HEDIS® 2000 (Summary) Documentation for Reporting Year 1999

General Information

This documentation presents (1) a description of each HEDIS® measure that CMS collected for 302 Medicare managed care contract markets on health care provided in calendar year 1999 to Medicare beneficiaries and (2) the location of the rates associated with each HEDIS measure within the HEDIS workbook (HEDIS2000.XLS). CMS took the description and additional information for each measure from HEDIS 2000 Volume 2: Technical Specifications. This release contains only those rates, percentages, or averages for each measure and not the numerator or denominator used to create those measures. CMS has made minor modifications to the original data. CMS confirmed that all reported rates are commensurate with the HEDIS general guidelines. For example, the HEDIS guidelines advise plans to report "not applicable" for measures that rely on a small number of observations, and CMS appropriately suppressed these rates. CMS also added two variables to the database. A brief discussion of each issue identified here appears below.

For this measurement year, CMS required that all managed care organizations undergo an audit on all HEDIS measures. The summary data file includes all submitted data.

The HEDIS measure descriptions reprinted here are done so with the permission of the National Committee for Quality Assurance ("NCQA"). HEDIS (R) is a registered trademark of NCQA, and a copyright for HEDIS (R) 2000 is held by the National Committee for Quality Assurance, 2000 L Street, NW, Suite 500, Washington, DC 20036. All rights reserved.

The Medicare HEDIS reporting unit is a "contract market"

In 2000, CMS collected 302 HEDIS submissions from Medicare managed care plans for health care delivered in 1999. The reporting unit for CMS is a "contract market." CMS signs contracts with health plans to provide health care for a given geographic area. A contract market is usually the entire contract area. However, CMS did not believe that HEDIS results would adequately represent local health care when a contract covers a large geographic region with high enrollment. For this reason, CMS broke large contracts covering several areas with high enrollment into smaller "market areas" containing at least 5,000 beneficiaries. The 302 submissions by contract market represent 270 contracts. The "GENERAL" sheet in the HEDIS workbook identifies the state and counties for each submission. If the submission is a "market area," the city designation appears next to the state. For example, the state variable for a contract in Ohio with two market areas might appear as "OH: Eastern Ohio" and "OH: Western & Southern Ohio."

CMS collected most data at the contract market level. However, some reported information, such as financial data reflects the health plan, which could administer several contracts. This documentation indicates the reporting level for each measure.

CMS copied the description of each measure from the HEDIS Technical Specifications

The description and related information provided for each measure in this documentation are taken from the HEDIS 2000 Technical Specifications, which are the specific instructions for calculating HEDIS measures that NCQA provides to Medicare managed care plans. For each measure, the Technical Specifications detail the precise method for sampling (when appropriate), identification of the numerator and denominator, measure calculation, and any other important considerations specific to that measure. The technical specifications also contain general guidelines that apply to all measures, such as the use of medical records and when a plan should not report a measure because its eligible membership is too small. Some measures require more detailed specifications than others. As opposed to the Beta Blocker measure described below, the calculation of the measure for the number of years a plan has had a commercial product is fairly straightforward. The technical specifications necessary to produce HEDIS measures are available from NCQA in HEDIS 2000, Volume 2: Technical Specifications."

The specifications for Beta Blocker Treatment After Heart Attack demonstrate the extent of detailed instructions provided for many measures. For this measure, the specifications describe the unit of measurement (members vs. procedures or discharges); data sources used to identify the numerator and denominator (membership, claims/encounter, hospital discharge, and pharmacy data); the period of time under consideration (the reporting year); age ranges for member inclusion in the measure (35 and older); diagnosis codes to identify acute myocardial infarction (AMI); diagnosis codes to identify exclusions for beta blocker; a list of beta blocker prescriptions; appropriate sample size if the plan chooses to use a sample; and other instructions, such as the appropriate interpretation of two AMI episodes for an individual member.

HEDIS Guidelines identify two types of missing values: NA and NR

The HEDIS guidelines distinguish between two different types of missing values in the rate field: Not Applicable (NA) and Not Report (NR). Health plans report NA when they: do not have a large enough population to calculate a representative rate (e.g., many measures require that rates be based on at least 30 members) or are not eligible for a measure (e.g., a health plan cannot calculate outpatient drug utilization if it does not offer an outpatient drug benefit; a health plan cannot calculate a measure requiring a year of continuous enrollment if its first enrollment began mid-way through the reporting year.)

Health plans report NR when: they choose not to calculate and report a rate, or the health plan’s HEDIS Compliance Auditor determines that a rate is materially biased (applicable only to audited measures).

For measures reported as a percentage, material bias is defined as a deviation of more than five percentage points from the true rate. For other measures (e.g., procedures per 1000 member years), material bias exists if the number of counted procedures deviates by more than ten percent from the true number of procedures.

CMS suppressed a small number of rates to meet privacy requirements.

Under the Privacy Act, CMS cannot publish or otherwise disclose the data in a form raising unacceptable possibilities that an individual could be identified (i.e., the data must not be beneficiary-specific and must be aggregated to a level where no data cells have 10 or fewer beneficiaries). To ensure that no beneficiary can be identified, CMS has chosen not to report certain measures, specifically reported enrollment by age category, and has suppressed an extremely small number of rates. CMS has replaced suppressed rates with a ‘NA.' Please see the section on missing values above for an explanation of missing value designations.

CMS has added variables to the HEDIS data.

CMS includes our record of enrollment as of December of the measurement year in the "GENERAL" sheet in the HEDIS workbook. The HEDIS reported value is adjusted for individuals with partial-year enrollment and reflects the entire contract's enrollment. CMS's enrollment is now broken down by the number enrolled in the CMS approved contract market area.

We have also changed the way we are reporting the area served by each contract. The states served by each contract used to be reported within every measure. Since this data is constant for the measurement year and the size of the areas covered by each contract have increased dramatically, we have moved the area served into its own separate reports. You will find a separate sheet called "Service Area" in the HEDIS workbook which contains the contract, state(s) and counties served by the contracts reporting HEDIS. There is additional field "EGHP" which indicates if the county is available only to beneficiaries in Employer Groups. The old "Service State" field in each measure now just lists the Market Area served by the contract for the contracts still reporting by market area.

National Enrollment Weighted Average Score

CMS has calculated and included a weighted National average for all of the Effectiveness of Care (EOC) measures. These rates are reported on a separate sheet called "National Rates" in the HEDIS Workbook. The rate for each of the EOC measures was calculated using the following formula:

((En1/TotE)*Sn1)+((En2/TotE)*Sn2)+…+((Enx/TotE)*Snx)=National Enrollment Weighted Average Score

Where:   TotE = Total enrollment for all contracts with a valid numeric rate in the measure
En1 = Enrollment in the first contract with a valid numeric rate
Sn1 = Reported rate for the first contract with a valid numeric rate
Enx = Enrollment in the last contract with a valid numeric rate
Snx = Reported rate for the last contract with a valid numeric rate


Measure   Measure Name/Measure Description/Field Name/Field Description

AOC201 – Adults' Access to Preventive/Ambulatory Health Services

     DESCRIPTION - The percentage of enrollees age 20 through 44, 45 through 64 and 65 years and older who have had an ambulatory or preventive-care visit. Nine separate rates are calculated, one for each of the three product lines for each of the three age groups. Report the percentage of:

     - Medicaid and Medicare enrollees who were continuously enrolled during the measurement year and who had ambulatory or preventive-care visit during the measurement year.

     - Commercial enrollees who were continuously enrolled during the measurement year and the two calendar years preceding the measurement year and who had an ambulatory or preventive-care visit during year or the two calendar years preceding the measurement year. (HEDIS 2000, Volume 2: Technical Specification, Pg. 118)

     REPORTING LEVEL - Contract Market

          AOC201-0010    Rate (Ages 20-44)

          AOC201-0020    Rate (Ages 45-64)

          AOC201-0030    Rate (Ages 65 and older)

AOC209a – Availability of Language Interpretation Services

     DESCRIPTION - MCOs should complete two tables for this measure: (Part 1 of 3)

     The number of MCO providers and member service staff who serve each product line and who speak languages other than English (See AOC210)

     A description of out-of-MCO interpreter services secured during the measurement year for Medicaid, commercial and Medicare members.(HEDIS 2000, Volume 2: Technical Specification, Pg. 130)

     REPORTING LEVEL - Contract Market

          AOC209-0010    Out-of-Plan interpreter services secured during the reporting year - Language 1 (Language)

          AOC209-0020    Out-of-Plan interpreter services secured during the reporting year - Language 1 (Interpreter Services)

          AOC209-0030    Out-of-Plan interpreter services secured during the reporting year - Language 1 (Description)

          AOC209-0040    Out-of-Plan interpreter services secured during the reporting year - Language 1 (Type of Agreement)

          AOC209-0050    Out-of-Plan interpreter services secured during the reporting year - Language 1 (Restrictions on Availability)

          AOC209-0060    Out-of-Plan interpreter services secured during the reporting year - Language 2 (Language)

          AOC209-0070    Out-of-Plan interpreter services secured during the reporting year - Language 2 (Interpreter Services)

          AOC209-0080    Out-of-Plan interpreter services secured during the reporting year - Language 2 (Description)

          AOC209-0090    Out-of-Plan interpreter services secured during the reporting year - Language 2 (Type of Agreement)

          AOC209-0100    Out-of-Plan interpreter services secured during the reporting year - Language 2 (Restrictions on Availability)

          AOC209-0110    Out-of-Plan interpreter services secured during the reporting year - Language 3 (Language)

          AOC209-0120    Out-of-Plan interpreter services secured during the reporting year - Language 3 (Interpreter Services)

          AOC209-0130    Out-of-Plan interpreter services secured during the reporting year - Language 3 (Description)

          AOC209-0140    Out-of-Plan interpreter services secured during the reporting year - Language 3 (Type of Agreement)

          AOC209-0150    Out-of-Plan interpreter services secured during the reporting year - Language 3 (Restrictions on Availability)

          AOC209-0160    Out-of-Plan interpreter services secured during the reporting year - Language 4 (Language)

          AOC209-0170    Out-of-Plan interpreter services secured during the reporting year - Language 4 (Interpreter Services)

          AOC209-0180    Out-of-Plan interpreter services secured during the reporting year - Language 4 (Description)

          AOC209-0190    Out-of-Plan interpreter services secured during the reporting year - Language 4 (Type of Agreement)

          AOC209-0200    Out-of-Plan interpreter services secured during the reporting year - Language 4 (Restrictions on Availability)

          AOC209-0210    Out-of-Plan interpreter services secured during the reporting year - Language 5 (Language)

          AOC209-0220    Out-of-Plan interpreter services secured during the reporting year - Language 5 (Interpreter Services)

          AOC209-0230    Out-of-Plan interpreter services secured during the reporting year - Language 5 (Description)

          AOC209-0240    Out-of-Plan interpreter services secured during the reporting year - Language 5 (Type of Agreement)

          AOC209-0250    Out-of-Plan interpreter services secured during the reporting year - Language 5 (Restrictions on Availability)

          AOC209-0260    Out-of-Plan interpreter services secured during the reporting year - Language 6 (Language)

          AOC209-0270    Out-of-Plan interpreter services secured during the reporting year - Language 6 (Interpreter Services)

          AOC209-0280    Out-of-Plan interpreter services secured during the reporting year - Language 6 (Description)

          AOC209-0290    Out-of-Plan interpreter services secured during the reporting year - Language 6 (Type of Agreement)

          AOC209-0300    Out-of-Plan interpreter services secured during the reporting year - Language 6 (Restrictions on Availability)

          AOC209-0310    Out-of-Plan interpreter services secured during the reporting year - Language 7 (Language)

          AOC209-0320    Out-of-Plan interpreter services secured during the reporting year - Language 7 (Interpreter Services)

          AOC209-0330    Out-of-Plan interpreter services secured during the reporting year - Language 7 (Description)

          AOC209-0340    Out-of-Plan interpreter services secured during the reporting year - Language 7 (Type of Agreement)

          AOC209-0350    Out-of-Plan interpreter services secured during the reporting year - Language 7 (Restrictions on Availability)

Measure   Measure Name/Measure Description/Field Name/Field Description

          AOC209-0360    Out-of-Plan interpreter services secured during the reporting year - Language 8 (Language)

          AOC209-0370    Out-of-Plan interpreter services secured during the reporting year - Language 8 (Interpreter Services)

          AOC209-0380    Out-of-Plan interpreter services secured during the reporting year - Language 8 (Description)

          AOC209-0390    Out-of-Plan interpreter services secured during the reporting year - Language 8 (Type of Agreement)

          AOC209-0400    Out-of-Plan interpreter services secured during the reporting year - Language 8 (Restrictions on Availability)

          AOC209-0410    Out-of-Plan interpreter services secured during the reporting year - Language 9 (Language)

          AOC209-0420    Out-of-Plan interpreter services secured during the reporting year - Language 9 (Interpreter Services)

          AOC209-0430    Out-of-Plan interpreter services secured during the reporting year - Language 9 (Description)

          AOC209-0440    Out-of-Plan interpreter services secured during the reporting year - Language 9 (Type of Agreement)

          AOC209-0450    Out-of-Plan interpreter services secured during the reporting year - Language 9 (Restrictions on Availability)

          AOC209-0460    Out-of-Plan interpreter services secured during the reporting year - Language 10 (Language)

          AOC209-0470    Out-of-Plan interpreter services secured during the reporting year - Language 10 (Interpreter Services)

          AOC209-0480    Out-of-Plan interpreter services secured during the reporting year - Language 10 (Description)

          AOC209-0490    Out-of-Plan interpreter services secured during the reporting year - Language 10 (Type of Agreement)

          AOC209-0500    Out-of-Plan interpreter services secured during the reporting year - Language 10 (Restrictions on Availability)

AOC209b – Availability of Language Interpretation Services

     DESCRIPTION - MCOs should complete two tables for this measure: (Part 2 of 3)

     The number of MCO providers and member service staff who serve each product line and who speak languages other than English (See AOC210)

     A description of out-of-MCO interpreter services secured during the measurement year for Medicaid, commercial and Medicare members.(HEDIS 2000, Volume 2: Technical Specification, Pg. 130)

     REPORTING LEVEL - Contract Market

          AOC209-0510    Out-of-Plan interpreter services secured during the reporting year - Language 11 (Language)

          AOC209-0520    Out-of-Plan interpreter services secured during the reporting year - Language 11 (Interpreter Services)

          AOC209-0530    Out-of-Plan interpreter services secured during the reporting year - Language 11 (Description)

          AOC209-0540    Out-of-Plan interpreter services secured during the reporting year - Language 11 (Type of Agreement)

