This documentation presents (1) a description of each HEDIS® measure that CMS collected for 356 Medicare managed care contract markets on health care provided in calendar year 2007 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 2008 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) 2008 is held by the National Committee for Quality Assurance, 1100 13th Street, NW, Suite 1000, Washington, DC 20005. All rights reserved.
In 2008, CMS collected data from 356 Medicare managed care contracts for health care delivered in 2007. 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 357.
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.")
The description and related information provided for each measure in this documentation are taken from the HEDIS 2008 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 2008, 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.
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.
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 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 2007. 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.
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
DESCRIPTION - The percentage of enrollees 20 years and older who had an ambulatory or preventive care visit. The organization reports three separate percentages for each product line.
• Medicaid and Medicare members who had an ambulatory or preventive care visit during the measurement year
• Commercial members who had an ambulatory or preventive care visit during the measurement year or the two years prior to the measurement year. (HEDIS 2008, Volume 2: Technical Specification, Pg. 196)
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 Rate - Total
AOC201-0100 Lower Confidence Interval - All
AOC201-0110 Upper Confidence Interval - All
DESCRIPTION - The percentage of calls received by the organization's Member Services call centers (during operating hours) during the measurement year that were abandoned by the caller before being answered by a live voice. (HEDIS 2008, Volume 2: Technical Specification, Pg. 220)
AOC220-0010 Reported rate
AOC220-0020 Lower Confidence Interval
AOC220-0030 Upper Confidence Interval
DESCRIPTION - The percentage of calls received by the organization's Member Services call centers (during operating hours) during the measurement year that were answered by a live voice within 30 seconds. (HEDIS 2008, Volume 2: Technical Specification, Pg. 222)
AOC225-0010 Reported rate
AOC225-0020 Lower Confidence Interval
AOC225-0030 Upper Confidence Interval
DESCRIPTION - The percentage of adolescent and adult members with a new episode of alcohol or other drug (AOD) dependence who received the following.
• Initiation of AOD Dependence Treatment. The percentage of members who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis.
• Engagement of AOD Treatment. The percentage of members who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit. (HEDIS 2008, Volume 2: Technical Specification, Pg. 203)
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
AOC235-0040 Rate - Initiation - Overall Year Olds
AOC235-0050 Lower Confidence Interval - Initiation - Overall Year Olds
AOC235-0060 Upper Confidence Interval - Initiation - Overall Year Olds
DESCRIPTION - The relative resource use by members with diabetes during the measurement year. (HEDIS 2008, Volume 2: Technical Specification, Pg. 325)
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
COC605-0460 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
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
COC605-0670 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
COC605-0880 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
COC605-1090 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
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
DESCRIPTION - The relative resource use by members with cardiovascular conditions during the measurement year. (HEDIS 2008, Volume 2: Technical Specification, Pg. 348)
COC610-0010 Medical Benefit Member Months (CHF With Comorbidity) - Male Total
COC610-0020 Medical Benefit Member Months (CHF With Comorbidity) - Female Total
COC610-0030 Medical Benefit Member Months (CHF With Comorbidity) - Total
COC610-0040 Medical Benefit Member Months (CHF Without Comorbidity) - Male Total
COC610-0050 Medical Benefit Member Months (CHF Without Comorbidity) - Female Total
COC610-0060 Medical Benefit Member Months (CHF Without Comorbidity) - Total
COC610-0070 Medical Benefit Member Months (AMI With Comorbidity) - Male Total
COC610-0080 Medical Benefit Member Months (AMI With Comorbidity) - Female Total
COC610-0090 Medical Benefit Member Months (AMI With Comorbidity) - Total
COC610-0100 Medical Benefit Member Months (AMI Without Comorbidity) - Male Total
COC610-0110 Medical Benefit Member Months (AMI Without Comorbidity) - Female Total
COC610-0120 Medical Benefit Member Months (AMI Without Comorbidity) - Total
COC610-0130 Medical Benefit Member Months (Angina With Comorbidity) - Male Total
COC610-0140 Medical Benefit Member Months (Angina With Comorbidity) - Female Total
COC610-0150 Medical Benefit Member Months (Angina With Comorbidity) - Total
COC610-0160 Medical Benefit Member Months (Angina Without Comorbidity) - Male Total
COC610-0170 Medical Benefit Member Months (Angina Without Comorbidity) - Female Total
