HEDIS® 2007 (Summary) Documentation for Reporting Year 2006

General Information

This documentation presents (1) a description of each HEDIS® measure that CMS collected for 276 Medicare managed care contract markets on health care provided in calendar year 2006 to Medicare beneficiaries and (2) the location of the rates associated with each HEDIS measure within the HEDIS workbook (HEDIS2007.XLS). CMS took the description and additional information for each measure from HEDIS 2007 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) 2007 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 the contract

In 2007, CMS collected data from 275 Medicare managed care contracts for health care delivered in 2006. CMS considers the reporting unit for a health plan as the equivalent to a contract. CMS signs a contract with health plans to provide health care for a given geographic service area. One contract still divides its geographic service area in two and reports at the "market area" level. This makes the total number of reported submissions 276.

The "Service_Area" sheet in the HEDIS workbook identifies the state and counties for each submission. If the contract that reports at the "market area" level is shown with the market area after the state (CA: Northern California" and "CA: Southern California.")

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 2007 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 2007, 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 three types of missing values: NA, NB and NR

The HEDIS guidelines distinguish between three different types of missing values in the rate field: Not Applicable (NA), No Benefit (NB) 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.)

A value of NB is recorded when the health plan did not offer the health benefit required by the measure (e.g., Mental Health/Chemical Dependency). 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 included the Medicare Modernization Act plan type designations as well as indicators if the contract offers a Special Needs benefit packages or a Part D Drug benefit in 2006. These values can be found on the sheet named "GENERAL".

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 20–44, 45–64 and 65 years and older who 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. The MCO reports the percentage of:

     • Medicaid and Medicare enrollees who had an ambulatory or preventive care visit during the measurement year

     • Commercial enrollees who had an ambulatory or preventive care visit during the measurement year or the two years prior to the measurement year.

     (HEDIS 2007, Volume 2: Technical Specification, Pg. 182)

     REPORTING LEVEL - Contract Market

             AOC201-0010     Rate 20-44

             AOC201-0020     Rate 45-64

             AOC201-0030     Rate 65+

             AOC201-0040     Lower Confidence Interval - 20-44

             AOC201-0050     Upper Confidence Interval - 20-44

             AOC201-0060     Lower Confidence Interval - 45-64

             AOC201-0070     Upper Confidence Interval - 45-64

             AOC201-0080     Lower Confidence Interval - 65+

             AOC201-0090     Upper Confidence Interval - 65+

             AOC201-0095     Combined Total

             AOC201-0100     Lower Confidence Interval - All

             AOC201-0110     Upper Confidence Interval - All

AOC220 – Call Abandonment

     DESCRIPTION - The percentage of calls received by the MCO’s Member Services call centers (during Member Services operating hours) during the measurement year that were abandoned by the caller before being answered by a live voice. (HEDIS 2007, Volume 2: Technical Specification, Pg. 208)

       REPORTING LEVEL - Contract Market

             AOC220-0010     Reported rate

             AOC220-0020     Lower Confidence Interval

             AOC220-0030     Upper Confidence Interval

AOC225 – Call Answer Timeliness

     DESCRIPTION - The percentage of calls received by the MCO’s Member Services call centers (during Member Services operating hours) during the measurement year that were answered by a live voice within 30 seconds.. (HEDIS 2007, Volume 2: Technical Specification, Pg. 206)

       REPORTING LEVEL - Contract Market

             AOC225-0010     Reported rate

             AOC225-0020     Lower Confidence Interval

             AOC225-0030     Upper Confidence Interval

AOC235 – Initiation and Engagement of Alcohol and Other Drug Dependence Treatmen

     DESCRIPTION - This measure calculates two rates for adult members and two rates for adolescent members with Alcohol and Other Drug (AOD) dependence.

     • Initiation of AOD Dependence Treatment. The percentage of adolescent and adult members diagnosed with AOD dependence who initiate treatment through either:

     – An inpatient AOD admission, or

     – An outpatient service, for AOD dependence and an additional AOD service within 14 days.

     • Engagement of AOD Treatment. An intermediate step between initially accessing care (initiation treatment) and completing a full course of treatment. This measure is designed to assess the degree to which members engage in treatment with two additional AOD services within 30 days after initiation.

     (HEDIS 2007, Volume 2: Technical Specification, Pg. 201)

     REPORTING LEVEL - Contract Market

             AOC235-0010     Rate - Engagement - Overall Year Olds

             AOC235-0020     Lower Confidence Interval - Engagement - Overall Year Olds

             AOC235-0030     Upper Confidence Interval - Engagement - Overall Year Olds


 

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

COC605 – Relative Resource Use for People With Diabetes

     DESCRIPTION - This measure reports the relative resource use, during the measurement year, for members with diabetes. Health plans calculate and report the eligible populations’ total standard cost (based on NCQA provided standard price tables) and utilization by member cohort as instructed in the specification. Upon receiving and based on all health plan data NCQA will calculate expected (or average) total standard cost and utilization results (regional and national), after which health plans will receive their observed-to-expected ratio (or relative resource use ratio) for the clinical condition and each service category. When evaluated with the HEDIS Comprehensive Diabetes Care (CDC) measure, the relative resource use ratios provide a better understanding of the efficiency or value of services rendered by the MCO.See the Cost of Care Guidelines for definitions, methods to apply standard price to services and calculation processes. (HEDIS 2007, Volume 2: Technical Specification, Pg. 321)