          AOC209-0550    Out-of-Plan interpreter services secured during the reporting year - Language 11 (Restrictions on Availability)

          AOC209-0560    Out-of-Plan interpreter services secured during the reporting year - Language 12 (Language)

          AOC209-0570    Out-of-Plan interpreter services secured during the reporting year - Language 12 (Interpreter Services)

          AOC209-0580    Out-of-Plan interpreter services secured during the reporting year - Language 12 (Description)

          AOC209-0590    Out-of-Plan interpreter services secured during the reporting year - Language 12 (Type of Agreement)

          AOC209-0600    Out-of-Plan interpreter services secured during the reporting year - Language 12 (Restrictions on Availability)

          AOC209-0610    Out-of-Plan interpreter services secured during the reporting year - Language 13 (Language)

          AOC209-0620    Out-of-Plan interpreter services secured during the reporting year - Language 13 (Interpreter Services)

          AOC209-0630    Out-of-Plan interpreter services secured during the reporting year - Language 13 (Description)

          AOC209-0640    Out-of-Plan interpreter services secured during the reporting year - Language 13 (Type of Agreement)

          AOC209-0650    Out-of-Plan interpreter services secured during the reporting year - Language 13 (Restrictions on Availability)

          AOC209-0660    Out-of-Plan interpreter services secured during the reporting year - Language 14 (Language)

          AOC209-0670    Out-of-Plan interpreter services secured during the reporting year - Language 14 (Interpreter Services)

          AOC209-0680    Out-of-Plan interpreter services secured during the reporting year - Language 14 (Description)

          AOC209-0690    Out-of-Plan interpreter services secured during the reporting year - Language 14 (Type of Agreement)

          AOC209-0700    Out-of-Plan interpreter services secured during the reporting year - Language 14 (Restrictions on Availability)

          AOC209-0710    Out-of-Plan interpreter services secured during the reporting year - Language 15 (Language)

          AOC209-0720    Out-of-Plan interpreter services secured during the reporting year - Language 15 (Interpreter Services)

          AOC209-0730    Out-of-Plan interpreter services secured during the reporting year - Language 15 (Description)

          AOC209-0740    Out-of-Plan interpreter services secured during the reporting year - Language 15 (Type of Agreement)

          AOC209-0750    Out-of-Plan interpreter services secured during the reporting year - Language 15 (Restrictions on Availability)

          AOC209-0760    Out-of-Plan interpreter services secured during the reporting year - Language 16 (Language)

          AOC209-0770    Out-of-Plan interpreter services secured during the reporting year - Language 16 (Interpreter Services)

          AOC209-0780    Out-of-Plan interpreter services secured during the reporting year - Language 16 (Description)

          AOC209-0790    Out-of-Plan interpreter services secured during the reporting year - Language 16 (Type of Agreement)

          AOC209-0800    Out-of-Plan interpreter services secured during the reporting year - Language 16 (Restrictions on Availability)

          AOC209-0810    Out-of-Plan interpreter services secured during the reporting year - Language 17 (Language)

          AOC209-0820    Out-of-Plan interpreter services secured during the reporting year - Language 17 (Interpreter Services)

          AOC209-0830    Out-of-Plan interpreter services secured during the reporting year - Language 17 (Description)

Measure   Measure Name/Measure Description/Field Name/Field Description

          AOC209-0840    Out-of-Plan interpreter services secured during the reporting year - Language 17 (Type of Agreement)

          AOC209-0850    Out-of-Plan interpreter services secured during the reporting year - Language 17 (Restrictions on Availability)

          AOC209-0860    Out-of-Plan interpreter services secured during the reporting year - Language 18 (Language)

          AOC209-0870    Out-of-Plan interpreter services secured during the reporting year - Language 18 (Interpreter Services)

          AOC209-0880    Out-of-Plan interpreter services secured during the reporting year - Language 18 (Description)

          AOC209-0890    Out-of-Plan interpreter services secured during the reporting year - Language 18 (Type of Agreement)

          AOC209-0900    Out-of-Plan interpreter services secured during the reporting year - Language 18 (Restrictions on Availability)

          AOC209-0910    Out-of-Plan interpreter services secured during the reporting year - Language 19 (Language)

          AOC209-0920    Out-of-Plan interpreter services secured during the reporting year - Language 19 (Interpreter Services)

          AOC209-0930    Out-of-Plan interpreter services secured during the reporting year - Language 19 (Description)

          AOC209-0940    Out-of-Plan interpreter services secured during the reporting year - Language 19 (Type of Agreement)

          AOC209-0950    Out-of-Plan interpreter services secured during the reporting year - Language 19 (Restrictions on Availability)

          AOC209-0960    Out-of-Plan interpreter services secured during the reporting year - Language 20 (Language)

          AOC209-0970    Out-of-Plan interpreter services secured during the reporting year - Language 20 (Interpreter Services)

          AOC209-0980    Out-of-Plan interpreter services secured during the reporting year - Language 20 (Description)

          AOC209-0990    Out-of-Plan interpreter services secured during the reporting year - Language 20 (Type of Agreement)

          AOC209-1000    Out-of-Plan interpreter services secured during the reporting year - Language 20 (Restrictions on Availability)

AOC209c – Availability of Language Interpretation Services

     DESCRIPTION - MCOs should complete two tables for this measure: (Part 3 of 3)

     The number of MCO providers and member service staff who serve each product line and who speak languages other than English (See AOC210)

     A description of out-of-MCO interpreter services secured during the measurement year for Medicaid, commercial and Medicare members.(HEDIS 2000, Volume 2: Technical Specification, Pg. 130)

     REPORTING LEVEL - Contract Market

          AOC209-1010    Out-of-Plan interpreter services secured during the reporting year - Language 21 (Language)

          AOC209-1020    Out-of-Plan interpreter services secured during the reporting year - Language 21 (Interpreter Services)

          AOC209-1030    Out-of-Plan interpreter services secured during the reporting year - Language 21 (Description)

          AOC209-1040    Out-of-Plan interpreter services secured during the reporting year - Language 21 (Type of Agreement)

          AOC209-1050    Out-of-Plan interpreter services secured during the reporting year - Language 21 (Restrictions on Availability)

          AOC209-1060    Out-of-Plan interpreter services secured during the reporting year - Language 22 (Language)

          AOC209-1070    Out-of-Plan interpreter services secured during the reporting year - Language 22 (Interpreter Services)

          AOC209-1080    Out-of-Plan interpreter services secured during the reporting year - Language 22 (Description)

          AOC209-1090    Out-of-Plan interpreter services secured during the reporting year - Language 22 (Type of Agreement)

          AOC209-1100    Out-of-Plan interpreter services secured during the reporting year - Language 22 (Restrictions on Availability)

          AOC209-1110    Out-of-Plan interpreter services secured during the reporting year - Language 23 (Language)

          AOC209-1120    Out-of-Plan interpreter services secured during the reporting year - Language 23 (Interpreter Services)

          AOC209-1130    Out-of-Plan interpreter services secured during the reporting year - Language 23 (Description)

          AOC209-1140    Out-of-Plan interpreter services secured during the reporting year - Language 23 (Type of Agreement)

          AOC209-1150    Out-of-Plan interpreter services secured during the reporting year - Language 23 (Restrictions on Availability)

          AOC209-1160    Out-of-Plan interpreter services secured during the reporting year - Language 24 (Language)

          AOC209-1170    Out-of-Plan interpreter services secured during the reporting year - Language 24 (Interpreter Services)

          AOC209-1180    Out-of-Plan interpreter services secured during the reporting year - Language 24 (Description)

          AOC209-1190    Out-of-Plan interpreter services secured during the reporting year - Language 24 (Type of Agreement)

          AOC209-1200    Out-of-Plan interpreter services secured during the reporting year - Language 24 (Restrictions on Availability)

          AOC209-1210    Out-of-Plan interpreter services secured during the reporting year - Language 25 (Language)

          AOC209-1220    Out-of-Plan interpreter services secured during the reporting year - Language 25 (Interpreter Services)

          AOC209-1230    Out-of-Plan interpreter services secured during the reporting year - Language 25 (Description)

          AOC209-1240    Out-of-Plan interpreter services secured during the reporting year - Language 25 (Type of Agreement)

          AOC209-1250    Out-of-Plan interpreter services secured during the reporting year - Language 25 (Restrictions on Availability)

          AOC209-1260    Out-of-Plan interpreter services secured during the reporting year - Language 26 (Language)

          AOC209-1270    Out-of-Plan interpreter services secured during the reporting year - Language 26 (Interpreter Services)

          AOC209-1280    Out-of-Plan interpreter services secured during the reporting year - Language 26 (Description)

          AOC209-1290    Out-of-Plan interpreter services secured during the reporting year - Language 26 (Type of Agreement)

          AOC209-1300    Out-of-Plan interpreter services secured during the reporting year - Language 26 (Restrictions on Availability)

          AOC209-1310    Out-of-Plan interpreter services secured during the reporting year - Language 27 (Language)

Measure   Measure Name/Measure Description/Field Name/Field Description

          AOC209-1320    Out-of-Plan interpreter services secured during the reporting year - Language 27 (Interpreter Services)

          AOC209-1330    Out-of-Plan interpreter services secured during the reporting year - Language 27 (Description)

          AOC209-1340    Out-of-Plan interpreter services secured during the reporting year - Language 27 (Type of Agreement)

          AOC209-1350    Out-of-Plan interpreter services secured during the reporting year - Language 27 (Restrictions on Availability)

          AOC209-1360    Out-of-Plan interpreter services secured during the reporting year - Language 28 (Language)

          AOC209-1370    Out-of-Plan interpreter services secured during the reporting year - Language 28 (Interpreter Services)

          AOC209-1380    Out-of-Plan interpreter services secured during the reporting year - Language 28 (Description)

          AOC209-1390    Out-of-Plan interpreter services secured during the reporting year - Language 28 (Type of Agreement)

          AOC209-1400    Out-of-Plan interpreter services secured during the reporting year - Language 28 (Restrictions on Availability)

          AOC209-1410    Out-of-Plan interpreter services secured during the reporting year - Language 29 (Language)

          AOC209-1420    Out-of-Plan interpreter services secured during the reporting year - Language 29 (Interpreter Services)

          AOC209-1430    Out-of-Plan interpreter services secured during the reporting year - Language 29 (Description)

          AOC209-1440    Out-of-Plan interpreter services secured during the reporting year - Language 29 (Type of Agreement)

          AOC209-1450    Out-of-Plan interpreter services secured during the reporting year - Language 29 (Restrictions on Availability)

          AOC209-1460    Out-of-Plan interpreter services secured during the reporting year - Language 30 (Language)

          AOC209-1470    Out-of-Plan interpreter services secured during the reporting year - Language 30 (Interpreter Services)

          AOC209-1480    Out-of-Plan interpreter services secured during the reporting year - Language 30 (Description)

          AOC209-1490    Out-of-Plan interpreter services secured during the reporting year - Language 30 (Type of Agreement)

          AOC209-1500    Out-of-Plan interpreter services secured during the reporting year - Language 30 (Restrictions on Availability)

          AOC209-1510    Out-of-Plan interpreter services secured during the reporting year - Language 31 (Language)

          AOC209-1520    Out-of-Plan interpreter services secured during the reporting year - Language 31 (Interpreter Services)

          AOC209-1530    Out-of-Plan interpreter services secured during the reporting year - Language 31 (Description)

          AOC209-1540    Out-of-Plan interpreter services secured during the reporting year - Language 31 (Type of Agreement)

          AOC209-1550    Out-of-Plan interpreter services secured during the reporting year - Language 31 (Restrictions on Availability)

          AOC209-1560    Out-of-Plan interpreter services secured during the reporting year - Language 32 (Language)

          AOC209-1570    Out-of-Plan interpreter services secured during the reporting year - Language 32 (Interpreter Services)

          AOC209-1580    Out-of-Plan interpreter services secured during the reporting year - Language 32 (Description)

          AOC209-1590    Out-of-Plan interpreter services secured during the reporting year - Language 32 (Type of Agreement)

          AOC209-1600    Out-of-Plan interpreter services secured during the reporting year - Language 32 (Restrictions on Availability)

AOC210 – Availability of Language Interpretation Services

     DESCRIPTION - MCOs should complete two tables for this measure:

     The number of MCO providers and member service staff who serve each product line and who speak languages other than English

     A description of out-of-MCO interpreter services secured during the measurement year for Medicaid, commercial and Medicare members. (See AOC209a, AOC209b and AOC209c) (HEDIS 2000, Volume 2: Technical Specification, Pg. 130)

