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ANALYSIS OF MEDICAID HMO Within 30 days receipt of final report
ANALYSIS OF MEDICAID HMO
(FY2008 Appropriation Bill - Public Act 123 of 2007)
Within 30 days receipt of final report
Section 1662: (1) The department shall assure that an external quality review of
each contracting HMO is performed that results in an analysis and evaluation of
aggregated information on quality, timeliness, and access to health care services that
the HMO or its contractors furnish to Medicaid beneficiaries. (2) The department shall
provide a copy of the analysis of the Medicaid HMO annual audited health employer
data and information set reports and the annual external quality review report to the
senate and house of representatives appropriations subcommittees on community
health, the senate and house fiscal agencies, and the state budget director, within 30
days of the department’s receipt of the final reports from the contractors. (3) The
department shall work with the Michigan association of health plans and the Michigan
association for local public health to improve service delivery and coordination in the
MSS/ISS and EPSDT programs. (4) The department shall assure that training and
technical assistance are available for EPSDT and MSS/ISS for Medicaid health plans,
local health departments, and MSS/ISS contractors.
State of Michigan
Department of Community Health
Michigan Medicaid HEDIS® 2007 Results
STATEWIDE AGGREGATE REPORT
December 2007
1600 East Northern Avenue, Suite 100  Phoenix, AZ 85020
Phone 602.264.6382  Fax 602.241.0757
CONTENTS
1. Executive Summary .......................................................................................................... 1-1
I n t r o d u c t i o n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - 1
Key Findings and Recommendations ............................................................................................... 1-2
Summary of Results ......................................................................................................................... 1-7
2. How to Get the Most From This Report .......................................................................... 2-1
Summary of Michigan Medicaid HEDIS 2007 Key Measures .......................................................... 2-1
Key Measure Audit Designations ..................................................................................................... 2-2
Dimensions of Care .......................................................................................................................... 2-2
Changes to Measures ...................................................................................................................... 2-3
Performance Levels.......................................................................................................................... 2-4
Michigan Medicaid Weighted Averages ........................................................................................... 2-5
Interpreting and Using Reported Weighted Averages and Aggregate Results ................................ 2-5
Significance Testing ......................................................................................................................... 2-6
Calculation Methods: Administrative Versus Hybrid ......................................................................... 2-7
Interpreting Results .......................................................................................................................... 2-8
Understanding Sampling Error ....................................................................................................... 2-10
Health Plan Name Key ................................................................................................................... 2-11
3. Pediatric Care.................................................................................................................... 3-1
I n t r o d u c t i o n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 - 1
Childhood Immunization Status ........................................................................................................ 3-3
Adolescent Immunization Status ...................................................................................................... 3-9
Well-Child Visits in the First 15 Months of Life ............................................................................... 3-12
Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life ............................................... 3-17
Adolescent Well-Care Visits ........................................................................................................... 3-20
Appropriate Treatment for Children With Upper Respiratory Infection ........................................... 3-23
Appropriate Testing for Children With Pharyngitis .......................................................................... 3-25
Pediatric Care Findings and Recommendations ............................................................................ 3-27
4. Women's Care ................................................................................................................... 4-1
I n t r o d u c t i o n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 - 1
Breast Cancer Screening ................................................................................................................. 4-2
Cervical Cancer Screening ............................................................................................................... 4-6
Chlamydia Screening in Women ...................................................................................................... 4-9
Prenatal and Postpartum Care ....................................................................................................... 4-13
Women’s Care Findings and Recommendations ........................................................................... 4-19
5. Living With Illness ............................................................................................................ 5-1
I n t r o d u c t i o n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 - 1
Comprehensive Diabetes Care ........................................................................................................ 5-4
Use of Appropriate Medications for People With Asthma ............................................................... 5-24
Controlling High Blood Pressure .................................................................................................... 5-32
Medical Assistance With Smoking Cessation ................................................................................. 5-36
Living With Illness Findings and Recommendations ...................................................................... 5-40
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page i
MI2007_HEDIS_Aggr_F1_1207
CONTENTS
6. Access to Care .................................................................................................................. 6-1
I n t r o d u c t i o n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 - 1
Children’s and Adolescents’ Access to Primary Care Practitioners ................................................. 6-3
Adults’ Access to Preventive/Ambulatory Health Services ............................................................. 6-11
Access to Care Findings and Recommendations ........................................................................... 6-15
7. HEDIS Reporting Capabilities .......................................................................................... 7-1
Key Findings ..................................................................................................................................... 7-1
Conclusions and Recommendations ................................................................................................ 7-2
Appendix A: Tabular Results for Key Measures by Health Plan ..................................... A-1
Appendix B: National HEDIS 2006 Medicaid Percentiles ................................................. B-1
Appendix C: Trend Tables ................................................................................................... C-1
Appendix D: Glossary ......................................................................................................... D-1
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page ii
MI2007_HEDIS_Aggr_F1_1207
ACKNOWLEDGMENTS AND COPYRIGHTS
HEDIS® refers to the Healthcare Effectiveness Data and Information Set and is a registered trademark
of the National Committee for Quality Assurance (NCQA).
NCQA HEDIS Compliance Audit™ is a trademark of the NCQA.
CAHPS® refers to the Consumer Assessment of Healthcare Providers and Systems and is a registered
trademark of the Agency for Healthcare Research and Quality (AHRQ).
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page iii
MI2007_HEDIS_Aggr_F1_1207
1. Executive Summary
Introduction
During 2006, the Michigan Department of Community Health (MDCH) contracted with 13 health
plans to provide managed care services to 945,515 Michigan Medicaid enrollees.1-1 To evaluate
performance levels, MDCH implemented a system to provide an objective, comparative review of
health plan quality-of-care outcomes and performance measures. One component of the evaluation
system was based on the Healthcare Effectiveness Data and Information Set (HEDIS). MDCH
selected 17 HEDIS measures from the standard Medicaid HEDIS reporting set as the key measures
by which to evaluate performance by the Michigan Medicaid health plans (MHPs). These 17
measures consist of 39 distinct rates.
MDCH expects its contracted health plans to support health care claims systems, membership and
provider files, and hardware/software management tools that facilitate accurate and reliable
reporting of HEDIS measures. MDCH has contracted with Health Services Advisory Group, Inc.
(HSAG) to analyze Michigan MHP HEDIS results objectively and evaluate each MHP’s current
performance level relative to national Medicaid percentiles. MDCH uses HEDIS rates for the
annual Medicaid consumer guide, as well as for the annual performance assessment.
Performance levels for Michigan MHPs have been established for all of the key measures. The
performance levels have been set at specific, attainable rates and are based on national percentiles.
