

8

0.31%

58

0.21%

66

0.22%

8

0.23%

42

0.25%

50

0.25%

0

0.00%

0

0.00%

3,650,580 6,681,692

Outpatient/ED

Number 69 54 123 681 340
1,021 201 658 859 231 1529 1,760 334 946 1,280
0 0

Percent 0.04% 0.03% 0.03% 1.41% 0.69% 1.05% 2.59% 2.58% 2.59% 9.01% 5.64% 5.93% 9.41% 5.73% 6.38% 0.00% 0.00%

3,031,112

3,650,580

71 of 139

September 2013

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

Unknown Total

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

1,710

0.68%

334

0.13%

64

0.03%

1,516

0.60%

F

4,276

1.41%

1,321

0.43%

150

0.05%

3,527

1.16%

Total

5,986

1.08%

1,655

0.30%

214

0.04%

5,043

0.91%

72 of 139

September 2013

atient/ED)
Total 4,517,167 1,169,024 398,630 356,138 240,639
94 0
6,681,692

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

73 of 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

18-24

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

0-12

Number

Percent

Number

Percent

Number

Percent

Number

Percent

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

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

18-24

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

25-34

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

M

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

74 of 139

September 2013

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

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

75 of 139

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 WellCare

76 of 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

18-24

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

0-12

Number

Percent

Number

Percent

Number

Percent

Number

Percent

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

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

18-24

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

25-34

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

M

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

77 of 139

September 2013

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

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

78 of 139

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 WellCare

79 of 139

September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

18-24

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

0-12

Number

Percent

Number

Percent

Number

Percent

Number

Percent

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

13-17

F

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

18-24

F

NR

NR

NR

NR

NR

NR

NR

NR

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

25-34

F

NR

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

M

35-64

F

NR

NR

NR

NR

NR

NR

NR

NR

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

Member Months (Outpa

Male NR NR NR NR NR NR NR NR

Female NR NR NR NR NR NR NR NR

80 of 139

September 2013

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

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

81 of 139

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 WellCare

82 of 139

September 2013

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

Mental Health Utilization: Total (MPTA)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

2286598

2230569 4,517,167 2286598

2230569 4,517,167 2286598

2230569 4,517,167

13-17

578034

590990

1,169,024

578034

590990

1,169,024

578034

590990

1,169,024

18-64

166438

828969

995,407

166438

828969

995,407

166438

828969

995,407

65+

42

52

94

42

52

94

42

52

94

Unknown

0

0

0

0

0

0

0

0

0

Total

3,031,112 3,650,580 6,681,692 3,031,112 3,650,580 6,681,692 3,031,112 3,650,580 6,681,692

Age

Sex

Any Services

Inpatient

Intensive Outpatient/Partial
Hospitalization

Outpatient/ED

Number

Percent

Number

Percent

Number

Percent

Number

Percent

M

16754

8.79%

307

0.16%

128

0.07%

16719

8.77%

0-12

F

10053

5.41%

168

0.09%

63

0.03%

10021

5.39%

Total

26,807

7.12%

475

0.13%

191

0.05%

26,740

7.10%

M

6197

12.86%

411

0.85%

116

0.24%

6123

12.71%

13-17

F

6127

12.44%

665

1.35%

150

0.30%

6039

12.26%

Total

12,324

12.65%

1,076

1.10%

266

0.27%

12,162

12.48%

M

1332

9.60%

151

1.09%

29

0.21%

1290

9.30%

18-64

F

8180

11.84%

745

1.08%

121

0.18%

7984

11.56%

Total

9,512

11.47%

896

1.08%

150

0.18%

9,274

11.18%

M

0

0.00%

0

0.00%

0

0.00%

0

0.00%

65+

F

0

0.00%

0

0.00%

0

0.00%

0

0.00%

Total

0

0.00%

0

0.00%

0

0.00%

0

0.00%

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

24,283

9.61%

869

0.34%

273

0.11%

24,132

9.55%

Total

F

24,360

8.01%

1,578

0.52%

334

0.11%

24,044

7.90%

Total

48,643

8.74%

2,447

0.44%

607

0.11%

48,176

8.65%

Member Months (Outpa

Male 2286598 578034 166438
42 0 3,031,112

Female 2230569 590990 828969
52 0 3,650,580

83 of 139

September 2013

atient/ED)
Total 4,517,167 1,169,024 995,407
94 0 6,681,692

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

84 of 139

September 2013

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

Mental Health Utilization: Dual Eligibles (MPTB)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

85 of 139

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 WellCare

86 of 139

September 2013

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

Mental Health Utilization: Disabled (MPTC)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

87 of 139

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 WellCare

88 of 139

September 2013

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

Mental Health Utilization: Other (MPTD)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

89 of 139

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 WellCare

90 of 139

September 2013

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

Antibiotic Utilization: Total (ABXA)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Pharmacy Benefit Member Months

