P R I M E R. Medicaid and MinnesotaCare. Health Plan Employer Data and Information Set (HEDIS) HEDIS 2002 Results Calendar Year 2001 Data.

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1 P R I M E R on the Medicaid and MinnesotaCare Health Plan Employer Data and Information Set (HEDIS) HEDIS 22 Results Calendar Year 21 Data Minnesota Department of Human Services Performance Measurement and Quality Improvement January 23 DM-119

2 For more information contact: Robert Lloyd Minnesota Department of Human Services Performance Measurement and Quality Improvement Health Program Quality 444 Lafayette Road North St. Paul, MN Phone: This document is available on the Internet at: This document is available in other forms to people with disabilities by contacting us at (voice). TDD users can call the Minnesota Relay at 711 or For the Speech-to-Speech Relay, call For detailed/complete HEDIS data, contact the Minnesota Department of Health website at: HEDIS 22, Volume 2: Technical Specifications may be purchased from National Committee for Quality Assurance Customer Support at [HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).]

3 P R I M E R on the Medicaid and MinnesotaCare Health Plan Employer Data and Information Set (HEDIS) HEDIS 22 Results Calendar Year 21 Data Performance Measurement and Quality Improvement January 23

4 Table of Contents Part I: HEDIS Primer Introduction Comparing MCO Performance How HEDIS Reporting Works How HEDIS Data Are Computed How HEDIS Data Should Be Used How HEDIS Data Appear in Publication HEDIS Report For Calendar Year Part II: HEDIS 22 Report For Calendar Year Report Summary Report Format Limitations Trends Effectiveness and Utilization Measures Childhood Immunization Status - Combination # Childhood Immunization Status - Combination # Adolescent Immunization Status - Combination # Chlamydia Screening in Women Overall Rate Age Antidepressant Medication Management - Effective Acute Phase Treatment Antidepressant Medication Management Effective Continuation Phase Treatment Adults Access to Prevention/Ambulatory Services - Age Adults Access to Prevention/Ambulatory Services - Age HEDIS Primer 4 January 23

5 Table of Contents (continued) Children s Access to Primary Care Practitioners - Age Months Children s Access to Primary Care Practitioners - Age 2-6 Years Children s Access to Primary Care Practitioners - Age 7-11 Years Well-Child Visits in First 15 Months of Life Six or More Visits Well-Child Visits in 3 rd, 4 th, 5 th and 6 th Years of Life Adolescent Well-Care Visits Inpatient Utilization - General Hospital/Acute Care - Average Length of Stay Trend Measures Childhood Immunizations - Diphtheria/Tetanus/Pertussis Childhood Immunizations - Polio Childhood Immunizations - Mumps/Measles/Rubella Childhood Immunizations - Chicken Pox Comprehensive Diabetic Care - Diabetic Eye Care Well-Child Visits in 3 rd, 4 th, 5 th and 6 th Years of Life Diabetes HbA1c Testing - MSHO Program Controlling High Blood Pressure MSHO Program Appendix I: Enrolled Populations of Minnesota s Managed Care Organizations Public Health Care Programs Appendix II: HEDIS 22 Measures Required for Minnesota s Public Health Care Programs in Calendar Year Appendix III: HEDIS Measures and Results For MSHO and GAMC Programs in Calendar Year HEDIS Primer 5 January 23

6 HEDIS Primer 6 January 23

7 Part I HEDIS Primer HEDIS Primer 7 January 23

8 Health Plan Employer Data and Information Set Standard Performance Measures for MCOs Legislators, health care managers, consumers, and others may find HEDIS data useful Comparing Performance Among MCOs Introduction The Health Plan Employer Data and Information Set (HEDIS ) is today s national standard for assessing the performance of managed health care organizations (MCOs). HEDIS was developed and is maintained by the National Committee for Quality Assurance (NCQA). The State of Minnesota uses HEDIS as part of its effort to assess the performance of its contracted MCOs. The State contracts with eight MCOs to provide care to citizens enrolled in several publicly funded health care programs, most notably, the Prepaid Medical Assistance Program (PMAP) and MinnesotaCare. HEDIS consists of a set of performance measures across several domains. Those domains include Effectiveness of Care, Access and Availability of Care, Use of Services, and MCO descriptive information. The HEDIS measurements, reported by the MCOs, typically take the form of percentages, such as the percentage of children of immunization age who received their immunizations. All HEDIS measurements are annual. The primary goal of HEDIS is to provide standardized objective measures of the quality of care and services provided to managed care enrollees. These measures can alert the State and the MCOs to areas needing additional attention. For example, an MCO that, according to HEDIS information, is providing fewer childhood immunizations than other MCOs, might analyze its provider network, its policies, and its procedures, and based on what it finds implement a new approach to address the problem. HEDIS information can also effect how the State chooses to purchase services for its public programs. The State may provide incentive opportunities, both financial and non-financial, to encourage MCOs to improve performance on particular HEDIS measures. Those who may find this document useful include legislators, managers and regulators of state-funded health care programs, health care consumers, and others concerned about the quality of health care provided to enrollees of Minnesota s publicly funded programs. Comparing MCO Performance When comparing performance among MCOs on a given measure such as their rates of childhood immunization it is important to consider more than the HEDIS information itself. Differences in the populations enrolled by the MCOs can affect the HEDIS information. Differences in data systems operated by the MCOs can affect how the information is produced. Because many MCOs use sampling procedures to produce HEDIS data, and HEDIS Primer 8 January 23