     REPORTING LEVEL - Contract Market

          AOC210-0000    Language 1-Language

          AOC210-0010    Language 1-No of dental prov

          AOC210-0020    Language 1-No of OB/GYN prov

          AOC210-0030    Language 1-No of MH/CD prov

          AOC210-0040    Language 1-No of mem svcs staff

          AOC210-0050    Language 1-No of PCP

          AOC210-0060    Language 2-Language

          AOC210-0070    Language 2-No of dental prov

          AOC210-0080    Language 2-No of OB/GYN prov

          AOC210-0090    Language 2-No of MH/CD prov

          AOC210-0100    Language 2-No of mem svcs staff

          AOC210-0110    Language 2-No of PCP

          AOC210-0120    Language 3-Language

          AOC210-0130    Language 3-No of dental prov

          AOC210-0140    Language 3-No of OB/GYN prov

          AOC210-0150    Language 3-No of MH/CD prov

          AOC210-0160    Language 3-No of mem svcs staff

          AOC210-0170    Language 3-No of PCP

          AOC210-0180    Language 4-Language

          AOC210-0190    Language 4-No of dental prov

Measure   Measure Name/Measure Description/Field Name/Field Description

          AOC210-0200    Language 4-No of OB/GYN prov

          AOC210-0210    Language 4-No of MH/CD prov

          AOC210-0220    Language 4-No of mem svcs staff

          AOC210-0230    Language 4-No of PCP

          AOC210-0240    Language 5-Language

          AOC210-0250    Language 5-No of dental prov

          AOC210-0260    Language 5-No of OB/GYN prov

          AOC210-0270    Language 5-No of MH/CD prov

          AOC210-0280    Language 5-No of mem svcs staff

          AOC210-0290    Language 5-No of PCP

          AOC210-0300    Language 6-Language

          AOC210-0310    Language 6-No of dental prov

          AOC210-0320    Language 6-No of OB/GYN prov

          AOC210-0330    Language 6-No of MH/CD prov

          AOC210-0340    Language 6-No of mem svcs staff

          AOC210-0350    Language 6-No of PCP

          AOC210-0360    Language 7-Language

          AOC210-0370    Language 7-No of dental prov

          AOC210-0380    Language 7-No of OB/GYN prov

          AOC210-0390    Language 7-No of MH/CD prov

          AOC210-0400    Language 7-No of mem svcs staff

          AOC210-0410    Language 7-No of PCP

          AOC210-0420    Language 8-Language

          AOC210-0430    Language 8-No of dental prov

          AOC210-0440    Language 8-No of OB/GYN prov

          AOC210-0450    Language 8-No of MH/CD prov

          AOC210-0460    Language 8-No of mem svcs staff

          AOC210-0470    Language 8-No of PCP

          AOC210-0480    Language 9-Language

          AOC210-0490    Language 9-No of dental prov

          AOC210-0500    Language 9-No of OB/GYN prov

          AOC210-0510    Language 9-No of MH/CD prov

          AOC210-0520    Language 9-No of mem svcs staff

          AOC210-0530    Language 9-No of PCP

          AOC210-0540    Language 10-Language

          AOC210-0550    Language 10-No of dental prov

          AOC210-0560    Language 10-No of OB/GYN prov

          AOC210-0570    Language 10-No of MH/CD prov

          AOC210-0580    Language 10-No of mem svcs staff

          AOC210-0590    Language 10-No of PCP

          AOC210-0600    Language 11-Language

          AOC210-0610    Language 11-No of dental prov

          AOC210-0620    Language 11-No of OB/GYN prov

          AOC210-0630    Language 11-No of MH/CD prov

          AOC210-0640    Language 11-No of mem svcs staff

          AOC210-0650    Language 11-No of PCP

          AOC210-0660    Language 12-Language

          AOC210-0670    Language 12-No of dental prov

          AOC210-0680    Language 12-No of OB/GYN prov

          AOC210-0690    Language 12-No of MH/CD prov

          AOC210-0700    Language 12-No of mem svcs staff

          AOC210-0710    Language 12-No of PCP

          AOC210-0720    Language 13-Language

          AOC210-0730    Language 13-No of dental prov

          AOC210-0740    Language 13-No of OB/GYN prov

          AOC210-0750    Language 13-No of MH/CD prov

Measure   Measure Name/Measure Description/Field Name/Field Description

          AOC210-0760    Language 13-No of mem svcs staff

          AOC210-0770    Language 13-No of PCP

          AOC210-0780    Language 14-Language

          AOC210-0790    Language 14-No of dental prov

          AOC210-0800    Language 14-No of OB/GYN prov

          AOC210-0810    Language 14-No of MH/CD prov

          AOC210-0820    Language 14-No of mem svcs staff

          AOC210-0830    Language 14-No of PCP

          AOC210-0840    Language 15-Language

          AOC210-0850    Language 15-No of dental prov

          AOC210-0860    Language 15-No of OB/GYN prov

          AOC210-0870    Language 15-No of MH/CD prov

          AOC210-0880    Language 15-No of mem svcs staff

          AOC210-0890    Language 15-No of PCP

          AOC210-0900    Language 16-Language

          AOC210-0910    Language 16-No of dental prov

          AOC210-0920    Language 16-No of OB/GYN prov

          AOC210-0930    Language 16-No of MH/CD prov

          AOC210-0940    Language 16-No of mem svcs staff

          AOC210-0950    Language 16-No of PCP

          AOC210-0960    Language 17-Language

          AOC210-0970    Language 17-No of dental prov

          AOC210-0980    Language 17-No of OB/GYN prov

          AOC210-0990    Language 17-No of MH/CD prov

          AOC210-1000    Language 17-No of mem svcs staff

          AOC210-1010    Language 17-No of PCP

          AOC210-1020    Language 18-Language

          AOC210-1030    Language 18-No of dental prov

          AOC210-1040    Language 18-No of OB/GYN prov

          AOC210-1050    Language 18-No of MH/CD prov

          AOC210-1060    Language 18-No of mem svcs staff

          AOC210-1070    Language 18-No of PCP

          AOC210-1080    Language 19-Language

          AOC210-1090    Language 19-No of dental prov

          AOC210-1100    Language 19-No of OB/GYN prov

          AOC210-1110    Language 19-No of MH/CD prov

          AOC210-1120    Language 19-No of mem svcs staff

          AOC210-1130    Language 19-No of PCP

          AOC210-1140    Language 20-Language

          AOC210-1150    Language 20-No of dental prov

          AOC210-1160    Language 20-No of OB/GYN prov

          AOC210-1170    Language 20-No of MH/CD prov

          AOC210-1180    Language 20-No of mem svcs staff

          AOC210-1190    Language 20-No of PCP

          AOC210-1200    Language 21-Language

          AOC210-1210    Language 21-No of dental prov

          AOC210-1220    Language 21-No of OB/GYN prov

          AOC210-1230    Language 21-No of MH/CD prov

          AOC210-1240    Language 21-No of mem svcs staff

          AOC210-1250    Language 21-No of PCP

          AOC210-1260    Language 22-Language

          AOC210-1270    Language 22-No of dental prov

          AOC210-1280    Language 22-No of OB/GYN prov

          AOC210-1290    Language 22-No of MH/CD prov

          AOC210-1300    Language 22-No of mem svcs staff

          AOC210-1310    Language 22-No of PCP

Measure   Measure Name/Measure Description/Field Name/Field Description

          AOC210-1320    Language 23-Language

          AOC210-1330    Language 23-No of dental prov

          AOC210-1340    Language 23-No of OB/GYN prov

          AOC210-1350    Language 23-No of MH/CD prov

          AOC210-1360    Language 23-No of mem svcs staff

          AOC210-1370    Language 23-No of PCP

          AOC210-1380    Language 24-Language

          AOC210-1390    Language 24-No of dental prov

          AOC210-1400    Language 24-No of OB/GYN prov

          AOC210-1410    Language 24-No of MH/CD prov

          AOC210-1420    Language 24-No of mem svcs staff

          AOC210-1430    Language 24-No of PCP

          AOC210-1440    Language 25-Language

          AOC210-1450    Language 25-No of dental prov

          AOC210-1460    Language 25-No of OB/GYN prov

          AOC210-1470    Language 25-No of MH/CD prov

          AOC210-1480    Language 25-No of mem svcs staff

          AOC210-1490    Language 25-No of PCP

          AOC210-1500    Language 26-Language

          AOC210-1510    Language 26-No of dental prov

          AOC210-1520    Language 26-No of OB/GYN prov

          AOC210-1530    Language 26-No of MH/CD prov

          AOC210-1540    Language 26-No of mem svcs staff

          AOC210-1550    Language 26-No of PCP

          AOC210-1560    Language 27-Language

          AOC210-1570    Language 27-No of dental prov

          AOC210-1580    Language 27-No of OB/GYN prov

          AOC210-1590    Language 27-No of MH/CD prov

          AOC210-1600    Language 27-No of mem svcs staff

          AOC210-1610    Language 27-No of PCP

          AOC210-1620    Language 28-Language

          AOC210-1630    Language 28-No of dental prov

          AOC210-1640    Language 28-No of OB/GYN prov

          AOC210-1650    Language 28-No of MH/CD prov

          AOC210-1660    Language 28-No of mem svcs staff

          AOC210-1670    Language 28-No of PCP

          AOC210-1680    Language 29-Language

          AOC210-1690    Language 29-No of dental prov

          AOC210-1700    Language 29-No of OB/GYN prov

          AOC210-1710    Language 29-No of MH/CD prov

          AOC210-1720    Language 29-No of mem svcs staff

          AOC210-1730    Language 29-No of PCP

          AOC210-1740    Language 30-Language

          AOC210-1750    Language 30-No of dental prov

          AOC210-1760    Language 30-No of OB/GYN prov

          AOC210-1770    Language 30-No of MH/CD prov

          AOC210-1780    Language 30-No of mem svcs staff

          AOC210-1790    Language 30-No of PCP

          AOC210-1800    Language 31-Language

          AOC210-1810    Language 31-No of dental prov

          AOC210-1820    Language 31-No of OB/GYN prov

          AOC210-1830    Language 31-No of MH/CD prov

          AOC210-1840    Language 31-No of mem svcs staff

          AOC210-1850    Language 31-No of PCP

          AOC210-1860    Language 32-Language

          AOC210-1870    Language 32-No of dental prov

Measure   Measure Name/Measure Description/Field Name/Field Description

          AOC210-1880    Language 32-No of OB/GYN prov

          AOC210-1890    Language 32-No of MH/CD prov

          AOC210-1900    Language 32-No of mem svcs staff

          AOC210-1910    Language 32-No of PCP

COC601 – Rate Trends

     DESCRIPTION - An effective managed care organization (MCO) is expected to control the rate of increase in premiums. This measure provides information on an MCO's actual expenses per member per month (PMPM) and prospective rate trend assumptions for the measurement year and the two preceding years. Purchasers may compare the predicted increase in the cost to deliver health care (i.e., prospective rate trend assumptions) to actual costs incurred by the MCO. (HEDIS 2000, Volume 2: Technical Specification, Pg. 229)

     REPORTING LEVEL - Contract

          COC601-0010    Actual expense PMPM (1997)

          COC601-0020    Actual expense PMPM (1998)

          COC601-0030    Actual expense PMPM (1999)

          COC601-0040    % change (1997)

          COC601-0050    % change (1998)

          COC601-0060    % change (1999)

          COC601-0070    Rate trend (1997)

          COC601-0080    Rate trend (1998)

          COC601-0090    Rate trend (1999)

COC602 – High-Occurrence/High-Cost DRGs

     DESCRIPTION - Discharges per 1,000 members per year, average cost per discharge and average length of stay are reported for nine high-occurrence/high-cost DRGs for the commercial product line and for six high-occurrence/high-cost DRGs for the Medicare product line.

     Medicare: Complete Table C2-3 and report discharges per 1,000 members per year, average length of stay and average cost information for Medicare members age 0 through 85 years and older during the memasurement year for cardiac conditions, respiratory conditions and other conditions listed in Table C2-A. HCFA intends to use this information in its assessment of the adjusted community rate (ACR) submitted annually by MCOs. (HEDIS 2000, Volume 2: Technical Specification, Pg. 273)

     REPORTING LEVEL - Contract

          COC602-0010    DRG 127: Heart failure (Discharges Per 1000 Member Years)

          COC602-0020    DRG 127: Heart failure (Average Cost/Discharge)

          COC602-0030    DRG 127: Heart failure (Average Length of Stay)

          COC602-0040    DRG 140: Angina pectoris (Discharges Per 1000 Member Years)

          COC602-0050    DRG 140: Angina pectoris (Average Cost/Discharge)

          COC602-0060    DRG 140: Angina pectoris (Average Length of Stay)

          COC602-0070    Cardiac (Subtotal) (Discharges Per 1000 Member Years)

          COC602-0080    Cardiac (Subtotal) (Average Cost/Discharge)

          COC602-0090    Cardiac (Subtotal) (Average Length of Stay)

          COC602-0100    DRG 89: Simple Pneumonia and pleurisy s/CC (Discharges Per 1000 Member Years)

          COC602-0110    DRG 89: Simple Pneumonia and pleurisy s/CC (Average Cost/Discharge)

          COC602-0120    DRG 89: Simple Pneumonia and pleurisy s/CC (Average Length of Stay)

          COC602-0130    DRG 88: Chronic obstructive pulmonary disease (Discharges Per 1000 Member Years)

          COC602-0140    DRG 88: Chronic obstructive pulmonary disease (Average Cost/Discharge)

          COC602-0150    DRG 88: Chronic obstructive pulmonary disease (Average Length of Stay)

          COC602-0170    Respiratory (Subtotal) (Average Cost/Discharge)

          COC602-0180    Respiratory (Subtotal) (Average Length of Stay)

          COC602-0190    DRG 14: Specific cerebrovascular disorders except TIA (Discharges Per 1000 Member Years)

          COC602-0200    DRG 14: Specific cerebrovascular disorders except TIA (Average Cost/Discharge)

          COC602-0210    DRG 14: Specific cerebrovascular disorders except TIA (Average Length of Stay)

          COC602-0220    DRG 209: Major joint and limb reattachment (Discharges Per 1000 Member Years)

          COC602-0230    DRG 209: Major joint and limb reattachment (Average Cost/Discharge)

          COC602-0240    DRG 209: Major joint and limb reattachment (Average Length of Stay)

          COC602-0250    Cerebrovascular & Reattachment Procedures (Subtotal) (Discharges Per 1000 Member Years)

          COC602-0260    Cerebrovascular & Reattachment Procedures (Subtotal) (Average Cost/Discharge)

          COC602-0270    Cerebrovascular & Reattachment Procedures (Subtotal) (Average Length of Stay)

Measure   Measure Name/Measure Description/Field Name/Field Description

EOC003 – Breast Cancer Screening

     DESCRIPTION - The percentage of women age 52 through 69 years, who were continuously enrolled during the measurement year and the preceding year, and who had a mammogram during the measurement year or the preceding year.(HEDIS 2000, Volume 2: Technical Specification, Pg. 62)

     REPORTING LEVEL - Contract Market

          EOC003-0010    Rate

          EOC003-0020    Lower 95% confidence interval

          EOC003-0030    Upper 95% confidence interval

EOC008 – Beta Blocker Treatment

     DESCRIPTION - The percentage of enrolled members age 35 years and older during the measurement year, who were hospitalized and discharged alive from January 1 through December 24 of the measurement year with a diagnosis of acute myocardial infarction (AMI) and who received an ambulatory prescription for beta blockers upon discharge. The intent of this measure is to capture whether appropriate follow-up care has been rendered to members who suffer a heart attack. (HEDIS 2000, Volume 2: Technical Specification, Pg. 84)

     REPORTING LEVEL - Contract Market

          EOC008-0010    Rate

          EOC008-0020    Lower 95% confidence interval

          EOC008-0030    Upper 95% confidence interval

EOC010 – Followup after Hospitalization for Mental Illness

      DESCRIPTION - The percentage of members age six years and older who were hospitalized for treatment of selected mental health disorders who were continuously enrolled for 30 days after discharge (without gaps) and who were seen on an ambulatory basis or were in day/night treatment with a mental health provider. This specification uses either hospital inpatient discharge summaries or the UB-92 to identify those members who have been discharged with a selected mental health diagnosis and uses encounter data (HCFA 1500, UB-92, or equivalent) to identify those who have received appropriate follow-up care. Six separate calculations are required-one for each of the three product lines for both of the following:

      - the percentage of members who had an ambulatory or day/night mental health visit within 30 days of hospital discharge

      - The percentage of members who had an ambulatory or day/night mental health visit within 7 days of hospital discharge.(HEDIS 2000, Volume 2: Technical Specification, Pg. 101)