Age

Male

Female

Total

0-9

1840826

1790797

3,631,623

10-17

1023806

1030762

2,054,568

18-34

123849

630919

754,768

35-49

35857

172613

208,470

50-64

6732

25437

32,169

65-74

41

48

89

75-84

1

3

4

85+

0

1

1

Unknown

0

0

0

Total

3,031,112 3,650,580

6,681,692

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

221675

1.45

2058573

9.29

102431

0.67

46.21%

0-9

F

215469

1.44

2024899

9.40

93133

0.62

43.22%

Total

437,144

1.44

4,083,472

9.34

195,564

0.65

44.74%

M

61804

0.72

624333

10.10

27791

0.33

44.97%

10-17

F

82024

0.95

783189

9.55

34797

0.41

42.42%

Total

143,828

0.84

1,407,522

9.79

62,588

0.37

43.52%

M

8876

0.86

84330

9.50

3455

0.33

38.93%

18-34

F

109316

2.08

864671

7.91

37206

0.71

34.04%

Total

118,192

1.88

949,001

8.03

40,661

0.65

34.40%

M

3886

1.30

35861

9.23

1638

0.55

42.15%

35-49

F

31466

2.19

266057

8.46

13461

0.94

42.78%

Total

35,352

2.03

301,918

8.54

15,099

0.87

42.71%

M

765

1.36

6729

8.80

359

0.64

46.93%

50-64

F

4488

2.12

38878

8.66

2202

1.04

49.06%

91 of 139

September 2013

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

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

5,253 3 2 5 0 0 0 0 0 0 0 0 0
297,009 442,765 739,774
Total Quinolone
Scrips
79 133 212 505 1451 1,956 590 8711 9,301 453 4219 4,672