     REPORTING LEVEL - Contract Market

          COC605-0010    MM Med Benefit Diabetes T1 w/ Co-morbidity M Tot

          COC605-0020    MM Med Benefit Diabetes T1 w/ Co-morbidity F Tot

          COC605-0030    MM Med Benefit Diabetes T1 w/ Co-morbidity MF Tot

          COC605-0040    MM Phar Benefit Diabetes T1 w/ Co-morbidity M Tot

          COC605-0050    MM Phar Benefit Diabetes T1 w/ Co-morbidity F Tot

          COC605-0060    MM Phar Benefit Diabetes T1 w/ Co-morbidity MF Tot

          COC605-0070    MM Med Benefit Diabetes T1 w/o Co-morbidity M Tot

          COC605-0080    MM Med Benefit Diabetes T1 w/o Co-morbidity F Tot

          COC605-0090    MM Med Benefit Diabetes T1 w/o Co-morbidity MF Tot

          COC605-0100    MM Phar Benefit Diabetes T1 w/o Co-morbidity M Tot

          COC605-0110    MM Phar Benefit Diabetes T1 w/o Co-morbidity F Tot

          COC605-0120    MM Phar Benefit Diabetes T1 w/o Co-morbidity MF Tot

          COC605-0130    MM Med Benefit Diabetes T2 w/ Co-morbidity M Tot

          COC605-0140    MM Med Benefit Diabetes T2 w/ Co-morbidity F Tot

          COC605-0150    MM Med Benefit Diabetes T2 w/ Co-morbidity MF Tot

          COC605-0160    MM Phar Benefit Diabetes T2 w/ Co-morbidity M Tot

          COC605-0170    MM Phar Benefit Diabetes T2 w/ Co-morbidity F Tot

          COC605-0180    MM Phar Benefit Diabetes T2 w/ Co-morbidity MF Tot

          COC605-0190    MM Med Benefit Diabetes T2 w/o Co-morbidity M Tot

          COC605-0200    MM Med Benefit Diabetes T2 w/o Co-morbidity F Tot

          COC605-0210    MM Med Benefit Diabetes T2 w/o Co-morbidity MF Tot

          COC605-0220    MM Phar Benefit Diabetes T2 w/o Co-morbidity M Tot

          COC605-0230    MM Phar Benefit Diabetes T2 w/o Co-morbidity F Tot

          COC605-0240    MM Phar Benefit Diabetes T2 w/o Co-morbidity MF Tot

          COC605-0250    Diabetes T1 w/ Co-morbidity IP Std Price M Tot

          COC605-0260    Diabetes T1 w/ Co-morbidity IP Std Price F Tot

          COC605-0270    Diabetes T1 w/ Co-morbidity IP Std Price MF Tot

          COC605-0280    Diabetes T1 w/ Co-morbidity EM Std Price M Tot

          COC605-0290    Diabetes T1 w/ Co-morbidity EM Std Price F Tot

          COC605-0300    Diabetes T1 w/ Co-morbidity EM Std Price MF Tot

          COC605-0310    Diabetes T1 w/ Co-morbidity Surgery Std Price M Tot

          COC605-0320    Diabetes T1 w/ Co-morbidity Surgery Std Price F Tot

          COC605-0330    Diabetes T1 w/ Co-morbidity Surgery Std Price MF Tot

          COC605-0340    Diabetes T1 w/ Co-morbidity Pharmacy Std Price M Tot

          COC605-0350    Diabetes T1 w/ Co-morbidity Pharmacy Std Price F Tot

          COC605-0360    Diabetes T1 w/ Co-morbidity Pharmacy Std Price MF Tot

          COC605-0370    Diabetes T1 w/ Co-morbidity Dis Svs Freq M Tot

          COC605-0380    Diabetes T1 w/ Co-morbidity Dis Svs Freq F Tot

          COC605-0390    Diabetes T1 w/ Co-morbidity Dis Svs Freq MF Tot

          COC605-0400    Diabetes T1 w/ Co-morbidity ED Svs Freq M Tot

          COC605-0410    Diabetes T1 w/ Co-morbidity ED Svs Freq F Tot

          COC605-0420    Diabetes T1 w/ Co-morbidity ED Svs Freq MF Tot

          COC605-0430    Diabetes T1 w/ Co-morbidity Obs Rm Stays Svs Freq M Tot

          COC605-0440    Diabetes T1 w/ Co-morbidity Obs Rm Stays Svs Freq F Tot

          COC605-0450    Diabetes T1 w/ Co-morbidity Obs Rm Stays Svs Freq MF Tot

          COC605-0460    Diabetes T1 w/o Co-morbidity IP Std Price M Tot

          COC605-0470    Diabetes T1 w/o Co-morbidity IP Std Price F Tot

          COC605-0480    Diabetes T1 w/o Co-morbidity IP Std Price MF Tot

          COC605-0490    Diabetes T1 w/o Co-morbidity EM Std Price M Tot

          COC605-0500    Diabetes T1 w/o Co-morbidity EM Std Price F Tot

          COC605-0510    Diabetes T1 w/o Co-morbidity EM Std Price MF Tot

          COC605-0520    Diabetes T1 w/o Co-morbidity Surgery Std Price M Tot

          COC605-0530    Diabetes T1 w/o Co-morbidity Surgery Std Price F Tot

          COC605-0540    Diabetes T1 w/o Co-morbidity Surgery Std Price MF Tot

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

          COC605-0550    Diabetes T1 w/o Co-morbidity Pharmacy Std Price M Tot

          COC605-0560    Diabetes T1 w/o Co-morbidity Pharmacy Std Price F Tot

          COC605-0570    Diabetes T1 w/o Co-morbidity Pharmacy Std Price MF Tot

          COC605-0580    Diabetes T1 w/o Co-morbidity Dis Svs Freq M Tot

          COC605-0590    Diabetes T1 w/o Co-morbidity Dis Svs Freq F Tot

          COC605-0600    Diabetes T1 w/o Co-morbidity Dis Svs Freq MF Tot

          COC605-0610    Diabetes T1 w/o Co-morbidity ED Svs Freq M Tot

          COC605-0620    Diabetes T1 w/o Co-morbidity ED Svs Freq F Tot

          COC605-0630    Diabetes T1 w/o Co-morbidity ED Svs Freq MF Tot

          COC605-0640    Diabetes T1 w/o Co-morbidity Obs Rm Stays Svs Freq M Tot

          COC605-0650    Diabetes T1 w/o Co-morbidity Obs Rm Stays Svs Freq F Tot

          COC605-0660    Diabetes T1 w/o Co-morbidity Obs Rm Stays Svs Freq MF Tot

          COC605-0670    Diabetes T2 w/ Co-morbidity IP Std Price M Tot

          COC605-0680    Diabetes T2 w/ Co-morbidity IP Std Price F Tot

          COC605-0690    Diabetes T2 w/ Co-morbidity IP Std Price MF Tot

          COC605-0700    Diabetes T2 w/ Co-morbidity EM Std Price M Tot

          COC605-0710    Diabetes T2 w/ Co-morbidity EM Std Price F Tot

          COC605-0720    Diabetes T2 w/ Co-morbidity EM Std Price MF Tot

          COC605-0730    Diabetes T2 w/ Co-morbidity Surgery Std Price M Tot

          COC605-0740    Diabetes T2 w/ Co-morbidity Surgery Std Price F Tot

          COC605-0750    Diabetes T2 w/ Co-morbidity Surgery Std Price MF Tot

          COC605-0760    Diabetes T2 w/ Co-morbidity Pharmacy Std Price M Tot

          COC605-0770    Diabetes T2 w/ Co-morbidity Pharmacy Std Price F Tot

          COC605-0780    Diabetes T2 w/ Co-morbidity Pharmacy Std Price MF Tot

          COC605-0790    Diabetes T2 w/ Co-morbidity Dis Svs Freq M Tot

          COC605-0800    Diabetes T2 w/ Co-morbidity Dis Svs Freq F Tot

          COC605-0810    Diabetes T2 w/ Co-morbidity Dis Svs Freq MF Tot

          COC605-0820    Diabetes T2 w/ Co-morbidity ED Svs Freq M Tot

          COC605-0830    Diabetes T2 w/ Co-morbidity ED Svs Freq F Tot

          COC605-0840    Diabetes T2 w/ Co-morbidity ED Svs Freq MF Tot

          COC605-0850    Diabetes T2 w/ Co-morbidity Obs Rm Stays Svs Freq M Tot

          COC605-0860    Diabetes T2 w/ Co-morbidity Obs Rm Stays Svs Freq F Tot

          COC605-0870    Diabetes T2 w/ Co-morbidity Obs Rm Stays Svs Freq MF Tot

          COC605-0880    Diabetes T2 w/o Co-morbidity IP Std Price M Tot

          COC605-0890    Diabetes T2 w/o Co-morbidity IP Std Price F Tot

          COC605-0900    Diabetes T2 w/o Co-morbidity IP Std Price MF Tot

          COC605-0910    Diabetes T2 w/o Co-morbidity EM Std Price M Tot

          COC605-0920    Diabetes T2 w/o Co-morbidity EM Std Price F Tot

          COC605-0930    Diabetes T2 w/o Co-morbidity EM Std Price MF Tot

          COC605-0940    Diabetes T2 w/o Co-morbidity Surgery Std Price M Tot

          COC605-0950    Diabetes T2 w/o Co-morbidity Surgery Std Price F Tot

          COC605-0960    Diabetes T2 w/o Co-morbidity Surgery Std Price MF Tot

          COC605-0970    Diabetes T2 w/o Co-morbidity Pharmacy Std Price M Tot

          COC605-0980    Diabetes T2 w/o Co-morbidity Pharmacy Std Price F Tot

          COC605-0990    Diabetes T2 w/o Co-morbidity Pharmacy Std Price MF Tot

          COC605-1000    Diabetes T2 w/o Co-morbidity Dis Svs Freq M Tot

          COC605-1010    Diabetes T2 w/o Co-morbidity Dis Svs Freq F Tot

          COC605-1020    Diabetes T2 w/o Co-morbidity Dis Svs Freq MF Tot

          COC605-1030    Diabetes T2 w/o Co-morbidity ED Svs Freq M Tot

          COC605-1040    Diabetes T2 w/o Co-morbidity ED Svs Freq F Tot

          COC605-1050    Diabetes T2 w/o Co-morbidity ED Svs Freq MF Tot

          COC605-1060    Diabetes T2 w/o Co-morbidity Obs Rm Stays Svs Freq M Tot

          COC605-1070    Diabetes T2 w/o Co-morbidity Obs Rm Stays Svs Freq F Tot

          COC605-1080    Diabetes T2 w/o Co-morbidity Obs Rm Stays Svs Freq MF Tot

          COC605-1090    Diabetes Total IP Std Price M Tot PMPM

          COC605-1100    Diabetes Total IP Std Price F Tot PMPM

          COC605-1110    Diabetes Total IP Std Price MF Tot PMPM

          COC605-1120    Diabetes Total EM Std Price M Tot PMPM

          COC605-1130    Diabetes Total EM Std Price F Tot PMPM

          COC605-1140    Diabetes Total EM Std Price MF Tot PMPM

          COC605-1150    Diabetes Total Surgery Std Price M Tot PMPM

          COC605-1160    Diabetes Total Surgery Std Price F Tot PMPM

          COC605-1170    Diabetes Total Surgery Std Price MF Tot PMPM

          COC605-1180    Diabetes Total Pharmacy Std Price M Tot PMPM

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

          COC605-1190    Diabetes Total Pharmacy Std Price F Tot PMPM

          COC605-1200    Diabetes Total Pharmacy Std Price MF Tot PMPM

          COC605-1210    Diabetes Total Dis Svs Freq M Tot/1000

          COC605-1220    Diabetes Total Dis Svs Freq F Tot/1000

          COC605-1230    Diabetes Total Dis Svs Freq MF Tot/1000

          COC605-1240    Diabetes Total ED Svs Freq M Tot/1000

          COC605-1250    Diabetes Total ED Svs Freq F Tot/1000

          COC605-1260    Diabetes Total ED Svs Freq MF Tot/1000

          COC605-1270    Diabetes Total Obs Rm Stays Svs Freq M Tot/1000

          COC605-1280    Diabetes Total Obs Rm Stays Svs Freq F Tot/1000

          COC605-1290    Diabetes Total Obs Rm Stays Svs Freq MF Tot/1000

EOC003 – Breast Cancer Screening

     DESCRIPTION - The percentage of women 40–69 years of age who had a mammogram to screen for breast cancer.  (HEDIS 2007, Volume 2: Technical Specification, Pg. 85)

     REPORTING LEVEL - Contract Market

             EOC003-0040     Reported Rate - 42-51

             EOC003-0050     Lower Confidence Interval - 42-51

             EOC003-0060     Upper Confidence Interval - 42-51

             EOC003-0070     Reported Rate - 52-69

             EOC003-0080     Lower Confidence Interval - 52-69

             EOC003-0090     Upper Confidence Interval - 52-69

             EOC003-0100     Rate - Total

             EOC003-0110     Lower Confidence Interval - tot

             EOC003-0120     Upper Confidence Interval - tot

EOC008 – Beta Blocker Treatment

     DESCRIPTION - The percentage of members 35 years of age and older during the measurement year who were hospitalized and discharged alive from January 1–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. (HEDIS 2007, Volume 2: Technical Specification, Pg. 101)

     REPORTING LEVEL - Contract Market

             EOC008-0010     Rate

             EOC008-0020     Upper Confidence Interval

             EOC008-0030     Lower Confidence Interval

EOC010 – Followup after Hospitalization for Mental Illness

     DESCRIPTION - The percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental health disorders and who were seen on an outpatient basis or were in intermediate treatment with a mental health provider.

     Six separate calculations are required—one for each of the three product lines for both of the following.

     • The percentage of discharges for members who had an outpatient or intermediate mental health visit on the date of discharge, up to 30 days after hospital discharge, and

     • The percentage of discharges for members who had an outpatient or intermediate mental health visit on the date of discharge, up to seven days after hospital discharge.

     (HEDIS 2007, Volume 2: Technical Specification, Pg. 132)

     REPORTING LEVEL - Contract Market

             EOC010-0011     Rate - 7 Days

             EOC010-0012     Rate - 30 Days

             EOC010-0021     Upper Confidence Interval - 7 Days

             EOC010-0022     Upper Confidence Interval - 30 Days

             EOC010-0031     Lower Confidence Interval - 7 Days

             EOC010-0032     Lower Confidence Interval - 30 Days


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

EOC020 – Comprehensive Diabetes Care

     DESCRIPTION - The percentage of members 18–75 years of age with diabetes (type 1 and type 2) who had each of the following.

     • Hemoglobin A1c (HbA1c) testing

     • HbA1c poor control (>9.0%)

     • HbA1c good control (<7.0%)

     • Eye exam (retinal) performed

     • LDL-C screening performed

     • LDL-C control (<100 mg/dL)

     • Medical attention for nephropathy

     • Blood pressure control (<140/90 mm Hg)

     • Blood pressure control (<130/80 mm Hg)

     (HEDIS 2007, Volume 2: Technical Specifications, Pg. 113)

       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

             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

             EOC020-0160     Rate - Monitoring Diabetic Nephropathy

             EOC020-0170     Lower Confidence Interval - Monitoring Diabetic Nephropathy

             EOC020-0180     Upper Confidence Interval - Monitoring Diabetic Nephropathy

             EOC020-0220     Rate <100 LDL-C Level

             EOC020-0230     Lower Confidence Interval <100 LDL-C Level

             EOC020-0240     Upper Confidence Interval <100 LDL-C Level

             EOC020-0250     Rate - Good HbA1c Control

             EOC020-0260     Lower Confidence Interval - Good HbA1c Control

             EOC020-0270     Upper Confidence Interval - Good HbA1c Control

             EOC020-0280     Rate - Blood Press Cont <130/80

             EOC020-0290     Lower Confidence Interval - Blood Press Cont <130/80

             EOC020-0300     Upper Confidence Interval - Blood Press Cont <130/80

             EOC020-0310     Rate - Blood Press Cont <140/90

             EOC020-0320     Lower Confidence Interval - Blood Press Cont <140/90

             EOC020-0330     Upper Confidence Interval - Blood Press Cont <140/90

EOC026 – Cholesterol Management for Patients with Cardiovascular Conditions

     DESCRIPTION - The percentage of members 18–75 years of age who, from January 1–November 1 of the year prior to the measurement year, were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA), or who had a diagnosis of ischemic vascular disease (IVD), who had each of the following during the measurement year.

     • LDL-C screening performed

     • LDL-C control (<100 mg/dL)

     (HEDIS 2007, Volume 2: Technical Specifications, Pg. 108)

     REPORTING LEVEL - Contract Market

             EOC026-0010     Rate - LDL-C Screening

             EOC026-0020     Lower Confidence Interval - LDL-C Screening

             EOC026-0030     Upper Confidence Interval - LDL-C Screening

             EOC026-0070     Rate <100 LDL-C Level

             EOC026-0080     Lower Confidence Interval <100 LDL-C Level

             EOC026-0090     Upper Confidence Interval <100 LDL-C Level


 

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

EOC030 – Antidepressant Medication Management

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

     • Optimal Practitioner Contacts for Medication Management. The percentage of members 18 years of age and older as of April 30 of the measurement year who were diagnosed with a new episode of depression and treated with antidepressant medication, and who had at least three follow-up contacts with a practitioner coded with a mental health diagnosis during the 84-day (12-week) Acute Treatment Phase. At least one of the three follow-up contacts must be with a prescribing practitioner.

     • Effective Acute Phase Treatment. The percentage of members 18 years of age and older as of April 30 of the measurement year who were diagnosed with a new episode of depression, were treated with antidepressant medication and remained on an antidepressant drug during the entire 84-day (12-week) Acute Treatment Phase.

     • Effective Continuation Phase Treatment. The percentage of members 18 years of age and older as of April 30 of the measurement year who were diagnosed with a new episode of depression and treated with anti-depressant medication and who remained on an antidepressant drug for at least 180 days.

     (HEDIS 2007, Volume 2: Technical Specifications, Pg. 135)

     REPORTING LEVEL - Contract Market

             EOC030-0010     Rate - Effect.Continuation Phase Treat.

             EOC030-0020     Lower Confidence Interval - Effect.Continuation Phase Treat.

             EOC030-0030     Upper Confidence Interval - Effect.Continuation Phase Treat.

             EOC030-0040     Rate - Effect.Acute Phase Treatment

             EOC030-0050     Lower Confidence Interval - Effect.Acute Phase Treatment

             EOC030-0060     Upper Confidence Interval - Effect.Acute Phase Treatment

             EOC030-0070     Rate - Optimal Practioner Contacts for Medication Mngmnt.

             EOC030-0080     Lower Confidence Interval - Contacts for Medication Mngmnt.

             EOC030-0090     Upper Confidence Interval - Contacts for Medication Mngmnt.

