2019 hmo hedis quality measures · 2019 hmo hedis® quality measures data based on the 2018...

2019 HMO HEDIS® Quality Measures Data based on the 2018 measurement year.

PrimeWest Health Report Generated: 4/30/2020

Table of Contents

Code General Information / Disclaimers Page

INFO General Information / Disclaimers 3

Code Effectiveness of Care (Prevention and Screening) Page

ABA Adult BMI Assessment 4

WCC Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents 5

CIS Childhood Immunization Status 8

IMA Immunizations for Adolescents 14

BCS Breast Cancer Screening 17

CCS Cervical Cancer Screening 21

COL Colorectal Cancer Screening 22

CHL Chlamydia Screening in Women 26

COA Care for Older Adults 29

Code Effectiveness of Care (Respiratory Condition) Page

SPR Use of Spirometry Testing in the Assessment and Diagnosis of COPD 30

PCE Pharmacotherapy Management of COPD Exacerbation 31

MMA Medication Management for People with Asthma 35

AMR Asthma Medication Ratio 38

Code Effectiveness of Care (Medication Management and Care Coordination) Page

MPM Annual Monitoring for Patients on Persistent Medications 86

MRP Medication Reconciliation Post Discharge 89

TRC Transitions of Care 90

Code Effectiveness of Care (Overuse/Appropriateness) Page

DDE Potentially Harmful Drug-Disease Interactions in the Elderly 93

DAE Use of High Risk Medications in the Elderly 95

UOD Use of Opioids at High Dosage 97

UOP Use of Opioids from Multiple Providers 98

Code Access / Availability of Care Page

AAP Adult's Access to Preventive/Ambulatory Health Services 105

CAP Children's and Adolescents' Access to Primary Care Practitioners 112

ADV Annual Dental Visit 115

IET Initiation/Engagement of Alcohol & Other Drug Dependence Treatment 117

PPC Prenatal and Postpartum Care 135

Code Effectiveness of Care (Cardiovascular Conditions) Page

CBP Controlling High Blood Pressure 41

PBH Persistence of Beta Blocker Treatment After Heart Attack 42

Code Effectiveness of Care (Diabetes) Page

CDC Comprehensive Diabetes Care 43

Code Effectiveness of Care (Musculoskeletal Conditions) Page

ART Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis 53

OMW Osteoporosis Management in Women Who had a Fracture 54

Code Effectiveness of Care (Behavioral Health) Page

AMM Antidepressant Medication Management 55

ADD Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder Medication 62

FUH Follow-up After Hospitalization for Mental Illness 65

FUM Follow-up After Emergecy Visit for Mental Illness 72

FUA Follow-up After Emergecy Visit for Alcohol and Other Drug Abuse 79

Code Utilization and Risk Adjusted Utilization Page

W15 Well Child Visits in the First 15 Months of Life 138

W34 Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life 141

AWC Adolescent Well-Care Visits 142

IAD Identification of Alcohol and Other Drug Services 143

MPT Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services 171

PCR Plan All-Cause Readmissions 178

Code Health Plan Descriptive Information Page

BCR Board Certification 182

ENP Enrollment by Product Line (Age & Sex) 185

PrimeWest Health HEDIS® 2019

General Information / Disclaimers

• Special Needs Basic Care Special Needs Basic Care (SNBC) is a voluntary managed care program for people with disabilities who are 18-64 years old and have Medical Assistance

• Special Needs Plan (SNP) - The plan integrates and provides both Medicaid and Medicare services. • Non-Special Needs Plan (Non-SNP) - The plan provides Medicaid services only and Medicare is provided fee for service.

• Audit Designation & Rate Status HEDIS Compliance Audits result in audited rates or calculations at the measure and indicator level, and indicate if the measures can be publicly reported. All measures selected for public reporting must have a final, audited result. The auditor approves the rate or report status of each measure and survey included in the audit, as shown below.

Rate/ Result Comment

R Reportable. A reportable rate was submitted for the measure.

NA

Small Denominator. The organization followed the specifications, but the denominator was too small (<30) to report a valid rate. a. For EOC and EOC-like measures, when the denominator is fewer than 30; and for HAI, when Total Inpatient Discharges is fewer than 30. b. For utilization measures that count member months, when the denominator is fewer than 360 member months.

c. For all risk-adjusted utilization measures, except PCR and HPC, when the denominator is fewer than 150.

NB No Benefit . The organization did not offer the health benefit required by the measure (e.g., mental health, chemical dependency).

NR Not Reported . The organization chose not to report the measure.

NQ Not Required. The organization was not required to report the measure.

BR Biased Rate. The calculated rate was materially biased.

UN Unaudited. The organization chose to report a measure that is not required to be audited. This result applies only to a limited set of measures (e.g., Board Certification, ECDS measures).

• Disclaimers

• NCQA removed the "Lower 95% Confidence Interval" and "Upper 95% Confidence Interval" data elements from the Data Elements for Reporting tables in all measures.


Effectiveness of Care Adult BMI Assessment

Data Elements Commercial Medicare Advantage

MHCP-MC (F&C)

MHCP-MC (MN Care)

SNBC SNP

SNBC Non-SNP

Audit Designation Reportable Reportable Reportable Reportable

Measurement Year 2018 2018 2018 2018 Data Collection Methodology H H H H Eligible Member Population 5613 1166 174 483 Numerator Events by Admin Data on Eligible Population (before exclusions) 2313 516 128 313

Current Year's Admin Rate 41.21% 44.25% 73.56% 64.80% Minimum Required Sample Size 411 411 174 411 Oversampling Rate 5.00% 5.00% 0.00% 5.00% Number of Oversample Records 21 21 21 Number of numerator events by administrative data in MRSS 208 219 141 292

Administrative rate on MRSS 50.61% 53.28% 81.03% 71.05% Number of Records Excluded because of Valid Data Errors 0 0 0 0

Number of Optional Administrative Data Records Excluded 0 0 0 0

Number of Optional Medical Record Data Records Excluded 0 0 0 0

Number of Employee/Dependent Medical Records Excluded 0 0 0 0

Records Added from the Oversample List 0 0 0 0 Denominator 411 411 174 411 Numerator Events by Admin Data 105 109 117 205 Numerator Events by Medical Record 173 146 28 88 Numerator Events by Supplemental Data 103 110 24 87 Rate Status R R R R Reported Rate 92.70% 88.81% 97.13% 92.46%


Effectiveness of Care Weight Assessment/Counseling for Nutrition/Physical Activity for Children/Adolescents

Commercial Data Elements

BMI Percentage Counseling for Nutrition Counseling for Physical Activity Ages 3-11 Ages 12-17 Total Ages 3-11 Ages 12-17 Total Ages 3-11 Ages 12-17 Total

Audit Designation

Measurement Year Data Collection Methodology Eligible Member Population Numerator events by admin data in eligible population Current Year's Administrative Rate Minimum Required Sample Size Oversampling Rate Number of oversample records Number of numerator events by admin data in MRSS Administrative rate on MRSS Number of Records Excluded Because of Valid Data Errors Number of optional administrative data records excluded Number of optional medical records excluded Number of employee/dependent records excluded Records Added from the Oversample List Denominator Numerator Events by Admin Data Numerator Events by Medical Record Numerator Events by Supplemental Data Rate Status Reported Rate



Minnesota Health Care Programs - Managed Care (Families and Children) Data Elements


Audit Designation Reportable Reportable Reportable

Measurement Year 2018 2018 2018 2018 2018 2018 2018 2018 2018 Data Collection Methodology H H H H H H H H H Eligible Member Population 5698 3102 8800 5698 3102 8800 5698 3102 8800 Numerator events by admin data in eligible population 197 161 358 59 50 109 44 159 203

Current Year's Administrative Rate 3.46% 5.19% 4.07% 1.04% 1.61% 1.24% 0.77% 5.13% 2.31% Minimum Required Sample Size 411 411 411 411 411 411 411 411 411 Oversampling Rate 5.00% 5.00% 5.00% Number of oversample records 21 21 21 21 21 21 21 21 21 Number of numerator events by admin data in MRSS 27 11 38 17 5 22 15 7 22

Administrative rate on MRSS 6.57% 2.68% 9.25% 4.14% 1.22% 5.35% 3.65% 1.70% 5.35% Number of Records Excluded Because of Valid Data Errors 0 0 0

Number of optional administrative data records excluded 0 0 0

Number of optional medical records excluded 0 0 0

Number of employee/dependent records excluded 0 0 0

Records Added from the Oversample List 0 0 0 Denominator 259 152 411 259 152 411 259 152 411 Numerator Events by Admin Data 10 7 17 3 2 5 1 4 5 Numerator Events by Medical Record 148 88 236 136 66 202 115 63 178 Numerator Events by Supplemental Data 17 4 21 14 3 17 14 3 17 Rate Status R R R R R R R R R Reported Rate 67.57% 65.13% 66.67% 59.07% 46.71% 54.50% 50.19% 46.05% 48.66%



Minnesota Health Care Programs - Managed Care (MN Care) Data Elements




Current Year's Administrative Rate 4.35% 11.11% 6.25% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Minimum Required Sample Size 32 32 32 32 32 32 32 32 32 Oversampling Rate 0.00% 0.00% 0.00% Number of oversample records Number of numerator events by admin data in MRSS 3 1 4 1 0 1 1 0 1

Administrative rate on MRSS 9.38% 3.13% 12.50% 3.13% 0.00% 3.13% 3.13% 0.00% 3.13% Number of Records Excluded Because of Valid Data Errors 0 0 0

Number of optional administrative data records excluded 0 0 0

Number of optional medical records excluded 0 0 0

Number of employee/dependent records excluded 0 0 0

Records Added from the Oversample List 0 0 0 Denominator 23 9 32 23 9 32 23 9 32 Numerator Events by Admin Data 1 1 2 0 0 0 0 0 0 Numerator Events by Medical Record 12 3 15 11 5 16 10 7 17 Numerator Events by Supplemental Data 2 0 2 1 0 1 1 0 1 Rate Status NA NA R NA NA R NA NA R Reported Rate 65.22% 44.44% 59.38% 52.17% 55.56% 53.13% 47.83% 77.78% 56.25%


Effectiveness of Care Childhood Immunization Status

Commercial (1 of 2)

Data Elements DTaP IPV MMR HiB Hepatitis B VZV Pneumo-

coccal Conjugate

Hepatitis A Rotavirus Influenza

Audit Designation

Measurement Year Data Collection Methodology Eligible Member Population Numerator events by admin data in eligible population Current Year's Administrative Rate Minimum Required Sample Size Oversampling Rate Number of oversample records

Numerator events by admin data in MRSS

Admin rate on MRSS Number of Records Excluded Because of Valid Data Errors Number of administrative data records excluded

Number of medical data records excluded

Number of employee/dependent records excluded Records Added from the Oversample List Denominator Numerator Events by administrative Data Numerator Events by Medical Record Numerator Events by Supplemental Data Rate Status Reported Rate



Commercial (2 of 2)

Data Elements Combo 2 Combo 3 Combo 4 Combo 5 Combo 6 Combo 7 Combo 8 Combo 9 Combo10

Audit Designation



Admin rate on MRSS Number of Records Excluded Because of Valid Data Errors Number of administrative data records excluded


Number of employee/dependent records excluded Records Added from the Oversample List Denominator Numerator Events by administrative Data Numerator Events by Medical Record Numerator Events by Supplemental Data Rate Status Reported Rate