1.96

45,607

8.68

2,561

0.96

48.75%

0.88

26

8.67

2

0.59

66.67%

0.50

15

7.50

2

0.50

100.00%

0.67

41

8.20

4

0.54

80.00%

0.00

0

NA

0

0.00

NA

0.00

0

NA

0

0.00

NA

0.00

0

NA

0

0.00

NA

NA

0

NA

0

NA

NA

0.00

0

NA

0

0.00

NA

0.00

0

NA

0

0.00

NA

NA

0

NA

0

NA

NA

NA

0

NA

0

NA

NA

NA

0

NA

0

NA

NA

1.18

2,809,852

9.46

135,676

0.54

45.68%

1.46

3,977,709

8.98

180,801

0.59

40.83%

1.33

6,787,561

9.18

316,477

0.57

42.78%

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

Generation

Average Scrips PMPY for
Azithromycins and Clarithro-
mycins

Total Amoxicillin/ Clavulanate
Scrips

Average Scrips PMPY for
Amoxicillin/ Clavulanates

Total Ketolides
Scrips

0.00

26494

0.17

41268

0.27

32204

0.21

0

0.00

25273

0.17

37248

0.25

28267

0.19

0

0.00

51,767

0.17

78,516

0.26

60,471

0.20

0

0.01

3927

0.05

14383

0.17

7467

0.09

0

0.02

5395

0.06

17730

0.21

8132

0.09

0

0.01

9,322

0.05

32,113

0.19

15,599

0.09

0

0.06

222

0.02

1588

0.15

657

0.06

0

0.17

2114

0.04

17010

0.32

5290

0.10

0

0.15

2,336

0.04

18,598

0.30

5,947

0.09

0

0.15

105

0.04

613

0.21

267

0.09

0

0.29

786

0.05

5197

0.36

1987

0.14

0

0.27

891

0.05

5,810

0.33

2,254

0.13

0

92 of 139

September 2013

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

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

93 798 891
1 1 2 0 0 0 0 0 0 0 0 0 1,721 15,313 17,034

0.17

35

0.06

133

0.38

126

0.06

776

0.33

161

0.06

909

0.29

0

0.00

1

0.25

0

0.00

0

0.27

0

0.00

1

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

NA

0

NA

0

0.00

0

0.00

0

0.00

0

0.00

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

0.01

30,783

0.12

57,986

0.05

33,694

0.11

77,961

0.03

64,477

0.12

135,947

0.24

50

0.09

0

0.37

307

0.14

0

0.34

357

0.13

0

0.29

0

0.00

0

0.00

1

0.25

0

0.13

1

0.13

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

NA

0

NA

0

0.00

0

0.00

0

0.00

0

0.00

0

NA

0

NA

0

NA

0

NA

0

NA

0

NA

0

0.23

40,645

0.16

0

0.26

43,984

0.14

0

0.24

84,629

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

10227

0.07

15

0.00

13357

0.09

0

0.00

227

15703

0.11

10

0.00

14213

0.10

0

0.00

271

25,930

0.09

25

0.00

27,570

0.09

0

0.00

498

4362

0.05

26

0.00

6132

0.07

0

0.00

223

8176

0.10

54

0.00

6991

0.08

0

0.00

219

12,538

0.07

80

0.00

13,123

0.08

0

0.00

442

863

0.08

0

0.00

786

0.08

0

0.00

61

9658

0.18

9

0.00

7756

0.15

0

0.00

486

10,521

0.17

9

0.00

8,542

0.14

0

0.00

547

474

0.16

0

0.00

362

0.12

0

0.00

25

3234

0.22

4

0.00

2016

0.14

0

0.00

174

93 of 139

September 2013

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

Total

3,708

0.21

4

0.00

2,378

0.14

0

M

93

0.17

0

0.00

64

0.11

0

50-64

F

408

0.19

0

0.00

373

0.18

0

Total

501

0.19

0

0.00

437

0.16

0

M

0

0.00

0

0.00

0

0.00

0

65-74

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

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

NA

0

NA

0

NA

0

85+

F

0

0.00

0

0.00

0

0.00

0

Total

0

0.00

0

0.00

0

0.00

0

M

0

NA

0

NA

0

NA

0

Unknown

F

0

NA

0

NA

0

NA

0

Total

0

NA

0

NA

0

NA

0

M

16,019

0.06

41

0.00

20,701

0.08

0

Total

F

37,179

0.12

77

0.00

31,349

0.10

0

Total

53,198

0.10

118

0.00

52,050

0.09

0

0.00

199

0.00

5

0.00

34

0.00

39

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

0.00

0

NA

0

0.00

0

0.00

0

NA

0

NA

0

NA

0

0.00

541

0.00

1,184

0.00

1,725

94 of 139

September 2013

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

95 of 139

September 2013

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

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

2362

0.02

24

0.00

0.00

2185

0.01

27

0.00

0.00

4,547

0.02

51

0.00

0.00

1475

0.02

34

0.00

0.00

2067

0.02

22

0.00

0.00

3,542

0.02

56

0.00

0.00

386

0.04

12

0.00

0.00

4037

0.08

44

0.00

0.00

4,423

0.07

56

0.00

0.00

198

0.07

2

0.00

0.00

1207

0.08

65

0.00

0.00

1,405

0.08

67

0.00

96 of 139

September 2013

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

0.00

42

0.07

6

0.01

0.00

173

0.08

22

0.01

0.00

215

0.08

28

0.01

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

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

4,463

0.02

78

0.00

0.00

9,669

0.03

180

0.00

0.00

14,132

0.03

258

0.00

Average

Scrips

PMPY for Total Penicillin

Macrolides

Scrips

(not azith. or

Average Scrips PMPY for Penicillins

clarith.)

0.00

95133

0.62

0.00

91283

0.61

0.00

186,416

0.62

0.00

17952

0.21

0.00

22278

0.26

0.00

40,230

0.23

0.01

2473

0.24

0.01

20675

0.39

0.01

23,148

0.37

0.01

906

0.30

0.01

5657

0.39

Total Tetracycline
Scrips
67 47 114 4994 5336 10,330 1049 7310 8,359 343 2292

Average Scrips PMPY
for Tetracyclines
0.00 0.00 0.00 0.06 0.06 0.06 0.10 0.14 0.13 0.11 0.16

Total Misc. Antibiotic
Scrips
218 809 1,027 324 4173 4,497 189 26216 26,405 138 4628

Average Scrips PMPY for Misc. Antibiotics
0.00 0.01 0.00 0.00 0.05 0.03 0.02 0.50 0.42 0.05 0.32

97 of 139

September 2013

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

0.01

6,563

0.38

2,635

0.15

4,766

0.27

0.01

153

0.27

57

0.10

34

0.06

0.02

749

0.35

307

0.14

415

0.20

0.01

902

0.34

364

0.14

449

0.17

0.00

1

0.29

0

0.00

0

0.00

0.00

0

0.00

0

0.00

0

0.00

0.00

1

0.13

0

0.00

0

0.00

0.00

0

0.00

0

0.00

0

0.00

0.00

0

0.00

0

0.00

0

0.00

0.00

0

0.00

0

0.00

0

0.00

NA

0

NA

0

NA

0

NA

0.00

0

0.00

0

0.00

0

0.00

0.00

0

0.00

0

0.00

0

0.00

NA

0

NA

0

NA

0

NA

NA

0

NA

0

NA

0

NA

NA

0

NA

0

NA

0

NA

0.00

116,618

0.46

6,510

0.03

903

0.00

0.00

140,642

0.46

15,292

0.05

36,241

0.12

0.00

257,260

0.46

21,802

0.04

37,144

0.07

98 of 139

September 2013

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

Antibiotic Utilization: Dual Eligibles (ABXB)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

Total Days

Scrips PMPY Supplied for All

for Antibiotics Antibiotic Scrips

Average Days Supplied per Antibiotic Scrip

Total Number of Scrips for Antibiotics of
Concern

Average Scrips PMPY for
Anitbiotics of Concern

Percentage of Antibiotics of Concern of all
Antibiotic Scrips

M

NR

NR

NR

0-9

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

10-17

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

18-34

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

35-49

F

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

99 of 139

September 2013

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

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Antibiotics of Concern Utilization

Total Quinolone
Scrips

Average Scrips PMPY
for Quinolones

Total Cephalosporin
2nd-4th Generation
Scrips

Average Scrips PMPY for
Cephalosporins 2nd-4th
Generation

Total Azithromycin
and Clarithromycin
Scrips

Average Scrips PMPY for
Azithromycins and
Clarithromycins

Total Amoxicillin/ Clavulanate
Scrips

Average Scrips PMPY for
Amoxicillin/ Clavulanates

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

100 of 139

September 2013

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

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

All Other Antibiotics Utilization

Total Absorbable Sulfonamide
Scrips

Average Scrips PMPY
for Absorbable Sulfonamides

Total Aminoglycoside
Scrips

Average Scrips PMPY for
Aminoglycosides

Total 1st Generation Cephalosporin
Scrips

Average Scrips PMPY for 1st Generation
Cephalosporins

Total

Average Scrips

Lincosamide PMPY for

Scrips

Lincosamides

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

101 of 139

September 2013

M

NR

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 WellCare

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

102 of 139

September 2013

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

103 of 139

September 2013

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

Total Ketolides
Scrips

Average Scrips PMPY for Ketolides

Total Clindamycin
Scrips

Total Misc. Average Scrips

Average Scrips PMPY for
Clindamycins

Antibiotics of Concern 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

104 of 139

September 2013

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

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

Total Penicillin
Scrips
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

105 of 139

September 2013

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

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 139

September 2013

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

Antibiotic Utilization: Disabled (ABXC)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