This standardization allows for comparison to the performance levels. Health plans meeting the high
performance level (HPL) exhibit rates among the top in the nation. The low performance level (LPL)
has been set to identify health plans with the greatest need for improvement. Details are shown in
Section 2, “How to Get the Most From This Report.”
HSAG has examined the key measures along four different dimensions of care: (1) Pediatric Care,
(2) Women’s Care, (3) Living With Illness, and (4) Access to Care. These dimensions reflect important
groupings and expand on the dimensions model used by the Foundation for Accountability (FACCT).
This approach to the analysis is designed to encourage health plans to consider the key measures as a
whole rather than in isolation, and to think about the strategic and tactical changes required to improve
overall performance.
1-1
Michigan Medicaid Managed Care. Medicaid Health Plan Enrollment Report. July 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 1-1
MI2007_HEDIS_Aggr_F1_1207
EXECUTIVE SUMMARY
Michigan Medicaid HEDIS results are analyzed in this report in several ways. For each of the four
dimensions of care:
‹
A weighted average comparison presents the Michigan Medicaid 2007 results relative to the
2006 Michigan Medicaid weighted averages and the national HEDIS 2006 Medicaid 50th
percentiles.
‹
A performance profile analysis discusses the overall Michigan Medicaid 2007 results and
presents a summary of health plan performance relative to the Michigan Medicaid performance
levels.
‹
A health plan ranking analysis provides a more detailed comparison, showing results relative to
the Michigan Medicaid performance levels.
‹
A data collection analysis evaluates the potential impact of data collection methodology on
reported rates.
In addition, Section 7 (“HEDIS Reporting Capabilities”) of the report provides a summary of the
HEDIS data collection processes used by the Michigan MHPs and audit findings in relation to the
National Committee for Quality Assurance’s (NCQA’s) information system (IS) standards.
Key Findings and Recommendations
This is the seventh year that HSAG has examined the MDCH HEDIS results, and improvement
continues to be observed. Figure 1-1 shows Michigan MHP performance compared with national
Medicaid percentiles. The columns represent the number of Michigan Medicaid weighted averages
falling into the percentile grouping listed on the horizontal axis. Of the 33 weighted averages for
which national percentile data were available, 2 (or 6 percent) fell between the national Medicaid
10th and 25th percentiles, 11 (or 33 percent) fell between the 25th and 50th percentiles, 14 (or 42
percent) fell between the 50th and 75th percentiles, four (or 12 percent) fell between the 75th and
90th percentiles, and 2 (or 6 percent) ranked above the 90th percentile. The 2007 weighted averages
showed a slight downward shift in performance. In 2006, five of the rates exceeded the 90th
percentile, whereas this year, only two weighted averages were in this range. It is important to note,
though, that four of the five rates that exceeded the 90th percentile in 2006 were for indicators that
made up the Use of Appropriate Medication for People With Asthma measure, which experienced
significant specification changes in 2006. The rate increases, therefore, were likely not reflective of
true improvement. However, a comparison between the 2007 weighted averages and the 2005
weighted averages, none of which ranked above the 90th percentile, indicates improvement. Two
rates (Comprehensive Diabetes Care—LDL-C Screening and Controlling High Blood Pressure—46
to 85 Years) fell into the 10th to 25th percentile range. Changes to the 2007 HEDIS technical
specifications for both of these measures may have contributed to a decline in these rates; however,
changes to the Controlling High Blood Pressure—46 to 85 Years measure were minor and would
not explain a significant drop in the rate.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 1-2
MI2007_HEDIS_Aggr_F1_1207
EXECUTIVE SUMMARY
Figure 1-1—Michigan Medicaid HEDIS 2007:
Health Plan Performance Compared With National Medicaid Percentiles
Health Plan Performance Compared to National Medicaid Benchmarks
16
14
Number of Weighted Average Rates
14
12
11
10
8
6
4
4
2
2
2
0
0
0 TO 10
10 TO 25
25 TO 50
50 TO 75
75 TO 90
90 TO 100
2006 National Medicaid Percentile Range
Four of the 33 weighted averages declined from last year, and two of these declines were
statistically significant. The declines were seen in measures in the Living With Illness dimension:
Comprehensive Diabetes Care—LDL-C Screening (statistically significant), Comprehensive
Diabetes Care—LDL-C Level <100, Use of Appropriate Medications for People With Asthma—
Ages 10 to 17 Years, and Controlling High Blood Pressure—46 to 85 Years (statistically
significant). Both of the measures that showed statistically significant declines in their weighted
averages had changes to the technical specifications in 2007 that could have contributed to the
decline in rates.
Improvement was seen in the remaining 29 weighted averages, with three of these increases being
statistically significant. The measures that showed statistically significant improvement were:
Childhood Immunization Status—Combination #3, Adolescent Immunization Status—Combination
#2, and Comprehensive Diabetes Care—Medical Attention for Nephropathy. There was a change to
the 2007 HEDIS technical specification for the Comprehensive Diabetes Care—Medical Attention
for Nephropathy measure, which may have led to an increase of 29.1 percentage points from the
weighted average in 2006.
In the Pediatric Care dimension, all of the measures’ rates showed improvement compared to the
2006 Michigan Medicaid weighted average, and seven of the nine measures’ rates ranked better
than the national HEDIS 2006 Medicaid 50th percentile. The weighted average for Childhood
Immunization Status—Combination #2 continued to perform above the HEDIS 2006 Medicaid 90th
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 1-3
MI2007_HEDIS_Aggr_F1_1207
EXECUTIVE SUMMARY
percentile with an increase of four percentage points from 2006. While the rates for Appropriate
Treatment for Children With Upper Respiratory Infections and Appropriate Testing for Children
With Pharyngitis showed improvement in 2007, more than half of the health plans still performed
below the national HEDIS 2006 Medicaid 50th percentile.
The performance of measures in the Women’s Care dimension improved from 2006. All of the
health plans showed improvement in their weighted averages; however, none of the improvements
were statistically significant. The rate for Timeliness of Prenatal Care was slightly below the
national HEDIS 2006 Medicaid 50th percentile, but only by 0.1 percentage point. The improvement
efforts put forth by the MHPs in the area of Women’s Care continued to show success.
The rates for measures in the Living With Illness dimension showed some declines when compared
to last year. It is important to remember that the statistically significant improvement in 2006 in four
of the indicators that make up the Use of Appropriate Medications for People With Asthma measure
may have been the result of changes to the HEDIS technical specifications. Similar to last year,
several of the measures in this dimension had changes to the technical specifications that may have
contributed to the increases and decreases in rates. Controlling High Blood Pressure—46 to 85
Years saw a statistically significant decline in its rate from 2006 and should be further investigated
to determine the reasons for the decline. One MHP saw a drop of nearly 20 percent in its reported
rate for this measure.