COC610-0180 Medical Benefit Member Months (Angina Without Comorbidity) - Total
COC610-0190 Medical Benefit Member Months (CAD With Comorbidity) - Male Total
COC610-0200 Medical Benefit Member Months (CAD With Comorbidity) - Female Total
COC610-0210 Medical Benefit Member Months (CAD With Comorbidity) - Total
COC610-0220 Medical Benefit Member Months (CAD Without Comorbidity) - Male Total
COC610-0230 Medical Benefit Member Months (CAD Without Comorbidity) - Female Total
COC610-0240 Medical Benefit Member Months (CAD Without Comorbidity) - Total
COC610-0250 Pharmacy Benefit Member Months (CHF With Comorbidity) - Male Total
COC610-0260 Pharmacy Benefit Member Months (CHF With Comorbidity) - Female Total
COC610-0270 Pharmacy Benefit Member Months (CHF With Comorbidity) - Total
COC610-0280 Pharmacy Benefit Member Months (CHF Without Comorbidity) - Male Total
COC610-0290 Pharmacy Benefit Member Months (CHF Without Comorbidity) - Female Total
COC610-0300 Pharmacy Benefit Member Months (CHF Without Comorbidity) - Total
COC610-0310 Pharmacy Benefit Member Months (AMI With Comorbidity) - Male Total
COC610-0320 Pharmacy Benefit Member Months (AMI With Comorbidity) - Female Total
COC610-0330 Pharmacy Benefit Member Months (AMI With Comorbidity) - Total
COC610-0340 Pharmacy Benefit Member Months (AMI Without Comorbidity) - Male Total
COC610-0350 Pharmacy Benefit Member Months (AMI Without Comorbidity) - Female Total
COC610-0360 Pharmacy Benefit Member Months (AMI Without Comorbidity) - Total
COC610-0370 Pharmacy Benefit Member Months (Angina With Comorbidity) - Male Total
COC610-0380 Pharmacy Benefit Member Months (Angina With Comorbidity) - Female Total
COC610-0390 Pharmacy Benefit Member Months (Angina With Comorbidity) - Total
COC610-0400 Pharmacy Benefit Member Months (Angina Without Comorbidity) - Male Total
COC610-0410 Pharmacy Benefit Member Months (Angina Without Comorbidity) - Female Total
COC610-0420 Pharmacy Benefit Member Months (Angina Without Comorbidity) - Total
COC610-0430 Pharmacy Benefit Member Months (CAD With Comorbidity) - Male Total
COC610-0440 Pharmacy Benefit Member Months (CAD With Comorbidity) - Female Total
COC610-0450 Pharmacy Benefit Member Months (CAD With Comorbidity) - Total
COC610-0460 Pharmacy Benefit Member Months (CAD Without Comorbidity) - Male Total
COC610-0470 Pharmacy Benefit Member Months (CAD Without Comorbidity) - Female Total
COC610-0480 Pharmacy Benefit Member Months (CAD Without Comorbidity) - Total
COC610-0490 Total Std Price for CHF with Comorbidity - Inpatient Facility - Male Total
COC610-0500 Total Std Price for CHF with Comorbidity - E & M - Male Total
COC610-0510 Total Std Price for CHF with Comorbidity - Surgery - PMPM - Male Total
COC610-0520 Total Std Price for CHF with Comorbidity - Pharmacy - Male Total
COC610-0530 Service Frequency for CHF with Comorbidity - Inpatient Facility Discharges - Male Total
COC610-0540 Service Frequency for CHF with Comorbidity - ED Visits - Male Total
COC610-0550 Total Std Price for CHF with Comorbidity - Inpatient Facility - Female Total
COC610-0560 Total Std Price for CHF with Comorbidity - E & M - Female Total
COC610-0570 Total Std Price for CHF with Comorbidity - Surgery - PMPM - Female Total
COC610-0580 Total Std Price for CHF with Comorbidity - Pharmacy - Female Total
COC610-0590 Service Frequency for CHF with Comorbidity - Inpatient Facility Discharges - Female Total
COC610-0600 Service Frequency for CHF with Comorbidity - ED Visits - Female Total
COC610-0610 Total Std Price for CHF with Comorbidity - Inpatient Facility - Total
COC610-0620 Total Std Price for CHF with Comorbidity - E & M - Total
COC610-0630 Total Std Price for CHF with Comorbidity - Surgery - PMPM - Total
COC610-0640 Total Std Price for CHF with Comorbidity - Pharmacy - Total
COC610-0650 Service Frequency for CHF with Comorbidity - Inpatient Facility Discharges - Total
COC610-0660 Service Frequency for CHF with Comorbidity - ED Visits - Total
COC610-0670 Total Std Price for CHF without Comorbidity - Inpatient Facility - Male Total
COC610-0680 Total Std Price for CHF without Comorbidity - E & M - Male Total
COC610-0690 Total Std Price for CHF without Comorbidity - Surgery - Male Total
COC610-0700 Total Std Price for CHF without Comorbidity - Pharmacy - Male Total
COC610-0710 Service Frequency for CHF without Comorbidity - Inpatient Facility Discharges - Male Total
COC610-0720 Service Frequency for CHF without Comorbidity - ED Visits - Male Total
COC610-0730 Total Std Price for CHF without Comorbidity - Inpatient Facility - Female Total
COC610-0740 Total Std Price for CHF without Comorbidity - E & M - Female Total
COC610-0750 Total Std Price for CHF without Comorbidity - Surgery - Female Total
COC610-0760 Total Std Price for CHF without Comorbidity - Pharmacy - Female Total
COC610-0770 Service Frequency for CHF without Comorbidity - Inpatient Facility Discharges - Female Total
COC610-0780 Service Frequency for CHF without Comorbidity - ED Visits - Female Total
COC610-0790 Total Std Price for CHF without Comorbidity - Inpatient Facility - Total
COC610-0800 Total Std Price for CHF without Comorbidity - E & M - Total
COC610-0810 Total Std Price for CHF without Comorbidity - Surgery - Total
COC610-0820 Total Std Price for CHF without Comorbidity - Pharmacy - Total