     REPORTING LEVEL - Contract Market

          EOC010-0011    Rate within 7days

          EOC010-0012    Rate within 30days

          EOC010-0021    Lower 95% confidence interval within 7days

          EOC010-0022    Lower 95% confidence interval within 30days

          EOC010-0031    Upper 95% confidence interval within 7days

          EOC010-0032    Upper 95% confidence interval within 30days

EOC020 – Comprehensive Diabetes Care

     DESCRIPTION - The percentage of members with diabetes (Type 1 and Type 2) age 18 through 75 years old, who were continuously enrolled during the measurement year, who had each of the following:

      - Hemoglobin A1c (HbA1c)tested

      - HbA1c poorly controlled (>9.5%)

      - lipid profile performed

      - lipids controlled (LDL <130 mg/dL)

      - dilated eye exam performed

      - kidney disease (nephropathy) monitored

     MCOs will report six separate rates (one for each aspect of diabetes care identified) for each product line. Readers should note that these measures are consistent with the Diabetes Quality Improvement Project (DQIP) set of measures (excluding hypertension and foot care). (HEDIS 2000, Volume 2: Technical Specifications, Pg. 91)

     REPORTING LEVEL - Contract Market

          EOC020-0010    Rate - HbA1c Testing

          EOC020-0020    Lower Confidence Interval - HbA1c Testing

          EOC020-0030    Upper Confidence Interval - HbA1c Testing

          EOC020-0040    Rate - Poor HbA1c Control

          EOC020-0050    Lower Confidence Interval - Poor HbA1c Control

          EOC020-0060    Upper Confidence Interval - Poor HbA1c Control

Measure   Measure Name/Measure Description/Field Name/Field Description

          EOC020-0070    Rate - Eye Exams

          EOC020-0080    Lower Confidence Interval - Eye Exams

          EOC020-0090    Upper Confidence Interval - Eye Exams

          EOC020-0100    Rate - Lipid Profile

          EOC020-0110    Lower Confidence Interval -Lipid Profile

          EOC020-0120    Upper Confidence Interval -Lipid Profile

          EOC020-0130    Rate - Lipid Control

          EOC020-0140    Lower Confidence Interval - Lipid Control

          EOC020-0150    Upper Confidence Interval - Lipid Control

          EOC020-0160    Rate - Nephropathy Monitor

          EOC020-0170    Lower Confidence Interval - Nephropathy Monitor

          EOC020-0180    Upper Confidence Interval - Nephropathy Monitor

EOC025 – Cholesterol Management After Acute Cardiovascular Events

     DESCRIPTION - The percentage of members age 18 through 75 years old as of December 31 of the measurement year, who are discharged alive in the year prior to the measurement year for acute myocardial infarction (AMI), Coronary Artery Bypass Graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) and had evidence of LDL-C screening and an LDL-C < 130 mg/dL. (HEDIS 2000, Volume 2: Techincal Specifications, Pg. 88)

     REPORTING LEVEL - Contract Market

          EOC025-0010    Rate - LDL-C Screening

          EOC025-0020    Lower Confidence Interval - LDL-C Screening

          EOC025-0030    Upper Confidence Interval - LDL-C Screening

          EOC025-0040    Rate - level <130mg/dL

          EOC025-0050    Lower Confidence Interval - level <130mg/dL

          EOC025-0060    Upper Confidence Interval - level <130mg/dL

EOC030 – Antidepressant Medication Management

     DESCRIPTION - The following three components of this measure assess different facets of the successful pharmacological management of depression:

     1. Optimal Practitioner Contacts for Medication Management.

     2. Effective Acute Phase Treatment.

     3. Effective Continuation Phase Treatment.

     (HEDIS 2000, Volume 2: Technical Specifications, Pg. 105)

     REPORTING LEVEL - Contract Market

          EOC030-0010    Rate - Effective Continuation Phase Treatment

          EOC030-0020    Lower Confidence Interval - Effective Continuation Phase Treatment

          EOC030-0030    Upper Confidence Interval - Effective Continuation Phase Treatment

          EOC030-0040    Rate - Effective Acute Phase Treatment

          EOC030-0050    Lower Confidence Interval - Effective Acute Phase Treatment

          EOC030-0060    Upper Confidence Interval - Effective Acute Phase Treatment

          EOC030-0070    Rate-Practitioner Contacts for Medication Management

          EOC030-0080    Lower Confidence Interval - Practitioner Contacts for Medication Management

          EOC030-0090    Upper Confidence Interval - Practitioner Contacts for Medication Management

EOC035 – Controlling High Blood Pressure

     DESCRIPTION - This intermediate outcome measure assesses whether blood pressure (BP) was controlled among adult persons with diagnosed hypertension (HTN). This measure can be calculated only by using the hybrid method. This specification uses membership data and ambulatory claims/encounter data to identify members with a diagnosis of hypertension age 46 to 85 years and medical record review to confirm the HTN diagnosis and assess BP control during the measurement year. (HEDIS 3.0/2000, Volume 2: Technical Specification, Pg. 80)

     REPORTING LEVEL - Contract Market

          EOC035-0010    Rate - Effective Control of Hypertension

          EOC035-0020    Lower Confidence Interval - Effective Control of Hypertension

          EOC035-0030    Upper Confidence Interval - Effective Control of Hypertension


 

Measure   Measure Name/Measure Description/Field Name/Field Description

GENERAL – General Information

     DESCRIPTION - General MCO Information. These fields are not explicitly identified in the HEDIS Technical Specifications.

     REPORTING LEVEL - N/A

             GENERAL-0010  Type of Plan (Risk, Cost)

             GENERAL-0011  Type of Plan (Post Balanced Buget Amendment Naming)

             GENERAL-0012  M+C Plan Type (Yes or No)

             GENERAL-0013  Coordinated Care Plan Type (Yes or No)

             GENERAL-0020  Line of Business (HMO, POS)

             GENERAL-0030  Model Type (Group, IPA, Mixed, Network, Other, Staff)

             GENERAL-0050  1999 Enrollment as Reported by HCFA's Plan Information Control System (PICS)

             GENERAL-0060  HCFA Region Number

             GENERAL-0070  HCFA Region Name

             GENERAL-0080  Patient Population

HPS401 – Disenrollment

     DESCRIPTION - This measure provides information on the number of MCO members who disenrolled during the measurement year. Membership data is used to identify all members who were enrolled as of December 31 of the year preceding the measurement year who were not enrolled as of December 31 of the measurement year. This measure should be reported for the entire commercial managed care book of business in the aggregate rather than by product (I.e., HMO, POS, PPO).

     The annual disenrollment rate serves strictly as a measure of stability of membership in the MCO. Because this emasure does not differentiate between voluntary and involuntary disenrollment, it should not be used as a proxy for dissatisfaction. (HEDIS 2000, Volume 2: Technical Specification, Pg. 139)

     REPORTING LEVEL - Contract Market

             HPS401-0010     Disenrollment

HPS402 – Provider Turnover

     DESCRIPTION - MCOs use their provider database to report the following two percentages each product line:

     - The percentage of primary care physicians affiliated with the MCO as of December 31 of the year preceding the measurement year who were NOT affiliated with the MCO as of December 31 of the measurement year.

     - The percentage of non-physician primary care providers affiliated with the MCO as of December 31 of the year preceding the measurement year who were NOT affiliated with the MCO as of December 31 of the measurement year.

     (HEDIS 2000, Volume 2: Technical Specification, Pg. 141)

     REPORTING LEVEL - Contract Market

          HPS402-0010    Provider Turnover- Primary Care Physicians

          HPS402-0020    Provider Turnover- Non-Physicians Primary Care Providers

HPS403 – Years In Business/Total Membership

     DESCRIPTION - This table reports the number of years since licensure (i.e., the number of years each product line has existed) and the number of members enrolled as of December 31 of the measurement year. The number of years of operation should be considered when evaluating an MCO's financial profile. For example, a new MCO may have a greater level of debt than a more mature MCO. Also, financial profiles may vary according to MCO type (e.g., staff model HMO, POS, IPA). (HEDIS 2000, Volume 2: Technical Specification, Pg. 146)

     REPORTING LEVEL - Contract Market

          HPS403-0010    HMO Total (Years In Business)

          HPS403-0020    HMO Medicaid (Years In Business)

          HPS403-0030    HMO Commercial (Years In Business)

          HPS403-0040    HMO Medicare Risk (Years In Business)

          HPS403-0060    HMO Self-insured (Years In Business)

          HPS403-0070    HMO Other (Years In Business)

          HPS403-0080    PPO Total (Years In Business)

          HPS403-0090    PPO Commercial (Years In Business)

          HPS403-0100    PPO Medicare Risk (Years In Business)

          HPS403-0120    PPO Self-insured (Years In Business)

          HPS403-0130    PPO Other (Years In Business)

          HPS403-0140    POS Total (Years In Business)

          HPS403-0150    POS Commercial (Years In Business)

          HPS403-0160    POS Medicare Risk (Years In Business)

Measure   Measure Name/Measure Description/Field Name/Field Description

          HPS403-0180    POS Self-insured (Years In Business)

          HPS403-0190    POS Other (Years In Business)

          HPS403-0210    HMO Total (Members)

          HPS403-0220    HMO Medicaid (Members)

          HPS403-0230    HMO Commercial (Members)

          HPS403-0240    HMO Medicare Risk (Members)

          HPS403-0260    HMO Self-insured (Members)

          HPS403-0270    HMO Other (Members)

          HPS403-0280    PPO Total (Members)

          HPS403-0290    PPO Commercial (Members)

          HPS403-0300    PPO Medicare Risk (Members)

          HPS403-0320    PPO Self-insured (Members)

          HPS403-0330    PPO Other (Members)

          HPS403-0340    POS Total (Members)

          HPS403-0350    POS Commercial (Members)

          HPS403-0360    POS Medicare Risk (Members)

          HPS403-0380    POS Self-insured (Members)

          HPS403-0390    POS Other (Members)

          HPS403-0400    Total Product Lines/Payers (Members)

HPS404 – Indicators of Financial Stability

     DESCRIPTION - This measure presents information commonly used to evaluate the financial stability of an MCO. The financial profiles and specific results of different MCOs are dependent on the type of operations involved (e.g., staff model HMO versus an IPA). For each measure, the description of the financial indicator, the definition of the financial indicator, the NAIC report location for the financial indicator (NAIC Annual Statement HMO-Association Edition, revised 1998), and the range by which to evaluate the financial indicator are provided. (HEDIS 2000, Volume 2: Technical Specification, Pg. 147)

     REPORTING LEVEL - Legal Entity

          HPS404-0010    Total membership (1997)

          HPS404-0020    Total membership (1998)

          HPS404-0030    Total membership (1999)

          HPS404-0040    Total membership (Change from 1998 to 1999)

          HPS404-0050    Total membership (Percent change from 1998 to 1999)

          HPS404-0060    Total revenue (1997)

          HPS404-0070    Total revenue (1998)

          HPS404-0080    Total revenue (1999)

          HPS404-0090    Total revenue (Change from 1998 to 1999)

          HPS404-0100    Total revenue (Percent change from 1998 to 1999)

          HPS404-0110    Net income (1997)

          HPS404-0120    Net income (1998)

          HPS404-0130    Net income (1999)

          HPS404-0140    Net income (Change from 1998 to 1999)

          HPS404-0150    Net income (Percent change from 1998 to 1999)

          HPS404-0160    Net worth (1997)

          HPS404-0170    Net worth (1998)

          HPS404-0180    Net worth (1999)

          HPS404-0190    Net worth (Change from 1998 to 1999)

          HPS404-0200    Net worth (Percent change from 1998 to 1999)

          HPS404-0210    Dept-to-service ratio (1997)

          HPS404-0220    Dept-to-service ratio (1998)

          HPS404-0230    Dept-to-service ratio (1999)

          HPS404-0240    Dept-to-service ratio (Change from 1998 to 1999)

          HPS404-0250    Dept-to-service ratio (Percent change from 1998 to 1999)

          HPS404-0260    Overall loss ratio (1997)

          HPS404-0270    Overall loss ratio (1998)

          HPS404-0280    Overall loss ratio (1999)

          HPS404-0290    Overall loss ratio (Change from 1998 to 1999)

          HPS404-0300    Overall loss ratio (Percent change from 1998 to 1999)

Measure   Measure Name/Measure Description/Field Name/Field Description

          HPS404-0310    Administrative loss ratio (1997)

          HPS404-0320    Administrative loss ratio (1998)

          HPS404-0330    Administrative loss ratio (1999)

          HPS404-0340    Administrative loss ratio (Change from 1998 to 1999)

          HPS404-0350    Administrative loss ratio (Percent change from 1998 to 1999)

          HPS404-0360    Medical loss ratio (1997)

          HPS404-0370    Medical loss ratio (1998)

          HPS404-0380    Medical loss ratio (1999)

          HPS404-0390    Medical loss ratio (Change from 1998 to 1999)

          HPS404-0400    Medical loss ratio (Percent change from 1998 to 1999)

          HPS404-0410    Operating profit margin (1997)

          HPS404-0420    Operating profit margin (1998)

          HPS404-0430    Operating profit margin (1999)

          HPS404-0440    Operating profit margin (Change from 1998 to 1999)

          HPS404-0450    Operating profit margin (Percent change from 1998 to 1999)

          HPS404-0460    Overall profit margin (1997)

          HPS404-0470    Overall profit margin (1998)

          HPS404-0480    Overall profit margin (1999)

          HPS404-0490    Overall profit margin (Change from 1998 to 1999)

          HPS404-0500    Overall profit margin (Percent change from 1998 to 1999)

          HPS404-0510    Days cash on hand (1997)

          HPS404-0520    Days cash on hand (1998)

          HPS404-0530    Days cash on hand (1999)

          HPS404-0540    Days cash on hand (Change from 1998 to 1999)

          HPS404-0550    Days cash on hand (Percent change from 1998 to 1999)

          HPS404-0560    Ratio of cash to claims payable (1997)

          HPS404-0570    Ratio of cash to claims payable (1998)

          HPS404-0580    Ratio of cash to claims payable (1999)

          HPS404-0590    Ratio of cash to claims payable (Change from 1998 to 1999)

          HPS404-0600    Ratio of cash to claims payable (Percent change from 1998 to 1999)

          HPS404-0610    Days in receivables (1997)

          HPS404-0620    Days in receivables (1998)

          HPS404-0630    Days in receivables (1999)

          HPS404-0640    Days in receivables (Change from 1998 to 1999)

          HPS404-0650    Days in receivables (Percent change from 1998 to 1999)

          HPS404-0660    Days in unpaid claims (1997)