Minnesota Health Care Programs - Managed Care (Families and Children) (1 of 2)


coccal Conjugate


Audit Designation Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable

Measurement Year 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 Data Collection Methodology H H H H H H H H H H Eligible Member Population 752 752 752 752 752 752 752 752 752 752 Numerator events by admin data in eligible population 564 658 651 635 657 641 579 607 525 324

Current Year's Administrative Rate 75.00% 87.50% 86.57% 84.44% 87.37% 85.24% 76.99% 80.72% 69.81% 43.09% Minimum Required Sample Size 411 411 411 411 411 411 411 411 411 411 Oversampling Rate 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% Number of oversample records 21 21 21 21 21 21 21 21 21 21

Numerator events by admin data in MRSS 298 353 355 344 352 348 305 331 281 177

Admin rate on MRSS 72.51% 85.89% 86.37% 83.70% 85.64% 84.67% 74.21% 80.54% 68.37% 43.07% Number of Records Excluded Because of Valid Data Errors 0 0 0 0 0 0 0 0 0 0

Number of administrative data records excluded 0 0 0 0 0 0 0 0 0 0

Number of medical data records excluded 0 0 0 0 0 0 0 0 0 0

Number of employee/dependent records excluded 0 0 0 0 0 0 0 0 0 0

Records Added from the Oversample List 0 0 0 0 0 0 0 0 0 0 Denominator 411 411 411 411 411 411 411 411 411 411 Numerator Events by administrative Data 165 207 292 229 142 287 175 290 166 145 Numerator Events by Medical Record 7 9 0 7 9 0 8 2 6 3 Numerator Events by Supplemental Data 133 146 63 115 210 61 130 41 115 32 Rate Status R R R R R R R R R R Reported Rate 74.21% 88.08% 86.37% 85.40% 87.83% 84.67% 76.16% 81.02% 69.83% 43.80%



Minnesota Health Care Programs - Managed Care (Families and Children) (2 of 2)


Audit Designation Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable


Current Year's Administrative Rate 70.61% 67.82% 66.49% 59.97% 37.77% 59.18% 36.97% 35.24% 34.71% Minimum Required Sample Size 411 411 411 411 411 411 411 411 411 Oversampling Rate 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% Number of oversample records 21 21 21 21 21 21 21 21 21

Numerator events by admin data in MRSS 287 273 270 242 155 240 154 143 143

Admin rate on MRSS 69.83% 66.42% 65.69% 58.88% 37.71% 58.39% 37.47% 34.79% 34.79% Number of Records Excluded Because of Valid Data Errors 0 0 0 0 0 0 0 0 0

Number of administrative data records excluded 0 0 0 0 0 0 0 0 0

Number of medical data records excluded 0 0 0 0 0 0 0 0 0

Number of employee/dependent records excluded 0 0 0 0 0 0 0 0 0

Records Added from the Oversample List 0 0 0 0 0 0 0 0 0 Denominator 411 411 411 411 411 411 411 411 411 Numerator Events by administrative Data 105 103 103 90 54 90 54 50 50 Numerator Events by Medical Record 4 4 4 3 2 3 2 1 1 Numerator Events by Supplemental Data 182 170 167 152 101 150 100 93 93 Rate Status R R R R R R R R R Reported Rate 70.80% 67.40% 66.67% 59.61% 38.20% 59.12% 37.96% 35.04% 35.04%



Minnesota Health Care Programs - Managed Care (MN Care) (1 of 2)


coccal Conjugate


Audit Designation Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Measurement Year 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 Data Collection Methodology H H H H H H H H H H Eligible Member Population 7 7 7 7 7 7 7 7 7 7 Numerator events by admin data in eligible population 7 7 7 7 7 7 7 7 7 4

Current Year's Administrative Rate 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 57.14% Minimum Required Sample Size 7 7 7 7 7 7 7 7 7 7 Oversampling Rate 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Number of oversample records

Numerator events by admin data in MRSS 7 7 7 7 7 7 7 7 7 4

Admin rate on MRSS 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 57.14% Number of Records Excluded Because of Valid Data Errors 0 0 0 0 0 0 0 0 0 0

Number of administrative data records excluded 0 0 0 0 0 0 0 0 0 0

Number of medical data records excluded 0 0 0 0 0 0 0 0 0 0

Number of employee/dependent records excluded 0 0 0 0 0 0 0 0 0 0

Records Added from the Oversample List 0 0 0 0 0 0 0 0 0 0 Denominator 7 7 7 7 7 7 7 7 7 7 Numerator Events by administrative Data 4 4 7 4 3 7 4 7 4 4 Numerator Events by Medical Record 0 0 0 0 0 0 0 0 0 0 Numerator Events by Supplemental Data 3 3 0 3 4 0 3 0 3 0 Rate Status NA NA NA NA NA NA NA NA NA NA Reported Rate 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 57.14%



Minnesota Health Care Programs - Managed Care (MN Care) (2 of 2)



Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator


Current Year's Administrative Rate 100.00% 100.00% 100.00% 100.00% 57.14% 100.00% 57.14% 57.14% 57.14% Minimum Required Sample Size 7 7 7 7 7 7 7 7 7 Oversampling Rate 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Number of oversample records

Numerator events by admin data in MRSS 7 7 7 7 4 7 4 4 4

Admin rate on MRSS 100.00% 100.00% 100.00% 100.00% 57.14% 100.00% 57.14% 57.14% 57.14% Number of Records Excluded Because of Valid Data Errors 0 0 0 0 0 0 0 0 0

Number of administrative data records excluded 0 0 0 0 0 0 0 0 0

Number of medical data records excluded 0 0 0 0 0 0 0 0 0

Number of employee/dependent records excluded 0 0 0 0 0 0 0 0 0

Records Added from the Oversample List 0 0 0 0 0 0 0 0 0 Denominator 7 7 7 7 7 7 7 7 7 Numerator Events by administrative Data 3 3 3 3 1 3 1 1 1 Numerator Events by Medical Record 0 0 0 0 0 0 0 0 0 Numerator Events by Supplemental Data 4 4 4 4 3 4 3 3 3 Rate Status NA NA NA NA NA NA NA NA NA Reported Rate 100.00% 100.00% 100.00% 100.00% 57.14% 100.00% 57.14% 57.14% 57.14%


Effectiveness of Care Immunizations for Adolescents

Commercial Data Elements Meningococcal Tdap Combo 1 Combo 2 HPV

Audit Designation

Measurement Year Data Collection Methodology Eligible Member Population Numerator Events by Admin Data on Eligible Population (before exclusions) Current Year's Admin Rate Minimum Required Sample Size Oversampling Rate Number of oversample records


Admin Rate on MRSS Records Excluded because of Valid Data Errors Number of administrative data records excluded


Number of employee/dependent medical records excluded Records Added from the Oversample List Denominator Numerator Events by Admin Data Numerator Events by Medical Record Numerator Events by Supplemental Data Rate Status Reported Rate



Minnesota Health Care Programs - Managed Care (Families and Children) Data Elements Meningococcal Tdap Combo 1 Combo 2 HPV

Audit Designation Reportable Reportable Reportable Reportable Reportable

Measurement Year 2018 2018 2018 2018 2018 Data Collection Methodology H H H H H Eligible Member Population 745 745 745 745 745 Numerator Events by Admin Data on Eligible Population (before exclusions) 610 624 603 196 202

Current Year's Admin Rate 81.88% 83.76% 80.94% 26.31% 27.11% Minimum Required Sample Size 411 411 411 411 411 Oversampling Rate 5.00% 5.00% 5.00% 5.00% 5.00% Number of oversample records 21 21 21 21 21

Numerator events by admin data in MRSS 335 345 334 109 111

Admin Rate on MRSS 81.51% 83.94% 81.27% 26.52% 27.01% Records Excluded because of Valid Data Errors 0 0 0 0 0

Number of administrative data records excluded 0 0 0 0 0

Number of medical data records excluded 0 0 0 0 0

Number of employee/dependent medical records excluded 0 0 0 0 0

Records Added from the Oversample List 0 0 0 0 0 Denominator 411 411 411 411 411 Numerator Events by Admin Data 288 292 280 80 83 Numerator Events by Medical Record 1 0 1 0 0 Numerator Events by Supplemental Data 47 53 54 29 28 Rate Status R R R R R Reported Rate 81.75% 83.94% 81.51% 26.52% 27.01%



Minnesota Health Care Programs - Managed Care (MN Care) Data Elements Meningococcal Tdap Combo 1 Combo 2 HPV


Small Denominator

Small Denominator

Small Denominator

Small Denominator

Measurement Year 2018 2018 2018 2018 2018 Data Collection Methodology H H H H H Eligible Member Population 2 2 2 2 2 Numerator Events by Admin Data on Eligible Population (before exclusions) 2 2 2 0 0

Current Year's Admin Rate 100.00% 100.00% 100.00% 0.00% 0.00% Minimum Required Sample Size 2 2 2 2 2 Oversampling Rate 0.00% 0.00% 0.00% 0.00% 0.00% Number of oversample records

Numerator events by admin data in MRSS 2 2 2 0 0

Admin Rate on MRSS 100.00% 100.00% 100.00% 0.00% 0.00% Records Excluded because of Valid Data Errors 0 0 0 0 0

Number of administrative data records excluded 0 0 0 0 0

Number of medical data records excluded 0 0 0 0 0


Records Added from the Oversample List 0 0 0 0 0 Denominator 2 2 2 2 2 Numerator Events by Admin Data 1 1 1 0 0 Numerator Events by Medical Record 0 0 0 0 0 Numerator Events by Supplemental Data 1 1 1 0 0 Rate Status NA NA NA NA NA Reported Rate 100.00% 100.00% 100.00% 0.00% 0.00%


Effectiveness of Care Breast Cancer Screening

Data Elements Commercial MHCP-MC (F&C)

MHCP-MC (MN Care)

SNBC Non-SNP


Measurement Year 2018 2018 2018 Data Collection Methodology A A A Eligible Member Population 677 196 121 Number of Optional Admin Data Records Excluded 4 2 0

Numerator Events by Admin Data 458 143 72 Numerator Events by Supplemental Data 0 0 0 Rate Status R R R Reported Rate 67.65% 72.96% 59.50%



Medicare Advantage Data Elements Non-LIS/DE,

Nondisability LIS/DE Disability LIS/DE and Disability Other Unknown Total

Audit Designation

Measurement Year Data Collection Methodology Eligible Member Population Number of Optional Admin Data Records Excluded Numerator Events by Admin Data Numerator Events by Supplemental Data Rate Status Reported Rate



Minnesota Senior Health Options Data Elements Non-LIS/DE,


Audit Designation Small Denominator Reportable Small

Denominator Reportable Small Denominator

Small Denominator Reportable

Measurement Year 2018 2018 2018 2018 2018 2018 2018 Data Collection Methodology A A A A A A A Eligible Member Population 1 113 1 85 0 0 200 Number of Optional Admin Data Records Excluded 0 0 0 2 0 0 2

Numerator Events by Admin Data 1 69 1 57 0 0 128 Numerator Events by Supplemental Data 0 0 0 0 0 0 0 Rate Status NA R NA R NA NA R Reported Rate 100.00% 61.06% 100.00% 67.06% 64.00%