COC610-0830 Service Frequency for CHF without Comorbidity - Inpatient Facility Discharges - Total
COC610-0840 Service Frequency for CHF without Comorbidity - ED Visits - Total
COC610-0850 Total Std Price for AMI with Comorbidity - Inpatient Facility - Male Total
COC610-0860 Total Std Price for AMI with Comorbidity - E & M - Male Total
COC610-0870 Total Std Price for AMI with Comorbidity - Surgery - Male Total
COC610-0880 Total Std Price for AMI with Comorbidity - Pharmacy - Male Total
COC610-0890 Service Frequency for AMI with Comorbidity - Inpatient Facility Discharges - Male Total
COC610-0900 Service Frequency for AMI with Comorbidity - ED Visits - Male Total
COC610-0910 Total Std Price for AMI with Comorbidity - Inpatient Facility - Female Total
COC610-0920 Total Std Price for AMI with Comorbidity - E & M - Female Total
COC610-0930 Total Std Price for AMI with Comorbidity - Surgery - Female Total
COC610-0940 Total Std Price for AMI with Comorbidity - Pharmacy - Female Total
COC610-0950 Service Frequency for AMI with Comorbidity - Inpatient Facility Discharges - Female Total
COC610-0960 Service Frequency for AMI with Comorbidity - ED Visits - Female Total
COC610-0970 Total Std Price for AMI with Comorbidity - Inpatient Facility - Total
COC610-0980 Total Std Price for AMI with Comorbidity - E & M - Total
COC610-0990 Total Std Price for AMI with Comorbidity - Surgery - Total
COC610-1000 Total Std Price for AMI with Comorbidity - Pharmacy - Total
COC610-1010 Service Frequency for AMI with Comorbidity - Inpatient Facility Discharges - Total
COC610-1020 Service Frequency for AMI with Comorbidity - ED Visits - Total
COC610-1030 Total Std Price for AMI without Comorbidity - Inpatient Facility - Male Total
COC610-1040 Total Std Price for AMI without Comorbidity - E & M - Male Total
COC610-1050 Total Std Price for AMI without Comorbidity - Surgery - Male Total
COC610-1060 Total Std Price for AMI without Comorbidity - Pharmacy - Male Total
COC610-1070 Service Frequency for AMI without Comorbidity - Inpatient Facility Discharges - Male Total
COC610-1080 Service Frequency for AMI without Comorbidity - ED Visits - Male Total
COC610-1090 Total Std Price for AMI without Comorbidity - Inpatient Facility - Female Total
COC610-1100 Total Std Price for AMI without Comorbidity - E & M - Female Total
COC610-1110 Total Std Price for AMI without Comorbidity - Surgery - Female Total
COC610-1120 Total Std Price for AMI without Comorbidity - Pharmacy - Female Total
COC610-1130 Service Frequency for AMI without Comorbidity - Inpatient Facility Discharges - Female Total
COC610-1140 Service Frequency for AMI without Comorbidity - ED Visits - Female Total
COC610-1150 Total Std Price for AMI without Comorbidity - Inpatient Facility - Total
COC610-1160 Total Std Price for AMI without Comorbidity - E & M - Total
COC610-1170 Total Std Price for AMI without Comorbidity - Surgery - Total
COC610-1180 Total Std Price for AMI without Comorbidity - Pharmacy - Total
COC610-1190 Service Frequency for AMI without Comorbidity - Inpatient Facility Discharges - Total
COC610-1200 Service Frequency for AMI without Comorbidity - ED Visits - Total
COC610-1210 Total Std Price for Angina with Comorbidity - Inpatient Facility - Male Total
COC610-1220 Total Std Price for Angina with Comorbidity - E & M - Male Total
COC610-1230 Total Std Price for Angina with Comorbidity - Surgery - Male Total
COC610-1240 Total Std Price for Angina with Comorbidity - Pharmacy - Male Total
COC610-1250 Service Frequency for Angina with Comorbidity - Inpatient Facility Discharges - Male Total
COC610-1260 Service Frequency for Angina with Comorbidity - ED Visits - Male Total
COC610-1270 Total Std Price for Angina with Comorbidity - Inpatient Facility - Female Total
COC610-1280 Total Std Price for Angina with Comorbidity - E & M - Female Total
COC610-1290 Total Std Price for Angina with Comorbidity - Surgery - Female Total
COC610-1300 Total Std Price for Angina with Comorbidity - Pharmacy - Female Total
COC610-1310 Service Frequency for Angina with Comorbidity - Inpatient Facility Discharges - Female Total
COC610-1320 Service Frequency for Angina with Comorbidity - ED Visits - Female Total
COC610-1330 Total Std Price for Angina with Comorbidity - Inpatient Facility - Total
COC610-1340 Total Std Price for Angina with Comorbidity - E & M - Total
COC610-1350 Total Std Price for Angina with Comorbidity - Surgery - Total
COC610-1360 Total Std Price for Angina with Comorbidity - Pharmacy - Total
COC610-1370 Service Frequency for Angina with Comorbidity - Inpatient Facility Discharges - Total
COC610-1380 Service Frequency for Angina with Comorbidity - ED Visits - Total
COC610-1390 Total Std Price for Angina without Comorbidity - Inpatient Facility - Male Total
COC610-1400 Total Std Price for Angina without Comorbidity - E & M - Male Total
COC610-1410 Total Std Price for Angina without Comorbidity - Surgery - Male Total
COC610-1420 Total Std Price for Angina without Comorbidity - Pharmacy - Male Total
COC610-1430 Service Frequency for Angina without Comorbidity - Inpatient Facility Discharges - Male Total
COC610-1440 Service Frequency for Angina without Comorbidity - ED Visits - Male Total
COC610-1450 Total Std Price for Angina without Comorbidity - Inpatient Facility - Female Total
COC610-1460 Total Std Price for Angina without Comorbidity - E & M - Female Total