0-9 10-17 18-34 35-49

M

NR

NR

NR

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

F

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

107 of 139

September 2013

50-64 65-74 75-84 85+ Unknown Total
Age
0-9 10-17 18-34
108 of 139

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

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

Antibiotics of Concern Utilization

Total Quinolone
Scrips

Average Scrips PMPY for
Quinolones

Total Cephalosporin
2nd-4th Generation
Scrips

Average Scrips

Total

PMPY for Cephalosporins 2nd-4th Generation

Azithromycin and
Clarithromycin Scrips

Average Scrips PMPY for
Azithromycins and
Clarithromycins

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

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

35-49 50-64 65-74 75-84 85+ Unknown Total
Age
0-9 10-17 18-34
109 of 139

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

All Other Antibiotics U

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

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

35-49 50-64 65-74 75-84 85+ Unknown Total

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

M

NR

NR

NR

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

F

NR

NR

NR

Total

NR

NR

NR

M

NR

NR

NR

F

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

110 of 139

September 2013

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

Percentage of Antibiotics of Concern of all
Antibiotic Scrips
NR NR NR NR NR NR NR NR NR NR NR NR
111 of 139

September 2013

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

NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR

Total Amoxicillin/ Clavulanate
Scrips

Average Scrips PMPY for
Amoxicillin/ Clavulanates

Total Ketolides
Scrips

Average Scrips PMPY for Ketolides

Total Clindamycin
Scrips

Total Misc.

Average Scrips PMPY for
Clindamycins

Antibiotics of Concern Scrips

Average Scrips PMPY for Misc. Antibiotics of
Concern

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

112 of 139

September 2013

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Utilization

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

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 Lincosamide
Scrips

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 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

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

113 of 139

September 2013

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

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 139

September 2013

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

Antibiotic Utilization: Other (ABXD)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

NR

NR

NR

NR

0-9

F

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

10-17

F

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

18-34

F

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

M

NR

NR

NR

NR

NR

NR

NR

35-49

F

NR

NR

NR

NR

NR

NR

NR

Total

NR

NR

NR

NR

NR

NR

NR

115 of 139

September 2013

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

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

Antibiotics of Concern Utilization

Total Quinolone
Scrips

Average Scrips PMPY for
Quinolones

Total Cephalosporin
2nd-4th Generation
Scrips

Average Scrips PMPY for
Cephalosporins 2nd-4th
Generation

Total Azithromycin
and Clarithromycin
Scrips

Average Scrips PMPY for
Azithromycins and
Clarithromycins

Total Amoxicillin/ Clavulanate
Scrips

Average Scrips PMPY for
Amoxicillin/ Clavulanates

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

116 of 139

September 2013

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

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

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

All Other Antibiotics Utilization

Total Absorbable Sulfonamide
Scrips

Average Scrips PMPY for
Absorbable Sulfonamides

Total Aminoglycoside
Scrips

Average Scrips PMPY for
Aminoglycosides

Total 1st Generation Cephalosporin
Scrips

Average Scrips PMPY for 1st Generation
Cephalosporins

Total

Average Scrips

Lincosamide PMPY for

Scrips

Lincosamides

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

117 of 139

September 2013

M

NR

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 WellCare

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

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 139

September 2013

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

119 of 139

September 2013

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

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

120 of 139

September 2013

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

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

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

Average Scrips PMPY for Penicillins

Total Tetracycline
Scrips

Average Scrips PMPY
for Tetracyclines

Total Misc. Antibiotic
Scrips

Average Scrips PMPY for Misc. Antibiotics

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

121 of 139

September 2013

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

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

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

NR

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

Board Certification (BCR)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

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

Number of Physicians in Each Practice
Area
1282 1321 896 1105
39 4474

Board Certification

Number

Percent

863 827 542 682 27 2608

67.32% 62.60% 60.49% 61.72% 69.23% 58.29%

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

Total Membership (TLM)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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*
572,311 572311
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 572,311

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September 2013

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

Enrollment by Product Line: Total (ENPA)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 237364 747508 855954 702309 321497
83240 2,947,872
97.25% 9854 14056 16699 15693 11856 68,158 2.25% 8308 4521 1718 493 15,040 0.50% 35 6 0 1 0 0 42 0.00% 0

Female Member Months 231923 720325 838549 697633 333129 118677 2,940,236 80.54% 186859 178669 146714
94364 51051 657,657 18.02% 27198 15085 6643 3709 52,635 1.44%
48 0 3 0 0 1 52 0.00% 0

Total Member Months 469,287 1,467,833 1,694,503 1,399,942 654,626 201,917 5,888,108 88.12% 196,713 192,725 163,413 110,057 62,907 725,815 10.86% 35,506 19,606
8,361 4,202 67,675 1.01%
83 6 3 1 0 1 94 0.00% 0

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September 2013

Total

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for WellCare
3,031,112 3,650,580 6,681,692

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

Enrollment by Product Line: Dual Eligibles (ENPB)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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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September 2013

Total

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

NR

NR

NR

128 of 139

September 2013

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

Enrollment by Product Line: Disabled (ENPC)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

129 of 139

September 2013

Total

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

NR

NR

NR

130 of 139

September 2013

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

Enrollment by Product Line: Other (ENPD)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

131 of 139

September 2013

Total

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

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 WellCare

Enrollment by State (EBS)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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 32 0 1 1 6 1 0 0 0 47
572111 0 0 15 1 1 0 7 2 0 2 1 2 0 4 7 0 0 0 0 5 0