Special Needs Basic Care - Special Needs Plan Data Elements Non-LIS/DE,



Small Denominator

Small Denominator Reportable Small

Denominator Small

Denominator Reportable

Measurement Year 2018 2018 2018 2018 2018 2018 2018 Data Collection Methodology A A A A A A A Eligible Member Population 0 0 0 61 0 0 61 Number of Optional Admin Data Records Excluded 0 0 0 1 0 0 1

Numerator Events by Admin Data 0 0 0 51 0 0 51 Numerator Events by Supplemental Data 0 0 0 0 0 0 0 Rate Status NA NA NA R NA NA R Reported Rate 83.61% 83.61%


Effectiveness of Care Cervical Cancer Screening


MHCP-MC (MN Care)

SNBC Non-SNP


Measurement Year 2018 2018 2018 Data Collection Methodology H H H Eligible Member Population 5154 1185 305 Numerator Events by Admin Data on Eligible Population (before exclusions) 2650 616 139

Current Year's Admin Rate 51.42% 51.98% 45.57% Minimum Required Sample Size 411 411 265 Oversampling Rate 10.00% 10.00% 0.00% Number of Oversample Records 42 42 Numerator events by admin data in MRSS 223 237 140 Admin Rate on MRSS 54.26% 57.66% 52.83% Records Excluded because of Valid Data Errors 0 0 0

Number of administrative data records excluded 4 2 4

Number of medical record data records excluded 10 16 6

Number of employee/dependent medical records excluded 0 0 0

Records Added from the Oversample List 14 18 0

Denominator 411 411 255 Numerator Events by Admin Data 207 228 128 Numerator Events by Medical Record 28 37 5 Numerator Events by Supplemental Data 16 9 12 Rate Status R R R Reported Rate 61.07% 66.67% 56.86%


Effectiveness of Care Colorectal Cancer Screening

Commercial Data Elements General

Measure Data Disability LIS/DE LIS/DE Non-LIS/DE Nondisability Other Unknown

Audit Designation

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 Number of oversample records Number of numerator events by administrative data in MRSS Administrative rate on MRSS Number of original sample records excluded because of valid data errors Number of optional administrative data records excluded Number of medical record 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 Numerator Events by Supplemental Data Rate Status Reported rate



Medicare Advantage Data Elements General


Audit Designation

Measurement Year Data collection methodology (administrative or hybrid) Eligible population Number of numerator events by administrative data in eligible population (before exclusions)


Minimum required sample size (MRSS) or other sample size Oversampling rate Number of oversample records Number of numerator events by administrative data in MRSS Administrative rate on MRSS Number of original sample records excluded because of valid data errors Number of optional administrative data records excluded Number of medical record 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 Numerator Events by Supplemental Data Rate Status Reported rate



Minnesota Senior Health Options Data Elements General


Audit Designation Reportable Small Denominator Reportable Reportable Small

Denominator Small

Denominator Small

Denominator Measurement Year 2018 2018 2018 2018 2018 2018 2018 Data collection methodology (administrative or hybrid) H H H H H H H

Eligible population 373 2 201 169 1 0 0 Number of numerator events by administrative data in eligible population (before exclusions)

207

Current year's administrative rate (before exclusions) 55.50%

Minimum required sample size (MRSS) or other sample size 372

Oversampling rate 0.00% Number of oversample records Number of numerator events by administrative data in MRSS 228

Administrative rate on MRSS 61.29% Number of original sample records excluded because of valid data errors 1

Number of optional administrative data records excluded 0

Number of medical record data records excluded 0

Number of employee/dependent medical records excluded 0

Records added from the oversample list 0 Denominator 371 2 200 168 1 0 0 Numerator events by administrative data 215 2 111 101 1 0 0 Numerator events by medical records 14 0 9 5 0 0 0 Numerator Events by Supplemental Data 13 0 5 8 0 0 0 Rate Status R NA R R NA NA NA Reported rate 65.23% 100.00% 62.50% 67.86% 100.00%



Special Needs Basic Care - Special Needs Plan Data Elements General


Audit Designation Reportable Small Denominator


Denominator Small

Denominator Small

Denominator Measurement Year 2018 2018 2018 2018 2018 2018 2018 Data collection methodology (administrative or hybrid) H H H H H H H

Eligible population 104 0 0 104 0 0 0 Number of numerator events by administrative data in eligible population (before exclusions)

72

Current year's administrative rate (before exclusions) 69.23%

Minimum required sample size (MRSS) or other sample size 104

Oversampling rate 0.00% Number of oversample records Number of numerator events by administrative data in MRSS 84

Administrative rate on MRSS 80.77% Number of original sample records excluded because of valid data errors 0

Number of optional administrative data records excluded 0

Number of medical record data records excluded 0

Number of employee/dependent medical records excluded 0

Records added from the oversample list 0 Denominator 104 0 0 104 0 0 0 Numerator events by administrative data 82 0 0 82 0 0 0 Numerator events by medical records 0 0 0 0 0 0 0 Numerator Events by Supplemental Data 2 0 0 2 0 0 0 Rate Status R NA NA R NA NA NA Reported rate 80.77% 80.77%


Effectiveness of Care Chlamydia Screening in Women

Commercial Data Elements Ages 16-20 Ages 21-24 Total

Audit Designation

Measurement Year Data Collection Methodology Eligible Member Population Number of optional administrative data records excluded Numerator Events by Admin Data Numerator Events by Supplemental Data Rate Status Reported Rate



Minnesota Health Care Programs - Managed Care (Families and Children) Data Elements Ages 16-20 Ages 21-24 Total


Measurement Year 2018 2018 2018 Data Collection Methodology A A A Eligible Member Population 688 490 1178 Number of optional administrative data records excluded 31 13 44




Minnesota Health Care Programs - Managed Care (MN Care) Data Elements Ages 16-20 Ages 21-24 Total


Measurement Year 2018 2018 2018 Data Collection Methodology A A A Eligible Member Population 55 66 121 Number of optional administrative data records excluded 0 0 0



Effectiveness of Care Care for Older Adults

Minnesota Senior Health Options

Data Elements Advance Care Planning

Medication Review

Functional Status

Assessment Pain Screening


Measurement Year 2018 2018 2018 2018 Data Collection Methodology H H H H Eligible Member Population 1495 1495 1495 1495 Numerator Events by Admin Data on Eligible Population (before exclusions) 895 23 860 793

Current Year's Admin Rate 59.87% 1.54% 57.53% 53.04% Minimum Required Sample Size 411 411 411 411 Oversampling Rate 5.00% 5.00% 5.00% 5.00% Number of oversample records 21 21 21 21 Numerator events by admin data in MRSS 223 8 221 192 Admin Rate on MRSS 54.26% 1.95% 53.77% 46.72% Records Excluded because of Valid Data Errors 0 0 0 0

Number of employee/dependent medical records excluded 0 0 0 0

Records Added from the Oversample List 0 0 0 0 Denominator 411 411 411 411 Numerator Events by Admin Data 52 5 65 2 Numerator Events by Medical Record 146 374 159 206 Numerator Events by Supplemental Data 171 3 156 190 Rate Status R R R R Reported Rate 89.78% 92.94% 92.46% 96.84%


Effectiveness of Care Use of Spirometry Testing in the Assessment and Diagnosis of COPD

Data Elements Medicare Advantage MSHO SNBC

SNP SNBC

Non-SNP


Small Denominator

Measurement Year 2018 2018 2018 Data Collection Methodology A A A Eligible Member Population 57 8 13 Numerator Events by Admin Data 11 2 3 Numerator Events by Supplemental Data 0 0 0 Rate Status R NA NA Reported Rate 19.30% 25.00% 23.08%


Effectiveness of Care Pharmacotherapy Management of COPD Exacerbation

Medicare Advantage Data Elements Systemic

Corticosteroid Bronchodilator

Audit Designation

Measurement Year Data Collection Methodology Eligible Member Population Numerator Events by Admin Data Numerator Events by Supplemental Data Rate Status Reported Rate



Minnesota Senior Health Options Data Elements Systemic


Audit Designation Reportable Reportable

Measurement Year 2018 2018 Data Collection Methodology A A Eligible Member Population 59 59 Numerator Events by Admin Data 38 51 Numerator Events by Supplemental Data 0 0 Rate Status R R Reported Rate 64.41% 86.44%



Special Needs Basic Care - Special Needs Plan Data Elements Systemic



Small Denominator

Measurement Year 2018 2018 Data Collection Methodology A A Eligible Member Population 19 19 Numerator Events by Admin Data 16 18 Numerator Events by Supplemental Data 0 0 Rate Status NA NA Reported Rate 84.21% 94.74%



Special Needs Basic Care - Non-Special Needs Plan Data Elements Systemic


Audit Designation Small Denominator Small Denominator

Measurement Year 2018 2018 Data Collection Methodology A A Eligible Member Population 14 14 Numerator Events by Admin Data 11 12 Numerator Events by Supplemental Data 0 0 Rate Status NA NA Reported Rate 78.57% 85.71%


Effectiveness of Care Medication Management for People with Asthma

Commercial

Data Elements Medication Compliance 50% Medication Compliance 75%

Ages 5-11

Ages 12-18

Ages 19-50

Ages 51-64 Total Ages 5-11 Ages 12-18 Ages 19-50 Ages 51-64 Total

Audit Designation

Measurement Year Data Collection Methodology Eligible Member Population Number of required exclusions Numerator Events by Admin Data Numerator Events by Supplemental Data Rate Status Reported Rate



Minnesota Health Care Programs - Managed Care (Families and Children)


Ages 5-11

Ages 12-18

Ages 19-50


Audit Designation Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable

Measurement Year 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 Data Collection Methodology A A A A A A A A A A Eligible Member Population 66 66 105 30 267 66 66 105 30 267 Number of required exclusions 7 7 48 76 138 7 7 48 76 138 Numerator Events by Admin Data 46 46 70 28 190 24 28 51 20 123 Numerator Events by Supplemental Data 0 0 0 0 0 0 0 0 0 0 Rate Status R R R R R R R R R R Reported Rate 69.70% 69.70% 66.67% 93.33% 71.16% 36.36% 42.42% 48.57% 66.67% 46.07%



Minnesota Health Care Programs - Managed Care (MN Care)


Ages 5-11

Ages 12-18

Ages 19-50



Small Denominator

Small Denominator


Denominator Small

Denominator Small

Denominator Small


Measurement Year 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 Data Collection Methodology A A A A A A A A A A Eligible Member Population 0 0 22 9 31 0 0 22 9 31 Number of required exclusions 0 0 3 8 11 0 0 3 8 11 Numerator Events by Admin Data 0 0 15 8 23 0 0 12 6 18 Numerator Events by Supplemental Data 0 0 0 0 0 0 0 0 0 0 Rate Status NA NA NA NA R NA NA NA NA R Reported Rate 68.18% 88.89% 74.19% 54.55% 66.67% 58.06%


Effectiveness of Care Asthma Medication Ratio

Commercial Data Elements Ages 5-11 Ages 12-18 Ages 19-50 Ages 51-64 Total

Audit Designation

Measurement Year Data Collection Methodology Eligible Member Population Number of required exclusions Numerator Events by Admin Data Numerator events by Supplemental Data Rate Status Reported Rate



Minnesota Health Care Programs - Managed Care (Families and Children) Data Elements Ages 5-11 Ages 12-18 Ages 19-50 Ages 51-64 Total