          HPS404-0670    Days in unpaid claims (1998)

          HPS404-0680    Days in unpaid claims (1999)

          HPS404-0690    Days in unpaid claims (Change from 1998 to 1999)

          HPS404-0700    Days in unpaid claims (Percent change from 1998 to 1999)

          HPS404-0710    State minimum reserve requirements (1997)

          HPS404-0720    State minimum reserve requirements (1998)

          HPS404-0730    State minimum reserve requirements (1999)

          HPS404-0740    State minimum reserve requirements (Change from 1998 to 1999)

          HPS404-0750    State minimum reserve requirements (Percent change from 1998 to 1999)

          HPS404-0760    Actual reserves held by plan (1997)

          HPS404-0770    Actual reserves held by plan (1998)

          HPS404-0780    Actual reserves held by plan (1999)

          HPS404-0790    Actual reserves held by plan (Change from 1998 to 1999)

          HPS404-0800    Actual reserves held by plan (Percent change from 1998 to 1999)


 

Measure   Measure Name/Measure Description/Field Name/Field Description

PDI801 – Board Certification

     DESCRIPTION - This measure reports the percentage of the following physicians that have completed residency training or fellowship training (in their respective specialties) and who are board certified:

     - primary care physicians

     - OB/GYN physicians

     - pediatric physician specialists

     - geriatricians

     - all other physician specialists

     Board certification refers to the various specialty certification programs of the American Board of Medical Specialties and the American Osteopathic Association. MCOs should report separately for each product as of December 31 of the measurement year. This measure does not capture chiropractors, podiatrists or other providers who are certified by other programs. (HEDIS 2000, Volume 2: Technical Specification, Pg. 241)

     REPORTING LEVEL - Contract Market

          PDI801-0010     Board Certification - Primary Care Physicians (Percentage)

          PDI801-0020     Residency Completion - Primary Care Physicians (Percentage)

          PDI801-0030     Board Certification - Physician Specialists (Percentage)

          PDI801-0040     Residency Completion - Physician Specialists (Percentage)

          PDI801-0050     Board Certification - Geriatricians (Percentage)

          PDI801-0060     Residency Completion - Geriatricians (Percentage)

PDI802 – Physician Payment Arrangement

     DESCRIPTION - This measure reports quantitative and qualitative information on the MCO's compensation arrangements with:

     - primary care practitioners (for Medicaid, commercial and Medicare)

     - specialist (for Medicaid only)

     - mental health practitioners (for Medicaid only)

     - chemical dependency practitioners (for Medicaid only)

     - dentists (for Medicaid only)

     MCOs should report the number of practitioners who participate with the MCO individually or as part of a group or IPA.

      (HEDIS 2000, Volume 2: Technical Specification, Pg. 246)

     REPORTING LEVEL - Contract

          PDI802-0030     Salary without withhold or bonus (Number)

          PDI802-0040     Salary without withhold or bonus (Percentage)

          PDI802-0050     Salary without withhold or bonus (Basis for Bonus/Withhold)

          PDI802-0060     Salary with withhold (Lower range boundry)

          PDI802-0070     Salary with withhold (Upper range boundry)

          PDI802-0080     Salary with withhold (Number)

          PDI802-0090     Salary with withhold (Percentage)

          PDI802-0100     Salary with withhold (Basis for Bonus/Withhold)

          PDI802-0110     Salary with bonus (Lower range boundry)

          PDI802-0120     Salary with bonus (Upper range boundry)

          PDI802-0130     Salary with bonus (Number)

          PDI802-0140     Salary with bonus (Percentage)

          PDI802-0150     Salary with bonus (Basis for Bonus/Withhold)

          PDI802-0180     Fee for service without withhold or bonus (Number)

          PDI802-0190     Fee for service without withhold or bonus (Percentage)

          PDI802-0200     Fee for service without withhold or bonus (Basis for Bonus/Withhold)

          PDI802-0210     Fee for service with withhold (Lower range boundry)

          PDI802-0220     Fee for service with withhold (Upper range boundry)

          PDI802-0230     Fee for service with withhold (Number)

          PDI802-0240     Fee for service with withhold (Percentage)

          PDI802-0250     Fee for service with withhold (Basis for Bonus/Withhold)

          PDI802-0260     Fee for service with bonus (Lower range boundry)

          PDI802-0270     Fee for service with bonus (Upper range boundry)

          PDI802-0280     Fee for service with bonus (Number)

          PDI802-0290     Fee for service with bonus (Percentage)

Measure   Measure Name/Measure Description/Field Name/Field Description

          PDI802-0300     Fee for service with bonus (Basis for Bonus/Withhold)

          PDI802-0311     Capitated without withhold or bonus and capitated as individuals

          PDI802-0312     List of services capitated (capitated as individuals)

          PDI802-0313     Capitated without withhold or bonus and capitated as IPA

          PDI802-0314     Capitated without withhold or bonus and capitated as Group Model

          PDI802-0330     Capitated without withhold or bonus (Number)

          PDI802-0340     Capitated without withhold or bonus (Percentage)

          PDI802-0350     Capitated without withhold or bonus (Basis for Bonus/Withhold)

          PDI802-0361     Capitated with withhold and capitated as individuals

          PDI802-0362     List of services capitated (capitated as individuals)

          PDI802-0363     Capitated with withhold and capitated as IPA

          PDI802-0364     Capitated with withhold and capitated as Group Model

          PDI802-0380     Capitated with withhold (Number)

          PDI802-0390     Capitated with withhold (Percentage)

          PDI802-0400     Capitated with withhold (Basis for Bonus/Withhold)

          PDI802-0411     Capitated with bonus and capitated as individuals

          PDI802-0412     List of services capitated (capitated as individuals)

          PDI802-0413     Capitated with bonus and capitated as IPA

          PDI802-0414     Capitated with bonus and capitated as Group Model

          PDI802-0430     Capitated with bonus (Number)

          PDI802-0440     Capitated with bonus (Percentage)

          PDI802-0450     Capitated with bonus (Basis for Bonus/Withhold)

PDI805 – Total Enrollment

     DESCRIPTION - This measure is intended to provide an overview of the mix of MCO membership. MCOs report the percentage of total member months contributed by each product by age and sex, during the measurement year. (HEDIS 2000, Volume 2: Technical Specification, Pg. 251)

     REPORTING LEVEL - Contract

          PDI805-0010     Percent of Plan's Total Member Months (Male - Commercial - Age < 1)

          PDI805-0020     Percent of Plan's Total Member Months (Male - Medicaid - Age < 1)

          PDI805-0030     Percent of Plan's Total Member Months (Male - Medicare - Age < 1)

          PDI805-0040     Percent of Plan's Total Member Months (Male - Other - Age < 1)

          PDI805-0050     Percent of Plan's Total Member Months (Male - Commercial - Age 1-4)

          PDI805-0060     Percent of Plan's Total Member Months (Male - Medicaid - Age 1-4)

          PDI805-0070     Percent of Plan's Total Member Months (Male - Medicare - Age 1-4)

          PDI805-0080     Percent of Plan's Total Member Months (Male - Other - Age 1-4)

          PDI805-0090     Percent of Plan's Total Member Months (Male - Commercial - Age 5-9)

          PDI805-0100     Percent of Plan's Total Member Months (Male - Medicaid - Age 5-9)

          PDI805-0110     Percent of Plan's Total Member Months (Male - Medicare - Age 5-9)

          PDI805-0120     Percent of Plan's Total Member Months (Male - Other - Age 5-9)

          PDI805-0130     Percent of Plan's Total Member Months (Male - Commercial - Age 10-14)

          PDI805-0140     Percent of Plan's Total Member Months (Male - Medicaid - Age 10-14)

          PDI805-0150     Percent of Plan's Total Member Months (Male - Medicare - Age 10-14)

          PDI805-0160     Percent of Plan's Total Member Months (Male - Other - Age 10-14)

          PDI805-0170     Percent of Plan's Total Member Months (Male - Commercial - Age 15-17)

          PDI805-0180     Percent of Plan's Total Member Months (Male - Medicaid - Age 15-17)

          PDI805-0190     Percent of Plan's Total Member Months (Male - Medicare - Age 15-17)

          PDI805-0200     Percent of Plan's Total Member Months (Male - Other - Age 15-17)

          PDI805-0210     Percent of Plan's Total Member Months (Male - Commercial - Age 18-19)

          PDI805-0220     Percent of Plan's Total Member Months (Male - Medicaid - Age 18-19)

          PDI805-0230     Percent of Plan's Total Member Months (Male - Medicare - Age 18-19)

          PDI805-0240     Percent of Plan's Total Member Months (Male - Other - Age 18-19)

          PDI805-0250     Percent of Plan's Total Member Months (Male - Commercial - Subtotal: Age 0-19)

          PDI805-0260     Percent of Plan's Total Member Months (Male - Medicaid - Subtotal: Age 0-19)

          PDI805-0270     Percent of Plan's Total Member Months (Male - Medicare - Age 0-19)

          PDI805-0280     Percent of Plan's Total Member Months (Male - Other - Age 0-19)

          PDI805-0290     Percent of Plan's Total Member Months (Male - Commercial - Age 20-24)

Measure   Measure Name/Measure Description/Field Name/Field Description

          PDI805-0300     Percent of Plan's Total Member Months (Male - Medicaid - Age 20-24)

          PDI805-0310     Percent of Plan's Total Member Months (Male - Medicare - Age 20-24)

          PDI805-0320     Percent of Plan's Total Member Months (Male - Other - Age 20-24)

          PDI805-0330     Percent of Plan's Total Member Months (Male - Commercial - Age 25-29)

          PDI805-0340     Percent of Plan's Total Member Months (Male - Medicaid - Age 25-29)

          PDI805-0350     Percent of Plan's Total Member Months (Male - Medicare - Age 25-29)

          PDI805-0360     Percent of Plan's Total Member Months (Male - Other - Age 25-29)

          PDI805-0370     Percent of Plan's Total Member Months (Male - Commercial - Age 30-34)

          PDI805-0380     Percent of Plan's Total Member Months (Male - Medicaid - Age 30-34)

          PDI805-0390     Percent of Plan's Total Member Months (Male - Medicare - Age 30-34)

          PDI805-0400     Percent of Plan's Total Member Months (Male - Other - Age 30-34)

          PDI805-0410     Percent of Plan's Total Member Months (Male - Commercial - Age 35-39)

          PDI805-0420     Percent of Plan's Total Member Months (Male - Medicaid - Age 35-39)

          PDI805-0430     Percent of Plan's Total Member Months (Male - Medicare - Age 35-39)

          PDI805-0440     Percent of Plan's Total Member Months (Male - Other - Age 35-39)

          PDI805-0450     Percent of Plan's Total Member Months (Male - Commercial - Age 40-44)

          PDI805-0460     Percent of Plan's Total Member Months (Male - Medicaid - Age 40-44)

          PDI805-0470     Percent of Plan's Total Member Months (Male - Medicare - Age 40-44)

          PDI805-0480     Percent of Plan's Total Member Months (Male - Other - Age 40-44)

          PDI805-0490     Percent of Plan's Total Member Months (Male - Commercial - Subtotal: Age 20-44)

          PDI805-0500     Percent of Plan's Total Member Months (Male - Medicaid - Subtotal: Age 20-44)

          PDI805-0510     Percent of Plan's Total Member Months (Male - Medicare - Age 20-44)

          PDI805-0520     Percent of Plan's Total Member Months (Male - Other - Age 20-44)

          PDI805-0530     Percent of Plan's Total Member Months (Male - Commercial - Age 45-49)

          PDI805-0540     Percent of Plan's Total Member Months (Male - Medicaid - Age 45-49)

          PDI805-0550     Percent of Plan's Total Member Months (Male - Medicare - Age 45-49)

          PDI805-0560     Percent of Plan's Total Member Months (Male - Other - Age 45-49)

          PDI805-0570     Percent of Plan's Total Member Months (Male - Commercial - Age 50-54)

          PDI805-0580     Percent of Plan's Total Member Months (Male - Medicaid - Age 50-54)

          PDI805-0590     Percent of Plan's Total Member Months (Male - Medicare - Age 50-54)

          PDI805-0600     Percent of Plan's Total Member Months (Male - Other - Age 50-54)

          PDI805-0610     Percent of Plan's Total Member Months (Male - Commercial - Age 55-59)

          PDI805-0620     Percent of Plan's Total Member Months (Male - Medicaid - Age 55-59)

          PDI805-0630     Percent of Plan's Total Member Months (Male - Medicare - Age 55-59)

          PDI805-0640     Percent of Plan's Total Member Months (Male - Other - Age 55-59)

          PDI805-0650     Percent of Plan's Total Member Months (Male - Commercial - Age 60-64)

          PDI805-0660     Percent of Plan's Total Member Months (Male - Medicaid - Age 60-64)

          PDI805-0670     Percent of Plan's Total Member Months (Male - Medicare - Age 60-64)

          PDI805-0680     Percent of Plan's Total Member Months (Male - Other - Age 60-64)

          PDI805-0690     Percent of Plan's Total Member Months (Male - Commercial - Subtotal: Age 45-64)

          PDI805-0700     Percent of Plan's Total Member Months (Male - Medicaid - Subtotal: Age 45-64)

          PDI805-0710     Percent of Plan's Total Member Months (Male - Medicare - Age 45-64)

          PDI805-0720     Percent of Plan's Total Member Months (Male - Other - Age 45-64)

          PDI805-0730     Percent of Plan's Total Member Months (Male - Commercial - Age 65-69)

          PDI805-0740     Percent of Plan's Total Member Months (Male - Medicaid - Age 65-69)

          PDI805-0750     Percent of Plan's Total Member Months (Male - Medicare - Age 65-69)

          PDI805-0760     Percent of Plan's Total Member Months (Male - Other - Age 65-69)

          PDI805-0770     Percent of Plan's Total Member Months (Male - Commercial - Age 70-74)

          PDI805-0780     Percent of Plan's Total Member Months (Male - Medicaid - Age 70-74)

          PDI805-0790     Percent of Plan's Total Member Months (Male - Medicare - Age 70-74)

          PDI805-0800     Percent of Plan's Total Member Months (Male - Other - Age 70-74)

          PDI805-0810     Percent of Plan's Total Member Months (Male - Commercial - Age 75-79)

          PDI805-0820     Percent of Plan's Total Member Months (Male - Medicaid - Age 75-79)

          PDI805-0830     Percent of Plan's Total Member Months (Male - Medicare - Age 75-79)

          PDI805-0840     Percent of Plan's Total Member Months (Male - Other - Age 75-79)

          PDI805-0850     Percent of Plan's Total Member Months (Male - Commercial - Age 80-84)