9 Observed differences and confidence intervals Administrative databases and medical records as data sources HEDIS data are rates because this often limits them to small sample sizes, results on HEDIS measures can have large confidence intervals that confound comparisons. For example, in Figure 1, MCO A s immunization rate is 6.6%. MCO B s rate is 55.1%. Each has a confidence interval of ±1%. We cannot conclude in this example that the observed difference in rates is an actual, or true, difference, because the confidence intervals of the two MCOs overlap. % Figure 1: Immunization Rate Example, Showing Confidence Intervals 6.6 Plan A 1% confidence intervals 55.1 Plan B How HEDIS Reporting Works The Minnesota Department of Health (MDH) issues HEDIS reporting requirements to all licensed MCO s each year, including requirements for those MCOs contracted by the Minnesota Department of Human Services (DHS) for its state-funded health care programs. In practice, the MCOs report their HEDIS data to NCQA. After performing some data quality checks, NCQA sends the data to MDH, which then summarizes and distributes the HEDIS data to various audiences, including researchers, legislators, and public health programs. MDH sends the data to DHS as well, where the data are incorporated into health care purchasing and contracting decisions. The MCOs derive their HEDIS data annually from administrative databases (computerized health care claims), or from medical records data when administrative data are inadequate or unavailable. Most of the MCOs in Minnesota use a combination of administrative and medical records data, which is referred to as the hybrid method of reporting. In calendar year 22, seven DHS-contracted MCOs submitted HEDIS data: Blue Plus First Plan HealthPartners Itasca Medical Care (IMC) Medica Health Plans (Medica) Metropolitan Health Plan (MHP) UCare Minnesota (UCare) The data submitted by these MCOs were for services provided in calendar year 21. How HEDIS Data Are Computed Each MCO can report data on up to 5 or more measures. As mentioned, the data typically take the form of percentages, such as the percentage of persons eligible for a service who actually received the service during the year. Sometimes the data take other forms. For inpatient services, average length of stay (in days), or number of discharges per 1 enrollees, are used. From this point HEDIS Primer 9 January 23

10 The devil is in the denominator Many factors can influence rate differences among MCOs forward, this document refers to all of these measurements simply as rates. To compute their rates, it is important for the MCOs to select the correct numerator and denominator. HEDIS reporting requirements include precise instructions for this. As an example, when asked to compute the percentage of its enrollees immunized against chicken pox during the year, the MCO must first select those individuals in its enrolled population who would need such a service that year. That would be the denominator. The MCO then selects those persons who actually received the immunization the numerator. The computation from that point on is straightforward (see Figure 2). Most of the complexity in deriving HEDIS rates is in the detailed instructions for selecting individuals into the denominators and numerators. Denominator: enrollees meeting specified criteria Rate = Numerator Denominator Figure 2: Rate Computation X 1 Total Enrolled Population Numerator: service recipients When the hybrid method is used, the MCO draws a random sample of records from which to estimate its rates for the whole population. Because these results are estimates, they come with confidence intervals (Figure 1). For some measures, certain MCOs have denominators that are too small to provide statistically reliable rates. These MCOs may not report the rates for these measures, but do report the denominators and numerators. The results reported in Part II of this document include some rates that were not reported by MCOs, but were computed by DHS from reported denominators and numerators. How HEDIS Data Should Be Used Carefully. Many factors can influence an MCO s performance its rate on a given measure. From year to year, there will be fluctuations in rates due simply to chance. More significant changes in rates can be due to changes in coverage, in reimbursement rates, in data systems, in the definitions of measures from year to year, in availability of alternative service providers, or in the makeup of the enrolled populations. (See Appendix I for information on the enrolled populations of Minnesota s contracted MCOs.) HEDIS rates will vary among MCOs, and comparisons among MCOs are unavoidable. Differences in data systems and in enrolled populations, from MCO to MCO, to some extent affect observed differences in HEDIS rates. HEDIS Primer 1 January 23

11 Data leakage Performance is best assessed using an array of measures External standards are useful Use of alternative providers can have similar effects. For example, MCO A s immunization rate might be lower than MCO B s rate because many of MCO A s enrollees received their immunizations from public health clinics rather than through the MCO. This results in the data leakage effect. No one measure tells the story about an MCO s performance. It is best to look at an array of measures related to a single aspect of health care, such as prevention, or to a narrowly defined population, such as young children, or to a specific health problem, such as diabetes (Figure 3). Comparison to some sort of external standard is also useful. Figure 3: Making Comparisons Among MCOs Look across an array of measures related to: - a narrowly defined population - a specific health problem Use external standards, if available Consider differences among MCOs: - in their enrolled populations - in their provider networks Performance standards are hard to come by. However, some national Medicaid HEDIS data are available, against which the performance of MCOs can be assessed. Again, it is consistent patterns of performance across an array of measures, and over time, that make the best basis for comparison. How HEDIS Data Appear In Publication Both MDH and DHS publish HEDIS data. The data are also made available by the NCQA, and by MCOs. The sheer quantity of data argues for presentation in the form of tables, such as the table shown in Figure 4. Note that this example is for only one submeasure of the childhood immunization measure. More tables would be required to present all the immunization data, and many more to present all measures. Numerators and denominators are not included in Figure 4, nor is other information such as confidence intervals or the method of data collection. Figure 4: HEDIS Data in Table Measure: Childhood Immunization Rate Submeasure: Chicken Pox Product Line MCO PMAP MinnesotaCare Commercial A B C Because important patterns are sometimes hard to identify in tabular data, HEDIS data are often presented in graphic form. Figure 5 is an example of the style of graphic presentation used in Part II of this document. It combines MCO data on public programs with data on national Medicaid average, MCO average, and commercial (non-public) product lines. Use of the bar-chart format facilitates comparisons across MCOs and between MCOs and selected standards. HEDIS Primer 11 January 23