All rates in the Access to Care dimension improved from 2006; however, there appears to be
opportunities for improvement for children and adolescents accessing care between the ages of 25
months and 19 years of age. The MHPs should continue to work to improve access to care and
investigate whether or not there are barriers related to members accessing care or if there are issues
with providers submitting encounter data to the health plans for services rendered.
HSAG examined the quality improvement (QI) plans from each of the MHPs. The review found
that all of the MHPs have disease management programs for diabetes and asthma, and many have
programs for prenatal and postpartum care, smoking cessation, and cardiovascular disease. Several
of the MHPs have or are considering adding depression and hypertension programs, as well.
Overall, the MHPs focused on improving the rates of key HEDIS measures or plan to do this as part
of their QI goals for 2007. The interventions included: reminder mailings or telephone calls to both
providers and members for services due, incentives offered to both members and providers when
services were rendered, and provider report cards and bonuses based on performance. Other
interventions included: evaluation of missed opportunities, assessment of the adequacy of provider
and provider specialty networks to meet the needs of their members, and identification of barriers to
accessing care and barriers to members complying with appointments for preventive care.
Most of the MHPs provided educational services to members and providers, including: educational
material sent to members and providers, Web-based educational information and programs, and
documentation given to providers to enhance data capture of HEDIS-related codes for services
provided to members.
Only a few MHPs mentioned that they evaluated assessment of data completeness. All of the MHPs
should focus on this area because there may be missing service data due to capitation or claims that
providers may not bother to submit if they perceive that reimbursement will be low. Any efforts to
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 1-4
MI2007_HEDIS_Aggr_F1_1207
EXECUTIVE SUMMARY
improve the submission of encounter data could improve all of the HEDIS rates as well as reduce
the burden of medical record review. The MHPs could use the hybrid rates as one method to assess
missing administrative data. A comparison between the hybrid and administrative rates would
identify missing encounter or claims data and would assist in identifying problem providers. The
MHPs should also focus on expected claims or encounter volumes by provider type to help identify
missing data.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 1-5
MI2007_HEDIS_Aggr_F1_1207
EXECUTIVE SUMMARY
Weighted Average Comparisons for the Four Dimensions of Care
Figure 1-2 through Figure 1-5 show Michigan Medicaid HEDIS 2007 results for each dimension of
care, comparing the current weighted average for each measure relative to the 2006 Michigan
Medicaid weighted average and the national HEDIS 2006 Medicaid 50th percentile.
In each figure, the following information will help the reader interpret these data:
‹
The light-colored bars show the difference in percentage points between this year’s Michigan
results and last year’s Michigan results, comparing the 2007 and 2006 Michigan Medicaid
weighted averages.
‹
The dark-colored bars show the difference in percentage points between this year’s Michigan
results and the national results, comparing the 2007 Michigan Medicaid weighted average with
the national HEDIS 2006 Medicaid 50th percentile.
For all measures (except two), a bar to the right indicates an improvement in performance and a
bar to the left indicates a decline in performance.
The two exceptions are:
1. Well-Child Visits in the First 15 Months of Life—Zero Visits
2. Comprehensive Diabetes Care—Poor HbA1c Control
For these exceptions, lower rates (a bar to the left) indicate better performance.
‹
A weighted average for Advising Smokers to Quit and Discussing Smoking Cessation Strategies
could not be calculated. National percentile data are not available for these measures.
Performance Level Analysis
Table 1-1 through Table 1-4 show performance summary results for all Michigan MHPs for each
dimension of care. Results were calculated using a scoring algorithm based on individual health
plan performance relative to the HPL, LPL, and the national HEDIS 2006 Medicaid 50th percentile.
For each health plan, points were summed across all measures in the dimension and then averaged
by the number of measures in that dimension. Decimals of 0.5 or greater were rounded up to the
next whole number. For measures that had an audit designation of Report with a rationale of Not
Applicable (NA), rates were not included since the denominator was less than 30 cases.
Results are presented in this report using a star system assigned as follows:
‹
‹
‹
Three stars (Ì
ÌÌÌ) for performance at or above the HPL (≥ 90th percentile).
Two stars (Ì
ÌÌ) for performance above the LPL but below the HPL
(>25th percentile to <90th percentile).
One star (Ì
Ì) for performance at or below the LPL (≤ 25th percentile) or for Not Report (NR)
designations.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 1-6
MI2007_HEDIS_Aggr_F1_1207
EXECUTIVE SUMMARY
Summary of Results
Pediatric Care
All of the Pediatric Care measures showed improvement from 2006. Childhood Immunization
Status—Combination #3 showed statistically significant improvement with an increase of 23.8
percentage points from the 2006 Michigan Medicaid weighted average. Combo #3 was a new
measure in 2006, so this was the first year that this measure was trended and compared to national
performance standards. The Adolescent Immunization Status—Combination #2 weighted average of
65.9 percent also showed statistically significant improvement over the 2006 rate. This
improvement demonstrates an effort by the MHPs to capture and report complete data.
All of the well-care measures showed improvement in 2007 and all of the weighted averages
performed better than the national HEDIS 2006 Medicaid 50th percentile. The Well-Child Visits in
the First 15 Months of Life—6 or More Visits rate improved by 7.4 percentage points from 2006.
All of the MHPs’ rates for these measures came primarily from administrative data. The increase in
administrative data rates means that the health plans have more complete data and are having to rely
less on medical record review.
The rates for Appropriate Treatment for Children With Upper Respiratory Infection and Appropriate
Testing for Children With Pharyngitis improved from 2006; however, more than half of the plans
continue to perform below the national HEDIS 2006 Medicaid 50th percentile for these measures.
There are still many opportunities for the MHPs to improve their rates for these measures.