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September 2013

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

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

9 6 0 7 5 1 0 1 14 0 5 13 0 0 1 2 0 1 0 0 0 0 0 0 1 0 572,312

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

Race/Ethnicity Diversity of Membership (RDM)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Race/Ethnicity Diversity of Membership

Total Unduplicated Membership During the Measurement Year

774412

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

Direct Data Collection Method

Indirect Data Collection Method

Unknown

Direct Total 100.00%

Race

Health Plan Direct*
CMS/State Database*

0.0000 1.0000

Indirect Total*

0.0000

Total*

0.0000

Other*

0.0000

Direct Total 100.00%

Ethnicity

Health Plan Direct*
CMS/State Database*

0.0000 1.0000

Indirect Total*

0.0000

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

Unknown Ethnicity Number Percentage

White

0

0.00%

1847

3.60%

311328

43.97%

Black or African American

0

0.00%

28965

56.49%

260994

36.86%

American-Indian and Alaska Native

0

0.00%

488

0.95%

0

0.00%

Asian

0

0.00%

11791

22.99%

0

0.00%

Native Hawaiian and Other Pacific Islanders

0

0.00%

473

0.92%

0

0.00%

Some Other Race

0

0.00%

7713

15.04%

0

0.00%

Two or More Races

0

0.00%

0

0.00%

3

0.00%

Unknown

15079

100.00%

0

0.00%

135731

19.17%

Declined

0

0.00%

0

0.00%

0

0.00%

Total

15,079

100.00%

51,277

100.00%

708,056

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 313,175 289,959
488 11,791
473
7,713 3
150,810 0
774,412

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September 2013

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

tal Percentage 40.44% 37.44% 0.06% 1.52% 0.06% 1.00% 0.00% 19.47% 0.00% 100.00%
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September 2013

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

Language Diversity of Membership (LDM)
WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

0.8506

0.1494

Preferred Language for Written Materials*

0.0000

Other Language Needs*

0.0000

*Enter percentage as a value between 0 and 1.

Spoken Language Preferred for Health Care

Number

English

713570

Non-English

54704

Unknown

6138

Declined

0

Total*

774,412

Language Preferred for Written Materials

Number

English

713479

Non-English

54699

Unknown

6234

Declined

0

Total*

774,412

Other Language Needs

Number

English

0

Non-English

0

Unknown

774412

Declined

0

Total*

774,412

0.0000
0.0000
Percentage 92.14% 7.06% 0.79% 0.00% 100.00%
Percentage 92.13% 7.06% 0.80% 0.00% 100.00%
Percentage 0.00% 0.00%
100.00% 0.00%
100.00%

1.0000 1.0000

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September 2013

Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for WellCare
*Should sum to 100%

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September 2013

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

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

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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
3136 2458 17599 4431 2370 29,994

Percentage 10.46% 8.19% 58.68% 14.77% 7.90% 100.00%

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

Audit Review Table

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, 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

Weight Assessment and Counseling for Nutrition

and Physical Activity for Children/Adolescents

Y

(wcc)

BMI Percentile

Counseling for Nutrition

Counseling for Physical Activity

Childhood Immunization Status (cis)

Y

DTaP

IPV

MMR

HiB

Hepatitis B

VZV

Pneumococcal Conjugate

Hepatitis A

Rotavirus

Influenza

Combination #2

Combination #3

Combination #4

Combination #5

Combination #6

Combination #7

Combination #8

Combination #9

Combination #10

Immunizations for Adolescents (ima)

Y

N

67.88%

R

N

38.69%

R

55.47%

R

42.09%

R

N

88.56%

R

96.11%

R

94.16%

R

95.13%

R

94.65%

R

94.16%

R

85.40%

R

94.40%

R

74.21%

R

47.20%

R

84.43%

R

78.83%

R

78.35%

R

64.72%

R

42.82%

R

64.48%

R

42.58%

R

38.69%

R

38.44%

R

1 of 17

Comment
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 WellCare

Meningococcal

72.99%

R

Tdap/Td

80.75%

R

Combination #1

70.98%

R

Human Papillomavirus Vaccine for Female Adolescents (hpv)

Y

19.95%

R

Lead Screening in Children (lsc)

Y

N

75.34%

R

Breast Cancer Screening (bcs)

Y

55.78%

R

Cervical Cancer Screening (ccs)

Y

72.51%

R

Chlamydia Screening in Women (chl)

Y

16-20 Years

44.26%

R

21-24 Years

62.42%

R

Total

48.66%

R

Effectiveness of Care: Respiratory Conditions

Appropriate Testing for Children with Pharyngitis (cwp)

Y

Y

75.70%

R

Appropriate Treatment for Children With URI (uri)

Y

Y

79.95%

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%

16.30%

R

39.62%

R

73.28%

R

84.73%

R

90.56%

R

88.16%

R

75.65%

R

NA

R

89.12%

R

44.39%

R

20.41%

R

2 of 17

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

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

12-18 Years - Medication Compliance 50%

12-18 Years - Medication Compliance 75%

19-50 Years - Medication Compliance 50%

19-50 Years - Medication Compliance 75%

51-64 Years - Medication Compliance 50%

51-64 Years - Medication Compliance 75%

Total - Medication Compliance 50%

Total - Medication Compliance 75%

Asthma Medication Ratio (amr)

Y

Y

5-11 Years

12-18 Years

19-50 Years

51-64 Years

Total

41.40%

R

19.20%

R

54.15%

R

33.17%

R

NA

R

NA

R

43.85%

R

20.55%

R

65.62%

R

62.25%

R

45.90%

R

NA

R

63.72%

R

Effectiveness of Care: Cardiovascular

Cholesterol Management for Patients With Cardiovascular Conditions (cmc)