12 % Figure 5: HEDIS Data in Chart National Average Commercial Rate MCO Average Plan A Plan B Plan C MCO s Rate HEDIS Report For Calendar Year 21 Part II contains HEDIS 22 results for measurement year 21. Results for 15 measures are included, representing about 3% of all required HEDIS measures for that year (Appendix II). With each measure comes a description of the measure, and the specific criteria used for identifying the denominator and numerator of the calculation. Part II also contains trend data on seven HEDIS measures. The trend data cover calendar years 1998 through 21. Trend analysis adds an additional dimension and new information to any assessment of MCO performance. Those readers interested in seeing the detailed specifications for HEDIS 22 measures should request the publication HEDIS 22, Volume 2: Technical Specifications from the NCQA. HEDIS Primer 12 January 23

13 Part II HEDIS 22 Report for Calendar Year 21 HEDIS Primer 13 January 23

14 PMAP MinnesotaCare Only a subset of HEDIS 22 measures are reported here See Minnesota Department of Health website for more details Report Summary The HEDIS 22 measures selected for this report are those believed best suited for making comparisons among MCOs, and between MCOs and national Medicaid averages. Those readers who want to see more HEDIS results than are presented here should contact the Minnesota Department of Health website (see inside cover of this document). This report presents data primarily for the Prepaid Medical Assistance Program (PMAP) and the MinnesotaCare Program. HEDIS data on the Minnesota Senior Health Options (MSHO) and General Assistance Medical Care (GAMC) programs can be found in Appendix III. Results vary from measure to measure. Some general findings stand out, however: Minnesota s MCOs meet or exceed national Medicaid averages for 67% of the HEDIS measures considered here. (By MCO: Blue Plus- 6%; First Plan-47%; HealthPartners-83%; IMC-5%; Medica-7%; MHP-7%; UCare- 57%.) Variation in performance among Minnesota s MCOs is significant on many HEDIS measures. Those MCOs that most consistently exceed the average performance among Minnesota s MCOs are HealthPartners and MHP. Despite favorable results in relation to national averages, in many cases Minnesota MCOs Medicaid and MinnesotaCare plans are not meeting the goal of matching the performance of the MCOs own commercial plans. Those readers who want to see more of the HEDIS results than are presented here should contact the Minnesota Department of Health website (see inside cover of this document). Report Format Two bar-charts are presented for each measure: one for the PMAP program and one for the MinnesotaCare program. In the charts, MCO names are indicated along the bottom (horizontal) axis, and the rate (usually a percentage) is shown on the vertical axis. Because most of the MCOs use the hybrid method for deriving their HEDIS data, drawing some cases from their administrative data systems and some from medical records samples, the data represent estimates. As estimates, some degree of sampling error, or uncertainty, attaches to them. For example, if MCO A s reported rate for the chicken pox immunization measure is 62%, it should be understood that the actual figure, were it known, could be plus or minus some number of percentage points from that figure perhaps 5%. In that case the actual rate would lie somewhere between 57% and 67%. For this reason, when comparing rates among MCOs, differences of a few percentage HEDIS Primer 14 January 23

15 National Medicaid average and MCO average Commercial rates As targets points are not meaningful differences. Figure 6 is a replica of Figure 5 from Part I, with confidence intervals added just below the reported rate. The confidence interval for MCO B, for instance, is ±7%. Figure 6 is the basic format of the charts that follow in this report. % ±5 Figure 6: HEDIS Data in Chart National Average Commercial Rate ±7 ±12 MCO Average Plan A Plan B Plan C MCO s Rate Confidence Interval Also included on most bar-charts are two lines. The solid line indicates the national Medicaid average for the measure, as provided by the NCQA s Quality Compass 22. This average is only available as the combined average for all public programs, and is therefore the same in each chart, where ideally we would have separate national averages for each program. The dashed line on the charts indicates the weighted average among the seven Minnesota MCOs. (These are weighted by the proportion of each MCOs sample size to the total sample size of all MCOs combined.) The small pyramids show the commercial rates reported by some MCOs for the measure. For other MCOs these rates are not available. Along with the bar-charts, the following pages provide a Description of each measure, the criteria used to select enrollees into the denominator and numerator used to compute the rate, and a brief Discussion. The criteria listed for each measure are the criteria specified for administrative data. In some cases, criteria for medical records data can be somewhat different. Criteria may be simplified from actual operational specifications that can fill pages with detailed text and tables. Discussion sections mention a pattern of features of the charts, such as MCOs with rates above the national average, and any special limitations of the data or cautions on interpretation of the data. Limitations As already mentioned, the following pages contain results on a limited set of HEDIS 22 measures. This report further limits the presentation by, in some cases, collapsing rates for several age groups or gender groups into a single rate, or by selecting a single submeasure from a range of submeasures. For example, the measure Well-Child Visits in the First 15 Months of Life is reported by the MCOs as seven submeasures the percent of children receiving zero visits, one visit, two visits, etc. Here only one submeasure is presented: 6 or more visits. HEDIS Primer 15 January 23