Figure 1-2—Michigan Medicaid HEDIS 2007 Weighted Average Comparison:
Pediatric Care
Chil dhood Im m uni zation Com bo 2
Chil dhood Im m uni zation Com bo 3
Adolescent Im m unizati on Com bo 2
Well -Child 1st 15 M os, 0 Vi sits
Well -Child 1st 15 M os, 6+ Visits
Well -Child 3rd-6th Years of Li fe
Adolescent Wel l-Care Visi ts
Appropri ate T reatm ent / URI
Appropri ate T esti ng with Pharyngiti s
-25%
-20%
-15%
-10%
-5%
0%
5%
10%
15%
20%
25%
Com pare d to National HEDIS 2006 M e dicaid 50th Pe rce ntile
Com pare d to 2006 M ichigan M e dicaid We ighte d Ave rage
Note: For Well-Child Visits in the First 15 Months of Life—Zero Visits, a bar to the left (lower rates) indicates
better performance.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 1-7
MI2007_HEDIS_Aggr_F1_1207
EXECUTIVE SUMMARY
Table 1-1—Michigan Medicaid HEDIS 2007 Performance Summary:
Pediatric Care
Health
Childhood
Childhood
Adolescent
Plan Immunization Immunization Immunization
Name
Combo 2
Combo 3
Combo 2
Well-Child Well-Child
1st 15
1st 15
Well-Child Adolescent Appropriate
Mos,
Mos,
3rd–6th
Well-Care
Treatment
0 Visits
6+ Visits Yrs of Life
Visits
URI
Children
With
Pharyngitis
CCM
ÌÌ
ÌÌÌ
ÌÌ
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Ì
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Ì
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GLH
ÌÌ
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ÌÌÌ
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Ì
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HPM
ÌÌÌ
ÌÌÌ
ÌÌÌ
ÌÌ
ÌÌÌ
ÌÌ
ÌÌÌ
ÌÌ
ÌÌ
HPP
ÌÌÌ
ÌÌÌ
ÌÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
Ì
Ì
MCD
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌÌ
MCL
ÌÌ
ÌÌÌ
ÌÌ
ÌÌ
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ÌÌ
Ì
ÌÌ
MID
ÌÌ
ÌÌÌ
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ÌÌ
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ÌÌ
Ì
Ì
MOL
ÌÌ
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ÌÌ
OCH
ÌÌ
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Ì
PMD
ÌÌ
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Ì
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PRI
ÌÌÌ
ÌÌÌ
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THC
ÌÌ
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ÌÌÌ
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Ì
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UPP
ÌÌ
ÌÌÌ
ÌÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
This symbol
shows this performance level
3 stars ÌÌÌ ≥ HPL
2 stars
ÌÌ
1 star
Ì
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
> LPL and < HPL
≤ LPL, or for Not Report (NR)
Page 1-8
MI2007_HEDIS_Aggr_F1_1207
EXECUTIVE SUMMARY
Women’s Care
All seven of the Women’s Care measures’ weighted averages showed improvement compared to the
2006 results. Timeliness of Prenatal Care was the only measure that did not reach or exceed the
national HEDIS 2006 Medicaid 50th percentile; however, it was only 0.1 percentage points shy.
The administrative rates for the three hybrid measures continue to improve, minimizing the burden
of medical record review.
Figure 1-3—Michigan Medicaid HEDIS 2007 Weighted Average Comparison:
Women’s Care
Breast Cancer Screeni ng *
Cervical Cancer Screening
Chlam ydi a Screening, 16-20 Years
Chlam ydi a Screening, 21-25 Years
Chlam ydi a Screening, Com bi ned
T im el iness of Prenatal Care
Postpartum Care
-15%
-10%
-5%
0%
5%
10%
15%
Com pare d to National HEDIS 2006 M e dicaid 50th Pe rce ntile
Com pare d to 2006 M ichigan M e dicaid We ighte d Ave rage
*This measure represents the Breast Cancer Screening—52 to 69 Years rate.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 1-9
MI2007_HEDIS_Aggr_F1_1207
EXECUTIVE SUMMARY
Table 1-2—Michigan Medicaid HEDIS 2007 Performance Summary:
Women’s Care
Health
Plan
Name
Breast
Cancer
Screening
52-69 Yrs
Cervical
Cancer
Screening
Chlamydia
Screening
16–20 Yrs
Chlamydia
Screening
21–25 Yrs
Chlamydia
Screening
Combined
Timeliness
of
Prenatal
Care
Postpartum
Care
CCM
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
GLH
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
HPM
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
HPP
ÌÌ
ÌÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌÌ
ÌÌ
MCD
ÌÌ
ÌÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
MCL
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌÌ
ÌÌÌ
MID
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
MOL
ÌÌ
Ì
ÌÌ
ÌÌ
ÌÌ
Ì
Ì
OCH
ÌÌ
ÌÌ
ÌÌÌ
ÌÌÌ
ÌÌÌ
ÌÌ
ÌÌ
PMD
ÌÌ
ÌÌ
ÌÌÌ
ÌÌ
ÌÌÌ
ÌÌ
ÌÌ
PRI
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
THC
ÌÌ
ÌÌ
ÌÌ
ÌÌÌ
ÌÌ
ÌÌ
ÌÌ
UPP
ÌÌÌ
ÌÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
This symbol
3 stars
shows this performance level
ÌÌÌ ≥ HPL
2 stars
ÌÌ
1 star
Ì
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
> LPL and < HPL
≤ LPL, or for Not Report (NR)
Page 1-10
MI2007_HEDIS_Aggr_F1_1207
EXECUTIVE SUMMARY
Living With Illness
Three of the measures in the Living With Illness dimension showed statistically significant changes
in the 2007 weighted averages. Comprehensive Diabetes Care—LDL-C Screening and Controlling
High Blood Pressure—46 to 85 Years showed significant declines, while Comprehensive Diabetes
Care—Monitoring for Diabetic Nephropathy showed significant improvement. The significance of
these changes should be considered with respect to changes made to the HEDIS 2007 Technical
Specifications for each of these measures. Of the above mentioned measures, only Controlling High
Blood Pressure—46 to 85 had a rate that was directly comparable to the 2006 weighted average and
the national performance standards, and should be looked at to determine reasons for the significant
decline. Overall, performance in this area continues to offer opportunities for improvement.
Figure 1-4—Michigan Medicaid HEDIS 2007 Weighted Average Comparison:
Living With Illness
Di abetes Care HbA1c T esti ng
Di abetes Care Poor HbA1c Control
Di abetes Care Eye Exam
Di abetes Care LDL-C Screeni ng
Di abetes Care LDL-C Level <100
Diabetes Care Nephropathy
Asthm a, 5-9 Years
Asthm a, 10-17 Years
Asthm a, 18-56 Years
Asthm a, Com bi ned Rate
Controll ing High Bl ood Pressure *
-25% -20%
-15% -10%
-5%
0%
5%
10%
15%
20%
25%
30% 35%
Com pare d to National HEDIS 2006 M e dicaid 50th Pe rce ntile
Com pare d to 2006 M ichigan M e dicaid We ighte d Ave rage
Notes: For Comprehensive Diabetes Care—Poor HbA1c Control, a bar to the left (for lower rates) indicates better
performance. Advising Smokers to Quit is not included in this figure. National percentile data are not available nor
could a weighted average be calculated.