EOC035 – Controlling High Blood Pressure

     DESCRIPTION -The percentage of members 18–85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90) during the measurement year. Use the Hybrid Method for this measure.  (HEDIS 2007, Volume 2: Technical Specification, Pg. 96)

       REPORTING LEVEL - Contract Market

             EOC035-0040     Reported Rate 18-45

             EOC035-0050     Lower Confidence Interval 18-45

             EOC035-0060     Upper Confidence Interval 18-45

             EOC035-0070     Reported Rate 46-85

             EOC035-0080     Lower Confidence Interval 46-85

             EOC035-0090     Upper Confidence Interval 46-85

             EOC035-0100     Rate - Total

             EOC035-0110     Lower Confidence Interval tot

             EOC035-0120     Upper Confidence Interval tot

EOC040 – Colorectal Cancer Screening

     DESCRIPTION -The percentage of adults 50–80 years of age who had appropriate screening for colorectal cancer (CRC). The hybrid method is recommended to calculate this measure. (HEDIS 2007, Volume 2: Technical Specification, Pg. 81)

     REPORTING LEVEL - Contract Market

             EOC040-0010     Rate

             EOC040-0020     Lower Confidence Interval

             EOC040-0030     Upper Confidence Interval

EOC045 – Osteoporosis Management in Women Who Had a Fracture

     DESCRIPTION -The percentage of women 67 years of age and older who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat or prevent osteoporosis in the six months after date of the fracture.  (HEDIS 2007, Volume 2: Technical Specification, Pg. 93)

       REPORTING LEVEL - Contract Market

             EOC045-0010     Reported rate

             EOC045-0020     Lower Confidence Interval

             EOC045-0030     Upper Confidence Interval


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

EOC050 – Glaucoma Screening in Older Adults

     DESCRIPTION - The percentage of Medicare members 65 years and older without a prior diagnosis of glaucoma or glaucoma suspect who received a glaucoma eye exam by an eye-care professional for early identification of persons with glaucomatous conditions. An eye-care professional is an ophthalmologist or optometrist. (HEDIS 2007, Volume 2: Technical Specification, Pg. 146)

     REPORTING LEVEL - Contract Market

             EOC050-0010     Reported Rate

             EOC050-0020     Lower Confidence Interval

             EOC050-0030     Upper Confidence Interval

EOC055 – Persistence of Beta-Blocker Treatment After a Heart Attack

     DESCRIPTION - The percentage of members 35 years of age and older during the measurement year who were hospitalized and discharged alive from July 1 of the year prior to the measurement year to June 30 of the measurement year with a diagnosis of acute myocardial infarction (AMI) and who received persistent beta-blocker treatment for six months after discharge.

     Note: Although similar in clinical logic to the Beta-Blocker Treatment After a Heart Attack measure, this measure has multiple differences with regard to the eligible population criteria and data collection methodology. The measure is administrative-only, due to the need for pharmacy claims confirmation to validate persistence of therapy for 135 of 180 days. (HEDIS 2007, Volume 2: Technical Specification, Pg. 105)

     REPORTING LEVEL - Contract Market

             EOC055-0010     Reported rate

             EOC055-0020     Lower Confidence Interval

             EOC055-0030     Upper Confidence Interval

EOC060 – Management of Urinary Incontinence in Older Adults

     DESCRIPTION - The following components of this measure assess the management of urinary incontinence (UI) in older adults.

     Discussing Urinary Incontinence - The percentage of Medicare members 65 years of age and older who reported having a problem with urine leakage in the past six months and who discussed their urine leakage problem with their current practitioner.

     Receiving Urinary Incontinence Treatment - The percentage of Medicare members 65 years of age and older who reported having a urine leakage problem in the past six months and who received treatment for their current urine leakage problem.

     (HEDIS 2007, Volume 2: Technical Specification, Pg. 174)

     REPORTING LEVEL - Contract Market

             EOC060-0010     Discussing Urinary Incontinence Rate

             EOC060-0020     Receiving Urinary Incontinence Treatment Rate

EOC065 – Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis

     DESCRIPTION - This measure assesses whether patients diagnosed with rheumatoid arthritis have had at least one ambulatory prescription dispensed for a disease modifying anti-rheumatic drug (DMARD). (HEDIS 2007, Volume 2: Technical Specification, Pg. 151)

       REPORTING LEVEL - Contract Market

             EOC065-0010     Reported rate

             EOC065-0020     Lower Confidence Interval

             EOC065-0030     Upper Confidence Interval

EOC070 – Drugs to be Avoided in the Elderly

     DESCRIPTION - This measure summarizes:

     • The percentage of Medicare members 65 years of age who received at least one drug to be avoided in the elderly .

     • The percentage of Medicare members 65 years of age who received at least two different drugs to be avoided by the elderly.

     The first rate assesses the extent to which elderly members have had some exposure to potentially harmful drugs. The second rate further assesses if elderly members have been exposed to multiple harmful drugs—which puts the elderly at increased risk for patient safety and adverse drug events. For both rates, a lower rate represents better performance. 

     (HEDIS 2007, Volume 2: Technical Specification, Pg. 161)

     REPORTING LEVEL - Contract Market

             EOC070-0010     Rate - one prescription

             EOC070-0020     Lower Confidence Interval - one prescription

             EOC070-0030     Upper Confidence Interval - one prescription

             EOC070-0040     Rate - at least 2 prescriptions

             EOC070-0050     Lower Confidence Interval - at least 2 prescriptions

             EOC070-0060     Upper Confidence Interval - at least 2 prescriptions

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

EOC075 – Annual Monitoring for Patients on Persistent Medications

     DESCRIPTION - The percentage of members 18 years of age and older who received at least a 180-days supply of ambulatory medication therapy for the selected therapeutic agent during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year. For each product line, report each of the five rates separately and as a total rate.

     • Annual monitoring for members on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB)

     • Annual monitoring for members on digoxin

     • Annual monitoring for members on diuretics

     • Annual monitoring for members on anticonvulsants

     • Annual monitoring for members on statins

     • Total rate (the sum of the five numerators divided by the sum of the five denominators)

     Note: NCQA will provide a comprehensive list of NDC codes for drugs to identify members on persistent medications on its Web site at www.ncqa.org by November 15, 2006. (HEDIS 2007, Volume 2: Technical Specification, Pg. 154)

     REPORTING LEVEL - Contract Market

             EOC075-0010     Reported rate - ACE inhibitors or ARBs

             EOC075-0020     Lower Confidence Interval - ACE inhibitors or ARBs

             EOC075-0030     Upper Confidence Interval - ACE inhibitors or ARBs

             EOC075-0040     Reported rate - Digoxin

             EOC075-0050     Lower Confidence Interval - Digoxin

             EOC075-0060     Upper Confidence Interval - Digoxin

             EOC075-0070     Reported rate - Diuretics

             EOC075-0080     Lower Confidence Interval - Diuretics

             EOC075-0090     Upper Confidence Interval - Diuretics

             EOC075-0100     Reported rate - Anticonvulsants

             EOC075-0110     Lower Confidence Interval - Anticonvulsants

             EOC075-0120     Upper Confidence Interval - Anticonvulsants

             EOC075-0160     Reported rate - Total

             EOC075-0170     Lower Confidence Interval - Total

             EOC075-0180     Upper Confidence Interval - Total

EOC080 – Use of Spirometry Testing in the Assessment and Diagnosis of COPD

     DESCRIPTION - The percentage of members 40 years of age and older with a new diagnosis or newly active chronic obstructive pulmonary disease (COPD) who received appropriate spirometry testing to confirm the diagnosis (this measure identifies incident cases using a clean claim period). (HEDIS 2007, Volume 2: Technical Specification, Pg. 130)

     REPORTING LEVEL - Contract Market

             EOC080-0010     Reported rate

             EOC080-0020     Lower Confidence Interval

             EOC080-0030     Upper Confidence Interval

EOC085 – Physical Activity in Older Adults (HOS)

     DESCRIPTION - The following components of this measure assess different facets of promoting physical activity in older adults:

     Discussing Physical Activity - The percentage of Medicare members 65 years of age and older who had a doctor’s visit in the past 12 months and who spoke with a doctor or other health provider about their level of exercise or physical activity.

     Advising Physical Activity - The percentage of Medicare members 65 years of age and older who had a doctor’s visit in the past 12 months and who received advice to start, increase or maintain their level exercise or physical activity. (HEDIS 2007, Volume 2: Technical Specification, Pg. 175)

     REPORTING LEVEL - Contract Market

             EOC085-0010     Discussing Physical Activity Rate

             EOC085-0020     Advising Physical Activity Rate


 

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

EOC090 – Potentially Harmful Drug-Disease Interactions in the Elderly

     DESCRIPTION - The percentage of Medicare members 65 years of age and older who have evidence of an underlying disease, condition or health concern and who were dispensed an ambulatory prescription for a contraindicated medication, concurrent with or after the diagnosis. Report each of the three rates separately and as a total rate.

     • A history of falls and a prescription for tricyclic antidepressants, antipsychotics or sleep agents

     • Dementia and a prescription for tricyclic antidepressants or anticholinergic agents

     • Chronic renal failure and prescription for nonaspirin NSAIDs or Cox-2 Selective NSAIDs

     • Total rate (the sum of the three numerators divided by the sum of the three denominators)

     Members with more than one disease or condition can appear in the measure multiple times (i.e., in each indicator for which they qualify).

     Note: NCQA will provide a comprehensive list of NDC codes for drugs to identify members on persistent medications on its Web site at www.ncqa.org by November 15, 2006.  (HEDIS 2007, Volume 2: Technical Specification, Pg. 164)

       REPORTING LEVEL - Contract Market

             EOC090-0010     Rate - DDI Falls + Tricyclic Antidepress or Antipsych

             EOC090-0020     Lower Confidence Interval - DDI Falls + Tricyclic Antidepress or Antipsych

             EOC090-0030     Upper Confidence Interval - DDI Falls + Tricyclic Antidepress or Antipsych

             EOC090-0040     Rate - DDI Dementia + Tricyclic Antidepress or Anticholl

             EOC090-0050     Lower Confidence Interval - DDI Dementia + Tricyclic Antidepress or Anticholl

             EOC090-0060     Upper Confidence Interval - DDI Dementia + Tricyclic Antidepress or Anticholl

             EOC090-0070     Rate - DDI Chronic Renal Failure + Non Asp NSAIDs or Cox-2

             EOC090-0080     Lower Confidence Interval - DDI Chronic Renal Failure + Non Asp NSAIDs or Cox-2

             EOC090-0090     Upper Confidence Interval - DDI Chronic Renal Failure + Non Asp NSAIDs or Cox-2

             EOC090-0100     Rate - Total

             EOC090-0110     Lower Confidence Interval - Total

             EOC090-0120     Upper Confidence Interval - Total

EOC095 – Fall Risk Management

     DESCRIPTION - The following components of this measure assess different facets of fall risk management.

     Discussing Fall Risk - The percentage of Medicare members:

     • 75 years of age and older, or

     • 65–74 years of age with balance or walking problems or a fall in the past 12 months

     who were seen by an MCO practitioner in the past 12 months and who discussed falls or problems with balance or walking with their current practitioner.

     Managing Fall Risk - The percentage of Medicare members 65 years of age and older who had a fall or had problems with balance or walking in the past 12 months, who were seen by an MCO practitioner in the past 12 months and who received fall risk intervention from their current practitioner.

      (HEDIS 2007, Volume 2: Technical Specification, Pg. 177)

     REPORTING LEVEL - Contract Market

             EOC095-0010     Discussing Falls Risk Rate

             EOC095-0020     Discussing Falls Risk Rate

EOC100 – Osteoporosis Testing in Older Women

     DESCRIPTION - This measure assesses the number of Medicare women 65 years of age and older who report ever having received a bone density test to check for osteoporosis. (HEDIS 2007, Volume 2: Technical Specification, Pg. 177)

     REPORTING LEVEL - Contract Market

          EOC100-0010    Osteoporosis Testing Percent

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 Organization (Local CCP, 1876 Cost, etc.)

          General-0011     Type of Plan (Post Balanced Budget Amendment Naming)

          General-0014     Offers Special Needs Plans to beneficiaries (Yes or No)

          General-0015     Offers Part D benefits (Yes or No)

          General-0020     Line of Business (HMO, POS, etc.)

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

          General-0050     2005 Enrollment as Reported by the Medicare Advantage Prescription Drug (MARx) system

          General-0060     CMS Region Number

          General-0070     CMS Region Name

          General-0080     Patient Population

          General-0085     Submitted summary level HEDIS 2008 data to NCQA

          General-0087     Included in HOS data from NCQA

HPS403 – Years In Business/Total Membership

     DESCRIPTION - The number of years since licensure (the number of years that each product line has existed) and the number of members enrolled as of December 31 of the measurement year. (HEDIS 2007, Volume 2: Technical Specification, Pg. 219)

     REPORTING LEVEL - Contract Market

             HPS403-0010     Years in Bus. HMO-Tot

             HPS403-0020     Years in Bus. HMO-Medicaid

             HPS403-0030     Years in Bus. HMO-Commercial

             HPS403-0040     Years in Bus. HMO-Medicare Risk/Cost

             HPS403-0060     Years in Bus. HMO-Self-insured

             HPS403-0070     Years in Bus. HMO-Oth

             HPS403-0080     Years in Bus. PPO-Tot

             HPS403-0090     Years in Bus. PPO-Commercial

             HPS403-0100     Years in Bus. PPO-Medicare Risk/Cost

             HPS403-0120     Years in Bus. PPO-Self-insured

             HPS403-0130     Years in Bus. PPO-Oth

             HPS403-0140     Years in Bus. POS-Tot

             HPS403-0150     Years in Bus. POS-Commercial

             HPS403-0160     Years in Bus. POS-Medicare Risk/Cost

             HPS403-0180     Years in Bus. POS-Self-insured

             HPS403-0190     Years in Bus. POS-Oth

             HPS403-0210     Membership HMO-Tot

             HPS403-0220     Membership HMO-Medicaid

             HPS403-0230     Membership HMO-Commercial

             HPS403-0240     Membership HMO-Medicare Risk/Cost

             HPS403-0260     Membership HMO-Self-insured

             HPS403-0270     Membership HMO-Oth

             HPS403-0280     Membership PPO-Tot

             HPS403-0290     Membership PPO-Commercial

             HPS403-0300     Membership PPO-Medicare Risk/Cost

             HPS403-0320     Membership PPO-Self-insured

             HPS403-0330     Membership PPO-Oth

             HPS403-0340     Membership POS-Tot

             HPS403-0350     Membership POS-Commercial

             HPS403-0360     Membership POS-Medicare Risk/Cost

             HPS403-0380     Membership POS-Self-insured

             HPS403-0390     Membership POS-Oth

             HPS403-0400     Tot Membership Tot


 

PDI801 – Board Certification/Residency Completion

     DESCRIPTION - The percentage of the following physicians whose board certification is active as of December 31 of the measurement year.