Measure   Measure Name/Measure Description/Field Name/Field Description

          PDI805-0860     Percent of Plan's Total Member Months (Male - Medicaid - Age 80-84)

          PDI805-0870     Percent of Plan's Total Member Months (Male - Medicare - Age 80-84)

          PDI805-0880     Percent of Plan's Total Member Months (Male - Other - Age 80-84)

          PDI805-0890     Percent of Plan's Total Member Months (Male - Commercial - Age 85-89)

          PDI805-0900     Percent of Plan's Total Member Months (Male - Medicaid - Age 85-89)

          PDI805-0910     Percent of Plan's Total Member Months (Male - Medicare - Age 85-89)

          PDI805-0920     Percent of Plan's Total Member Months (Male - Other - Age 85-89)

          PDI805-0930     Percent of Plan's Total Member Months (Male - Commercial - Age >=90)

          PDI805-0940     Percent of Plan's Total Member Months (Male - Medicaid - Age >=90)

          PDI805-0950     Percent of Plan's Total Member Months (Male - Medicare - Age >=90)

          PDI805-0960     Percent of Plan's Total Member Months (Male - Other - Age >=90)

          PDI805-0970     Percent of Plan's Total Member Months (Male - Commercial - Subtotal: Age >=65)

          PDI805-0980     Percent of Plan's Total Member Months (Male - Medicaid - Subtotal: Age >=65)

          PDI805-0990     Percent of Plan's Total Member Months (Male - Medicare - Age >=65)

          PDI805-1000     Percent of Plan's Total Member Months (Male - Other - Age >=65)

          PDI805-1010     Percent of Plan's Total Member Months (Female - Commercial - Age < 1)

          PDI805-1020     Percent of Plan's Total Member Months (Female - Medicaid - Age < 1)

          PDI805-1030     Percent of Plan's Total Member Months (Female - Medicare - Age < 1)

          PDI805-1040     Percent of Plan's Total Member Months (Female - Other - Age < 1)

          PDI805-1050     Percent of Plan's Total Member Months (Female - Commercial - Age 1-4)

          PDI805-1060     Percent of Plan's Total Member Months (Female - Medicaid - Age 1-4)

          PDI805-1070     Percent of Plan's Total Member Months (Female - Medicare - Age 1-4)

          PDI805-1080     Percent of Plan's Total Member Months (Female - Other - Age 1-4)

          PDI805-1090     Percent of Plan's Total Member Months (Female - Commercial - Age 5-9)

          PDI805-1100     Percent of Plan's Total Member Months (Female - Medicaid - Age 5-9)

          PDI805-1110     Percent of Plan's Total Member Months (Female - Medicare - Age 5-9)

          PDI805-1120     Percent of Plan's Total Member Months (Female - Other - Age 5-9)

          PDI805-1130     Percent of Plan's Total Member Months (Female - Commercial - Age 10-14)

          PDI805-1140     Percent of Plan's Total Member Months (Female - Medicaid - Age 10-14)

          PDI805-1150     Percent of Plan's Total Member Months (Female - Medicare - Age 10-14)

          PDI805-1160     Percent of Plan's Total Member Months (Female - Other - Age 10-14)

          PDI805-1170     Percent of Plan's Total Member Months (Female - Commercial - Age 15-17)

          PDI805-1180     Percent of Plan's Total Member Months (Female - Medicaid - Age 15-17)

          PDI805-1190     Percent of Plan's Total Member Months (Female - Medicare - Age 15-17)

          PDI805-1200     Percent of Plan's Total Member Months (Female - Other - Age 15-17)

          PDI805-1210     Percent of Plan's Total Member Months (Female - Commercial - Age 18-19)

          PDI805-1220     Percent of Plan's Total Member Months (Female - Medicaid - Age 18-19)

          PDI805-1230     Percent of Plan's Total Member Months (Female - Medicare - Age 18-19)

          PDI805-1240     Percent of Plan's Total Member Months (Female - Other - Age 18-19)

          PDI805-1250     Percent of Plan's Total Member Months (Female - Commercial - Subtotal: Age 0-19)

          PDI805-1260     Percent of Plan's Total Member Months (Female - Medicaid - Subtotal: Age 0-19)

          PDI805-1270     Percent of Plan's Total Member Months (Female - Medicare - Age 0-19)

          PDI805-1280     Percent of Plan's Total Member Months (Female - Other - Age 0-19)

          PDI805-1290     Percent of Plan's Total Member Months (Female - Commercial - Age 20-24)

          PDI805-1300     Percent of Plan's Total Member Months (Female - Medicaid - Age 20-24)

          PDI805-1310     Percent of Plan's Total Member Months (Female - Medicare - Age 20-24)

          PDI805-1320     Percent of Plan's Total Member Months (Female - Other - Age 20-24)

          PDI805-1330     Percent of Plan's Total Member Months (Female - Commercial - Age 25-29)

          PDI805-1340     Percent of Plan's Total Member Months (Female - Medicaid - Age 25-29)

          PDI805-1350     Percent of Plan's Total Member Months (Female - Medicare - Age 25-29)

          PDI805-1360     Percent of Plan's Total Member Months (Female - Other - Age 25-29)

          PDI805-1370     Percent of Plan's Total Member Months (Female - Commercial - Age 30-34)

          PDI805-1380     Percent of Plan's Total Member Months (Female - Medicaid - Age 30-34)

          PDI805-1390     Percent of Plan's Total Member Months (Female - Medicare - Age 30-34)

          PDI805-1400     Percent of Plan's Total Member Months (Female - Other - Age 30-34)

          PDI805-1410     Percent of Plan's Total Member Months (Female - Commercial - Age 35-39)

Measure   Measure Name/Measure Description/Field Name/Field Description

          PDI805-1420     Percent of Plan's Total Member Months (Female - Medicaid - Age 35-39)

          PDI805-1430     Percent of Plan's Total Member Months (Female - Medicare - Age 35-39)

          PDI805-1440     Percent of Plan's Total Member Months (Female - Other - Age 35-39)

          PDI805-1450     Percent of Plan's Total Member Months (Female - Commercial - Age 40-44)

          PDI805-1460     Percent of Plan's Total Member Months (Female - Medicaid - Age 40-44)

          PDI805-1470     Percent of Plan's Total Member Months (Female - Medicare - Age 40-44)

          PDI805-1480     Percent of Plan's Total Member Months (Female - Other - Age 40-44)

          PDI805-1490     Percent of Plan's Total Member Months (Female - Commercial - Subtotal: Age 20-44)

          PDI805-1500     Percent of Plan's Total Member Months (Female - Medicaid - Subtotal: Age 20-44)

          PDI805-1510     Percent of Plan's Total Member Months (Female - Medicare - Age 20-44)

          PDI805-1520     Percent of Plan's Total Member Months (Female - Other - Age 20-44)

          PDI805-1530     Percent of Plan's Total Member Months (Female - Commercial - Age 45-49)

          PDI805-1540     Percent of Plan's Total Member Months (Female - Medicaid - Age 45-49)

          PDI805-1550     Percent of Plan's Total Member Months (Female - Medicare - Age 45-49)

          PDI805-1560     Percent of Plan's Total Member Months (Female - Other - Age 45-49)

          PDI805-1570     Percent of Plan's Total Member Months (Female - Commercial - Age 50-54)

          PDI805-1580     Percent of Plan's Total Member Months (Female - Medicaid - Age 50-54)

          PDI805-1590     Percent of Plan's Total Member Months (Female - Medicare - Age 50-54)

          PDI805-1600     Percent of Plan's Total Member Months (Female - Other - Age 50-54)

          PDI805-1610     Percent of Plan's Total Member Months (Female - Commercial - Age 55-59)

          PDI805-1620     Percent of Plan's Total Member Months (Female - Medicaid - Age 55-59)

          PDI805-1630     Percent of Plan's Total Member Months (Female - Medicare - Age 55-59)

          PDI805-1640     Percent of Plan's Total Member Months (Female - Other - Age 55-59)

          PDI805-1650     Percent of Plan's Total Member Months (Female - Commercial - Age 60-64)

          PDI805-1660     Percent of Plan's Total Member Months (Female - Medicaid - Age 60-64)

          PDI805-1670     Percent of Plan's Total Member Months (Female - Medicare - Age 60-64)

          PDI805-1680     Percent of Plan's Total Member Months (Female - Other - Age 60-64)

          PDI805-1690     Percent of Plan's Total Member Months (Female - Commercial - Subtotal: Age 45-64)

          PDI805-1700     Percent of Plan's Total Member Months (Female - Medicaid - Subtotal: Age 45-64)

          PDI805-1710     Percent of Plan's Total Member Months (Female - Medicare - Age 45-64)

          PDI805-1720     Percent of Plan's Total Member Months (Female - Other - Age 45-64)

          PDI805-1730     Percent of Plan's Total Member Months (Female - Commercial - Age 65-69)

          PDI805-1740     Percent of Plan's Total Member Months (Female - Medicaid - Age 65-69)

          PDI805-1750     Percent of Plan's Total Member Months (Female - Medicare - Age 65-69)

          PDI805-1760     Percent of Plan's Total Member Months (Female - Other - Age 65-69)

          PDI805-1770     Percent of Plan's Total Member Months (Female - Commercial - Age 70-74)

          PDI805-1780     Percent of Plan's Total Member Months (Female - Medicaid - Age 70-74)

          PDI805-1790     Percent of Plan's Total Member Months (Female - Medicare - Age 70-74)

          PDI805-1800     Percent of Plan's Total Member Months (Female - Other - Age 70-74)

          PDI805-1810     Percent of Plan's Total Member Months (Female - Commercial - Age 75-79)

          PDI805-1820     Percent of Plan's Total Member Months (Female - Medicaid - Age 75-79)

          PDI805-1830     Percent of Plan's Total Member Months (Female - Medicare - Age 75-79)

          PDI805-1840     Percent of Plan's Total Member Months (Female - Other - Age 75-79)

          PDI805-1850     Percent of Plan's Total Member Months (Female - Commercial - Age 80-84)

          PDI805-1860     Percent of Plan's Total Member Months (Female - Medicaid - Age 80-84)

          PDI805-1870     Percent of Plan's Total Member Months (Female - Medicare - Age 80-84)

          PDI805-1880     Percent of Plan's Total Member Months (Female - Other - Age 80-84)

          PDI805-1890     Percent of Plan's Total Member Months (Female - Commercial - Age 85-89)

          PDI805-1900     Percent of Plan's Total Member Months (Female - Medicaid - Age 85-89)

          PDI805-1910     Percent of Plan's Total Member Months (Female - Medicare - Age 85-89)

          PDI805-1920     Percent of Plan's Total Member Months (Female - Other - Age 85-89)

          PDI805-1930     Percent of Plan's Total Member Months (Female - Commercial - Age >=90)

          PDI805-1940     Percent of Plan's Total Member Months (Female - Medicaid - Age >=90)

          PDI805-1950     Percent of Plan's Total Member Months (Female - Medicare - Age >=90)

          PDI805-1960     Percent of Plan's Total Member Months (Female - Other - Age >=90)

          PDI805-1970     Percent of Plan's Total Member Months (Female - Commercial - Subtotal: Age >=65)

Measure   Measure Name/Measure Description/Field Name/Field Description

          PDI805-1980     Percent of Plan's Total Member Months (Female - Medicaid - Subtotal: Age >=65)

          PDI805-1990     Percent of Plan's Total Member Months (Female - Medicare - Age >=65)

          PDI805-2000     Percent of Plan's Total Member Months (Female - Other - Age >=65)

          PDI805-2010     Percent of Plan's Total Member Months (Total - Commercial - Subtotal: Age 0-19)

          PDI805-2020     Percent of Plan's Total Member Months (Total - Medicaid - Subtotal: Age 0-19)

          PDI805-2030     Percent of Plan's Total Member Months (Total - Medicare - Subtotal: Age 0-19)

          PDI805-2040     Percent of Plan's Total Member Months (Total - Other - Subtotal: Age 0-19)

          PDI805-2050     Percent of Plan's Total Member Months (Total - Commercial - Subtotal: Age 20-44)

          PDI805-2060     Percent of Plan's Total Member Months (Total - Medicaid - Subtotal: Age 20-44)

          PDI805-2070     Percent of Plan's Total Member Months (Total - Medicare - Subtotal: Age 20-44)

          PDI805-2080     Percent of Plan's Total Member Months (Total - Other - Subtotal: Age 20-44)

          PDI805-2090     Percent of Plan's Total Member Months (Total - Commercial - Subtotal: Age 45-64)

          PDI805-2100     Percent of Plan's Total Member Months (Total - Medicaid - Subtotal: Age 45-64)

          PDI805-2110     Percent of Plan's Total Member Months (Total - Medicare - Subtotal: Age 45-64)

          PDI805-2120     Percent of Plan's Total Member Months (Total - Other - Subtotal: Age 45-64)

          PDI805-2130     Percent of Plan's Total Member Months (Total - Commercial - Subtotal: Age >=65)

          PDI805-2140     Percent of Plan's Total Member Months (Total - Medicaid - Subtotal: Age >=65)

          PDI805-2150     Percent of Plan's Total Member Months (Total - Medicare - Subtotal: Age >=65)

          PDI805-2160     Percent of Plan's Total Member Months (Total - Other - Subtotal: Age >=65)

          PDI805-2170     Percent of Plan's Total Member Months (Total - Commercial - Subtotal: Age Unknown)

          PDI805-2180     Percent of Plan's Total Member Months (Total - Medicaid - Subtotal: Age Unknown)

          PDI805-2190     Percent of Plan's Total Member Months (Total - Medicare - Subtotal: Age Unknown)

          PDI805-2200     Percent of Plan's Total Member Months (Total - Other - Subtotal: Age Unknown)

          PDI805-2210     Percent of Plan's Total Member Months (Total - Commercial)

          PDI805-2220     Percent of Plan's Total Member Months (Total - Medicaid)

          PDI805-2230     Percent of Plan's Total Member Months (Total - Medicare)

          PDI805-2240     Percent of Plan's Total Member Months (Total - Other)

PDI806 – Enrollment by Payer

     DESCRIPTION - This measure reports the total number of members for each product line stratified by age and sex.

     Medicaid is reported in the member months contributed by enrollees during the measurement year, it is stratified by Medicaaid eligibility category, age and sex. MCOs can report this information only if it is provided by their state Medicaid agencies.