*This measure represents the Controlling High Blood Pressure—46 to 85 Years rate.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 1-11
MI2007_HEDIS_Aggr_F1_1207
EXECUTIVE SUMMARY
Table 1-3—Michigan Medicaid HEDIS 2007 Performance Summary:
Living With Illness (Part 1)
Health Plan
Name
Diabetes
Care
HbA1c
Testing
Diabetes
Care Poor
HbA1c
Control
Diabetes
Care
Eye
Exam
Diabetes
Care
LDL-C
Screening
Diabetes
Care
LDL-C
Level <100
Diabetes
Care
Nephropathy
CCM
ÌÌ
ÌÌ
ÌÌ
Ì
ÌÌ
ÌÌÌ
GLH
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌÌ
HPM
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌÌ
HPP
ÌÌ
ÌÌ
ÌÌÌ
Ì
ÌÌ
ÌÌÌ
MCD
ÌÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌÌ
MCL
ÌÌ
ÌÌ
ÌÌ
Ì
ÌÌ
ÌÌÌ
MID
Ì
ÌÌ
ÌÌ
Ì
ÌÌ
ÌÌÌ
MOL
ÌÌ
ÌÌ
ÌÌ
Ì
ÌÌÌ
ÌÌÌ
OCH
ÌÌ
ÌÌ
ÌÌ
Ì
ÌÌ
ÌÌÌ
PMD
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌÌ
PRI
ÌÌÌ
ÌÌÌ
ÌÌÌ
ÌÌ
ÌÌ
ÌÌÌ
THC
ÌÌ
ÌÌ
ÌÌ
Ì
ÌÌ
ÌÌÌ
UPP
ÌÌÌ
ÌÌÌ
ÌÌÌ
ÌÌ
ÌÌ
ÌÌÌ
This symbol
shows this performance level
3 stars ÌÌÌ ≥ HPL
2 stars
ÌÌ
1 star
Ì
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
> LPL and < HPL
≤ LPL, or for Not Report (NR)
Page 1-12
MI2007_HEDIS_Aggr_F1_1207
EXECUTIVE SUMMARY
Table 1-3—Michigan Medicaid HEDIS 2007 Performance Summary:
Living With Illness (Part 2)
Asthma
Combined
Controlling
High Blood
Pressure
46-85 Yrs
Advising
Smokers
to Quit*
Discussing
Smoking
Cessation
Strategies*
ÌÌ
ÌÌ
ÌÌ
NA
NA
Ì
ÌÌ
ÌÌ
Ì
NA
NA
ÌÌÌ
ÌÌÌ
ÌÌÌ
ÌÌÌ
Ì
NA
NA
HPP
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
NA
NA
MCD
ÌÌÌ
ÌÌ
ÌÌ
ÌÌÌ
ÌÌ
NA
NA
MCL
ÌÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
NA
NA
MID
ÌÌ
Ì
ÌÌ
Ì
Ì
NA
NA
MOL
Ì
Ì
ÌÌ
Ì
Ì
NA
NA
OCH
Ì
Ì
ÌÌ
Ì
Ì
NA
NA
PMD
ÌÌ
ÌÌ
ÌÌÌ
ÌÌ
ÌÌ
NA
NA
PRI
ÌÌÌ
ÌÌÌ
ÌÌ
ÌÌÌ
ÌÌ
NA
NA
THC
Ì
Ì
ÌÌ
Ì
Ì
NA
NA
UPP
ÌÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
NA
NA
Health Plan
Name
Asthma
5–9
Yrs
Asthma
10–17
Yrs
Asthma
18–56
Yrs
CCM
ÌÌ
ÌÌ
GLH
Ì
HPM
*Means and percentiles are not available for the Advising Smokers to Quit and Discussing Smoking Cessation
Strategies measures.
This symbol
shows this performance level
3 stars ÌÌÌ ≥ HPL
2 stars
ÌÌ
1 star
Ì
> LPL and < HPL
≤ LPL, or for Not Report (NR)
“NA” means “Not Applicable.”
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 1-13
MI2007_HEDIS_Aggr_F1_1207
EXECUTIVE SUMMARY
Access to Care
All of the measures in this dimension showed improvement over the 2006 Michigan Medicaid
weighted averages; however, only three of the 2007 weighted averages, Children’s Access to
Primary Care Practitioners—Ages 12 to 24 Months, Children’s Access to Primary Care
Practitioners—Ages 25 Months to 6 Years, and Adults’ Access to Primary Care Practitioners—
Ages 45 to 64 Years, performed better than the national HEDIS 2006 50th percentile. There
continued to be variations between the plans’ performance on these measures and opportunities for
improvement.
Figure 1-5—Michigan Medicaid HEDIS 2007 Weighted Average Comparison:
Access to Care
Children's Access 12-24 M onths
Chil dren's Access 25 M os-6 Years
Children's Access 7-11 Years
Adol escents' Access 12-19 Years
Adults' Access 20-44 Years
Adults' Access 45-64 Years
-15%
-10%
-5%
0%
5%
10%
15%
Com pare d to National HEDIS 2006 M e dicaid 50th Pe rce ntile
Com pare d to 2006 M ichigan M e dicaid We ighte d Ave rage
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 1-14
MI2007_HEDIS_Aggr_F1_1207
EXECUTIVE SUMMARY
Table 1-4—Michigan Medicaid HEDIS 2007 Performance Summary:
Access to Care
Health
Plan
Name
Children’s
Access
12–24 Mos
Children’s
Access
25 Mos–6 Yrs
Children’s
Access
7–11 Yrs
Adolescents’
Access
12–19 Yrs
Adults’
Access
20–44 Yrs
Adults’
Access
45–64 Yrs
CCM
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
GLH
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
HPM
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌÌ
HPP
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌÌ
MCD
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
MCL
ÌÌ
Ì
Ì
ÌÌ
ÌÌ
ÌÌ
MID
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
MOL
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
OCH
Ì
Ì
Ì
Ì
ÌÌ
ÌÌ
PMD
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
PRI
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌÌ
THC
ÌÌ
Ì
Ì
ÌÌ
ÌÌ
ÌÌ
UPP
ÌÌ
ÌÌ
ÌÌ
ÌÌ
ÌÌÌ
ÌÌÌ
This symbol
shows this performance level
3 stars ÌÌÌ ≥ HPL
2 stars
ÌÌ
1 star
Ì
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
> LPL and < HPL
≤ LPL, or for Not Report (NR)
Page 1-15
MI2007_HEDIS_Aggr_F1_1207
2. How to Get the Most From This Report
Summary of Michigan Medicaid HEDIS 2007 Key Measures
HEDIS includes a standard set of measures that can be reported by MHPs nationwide. MDCH selected
17 HEDIS measures from the standard Medicaid set and divided them into 39 distinct rates, shown in
Table 2-1. These 39 rates represent the 2007 MDCH key measures. Thirteen Michigan MHPs were
required to report the key measures in 2007.