Measurement Year 2018 2018 2018 2018 2018 Data Collection Methodology A A A A A Eligible Member Population 69 71 128 40 308 Number of required exclusions 4 2 25 66 97 Numerator Events by Admin Data 58 51 83 24 216 Numerator events by Supplemental Data 0 0 0 0 0 Rate Status R R R R R Reported Rate 84.06% 71.83% 64.84% 60.00% 70.13%



Minnesota Health Care Programs - Managed Care (MN Care) Data Elements Ages 5-11 Ages 12-18 Ages 19-50 Ages 51-64 Total


Small Denominator

Small Denominator


Measurement Year 2018 2018 2018 2018 2018 Data Collection Methodology A A A A A Eligible Member Population 0 0 25 9 34 Number of required exclusions 0 0 0 8 8 Numerator Events by Admin Data 0 0 18 9 27 Numerator events by Supplemental Data 0 0 0 0 0 Rate Status NA NA NA NA R Reported Rate 72.00% 100.00% 79.41%


Effectiveness of Care Controlling High Blood Pressure


MHCP-MC (F&C)

MHCP-MC (MN Care) MSHO SNBC

SNP SNBC

Non-SNP


Measurement Year 2018 2018 2018 2018 2018 Data Collection Methodology (Hybrid) H H H H H Eligible Member Population 1079 312 300 58 143 Numerator Events by Admin Data on Eligible Population (before exclusions) 256 67 61 7 42

Minimum Required Sample Size 411 306 285 57 130 Number of oversample records 42 Numerator events by admin data in MRSS 128 98 86 17 52 Records Excluded because of Valid Data Errors 0 0 1 0 0

Number of administrative data records excluded - Optional 0 0 0 1 1

Number of medical record data records excluded 0 0 0 0 0


Records Added from the OverSample List 0 0 0 0 0 Denominator 411 306 284 56 129 Numerator Events by Admin Data 0 0 0 0 0 Numerator Events by Medical Record 161 133 128 28 44 Numerator Events by Supplemental Data 128 98 86 17 52 Rate Status R R R R R Reported Rate 70.32% 75.49% 75.35% 80.36% 74.42%


Effectiveness of Care Persistence of Beta Blocker Treatment After Heart Attack


MHCP-MC (F&C)


SNP SNBC

Non-SNP


Small Denominator

Small Denominator

Small Denominator

Small Denominator

Measurement Year 2018 2018 2018 2018 2018 Data Collection Methodology A A A A A Eligible Member Population 19 5 1 0 4 Number of optional exclusions 7 0 1 0 1 Numerator Events by Admin Data on Eligible Population 16 1 1 0 4

Numerator events by Supplemental Data 0 0 0 0 0 Rate Status NA NA NA NA NA Reported Rate 84.21% 20.00% 100.00% 100.00%


Effectiveness of Care Comprehensive Diabetes Care

Commercial

Data Elements HbA1c Testing Poor HbA1c Control (>9.0%)

Good HbA1c Control (<7.0%)

Adequate HbA1c Control

(<8.0%) Eye Exam

Monitoring for Diabetic

Nephropathy

Blood Pressure <140/90 mm Hg

Audit Designation



Admin rate on MRSS Number of Records Excluded Because of Valid Data Errors Number of optional administrative data records excluded -Number of medical record data records excluded Number of employee/dependent medical records excluded Number of HbA1c < 7 required administrative data records excluded Number of HbA1c < 7 required medical records excluded Additional Records Added from the Oversample List Denominator Numerator Events by Admin Data Numerator Events by Medical Record Numerator Events by Supplemental Data Rate Status Reported Rate



Medicare Advantage (1 of 2)




(<8.0%) Eye Exam


Nephropathy


Audit Designation



Admin rate on MRSS Number of Records Excluded Because of Valid Data Errors Number of optional administrative data records excluded -Number of medical record data records excluded Number of employee/dependent medical records excluded Number of HbA1c < 7 required administrative data records excluded Number of HbA1c < 7 required medical records excluded Additional Records Added from the Oversample List Denominator Numerator Events by Admin Data Numerator Events by Medical Record Numerator Events by Supplemental Data Rate Status Reported Rate



Medicare Advantage (2 of 2)

Data Elements Eye Exam Breakout

Non-LIS/DE, Nondisability LIS/DE Disability LIS/DE and

Disability Other Unknown Total

Audit Designation

Measurement Year Data Collection Methodology Eligible Member Population Denominator Numerator Events by Admin Data Numerator Events by Medical Record Numerator Events by Supplemental Data Rate Status Reported Rate







(<8.0%) Eye Exam


Nephropathy


Audit Designation Reportable Reportable Reportable Reportable Reportable Reportable Reportable

Measurement Year 2018 2018 2018 2018 2018 2018 2018 Data Collection Methodology H H H H H H H Eligible Member Population 691 691 555 691 691 691 691 Numerator events by admin data in eligible population 608 547 53 103 448 605 231

Current Year's Administrative Rate 87.99% 79.16% 9.55% 14.91% 64.83% 87.55% 33.43% Minimum Required Sample Size 548 548 548 548 548 548 548 Oversampling Rate 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% Number of oversample records 55 55 55 55 55 55 55

Numerator events by admin data in MRSS 527 111 59 90 395 529 117

Admin rate on MRSS 96.17% 20.26% 10.77% 16.42% 72.08% 96.53% 21.35% Number of Records Excluded Because of Valid Data Errors 0 0 0 0 0 0 0

Number of optional administrative data records excluded - 0 0 0 0 0 0 0

Number of medical record data records excluded 1 1 1 1 1 1 1

Number of employee/dependent medical records excluded 0 0 0 0 0 0 0

Number of HbA1c < 7 required administrative data records excluded 120

Number of HbA1c < 7 required medical records excluded 3

Additional Records Added from the Oversample List 55 55 55 55 55 55 55

Denominator 602 602 479 602 602 602 602 Numerator Events by Admin Data 526 94 2 2 395 529 0 Numerator Events by Medical Record 17 108 105 216 33 16 369 Numerator Events by Supplemental Data 1 17 57 88 0 0 117 Rate Status R R R R R R R Reported Rate 90.37% 36.38% 34.24% 50.83% 71.10% 90.53% 80.73%







(<8.0%) Eye Exam


Nephropathy




Current Year's Administrative Rate 90.70% 82.56% 5.44% 13.37% 67.44% 92.44% 24.42% Minimum Required Sample Size 170 170 170 170 170 170 170 Oversampling Rate 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Number of oversample records












Minnesota Senior Health Options (1 of 2)




(<8.0%) Eye Exam


Nephropathy


Audit Designation Reportable Reportable Reportable Reportable Reportable Reportable

Measurement Year 2018 2018 2018 2018 2018 2018 Data Collection Methodology H H H H H H Eligible Member Population 134 134 134 134 134 134 Numerator events by admin data in eligible population 125 108 24 105 128 26

Current Year's Administrative Rate 93.28% 80.60% 17.91% 78.36% 95.52% 19.40% Minimum Required Sample Size 134 134 134 134 134 134 Oversampling Rate 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Number of oversample records

Numerator events by admin data in MRSS 124 17 25 104 127 25

Admin rate on MRSS 92.54% 12.69% 18.66% 77.61% 94.78% 18.66% Number of Records Excluded Because of Valid Data Errors 2 2 2 2 2 2

Number of optional administrative data records excluded - 0 0 0 0 0 0

Number of medical record data records excluded 0 0 0 0 0 0

Number of employee/dependent medical records excluded 0 0 0 0 0 0

Number of HbA1c < 7 required administrative data records excluded Number of HbA1c < 7 required medical records excluded Additional Records Added from the Oversample List 0 0 0 0 0 0

Denominator 132 132 132 132 132 132 Numerator Events by Admin Data 124 17 0 104 127 0 Numerator Events by Medical Record 1 8 70 10 2 81 Numerator Events by Supplemental Data 0 0 25 0 0 25 Rate Status R R R R R R Reported Rate 94.70% 18.94% 71.97% 86.36% 97.73% 80.30%



Minnesota Senior Health Options (2 of 2)




Audit Designation Small Denominator Reportable Small

Denominator Reportable Small Denominator


Measurement Year 2018 2018 2018 2018 2018 2018 2018 Data Collection Methodology H H H H H H H Eligible Member Population 0 64 1 69 0 0 134 Denominator 0 64 1 67 0 0 132 Numerator Events by Admin Data 0 47 1 56 0 0 104 Numerator Events by Medical Record 0 5 0 5 0 0 10 Numerator Events by Supplemental Data 0 0 0 0 0 0 0 Rate Status NA R NA R NA NA R Reported Rate 81.25% 100.00% 91.04% 86.36%



Special Needs Basic Care - Special Needs Plan (1 of 2)




(<8.0%) Eye Exam


Nephropathy


Audit Designation Reportable Reportable Reportable Reportable Reportable Reportable

Measurement Year 2018 2018 2018 2018 2018 2018 Data Collection Methodology H H H H H H Eligible Member Population 47 47 47 47 47 47 Numerator events by admin data in eligible population 44 41 6 44 46 6

Current Year's Administrative Rate 93.62% 87.23% 12.77% 93.62% 97.87% 12.77% Minimum Required Sample Size 47 47 47 47 47 47 Oversampling Rate 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Number of oversample records


Admin rate on MRSS 95.74% 8.51% 21.28% 93.62% 97.87% 25.53% Number of Records Excluded Because of Valid Data Errors 0 0 0 0 0 0

Number of optional administrative data records excluded - 0 0 0 0 0 0

Number of medical record data records excluded 0 0 0 0 0 0

Number of employee/dependent medical records excluded 0 0 0 0 0 0

Number of HbA1c < 7 required administrative data records excluded Number of HbA1c < 7 required medical records excluded Additional Records Added from the Oversample List 0 0 0 0 0 0

Denominator 47 47 47 47 47 47 Numerator Events by Admin Data 45 4 1 44 46 0 Numerator Events by Medical Record 0 1 26 2 0 25 Numerator Events by Supplemental Data 0 0 9 0 0 12 Rate Status R R R R R R Reported Rate 95.74% 10.64% 76.60% 97.87% 97.87% 78.72%



Special Needs Basic Care - Special Needs Plan (2 of 2)





Small Denominator


Denominator Small


Measurement Year 2018 2018 2018 2018 2018 2018 2018 Data Collection Methodology H H H H H H H Eligible Member Population 0 0 0 47 0 0 47 Denominator 0 0 0 47 0 0 47 Numerator Events by Admin Data 0 0 0 44 0 0 44 Numerator Events by Medical Record 0 0 0 2 0 0 2 Numerator Events by Supplemental Data 0 0 0 0 0 0 0 Rate Status NA NA NA R NA NA R Reported Rate 97.87% 97.87%



Special Needs Basic Care - Non-Special Needs Plan




(<8.0%) Eye Exam


Nephropathy




Current Year's Administrative Rate 87.14% 78.57% 12.68% 16.43% 64.29% 87.86% 34.29% Minimum Required Sample Size 140 140 140 140 140 140 140 Oversampling Rate 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Number of oversample records











Effectiveness of Care Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis

Medicare Advantage Data Elements Medicare

Advantage MSHO

Audit Designation

Measurement Year Data Collection Methodology Eligible Member Population Number of optional exclusions Numerator Events by Admin Data Numerator Events by Supplemental Data Rate Status Reported Rate