     • Family medicine physicians

     • Internal medicine physicians

     • Pediatricians

     • OB/GYN physicians

     • Geriatricians

     • All other physician specialists and subspecialists

     Board certification refers to the various specialty certification programs of the American Board of Medical Specialties and the American Osteopathic Association. The MCO should report separately for each product as of December 31 of the measurement year. (HEDIS 2007, Volume 2: Technical Specification, Pg. 381)

       REPORTING LEVEL - Contract Market

             PDI801-0010       PCP Board Cert Pct

             PDI801-0030       Oth Specialists Board Cert Pct

             PDI801-0050       Geriatricians Board Cert Pct

PDI806 – Enrollment by Product Line

     DESCRIPTION - This measure reports the total number of members enrolled for each product line stratified by age and sex. Report Medicaid in number of member months contributed by enrollees during the measurement year and stratified by Medicaid eligibility category, age and sex. The MCO may report this information only if it is provided by the state Medicaid agency. Report commercial and Medicare in number of member years contributed by enrollees during the measurement year, stratified by product line, age and sex.  (HEDIS 2006, Volume 2: Technical Specification, Pg. 386)

     REPORTING LEVEL - Contract

             PDI806-0010       Enr by Product Line Tot M

             PDI806-0020       Enr by Product Line Tot F

             PDI806-0030       Enr by Product Line Tot Tot

PDI807 – Language Diversity of Membership

     DESCRIPTION - An unduplicated count and percentage of Medicaid and Medicare members enrolled at any time during the measurement year by demand for language interpreter services and spoken language. (HEDIS 2006, Volume 2: Technical Specification, Pg. 401)

     REPORTING LEVEL - Contract Market

             PDI807-0010       Demand for Interpretation Services Yes M Pct

             PDI807-0020       Demand for Interpretation Services Yes F Pct

             PDI807-0030       Demand for Interpretation Services Yes MF Tot Pct

             PDI807-0040       Demand for Interpretation Services No M Pct

             PDI807-0050       Demand for Interpretation Services No F Pct

             PDI807-0060       Demand for Interpretation Services No MF Tot Pct

             PDI807-0070       Demand for Interpretation Services Unknown M Pct

             PDI807-0080       Demand for Interpretation Services Unknown F Pct

             PDI807-0090       Demand for Interpretation Services Unknown MF Tot Pct

             PDI807-0100       Demand for Interpretation Services M Total Pct

             PDI807-0110       Demand for Interpretation Services F Total Pct

             PDI807-0120       Demand for Interpretation Services MF Total Tot Pct

             PDI807-0130       Percentage Members With Interpretation Needs

             PDI807-0140       Spoken Language at Home English M Pct

             PDI807-0150       Spoken Language at Home English F Pct

             PDI807-0160       Spoken Language at Home English MF Tot Pct

             PDI807-0170       Spoken Language at Home Spanish/Creole M Pct

             PDI807-0180       Spoken Language at Home Spanish/Creole F Pct

             PDI807-0190       Spoken Language at Home Spanish/Creole MF Tot Pct

             PDI807-0200       Spoken Language at Home Oth Indo-European M Pct

             PDI807-0210       Spoken Language at Home Oth Indo-European F Pct

             PDI807-0220       Spoken Language at Home Oth Indo-European MF Tot Pct

             PDI807-0230       Spoken Language at Home Asian & Pacific Island M Pct

             PDI807-0240       Spoken Language at Home Asian & Pacific Island F Pct

             PDI807-0250       Spoken Language at Home Asian & Pacific Island MF Tot Pct

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

             PDI807-0260       Spoken Language at Home Other M Pct

             PDI807-0270       Spoken Language at Home Other F Pct

             PDI807-0280       Spoken Language at Home Other MF Tot Pct

             PDI807-0290       Spoken Language at Home Unknown M Pct

             PDI807-0300       Spoken Language at Home Unknown F Pct

             PDI807-0310       Spoken Language at Home Unknown MF Tot Pct

             PDI807-0320       Spoken Language at Home Total M Pct

             PDI807-0330       Spoken Language at Home Total F Pct

             PDI807-0340       Spoken Language at Home Total MF Tot Pct

             PDI807-0350       Percentage Members with Known Spoken Language

PDI808 – Race/Ethnicity Diversity of Membership

     DESCRIPTION - An unduplicated count and percentage of members enrolled any time during the measurement year by race and ethnicity. (HEDIS 2007, Volume 2: Technical Specification, Pg. 398)

     REPORTING LEVEL - Contract Market

             PDI808-0010       White M Hispanic (any) Pct

             PDI808-0020       White F Hispanic (any) Pct

             PDI808-0030       White MF Hispanic (any) Tot Pct

             PDI808-0040       Black or African American M Hispanic (any) Pct

             PDI808-0050       Black or African American F Hispanic (any) Pct

             PDI808-0060       Black or African American MF Hispanic (any) Tot Pct

             PDI808-0070       American-Indian & Alaska Native M Hispanic (any) Pct

             PDI808-0080       American-Indian & Alaska Native F Hispanic (any) Pct

             PDI808-0090       American-Indian & Alaska Native MF Hispanic (any) Tot Pct

             PDI808-0100       Asian M Hispanic (any) Pct

             PDI808-0110       Asian F Hispanic (any) Pct

             PDI808-0120       Asian MF Hispanic (any) Tot Pct

             PDI808-0130       Native Hawaiian & Oth Pac Islanders M Hispanic (any) Pct

             PDI808-0140       Native Hawaiian & Oth Pac Islanders F Hispanic (any) Pct

             PDI808-0150       Native Hawaiian & Oth Pac Islanders MF Hispanic (any) Tot Pct

             PDI808-0160       Some Other Race M Hispanic (any) Pct

             PDI808-0170       Some Other Race F Hispanic (any) Pct

             PDI808-0180       Some Other Race MF Hispanic (any) Tot Pct

             PDI808-0190       Two or More Races M Hispanic (any) Pct

             PDI808-0200       Two or More Races F Hispanic (any) Pct

             PDI808-0210       Two or More Races MF Hispanic (any) Tot Pct

             PDI808-0220       Unknown M Hispanic (any) Pct

             PDI808-0230       Unknown F Hispanic (any) Pct

             PDI808-0240       Unknown MF Hispanic (any) Tot Pct

             PDI808-0250       Total M Hispanic (any) Pct

             PDI808-0260       Total F Hispanic (any) Pct

             PDI808-0270       Total MF Hispanic (any) Tot Pct

          PDI808-0280     White M Not Hispanic or Latino Pct

          PDI808-0290     White F Not Hispanic or Latino Pct

          PDI808-0300     White MF Not Hispanic or Latino Tot Pct

          PDI808-0310     Black or African American M Not Hispanic or Latino Pct

          PDI808-0320     Black or African American F Not Hispanic or Latino Pct

          PDI808-0330     Black or African American MF Not Hispanic or Latino Tot Pct

          PDI808-0340     American-Indian & Alaska Native M Not Hispanic or Latino Pct

          PDI808-0350     American-Indian & Alaska Native F Not Hispanic or Latino Pct

          PDI808-0360     American-Indian & Alaska Native MF Not Hispanic or Latino Tot Pct

          PDI808-0370     Asian M Not Hispanic or Latino Pct

          PDI808-0380     Asian F Not Hispanic or Latino Pct

          PDI808-0390     Asian MF Not Hispanic or Latino Tot Pct

          PDI808-0400     Native Hawaiian & Oth Pac Islanders M Not Hispanic or Latino Pct

          PDI808-0410     Native Hawaiian & Oth Pac Islanders F Not Hispanic or Latino Pct

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

          PDI808-0420     Native Hawaiian & Oth Pac Islanders MF Not Hispanic or Latino Tot Pct

          PDI808-0430     Some Other Race M Not Hispanic or Latino Pct

          PDI808-0440     Some Other Race F Not Hispanic or Latino Pct

          PDI808-0450     Some Other Race MF Not Hispanic or Latino Tot Pct

          PDI808-0460     Two or More Races M Not Hispanic or Latino Pct

          PDI808-0470     Two or More Races F Not Hispanic or Latino Pct

          PDI808-0480     Two or More Races MF Not Hispanic or Latino Tot Pct

          PDI808-0490     Unknown M Not Hispanic or Latino Pct

          PDI808-0500     Unknown F Not Hispanic or Latino Pct

          PDI808-0510     Unknown MF Not Hispanic or Latino Tot Pct

          PDI808-0520     Total M Not Hispanic or Latino Pct

          PDI808-0530     Total F Not Hispanic or Latino Pct

          PDI808-0540     Total MF Not Hispanic or Latino Tot Pct

          PDI808-0550     White M Unknown Ethnicity Pct

          PDI808-0560     White F Unknown Ethnicity Pct

          PDI808-0570     White MF Unknown Ethnicity Tot Pct

          PDI808-0580     Black or African American M Unknown Ethnicity Pct

          PDI808-0590     Black or African American F Unknown Ethnicity Pct

          PDI808-0600     Black or African American MF Unknown Ethnicity Tot Pct

          PDI808-0610     American-Indian & Alaska Native M Unknown Ethnicity Pct

          PDI808-0620     American-Indian & Alaska Native F Unknown Ethnicity Pct

          PDI808-0630     American-Indian & Alaska Native MF Unknown Ethnicity Tot Pct

          PDI808-0640     Asian M Unknown Ethnicity Pct

          PDI808-0650     Asian F Unknown Ethnicity Pct

          PDI808-0660     Asian MF Unknown Ethnicity Tot Pct

          PDI808-0670     Native Hawaiian & Oth Pac Islanders M Unknown Ethnicity Pct

          PDI808-0680     Native Hawaiian & Oth Pac Islanders F Unknown Ethnicity Pct

          PDI808-0690     Native Hawaiian & Oth Pac Islanders MF Unknown Ethnicity Tot Pct

          PDI808-0700     Some Other Race M Unknown Ethnicity Pct

          PDI808-0710     Some Other Race F Unknown Ethnicity Pct

          PDI808-0720     Some Other Race MF Unknown Ethnicity Tot Pct

          PDI808-0730     Two or More Races M Unknown Ethnicity Pct

          PDI808-0740     Two or More Races F Unknown Ethnicity Pct

          PDI808-0750     Two or More Races MF Unknown Ethnicity Tot Pct

          PDI808-0760     Unknown M Unknown Ethnicity Pct

          PDI808-0770     Unknown F Unknown Ethnicity Pct

          PDI808-0780     Unknown MF Unknown Ethnicity Tot Pct

          PDI808-0790     Total M Unknown Ethnicity Pct

          PDI808-0800     Total F Unknown Ethnicity Pct

             PDI808-0810       Total MF Unknown Ethnicity Tot Pct

             PDI808-0820       White M Total Pct

             PDI808-0830       White F Total Pct

             PDI808-0840       White MF Total Tot Pct

             PDI808-0850       Black or African American M Total Pct

             PDI808-0860       Black or African American F Total Pct

             PDI808-0870       Black or African American MF Total Tot Pct

             PDI808-0880       American-Indian & Alaska Native M Total Pct

             PDI808-0890       American-Indian & Alaska Native F Total Pct

             PDI808-0900       American-Indian & Alaska Native MF Total Tot Pct

             PDI808-0910       Asian M Total Pct

             PDI808-0920       Asian F Total Pct

             PDI808-0930       Asian MF Total Tot Pct

             PDI808-0940       Native Hawaiian & Oth Pac Islanders M Total Pct

             PDI808-0950       Native Hawaiian & Oth Pac Islanders F Total Pct

             PDI808-0960       Native Hawaiian & Oth Pac Islanders MF Total Tot Pct

             PDI808-0970       Some Other Race M Total Pct

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

             PDI808-0980       Some Other Race F Total Pct

             PDI808-0990       Some Other Race MF Total Tot Pct

             PDI808-1000       Two or More Races M Total Pct

             PDI808-1010       Two or More Races F Total Pct

             PDI808-1020       Two or More Races MF Total Tot Pct

             PDI808-1030       Unknown M Total Pct

             PDI808-1040       Unknown F Total Pct

             PDI808-1050       Unknown MF Total Tot Pct

             PDI808-1060       Race EthnicityM Total Pct

             PDI808-1070       Race Ethnicity F Total Pct

             PDI808-1080       Race Ethnicity MF Total Tot Pct

             PDI808-1090       Percentage Known Ethnicity

PDI809 – Enrollment by State

     DESCRIPTION - The number of members enrolled as of December 31 of the measurement year, by state. (HEDIS 2007, Volume 2: Technical Specification, Pg. 398)