Y

N

LDL-C Screening Performed

89.39%

R

LDL-C Control (<100 mg/dL)

34.85%

R

Controlling High Blood Pressure (cbp)

Y

49.64%

R

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

Y

Y

NA

R

Effectiveness of Care: Diabetes

Comprehensive Diabetes Care (cdc)

Y

Hemoglobin A1c (HbA1c) Testing

HbA1c Poor Control (>9.0%)

HbA1c Control (<8.0%)

HbA1c Control (<7.0%)

Eye Exam (Retinal) Performed

LDL-C Screening Performed

LDL-C Control (<100 mg/dL)

Medical Attention for Nephropathy

Blood Pressure Control (<140/80 mm Hg)

Blood Pressure Control (<140/90 mm Hg)

N

78.47%

R

54.01%

R

39.05%

R

32.36%

R

40.51%

R

69.71%

R

28.10%

R

72.81%

R

28.47%

R

51.64%

R

3 of 17

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

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

Effectiveness of Care: Musculoskeletal

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

Y

Y

Use of Imaging Studies for Low Back Pain (lbp)

Y

Effectiveness of Care: Behavioral Health

Antidepressant Medication Management (amm)

Y

Y

Effective Acute Phase Treatment

Effective Continuation Phase Treatment

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

Y

Y

Initiation Phase

Continuation and Maintenance (C&M) Phase

Follow-Up After Hospitalization for Mental Illness (fuh)

Y

Y

30-Day Follow-Up

7-Day Follow-Up

Diabetes Screening for People With Schizophrenia

or Bipolar Disorder Who Are Using Antipsychotic

Y

Y

Medication (ssd)

Diabetes Monitoring for People With Diabetes and Schizophrenia (smd)

Y

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

Y

Adherence to Antipsychotic Medications for Individuals With Schizophrenia (saa)

Y

Y

Effectiveness of Care: Medication Management

Annual Monitoring for Patients on Persistent Medications (mpm)

Y

Y

ACE Inhibitors or ARBs

Digoxin

Diuretics

Anticonvulsants

Total

Access/Availability of Care

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

Y

62.20%

R

73.93%

R

50.00%

R

32.74%

R

39.39%

R

53.10%

R

77.16%

R

60.37%

R

84.93%

R

NA

R

NA

R

39.80%

R

88.51%

R

NA

R

87.85%

R

63.68%

R

87.06%

R

4 of 17

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

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

20-44 Years 45-64 Years
65+ Years Total

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

Y

12-24 Months

25 Months - 6 Years

7-11 Years

12-19 Years

Annual Dental Visit (adv)

Y

Y

2-3 Years

4-6 Years

7-10 Years

11-14 Years

15-18 Years

19-21 Years

Total

Initiation and Engagement of AOD Dependence Treatment (iet)

Y

Y

Initiation of AOD Treatment: 13-17 Years

Engagement of AOD Treatment: 13-17 Years

Initiation of AOD Treatment: 18+ Years

Engagement of AOD Treatment: 18+ Years

Initiation of AOD Treatment: Total

Engagement of AOD Treatment: Total

Prenatal and Postpartum Care (ppc)

Y

Timeliness of Prenatal Care

Postpartum Care

Call Answer Timeliness (cat)

Y

Utilization

Frequency of Ongoing Prenatal Care (fpc)

Y

<21 Percent

21-40 Percent

41-60 Percent

85.81%

R

91.21%

R

NA

R

86.49%

R

97.56%

R

91.63%

R

91.80%

R

89.57%

R

52.22%

R

77.61%

R

80.37%

R

73.72%

R

63.06%

R

41.88%

R

71.48%

R

49.07%

R

17.44%

R

48.07%

R

10.93%

R

48.28%

R

12.27%

R

84.18%

R

62.53%

R

85.10%

R

12.90%

R

5.11%

R

5.60%

R

5 of 17

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

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

61-80 Percent

13.87%

R

81+ Percent

62.53%

R

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

Y

N

0 Visits

3.06%

R

1 Visit

3.32%

R

2 Visits

2.55%

R

3 Visits

6.12%

R

4 Visits

7.65%

R

5 Visits

10.71%

R

6+ Visits

66.58%

R

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

Y

Adolescent Well-Care Visits (awc)

Y

Frequency of Selected Procedures (fsp)

Y

N

68.46%

R

N

51.58%

R

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:

Y

R

Total (ipua)

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

6 of 17

Reportable Reportable
Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Measure Unselected Measure Unselected Measure Unselected Reportable
Measure Unselected
Measure Unselected
Measure Unselected
Reportable
Measure Unselected
Measure Unselected
Measure Unselected Reportable
September 2013

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

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

Antibiotic Utilization: Disabled (abxc)

N

N

NR

Antibiotic Utilization: Other (abxd)

N

N

NR

Relative Resource Use

Relative Resource Use for People With Diabetes (rdi)

Y

R

Relative Resource Use for People With Asthma (ras)

Y

Y

R

Relative Resource Use for People With Cardiovascular Conditions (rca)

Y

R

Relative Resource Use for People With Hypertension (rhy)

Y

R

Relative Resource Use for People With COPD (rco)

Y

R

Health Plan Descriptive Information

Board Certification (bcr)

Y

R

Total Membership (tlm)

Y

R

Enrollment by Product Line: Total (enpa)