Table 2-1—Michigan Medicaid HEDIS 2007 Key Measures
Standard HEDIS 2007 Measures
2007 MDCH Key Measures
1. Childhood Immunization Status
1. Childhood Immunization Status—Combination #2
2. Childhood Immunization Status—Combination #3
2. Adolescent Immunization Status
3. Adolescent Immunization Status—Combination #2
3. Well-Child Visits in the First 15 Months of Life
4. Well-Child Visits in the First 15 Months of Life—Zero Visits
5. Well-Child Visits in the First 15 Months of Life—Six or More Visits
4. Well-Child Visits in the Third, Fourth, Fifth, and
Sixth Years of Life
6. Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life
5. Adolescent Well-Care Visits
7. Adolescent Well-Care Visits
6. Appropriate Treatment for Children With Upper
Respiratory Infection
8. Appropriate Treatment for Children With Upper Respiratory Infection
7. Appropriate Testing for Children With Pharyngitis
9. Appropriate Testing for Children With Pharyngitis
8. Breast Cancer Screening
10. Breast Cancer Screening—Ages 42 to 51 Years
11. Breast Cancer Screening—Ages 52 to 69 Years
12. Breast Cancer Screening—Combined Rate
9. Cervical Cancer Screening
13. Cervical Cancer Screening
10. Chlamydia Screening in Women
14. Chlamydia Screening in Women—Ages 16 to 20 Years
15. Chlamydia Screening in Women—Ages 21 to 25 Years
16. Chlamydia Screening in Women—Combined Rate
11. Prenatal and Postpartum Care
17. Prenatal and Postpartum Care—Timeliness of Prenatal Care
18. Prenatal and Postpartum Care—Postpartum Care
12. Comprehensive Diabetes Care
19.
20.
21.
22.
23.
24.
Comprehensive Diabetes Care—HbA1c Testing
Comprehensive Diabetes Care—Poor HbA1c Control
Comprehensive Diabetes Care—Eye Exam
Comprehensive Diabetes Care—LDL-C Screening
Comprehensive Diabetes Care—LDL-C Level <100
Comprehensive Diabetes Care—Medical Attention for Diabetic Nephropathy
13. Use of Appropriate Medications for People With
Asthma
25.
26.
27.
28.
Use of Appropriate Medications for People With Asthma—Ages 5 to 9 Years
Use of Appropriate Medications for People With Asthma—Ages 10 to 17 Years
Use of Appropriate Medications for People With Asthma—Ages 18 to 56 Years
Use of Appropriate Medications for People With Asthma—Combined Rate
14. Controlling High Blood Pressure
29. Controlling High Blood Pressure—Ages 18 to 45 Years
30. Controlling High Blood Pressure—Ages 46 to 85 Years
31. Controlling High Blood Pressure—Combined
15. Medical Assistance With Smoking Cessation
32. Medical Assistance With Smoking Cessation—Advising Smokers to Quit
33. Medical Assistance With Smoking Cessation—Smoking Cessation Strategies
16. Children’s and Adolescents’ Access to Primary
Care Practitioners
34. Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 12 to 24 Months
35. Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 25 Months to 6 Years
36. Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 7 to 11 Years
37. Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 12 to 19 Years
17. Adults’ Access to Preventive/Ambulatory Health
Services
38. Adults’ Access to Preventive/Ambulatory Health Services—Ages 20 to 44 Years
39. Adults’ Access to Preventive/Ambulatory Health Services—Ages 45 to 64 Years
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 2-1
MI2007_HEDIS_Aggr_F1_1207
HOW TO GET THE MOST FROM THIS REPORT
Key Measure Audit Designations
Through the audit process, each measure reported by a health plan is assigned an NCQA-defined
audit finding. Measures can receive one of four predefined audit findings: Report, Not Applicable,
Not Report, and No Benefit. An audit finding of Report indicates that the health plan complied with
all HEDIS specifications to produce an unbiased, reportable rate or rates, which can be released for
public reporting. Although a health plan may have complied with all applicable specifications, the
denominator identified may be considered too small to report a rate (i.e., less than 30). The measure
would have been assigned a Not Applicable audit finding. An audit finding of Not Report indicates
that the rate could not be publicly reported because the measure deviated from HEDIS
specifications such that the reported rate was significantly biased or an MHP chose not to report the
measure. A No Benefit audit finding indicates that the MHP did not offer the benefit required by the
measure.
It should be noted that NCQA allows health plans to “rotate” HEDIS measures in some
circumstances. A “rotation” schedule enables health plans to use the audited and reportable rates
from the prior year. This strategy allows health plans with higher rates for some measures to expend
resources toward improving rates for other measures. Rotated measures must have been audited in
the prior year and must have received a Report audit designation. Only hybrid measures are eligible
to be rotated.
The health plans that met the HEDIS criteria for hybrid measure rotation could choose to exercise
that option. Five health plans chose to rotate measures in 2007, and a total of 12 rates were rotated.
Following NCQA methodology, rotated measures were assigned the same reported rates from 2006
and were included in the calculations for the Michigan Medicaid weighted averages.
Dimensions of Care
HSAG has examined four different dimensions of care for Michigan Medicaid members: Pediatric
Care, Women’s Care, Living With Illness, and Access to Care. These dimensions reflect important
groupings similar to the dimensions model used by the FACCT. This approach to the analysis is
designed to encourage health plans to consider the key measures as a whole rather than in isolation,
and to think about the strategic and tactical changes required to improve overall performance.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 2-2
MI2007_HEDIS_Aggr_F1_1207
HOW TO GET THE MOST FROM THIS REPORT
Changes to Measures
For the 2007 HEDIS reporting year, NCQA made a few modifications to some of the measures
included in this report, which may impact trending patterns.
Breast Cancer Screening
‹
‹
Decreased the lower age limit to women 42 years of age.
Reported the measure in three age bands (42 to 51 years of age, 52 to 69 years of age, and
combined).
Cervical Cancer Screening
‹
Raised the lower age limit to 21 years of age.
Comprehensive Diabetes Care
‹
‹
‹
‹
‹
Retired the LDL-C control <130 mg/dL indicator.