     REPORTING LEVEL - Contract Market

          PDI809-0010     Alabama

          PDI809-0020     Alaska

          PDI809-0030     Arizona

          PDI809-0040     Arkansas

          PDI809-0050     California

          PDI809-0060     Colorado

          PDI809-0070     Connecticut

          PDI809-0080     Delaware

          PDI809-0090     District of Columbia

          PDI809-0100     Florida

          PDI809-0110     Georgia

          PDI809-0120     Hawaii

          PDI809-0130     Idaho

          PDI809-0140     Illinois

          PDI809-0150     Indiana

          PDI809-0160     Iowa

          PDI809-0170     Kansas

          PDI809-0180     Kentucky

          PDI809-0190     Louisiana

          PDI809-0200     Maine

          PDI809-0210     Maryland

          PDI809-0220     Massachusetts

          PDI809-0230     Michigan

          PDI809-0240     Minnesota

          PDI809-0250     Mississippi

          PDI809-0260     Missouri

          PDI809-0270     Montana

          PDI809-0280     Nebraska

          PDI809-0290     Nevada

          PDI809-0300     New Hampshire

          PDI809-0310     New Jersey

          PDI809-0320     New Mexico

          PDI809-0330     New York

          PDI809-0340     North Carolina

          PDI809-0350     North Dakota

          PDI809-0360     Ohio

          PDI809-0370     Oklahoma

          PDI809-0380     Oregon

          PDI809-0390     Pennsylvania

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

          PDI809-0400     Rhode Island

          PDI809-0410     South Carolina

          PDI809-0420     South Dakota

          PDI809-0430     Tennessee

          PDI809-0440     Texas

          PDI809-0450     Utah

          PDI809-0460     Vermont

          PDI809-0470     Virginia

          PDI809-0480     Washington

          PDI809-0490     West Virginia

          PDI809-0500     Wisconsin

          PDI809-0510     Wyoming

          PDI809-0520     American Samoa

          PDI809-0530     Federated States of Micronesia

          PDI809-0540     Guam

          PDI809-0550     Commonwealth of Northern Marianas

          PDI809-0560     Puerto Rico

          PDI809-0570     Virgin Islands

          PDI809-0580     Other

          PDI809-0590     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)

UOS505 – Frequency of Selected Procedures

     DESCRIPTION - This measure summarizes the number and rate of several frequently performed procedures that often show wide regional variation and have generated concern regarding potentially inappropriate utilization. For Medicaid members, the MCO reports the absolute number of procedures and the number of procedures per 1,000 member months. For commercial and Medicare members, the MCO reports the absolute number of procedures and the number of procedures per 1,000 member years. (HEDIS 2006, Volume 2: Technical Specification, Pg. 243)

     REPORTING LEVEL - Contract Market

          UOS05-0890      Mastectomy F <65 Procs/1000

          UOS05-0900      Mastectomy F 65-74 Procs/1000

          UOS05-0910      Mastectomy F 75-84 Procs/1000

          UOS05-0920      Mastectomy F 85+ Procs/1000

          UOS05-0930      Lumpectomy F <65 Procs/1000

          UOS05-0940      Lumpectomy F 65-74 Procs/1000

          UOS05-0950      Lumpectomy F 75-84 Procs/1000

          UOS05-0960      Lumpectomy F 85+ Procs/1000

          UOS505-0010    CABG M <65 Procs/1000

          UOS505-0020    CABG M 65-74 Procs/1000

          UOS505-0030    CABG M 75-84 Procs/1000

          UOS505-0040    CABG M 85+ Procs/1000

          UOS505-0050    Angioplasty (PTCA) M <65 Procs/1000

          UOS505-0060    Angioplasty (PTCA)M 65-74 Procs/1000

          UOS505-0070    Angioplasty (PTCA) M 75-84 Procs/1000

          UOS505-0080    Angioplasty (PTCA) M 85+ Procs/1000

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

          UOS505-0090    Carotid Endarterectomy M <65 Procs/1000

          UOS505-0100    Carotid Endarterectomy M 65-74 Procs/1000

          UOS505-0110    Carotid Endarterectomy M 75-84 Procs/1000

          UOS505-0120    Carotid Endarterectomy M 85+ Procs/1000

          UOS505-0130    Reduction of Fracture Femur M <65 Procs/1000

          UOS505-0140    Reduction of Fracture Femur M 65-74 Procs/1000

          UOS505-0150    Reduction of Fracture Femur M 75-84 Procs/1000

          UOS505-0160    Reduction of Fracture Femur M 85+ Procs/1000

          UOS505-0170    Total Hip Replacement M <65 Procs/1000

          UOS505-0180    Total Hip Replacement M 65-74 Procs/1000

          UOS505-0190    Total Hip Replacement M 75-84 Procs/1000

          UOS505-0200    Total Hip Replacement M 85+ Procs/1000

          UOS505-0210    Total Knee Replacement M <65 Procs/1000

          UOS505-0220    Total Knee Replacement M 65-74 Procs/1000

          UOS505-0230    Total Knee Replacement M 75-84 Procs/1000

          UOS505-0240    Total Knee Replacement M 85+ Procs/1000

          UOS505-0250    Partial Excision of Large Intestine M <65 Procs/1000

          UOS505-0260    Partial Excision of Large Intestine M 65-74 Procs/1000

          UOS505-0270    Partial Excision of Large Intestine M 75-84 Procs/1000

          UOS505-0280    Partial Excision of Large Intestine M 85+ Procs/1000

          UOS505-0290    Cholecystectomy opn M <65 Procs/1000

          UOS505-0300    Cholecystectomy opn M 65-74 Procs/1000

          UOS505-0310    Cholecystectomy opn M 75-84 Procs/1000

          UOS505-0320    Cholecystectomy opn M 85+ Procs/1000

          UOS505-0330    Cholecystectomy cld (laparoscopic) M <65 Procs/1000

          UOS505-0340    Cholecystectomy cld (laparoscopic) M 65-74 Procs/1000

          UOS505-0350    Cholecystectomy cld (laparoscopic) M 75-84 Procs/1000

          UOS505-0360    Cholecystectomy cld (laparoscopic) M 85+ Procs/1000

          UOS505-0370    Prostatectomy <65 Procs/1000

          UOS505-0380    Prostatectomy 65-74 Procs/1000

          UOS505-0390    Prostatectomy 75-84 Procs/1000

          UOS505-0400    Prostatectomy 85+ Procs/1000

          UOS505-0410    CABG F <65 Procs/1000

          UOS505-0420    CABG F 65-74 Procs/1000

          UOS505-0430    CABG F 75-84 Procs/1000

          UOS505-0440    CABG F 85+ Procs/1000

          UOS505-0450    Angioplasty (PTCA)F <65 Procs/1000

          UOS505-0460    Angioplasty (PTCA)F 65-74 Procs/1000

          UOS505-0470    Angioplasty (PTCA) F 75-84 Procs/1000

          UOS505-0480    Angioplasty (PTCA) F 85+ Procs/1000

          UOS505-0490    Carotid Endarterectomy F <65 Procs/1000

          UOS505-0500    Carotid Endarterectomy F 65-74 Procs/1000

          UOS505-0510    Carotid Endarterectomy F 75-84 Procs/1000

          UOS505-0520    Carotid Endarterectomy F 85+ Procs/1000

          UOS505-0530    Reduction of Fracture Femur F <65 Procs/1000

          UOS505-0540    Reduction of Fracture Femur F 65-74 Procs/1000

          UOS505-0550    Reduction of Fracture Femur F 75-84 Procs/1000

          UOS505-0560    Reduction of Fracture Femur F 85+ Procs/1000

          UOS505-0570    Total Hip Replacement F <65 Procs/1000

          UOS505-0580    Total Hip Replacement F 65-74 Procs/1000

          UOS505-0590    Total Hip Replacement F 75-84 Procs/1000

          UOS505-0600    Total Hip Replacement F 85+ Procs/1000

          UOS505-0610    Total Knee Replacement F <65 Procs/1000

             UOS505-0620     Total Knee Replacement F 65-74 Procs/1000

             UOS505-0630     Total Knee Replacement F 75-84 Procs/1000

             UOS505-0640     Total Knee Replacement F 85+ Procs/1000

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

             UOS505-0650     Partial Excision of Large Intestine F <65 Procs/1000

             UOS505-0660     Partial Excision of Large Intestine F 65-74 Procs/1000

             UOS505-0670     Partial Excision of Large Intestine F 75-84 Procs/1000

             UOS505-0680     Partial Excision of Large Intestine F 85+ Procs/1000

             UOS505-0690     Cholecystectomy opn F <65 Procs/1000

             UOS505-0700     Cholecystectomy opn F 65-74 Procs/1000

             UOS505-0710     Cholecystectomy opn F 75-84 Procs/1000

             UOS505-0720     Cholecystectomy opn F 85+ Procs/1000

             UOS505-0730     Cholecystectomy cld (laparoscopic) F <65 Procs/1000

             UOS505-0740     Cholecystectomy cld (laparoscopic) F 65-74 Procs/1000

             UOS505-0750     Cholecystectomy cld (laparoscopic) F 75-84 Procs/1000

             UOS505-0760     Cholecystectomy cld (laparoscopic) F 85+ Procs/1000

             UOS505-0771     Hysterectomy - Abdominal <65 Procs/1000

             UOS505-0772     Hysterectomy - Vaginal <65 Procs/1000

             UOS505-0781     Hysterectomy - Abdominal 65-74 Procs/1000

             UOS505-0782     Hysterectomy - Vaginal 65-74 Procs/1000

             UOS505-0791     Hysterectomy - Abdominal 75-84 Procs/1000

             UOS505-0792     Hysterectomy - Vaginal 75-84 Procs/1000

             UOS505-0801     Hysterectomy - Abdominal 85+ Procs/1000

             UOS505-0802     Hysterectomy - Vaginal 85+ Procs/1000

             UOS505-0810     Cardiac Catheterization M <65 Procs/1000

             UOS505-0820     Cardiac Catheterization F <65 Procs/1000

             UOS505-0830     Cardiac Catheterization M 65-74 Procs/1000

             UOS505-0840     Cardiac Catheterization F 65-74 Procs/1000

             UOS505-0850     Cardiac Catheterization M 75-84 Procs/1000

             UOS505-0860     Cardiac Catheterization F 75-84 Procs/1000

             UOS505-0870     Cardiac Catheterization M 85+ Procs/1000

             UOS505-0880     Cardiac Catheterization F 85+ Procs/1000

             UOS505-0970     Back Surgery M <65 Procs/1000

             UOS505-0980     Back Surgery F <65 Procs/1000

             UOS505-0990     Back Surgery M 65-74 Procs/1000

             UOS505-1000     Back Surgery F 65-74 Procs/1000

             UOS505-1010     Back Surgery M 75-84 Procs/1000

             UOS505-1020     Back Surgery F 75-84 Procs/1000

             UOS505-1030     Back Surgery M 85+ Procs/1000

             UOS505-1040     Back Surgery F 85+ Procs/1000

UOS506 – Inpatient Utilization-General Hospital/Acute Care

     DESCRIPTION - This measure summarizes utilization of acute inpatient services in the following categories.