Effectiveness of Care Osteoporosis Management in Women Who had a Fracture

Data Elements Medicare Advantage MSHO

Audit Designation mall Denominator

Measurement Year 2018 Data Collection Methodology A Eligible Member Population 10 Number of required exclusions 10 Numerator Events by Admin Data 3 Numerator Events by Supplemental Data 0 Rate Status NA Reported Rate 30.00%


Effectiveness of Care Antidepressant Medication Management

Commercial

Data Elements Effective Acute

Phase Treatment

Effective Continuation

Phase Treatment

Audit Designation




Medicare Advantage


Phase Treatment


Phase Treatment

Audit Designation






Phase Treatment


Phase Treatment


Measurement Year 2018 2018 Data Collection Methodology A A Eligible Member Population 38 38 Number of required exclusions 798 798 Numerator Events by Admin Data 35 35 Numerator Events by Supplemental Data 0 0 Rate Status R R Reported Rate 92.11% 92.11%



Special Needs Basic Care - Special Needs Plan


Phase Treatment


Phase Treatment


Small Denominator

Measurement Year 2018 2018 Data Collection Methodology A A Eligible Member Population 3 3 Number of required exclusions 81 81 Numerator Events by Admin Data 2 2 Numerator Events by Supplemental Data 0 0 Rate Status NA NA Reported Rate 66.67% 66.67%





Phase Treatment


Phase Treatment


Small Denominator

Measurement Year 2018 2018 Data Collection Methodology A A Eligible Member Population 29 29 Number of required exclusions 284 284 Numerator Events by Admin Data 15 11 Numerator Events by Supplemental Data 0 0 Rate Status NA NA Reported Rate 51.72% 37.93%





Phase Treatment


Phase Treatment




Effectiveness of Care Follow-Up Care for Children

Commercial

Data Elements Initiation Phase

Continuation and

Maintenance Phase

Audit Designation






Continuation and

Maintenance Phase


Measurement Year 2018 2018 Data Collection Methodology A A Eligible Member Population 211 54 Number of optional exclusions 0 0 Numerator Events by Admin Data 85 23 Numerator Events by Supplemental Data 0 0 Rate Status R R Reported Rate 40.28% 42.59%





Continuation and

Maintenance Phase


Small Denominator

Measurement Year 2018 2018 Data Collection Methodology A A Eligible Member Population 1 0 Number of optional exclusions 0 0 Numerator Events by Admin Data 0 0 Numerator Events by Supplemental Data 0 0 Rate Status NA NA Reported Rate 0.00%


Effectiveness of Care Follow-up After Hospitalization for Mental Illness


Within 7 Days of Discharge Within 30 Days of Discharge 6-17 18-64 65+ Total 6-17 18-64 65+ Total

Audit Designation




Medicare Advantage Data Elements


Audit Designation






Audit Designation Reportable Reportable Small Denominator Reportable Reportable Reportable Small


Measurement Year 2018 2018 2018 2018 2018 2018 2018 2018 Data Collection Methodology A A A A A A A A Eligible Member Population 108 210 0 318 108 210 0 318 Numerator Events by Admin Data 43 82 0 125 80 135 0 215 Numerator Events by Supplemental Data 0 0 0 0 0 0 0 0 Rate Status R R NA R R R NA R Reported Rate 39.81% 39.05% 39.31% 74.07% 64.29% 67.61%






Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Measurement Year 2018 2018 2018 2018 2018 2018 2018 2018 Data Collection Methodology A A A A A A A A Eligible Member Population 0 19 0 19 0 19 0 19 Numerator Events by Admin Data 0 10 0 10 0 15 0 15 Numerator Events by Supplemental Data 0 0 0 0 0 0 0 0 Rate Status NA NA NA NA NA NA NA NA Reported Rate 52.63% 52.63% 78.95% 78.95%



Minnesota Senior Health Options Data Elements



Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator




Special Needs Basic Care - Special Needs Plan Data Elements



Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator




Special Needs Basic Care - Non-Special Needs Plan Data Elements



Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator



Effectiveness of Care Follow-up After Emergecy Visit for Mental Illness



Audit Designation






Audit Designation






Audit Designation Reportable Reportable Small Denominator Reportable Reportable Reportable Small


Measurement Year 2018 2018 2018 2018 2018 2018 2018 2018 Data Collection Methodology A A A A A A A A Eligible Member Population 78 135 0 213 78 135 0 213 Numerator Events by Admin Data 55 75 0 130 64 95 0 159 Numerator Events by Supplemental Data 0 0 0 0 0 0 0 0 Rate Status R R NA R R R NA R Reported Rate 70.51% 55.56% 61.03% 82.05% 70.37% 74.65%






Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator



Effectiveness of Care Follow-up After Emergecy Visit for Alcohol and Other Drug Abuse


Within 7 Days of Discharge Within 30 Days of Discharge 6-17 65+ Total 6-17 65+ Total

Audit Designation






Audit Designation






Audit Designation Small Denominator Reportable Reportable Small

Denominator Reportable Reportable

Measurement Year 2018 2018 2018 2018 2018 2018 Data Collection Methodology A A A A A A Eligible Member Population 11 228 239 11 228 239 Numerator Events by Admin Data 1 26 27 2 45 47 Numerator Events by Supplemental Data 0 0 0 0 0 0 Rate Status NA R R NA R R Reported Rate 9.09% 11.40% 11.30% 18.18% 19.74% 19.67%






Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Measurement Year 2018 2018 2018 2018 2018 2018 Data Collection Methodology A A A A A A Eligible Member Population 0 9 9 0 9 9 Numerator Events by Admin Data 0 0 0 0 0 0 Numerator Events by Supplemental Data 0 0 0 0 0 0 Rate Status NA NA NA NA NA NA Reported Rate 0.00% 0.00% 0.00% 0.00%






Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator



Effectiveness of Care Annual Monitoring for Patients on Persistent Medications

Commercial

Data Elements Annual Monitoring for Members on

ACE Inhibitors or ARBs Diuretics Total

Audit Designation








Measurement Year 2018 2018 2018 Data Collection Methodology A A A Eligible Member Population 807 526 1333 Number of optional exclusions 0 0 0 Numerator Events by Admin Data 697 452 1149 Numerator Events by Supplemental Data 0 0 0 Rate Status R R R Reported Rate 86.37% 85.93% 86.20%







Measurement Year 2018 2018 2018 Data Collection Methodology A A A Eligible Member Population 283 161 444 Number of optional exclusions 2 0 2 Numerator Events by Admin Data 251 138 389 Numerator Events by Supplemental Data 0 0 0 Rate Status R R R Reported Rate 88.69% 85.71% 87.61%


Effectiveness of Care Medication Reconciliation Post Discharge

Data Elements Medicare Advantage MSHO SNBC

SNP


Measurement Year 2018 2018 Data collection methodology (Administrative or Hybrid) H H

Eligible member population 615 33 Number of numerator events by administrative data in eligible population (before exclusions)

174 9

Current Year's Admin Rate 28.29% 27.27% Minimum required sample size (MRSS) or other sample size 411 33

Oversampling rate 50.00% 0.00% Number of Oversample Records 206 Number of numerator events by administrative data in MRSS 164 9

Administrative rate on MRSS 39.90% 27.27% Number of original sample records excluded because of valid data errors 184 1

Number of employee/dependent medical records excluded 0 0

Records added from the Oversample List 132 0 Denominator 411 32 Numerator Events by Medical Record 71 9 Numerator Events by Admin Data 143 9 Numerator Events by Supplemental Data 0 0 Rate Status R R Reported rate 52.07% 56.25%


Effectiveness of Care Transitions of Care

Medicare Advantage

Data Elements Notification of Inpatient Admission Receipt of Discharge Information Patient Engagement After Inpatient

Discharge Medication Reconciliation Post-

Discharge 18-64 65+ Total 18-64 65+ Total 18-64 65+ Total 18-64 65+ Total

Audit Designation



Admin rate on MRSS Number of Records Excluded Because of Valid Data Errors Number of employee/dependent medical records excluded Additional Records Added from the Oversample List Denominator Numerator Events by Admin Data Numerator Events by Medical Record Numerator Events by Supplemental Data Rate Status Reported Rate







Audit Designation Small Denominator Reportable Reportable Small

Denominator Reportable Reportable Small Denominator Reportable Reportable Small


Measurement Year 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 Data Collection Methodology H H H H H H H H H H H H Eligible Member Population 0 615 615 0 615 615 0 615 615 0 615 615 Numerator events by admin data in eligible population 0 401 401 0 174 174

Current Year's Administrative Rate 65.20% 65.20% 28.29% 28.29% Minimum Required Sample Size 411 411 411 411 411 411 411 411 411 411 411 411 Oversampling Rate 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% Number of oversample records 206 206 206 206 206 206 206 206 206 206 206 206


Admin rate on MRSS 0.00% 93.92% 93.92% 0.00% 39.90% 39.90% Number of Records Excluded Because of Valid Data Errors 184 184 184 184 184 184 184 184 184 184 184 184

Number of employee/dependent medical records excluded 0 0 0 0 0 0 0 0 0 0 0 0

Additional Records Added from the Oversample List 132 132 132 132 132 132 132 132 132 132 132 132

Denominator 0 411 411 0 411 411 0 411 411 0 411 411 Numerator Events by Admin Data 0 322 322 0 143 143 Numerator Events by Medical Record 0 69 69 0 60 60 0 17 17 0 71 71 Numerator Events by Supplemental Data 0 0 0 0 0 0 Rate Status NA R R NA R R NA R R NA R R Reported Rate 16.79% 16.79% 14.60% 14.60% 82.48% 82.48% 52.07% 52.07%







Audit Designation Reportable Small Denominator Reportable Reportable Small

Denominator Reportable Reportable Small Denominator Reportable Reportable Small


Measurement Year 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 Data Collection Methodology H H H H H H H H H H H H Eligible Member Population 33 0 33 33 0 33 33 0 33 33 0 33 Numerator events by admin data in eligible population 31 0 31 9 0 9

Current Year's Administrative Rate 93.94% 93.94% 27.27% 27.27% Minimum Required Sample Size 33 33 33 33 33 33 33 33 33 33 33 33 Oversampling Rate 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% Number of oversample records


Admin rate on MRSS 93.94% 0.00% 93.94% 27.27% 0.00% 27.27% Number of Records Excluded Because of Valid Data Errors 1 1 1 1 1 1 1 1 1 1 1 1

Number of employee/dependent medical records excluded 0 0 0 0 0 0 0 0 0 0 0 0

Additional Records Added from the Oversample List 0 0 0 0 0 0 0 0 0 0 0 0

Denominator 32 0 32 32 0 32 32 0 32 32 0 32 Numerator Events by Admin Data 31 0 31 9 0 9 Numerator Events by Medical Record 3 0 3 7 0 7 0 0 0 9 0 9 Numerator Events by Supplemental Data 0 0 0 0 0 0 Rate Status R NA R R NA R R NA R R NA R Reported Rate 9.38% 9.38% 21.88% 21.88% 96.88% 96.88% 56.25% 56.25%


Effectiveness of Care Potentially Harmful Drug-Disease Interactions in the Elderly

Medicare Advantage

Data Elements

Drug-Disease Interactions

History of Falls + Tricyclic

Antidepressants, Antipsychotics or

Sleep Agents

Dementia + Tricyclic

Antidepressants or Anticholinergic

Agents

Chronic Renal Failure +

Nonaspirin NSAIDs or Cox-2 Selective NSAIDs

Total

Audit Designation

Measurement Year Data Collection Methodology Eligible Member Population Number of required exclusions Numerator Events by Admin Data Rate Status Reported Rate