16 Unreported rates are computed Changes over time are instructive Some MCOs may not report rates for some measures because there is an insufficient number of eligible enrollees (i.e., the size of the denominator is too low to produce reliable results). Where no MCO rates are reported, DHS computes the rate from the denominator and numerator reported by the MCO. To remind the reader, HEDIS data must be carefully used. Consideration should be given to all the issues attached to data quality and completeness, MCO reporting capabilities, differences among MCO s enrolled populations, changes in measure definitions, etc. Although standards such as the national Medicaid average or the average among Minnesota s MCOs provide comparison points, the fact that an MCO meets or exceeds the standard does not mean that further improvement is not possible or desirable. Trends Beginning on page 48, this report presents trend charts covering the years 1998 through 21. Recalling that one of the major uses of HEDIS data is quality improvement, monitoring a measure s trend over time can reveal progress toward performance standards or targets. Sometimes the degree of progress can be more important than the status of a measure at a single point in time. When a low-performing MCO shows significant improvement, even though its rates are still lower than other MCOs, there is an indication that it is doing something right. Whatever that something is could be useful in other settings. Another advantage of trend analysis is that it can reveal single-point-in-time aberrations. Rates sharply different from preceding or subsequent time periods may be erroneous in some way. One caution when comparing an MCO s performance against itself over time is that the definition of measures may change in subtle or in major ways from year to year, even though they may go by the same name. In some cases, specific procedure codes have been added to, or dropped from, the set of codes specified for a measure. A change in the method of data collection (administrative to medical records, for instance) can also complicate trend analyses. The trend analyses presented here are for carefully selected measures, those with consistency in definition over time. Because HEDIS data are annual, the trends depicted are from year to year. Most of the trends in this report pertain to the PMAP and MinnesotaCare programs; however, the last two pertain to the Minnesota Senior Health Options (MSHO) program. HEDIS Primer 16 January 23

17 HEDIS Primer 17 January 23

18 Measure: Childhood Immunization Status - Combination #1 Description Discussion The percentage of eligible children (denominator) who received a defined combination of vaccinations (numerator). Denominator: a. Children who were enrolled in the program on their second birthday, and b. who turned two years old during 21, and c. who were enrolled in the MCO for the 12 months immediately preceding their second birthday, with no more than one one-month gap in enrollment. Numerator: Of the denominator group, those who received four diphtheria/tetanus/pertussis vaccinations, three polio vaccinations, one mumps/measles/rubella vaccination, two H influenza type B vaccinations, and three hepatitis B vaccinations. PMAP a. The rates of four of the seven MCOs meet or exceed the national Medicaid average (58.9) for this measure. b. The average rate among Minnesota MCOs (55.4) falls slightly below the national Medicaid average. c. The range from highest to lowest rate is 26 percentage points. d. None of the MCOs rates exceed their commercial rates. MinnesotaCare a. The rates of five MCOs meet or exceed the national Medicaid average for this measure. b. The average rate among Minnesota MCOs (62.6) slightly exceeds the national Medicaid average. c. The range from highest to lowest rate is about 33 percentage points (discounting rates with large confidence intervals). d. Two MCOs (First Plan, Medica) meet or exceed their commercial rates. Further Cautions or Information: a. The upper confidence limits for First Plan/PMAP, MHP/MinnesotaCare and UCare/MinnesotaCare would also meet the national Medicaid averages. b. The MinnesotaCare rate for IMC is based on a small sample size. HEDIS Primer 18 January 23

19 Childhood Immunization Status - Combination #1 CY 21 1 National Medicaid Avg. MCO Avg. Commercial Rate ±n Confidence Interval 9 8 PMAP ±5 ±12 ±5 ±8 ±5 ±5 ±5 Blue Plus First Plan HealthPartners IM C M edica M HP UCare MinnesotaCare ±5 ±2 ±7 ±3 ±7 ±2 ±7 Blue Plus First Plan HealthPartners IM C M edica M HP UCare HEDIS Primer 19 January 23

20 Measure: Childhood Immunization Status - Combination #2 Description Discussion The percentage of eligible children (denominator) who received a defined combination of vaccinations (numerator). Denominator: a. Children who were enrolled in the program on their second birthday, and b. who turned two years old during 21, and c. who were enrolled in the MCO for the 12 months immediately preceding their second birthday, with no more than one one-month gap in enrollment. Numerator: Of the denominator group, those who received four diphtheria/tetanus/pertussis vaccinations, three polio vaccinations, one mumps/measles/rubella vaccination, two H influenza type B vaccinations, three hepatitis B vaccinations, and at least one chicken pox vacination. PMAP a. The rate of only one of the seven MCOs meets or exceeds the national Medicaid average (52.5) for this measure. b. The average rate among Minnesota MCOs (47.1) falls five points below the national Medicaid average. c. The range from highest to lowest rate is 34 percentage points. d. None of the MCOs rates exceed their commercial rates. MinnesotaCare a. The rates of four MCOs meet or exceed the national Medicaid average for this measure. b. The average rate among Minnesota MCOs (51.2) falls slightly below the national Medicaid average. c. The range from highest to lowest rate is 61 percentage points. d. Two MCOs (First Plan, Medica) meet or exceed their commercial rate. Further Cautions or Information: a. The upper confidence limits for Blue Plus/PMAP and Medica/PMAP would also meet the national Medicaid average. b. The upper confidence limit for UCare/MinnesotaCare would also meet the national Medicaid average. HEDIS Primer 2 January 23

21 Childhood Immunization Status - Combination #2 CY 21 1 National Medicaid Avg. MCO Avg. Commercial Rate ±n Confidence Interval PMAP ±5 ±5 ±5 ±5 ±5 ±5 ±5 Blue Plus First Plan HealthPartners IM C M edica M HP UCare MinnesotaCare ±5 ±26 ±7 ±2 ±7 ±2 ±7 Blue Plus First Plan HealthPartners IM C M edica M HP UCare HEDIS Primer 21 January 23