     • Total services

     • Medicine

     • Surgery

     • Maternity

     Nonacute care, mental health and chemical dependency services and newborn care are excluded. Medical and surgical services are reported separately because the factors influencing utilization in these two categories vary. This method facilitates comparison between ambulatory surgery utilization (refer to the Ambulatory Care measure) and inpatient surgery utilization. (HEDIS 2007, Volume 2: Technical Specification, Pg. 254)

     REPORTING LEVEL - Contract Market

          UOS506-0010    Tot IP Ds/1000 <1

          UOS506-0020    Tot IP Days/1000 <1

          UOS506-0030    Tot IP ALOS <1

          UOS506-0040    Tot IP Ds/1000 1-9

          UOS506-0050    Tot IP Days/1000 MM 1-9

          UOS506-0060    Tot IP ALOS 1-9

          UOS506-0070    Tot IP Ds/1000 MM 10-19

          UOS506-0080    Tot IP Days/1000 MM 10-19

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

          UOS506-0090    Tot IP ALOS 10-19

          UOS506-0100    Tot IP 20-44 Ds/1000

          UOS506-0110    Tot IP Days/1000 MM 20-44

          UOS506-0120    Tot IP ALOS 20-44

          UOS506-0130    Tot IP Ds/1000 MM 45-64

          UOS506-0140    Tot IP Days/1000 MM 45-64

          UOS506-0150    Tot IP ALOS 45-64

          UOS506-0160    Tot IP Ds/1000 MM 65-74

          UOS506-0170    Tot IP Days/1000 MM 65-74

          UOS506-0180    Tot IP ALOS 65-74

          UOS506-0190    Tot IP Ds/1000 MM 75-84

          UOS506-0200    Tot IP Days/1000 MM 75-84

          UOS506-0210    Tot IP ALOS 75-84

          UOS506-0220    Tot IP Ds/1000 MM 85+

          UOS506-0230    Tot IP Days/1000 MM 85+

          UOS506-0240    Tot IP ALOS 85+

          UOS506-0270    Tot IP Unk ALOS

          UOS506-0280    Tot IP Tot Ds/1000 MM

          UOS506-0290    Tot IP Tot Days/1000 MM

          UOS506-0300    Tot IP Tot ALOS

          UOS506-0310    Medicine <1 Ds/1000

          UOS506-0320    Medicine <1 Days/1000 MM

          UOS506-0330    Medicine <1 ALOS

          UOS506-0340    Medicine 1-9 Ds/1000 MM

          UOS506-0350    Medicine 1-9 Days/1000 MM

          UOS506-0360    Medicine 1-9 ALOS

          UOS506-0370    Medicine 10-19 Ds/1000 MM

          UOS506-0380    Medicine 10-19 Days/1000 MM

          UOS506-0390    Medicine 10-19 ALOS

          UOS506-0400    Medicine 20-44 Ds/1000

          UOS506-0410    Medicine 20-44 Days/1000 MM

          UOS506-0420    Medicine 20-44 ALOS

          UOS506-0430    Medicine 45-64 Days/1000 MM

          UOS506-0440    Medicine 45-64 Ds/1000

          UOS506-0450    Medicine 45-64 Days

          UOS506-0460    Medicine 65-74 Ds/1000

          UOS506-0470    Medicine 65-74 Days/1000 MM

          UOS506-0480    Medicine 65-74 ALOS

          UOS506-0490    Medicine 75-84 Ds/1000

          UOS506-0500    Medicine 75-84 Days/1000 MM

          UOS506-0510    Medicine 75-84 ALOS

          UOS506-0520    Medicine 85+ Ds/1000

          UOS506-0530    Medicine 85+ Days/1000 MM

          UOS506-0540    Medicine 85+ ALOS

          UOS506-0570    Medicine Unk ALOS

          UOS506-0580    Medicine Tot Ds/1000

          UOS506-0590    Medicine Tot Days/1000 MM

          UOS506-0600    Medicine Tot ALOS

          UOS506-0610    Surgery <1 Ds/1000

          UOS506-0620    Surgery <1 Days/1000 MM

          UOS506-0630    Surgery <1 ALOS

          UOS506-0640    Surgery 1-9 Ds/1000 MM

          UOS506-0650    Surgery 1-9 Days/1000 MM

          UOS506-0660    Surgery 1-9 ALOS

          UOS506-0670    Surgery 10-19 Ds/1000 MM

          UOS506-0680    Surgery 10-19 Days/1000 MM

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

             UOS506-0690     Surgery 10-19 ALOS

             UOS506-0700     Surgery 20-44 Ds/1000

             UOS506-0710     Surgery 20-44 Days/1000 MM

             UOS506-0720     Surgery 20-44 ALOS

             UOS506-0730     Surgery 45-64 Ds/1000

             UOS506-0740     Surgery 45-64 Days/1000 MM

             UOS506-0750     Surgery 45-64 ALOS

             UOS506-0760     Surgery 65-74 Ds/1000

             UOS506-0770     Surgery 65-74 Days/1000 MM

             UOS506-0780     Surgery 65-74 ALOS

             UOS506-0790     Surgery 75-84 Ds/1000

             UOS506-0800     Surgery 75-84 Days/1000 MM

             UOS506-0810     Surgery 75-84 ALOS

             UOS506-0820     Surgery 85+ Ds/1000

             UOS506-0830     Surgery 85+ Days/1000 MM

             UOS506-0840     Surgery 85+ ALOS

             UOS506-0870     Surgery Unk ALOS

             UOS506-0880     Surgery Tot Ds/1000

             UOS506-0890     Surgery Tot Days/1000 MM

             UOS506-0900     Surgery Tot ALOS

             UOS506-0910     Maternity 10-19 Ds/1000 MM

             UOS506-0920     Maternity 10-19 Days/1000 MM

             UOS506-0930     Maternity 10-19 ALOS

             UOS506-0940     Maternity 20-44 Ds/1000

             UOS506-0950     Maternity 20-44 Days/1000 MM

             UOS506-0960     Maternity 20-44 ALOS

             UOS506-0970     Maternity 45-64 Ds/1000

             UOS506-0980     Maternity 45-64 Days/1000 MM

             UOS506-0990     Maternity 45-64 ALOS

             UOS506-1020     Maternity Unk ALOS

             UOS506-1030     Maternity Tot Ds/1000

             UOS506-1040     Maternity Tot Days/1000 MM

             UOS506-1050     Maternity Tot ALOS

UOS507 – Ambulatory Care

     DESCRIPTION - This measure summarizes utilization of ambulatory services in the following categories.

     • Outpatient visits

     • Emergency department (ED) visits

     • Ambulatory surgery/procedures performed in hospital, outpatient facilities or freestanding surgical centers

     • 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 2007, Volume 2: Technical Specification, Pg. 261)

     REPORTING LEVEL - Contract Market

             UOS507-0010     AMB Tot OP <1 Visit/1000

             UOS507-0020     AMB Tot ER <1 Visit/1000

             UOS507-0030     AMB Tot Amb <1 Surg/Procs Procs/1000

             UOS507-0040     AMB Tot Observ Rm <1 Ds Stays/1000

             UOS507-0050     AMB Tot OP 1-9 Visit/1000

             UOS507-0060     AMB Tot ER 1-9 Visit/1000

             UOS507-0070     AMB Tot Amb 1-9 Surg/Procs Procs/1000

             UOS507-0080     AMB Tot Observ Rm 1-9 Ds Stays/1000

             UOS507-0090     AMB Tot OP 10-19 Visit/1000

             UOS507-0100     AMB Tot ER 10-19 Visit/1000

             UOS507-0110     AMB Tot Amb 10-19 Surg/Procs Procs/1000

             UOS507-0120     AMB Tot Observ Rm 10-19 Ds Stays/1000

             UOS507-0130     AMB Tot OP 20-44 Visit/1000

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

             UOS507-0140     AMB Tot ER 20-44 Visit/1000

             UOS507-0150     AMB Tot Amb 20-44 Surg/Procs Procs/1000

             UOS507-0160     AMB Tot Observ Rm 20-44 Ds Stays/1000

             UOS507-0170     AMB Tot OP 45-64 Visit/1000

             UOS507-0180     AMB Tot ER 45-64 Visit/1000

             UOS507-0190     AMB Tot Amb 45-64 Surg/Procs Procs/1000

             UOS507-0200     AMB Tot Observ Rm 45-64 Ds Stays/1000

             UOS507-0210     AMB Tot OP 65-74 Visit/1000

             UOS507-0220     AMB Tot ER 65-74 Visit/1000

             UOS507-0230     AMB Tot Amb 65-74 Surg/Procs Procs/1000

             UOS507-0240     AMB Tot Observ Rm 65-74 Ds Stays/1000

             UOS507-0250     AMB Tot OP 75-84 Visit/1000

             UOS507-0260     AMB Tot ER 75-84 Visit/1000

             UOS507-0270     AMB Tot Amb 75-84 Surg/Procs Procs/1000

             UOS507-0280     AMB Tot Observ Rm 75-84 Ds Stays/1000

             UOS507-0290     AMB Tot OP 85+ Visit/1000

             UOS507-0300     AMB Tot ER 85+ Visit/1000

             UOS507-0310     AMB Tot Amb 85+ Surg/Procs Procs/1000

             UOS507-0320     AMB Tot Observ Rm 85+ Ds Stays/1000

             UOS507-0370     AMB Tot OP Tot Visit/1000

             UOS507-0380     AMB Tot ER Tot Visit/1000

             UOS507-0390     AMB Tot Amb Tot Surg/Procs Procs/1000

             UOS507-0400     AMB Tot Observ Rm Tot Ds Stays/1000

UOS508 – Inpatient Utilization-NonAcute Care

     DESCRIPTION - This measure summarizes utilization of inpatient mental health services, stratified by age and sex. (HEDIS 2007, Volume 2: Technical Specification, Pg. 278)

       REPORTING LEVEL - Contract Market

             UOS508-0010     Inpat Nonacute <1 Ds/1000

             UOS508-0020     Inpat Nonacute <1 Days/1000

             UOS508-0030     Inpat Nonacute <1 ALOS

             UOS508-0040     Inpat Nonacute 1-9 Ds/1000

             UOS508-0050     Inpat Nonacute 1-9 Days/1000

             UOS508-0060     Inpat Nonacute 1-9 ALOS

             UOS508-0070     Inpat Nonacute 10-19 Ds/1000

             UOS508-0080     Inpat Nonacute 10-19 Days/1000

             UOS508-0090     Inpat Nonacute 10-19 ALOS

             UOS508-0100     Inpat Nonacute 20-44 Ds/1000

             UOS508-0110     Inpat Nonacute 20-44 Days/1000

             UOS508-0120     Inpat Nonacute 20-44 ALOS

             UOS508-0130     Inpat Nonacute 45-64 Ds/1000

             UOS508-0140     Inpat Nonacute 45-64 Days/1000

             UOS508-0150     Inpat Nonacute 45-64 ALOS

             UOS508-0160     Inpat Nonacute 65-74 Ds/1000

             UOS508-0170     Inpat Nonacute 65-74 Days/1000

             UOS508-0180     Inpat Nonacute 65-74 ALOS

             UOS508-0190     Inpat Nonacute 75-84 Ds/1000

             UOS508-0200     Inpat Nonacute 75-84 Days/1000

             UOS508-0210     Inpat Nonacute 75-84 ALOS

             UOS508-0220     Inpat Nonacute 85+ Ds/1000

             UOS508-0230     Inpat Nonacute 85+ Days/1000

             UOS508-0240     Inpat Nonacute 85+ ALOS

             UOS508-0270     Inpat Nonacute Unk ALOS

             UOS508-0280     Inpat Nonacute Tot Ds/1000

             UOS508-0290     Inpat Nonacute Tot Days/1000

             UOS508-0300     Inpat Nonacute Tot ALOS

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

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 2006, Volume 2: Technical Specification, Pg. 286)

     REPORTING LEVEL - Contract Market

             UOS512-0010     MH Inpat 0-12 M Ds/1000

             UOS512-0020     MH Inpat 0-12 M ALOS

             UOS512-0030     MH Inpat 13-17 M Ds/1000

             UOS512-0040     MH Inpat 13-17 M ALOS

             UOS512-0050     MH Inpat 18-64 M Ds/1000

             UOS512-0060     MH Inpat 18-64 M ALOS

             UOS512-0070     MH Inpat 65+ M Ds/1000

             UOS512-0080     MH Inpat 65+ M ALOS

             UOS512-0100     MH Inpat Unk M ALOS

             UOS512-0110     MH Inpat Tot M Ds/1000

             UOS512-0120     MH Inpat Tot M ALOS

             UOS512-0130     MH Inpat 0-12 F Ds/1000

             UOS512-0140     MH Inpat 0-12 F ALOS

             UOS512-0150     MH Inpat 13-17 F Ds/1000

             UOS512-0160     MH Inpat 13-17 F ALOS

             UOS512-0170     MH Inpat 18-64 F Ds/1000

             UOS512-0180     MH Inpat 18-64 F ALOS

             UOS512-0190     MH Inpat 65+ F Ds/1000

             UOS512-0200     MH Inpat 65+ F ALOS

             UOS512-0220     MH Inpat Unk F ALOS

             UOS512-0230     MH Inpat Tot F Ds/1000

             UOS512-0240     MH Inpat Tot F ALOS

             UOS512-0250     MH Inpat 0-12 Tot Ds/1000

             UOS512-0260     MH Inpat 0-12 Tot ALOS

             UOS512-0270     MH Inpat 13-17 Tot Ds/1000

             UOS512-0280     MH Inpat 13-17 Tot ALOS

             UOS512-0290     MH Inpat 18-64 Tot Ds/1000

             UOS512-0300     MH Inpat 18-64 Tot ALOS

             UOS512-0310     MH Inpat 65+ Tot Ds/1000

             UOS512-0320     MH Inpat 65+ Tot ALOS

             UOS512-0340     MH Inpat Unk Tot ALOS

             UOS512-0350     MH Inpat Tot Ds/1000

             UOS512-0360     MH Inpat Tot ALOS

UOS513 – Mental Health Utilization-% of Members Receiving Inpatient, Day/Night, and Ambulatory Services

     DESCRIPTION - This measure gives an overview of the extent to which different levels of mental health services are utilized. It summarizes the number and percentage of members receiving the following during the measurement year.