Effectiveness of Care Potentially Harmful Drug-Disease Interactions in the Elderly


Data Elements

Drug-Disease Interactions

History of Falls + Tricyclic

Antidepressants, Antipsychotics or

Sleep Agents

Dementia + Tricyclic

Antidepressants or Anticholinergic

Agents

Chronic Renal Failure +

Nonaspirin NSAIDs or Cox-2 Selective NSAIDs

Total


Measurement Year 2018 2018 2018 2018 Data Collection Methodology A A A A Eligible Member Population 258 270 74 602 Number of required exclusions 62 87 149 Numerator Events by Admin Data 179 144 6 329 Rate Status R R R R Reported Rate 69.38% 53.33% 8.11% 54.65%


Effectiveness of Care Use of High Risk Medications in the Elderly

Medicare Advantage Data Elements At least 1

Prescription At least 2

Prescriptions

Audit Designation

Measurement Year Data Collection Methodology Eligible Member Population Numerator Events by Admin Data Rate Status Reported Rate NR NR


Effectiveness of Care Use of High Risk Medications in the Elderly

Minnesota Senior Health Options Data Elements At least 1

Prescription At least 2

Prescriptions


Measurement Year 2018 2018 Data Collection Methodology A A Eligible Member Population 1494 1494 Numerator Events by Admin Data 236 223 Rate Status R R Reported Rate 15.80% 14.93%


Effectiveness of Care Use of Opioids at High Dosage


MHCP-MC (F&C)


SNP SNBC

Non-SNP


Measurement Year 2018 2018 2018 2018 2018 Data Collection Methodology A A A A A Eligible Member Population 592 70 308 32 101 Numerator Events by Admin Data on Eligible Population 12 1 16 2 10

Number of required exclusions 29 7 35 5 17 Rate Status R R R R R Reported Rate NR NR 2.03% 1.43% 5.19% 6.25% 9.90%


Effectiveness of Care Use of Opioids from Multiple Providers

Commercial

Data Elements Multiple Prescribers

Multiple Pharmacies

Multiple Prescribers and

Pharmacies

Audit Designation

Measurement Year Data Collection Methodology Eligible Member Population Numerator Events by Admin Data on Eligible Population Rate Status Reported Rate NR NR NR



Medicare Advantage


Multiple Pharmacies


Pharmacies

Audit Designation

Measurement Year Data Collection Methodology Eligible Member Population Numerator Events by Admin Data on Eligible Population Rate Status Reported Rate NR NR NR





Multiple Pharmacies


Pharmacies


Measurement Year 2018 2018 2018 Data Collection Methodology A A A Eligible Member Population 703 703 703 Numerator Events by Admin Data on Eligible Population 31 153 21

Rate Status R R R Reported Rate 4.41% 21.76% 2.99%





Multiple Pharmacies


Pharmacies





Access/Availability of Care Adult's Access to Preventive/Ambulatory Health Services

Commercial Data Elements Ages 20-44 Ages 45-64 Ages 65+ Total

Audit Designation

Measurement Year Data collection methodology (Administrative only) Eligible member population (i.e. members who meet all denominator criteria) Numerator events by administrative data Rate Status Reported rate



Medicare Advantage Data Elements Ages 20-44 Ages 45-64 Ages 65+ Total

Audit Designation

Measurement Year Data collection methodology (Administrative only) Eligible member population (i.e. members who meet all denominator criteria) Numerator events by administrative data Rate Status Reported rate



Minnesota Health Care Programs - Managed Care (Families and Children) Data Elements Ages 20-44 Ages 45-64 Ages 65+ Total

Audit Designation Reportable Reportable Small Denominator Reportable

Measurement Year 2018 2018 2018 2018 Data collection methodology (Administrative only) A A A A

Eligible member population (i.e. members who meet all denominator criteria) 6526 3151 1 9678

Numerator events by administrative data 5463 2712 1 8176 Rate Status R R NA R Reported rate 83.71% 86.07% 100.00% 84.48%



Minnesota Health Care Programs - Managed Care (MN Care) Data Elements Ages 20-44 Ages 45-64 Ages 65+ Total




Numerator events by administrative data 980 943 14 1937 Rate Status R R NA R Reported rate 84.85% 88.05% 82.35% 86.36%



Minnesota Senior Health Options Data Elements Ages 20-44 Ages 45-64 Ages 65+ Total


Small Denominator Reportable Reportable



Numerator events by administrative data 0 0 1513 1513 Rate Status NA NA R R Reported rate 98.89% 98.89%



Special Needs Basic Care - Special Needs Plan Data Elements Ages 20-44 Ages 45-64 Ages 65+ Total




Numerator events by administrative data 47 128 0 175 Rate Status R R NA R Reported rate 97.92% 99.22% 98.87%



Special Needs Basic Care - Non-Special Needs Plan Data Elements Ages 20-44 Ages 45-64 Ages 65+ Total




Numerator events by administrative data 251 364 0 615 Rate Status R R NA R Reported rate 92.96% 93.81% 93.47%


Access/Availability of Care Children's and Adolescents' Access to Primary Care Practitioners

Commercial Data Elements 12-24 months 25 months -

6 yrs. 7-11 yrs. 12-19 yrs.

Audit Designation

Measurement Year Data collection methodology (Administrative only) Eligible member population Numerator events by administrative data Rate Status Reported rate



Minnesota Health Care Programs - Managed Care (Families and Children) Data Elements 12-24 months 25 months -

6 yrs. 7-11 yrs. 12-19 yrs.



Eligible member population 847 3964 2863 3507 Numerator events by administrative data 778 3331 2535 3190 Rate Status R R R R Reported rate 91.85% 84.03% 88.54% 90.96%



Minnesota Health Care Programs - Managed Care (MA MN Care) Data Elements 12-24 months 25 months -

6 yrs. 7-11 yrs. 12-19 yrs.


Small Denominator



Eligible member population 6 29 6 60 Numerator events by administrative data 6 28 5 55 Rate Status NA NA NA R Reported rate 100.00% 96.55% 83.33% 91.67%


Access/Availability of Care Annual Dental Visit

Minnesota Health Care Programs - Managed Care (Families and Children) Data Elements 2-3 Years 4-6 Years 7-10 Years 11-14 Years 15-18 Years 19-20 Years Total


Measurement Year 2018 2018 2018 2018 2018 2018 2018 Data collection methodology (Administrative only) A A A A A A A

Eligible member population 1602 2420 3323 3036 2419 661 13461 Numerator events by administrative data 592 1453 2049 1791 1309 252 7446 Rate Status R R R R R R R Reported rate 36.95% 60.04% 61.66% 58.99% 54.11% 38.12% 55.32%


Access/Availability of Care Annual Dental Visit

Minnesota Health Care Programs - Managed Care (MN Care) Data Elements 2-3 Years 4-6 Years 7-10 Years 11-14 Years 15-18 Years 19-20 Years Total


Small Denominator

Small Denominator

Small Denominator

Small Denominator Reportable Reportable

Measurement Year 2018 2018 2018 2018 2018 2018 2018 Data collection methodology (Administrative only) A A A A A A A

Eligible member population 21 8 9 9 10 125 182 Numerator events by administrative data 4 3 6 3 6 56 78 Rate Status NA NA NA NA NA R R Reported rate 19.05% 37.50% 66.67% 33.33% 60.00% 44.80% 42.86%


Access/Availability of Care Initiation/Engagement of Alcohol Other Drug Dependence Treatment

Commercial (1 of 3) - 13 - 17 Year Olds

Data Elements Initiation AOD Tx Engagement

Alcohol Abuse Opiod Use Other Drug Total Alcohol

Abuse Opiod Use Other Drug Total

Audit Designation




Commercial (2 of 3) - 18+ Year Olds




Audit Designation




Commercial (3 of 3) - Total




Audit Designation




Medicare Advantage (1 of 3) - 13 - 17 Year Olds




Audit Designation




Medicare Advantage (2 of 3) - 18+ Year Olds




Audit Designation




Medicare Advantage (3 of 3) - Total




Audit Designation




Minnesota Health Care Programs - Managed Care (F&C) (1 of 3) - 13 - 17 Year Olds





Small Denominator Reportable Reportable Small

Denominator Small


Measurement Year 2018 2018 2018 2018 2018 2018 2018 2018 Data collection methodology (Administrative only) A A A A A A A A

Eligible member population 21 0 55 66 21 0 55 66 Numerator events by administrative data 12 0 29 33 5 0 11 12 Rate Status NA NA R R NA NA R R Reported rate 57.14% 52.73% 50.00% 23.81% 20.00% 18.18%



Minnesota Health Care Programs - Managed Care (F&C) (2 of 3) - 18+ Year Olds




Audit Designation Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable


Eligible member population 439 107 532 1011 439 107 532 1011 Numerator events by administrative data 183 52 251 448 55 24 65 139 Rate Status R R R R R R R R Reported rate 41.69% 48.60% 47.18% 44.31% 12.53% 22.43% 12.22% 13.75%



Minnesota Health Care Programs - Managed Care (F&C) (3 of 3) - Total




Audit Designation Reportable Reportable Reportable Reportable Reportable Reportable Reportable Reportable


Eligible member population 460 107 587 1077 460 107 587 1077 Numerator events by administrative data 195 52 280 481 60 24 76 151 Rate Status R R R R R R R R Reported rate 42.39% 48.60% 47.70% 44.66% 13.04% 22.43% 12.95% 14.02%



Minnesota Health Care Programs - Managed Care (MN Care) (1 of 3) - 13 - 17 Year Olds





Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator


Eligible member population 0 0 0 0 0 0 0 0 Numerator events by administrative data 0 0 0 0 0 0 0 0 Rate Status NA NA NA NA NA NA NA NA Reported rate



Minnesota Health Care Programs - Managed Care (MN Care) (2 of 3) - 18+ Year Olds






Denominator Small



Eligible member population 46 6 18 67 46 6 18 67 Numerator events by administrative data 25 2 9 35 6 1 1 8 Rate Status R NA NA R R NA NA R Reported rate 54.35% 33.33% 50.00% 52.24% 13.04% 16.67% 5.56% 11.94%



Minnesota Health Care Programs - Managed Care (MN Care) (3 of 3) - Total






Denominator Small



Eligible member population 46 6 18 67 46 6 18 67 Numerator events by administrative data 25 2 9 35 6 1 1 8 Rate Status R NA NA R R NA NA R Reported rate 54.35% 33.33% 50.00% 52.24% 13.04% 16.67% 5.56% 11.94%



Minnesota Senior Health Options (1 of 3) - 13 - 17 Year Olds





Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator





Minnesota Senior Health Options (2 of 3) - 18+ Year Olds





Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator


Eligible member population 14 9 2 25 14 9 2 25 Numerator events by administrative data 3 4 1 8 1 1 0 2 Rate Status NA NA NA NA NA NA NA NA Reported rate 21.43% 44.44% 50.00% 32.00% 7.14% 11.11% 0.00% 8.00%