Y

R

Enrollment by Product Line: Dual Eligibles (enpb)

N

NR

Enrollment by Product Line: Disabled (enpc)

N

NR

Enrollment by Product Line: Other (enpd)

N

NR

Enrollment by State (ebs)

Y

R

Race/Ethnicity Diversity of Membership (rdm)

Y

R

Language Diversity of Membership (ldm)

Y

R

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

Y

R

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

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September 2013

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

Relative Resource Use for People With Diabetes (RDI)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Data Element
Eligible Population Exclusions
Eligible Population per 1,000 Member Year Medical Eligible Population per 1,000 Member Year Pharmacy
NameBrandOnlyCount(N1) NameBrandGenericExistsCount(N2)
GenericOnlyCount (G1) GenericNameBrandExistsCount (G2) Total Prescriptions (N1+N2+G1+G2) Generic Utilization Rate [(G1 + G2)/(N2+G1+G2)] Generic Substitution Rate [(G2)/(N2+G2)] Overall Generic Utilization [(G1+G2)/(N1+N2+G1+G2)]
Inpatient Facility PMPM E&M Inpatient Services PMPM E&M Outpatient Services PMPM Surgery & Procedure Inpatient Services PMPM Surgery & Procedure Outpatient Services PMPM
Imaging Services PMPM Laboratory Services PMPM
Pharmacy PMPM Inpatient Facility: Acute Inpatient: Medical Days per 1000 MY Inpatient Facility: Acute Inpatient: Medical Discharges per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Days per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Discharges per 1000 MY
Inpatient Facility: Nonacute Days per 1000 MY Inpatient Facility: Nonacute Discharges per 1000 MY
Inpatient Facility Acute Medical ALOS Inpatient Facility Acute Surgery ALOS
Inpatient Facility Nonacute ALOS

Measure Data 2387 111
1,012.69 1,012.69
11775 5319 12320 97094 126,508.00 95.36% 94.81% 86.49% 291.94 13.78 90.75 13.27 60.69 77.52 69.35 160.13 1,184.51 339.83 209.16 47.94 0.00 0.00 3.49 4.36 NA

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September 2013

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

Total Inpatient Facility Acute ALOS Total Inpatient Facility ALOS
ED Discharges per 1000 MY Medical Cardiac Catheterization per 1000 MY Medical
PCI per 1000 MY Medical CABG per 1000 MY Medical Carotid Endarterectomy per 1000 MY Medical Carotid Artery Stenosis Diagnostic Test per 1000 MY Medical Cardiac Computed Tomography per 1000 MY Medical
CAD Diagnostic Test Using EBCT/Nuclear Imaging Stress Tests per 1000 MY Medical

3.59 3.59 2,612.13 21.64 5.52 2.12 0.42 1.27 1.27
120.06

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September 2013

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

Relative Resource Use for People With Asthma (RAS)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Data Element
Eligible Population Exclusions
Eligible Population per 1,000 Member Year Medical Eligible Population per 1,000 Member Year Pharmacy
NameBrandOnlyCount(N1) NameBrandGenericExistsCount(N2)
GenericOnlyCount (G1) GenericNameBrandExistsCount (G2) Total Prescriptions (N1+N2+G1+G2) Generic Utilization Rate [(G1 + G2)/(N2+G1+G2)] Generic Substitution Rate [(G2)/(N2+G2)] Overall Generic Utilization [(G1+G2)/(N1+N2+G1+G2)]
Inpatient Facility PMPM E&M Inpatient Services PMPM E&M Outpatient Services PMPM Surgery & Procedure Inpatient Services PMPM Surgery & Procedure Outpatient Services PMPM
Imaging Services PMPM Laboratory Services PMPM
Pharmacy PMPM Inpatient Facility: Acute Inpatient: Medical Days per 1000 MY Inpatient Facility: Acute Inpatient: Medical Discharges per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Days per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Discharges per 1000 MY
Inpatient Facility: Nonacute Days per 1000 MY Inpatient Facility: Nonacute Discharges per 1000 MY
Inpatient Facility Acute Medical ALOS Inpatient Facility Acute Surgery ALOS
Inpatient Facility Nonacute ALOS

Measure Data 6955 794
1,011.33 1,011.33
38516 27614 15304 86964 168,398.00 78.74% 75.90% 60.73% 34.41 1.97 59.88 1.04 10.88 12.80 9.43 110.47 149.19 52.64 14.83 4.22 23.41 1.02 2.83 3.52 23.00

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September 2013

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

Total Inpatient Facility Acute ALOS Total Inpatient Facility ALOS
ED Discharges per 1000 MY Medical

2.88 3.24 1,038.96

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September 2013

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

Relative Resource Use for People With Cardiovascular Conditions (RCA)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Data Element
Eligible Population Exclusions
Eligible Population per 1,000 Member Year Medical Eligible Population per 1,000 Member Year Pharmacy
NameBrandOnlyCount(N1) NameBrandGenericExistsCount(N2)
GenericOnlyCount (G1) GenericNameBrandExistsCount (G2) Total Prescriptions (N1+N2+G1+G2) Generic Utilization Rate [(G1 + G2)/(N2+G1+G2)] Generic Substitution Rate [(G2)/(N2+G2)] Overall Generic Utilization [(G1+G2)/(N1+N2+G1+G2)]
Inpatient Facility PMPM E&M Inpatient Services PMPM E&M Outpatient Services PMPM Surgery & Procedure Inpatient Services PMPM Surgery & Procedure Outpatient Services PMPM
Imaging Services PMPM Laboratory Services PMPM
Pharmacy PMPM Inpatient Facility: Acute Inpatient: Medical Days per 1000 MY Inpatient Facility: Acute Inpatient: Medical Discharges per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Days per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Discharges per 1000 MY
Inpatient Facility: Nonacute Days per 1000 MY Inpatient Facility: Nonacute Discharges per 1000 MY
Inpatient Facility Acute Medical ALOS Inpatient Facility Acute Surgery ALOS
Inpatient Facility Nonacute ALOS