COC610-1470 Total Std Price for Angina without Comorbidity - Surgery - Female Total
COC610-1480 Total Std Price for Angina without Comorbidity - Pharmacy - Female Total
COC610-1490 Service Frequency for Angina without Comorbidity - Inpatient Facility Discharges - Female Total
COC610-1500 Service Frequency for Angina without Comorbidity - ED Visits - Female Total
COC610-1510 Total Std Price for Angina without Comorbidity - Inpatient Facility - Total
COC610-1520 Total Std Price for Angina without Comorbidity - E & M - Total
COC610-1530 Total Std Price for Angina without Comorbidity - Surgery - Total
COC610-1540 Total Std Price for Angina without Comorbidity - Pharmacy - Total
COC610-1550 Service Frequency for Angina without Comorbidity - Inpatient Facility Discharges - Total
COC610-1560 Service Frequency for Angina without Comorbidity - ED Visits - Total
COC610-1570 Total Std Price for CAD with Comorbidity - Inpatient Facility - Male Total
COC610-1580 Total Std Price for CAD with Comorbidity - E & M - Male Total
COC610-1590 Total Std Price for CAD with Comorbidity - Surgery - Male Total
COC610-1600 Total Std Price for CAD with Comorbidity - Pharmacy - Male Total
COC610-1610 Service Frequency for CAD with Comorbidity - Inpatient Facility Discharges - Male Total
COC610-1620 Service Frequency for CAD with Comorbidity - ED Visits - Male Total
COC610-1630 Total Std Price for CAD with Comorbidity - Inpatient Facility - Female Total
COC610-1640 Total Std Price for CAD with Comorbidity - E & M - Female Total
COC610-1650 Total Std Price for CAD with Comorbidity - Surgery - Female Total
COC610-1660 Total Std Price for CAD with Comorbidity - Pharmacy - Female Total
COC610-1670 Service Frequency for CAD with Comorbidity - Inpatient Facility Discharges - Female Total
COC610-1680 Service Frequency for CAD with Comorbidity - ED Visits - Female Total
COC610-1690 Total Std Price for CAD with Comorbidity - Inpatient Facility - Total
COC610-1700 Total Std Price for CAD with Comorbidity - E & M - Total
COC610-1710 Total Std Price for CAD with Comorbidity - Surgery - Total
COC610-1720 Total Std Price for CAD with Comorbidity - Pharmacy - Total
COC610-1730 Service Frequency for CAD with Comorbidity - Inpatient Facility Discharges - Total
COC610-1740 Service Frequency for CAD with Comorbidity - ED Visits - Total
COC610-1750 Total Std Price for CAD without Comorbidity - Inpatient Facility - Male Total
COC610-1760 Total Std Price for CAD without Comorbidity - E & M - Male Total
COC610-1770 Total Std Price for CAD without Comorbidity - Surgery - Male Total
COC610-1780 Total Std Price for CAD without Comorbidity - Pharmacy - Male Total
COC610-1790 Service Frequency for CAD without Comorbidity - Inpatient Facility Discharge - Male Total
COC610-1800 Service Frequency for CAD without Comorbidity - ED Visits - Male Total
COC610-1810 Total Std Price for CAD without Comorbidity - Inpatient Facility - Female Total
COC610-1820 Total Std Price for CAD without Comorbidity - E & M - Female Total
COC610-1830 Total Std Price for CAD without Comorbidity - Surgery - Female Total
COC610-1840 Total Std Price for CAD without Comorbidity - Pharmacy - Female Total
COC610-1850 Service Frequency for CAD without Comorbidity - Inpatient Facility Discharge - Female Total
COC610-1860 Service Frequency for CAD without Comorbidity - ED Visits - Female Total
COC610-1870 Total Std Price for CAD without Comorbidity - Inpatient Facility - Total
COC610-1880 Total Std Price for CAD without Comorbidity - E & M - Total
COC610-1890 Total Std Price for CAD without Comorbidity - Surgery - Total
COC610-1900 Total Std Price for CAD without Comorbidity - Pharmacy - Total
COC610-1910 Service Frequency for CAD without Comorbidity - Inpatient Facility Discharge - Total
COC610-1920 Service Frequency for CAD without Comorbidity - ED Visits - Total
COC610-1930 Total Std Price for Cardiovascular Conditions Totals - Inpatient Facility - PMPM - Male Total
COC610-1940 Total Std Price for Cardiovascular Conditions Totals - E & M - PMPM - Male Total
COC610-1950 Total Std Price for Cardiovascular Conditions Totals - Surgery and Procedure - PMPM - Male Total
COC610-1960 Total Std Price for Cardiovascular Conditions Totals - Pharmacy - PMPM - Male Total
COC610-1970 Service Frequency for Cardiovascular Conditions Totals - Inpatient Facility Discharges/1,000 Member Years - Male Total
COC610-1980 Service Frequency for Cardiovascular Conditions Totals - ED Visits/1,000 Member Years - Male Total
COC610-1990 Total Std Price for Cardiovascular Conditions Totals - Inpatient Facility - PMPM - Female Total
COC610-2000 Total Std Price for Cardiovascular Conditions Totals - E & M - PMPM - Female Total
COC610-2010 Total Std Price for Cardiovascular Conditions Totals - Surgery and Procedure - PMPM - Female Total
COC610-2020 Total Std Price for Cardiovascular Conditions Totals - Pharmacy - PMPM - Female Total
COC610-2030 Service Frequency for Cardiovascular Conditions Totals - Inpatient Facility Discharges/1,000 Member Years - Female Total
COC610-2040 Service Frequency for Cardiovascular Conditions Totals - ED Visits/1,000 Member Years - Female Total
COC610-2050 Total Std Price for Cardiovascular Conditions Totals - Inpatient Facility - PMPM - Total
COC610-2060 Total Std Price for Cardiovascular Conditions Totals - E & M - PMPM - Total