Minnesota Senior Health Options (3 of 3) - Total





Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator





Special Needs Basic Care - Special Needs Plan (1 of 3) - 13 - 17 Year Olds





Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator





Special Needs Basic Care - Special Needs Plan (2 of 3) - 18+ Year Olds





Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator





Special Needs Basic Care - Special Needs Plan (3 of 3) - Total





Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator




Access/Availability of Care Prenatal and Postpartum Care

Commercial Data Elements Timeliness of

Prenatal Care Postpartum

Care

Audit Designation

Measurement Year Data collection methodology (Administrative or Hybrid) Eligible member population Number of numerator events by administrative data in eligible population (before exclusions)


Minimum required sample size (MRSS) or other sample size Oversampling rate Number of oversample records Number of numerator events by administrative data in FSS Administrative rate on MRSS 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 record Rate Status Reported rate



Minnesota Health Care Programs - Managed Care (Families and Children) Data Elements Timeliness of


Care




417 369

Current year's administrative rate (before exclusions) 50.92% 45.05%

Minimum required sample size (MRSS) or other sample size 411 411

Oversampling rate 10.00% 10.00% Number of oversample records 42 42 Number of numerator events by administrative data in FSS 225 195



Records added from the oversample list 2 2 Denominator 411 411 Numerator events by administrative data 226 195 Numerator events by medical record 119 78 Rate Status R R Reported rate 83.94% 66.42%



Minnesota Health Care Programs - Managed Care (MN Care) Data Elements Timeliness of


Care


Small Denominator



5 2

Current year's administrative rate (before exclusions) 83.33% 33.33%

Minimum required sample size (MRSS) or other sample size 6 6

Oversampling rate 0 0 Number of oversample records Number of numerator events by administrative data in FSS 5 2



Records added from the oversample list 0 0 Denominator 6 6 Numerator events by administrative data 5 2 Numerator events by medical record 0 0 Rate Status NA NA Reported rate 83.33% 33.33%


Utilization Well Child Visits in the First 15 Months of Life

Commercial Data Elements Zero Visits 1 visit 2 visits 3 visits 4 visits 5 visits 6 or more

visits

Audit Designation

Measurement Year Data Collection Methodology Eligible Member Population Numerator Events by Admin Data Numerator Events by Medical Record Numerator Events bySupplemental Data Rate Satus Reported Rate



Minnesota Health Care Programs - Managed Care (Families and Children) Data Elements Zero Visits 1 visit 2 visits 3 visits 4 visits 5 visits 6 or more

visits



Currect Year's Administrative Rate 6.07% 3.76% 3.90% 6.07% 11.13% 19.51% 49.57% Minimum Required Sample Size 411 411 411 411 411 411 411 Oversampling Rate 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% Number of Oversample Records 21 21 21 21 21 21 21


Administrative rate on MRSS 5.35% 3.89% 3.16% 5.84% 11.68% 18.98% 51.09% Number of Records Excluded Because of Valid Data Errors 0 0 0 0 0 0 0



Denominator 411 411 411 411 411 411 411 Numerator Events by Admin Data 18 10 10 17 31 47 214 Numerator Events by Medical Record 0 0 1 4 4 9 46 Numerator Events bySupplemental Data 0 0 0 0 0 0 0 Rate Satus R R R R R R R Reported Rate 4.38% 2.43% 2.68% 5.11% 8.52% 13.63% 63.26%



Minnesota Health Care Programs - Managed Care (MN Care) Data Elements Zero Visits 1 visit 2 visits 3 visits 4 visits 5 visits 6 or more

visits


Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator

Small Denominator


Currect Year's Administrative Rate 0.00% 0.00% 0.00% 0.00% 16.67% 16.67% 66.67% Minimum Required Sample Size 6 6 6 6 6 6 6 Oversampling Rate 0 0 0 0 0 0 0 Number of Oversample Records


Administrative rate on MRSS 0.00% 0.00% 0.00% 0.00% 16.67% 16.67% 66.67% Number of Records Excluded Because of Valid Data Errors 0 0 0 0 0 0 0



Denominator 6 6 6 6 6 6 6 Numerator Events by Admin Data 0 0 0 0 0 1 4 Numerator Events by Medical Record 0 0 0 0 0 1 0 Numerator Events bySupplemental Data 0 0 0 0 0 0 0 Rate Satus NA NA NA NA NA NA NA Reported Rate 0.00% 0.00% 0.00% 0.00% 0.00% 33.33% 66.67%


Utilization Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life


MHCP-MC (MN Care)


Measurement Year 2018 2018 Data Collection Methodology H H Eligible Member Population 3236 18 Numerator events by admin data in eligible population 1800 10

Current Year's Admin Rate 55.62% 55.56% Minimum Required Sample Size 411 18 Oversampling Rate 5.00% 0 Number of Oversample Records 21 Numerator events by admin data in MRSS 239 12 Administrative rate on MRSS 58.15% 66.67% Records Excluded because of Valid Data Errors 0 0


Records Added from the Oversample List 0 0 Denominator 411 18 Numerator Events by Admin Data 239 12 Numerator Events by Medical Record 7 0 Numerator Events by Supplemental Data 0 0 Rate Status R NA Reported Rate 59.85% 66.67%


Utilization Adolescent Well-Care Visits


MHCP-MC (MN Care)


Measurement Year 2018 2018 Data Collection Methodology H H Eligible Member Population 5560 193 Numerator events by admin data in eligible population 1797 30

Current Year's Admin Rate 32.32% 15.54% Minimum Required Sample Size (MRSS) 411 193 Oversampling Rate 5.00% 0.00% Number of oversample records 21 Numerator events by admin data in MRSS 145 32 Administrative rate on MRSS 35.28% 16.58% Records Excluded because of Valid Data Errors 0 0


Records Added from the Oversample List 0 0 Denominator 411 193 Numerator Events by Admin Data 145 32 Numerator Events by Medical Record 69 77 Numerator Events by Supplemental Data 0 0 Rate Status R R Reported Rate 52.07% 56.48%


Utilization Identification of Alcohol and Other Drug Services

Commercial (1 of 4) - Alcohol

Age Data Element

Any Services Inpatient Intensive Outpatient/Partial Hospitalization Outpatient/MAT ED Telehealth

Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total 0-12 Mbr Mnth

Number Percent

13-17 Mbr Mnth Number Percent




65+ Mbr Mnth Number Percent

Unknown Mbr Mnth Number

Total Mbr Mnth Number Percent



Commercial (2 of 4) - Opioid

Age Data Element



Number Percent










Commercial (3 of 4) - Other

Age Data Element



Number Percent










Commercial (4 of 4) - Total

Age Data Element



Number Percent










Medicare Advantage (1 of 4) - Alcohol

Age Data Element



Number Percent










Medicare Advantage (2 of 4) - Opioid

Age Data Element



Number Percent










Medicare Advantage (3 of 4) - Other

Age Data Element



Number Percent










Medicare Advantage (4 of 4) - Total

Age Data Element



Number Percent










Minnesota Health Care Programs - Managed Care (Families and Children) (1 of 4) - Alcohol

Age Data Element


Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total 0-12 Mbr Mnth 88724 83371 172095 88724 83371 172095 88724 83371 172095 88724 83371 172095 88724 83371 172095 88724 83371 172095

Number 1 0 1 1 0 1 0 0 0 1 0 1 0 0 0 0 0 0 Percent 0.01% 0.00% 0.01% 0.01% 0.00% 0.01% 0.00% 0.00% 0.00% 0.01% 0.00% 0.01% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

13-17 Mbr Mnth 25383 25298 50681 25383 25298 50681 25383 25298 50681 25383 25298 50681 25383 25298 50681 25383 25298 50681 Number 24 21 45 6 3 9 0 0 0 13 14 27 4 5 9 3 0 3 Percent 1.13% 1.00% 1.07% 0.28% 0.14% 0.21% 0.00% 0.00% 0.00% 0.61% 0.66% 0.64% 0.19% 0.24% 0.21% 0.14% 0.00% 0.07%




65+ Mbr Mnth 8 6 14 8 6 14 8 6 14 8 6 14 8 6 14 8 6 14 Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Unknown Mbr Mnth 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total Mbr Mnth 191445 221735 413180 191445 221735 413180 191445 221735 413180 191445 221735 413180 191445 221735 413180 191445 221735 413180 Number 556 507 1063 111 101 212 23 25 48 420 362 782 159 143 302 44 28 72 Percent 3.49% 2.74% 3.09% 0.70% 0.55% 0.62% 0.14% 0.14% 0.14% 2.63% 1.96% 2.27% 1.00% 0.77% 0.88% 0.28% 0.15% 0.21%



Minnesota Health Care Programs - Managed Care (Families and Children) (2 of 4) - Opioid

Age Data Element



Number 2 1 3 2 1 3 0 0 0 0 0 0 0 0 0 0 0 0 Percent 0.03% 0.01% 0.02% 0.03% 0.01% 0.02% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%










Minnesota Health Care Programs - Managed Care (Families and Children) (3 of 4) - Other

Age Data Element



Number 3 5 8 2 2 4 0 0 0 2 1 3 0 1 1 0 1 1 Percent 0.04% 0.07% 0.06% 0.03% 0.03% 0.03% 0.00% 0.00% 0.00% 0.03% 0.01% 0.02% 0.00% 0.01% 0.01% 0.00% 0.01% 0.01%










Minnesota Health Care Programs - Managed Care (Families and Children) (4 of 4) - Total

Age Data Element



Number 4 5 9 3 2 5 0 0 0 2 1 3 0 1 1 0 1 1 Percent 0.05% 0.07% 0.06% 0.04% 0.03% 0.03% 0.00% 0.00% 0.00% 0.03% 0.01% 0.02% 0.00% 0.01% 0.01% 0.00% 0.01% 0.01%










Minnesota Health Care Programs - MHCP-MC (MN Care) (1 of 4) - Alcohol

Age Data Element



Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%










Minnesota Health Care Programs - MHCP-MC (MN Care) (2 of 4) - Opioid

Age Data Element



Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%










Minnesota Health Care Programs - MHCP-MC (MN Care) (3 of 4) - Other

Age Data Element



Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%










Minnesota Health Care Programs - MHCP-MC (MN Care) (4 of 4) - Total

Age Data Element



Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%










Minnesota Senior Health Options (1 of 4) - Alcohol

Age Data Element



Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%










Minnesota Senior Health Options (2 of 4) - Opioid

Age Data Element



Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent

13-17 Mbr Mnth 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent









Minnesota Senior Health Options (3 of 4) - Other

Age Data Element



Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent










Minnesota Senior Health Options (4 of 4) - Total

Age Data Element



Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%










Special Needs Basic Care - Special Needs Plan (1 of 4) - Alcohol

Age Data Element



Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent










Special Needs Basic Care - Special Needs Plan (2 of 4) - Opioid

Age Data Element



Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent










Special Needs Basic Care - Special Needs Plan (3 of 4) - Other

Age Data Element



Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent










Special Needs Basic Care - Special Needs Plan (4 of 4) - Total

Age Data Element



Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent










Special Needs Basic Care - Non-Special Needs Plan (1 of 4) - Alcohol

Age Data Element



Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent










Special Needs Basic Care - Non-Special Needs Plan (2 of 4) - Opioid

Age Data Element



Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent










Special Needs Basic Care - Non-Special Needs Plan (3 of 4) - Other

Age Data Element



Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent










Special Needs Basic Care - Non-Special Needs Plan (4 of 4) - Total

Age Data Element



Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent









Utilization Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services

Commercial

Age Data

Element Any Services Inpatient Intensive Outpatient/Partial

Hospitalization Outpatient/MAT ED Telehealth

Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total 0-12 Mbr Mnths

Number Percent

13-17 Mbr Mnths Number Percent


65+ Mbr Mnths Number Percent

Unknown Mbr Mnths Number

Total Mbr Mnths Number Percent



Medicare Advantage

Age Data



Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total 0-12 Mbr Mnths

Number Percent



65+ Mbr Mnths Number Percent

Unknown Mbr Mnths Number

Total Mbr Mnths 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%




Age Data



Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total 0-12 Mbr Mnths 88724 83371 172095 88724 83371 172095 88724 83371 172095 88724 83371 172095 88724 83371 172095 88724 83371 172095