Measure Data 151 4
1,006.67 1,006.67
843 717 1209 10873 13,642.00 94.40% 93.81% 88.56% 802.49 36.27 124.17 80.54 83.68 123.38 98.72 248.61 2,133.33 560.00 1,113.33 206.67 0.00 0.00 3.81 5.39 NA

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September 2013

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

Total Inpatient Facility Acute ALOS Total Inpatient Facility ALOS
ED Discharges per 1000 MY Medical Cardiac Catheterization per 1000 MY Medical
PCI per 1000 MY Medical CABG per 1000 MY Medical Carotid Endarterectomy per 1000 MY Medical Carotid Artery Stenosis Diagnostic Test per 1000 MY Medical Cardiac Computed Tomography per 1000 MY Medical
CAD Diagnostic Test Using EBCT/Nuclear Imaging Stress Tests per 1000 MY Medical

4.23 4.23 2,806.67 120.00 120.00 60.00 6.67 26.67 0.00
520.00

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September 2013

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

Relative Resource Use for People With Hypertension (RHY)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Data Element
Eligible Population Exclusions
Eligible Population per 1,000 Member Year Medical Eligible Population per 1,000 Member Year Pharmacy
NameBrandOnlyCount(N1) NameBrandGenericExistsCount(N2)
GenericOnlyCount (G1) GenericNameBrandExistsCount (G2) Total Prescriptions (N1+N2+G1+G2) Generic Utilization Rate [(G1 + G2)/(N2+G1+G2)] Generic Substitution Rate [(G2)/(N2+G2)] Overall Generic Utilization [(G1+G2)/(N1+N2+G1+G2)]
Inpatient Facility PMPM E&M Inpatient Services PMPM E&M Outpatient Services PMPM Surgery & Procedure Inpatient Services PMPM Surgery & Procedure Outpatient Services PMPM
Imaging Services PMPM Laboratory Services PMPM
Pharmacy PMPM Inpatient Facility: Acute Inpatient: Medical Days per 1000 MY Inpatient Facility: Acute Inpatient: Medical Discharges per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Days per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Discharges per 1000 MY
Inpatient Facility: Nonacute Days per 1000 MY Inpatient Facility: Nonacute Discharges per 1000 MY
Inpatient Facility Acute Medical ALOS Inpatient Facility Acute Surgery ALOS
Inpatient Facility Nonacute ALOS

Measure Data 4830 529
1,012.28 1,012.28
13935 8874 28936 196703 248,448.00 96.22% 95.68% 90.82% 230.26 11.48 90.79 14.70 58.00 73.48 58.41 119.95 853.21 237.04 210.21 48.83 0.00 0.00 3.60 4.30 NA

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September 2013

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

Total Inpatient Facility Acute ALOS Total Inpatient Facility ALOS
ED Discharges per 1000 MY Medical

3.72 3.72 2,601.11

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September 2013

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

Relative Resource Use for People With COPD (RCO)

WellCare of Georgia, Inc. (Org ID: 4538, SubID: 10032, Medicaid, Spec Area: None, Spec Proj: None)

Data Element
Eligible Population Exclusions
Eligible Population per 1,000 Member Year Medical Eligible Population per 1,000 Member Year Pharmacy
NameBrandOnlyCount(N1) NameBrandGenericExistsCount(N2)
GenericOnlyCount (G1) GenericNameBrandExistsCount (G2) Total Prescriptions (N1+N2+G1+G2) Generic Utilization Rate [(G1 + G2)/(N2+G1+G2)] Generic Substitution Rate [(G2)/(N2+G2)] Overall Generic Utilization [(G1+G2)/(N1+N2+G1+G2)]
Inpatient Facility PMPM E&M Inpatient Services PMPM E&M Outpatient Services PMPM Surgery & Procedure Inpatient Services PMPM Surgery & Procedure Outpatient Services PMPM
Imaging Services PMPM Laboratory Services PMPM
Pharmacy PMPM Inpatient Facility: Acute Inpatient: Medical Days per 1000 MY Inpatient Facility: Acute Inpatient: Medical Discharges per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Days per 1000 MY Inpatient Facility: Acute Inpatient: Surgery Discharges per 1000 MY
Inpatient Facility: Nonacute Days per 1000 MY Inpatient Facility: Nonacute Discharges per 1000 MY
Inpatient Facility Acute Medical ALOS Inpatient Facility Acute Surgery ALOS
Inpatient Facility Nonacute ALOS

Measure Data 547 30
1,012.65 1,012.65
3308 2260 3939 30190 39,697.00 93.79% 93.04% 85.97% 448.50 23.37 112.32 23.05 84.94 104.00 82.44 213.87 1,601.36 462.82 336.93 72.20 81.46 5.55 3.46 4.67 14.67

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September 2013

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

Total Inpatient Facility Acute ALOS Total Inpatient Facility ALOS
ED Discharges per 1000 MY Medical

3.62 3.74 2,765.81

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September 2013