COC610-2070 Total Std Price for Cardiovascular Conditions Totals - Surgery and Procedure - PMPM - Total
COC610-2080 Total Std Price for Cardiovascular Conditions Totals - Pharmacy - PMPM - Total
COC610-2090 Service Frequency for Cardiovascular Conditions Totals - Inpatient Facility Discharges/1,000 Member Years - Total
COC610-2100 Service Frequency for Cardiovascular Conditions Totals - ED Visits/1,000 Member Years - Total
DESCRIPTION - The relative resource use by members with chronic obstructive pulmonary disease (COPD) during the measurement year. (HEDIS 2008, Volume 2: Technical Specification, Pg. 363)
COC615-0010 Member Benefit Member Months (With Comorbidity) - Male Total
COC615-0020 Member Benefit Member Months (With Comorbidity) - Female Total
COC615-0030 Member Benefit Member Months (With Comorbidity) - Total
COC615-0040 Member Benefit Member Months (Without Comorbidity) - Male Total
COC615-0050 Member Benefit Member Months (Without Comorbidity) - Female Total
COC615-0060 Member Benefit Member Months (Without Comorbidity) - Total
COC615-0070 Pharmacy Benefit Member Months (With Comorbidity) - Male Total
COC615-0080 Pharmacy Benefit Member Months (With Comorbidity) - Female Total
COC615-0090 Pharmacy Benefit Member Months (With Comorbidity) - Total
COC615-0100 Pharmacy Benefit Member Months (Without Comorbidity) - Male Total
COC615-0110 Pharmacy Benefit Member Months (Without Comorbidity) - Female Total
COC615-0120 Pharmacy Benefit Member Months (Without Comorbidity) - Total
COC615-0130 Total Std Price for COPD with Comorbidity - Inpatient Facility - Male Total
COC615-0140 Total Std Price for COPD with Comorbidity - E & M - Male Total
COC615-0150 Total Std Price for COPD with Comorbidity - Surgery - Male Total
COC615-0160 Total Std Price for COPD with Comorbidity - Pharmacy - Male Total
COC615-0170 Service Frequency for COPD with Comorbidity - Inpatient Facility Discharges - Male Total
COC615-0180 Service Frequency for COPD with Comorbidity - ED Visits - Male Total
COC615-0190 Total Std Price for COPD with Comorbidity - Inpatient Facility - Female Total
COC615-0200 Total Std Price for COPD with Comorbidity - E & M - Female Total
COC615-0210 Total Std Price for COPD with Comorbidity - Surgery - Female Total
COC615-0220 Total Std Price for COPD with Comorbidity - Pharmacy - Female Total
COC615-0230 Service Frequency for COPD with Comorbidity - Inpatient Facility Discharges - Female Total
COC615-0240 Service Frequency for COPD with Comorbidity - ED Visits - Female Total
COC615-0250 Total Std Price for COPD with Comorbidity - Inpatient Facility - Total
COC615-0260 Total Std Price for COPD with Comorbidity - E & M - Total
COC615-0270 Total Std Price for COPD with Comorbidity - Surgery - Total
COC615-0280 Total Std Price for COPD with Comorbidity - Pharmacy - Total
COC615-0290 Service Frequency for COPD with Comorbidity - Inpatient Facility Discharges - Total
COC615-0300 Service Frequency for COPD with Comorbidity - ED Visits - Total
COC615-0310 Total Std Price for COPD without Comorbidity - Inpatient Facility - Male Total
COC615-0320 Total Std Price for COPD without Comorbidity - E & M - Male Total
COC615-0330 Total Std Price for COPD without Comorbidity - Surgery - Male Total
COC615-0340 Total Std Price for COPD without Comorbidity - Pharmacy - Male Total
COC615-0350 Service Frequency for COPD without Comorbidity - Inpatient Facility Discharges - Male Total
COC615-0360 Service Frequency for COPD without Comorbidity - ED Visits - Male Total
COC615-0370 Total Std Price for COPD without Comorbidity - Inpatient Facility - Female Total
COC615-0380 Total Std Price for COPD without Comorbidity - E & M - Female Total
COC615-0390 Total Std Price for COPD without Comorbidity - Surgery - Female Total
COC615-0400 Total Std Price for COPD without Comorbidity - Pharmacy - Female Total
COC615-0410 Service Frequency for COPD without Comorbidity - Inpatient Facility Discharges - Female Total
COC615-0420 Service Frequency for COPD without Comorbidity - ED Visits - Female Total
COC615-0430 Total Std Price for COPD without Comorbidity - Inpatient Facility - Total
COC615-0440 Total Std Price for COPD without Comorbidity - E & M - Total
COC615-0450 Total Std Price for COPD without Comorbidity - Surgery - Total
COC615-0460 Total Std Price for COPD without Comorbidity - Pharmacy - Total
COC615-0470 Service Frequency for COPD without Comorbidity - Inpatient Facility Discharges - Total
COC615-0480 Service Frequency for COPD without Comorbidity - ED Visits - Total
COC615-0490 Total Std Price for COPD Totals - Inpatient Facility - PMPM - Male Total
COC615-0500 Total Std Price for COPD Totals - E & M - PMPM - Male Total
COC615-0510 Total Std Price for COPD Totals - Surgery - PMPM - Male Total
COC615-0520 Total Std Price for COPD Totals - Pharmacy - PMPM - Male Total
COC615-0530 Service Frequency for COPD Totals - Inpatient Facility Discharges/ 1,000 Member Years - Male Total
COC615-0540 Service Frequency for COPD Totals - ED Visits/1,000 Member Years - Male Total
COC615-0550 Total Std Price for COPD Totals - Inpatient Facility - PMPM - Female Total
COC615-0560 Total Std Price for COPD Totals - E & M - PMPM - Female Total
COC615-0570 Total Std Price for COPD Totals - Surgery - PMPM - Female Total
COC615-0580 Total Std Price for COPD Totals - Pharmacy - PMPM - Female Total
