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
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page i WellCare_GA2012-13_CMO_PMV_F1_0913
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
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page 1 WellCare_GA2012-13_CMO_PMV_F1_0913
VALIDATION OF PERFORMANCE MEASURES
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.
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page 2 WellCare_GA2012-13_CMO_PMV_F1_0913
VALIDATION OF PERFORMANCE MEASURES
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).
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page 3 WellCare_GA2012-13_CMO_PMV_F1_0913
VALIDATION OF PERFORMANCE MEASURES
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.
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page 4 WellCare_GA2012-13_CMO_PMV_F1_0913
VALIDATION OF PERFORMANCE MEASURES
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.
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page 5 WellCare_GA2012-13_CMO_PMV_F1_0913
VALIDATION OF PERFORMANCE MEASURES
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
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page 6 WellCare_GA2012-13_CMO_PMV_F1_0913
VALIDATION OF PERFORMANCE MEASURES
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
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page 7 WellCare_GA2012-13_CMO_PMV_F1_0913
VALIDATION OF PERFORMANCE MEASURES
Data Integration, Data Control, and Performance Measure Documentation
There are several aspects crucial to the calculation of performance measure rates. These include data integration, data control, and documentation of performance measure calculations. Each of the following sections describes the validation processes used and the validation findings. For more detailed information, see Appendix A of this report.
Data Integration
Accurate data integration is essential 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
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page 8 WellCare_GA2012-13_CMO_PMV_F1_0913
VALIDATION OF PERFORMANCE MEASURES
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.
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page 9 WellCare_GA2012-13_CMO_PMV_F1_0913
VALIDATION OF PERFORMANCE MEASURES
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.
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page 10 WellCare_GA2012-13_CMO_PMV_F1_0913
VALIDATION OF PERFORMANCE MEASURES
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.
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page 11 WellCare_GA2012-13_CMO_PMV_F1_0913
VALIDATION OF PERFORMANCE MEASURES
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
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page 12 WellCare_GA2012-13_CMO_PMV_F1_0913
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).
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page A-1 WellCare_GA2012-13_CMO_PMV_F1_0913
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.
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page A-2 WellCare_GA2012-13_CMO_PMV_F1_0913
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.
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page B-1 WellCare_GA2012-13_CMO_PMV_F1_0913
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).
WellCare of Georgia, Inc. Validation of Performance Measures State of Georgia
Page B-2 WellCare_GA2012-13_CMO_PMV_F1_0913
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%
7 of 12
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
9 of 12
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
6 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)
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%
15 of 139
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%
16 of 139
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%
17 of 139
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%
18 of 139
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%
19 of 139
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%
20 of 139
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%
23 of 139
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%
24 of 139
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%
25 of 139
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%
26 of 139
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%
29 of 139
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%
30 of 139
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%
31 of 139
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
122 of 139
September 2013
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%
123 of 139
September 2013
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
124 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: 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
125 of 139
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
126 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: 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
127 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
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
132 of 139
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
133 of 139
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
134 of 139
September 2013
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
135 of 139
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%
136 of 139
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
137 of 139
September 2013
Appendix F: Department of Community Health, State of Georgia Audited CY 2012 HEDIS Measure Results for WellCare
*Should sum to 100%
138 of 139
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%
139 of 139
September 2013
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
7 of 17
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
8 of 17
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
9 of 17
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
10 of 17
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
11 of 17
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
12 of 17
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
13 of 17
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
14 of 17
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
15 of 17
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
16 of 17
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
17 of 17
September 2013