22 Measure: Adolescent Immunization - Combination #1 Description Discussion The percentage of eligible adolescents (denominator) who received a defined combination of vaccinations (numerator). Denominator: a. Children who were enrolled in the program on their 13th birthday, and b. who turned 13 years old during 21, and c. who were enrolled in the MCO for the 12 months immediately preceding their 13th birthday, with no more than one one-month gap in enrollment. Numerator: Of the denominator group, those who received a second measles/mumps/rubella vaccination and three hepatitis B vaccinations by their 13 th birthday. PMAP a. The rates of four of the seven MCOs meet or exceed the national Medicaid average (37.3) for this measure. b. The average rate among Minnesota MCOs (42.3) is five points above the national Medicaid average. c. The range from highest to lowest rate is 27 percentage points. d. None of the MCOs rates exceed their commercial rates. MinnesotaCare a. The rates of six MCOs meet or exceed the national Medicaid average for this measure. b. The average rate among Minnesota MCOs (44.) exceeds the national Medicaid average by about seven percentage points. c. The range from highest to lowest rate is 49 percentage points. d. One MCO (Blue Plus) meets its commercial rate. Further Cautions or Information: IMC failed to report a PMAP rate or numerator for this measure. HEDIS Primer 22 January 23

23 Adolescent Immunization Status - Combination #1 CY 21 1 National Medicaid Avg. MCO Avg. Commercial Rate ±n Confidence Interval PMAP ±5 ±13 ±5 ±5 ±5 ±5 Blue Plus First Plan HealthPartners IM C M edica M HP UCare MinnesotaCare ±5 ±22 ±7 ±12 ±5 ±2 ±5 Blue Plus First Plan HealthPartners IM C M edica M HP UCare HEDIS Primer 23 January 23

24 Measure: Chlamydia Screening in Women Overall Rate Age Description Discussion The percentage of eligible women (denominator) who received at least one test for chlamydia (numerator) during the year. Denominator: a. Women aged as of Dec. 31, 21, b. who were enrolled in the MCO as of Dec. 31, 21, and c. who were enrolled in the MCO for a least eleven months of 21, and d. who were sexually active during 21. Numerator: Of the denominator group, those who received at least one chlamydia test during the year. PMAP a. The rates of three of the seven MCOs meet or exceed the national Medicaid average (4.4) for this measure. b. The average rate among Minnesota MCOs (42.7) slightly exceeds the national Medicaid average. c. The range from highest to lowest rate is 44 percentage points. d. Where commercial rates were reported, PMAP rates exceed commercial rates. MinnesotaCare a. The rate of only one MCO meets or exceeds the national Medicaid average for this measure. b. The average rate among Minnesota MCOs (26.7) falls well below the national Medicaid average. c. The range from highest to lowest rate is 34 percentage points. d. Where commercial rates were reported, MinnesotaCare rates exceed commercial rates. Further Cautions or Information: a. The upper confidence limits for First Plan/PMAP and IMC/PMAP would also meet the national Medicaid average. b. The upper confidence limit for HealthPartners/MinnesotaCare would also meet the national Medicaid average. HEDIS Primer 24 January 23

25 Chlamydia Screening in Women Overall Rate Age CY 21 1 National Medicaid Avg. MCO Avg. Commercial Rate ±n Confidence Interval PMAP ±2 ±8 ±3 ±12 ±2 ±8 ±2 Blue Plus First Plan HealthPartners IM C Medica M HP UCare MinnesotaCare ±2 ±6 ±4 ±12 ±3 ±12 ±2 Blue Plus First Plan HealthPartners IMC M edica M HP UCare HEDIS Primer 25 January 23

26 Measure: Antidepressant Medication Management Effective Acute Phase Treatment Description Discussion The percentage of eligible adults newly diagnosed with major depression (denominator) who received a specified level of care during the 12 weeks subsequent to diagnosis (numerator). Denominator: a. Adults 18 and older during the year who were newly diagnosed with major depression in 21, and b. who filled a prescription for antidepressant medication near the time of diagnosis, and c. who had pharmacy and mental health benefits through the MCO. Numerator: Of the denominator group, those who filled a sufficient number of prescriptions for antidepressant medication to provide continuous treatment for at least 12 weeks. PMAP a. The rates of six of the seven MCOs meet or exceed the national Medicaid average (45.5) for this measure. b. The average rate among Minnesota MCOs (46.3) slightly exceeds the national Medicaid average. c. The range from highest to lowest rate is 54 percentage points. d. Only one MCO (First Plan) meets or exceeds its commercial rate. MinnesotaCare a. The rates of all seven MCOs exceed the national Medicaid average for this measure. b. The average rate among Minnesota MCOs (6.1) exceeds the national Medicaid average by 12 percentage points. c. The range from highest to lowest rate is 46 percentage points. d. Two MCOs (Blue Plus, First Plan) exceed their commercial rates. Further Cautions or Information: The MinnesotaCare rates for First Plan, IMC, and MHP are based on very small sample sizes. HEDIS Primer 26 January 23

27 Antidepressant Medication Management Effective Acute Phase Treatment CY 21 1 National Medicaid Avg. MCO Avg. Commercial Rate ±n Confidence Interval PMAP ±8 ±15 ±6 ±35 ±6 ±2 ±6 Blue Plus First Plan HealthPartners IMC M edica M HP UCare MinnesotaCare ±5 ±3 ±7 ±4 ±1 ±4 ±8 Blue Plus First Plan HealthPartners IMC Medica MHP UCare HEDIS Primer 27 January 23