COC615-0590 Service Frequency for COPD Totals - Inpatient Facility Discharges/ 1,000 Member Years - Female Total
COC615-0600 Service Frequency for COPD Totals - ED Visits/1,000 Member Years - Female Total
COC615-0610 Total Std Price for COPD Totals - Inpatient Facility - PMPM - Total
COC615-0620 Total Std Price for COPD Totals - E & M - PMPM - Total
COC615-0630 Total Std Price for COPD Totals - Surgery - PMPM - Total
COC615-0640 Total Std Price for COPD Totals - Pharmacy - PMPM - Total
COC615-0650 Service Frequency for COPD Totals - Inpatient Facility Discharges/ 1,000 Member Years - Total
COC615-0660 Service Frequency for COPD Totals - ED Visits/1,000 Member Years - Total
DESCRIPTION - The relative resource use by members with uncomplicated HTN during the measurement year. (HEDIS 2008, Volume 2: Technical Specification, Pg. 356)
COC620-0010 Medical Benefit Member Months - Male Total
COC620-0020 Medical Benefit Member Months - Female Total
COC620-0030 Medical Benefit Member Months - Total
COC620-0040 Pharmacy Benefit Member Months - Male Total
COC620-0050 Pharmacy Benefit Member Months - Female Total
COC620-0060 Pharmacy Benefit Member Months - Total
COC620-0070 Total Std Price - Inpatient Facility - Male Total
COC620-0080 Total Std Price - E & M - Male Total
COC620-0090 Total Std Price - Surgery - Male Total
COC620-0100 Total Std Price - Pharmacy - Male Total
COC620-0110 Service Frequency - Inpatient Facility Discharges - Male Total
COC620-0120 Service Frequency - ED Visits - Male Total
COC620-0130 Total Std Price - Inpatient Facility - Female Total
COC620-0140 Total Std Price - E & M - Female Total
COC620-0150 Total Std Price - Surgery - Female Total
COC620-0160 Total Std Price - Pharmacy - Female Total
COC620-0170 Service Frequency - Inpatient Facility Discharges - Female Total
COC620-0180 Service Frequency - ED Visits - Female Total
COC620-0190 Total Std Price - Inpatient Facility - Total
COC620-0200 Total Std Price - E & M - Total
COC620-0210 Total Std Price - Surgery - Total
COC620-0220 Total Std Price - Pharmacy - Total
COC620-0230 Service Frequency - Inpatient Facility Discharges - Total
COC620-0240 Service Frequency - ED Visits - Total
COC620-0250 Total Std Price - Inpatient Facility - PMPM - Male Total
COC620-0260 Total Std Price - E & M - PMPM - Male Total
COC620-0270 Total Std Price - Surgery - PMPM - Male Total
COC620-0280 Total Std Price - Pharmacy - PMPM - Male Total
COC620-0290 Service Frequency - Inpatient Facility Discharges/1,000 Member Years - Male Total
COC620-0300 Service Frequency - ED Visits/1,000 Member Years - Male Total
COC620-0310 Total Std Price - Inpatient Facility - PMPM - Female Total
COC620-0320 Total Std Price - E & M - PMPM - Female Total
COC620-0330 Total Std Price - Surgery - PMPM - Female Total
COC620-0340 Total Std Price - Pharmacy - PMPM - Female Total
COC620-0350 Service Frequency - Inpatient Facility Discharges/1,000 Member Years - Female Total
COC620-0360 Service Frequency - ED Visits/1,000 Member Years - Female Total
COC620-0370 Total Std Price - Inpatient Facility - PMPM - Total
COC620-0380 Total Std Price - E & M - PMPM - Total
COC620-0390 Total Std Price - Surgery - PMPM - Total
COC620-0400 Total Std Price - Pharmacy - PMPM - Total
COC620-0410 Service Frequency - Inpatient Facility Discharges/1,000 Member Years - Total
COC620-0420 Service Frequency - ED Visits/1,000 Member Years - Total
DESCRIPTION - The percentage of women 40–69 years of age who had a mammogram to screen for breast cancer. (HEDIS 2008, Volume 2: Technical Specification, Pg. 72)
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
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 had an outpatient visit, an intensive outpatient encounter or partial hospitalization with a mental health practitioner. Two rates are reported.
1. The percentage of members who received follow-up within 30 days of discharge
2. The percentage of members who received follow-up within 7 days of discharge
(HEDIS 2008, Volume 2: Technical Specification, Pg. 164)
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
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
• LDL-C control (<100 mg/dL)
• Medical attention for nephropathy
• Blood pressure control (<130/80 mm Hg)
• Blood pressure control (<140/90 mm Hg)
(HEDIS 2008, Volume 2: Technical Specifications, Pg. 126)
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
DESCRIPTION - The percentage of members 18–75 years of age who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from January 1–November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to measurement year, who had each of the following during the measurement year.
• LDL-C screening
• LDL-C control (<100 mg/dL)
(HEDIS 2008, Volume 2: Technical Specifications, Pg. 112)
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
DESCRIPTION - The following components of this measure assess different facets of the successful pharmacological management of major 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 major 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 major 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 major depression and treated with anti-depressant medication and who remained on an antidepressant drug for at least 180 days.
(HEDIS 2008, Volume 2: Technical Specifications, Pg. 152)
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.