     Commercial and Medicare are reported in the number of member years contributed by enrollees during the measurement year, stratified by product line, age and sex. (HEDIS 20007, Volume 2: Technical Specification, Pg. 255)

     REPORTING LEVEL - Contract

          PDI806-0010     Member Years of Enrollment: Medicare Risk (Male)

          PDI806-0020     Member Years of Enrollment: Medicare Risk (Female)

          PDI806-0030     Member Years of Enrollment: Medicare Risk (Total)

Service_Area – Contract Service Area

     DESCRIPTION - The area where the contract provides services to Medicare care beneficiaries. This data comes from the Health Plan Management System (HPMS) as reported by the contract.

     REPORTING LEVEL - N/A

          SA-0010            Market Area Name

          SA-0020            Market Area Code

          SA-0030            Social Security Administration (SSA) State/County Code

          SA-0040            American National Standards Institute (ANSI) State/County Code INCITS 31-2009 (formerly Federal Information Processing Standard [FIPS] State/County codes)

          SA-0050            State Abbreviation (United States Postal Service (USPS) State Code)

          SA-0060            County Name

          SA-0070            County serves only beneficiaries in an Employer Group Health Plan (Y = Yes, N = No)


 

Measure   Measure Name/Measure Description/Field Name/Field Description

UOS505 – Frequency of Selected Procedures

     DESCRIPTION - This measure provides a summary of the number and rate of several frequently performed procedures. These procedures often show wide regional variation and have generated concern regarding potentially inappropriate utilization. For Medicaid members, MCOs report the absolute number of procedures and the number of procedures per 1,000 member months. For commercial and Medicare members, MCOs report the absolute number of procedures and the number of procedures per 1,000 members per year. (HEDIS 2000, Volume 2: Technical Specification, Pg. 175)

     REPORTING LEVEL - Contract Market

             UOS505-0010     CABG <65 (Male)

             UOS505-0020     CABG 65-74 (Male)

             UOS505-0030     CABG 75-84 (Male)

             UOS505-0040     CABG 85+ (Male)

             UOS505-0050     Angioplasty(PTCA) <65 (Male)

             UOS505-0060     Angioplasty(PTCA) 65-74 (Male)

             UOS505-0070     Angioplasty(PTCA) 75-84 (Male)

             UOS505-0080     Angioplasty(PTCA) 85+ (Male)

             UOS505-0090     Carotid Endarterectomy <65 (Male)

             UOS505-0100     Carotid Endarterectomy 65-74 (Male)

             UOS505-0110     Carotid Endarterectomy 75-84 (Male)

             UOS505-0120     Carotid Endarterectomy 85+ (Male)

             UOS505-0130     Reduction of Fracture of Femur <65 (Male)

             UOS505-0140     Reduction of Fracture of Femur 65-74 (Male)

             UOS505-0150     Reduction of Fracture of Femur 75-84 (Male)

             UOS505-0160     Reduction of Fracture of Femur 85+ (Male)

             UOS505-0170     Total Hip Replacement <65 (Male)

             UOS505-0180     Total Hip Replacement 65-74 (Male)

             UOS505-0190     Total Hip Replacement 75-84 (Male)

             UOS505-0200     Total Hip Replacement 85+ (Male)

             UOS505-0210     Total Knee Replacement <65 (Male)

             UOS505-0220     Total Knee Replacement 65-74 (Male)

             UOS505-0230     Total Knee Replacement 75-84 (Male)

             UOS505-0240     Total Knee Replacement 85+ (Male)

             UOS505-0250     Partial Excision of Large Intestine <65 (Male)

             UOS505-0260     Partial Excision of Large Intestine 65-74 (Male)

             UOS505-0270     Partial Excision of Large Intestine 75-84 (Male)

             UOS505-0280     Partial Excision of Large Intestine 85+ (Male)

             UOS505-0290     Cholecystectomy -open <65 (Male)

             UOS505-0300     Cholecystectomy -open 65-74 (Male)

             UOS505-0310     Cholecystectomy -open 75-84 (Male)

             UOS505-0320     Cholecystectomy -open 85+ (Male)

             UOS505-0330     Cholecystectomy -closed(laparoscopic) <65 (Male)

          UOS505-0340    Cholecystectomy -closed(laparoscopic) 65-74 (Male)

          UOS505-0350    Cholecystectomy -closed(laparoscopic) 75-84 (Male)

          UOS505-0360    Cholecystectomy -closed(laparoscopic) 85+ (Male)

          UOS505-0370    Prostatectomy <65 (Male)

          UOS505-0380    Prostatectomy 65-74 (Male)

          UOS505-0390    Prostatectomy 75-84 (Male)

          UOS505-0400    Prostatectomy 85+ (Male)

          UOS505-0410    CABG <65 (Female)

          UOS505-0420    CABG 65-74 (Female)

          UOS505-0430    CABG 75-84 (Female)

          UOS505-0440    CABG 85+ (Female)

          UOS505-0450    Angioplasty(PTCA) <65 (Female)

          UOS505-0460    Angioplasty(PTCA) 65-74 (Female)

          UOS505-0470    Angioplasty(PTCA) 75-84 (Female)

          UOS505-0480    Angioplasty(PTCA) 85+ (Female)

          UOS505-0490    Carotid Endarterectomy <65 (Female)

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS505-0500    Carotid Endarterectomy 65-74 (Female)

          UOS505-0510    Carotid Endarterectomy 75-84 (Female)

          UOS505-0520    Carotid Endarterectomy 85+ (Female)

          UOS505-0530    Reduction of Fracture of Femur <65 (Female)

          UOS505-0540    Reduction of Fracture of Femur 65-74 (Female)

          UOS505-0550    Reduction of Fracture of Femur 75-84 (Female)

          UOS505-0560    Reduction of Fracture of Femur 85+ (Female)

          UOS505-0570    Total Hip Replacement <65 (Female)

          UOS505-0580    Total Hip Replacement 65-74 (Female)

          UOS505-0590    Total Hip Replacement 75-84 (Female)

          UOS505-0600    Total Hip Replacement 85+ (Female)

          UOS505-0610    Total Knee Replacement <65 (Female)

          UOS505-0620    Total Knee Replacement 65-74 (Female)

          UOS505-0630    Total Knee Replacement 75-84 (Female)

          UOS505-0640    Total Knee Replacement 85+ (Female)

          UOS505-0650    Partial Excision of Large Intestine <65 (Female)

          UOS505-0660    Partial Excision of Large Intestine 65-74 (Female)

          UOS505-0670    Partial Excision of Large Intestine 75-84 (Female)

          UOS505-0680    Partial Excision of Large Intestine 85+ (Female)

          UOS505-0690    Cholecystectomy -open <65 (Female)

          UOS505-0700    Cholecystectomy -open 65-74 (Female)

          UOS505-0710    Cholecystectomy -open 75-84 (Female)

          UOS505-0720    Cholecystectomy -open 85+ (Female)

          UOS505-0730    Cholecystectomy -closed(laparoscopic) <65 (Female)

          UOS505-0740    Cholecystectomy -closed(laparoscopic) 65-74 (Female)

          UOS505-0750    Cholecystectomy -closed(laparoscopic) 75-84 (Female)

          UOS505-0760    Cholecystectomy -closed(laparoscopic) 85+ (Female)

          UOS505-0771    Hysterectomy - Abdominal <65 (Female)

          UOS505-0772    Hysterectomy - Vaginal <65 (Female)

          UOS505-0781    Hysterectomy - Abdominal 65-74 (Female)

          UOS505-0782    Hysterectomy - Vaginal 65-74 (Female)

          UOS505-0791    Hysterectomy - Abdominal 75-84 (Female)

          UOS505-0792    Hysterectomy - Vaginal 75-84 (Female)

          UOS505-0801    Hysterectomy - Abdominal 85+ (Female)

          UOS505-0802    Hysterectomy - Vaginal 85+ (Female)

          UOS505-0810    Cardiac Catherterization - <65 (Male)

          UOS505-0820    Cardiac Catherterization - 65-74 (Male)

          UOS505-0830    Cardiac Catherterization - 75-84 (Male)

          UOS505-0840    Cardiac Catherterization - 85+ (Male)

          UOS505-0850    Cardiac Catherterization - <65 (Female)

          UOS505-0860    Cardiac Catherterization - 65-74 (Female)

          UOS505-0870    Cardiac Catherterization - 75-84 (Female)

          UOS505-0880    Cardiac Catherterization - 85+ (Female)

UOS506 – Inpatient Utilization-General Hospital/Acute Care

     DESCRIPTION - This measure summarizes utilization of acute inpatient services in the following categories: total services, medicine, surgery and maternity. Nonacute care, mental health and chemical dependency services, as well as newborn care, are excluded. Medical and surgical services are reported separately because the factors influencing utilization in these two categories vary. This also facilitates comparisons between ambulatory surgery utilization (refer to the Ambulatory Care measure) and inpatient surgery utilization. (HEDIS 2000, Volume 2: Technical Specification, Pg. 185)

     REPORTING LEVEL - Contract Market

          UOS506-0010    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age < 1)

          UOS506-0020    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age < 1)

          UOS506-0030    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age < 1)

          UOS506-0040    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 1-9)

          UOS506-0050    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 1-9)

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS506-0060    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 1-9)

          UOS506-0070    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 10-19)

          UOS506-0080    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 10-19)

          UOS506-0090    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 10-19)

          UOS506-0100    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 20-44)

          UOS506-0110    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 20-44)

          UOS506-0120    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 20-44)

          UOS506-0130    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 45-64)

          UOS506-0140    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 45-64)

          UOS506-0150    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 45-64)

          UOS506-0160    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 65-74)

          UOS506-0170    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 65-74)

          UOS506-0180    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 65-74)

          UOS506-0190    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 75-84)

          UOS506-0200    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 75-84)

          UOS506-0210    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 75-84)

          UOS506-0220    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 85+)

          UOS506-0230    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 85+)

          UOS506-0240    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 85+)

          UOS506-0270    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age Unknown)

          UOS506-0280    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Total)

          UOS506-0290    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Total)

          UOS506-0300    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Total)

          UOS506-0310    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age < 1)

          UOS506-0320    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age < 1)

          UOS506-0330    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age < 1)

          UOS506-0340    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 1-9)

          UOS506-0350    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 1-9)

          UOS506-0360    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 1-9)

          UOS506-0370    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 10-19)

          UOS506-0380    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 10-19)

          UOS506-0390    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 10-19)

          UOS506-0400    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 20-44)

          UOS506-0410    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 20-44)

          UOS506-0420    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 20-44)

          UOS506-0430    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 45-64)

          UOS506-0440    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 45-64)

          UOS506-0450    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 45-64)

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS506-0460    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 65-74)

          UOS506-0470    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 65-74)

          UOS506-0480    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 65-74)

          UOS506-0490    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 75-84)

          UOS506-0500    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 75-84)

          UOS506-0510    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 75-84)

          UOS506-0520    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 85+)

          UOS506-0530    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 85+)

          UOS506-0540    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 85+)

          UOS506-0570    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age Unknown)

          UOS506-0580    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Total)

          UOS506-0590    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Total)

          UOS506-0600    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Total)

          UOS506-0610    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age < 1)

          UOS506-0620    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age < 1)

          UOS506-0630    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age < 1)

          UOS506-0640    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 1-9)

          UOS506-0650    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 1-9)

          UOS506-0660    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 1-9)

          UOS506-0670    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 10-19)

          UOS506-0680    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 10-19)

          UOS506-0690    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 10-19)

          UOS506-0700    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 20-44)

          UOS506-0710    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 20-44)

          UOS506-0720    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 20-44)

          UOS506-0730    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 45-64)

          UOS506-0740    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 45-64)

          UOS506-0750    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 45-64)

          UOS506-0760    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 65-74)

          UOS506-0770    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 65-74)

          UOS506-0780    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 65-74)

          UOS506-0790    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 75-84)

          UOS506-0800    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 75-84)

          UOS506-0810    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 75-84)

          UOS506-0820    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 85+)

          UOS506-0830    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 85+)

          UOS506-0840    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 85+)

          UOS506-0870    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age Unknown)

          UOS506-0880    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Total)

          UOS506-0890    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Total)

          UOS506-0900    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Total)

          UOS506-0901    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Age <1)

          UOS506-0902    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Age <1)

          UOS506-0903    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Age <1)

          UOS506-0904    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Ages 1-9)

          UOS506-0905    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Ages 1-9)


 

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS506-0906    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Ages 1-9)

          UOS506-0910    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Age 10-19)

          UOS506-0920    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Age 10-19)

          UOS506-0930    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Age 10-19)

          UOS506-0940    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Age 20-44)

          UOS506-0950    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Age 20-44)

          UOS506-0960    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Age 20-44)

          UOS506-0970    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Age 45-64)

          UOS506-0980    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Age 45-64)

          UOS506-0990    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Age 45-64)

          UOS506-1020    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Age Unknown)

          UOS506-1030    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Total)

          UOS506-1040    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Total)

          UOS506-1050    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Total)

          UOS506-1090    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Ages 65+)

          UOS506-1100    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Ages 65+)

          UOS506-1110    Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Ages 65+)

UOS507 – Ambulatory Care

     DESCRIPTION - This measure summarizes utilization of ambulatory services in the following categories: Outpatient Visits, Emergency Department Visits, Ambulatory Surgery/Procedures performed in hospital outpatient facilities or freestanding surgical centers, and Observation Room Stays that result in discharge (Observation Room Stays resulting in an inpatient admission are counted in the Inpatient Utilization - General Hospital Acute Care measure. (HEDIS 2000, Volume 2: Technical Specification, Pg. 191)

     REPORTING LEVEL - Contract Market

          UOS507-0010    Ambulatory Care- Total Outpatient Visits/1000 (Age < 1)

          UOS507-0020    Ambulatory Care- Total Emergency Room Visits/1000 (Age < 1)

          UOS507-0030    Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age < 1)

          UOS507-0040    Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age < 1)

          UOS507-0050    Ambulatory Care- Total Outpatient Visits/1000 (Age 1-9)

          UOS507-0060    Ambulatory Care- Total Emergency Room Visits/1000 (Age 1-9)

          UOS507-0070    Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 1-9)

          UOS507-0080    Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 1-9)

          UOS507-0090    Ambulatory Care- Total Outpatient Visits/1000 (Age 10-19)

          UOS507-0100    Ambulatory Care- Total Emergency Room Visits/1000 (Age 10-19)

          UOS507-0110    Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 10-19)

          UOS507-0120    Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 10-19)

          UOS507-0130    Ambulatory Care- Total Outpatient Visits/1000 (Age 20-44)

          UOS507-0140    Ambulatory Care- Total Emergency Room Visits/1000 (Age 20-44)

          UOS507-0150    Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 20-44)

          UOS507-0160    Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 20-44)

          UOS507-0170    Ambulatory Care- Total Outpatient Visits/1000 (Age 45-64)