Added a new indicator, HbA1c Good Control (<7.0 percent).
Added two new indicators, Blood Pressure Control <130/80 mm Hg and <140/90 mm Hg.
Restricted the LDL-C screening and control criteria to require testing during the measurement
year.
Added the use of agiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers
(ARBs) as numerator compliant for medical attention for nephropathy.
Controlling High Blood Pressure
‹
‹
‹
‹
‹
Decreased the lower age limit to 18 years of age.
Reported the measure in three age bands (18 to 45 years of age, 46 to 85 years of age, and
combined).
Changed adequately controlled blood pressure from ≤140/90 to <140/90.
Changed the methodology for determining representative blood pressure (BP). The lowest BP is
used as the representative BP regardless of posture.
Clarified that the lowest systolic and lowest diastolic values can be used to fulfill the numerator
criteria for the representative BP.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 2-3
MI2007_HEDIS_Aggr_F1_1207
HOW TO GET THE MOST FROM THIS REPORT
Performance Levels
The purpose of identifying performance levels is to compare the quality of services provided to
Michigan Medicaid managed care beneficiaries to national percentiles and ultimately improve the
Michigan Medicaid average for all of the key measures. The HPL represents current high
performance in national Medicaid managed care, and the LPL represents below-average
performance nationally. Health plans should focus their efforts on reaching and/or maintaining the
HPL for each key measure, rather than comparing themselves to other Michigan MHPs.
Comparative information in this report is based on the national NCQA Medicaid HEDIS 2006
percentiles, which are the most recent data available from NCQA. For this report, HEDIS rates were
calculated to the sixth decimal place. The results displayed in this report were rounded to the first
decimal place to be consistent with the display of national percentiles. There are some instances in
which the rounded rate may appear the same; however, the more precise rates are not identical. In
these instances, the hierarchy of the scores in the graphs is displayed in the correct order. For
example, Figure 3-1 shows a rate that looks identical to the national 50th percentile (72.4 percent).
This health plan had an actual rate of 72.39, which is slightly lower than the 72.4 percent.
For most key measures included in this report, the 90th percentile indicates the HPL, the 25th
percentile represents the LPL, and average performance falls between the LPL and the HPL. This
means that Michigan MHPs with reported rates above the 90th percentile (HPL) rank in the top 10
percent of all MHPs nationally. Similarly, health plans reporting rates below the 25th percentile
(LPL) rank in the bottom 25 percent nationally for that measure.
There are two key measures for which this differs—i.e., the 10th percentile (rather than the 90th)
shows excellent performance, and the 75th percentile (rather than the 25th) shows below-average
performance—because for these two measures only, lower rates indicate better performance. The
two measures are:
‹
Well-Child Visits in the First 15 Months of Life—Zero Visits, for which the lower rates of no
visits indicate better care.
‹
Comprehensive Diabetes Care—Poor HbA1c Control, for which the lower rates of poor control
indicate better care.
NCQA does not published national percentiles (90th, 50th, and 25th percentiles) for Medical
Assistance With Smoking Cessation—Advising Smokers to Quit and Medical Assistance With
Smoking Cessation—Smoking Cessation Strategies. Given the lack of performance data, no HPL or
LPL has been established for these key measures. Instead, health plan results are ranked highest to
lowest and are compared with the 2006 Michigan Medicaid weighted average.
This report identifies and specifies the number of Michigan MHPs with HPL, LPL, and average
performance levels.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 2-4
MI2007_HEDIS_Aggr_F1_1207
HOW TO GET THE MOST FROM THIS REPORT
Performance Trend Analysis
In Appendix C, the column titled “2006–2007 Health Plan Trend” shows, by key measure, the
comparison between the 2006 results and the 2007 results for each health plan. Trends are shown
graphically, using the key below:
Denotes a significant improvement in performance (the rate has increased more than
10 percentage points)
§¨ Denotes no significant change in performance (the rate has not changed more than
10 percentage points, which is considered within the margin of error)
ª Denotes a significant decline in performance (the rate has decreased more than
10 percentage points)
©
Different symbols (c
cd) are used to indicate a significant performance change for two key
measures. For only these two key measures (Well-Child Visits in the First 15 Months of Life—Zero
Visits and Comprehensive Diabetes Care—Poor HbA1c Control), a decrease in the rate indicates
better performance. A downward-pointing triangle (d
d) denotes a significant decline in
performance, as indicated by an increase in the rate of more than 10 percentage points. An upwardpointing triangle (c
c) denotes a significant improvement in performance, as indicated by a decrease
in the rate of more than 10 percentage points.
Michigan Medicaid Weighted Averages
The principal measure of overall Michigan Medicaid managed care performance on a given key
measure is the weighted average rate. The use of a weighted average, based on a health plan’s
eligible population for that measure, provides the most representative rate for the overall Michigan
Medicaid population. Weighting the rate by a health plan’s eligible population size ensures that
rates for a health plan with 125,000 members, for example, have a greater impact on the overall
Michigan Medicaid rate than do the rates for a health plan with only 10,000 members.
Interpreting and Using Reported Weighted Averages and Aggregate
Results
The 2007 Michigan Medicaid weighted average was computed by HSAG based on the reported
rates and weighted by the reported eligible population size for that measure. This is a better estimate
of care for all of Michigan’s Medicaid enrollees, rather than the average performance of Michigan
MHPs.
The 2007 Michigan Medicaid aggregate results, which illustrate how much of the final rate is
derived from administrative data and how much from medical record review, is not an average. It is
the sum of all numerator events divided by the sum of all the denominators across all the reporting
health plans for a given measure.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 2-5
MI2007_HEDIS_Aggr_F1_1207
HOW TO GET THE MOST FROM THIS REPORT
Example
For example, three health plans in a given state reported the following for a particular measure:
‹
Health Plan A used the administrative method and had 6,000 numerator events out of 10,000
members in the denominator (60 percent).
‹
Health Plan B also used the administrative method and found 5,000 numerator events out of
15,000 members (33 percent).
‹
Health Plan C used the hybrid methodology and had 8,000 numerator events (1,000 of which
came from medical record abstraction) and had 16,000 members in the denominator
(50 percent).
‹
There are a total of 41,000 members across health plans.
‹
There are 19,000 numerator events across health plans, 18,000 from administrative data, and
1,000 from medical record abstraction.
‹
The rates are as follows:
ƒ The overall aggregate rate is 46 percent (or 19,000/41,000).
ƒ
The administrative aggregate rate is 44 percent (or 18,000/41,000).
ƒ
The medical review rate is 2 percent (or 1,000/41,000).