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 2008, Volume 2: Technical Specification, Pg. 116)
EOC035-0100 Rate - Total
EOC035-0110 Lower Confidence Interval tot
EOC035-0120 Upper Confidence Interval tot
DESCRIPTION - The percentage of members 50–80 years of age who had appropriate screening for colorectal cancer. (HEDIS 2008, Volume 2: Technical Specification, Pg. 77)
EOC040-0010 Rate
EOC040-0020 Lower Confidence Interval
EOC040-0030 Upper Confidence Interval
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 the fracture. (HEDIS 2008, Volume 2: Technical Specification, Pg. 144)
EOC045-0010 Reported rate
EOC045-0020 Lower Confidence Interval
EOC045-0030 Upper Confidence Interval
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 glaucomatous conditions. (HEDIS 2008, Volume 2: Technical Specification, Pg. 84)
EOC050-0010 Reported Rate
EOC050-0020 Lower Confidence Interval
EOC050-0030 Upper Confidence Interval
DESCRIPTION - The percentage of members 18 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. (HEDIS 2008, Volume 2: Technical Specification, Pg. 121)
EOC055-0010 Reported rate
EOC055-0020 Lower Confidence Interval
EOC055-0030 Upper Confidence Interval
DESCRIPTION - The following components of this measure assess the management of urinary incontinence 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 2008, Volume 2: Technical Specification, Pg. 184)
EOC060-0010 Discussing Urinary Incontinence Rate
EOC060-0020 Receiving Urinary Incontinence Treatment Rate
DESCRIPTION - The percentage of members who were diagnosed with rheumatoid arthritis and who were dispensed at least one ambulatory prescription for a disease modifying anti-rheumatic drug (DMARD). (HEDIS 2008, Volume 2: Technical Specification, Pg. 142)
EOC065-0010 Reported rate
EOC065-0020 Lower Confidence Interval
EOC065-0030 Upper Confidence Interval
DESCRIPTION - • The percentage of Medicare members 65 years of age and older who received at least one high risk medication
• The percentage of Medicare members 65 years of age and older who received at least two different high risk medications
For both rates, a lower rate represents better performance
(HEDIS 2008, Volume 2: Technical Specification, Pg. 178)
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
DESCRIPTION - The percentage of members 18 years of age and older who received at least a 180-days supply of ambulatory medication therapy for a select 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 four 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
• Total rate (the sum of the four numerators divided by the sum of the four denominators)
(HEDIS 2008, Volume 2: Technical Specification, Pg. 168)
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
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. (HEDIS 2008, Volume 2: Technical Specification, Pg. 101)
EOC080-0010 Reported rate
EOC080-0020 Lower Confidence Interval
EOC080-0030 Upper Confidence Interval
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 2008, Volume 2: Technical Specification, Pg. 186)
EOC085-0010 Discussing Physical Activity Rate
EOC085-0020 Advising Physical Activity Rate
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). For all three rates, a lower rate represents better performance.
(HEDIS 2008, Volume 2: Technical Specification, Pg. 173)
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
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 a 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 a practitioner in the past 12 months and who received fall risk intervention from their current practitioner.
(HEDIS 2008, Volume 2: Technical Specification, Pg. 183)
EOC095-0010 Discussing Falls Risk Rate
EOC095-0020 Discussing Falls Risk Rate
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 2008, Volume 2: Technical Specification, Pg. 185)
EOC100-0010 Osteoporosis Testing Percent
DESCRIPTION - The percentage of COPD exacerbations for members 40 years of age and older who had an acute inpatient discharge or ED encounter between January 1–December 1 of the measurement year and who were dispensed appropriate medications. Two rates are reported.
1. Dispensed a systemic corticosteroid within 14 days of the event
2. Dispensed a bronchodilator within 30 days of the event
(HEDIS 2008, Volume 2: Technical Specification, Pg. 103)
EOC105-0010 Reported rate - Systemic corticosteroid
EOC105-0020 Lower 95% confidence interval - Systemic corticosteroid
EOC105-0030 Upper 95% confidence interval - Systemic corticosteroid
EOC105-0040 Reported rate - Bronchodilator
EOC105-0050 Lower 95% confidence interval - Bronchodilator
EOC105-0060 Upper 95% confidence interval - Bronchodilator
DESCRIPTION - General organization Information. These fields are not explicitly identified in the HEDIS Technical Specifications.
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.)
General-0050 12/2007 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
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 2008, Volume 2: Technical Specification, Pg. 399)
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
HPS403-0410 Years in Bus. PPO-Medicaid
HPS403-0420 Membership PPO-Medicaid
HPS403-0430 Years in Bus. POS-Medicaid
HPS403-0440 Membership POS-Medicaid
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
• Other physician specialists
Board certification refers to the various specialty certification programs of the American Board of Medical Specialties and the American Osteopathic Association. The organization should report separately for each product as of December 31 of the measurement year. (HEDIS 2008, Volume 2: Technical Specification, Pg. 371)
PDI801-0010 Family Medicine Board Cert Pct
PDI801-0030 Oth Specialists Board Cert Pct
PDI801-0050 Geriatricians Board Cert Pct
PDI801-0060 Internal Medicine Board Cert Pct
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 members during the measurement year and stratified by Medicaid eligibility category, age and sex. The organization 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 members during the measurement year, stratified by product line, age and sex.
(HEDIS 2006, Volume 2: Technical Specification, Pg. 375)
PDI806-0010 Enr by Product Line Tot M
PDI806-0020 Enr by Product Line Tot F
PDI806-0030 Enr by Product Line Tot Tot
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. 387)
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
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
DESCRIPTION - An unduplicated count and percentage of members enrolled any time during the measurement year by race and ethnicity. (HEDIS 2008, Volume 2: Technical Specification, Pg. 390)
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
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
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
DESCRIPTION - The number of members enrolled as of December 31 of the measurement year, by state. (HEDIS 2008, Volume 2: Technical Specification, Pg. 386)
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
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
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.