          UOS507-0180    Ambulatory Care- Total Emergency Room Visits/1000 (Age 45-64)

          UOS507-0190    Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 45-64)

          UOS507-0200    Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 45-64)

          UOS507-0210    Ambulatory Care- Total Outpatient Visits/1000 (Age 65-74)

          UOS507-0220    Ambulatory Care- Total Emergency Room Visits/1000 (Age 65-74)

          UOS507-0230    Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 65-74)

          UOS507-0240    Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 65-74)

          UOS507-0250    Ambulatory Care- Total Outpatient Visits/1000 (Age 75-84)

          UOS507-0260    Ambulatory Care- Total Emergency Room Visits/1000 (Age 75-84)

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS507-0270    Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 75-84)

          UOS507-0280    Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 75-84)

          UOS507-0290    Ambulatory Care- Total Outpatient Visits/1000 (Age 85+)

          UOS507-0300    Ambulatory Care- Total Emergency Room Visits/1000 (Age 85+)

          UOS507-0310    Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 85+)

          UOS507-0320    Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 85+)

          UOS507-0370    Ambulatory Care- Total Outpatient Visits/1000 (Total)

          UOS507-0380    Ambulatory Care- Total Emergency Room Visits/1000 (Total)

          UOS507-0390    Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Total)

          UOS507-0400    Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Total)

UOS508 – Inpatient Utilization-NonAcute Care

     DESCRIPTION - This measure summarizes utilization of nonacute inpatient care in the following facilities: hospice, nursing home, rehabilitation, SNF, transitional care and respite. These data excludes services with a principle diagnosis of mental health and chemical dependency. (HEDIS 2000, Volume 2: Technical Specification, Pg. 197)

     REPORTING LEVEL - Contract Market

          UOS508-0010    Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age < 1)

          UOS508-0020    Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age < 1)

          UOS508-0030    Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age < 1)

          UOS508-0040    Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 1-9)

          UOS508-0050    Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age 1-9)

          UOS508-0060    Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age 1-9)

          UOS508-0070    Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 10-19)

          UOS508-0080    Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age 10-19)

          UOS508-0090    Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age 10-19)

          UOS508-0100    Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 20-44)

          UOS508-0110    Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age 20-44)

          UOS508-0120    Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age 20-44)

          UOS508-0130    Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 45-64)

          UOS508-0140    Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age 45-64)

          UOS508-0150    Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age 45-64)

          UOS508-0160    Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 65-74)

          UOS508-0170    Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age 65-74)

          UOS508-0180    Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age 65-74)

          UOS508-0190    Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 75-84)

          UOS508-0200    Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age 75-84)

          UOS508-0210    Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age 75-84)

          UOS508-0220    Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 85+)

          UOS508-0230    Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age 85+)

          UOS508-0240    Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age 85+)

          UOS508-0270    Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age Unknown)

          UOS508-0280    Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Total)

          UOS508-0290    Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Total)

          UOS508-0300    Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Total)

UOS512 – Mental Health Utilization-Inpatient Discharges/Average Length of Stay

     DESCRIPTION - This measure summarizes utilization of inpatient mental health services, stratified by age and sex. (HEDIS 2000, Volume 2: Technical Specification, Pg. 211)

     REPORTING LEVEL - Contract Market

          UOS512-0010    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Male - Age 0-12)

          UOS512-0020    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Age 0-12)

          UOS512-0030    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Male - Age 13-17)

          UOS512-0040    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Age 13-17)

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS512-0050    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Male - Age 18-64)

          UOS512-0060    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Age 18-64)

          UOS512-0070    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Male - Age 65+)

          UOS512-0080    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Age 65+)

          UOS512-0100    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Age Uknown)

          UOS512-0110    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Male - Total)

          UOS512-0120    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Total)

          UOS512-0130    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Female - Age 0-12)

          UOS512-0140    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Age 0-12)

          UOS512-0150    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Female - Age 13-17)

          UOS512-0160    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Age 13-17)

          UOS512-0170    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Female - Age 18-64)

          UOS512-0180    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Age 18-64)

          UOS512-0190    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Female - Age 65+)

          UOS512-0200    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Age 65+)

          UOS512-0220    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Age Uknown)

          UOS512-0230    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Female - Total)

          UOS512-0240    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Total)

          UOS512-0250    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Total - Age 0-12)

          UOS512-0260    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Age 0-12)

          UOS512-0270    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Total - Age 13-17)

          UOS512-0280    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Age 13-17)

          UOS512-0290    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Total - Age 18-64)

          UOS512-0300    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Age 18-64)

          UOS512-0310    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Total - Age 65+)

          UOS512-0320    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Age 65+)

          UOS512-0340    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Age Uknown)

          UOS512-0350    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Total - Total)

          UOS512-0360    Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Total)

Measure   Measure Name/Measure Description/Field Name/Field Description

UOS513 – Mental Health Utilization-% of Members Receiving Inpatient, Day/Night, and Ambulatory Services

     DESCRIPTION - This measure reports the number and percentage of members receiving mental health services during the measurement year in the following categories: Any Mental Health Services (inpatient, day/night, ambulatory), Inpatient Mental Health Services, Day/Night Mental Health Services and Ambulatory Mental Health Services.

     Report in each category the number of members who received the respective service and, of all enrollees with a mental health benefit, the percentage who received the respective service. This information is reported by age and sex. This measure is intended to give an overview of the extent to which the MCO uses the different levels of mental health care.

     (HEDIS 2000, Volume 2: Technical Specification, Pg. 214)

     REPORTING LEVEL - Contract Market

          UOS513-0010    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 0-12)

          UOS513-0020    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 0-12)

          UOS513-0030    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 0-12)

          UOS513-0040    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 0-12)

          UOS513-0050    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 13-17)

          UOS513-0060    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 13-17)

          UOS513-0070    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 13-17)

          UOS513-0080    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 13-17)

          UOS513-0090    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 18-64)

          UOS513-0100    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 18-64)

          UOS513-0110    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 18-64)

          UOS513-0120    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 18-64)

          UOS513-0130    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 65+)

          UOS513-0140    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 65+)

          UOS513-0150    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 65+)

          UOS513-0160    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 65+)

          UOS513-0170    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age Unknown)

          UOS513-0180    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age Unknown)

          UOS513-0190    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age Unknown)

          UOS513-0200    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age Unknown)

          UOS513-0210    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Total)

          UOS513-0220    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Total)

          UOS513-0230    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Total)


 

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS513-0240    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male -Total)

          UOS513-0250    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 0-12)

          UOS513-0260    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 0-12)

          UOS513-0270    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 0-12)

          UOS513-0280    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 0-12)

          UOS513-0290    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 13-17)

          UOS513-0300    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 13-17)

          UOS513-0310    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 13-17)

          UOS513-0320    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 13-17)

          UOS513-0330    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 18-64)

          UOS513-0340    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 18-64)

          UOS513-0350    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 18-64)

          UOS513-0360    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 18-64)

          UOS513-0370    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 65+)

          UOS513-0380    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 65+)

          UOS513-0390    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 65+)

          UOS513-0400    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 65+)

          UOS513-0410    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age Unknown)

          UOS513-0420    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age Unknown)

          UOS513-0430    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age Unknown)

          UOS513-0440    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age Unknown)

          UOS513-0450    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Total)

          UOS513-0460    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Total)

          UOS513-0470    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Total)

          UOS513-0480    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female -Total)

          UOS513-0490    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 0-12)

          UOS513-0500    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 0-12)

          UOS513-0510    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 0-12)

          UOS513-0520    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 0-12)

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS513-0530    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 13-17)

          UOS513-0540    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 13-17)

          UOS513-0550    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 13-17)

          UOS513-0560    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 13-17)

          UOS513-0570    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 18-64)

          UOS513-0580    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 18-64)

          UOS513-0590    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 18-64)

          UOS513-0600    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 18-64)

          UOS513-0610    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 65+)

          UOS513-0620    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 65+)

          UOS513-0630    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 65+)

          UOS513-0640    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 65+)

          UOS513-0650    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age Unknown)

          UOS513-0660    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age Unknown)

          UOS513-0670    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age Unknown)

          UOS513-0680    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age Unknown)

          UOS513-0690    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Total)

          UOS513-0700    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Total)

          UOS513-0710    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Total)

          UOS513-0720    Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total -Total)

UOS515 – Chemical Dependency utilization-Inpatient Discharges/Average Length of Stay

     DESCRIPTION - This measure summarizes utilization of inpatient chemical dependency services, stratified by age and sex. (HEDIS 2000, Volume 2: Technical Specification, Pg. 218)

     REPORTING LEVEL - Contract Market

          UOS515-0010    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Male - Age 0-12)

          UOS515-0020    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Age 0-12)

          UOS515-0030    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Male - Age 13-17)

          UOS515-0040    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Age 13-17)

          UOS515-0050    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Male - Age 18-64)

          UOS515-0060    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Age 18-64)

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS515-0070    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Male - Age 65+)

          UOS515-0080    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Age 65+)

          UOS515-0100    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Age Unknown)

          UOS515-0110    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Male - Total)

          UOS515-0120    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Total)

          UOS515-0130    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Female - Age 0-12)

          UOS515-0140    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Age 0-12)

          UOS515-0150    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Female - Age 13-17)

          UOS515-0160    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Age 13-17)

          UOS515-0170    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Female - Age 18-64)

          UOS515-0180    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Age 18-64)

          UOS515-0190    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Female - Age 65+)

          UOS515-0200    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Age 65+)

          UOS515-0220    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Age Unknown)

          UOS515-0230    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Female - Total)

          UOS515-0240    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Total)

          UOS515-0250    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Total - Age 0-12)

          UOS515-0260    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Age 0-12)

          UOS515-0270    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Total - Age 13-17)

          UOS515-0280    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Age 13-17)

          UOS515-0290    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Total - Age 18-64)

          UOS515-0300    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Age 18-64)

          UOS515-0310    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Total - Age 65+)

          UOS515-0320    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Age 65+)

          UOS515-0340    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Age Unknown)

          UOS515-0350    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Total - Total)

          UOS515-0360    Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Total)


 

Measure   Measure Name/Measure Description/Field Name/Field Description

UOS516 – Chemical Dependency utilization-% of members Receiving Inpatient, Day/Night, and Ambulatory Services

     DESCRIPTION - This measure reports the number and percentage of members receiving chemical dependency services during the measurement year in the following categories: Any Chemical Dependency Services (inpatient, day/night, ambulatory), Inpatient Chemical Dependency Services,

     Day/Night Chemical Dependency Services and Ambulatory Chemical Depencdency Services. Report in each category the number of members who received the respective service and, of all enrollees with a chemical dependency benefit, the percentage that received the respective service, This information is reported by age and sex.

     This measure is intended to give an overview of the extent to which the MCO uses the different levels of chemical dependency care. (HEDIS 2000, Volume 2: Technical Specification, Pg. 221)

     REPORTING LEVEL - Contract Market

          UOS516-0010    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 0-12)

          UOS516-0020    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 0-12)

          UOS516-0030    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 0-12)

          UOS516-0040    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 0-12)

          UOS516-0050    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 13-17)

          UOS516-0060    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 13-17)

          UOS516-0070    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 13-17)

          UOS516-0080    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 13-17)

          UOS516-0090    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 18-64)

          UOS516-0100    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 18-64)

          UOS516-0110    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 18-64)

          UOS516-0120    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 18-64)

          UOS516-0130    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 65+)

          UOS516-0140    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 65+)

          UOS516-0150    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 65+)

          UOS516-0160    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 65+)

          UOS516-0170    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age Uknown)

          UOS516-0180    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age Unknown)

          UOS516-0190    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age Unknown)

          UOS516-0200    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age Unknown)

          UOS516-0210    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Total)

          UOS516-0220    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Total)

          UOS516-0230    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Total)

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS516-0240    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Total)

          UOS516-0250    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 0-12)

          UOS516-0260    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 0-12)

          UOS516-0270    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 0-12)

          UOS516-0280    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 0-12)

          UOS516-0290    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 13-17)

          UOS516-0300    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 13-17)

          UOS516-0310    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 13-17)

          UOS516-0320    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 13-17)

          UOS516-0330    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 18-64)

          UOS516-0340    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 18-64)

          UOS516-0350    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 18-64)

          UOS516-0360    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 18-64)

          UOS516-0370    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 65+)

          UOS516-0380    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 65+)

          UOS516-0390    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 65+)

          UOS516-0400    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 65+)

          UOS516-0410    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age Uknown)

          UOS516-0420    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age Unknown)

          UOS516-0430    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age Unknown)

          UOS516-0440    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age Unknown)

          UOS516-0450    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Total)

          UOS516-0460    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Total)

          UOS516-0470    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Total)

          UOS516-0480    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Total)

          UOS516-0490    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 0-12)

          UOS516-0500    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 0-12)

          UOS516-0510    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 0-12)

          UOS516-0520    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 0-12)

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS516-0530    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 13-17)

          UOS516-0540    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 13-17)

          UOS516-0550    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 13-17)

          UOS516-0560    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 13-17)

          UOS516-0570    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 18-64)

          UOS516-0580    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 18-64)

          UOS516-0590    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 18-64)

          UOS516-0600    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 18-64)

          UOS516-0610    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 65+)

          UOS516-0620    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 65+)

          UOS516-0630    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 65+)

          UOS516-0640    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 65+)

          UOS516-0650    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age Uknown)

          UOS516-0660    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age Unknown)

          UOS516-0670    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age Unknown)

          UOS516-0680    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age Unknown)

          UOS516-0690    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Total)

          UOS516-0700    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Total)

          UOS516-0710    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Total)

          UOS516-0720    Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Total)

UOS518 – Outpatient Drug Utilization

     DESCRIPTION - This measure summarizes data on outpatient utilization of drug prescriptions (Total Cost of Prescriptions, Average Cost of Prescriptions per Member per Month, Total Number of Prescriptions and Average Number of Prescriptions per Member per Year) during the measurement year, stratified by age. (HEDIS 2000, Volume 2: Technical Specification, Pg. 225)

     REPORTING LEVEL - Contract Market

          UOS518-0010    Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 0-9)

          UOS518-0020    Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 0-9)

          UOS518-0030    Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 10-19)

          UOS518-0040    Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 10-19)

          UOS518-0050    Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 20-44)

          UOS518-0060    Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 20-44)

          UOS518-0070    Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 45-64)

          UOS518-0080    Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 45-64)

          UOS518-0090    Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 65-74)

          UOS518-0100    Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 65-74)

          UOS518-0110    Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 75-84)

Measure   Measure Name/Measure Description/Field Name/Field Description

          UOS518-0120    Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 75-84)

          UOS518-0130    Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 85+)

          UOS518-0140    Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 85+)

          UOS518-0170    Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Total)

          UOS518-0180    Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Total)