28 Measure: Antidepressant Medication Management Effective Continuation Phase Treatment Description Discussion The percentage of eligible adults newly diagnosed with major depression (denominator) who received a specified level of care during the six months subsequent to diagnosis (numerator). Denominator: a. Adults 18 and older during the year who were newly diagnosed with major depression in 21, and b. who filled a prescription for antidepressant medication near the time of diagnosis, and c. who had pharmacy and mental health benefits through the MCO. Numerator: Of the denominator group, those who filled a sufficient number of prescriptions for antidepressant medication to provide continuous treatment for at least six months. PMAP a. The rates of five of the seven MCOs meet or exceed the national Medicaid average (3.) for this measure. b. The average rate among Minnesota MCOs (33.1) slightly exceeds the national Medicaid average. c. The range from highest to lowest rate is 35 percentage points. d. One MCO (First Plan) meets or exceeds its commercial rate. MinnesotaCare a. The rates of all seven MCOs meet or exceed the national Medicaid average for this measure. b. The average rate among Minnesota MCOs (41.2) exceeds the national Medicaid average by 11 points. c. The range from highest to lowest rate is 68 percentage points. d. Two MCOs (Blue Plus, First Plan) meet or exceed their commercial rates. Further Cautions or Information: a. The upper confidence limit for IMC/PMAP would also meet the national Medicaid average. b. The MinnesotaCare rates for First Plan, IMC, and MHP are based on very small sample sizes. HEDIS Primer 28 January 23

29 Antidepressant Medication Management Effective Continuation Phase Treatment CY 21 1 National Medicaid Avg. MCO Avg. Commercial Rate ±n Confidence Interval PMAP ±8 ±32 ±6 ±3 ±5 ±2 ±6 Blue Plus First Plan HealthPartners IMC M edica M HP UCare MinnesotaCare ±5 ±3 ±7 ±4 ±9 ±4 ±8 Blue Plus First Plan HealthPartners IM C M edica M HP UCare HEDIS Primer 29 January 23

30 Measure: Adults Access to Preventive/Ambulatory Health Services - Age 2-44 Description Discussion The percentage of eligible adults (denominator) who received at least one preventive or ambulatory care visit (numerator). Denominator: a. Adults age 2 to 44 as of Dec. 31, 21, b. who were enrolled in the MCO on Dec. 31, 21, and c. who were enrolled in the MCO for a least eleven months of 21. Numerator: Of the denominator group, those who received one or more preventive or ambulatory care visits during the year, excluding ER visits, inpatient stays, mental health and chemical dependency services. PMAP a. The rates of all seven MCOs exceed the national Medicaid average (73.9) for this measure. b. The average rate among Minnesota MCOs (86.7) exceeds the national Medicaid average by 13 percentage points. c. The range from highest to lowest rate is 11 percentage points. d. None of the MCOs rates exceed their commercial rates. MinnesotaCare a. The rates of all seven MCOs meet or exceed the national Medicaid average for this measure. b. The average rate among Minnesota MCOs (82.7) exceeds the national Medicaid average by nine percentage points. c. The range from highest to lowest rate is 11 percentage points. d. No MCOs rates meet or exceed their commercial rates. Further Cautions or Information: None. HEDIS Primer 3 January 23

31 Adults Access to Preventive/Ambulatory Services - Age 2-44 CY National Medicaid Avg. MCO Avg. Commercial Rate ±n Confidence Interval PMAP ±1 ±4 ±1 ±4 ±1 ±2 ±1 Blue Plus First Plan HealthPartners IM C M edica M HP UCare MinnesotaCare ±1 ±2 ±1 ±3 ±1 ±4 ±1 Blue Plus First Plan HealthPartners IM C M edica M HP UCare HEDIS Primer 31 January 23

32 Measure: Adults Access to Preventive/Ambulatory Health Services - Age Description Discussion The percentage of eligible adults (denominator) who received at least one preventive or ambulatory care visit (numerator). Denominator: a. Adults age 45 to 64 as of Dec. 31, 21, b. who were enrolled in the MCO on Dec. 31, 21, and c. who were enrolled in the MCO for a least eleven months of 21. Numerator: Of the denominator group, those who received one or more preventive or ambulatory care visits during the year, excluding ER visits, inpatient stays, mental health and chemical dependency services. PMAP a. The rates of five of the seven MCOs meet or exceed the national Medicaid average (8.8) for this measure. b. The average rate among Minnesota MCOs (86.) exceeds the national Medicaid average by six percentage points. c. The range from highest to lowest rate is 12 percentage points. d. None of the MCOs rates exceed their commercial rates. MinnesotaCare a. The rates of all seven MCOs meet or exceed the national Medicaid average for this measure. b. The average rate among Minnesota MCOs (85.6) exceeds the national Medicaid average by five percentage points. c. The range from highest to lowest rate is five percentage points. d. No MCOs meet or exceed their commercial rates. Further Cautions or Information: None. HEDIS Primer 32 January 23

33 Adults Access to Preventive/Ambulatory Services - Age CY 21 1 National Medicaid Avg. MCO Avg. Commercial Rate ±n Confidence Interval PMAP ±4 ±12 ±4 ±1 ±2 ±5 ±3 Blue Plus First Plan HealthPartners IM C M edica M HP UCare MinnesotaCare ±1 ±2 ±1 ±4 ±1 ±4 ±1 Blue Plus First Plan HealthPartners IM C M edica M HP UCare HEDIS Primer 33 January 23