Number 1240 993 2233 13 14 27 179 148 327 1228 987 2215 145 123 268 25 5 30 Percent 16.77% 14.29% 15.57% 0.18% 0.20% 0.19% 2.42% 2.13% 2.28% 16.61% 14.21% 15.44% 1.96% 1.77% 1.87% 0.34% 0.07% 0.21%

13-17 Mbr Mnths 25383 25298 50681 25383 25298 50681 25383 25298 50681 25383 25298 50681 25383 25298 50681 25383 25298 50681 Number 518 692 1210 31 60 91 82 118 200 510 674 1184 57 67 124 13 27 40 Percent 24.49% 32.82% 28.65% 1.47% 2.85% 2.15% 3.88% 5.60% 4.74% 24.11% 31.97% 28.03% 2.69% 3.18% 2.94% 0.61% 1.28% 0.95%


65+ Mbr Mnths 8 6 14 8 6 14 8 6 14 8 6 14 8 6 14 8 6 14 Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Unknown Mbr Mnths 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0





Age Data




Number 1 3 4 0 0 0 0 0 0 1 3 4 0 0 0 0 0 0 Percent 5.71% 12.33% 9.56% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 5.71% 12.33% 9.56% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%









Age Data




Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Percent 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%







Risk Adjusted Utilization Plan All-Cause Readmissions

Commercial Observed Expected - Observed/Expected

Age

Count of Index Stays (Observed)

Observed 30-Day

Re-admissions

Observed Re-

admission Rate

Count of Index Stays (Expected)

Expected 30-Day

Re-admissions

Expected Re-

admission Rate

Variance

Expected 30-Day

Re-admissions

Observed 30-Day

Re-admissions

Observed/ Expected

Ratio 18-44 45-54 55-64

Total (18-64)



Medicare Advantage Observed Expected - Observed/Expected

Age SES

Stratification


Observed 30-Day

Re-admissions

Observed Re-

admission Rate


Expected 30-Day

Re-admissions

Expected Re-

admission Rate

Variance

Expected 30-Day

Re-admissions

Observed 30-Day

Re-admissions

Observed/ Expected

Ratio

18-64

Non-LIS/DE, Nondisability

LIS/DE Disability

LIS/DE and Disability

Other Unknown

Total Medicare

Observed Expected - Observed/Expected

Age


Observed 30-Day

Re-admissions

Observed Re-

admission Rate


Expected 30-Day

Re-admissions

Expected Re-

admission Rate

Variance

Expected 30-Day

Re-admissions

Observed 30-Day

Re-admissions

Observed/ Expected

Ratio 18-44 45-54 55-64

Total (18-64)



Minnesota Senior Health Options Observed Expected - Observed/Expected

Age SES

Stratification


Observed 30-Day

Re-admissions

Observed Re-

admission Rate


Expected 30-Day

Re-admissions

Expected Re-

admission Rate

Variance

Expected 30-Day

Re-admissions

Observed 30-Day

Re-admissions

Observed/ Expected

Ratio

18-64

Non-LIS/DE, Nondisability 0 0 0 0 0

LIS/DE 0 0 0 0 0 Disability 0 0 0 0 0

LIS/DE and Disability 0 0 0 0 0

Other 0 0 0 0 0 Unknown 0 0 0 0 0

Total Medicare 0 0 0 0 0 0 0


Age


Observed 30-Day

Re-admissions

Observed Re-

admission Rate


Expected 30-Day

Re-admissions

Expected Re-

admission Rate

Variance

Expected 30-Day

Re-admissions

Observed 30-Day

Re-admissions

Observed/ Expected

Ratio 18-44 0 0 0 0 0 0 0 45-54 0 0 0 0 0 0 0 55-64 0 0 0 0 0 0 0

Total (18-64) 0 0 0 0 0 0 0



Special Needs Basic Care - Special Needs Plan Observed Expected - Observed/Expected

Age SES

Stratification


Observed 30-Day

Re-admissions

Observed Re-

admission Rate


Expected 30-Day

Re-admissions

Expected Re-

admission Rate

Variance

Expected 30-Day

Re-admissions

Observed 30-Day

Re-admissions

Observed/ Expected

Ratio

18-64

Non-LIS/DE, Nondisability 0 0 0 0 0

LIS/DE 0 0 0 0 0 Disability 0 0 0 0 0

LIS/DE and Disability 32 6 18.75% 32 7.2226 22.57% 4.8799

Other 0 0 0 0 0 Unknown 0 0 0 0 0

Total Medicare 32 6 18.75% 32 7.2226 22.57% 4.8799 7.2226 6 83.07%


Age


Observed 30-Day

Re-admissions

Observed Re-

admission Rate


Expected 30-Day

Re-admissions

Expected Re-

admission Rate

Variance

Expected 30-Day

Re-admissions

Observed 30-Day

Re-admissions

Observed/ Expected

Ratio 18-44 8 2 25.00% 8 2.1819 27.27% 1.383 2.1819 2 91.66% 45-54 9 1 11.11% 9 1.0127 11.25% 0.8916 1.0127 1 98.75% 55-64 15 3 20.00% 15 4.028 26.85% 2.6053 4.028 3 74.48%

Total (18-64) 32 6 18.75% 32 7.2226 22.57% 4.8799 7.2226 6 83.07%


Health Plan Descriptive Information Board Certification


Type of Physician Audit Designation

Number of Physicians in Each

Practice Area

Active Board Certification

Number Rate Status Percent

Family Medicine Unaudited 854 743 UN 87.00% Internal Medicine Unaudited 933 748 UN 80.17% Pediatrician Unaudited 356 309 UN 86.80% OB/GYN Unaudited 185 155 UN 83.78% Geriatricians Unaudited 30 19 UN 63.33% Other practitioner Specialists Unaudited 2478 2034 UN 82.08%






Practice Area





Health Plan Descriptive Information Enrollment by Product Line (Age & Sex)

Commercial Age Members Member Months

Male Female Total Male Female Total <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


45-49 50-54 55-59 60-64


65-69 70-74 75-79 80-84 85-89 >=90

>=65 Subtotal: >=65 Subtotal: %

Age Unknown Total



Medicare Advantage Age Members Member Months

Male Female Total Male Female Total <1 1-4 5-9 10-14 15-17 18-19


20-24 25-29 30-34 35-39 40-44


45-49 50-54 55-59 60-64


65-69 70-74 75-79 80-84 85-89 >=90

>=65 Subtotal: >=65 Subtotal: %

Age Unknown Total



Minnesota Health Care Programs - Managed Care (Families and Children) Age Members

Male Female Total <1 7154 6593 13747 1-4 28596 26585 55181 5-9 33968 31619 65587 10-14 30001 29499 59500 15-17 14388 14373 28761 18-19 6799 8034 14833

0-19 Subtotal: 120906 116703 237609 0-19 Subtotal: % 63.13% 52.62% 57.49%

20-24 9718 17619 27337 25-29 9859 19390 29249 30-34 10087 17399 27486 35-39 9305 14012 23317 40-44 6993 9105 16098


45-49 6087 7482 13569 50-54 6369 7209 13578 55-59 6728 7196 13924 60-64 5466 5659 11125


65-69 8 6 14 70-74 0 0 0 75-79 0 0 0 80-84 0 0 0 85-89 0 0 0 >=90 0 0 0

>=65 Subtotal: 8 6 14 >=65 Subtotal: % 0.00% 0.00% 0.00%

Age Unknown 0 0 0 Total 191526 221780 413306



Minnesota Health Care Programs - Managed Care (MN Care) Age Members



20-24 1502 2048 3550 25-29 1293 2311 3604 30-34 1840 2357 4197 35-39 1824 2343 4167 40-44 1537 2039 3576


45-49 1451 1989 3440 50-54 1505 1833 3338 55-59 1838 2181 4019 60-64 2096 2824 4920


65-69 39 60 99 70-74 56 13 69 75-79 0 21 21 80-84 0 0 0 85-89 0 0 0 >=90 0 0 0





Minnesota Senior Health Options Age Members Member Months

Male Female Total Male Female Total <1 0 0 0 0 0 0 1-4 0 0 0 0 0 0 5-9 0 0 0 0 0 0 10-14 0 0 0 0 0 0 15-17 0 0 0 0 0 0 18-19 0 0 0 0 0 0

0-19 Subtotal: 0 0 0 0 0 0 0-19 Subtotal: % 0.00% 0.00% 0.00%

20-24 0 0 0 0 0 0 25-29 0 0 0 0 0 0 30-34 0 0 0 0 0 0 35-39 0 0 0 0 0 0 40-44 0 0 0 0 0 0


45-49 0 0 0 0 0 0 50-54 0 0 0 0 0 0 55-59 0 0 0 0 0 0 60-64 0 1 1 5 7 12


65-69 128 184 312 1537 2205 3742 70-74 97 207 304 1167 2486 3653 75-79 92 198 290 1098 2375 3473 80-84 90 210 300 1078 2525 3603 85-89 68 235 303 813 2817 3630 >=90 68 355 423 821 4255 5076

>=65 Subtotal: 543 1389 1932 6514 16663 23177 >=65 Subtotal: % 100.00% 99.93% 99.95%

Age Unknown 0 0 0 0 0 0 Total 543 1390 1933



Special Needs Basic Care - Special Needs Plan Age Members Member Months

Male Female Total Male Female Total <1 0 0 0 0 0 0 1-4 0 0 0 0 0 0 5-9 0 0 0 0 0 0 10-14 0 0 0 0 0 0 15-17 0 0 0 0 0 0 18-19 0 0 0 0 0 0


20-24 1 1 2 14 12 26 25-29 3 0 3 37 0 37 30-34 7 4 11 81 44 125 35-39 4 11 15 53 132 185 40-44 9 10 19 103 120 223


45-49 7 11 18 80 137 217 50-54 15 19 34 185 227 412 55-59 19 28 47 231 341 572 60-64 17 25 42 201 295 496


65-69 1 0 1 9 3 12 70-74 0 0 0 0 0 0 75-79 0 0 0 0 0 0 80-84 0 0 0 0 0 0 85-89 0 0 0 0 0 0 >=90 0 0 0 0 0 0

>=65 Subtotal: 1 0 1 9 3 12 >=65 Subtotal: % 1.20% 0.00% 0.52%

Age Unknown 0 0 0 0 0 0 Total 83 109 192



Special Needs Basic Care - Non-Special Needs Plan Age Members



20-24 596 376 972 25-29 415 328 743 30-34 395 413 808 35-39 296 485 781 40-44 264 240 504


45-49 395 544 939 50-54 569 836 1405 55-59 709 806 1515 60-64 811 778 1589


65-69 1 5 6 70-74 0 0 0 75-79 0 0 0 80-84 0 0 0 85-89 0 0 0 >=90 0 0 0




2019 hmo hedis quality measures · 2019 hmo hedis® quality measures data based on the 2018...

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