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)
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 organization reports the absolute number of procedures and the number of procedures per 1,000 member months.
• For commercial and Medicare members, the organization reports the absolute number of procedures and the number of procedures per 1,000 member years.
(HEDIS 2006, Volume 2: Technical Specification, Pg. 253)
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
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
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
DESCRIPTION - This measure summarizes utilization of acute inpatient services in the following categories.
• Total inpatient
• Medicine
• Surgery
• Maternity
(HEDIS 2008, Volume 2: Technical Specification, Pg. 271)
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
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
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
DESCRIPTION - This measure summarizes utilization of ambulatory care in the following service categories.
• Outpatient Visits
• ED Visits
• Ambulatory Surgery/Procedures
• Observation Room Stays
(HEDIS 2008, Volume 2: Technical Specification, Pg. 264)
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
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
DESCRIPTION - This measure summarizes utilization of nonacute inpatient care in hospice, nursing home, rehabilitation, SNF, transitional care and respite. (HEDIS 2008, Volume 2: Technical Specification, Pg. 278)
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
DESCRIPTION - The number and percentage of members receiving the following mental health services during the measurement year.
• Any services
• Inpatient
• Intensive outpatient or partial hospitalization
• Outpatient or ED
(HEDIS 2006, Volume 2: Technical Specification, Pg. 286)
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
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
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
DESCRIPTION - TThis measure summarizes data on outpatient utilization of drug prescriptions, stratified by age, during measurement year. The following data are reported.
• Total cost of prescriptions
• Average cost of prescriptions PMPM
• Total number of prescriptions
• Average number of prescriptions PMPY
(HEDIS 2008, Volume 2: Technical Specification, Pg. 302)
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
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/
DESCRIPTION - This measure summarizes the number and percentage of members with an alcohol and other drug (AOD) claim who received the following chemical dependency services during the measurement year.
• Any services
• Inpatient
• Intensive outpatient or partial hospitalization
• Outpatient or ED
An AOD claim contains a diagnosis of AOD abuse or dependence and a specific AOD-related service.
(HEDIS 2008, Volume 2: Technical Specification, Pg. 281)
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
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
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
DESCRIPTION - This measure summarizes the following data on outpatient utilization of antibiotic prescriptions during the measurement year, stratified by age and gender.
• 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 2008, Volume 2: Technical Specification, Pg. 291)
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
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
UOS522-0645 AC Azithromycin and Clarithromycin Scrips F Tot Num
UOS522-0650 AC Azithromycin and Clarithromycin Scrips MF Tot Num
UOS522-0660 AC Amoxicillin/Clavulanate Scrips M Tot Num
UOS522-0670 AC Amoxicillin/Clavulanate Scrips F Tot Num
UOS522-0680 AC Amoxicillin/Clavulanate Scrips MF Tot Num
UOS522-0690 AC Ketolide Scrips M Tot Num
UOS522-0700 AC Ketolide Scrips F Tot Num
UOS522-0710 AC Ketolide Scrips MF Tot Num
UOS522-0720 AC Clindamycin Scrips M Tot Num
UOS522-0730 AC Clindamycin Scrips F Tot Num
UOS522-0740 AC Clindamycin Scrips MF Tot Num
UOS522-0750 AC Misc Antibiotics of Concern Scrips M Tot Num
UOS522-0760 AC Misc Antibiotics of Concern Scrips F Tot Num
UOS522-0770 AC Misc Antibiotics of Concern Scrips MF Tot Num
UOS522-0780 AO Absorbable Sulfonamide Scrips M Tot Num
UOS522-0790 AO Absorbable Sulfonamide Scrips F Tot Num
UOS522-0800 AO Absorbable Sulfonamide Scrips MF Tot Num
UOS522-0810 AO Aminoglycoside Scrips M Tot Num
UOS522-0820 AO Aminoglycoside Scrips F Tot Num
UOS522-0830 AO Aminoglycoside Scrips MF Tot Num
UOS522-0840 AO 1st Generation Cephalosporin Scrips M Tot Num
UOS522-0850 AO 1st Generation Cephalosporin Scrips F Tot Num
UOS522-0860 AO 1st Generation Cephalosporin Scrips MF Tot Num
UOS522-0870 AO Lincosamide Scrips M Tot Num
UOS522-0880 AO Lincosamide Scrips F Tot Num
UOS522-0890 AO Lincosamide Scrips MF Tot Num
UOS522-0900 AO Macrolide (not azith or clarith) Scrips M Tot Num
UOS522-0910 AO Macrolide (not azith or clarith) Scrips F Tot Num
UOS522-0920 AO Macrolide (not azith or clarith) Scrips MF Tot Num
UOS522-0930 AO Penicillin Scrips M Tot Num
UOS522-0940 AO Penicillin Scrips F Tot Num
UOS522-0950 AO Penicillin Scrips MF Tot Num
UOS522-0960 AO Tetracycline Scrips M Tot Num
UOS522-0970 AO Tetracycline Scrips F Tot Num
UOS522-0980 AO Tetracycline Scrips MF Tot Num
UOS522-0990 AO Misc Antibiotic Scrips M Tot Num
UOS522-1000 AO Misc Antibiotic Scrips F Tot Num
UOS522-1010 AO Misc Antibiotic Scrips MF Tot Num