34 Measure: Children s Access to Primary Care Practitioners - Age months Description Discussion The percentage of eligible children (denominator) who received at least one visit with a primary care practitioner (numerator). Denominator: a. Children age 12 to 24 months as of Dec. 31, 21, b. who were enrolled in the MCO on Dec. 31, 21, and c. who were enrolled in the MCO for a least eleven months of 21. Numerator: Of the denominator group, those who received one or more visits with a primary care practitioner during 21, excluding inpatient procedures, ER and specialist visits, mental health and chemical dependency services. PMAP a. The rates of six of the seven MCOs meet or exceed the national Medicaid average (9.7) for this measure. b. The average rate among Minnesota MCOs (94.7) slightly exceeds the national Medicaid average. c. The range from highest to lowest rate is 1 percentage points. d. Three MCOs (Blue Plus, HealthPartners, Medica) meet or nearly meet their commercial rates. MinnesotaCare a. The rates of all seven MCOs meet or exceed the national Medicaid average for this measure. b. The average rate among Minnesota MCOs (96.1) exceeds the national Medicaid average by five percentage points. c. The range from highest to lowest rate is five percentage points. d. Four MCOs (Blue Plus, First Plan, HealthPartners, Medica) meet or nearly meet their commercial rates. Further Cautions or Information: None. HEDIS Primer 34 January 23

35 Children s Access to Primary Care Practitioners - Age months CY 21 National Medicaid Avg. MCO Avg. Commercial Rate ±n Confidence Interval PMAP ±1 ±4 ±1 ±3 ±1 ±1 ±1 Blue Plus First Plan HealthPartners IM C M edica M HP UCare MinnesotaCare ±2 ±6 ±2 ±12 ±2 ±2 ±2 Blue Plus First Plan HealthPartners IM C M edica M HP UCare HEDIS Primer 35 January 23

36 Measure: Children s Access to Primary Care Practitioners - Age 2-6 years Description Discussion The percentage of eligible children (denominator) who received at least one visit with a primary care practitioner (numerator). Denominator: a. Children age 2 to 6 years as of Dec. 31, 21, b. who were enrolled in the MCO on Dec. 31, 21, and c. who were enrolled in the MCO for a least eleven months of 21. Numerator: Of the denominator group, those who received one or more visits with a primary care practitioner during 21, excluding inpatient procedures, ER and specialist visits, mental health and chemical dependency services. PMAP a. The rates of all seven MCOs meet, nearly meet, or exceed the national Medicaid average (79.3) for this measure. b. The average rate among Minnesota MCOs (84.) exceeds the national Medicaid average by five percentage points. c. The range from highest to lowest rate is 11 percentage points. d. One MCO (Blue Plus) meets its commercial rate. MinnesotaCare a. The rates of all seven MCOs meet or exceed the national Medicaid average for this measure. b. The average rate among Minnesota MCOs (87.3) exceeds the national Medicaid average by eight percentage points. c. The range from highest to lowest rate is eight percentage points. d. Three MCOs (Blue Plus, HealthPartners, Medica) meet their commercial rates. Further Cautions or Information: None. HEDIS Primer 36 January 23

37 Children s Access to Primary Care Practitioners - Age 2-6 years CY 21 1 National Medicaid Avg. MCO Avg. Commercial Rate ±n Confidence Interval PMAP ±1 ±4 ±1 ±4 ±1 ±2 ±1 Blue Plus First Plan HealthPartners IM C M edica M HP UCare MinnesotaCare ±1 ±5 ±2 ±5 ±2 ±5 ±2 Blue Plus First Plan HealthPartners IMC Medica MHP UCare HEDIS Primer 37 January 23

38 Measure: Children s Access to Primary Care Practitioners - Age 7-11 years Description Discussion The percentage of eligible children (denominator) who received at least one visit with a primary care practitioner (numerator). Denominator: a. Children age 7 to 11 years as of Dec. 31, 21, b. who were enrolled in the MCO on Dec. 31, 21, and c. who were enrolled in the MCO for a least eleven months of 21. Numerator: Of the denominator group, those who received one or more visits with a primary care practitioner during 2 or 21, excluding inpatient procedures, ER and specialist visits, mental health and chemical dependency services. PMAP a. The rates of four of the seven MCOs meet or exceed the national Medicaid average (79.3) for this measure. b. The average rate among Minnesota MCOs (79.5) equates to the national Medicaid average. c. The range from highest to lowest rate is 13 percentage points. d. One MCO (Blue Plus) meets or exceeds its commercial rate. MinnesotaCare a. The rates of all seven MCOs meet or exceed the national Medicaid average for this measure. b. The average rate among Minnesota MCOs (88.4) exceeds the national Medicaid average by 1 percentage points. c. The range from highest to lowest rate is nine percentage points. d. Four MCOs (Blue Plus, First Plan, HealthPartners, Medica) meet or exceed their commercial rates. Further Cautions or Information: The upper confidence limit for First Plan PMAP would also meet the national Medicaid average. HEDIS Primer 38 January 23

39 Children s Access to Primary Care Practitioners - Age 7-11 years CY 21 1 National Medicaid Avg. MCO Avg. Commercial Rate ±n Confidence Interval PMAP ±2 ±7 ±2 ±7 ±1 ±3 ±1 Blue Plus First Plan HealthPartners IMC Medica MHP UCare MinnesotaCare ±1 ±8 ±2 ±6 ±2 ±3 ±2 Blue Plus First Plan HealthPartners IM C M edica M HP UCare HEDIS Primer 39 January 23