     • Any mental health services (includes inpatient, intermediate or ambulatory)

     • Inpatient mental health services

     • Intermediate mental health services

     • Ambulatory mental health services

     Report in each category the number of members who received the respective service. For enrollees with a mental health benefit, report the percentage who received the respective service by age and sex. (HEDIS 2007, Volume 2: Technical Specification, Pg. 281)

     REPORTING LEVEL - Contract Market

             UOS513-0010     MH Svs Any 0-12 M Pct

             UOS513-0020     MH Svs Inpat 0-12 M Pct

             UOS513-0030     MH Svs Day/Night 0-12 M Pct

             UOS513-0040     MH Svs Amb 0-12 M Pct

             UOS513-0050     MH Svs Any 13-17 M Pct

             UOS513-0060     MH Svs Inpat13-17 M Pct

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

          UOS513-0070    MH Svs Day/Night 13-17 M Pct

          UOS513-0080    MH Svs Amb 13-17 M Pct

          UOS513-0090    MH Svs Any 18-64 M Pct

          UOS513-0100    MH Svs Inpat 18-64 M Pct

          UOS513-0110    MH Svs Day/Night 18-64 M Pct

          UOS513-0120    MH Svs Amb 18-64 M Pct

          UOS513-0130    MH Svs Any 65+ M Pct

          UOS513-0140    MH Svs Inpat 65+ M Pct

          UOS513-0150    MH Svs Day/Night 65+ M Pct

          UOS513-0160    MH Svs Amb 65+ M Pct

          UOS513-0170    MH Svs Any Unk M Pct

          UOS513-0180    MH Svs Inpat Unk M Pct

          UOS513-0190    MH Svs Day/Night Unk M Pct

          UOS513-0200    MH Svs Amb Unk M Pct

          UOS513-0210    MH Svs Any Tot M Pct

          UOS513-0220    MH Svs Inpat Tot M Pct

          UOS513-0230    MH Svs Day/Night Tot M Pct

          UOS513-0240    MH Svs Amb Tot M Pct

          UOS513-0250    MH Svs Any 0-12 F Pct

          UOS513-0260    MH Svs Inpat 0-12 F Pct

          UOS513-0270    MH Svs Day/Night 0-12 F Pct

          UOS513-0280    MH Svs Amb 0-12 F Pct

          UOS513-0290    MH Svs Any 13-17 F Pct

          UOS513-0300    MH Svs Inpat 13-17 F Pct

          UOS513-0310    MH Svs Day/Night 13-17 F Pct

          UOS513-0320    MH Svs Amb 13-17 F Pct

          UOS513-0330    MH Svs Any 18-64 F Pct

          UOS513-0340    MH Svs Inpat 18-64 F Pct

          UOS513-0350    MH Svs Day/Night 18-64 F Pct

          UOS513-0360    MH Svs Amb 18-64 F Pct

          UOS513-0370    MH Svs Any 65+ F Pct

          UOS513-0380    MH Svs Inpat 65+ F Pct

          UOS513-0390    MH Svs Day/Night 65+ F Pct

          UOS513-0400    MH Svs Amb 65+ F Pct

          UOS513-0410    MH Svs Any Unk F Pct

          UOS513-0420    MH Svs Inpat Unk F Pct

          UOS513-0430    MH Svs Day/Night Unk F Pct

          UOS513-0440    MH Svs Amb Unk F Pct

          UOS513-0450    MH Svs Any Tot F Pct

          UOS513-0460    MH Svs Inpat Tot Num

          UOS513-0470    MH Svs Day/Night Tot F Pct

          UOS513-0480    MH Svs Amb Tot F Pct

          UOS513-0490    MH Svs Any 0-12 Tot Pct

          UOS513-0500    MH Svs Inpat 0-12 Tot Pct

          UOS513-0510    MH Svs Day/Night 0-12 Tot Pct

          UOS513-0520    MH Svs Amb 0-12 Tot Pct

          UOS513-0530    MH Svs Any 13-17 Tot Pct

          UOS513-0540    MH Svs Inpat 13-17 Tot Pct

          UOS513-0550    MH Svs Day/Night 13-17 Tot Pct

          UOS513-0560    MH Svs Amb 13-17 Tot Pct

          UOS513-0570    MH Svs Any 18-64 Tot Pct

          UOS513-0580    MH Svs Inpat 18-64 Tot Pct

          UOS513-0590    MH Svs Day/Night 18-64 Tot Pct

          UOS513-0600    MH Svs Amb 18-64 Tot Pct

          UOS513-0610    MH Svs Any 65+ Tot Pct

          UOS513-0620    MH Svs Inpat 65+ Tot Pct

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

          UOS513-0630    MH Svs Day/Night 65+ Tot Pct

          UOS513-0640    MH Svs Amb 65+ Tot Pct

          UOS513-0650    MH Svs Any Unk Tot Pct

          UOS513-0660    MH Svs Inpat Unk Tot Pct

          UOS513-0670    MH Svs Day/Night Unk Tot Pct

          UOS513-0680    MH Svs Amb Unk Tot Pct

          UOS513-0690    MH Svs Any Tot Pct

          UOS513-0700    MH Svs Inpat Tot Pct

          UOS513-0710    MH Svs Day/Night Tot Pct

          UOS513-0720    MH Svs Amb Tot Pct

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 2007, Volume 2: Technical Specification, Pg. 285)

     REPORTING LEVEL - Contract Market

             UOS515-0010     CD IP 0-12 M Ds/1000

             UOS515-0020     CD IP 0-12 M ALOS

             UOS515-0030     CD IP 13-17 M Ds/1000

             UOS515-0040     CD IP 13-17 M ALOS

             UOS515-0050     CD IP 18-64 M Ds/1000

             UOS515-0060     CD IP 18-64 M ALOS

             UOS515-0070     CD IP 65+ M Ds/1000

             UOS515-0080     CD IP 65+ M ALOS

             UOS515-0100     CD IP Unk M ALOS

             UOS515-0110     CD IP Tot M Ds/1000

             UOS515-0120     CD IP Tot M ALOS

             UOS515-0130     CD IP 0-12 F Ds/1000

             UOS515-0140     CD IP 0-12 F ALOS

             UOS515-0150     CD IP 13-17 F Ds/1000

             UOS515-0160     CD IP 13-17 F ALOS

             UOS515-0170     CD IP 18-64 F Ds/1000

             UOS515-0180     CD IP 18-64 F ALOS

             UOS515-0190     CD IP 65+ F Ds/1000

             UOS515-0200     CD IP 65+ F ALOS

             UOS515-0220     CD IP Unk F ALOS

             UOS515-0230     CD IP Tot F Ds/1000

             UOS515-0240     CD IP Tot F ALOS

             UOS515-0250     CD IP 0-12 Tot Ds/1000

             UOS515-0260     CD IP 0-12 Tot ALOS

             UOS515-0270     CD IP 13-17 Tot Ds/1000

             UOS515-0280     CD IP 13-17 Tot ALOS

             UOS515-0290     CD IP 18-64 Tot Ds/1000

             UOS515-0300     CD IP 18-64 Tot ALOS

             UOS515-0310     CD IP 65+ Tot Ds/1000

             UOS515-0320     CD IP 65+ Tot ALOS

             UOS515-0340     CD IP Unk Tot ALOS

             UOS515-0350     CD IP Tot Ds/1000

             UOS515-0360     CD IP Tot ALOS

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 [PMPM]; total number of prescriptions; average number of prescriptions per member per year [PMPY]) during the measurement year, stratified by age. (HEDIS 2007, Volume 2: Technical Specification, Pg. 292)

     REPORTING LEVEL - Contract Market

             UOS518-0010     OP Rx 0-9 Avg Cst of Rx/Mem/Mnth

             UOS518-0020     OP Rx 0-9 Avg Num of Rx/

             UOS518-0030     OP Rx 10-19 Avg Cst of Rx/Mem/Mnth

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

             UOS518-0040     OP Rx 10-19 Avg Num of Rx/

             UOS518-0050     OP Rx 20-44 Avg Cst of Rx/Mem/Mnth

             UOS518-0060     OP Rx 20-44 Avg Num of Rx/

             UOS518-0070     OP Rx 45-64 Avg Cst of Rx/Mem/Mnth

             UOS518-0080     OP Rx 45-64 Avg Num of Rx/

             UOS518-0090     OP Rx 65-74 Avg Cst of Rx/Mem/Mnth

             UOS518-0100     OP Rx 65-74 Avg Num of Rx/

             UOS518-0110     OP Rx 75-84 Avg Cst of Rx/Mem/Mnth

             UOS518-0120     OP Rx 75-84 Avg Num of Rx/

             UOS518-0130     OP Rx 85+ Avg Cst of Rx/Mem/Mnth

             UOS518-0140     OP Rx 85+ Avg Num of Rx/

             UOS518-0170     OP Rx Tot Avg Cst of Rx/Mem/Mnth

             UOS518-0180     OP Rx Tot Avg Num of Rx/

UOS520 – Identification of Alcohol and Other Drug Services

     DESCRIPTION - This measure gives an overview of the extent to which different levels of chemical dependency services are utilized. It summarizes the number and percentage of members with an alcohol and other drug (AOD) claim who received the following during the measurement year.

     • Any chemical dependency services (includes inpatient, intermediate, ambulatory)

     • Inpatient chemical dependency services

     • Intermediate chemical dependency services

     • Ambulatory chemical dependency services

     An AOD claim contains a diagnosis of AOD abuse or dependence and a specific AOD-related service.  (HEDIS 2007, Volume 2: Technical Specification, Pg. 288)