40 Measure: Well-Child Visits in the First 15 Months of Life - Six or More Visits Description Discussion The percentage of eligible children (denominator) who received six or more well-child visits during the first 15 months of life (numerator). Denominator: a. Children who were enrolled in the MCO on the day they turned 15 months old, and b. who turned 15 months old during 21, and c. who were enrolled in the MCO from the age of 31 days through the age of 15 months, with no more than one one-month gap in enrollment. Numerator: Of the denominator group, those who received six or more well-child visits from a primary care practitioner prior to or on the day the child turned 15 months old. PMAP a. The rates of four of the seven MCOs meet or exceed the national Medicaid average (37.3) for this measure. b. The average rate among Minnesota MCOs (4.5) slightly exceeds the national Medicaid average. c. The range from highest to lowest rate is 23 percentage points. d. Only one MCO (First Plan) meets or nearly meets its commercial rate. MinnesotaCare a. The rates of six MCOs meet or exceed the national Medicaid average for this measure. b. The average rate among Minnesota MCOs (48.) exceeds the national Medicaid average by 1 percentage points. c. The range from highest to lowest rate is 26 percentage points. d. No MCOs rates meet or exceed their commercial rates. Further Cautions or Information: a. The upper confidence limit for Blue Plus/PMAP would also meet the national Medicaid average. b. The upper confidence limit for IMC/MinnesotaCare would also meet the national Medicaid average. c. The rates for First Plan, IMC, and MHP are based on small sample sizes. HEDIS Primer 4 January 23

41 Well-Child Visits in First 15 Months of Life - 6 or More Visits CY National Medicaid Avg. MCO Avg. Commercial Rate ±n Confidence Interval PMAP ±2 ±12 ±5 ±16 ±2 ±5 ±2 Blue Plus First Plan HealthPartners IM C M edica M HP UCare MinnesotaCare ±4 ±28 ±8 ±26 ±6 ±21 ±6 Blue Plus First Plan HealthPartners IM C M edica M HP UCare HEDIS Primer 41 January 23

42 Measure: Well-Child Visits in the 3 rd, 4 th, 5 th and 6 th Year of Life Description Discussion The percentage of eligible children (denominator) who received one or more well-child visits during the year (numerator). Denominator: a. Children who were enrolled in the MCO on Dec. 31, 21, and b. who were 3-6 years of age on Dec. 31, 21, and c. who were enrolled in the MCO for a least eleven months of 21. Numerator: Of the denominator group, those who received at least one well-child visit with a primary care practitioner during 21. PMAP a. The rates of two of the seven MCOs meet or exceed the national Medicaid average (56.) for this measure. Three MCOs rates are within five percentage points of the national average. b. The average rate among Minnesota MCOs (52.7) falls below the national average. c. The range from highest to lowest rate is 2 percentage points. d. Three MCOs (Blue Plus, HealthPartners, Medica) meet or exceed their commercial rates. MinnesotaCare a. The rates of three MCOs meet or exceed the national Medicaid average for this measure. Two other rates are close to the national average. b. The average rate among Minnesota MCOs (5.7) falls short of the national Medicaid average by five percentage points. c. The range from highest to lowest rate is 22 percentage points. d. Three MCOs (Blue Plus, HealthPartners, Medica) meet or exceed their commercial rates. Further Cautions or Information: a. The upper confidence limits for First Plan, IMC, Medica, and UCare PMAP programs would also meet or nearly meet the national Medicaid average. b. The upper confidence limits for First Plan and IMC MinnesotaCare would also meet the national Medicaid average. HEDIS Primer 42 January 23

43 Well-Child Visits in the 3 rd, 4 th, 5 th and 6 th Year of Life CY 21 1 National Medicaid Avg. MCO Avg. Commercial Rate ±n Confidence Interval PMAP ±2 ±8 ±5 ±8 ±1 ±5 ±2 Blue Plus First Plan HealthPartners IM C M edica M HP UCare MinnesotaCare ±2 ±6 ±5 ±1 ±2 ±1 ±2 Blue Plus First Plan HealthPartners IM C M edica M HP UCare HEDIS Primer 43 January 23

44 Measure: Adolescent Well-Care Visits Description Discussion The percentage of eligible members (denominator) who received one or more comprehensive well-care visits during the year (numerator). Denominator: a. Persons who were enrolled in the MCO on Dec. 31, 21, and b. who were years of age on Dec. 31, 21, and c. who were enrolled in the MCO for a least eleven months of 21. Numerator: Of the denominator group, those who received at least one comprehensive well-care visit with a primary care or OB/GYN practitioner during 21. PMAP a. The rates of two of the seven MCOs meet or exceed the national Medicaid average (32.6) for this measure. b. The average rate among Minnesota MCOs (28.4) falls four percentage points below the national Medicaid average. c. The range from highest to lowest rate is 19 percentage points. d. Where commercial rates were reported, PMAP rates generally meet or exceed commercial rates. MinnesotaCare a. The rates of two MCOs meet or exceed the national Medicaid average for this measure. b. The average rate among Minnesota MCOs (26.5) falls short of the national Medicaid average by six percentage points. c. The range from highest to lowest rate is 15 percentage points. d. Where commercial rates were reported, MinnesotaCare rates meet or exceed commercial rates. Further Cautions or Information: a. The upper confidence limits for IMC/PMAP would also meet the national Medicaid average. b. The upper confidence limits for the First Plan, Medica, and IMC MinnesotaCare programs would also meet the national Medicaid average. HEDIS Primer 44 January 23