     REPORTING LEVEL - Contract Market

          UOS520-0010    ID Svs Any 0-12 M Pct

          UOS520-0020    ID Svs Any 0-12 F Pct

          UOS520-0030    ID Svs Any 0-12 Tot Pct

          UOS520-0040    ID Svs Any 13-17 M Pct

          UOS520-0050    ID Svs Any 13-17 F Pct

          UOS520-0060    ID Svs Any 13-17 Tot Pct

          UOS520-0072    ID Svs Any 18-24 M Pct

          UOS520-0074    ID Svs Any 18-24 F Pct

          UOS520-0076    ID Svs Any 18-24 Tot Pct

          UOS520-0078    ID Svs Any 25-34 M Pct

          UOS520-0082    ID Svs Any 25-34 F Pct

          UOS520-0084    ID Svs Any 25-34 Tot Pct

          UOS520-0086    ID Svs Any 35-64 M Pct

          UOS520-0088    ID Svs Any 35-64 F Pct

          UOS520-0092    ID Svs Any 35-64 Tot Pct

          UOS520-0100    ID Svs Any 65+ M Pct

          UOS520-0110    ID Svs Any 65+ F Pct

          UOS520-0120    ID Svs Any 65+ Tot Pct

          UOS520-0130    ID Svs Any Unk M Pct

          UOS520-0140    ID Svs Any Unk F Pct

          UOS520-0150    ID Svs Any Unk Tot Pct

          UOS520-0160    ID Svs Any Tot M Pct

          UOS520-0170    ID Svs Any Tot F Pct

          UOS520-0180    ID Svs Any Tot Pct

          UOS520-0190    ID Svs Inpat 0-12 M Pct

          UOS520-0200    ID Svs Inpat 0-12 F Pct

          UOS520-0210    ID Svs Inpat 0-12 Tot Pct

          UOS520-0220    ID Svs Inpat 13-17 M Pct

          UOS520-0230    ID Svs Inpat 13-17 F Pct

          UOS520-0240    ID Svs Inpat 13-17 Tot Pct

          UOS520-0252    ID Svs Inpat 18-24 M Pct

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

          UOS520-0254    ID Svs Inpat 18-24 F Pct

          UOS520-0256    ID Svs Inpat 18-24 Tot Pct

          UOS520-0258    ID Svs Inpat 25-34 M Pct

          UOS520-0262    ID Svs Inpat 25-34 F Pct

          UOS520-0264    ID Svs Inpat 25-34 Tot Pct

          UOS520-0266    ID Svs Inpat 35-64 M Pct

          UOS520-0268    ID Svs Inpat 35-64 F Pct

          UOS520-0270    ID Svs Inpat 35-64 Tot Pct

          UOS520-0280    ID Svs Inpat 65+ M Pct

          UOS520-0290    ID Svs Inpat 65+ F Pct

          UOS520-0300    ID Svs Inpat 65+ Tot Pct

          UOS520-0310    ID Svs Inpat Unk M Pct

          UOS520-0320    ID Svs Inpat Unk F Pct

          UOS520-0330    ID Svs Inpat Unk Tot Pct

          UOS520-0340    ID Svs Inpat Tot M Pct

          UOS520-0350    ID Svs Inpat Tot F Pct

          UOS520-0360    ID Svs Inpat Tot Pct

          UOS520-0370    ID Svs Day/Night 0-12 M Pct

          UOS520-0380    ID Svs Day/Night 0-12 F Pct

          UOS520-0390    ID Svs Day/Night 0-12 Tot Pct

          UOS520-0400    ID Svs Day/Night 13-17 M Pct

          UOS520-0410    ID Svs Day/Night 13-17 F Pct

          UOS520-0420    ID Svs Day/Night 13-17 Tot Pct

          UOS520-0432    ID Svs Intermediate 18-24 M Pct

          UOS520-0434    ID Svs Intermediate 18-24 F Pct

          UOS520-0436    ID Svs Intermediate 18-24 Tot Pct

          UOS520-0438    ID Svs Intermediate 25-34 M Pct

          UOS520-0442    ID Svs Intermediate 25-34 F Pct

          UOS520-0444    ID Svs Intermediate 25-34 Tot Pct

             UOS520-0446     ID Svs Intermediate 35-64 M Pct

             UOS520-0448     ID Svs Intermediate 35-64 F Pct

             UOS520-0452     ID Svs Intermediate 35-64 Tot Pct

             UOS520-0460     ID Svs Day/Night 65+ M Pct

             UOS520-0470     ID Svs Day/Night 65+ F Pct

             UOS520-0480     ID Svs Day/Night 65+ Tot Pct

             UOS520-0490     ID Svs Day/Night Unk M Pct

             UOS520-0500     ID Svs Day/Night Unk F Pct

             UOS520-0510     ID Svs Day/Night Unk Tot Pct

             UOS520-0520     ID Svs Day/Night Tot M Pct

             UOS520-0530     ID Svs Day/Night Tot F Pct

             UOS520-0540     ID Svs Day/Night Tot Pct

             UOS520-0550     ID Svs Amb 0-12 M Pct

             UOS520-0560     ID Svs Amb 0-12 F Pct

             UOS520-0570     ID Svs Amb 0-12 Tot Pct

             UOS520-0580     ID Svs Amb 13-17 M Pct

             UOS520-0590     ID Svs Amb 13-17 F Pct

             UOS520-0600     ID Svs Amb 13-17 Tot Pct

             UOS520-0612     ID Svs Amb 18-24 M Pct

             UOS520-0614     ID Svs Amb 18-24 F Pct

             UOS520-0616     ID Svs Amb 18-24 Tot Pct

             UOS520-0618     ID Svs Amb 25-34 M Pct

             UOS520-0622     ID Svs Amb 25-34 F Pct

             UOS520-0624     ID Svs Amb 25-34 Tot Pct

             UOS520-0626     ID Svs Amb 35-64 M Pct

             UOS520-0628     ID Svs Amb 35-64 F Pct

             UOS520-0632     ID Svs Amb 35-64 Tot Pct

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

             UOS520-0640     ID Svs Amb 65+ M Pct

             UOS520-0650     ID Svs Amb 65+ F Pct

             UOS520-0660     ID Svs Amb 65+ Tot Pct

             UOS520-0670     ID Svs Amb Unk M Pct

             UOS520-0680     ID Svs Amb Unk F Pct

             UOS520-0690     ID Svs Amb Unk Tot Pct

             UOS520-0700     ID Svs Amb Tot M Pct

             UOS520-0710     ID Svs Amb Tot F Pct

             UOS520-0720     ID Svs Amb Tot Pct

UOS522 – Antibiotic Utilization

     DESCRIPTION - This measure summarizes data on outpatient utilization of antibiotic prescriptions during the measurement year, stratified by age and gender and reported for each product, including the following.

     • Total number of antibiotic prescriptions

     • Average number of antibiotic prescriptions per member per year (PMPY)

     • Total days supplied for all antibiotic prescriptions

     • Average days supplied per antibiotic prescription

     • Total number of prescriptions for antibiotics of concern

     • Average number of prescriptions PMPY for antibiotics of concern

     • Percentage of antibiotics of concern for all antibiotic prescriptions

     • Average number of antibiotics PMPY reported by drug class:

     – For selected “antibiotics of concern”

     – For all other antibiotics

     (HEDIS 2007, Volume 2: Technical Specification, Pg. 294)

     REPORTING LEVEL - Contract Market

             UOS522-0010     AU Antibiotic Scrips PMPY M Tot Avg

          UOS522-0020    AU Antibiotic Scrips PMPY F Tot Avg

          UOS522-0030    AU Antibiotic Scrips PMPY MF Tot Avg

          UOS522-0040    AU Days Supplied per Antibiotic Scrip M Tot Avg

          UOS522-0050    AU Days Supplied per Antibiotic Scrip F Tot Avg

          UOS522-0060    AU Days Supplied per Antibiotic Scrip MF Tot Avg

          UOS522-0070    AU Scrips PMPY for Anitbiotics of Concern M Tot Avg

          UOS522-0080    AU Scrips PMPY for Anitbiotics of Concern F Tot Avg

          UOS522-0090    AU Scrips PMPY for Anitbiotics of Concern MF Tot Avg

          UOS522-0100    AU Pct Antibiotics of All Antibiotic Scrips M Tot

          UOS522-0110    AU Pct Antibiotics of All Antibiotic Scrips F Tot

             UOS522-0120     AU Pct Antibiotics of All Antibiotic Scrips MF Tot

          UOS522-0130    AC Quinolones PMPY M Tot

          UOS522-0140    AC Quinolones PMPY F Tot

          UOS522-0150    AC Quinolones PMPY MF Tot

          UOS522-0160    AC Cephalosporins 2nd-4th Generation PMPY M Tot

          UOS522-0170    AC Cephalosporins 2nd-4th Generation PMPY F Tot

          UOS522-0180    AC Cephalosporins 2nd-4th Generation PMPY MF Tot

          UOS522-0190    AC Azithromycin and Clarithromycin PMPY M Tot

          UOS522-0200    AC Azithromycin and Clarithromycin PMPY F Tot

          UOS522-0210    AC Azithromycin and Clarithromycin PMPY MF Tot

          UOS522-0220    AC Amoxicillin/Clavulanate PMPY M Tot

          UOS522-0230    AC Amoxicillin/Clavulanate PMPY F Tot

          UOS522-0240    AC Amoxicillin/Clavulanate PMPY MF Tot

          UOS522-0250    AC Ketolides PMPY M Tot

          UOS522-0260    AC Ketolides PMPY F Tot

          UOS522-0270    AC Ketolides PMPY MF Tot

          UOS522-0280    AC Clindamycin PMPY M Tot

          UOS522-0290    AC Clindamycin PMPY F Tot

          UOS522-0300    AC Clindamycin PMPY MF Tot

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

          UOS522-0310    AC Misc Antibiotics of Concern PMPY M Tot

          UOS522-0320    AC Misc Antibiotics of Concern PMPY F Tot

          UOS522-0330    AC Misc Antibiotics of Concern PMPY MF Tot

          UOS522-0340    AO Absorbable Sulfonamides PMPY M Tot

          UOS522-0350    AO Absorbable Sulfonamides PMPY F Tot

          UOS522-0360    AO Absorbable Sulfonamides PMPY MF Tot

          UOS522-0370    AO Aminoglycosides PMPY M Tot

          UOS522-0380    AO Aminoglycosides PMPY F Tot

          UOS522-0390    AO Aminoglycosides PMPY MF Tot

          UOS522-0400    AO 1st Generation Cephalosporins PMPY M Tot

          UOS522-0410    AO 1st Generation Cephalosporins PMPY F Tot

          UOS522-0420    AO 1st Generation Cephalosporins PMPY MF Tot

          UOS522-0430    AO Lincosamides PMPY M Tot

          UOS522-0440    AO Lincosamides PMPY F Tot

          UOS522-0450    AO Lincosamides PMPY MF Tot

          UOS522-0460    AO Macrolides (not azith or clarith) PMPY M Tot

          UOS522-0470    AO Macrolides (not azith or clarith) PMPY F Tot

          UOS522-0480    AO Macrolides (not azith or clarith) PMPY MF Tot

          UOS522-0490    AO Penicillins PMPY M Tot

          UOS522-0500    AO Penicillins PMPY F Tot

          UOS522-0510    AO Penicillins PMPY MF Tot

          UOS522-0520    AO Tetracyclines PMPY M Tot

          UOS522-0530    AO Tetracyclines PMPY F Tot

          UOS522-0540    AO Tetracyclines PMPY MF Tot

          UOS522-0550    AO Misc Antibiotics PMPY M Tot

          UOS522-0560    AO Misc Antibiotics PMPY F Tot

          UOS522-0570    AO Misc Antibiotics PMPY MF Tot

          UOS522-0580    AC Quinolone Scrips M Tot Num

          UOS522-0590    AC Quinolone Scrips F Tot Num

          UOS522-0600    AC Quinolone Scrips MF Tot Num

          UOS522-0610    AC Cephalosporin Scrips 2nd-4th Generation M Tot Num

          UOS522-0620    AC Cephalosporin Scrips 2nd-4th Generation F Tot Num

          UOS522-0630    AC Cephalosporin Scrips 2nd-4th Generation MF Tot Num

          UOS522-0640    AC Azithromycin and Clarithromycin Scrips M Tot Num

          UOS522-0650    AC Azithromycin and Clarithromycin Scrips F Tot Num

          UOS522-0660    AC Azithromycin and Clarithromycin Scrips MF Tot Num

          UOS522-0670    AC Amoxicillin/Clavulanate Scrips M Tot Num

             UOS522-0680     AC Amoxicillin/Clavulanate Scrips F Tot Num

             UOS522-0690     AC Amoxicillin/Clavulanate Scrips MF Tot Num

             UOS522-0700     AC Ketolide Scrips M Tot Num

             UOS522-0710     AC Ketolide Scrips F Tot Num

             UOS522-0720     AC Ketolide Scrips MF Tot Num

             UOS522-0730     AC Clindamycin Scrips M Tot Num

             UOS522-0740     AC Clindamycin Scrips F Tot Num

             UOS522-0750     AC Clindamycin Scrips MF Tot Num

             UOS522-0760     AC Misc Antibiotics of Concern Scrips M Tot Num

             UOS522-0770     AC Misc Antibiotics of Concern Scrips F Tot Num

             UOS522-0780     AC Misc Antibiotics of Concern Scrips MF Tot Num

             UOS522-0790     AO Absorbable Sulfonamide Scrips M Tot Num

             UOS522-0800     AO Absorbable Sulfonamide Scrips F Tot Num

             UOS522-0810     AO Absorbable Sulfonamide Scrips MF Tot Num

             UOS522-0820     AO Aminoglycoside Scrips M Tot Num

             UOS522-0830     AO Aminoglycoside Scrips F Tot Num

             UOS522-0840     AO Aminoglycoside Scrips MF Tot Num

             UOS522-0850     AO 1st Generation Cephalosporin Scrips M Tot Num

             UOS522-0860     AO 1st Generation Cephalosporin Scrips F Tot Num

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

             UOS522-0870     AO 1st Generation Cephalosporin Scrips MF Tot Num

             UOS522-0880     AO Lincosamide Scrips M Tot Num

             UOS522-0890     AO Lincosamide Scrips F Tot Num

             UOS522-0900     AO Lincosamide Scrips MF Tot Num

             UOS522-0910     AO Macrolide (not azith or clarith) Scrips M Tot Num

             UOS522-0920     AO Macrolide (not azith or clarith) Scrips F Tot Num

             UOS522-0930     AO Macrolide (not azith or clarith) Scrips MF Tot Num

             UOS522-0940     AO Penicillin Scrips M Tot Num

             UOS522-0950     AO Penicillin Scrips F Tot Num

             UOS522-0960     AO Penicillin Scrips MF Tot Num

             UOS522-0970     AO Tetracycline Scrips M Tot Num

             UOS522-0980     AO Tetracycline Scrips F Tot Num

             UOS522-0990     AO Tetracycline Scrips MF Tot Num

             UOS522-1000     AO Misc Antibiotic Scrips M Tot Num

             UOS522-1010     AO Misc Antibiotic Scrips F Tot Num

             UOS522-1020     AO Misc Antibiotic Scrips MF Tot Num