Significance Testing
In this report, differences between the 2006 and 2007 Michigan Medicaid weighted averages have
been analyzed using a t-test to determine if the change was statistically significant. The t-test
evaluates the differences between the mean values of two groups relative to the variability of the
distribution of the scores. The t-value generated is used to judge how likely it is that the difference
is real and not the result of chance.
To determine the significance for this report, a risk level of 0.05 was selected. This risk level, or
alpha level, means that 5 times out of 100 we may find a statistically significant difference between
the mean values, even if none actually existed (that is, it happened “by chance”). All comparisons
between the 2006 and 2007 Michigan Medicaid weighted averages reported as statistically
significant in this report are significant at the 0.05 level.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 2-6
MI2007_HEDIS_Aggr_F1_1207
HOW TO GET THE MOST FROM THIS REPORT
Calculation Methods: Administrative Versus Hybrid
Administrative Method
The administrative method requires health plans to identify the eligible population (i.e., the
denominator) using administrative data derived from claims and encounters (i.e., statistical claims).
In addition, the numerator(s), or services provided to the members in the eligible population, are
derived solely from administrative data. Medical records cannot be used to retrieve information.
When using the administrative method, the entire eligible population becomes the denominator, and
sampling is not allowed. There are measures in each of the four dimensions of care in which HEDIS
methodology requires that the rates be derived using only the administrative method. Medical
record review is not permitted. These are:
‹
‹
‹
‹
‹
‹
‹
Appropriate Treatment for Children With Upper Respiratory Infection
Appropriate Testing for Children With Pharyngitis
Breast Cancer Screening
Chlamydia Screening in Women
Use of Appropriate Medications for People With Asthma
Children and Adolescents’ Access to Primary Care Practitioners
Adults’ Access to Preventive/Ambulatory Health Services
The administrative method is cost-efficient, but it can produce lower rates due to incomplete data
submission by capitated providers.
Hybrid Method
The hybrid method requires health plans to identify the eligible population using administrative data
and then extract a systematic sample of members from the eligible population, which becomes the
denominator. Administrative data are used to identify services provided to those members. Medical
records must then be reviewed for those members who do not have evidence of a service being
provided using administrative data.
The hybrid method generally produces higher results but is considerably more labor-intensive. For
example, a health plan has 10,000 members who qualify for the Prenatal and Postpartum Care
measure. The health plan chooses to perform the hybrid method. After randomly selecting 411
eligible members, the health plan finds that 161 members had evidence of a postpartum visit using
administrative data. The health plan then obtains and reviews medical records for the 250 members
who did not have evidence of a postpartum visit using administrative data. Of those 250 members,
54 were found to have a postpartum visit recorded in the medical record. The final rate for this
measure, using the hybrid method, would, therefore, be (161 + 54)/411, or 52 percent.
In contrast, using the administrative method, if the health plan finds that 4,000 members out of the
10,000 had evidence of a postpartum visit using only administrative data, the final rate for this
measure would be 4,000/10,000, or 40 percent.
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HOW TO GET THE MOST FROM THIS REPORT
Interpreting Results
As expected, HEDIS results can differ to a greater or lesser extent among health plans and even
across measures for the same health plan.
Four questions should be asked when examining these data:
1.
2.
3.
4.
How accurate are the results?
How do Michigan Medicaid rates compare to national percentiles?
How are Michigan MHPs performing overall?
Can the health plans do a better job calculating the measures?
The following paragraphs address these questions and explain the methods used in this report to
present the results for clear, easy, and accurate interpretation.
1.
How accurate are the results?
All Michigan MHPs are required by MDCH to have their HEDIS results confirmed by an NCQA
HEDIS Compliance Audit. As a result, any rate included in this report has been verified as an
unbiased estimate of the measure. The NCQA HEDIS protocol is designed so that the hybrid
method produces results with a sampling error of ± 5 percent at a 95 percent confidence level.
How sampling error affects the accuracy of results is best explained using an example. Suppose a
health plan uses the hybrid method to derive a Postpartum Care rate of 52 percent. Because of
sampling error, the true rate is actually ± 5 percent of this rate—somewhere between 47 percent and
57 percent at a 95 percent confidence level. If the target is a rate of 55 percent, it cannot be said
with certainty whether the true rate between 47 percent and 57 percent meets or does not meet the
target level.
To prevent such ambiguity, this report uses a standardized methodology that requires the reported
rate to be at or above the threshold level to be considered as meeting the target. For internal
purposes, health plans should understand and consider the issue of sampling error when
implementing interventions.
2.
How do Michigan Medicaid rates compare to national percentiles?
For each measure, a health plan ranking presents the reported rate in order from highest to lowest,
with bars representing the established HPL, LPL, and the national HEDIS 2006 Medicaid 50th
percentile. In addition, the 2007, 2006, and 2005 Michigan Medicaid weighted averages are
presented for comparison purposes.
Michigan MHPs with reported rates above the 90th percentile (HPL) rank in the top 10 percent of
all MHPs nationally. Similarly, health plans reporting rates below the 25th percentile (LPL) rank in
the bottom 25 percent nationally for that measure.
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HOW TO GET THE MOST FROM THIS REPORT
3.
How are Michigan MHPs performing overall?
For each dimension, a performance profile analysis compares the 2007 Michigan Medicaid
weighted average for each rate with the 2006 and 2005 Michigan Medicaid weighted averages and
the national HEDIS 2006 Medicaid 50th percentile.
4.
Can the health plans do a better job calculating the measures?
For each rate, a data collection analysis shows the number of health plans using each methodology
(hybrid or administrative). The proportion of each reported rate resulting from administrative data
and the proportion resulting from medical record review are displayed in a stacked bar, except for
measures reported administrative-only. Columns to the right of the stacked bar show precisely how
much of the final rate was derived from the administrative method and how much from medical
record review. Because of rounding differences, the sum of the administrative rate and the medical
record review rate may not always be exactly equal to the final rate.
The Michigan 2007 aggregate bar represents the sum of all administrative events and medical
record review events for all members in the statewide denominator, regardless of the data collection
methodology used.
In addition, Section 7 of this report discusses HEDIS reporting capabilities of the Michigan MHPs.
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Understanding Sampling Error
Correct interpretation of results for measures collected using the HEDIS hybrid methodology
requires an understanding of sampling error. It is rarely possible, logistically or financially, to do
medical record review for the entire eligible population for a given measure. Measures collected
using the HEDIS hybrid method include only a sample from the population, and statistical
techniques are used to maximize the probability that the sample results reflect the experience of the
entire eligible population.
For results to be generalized to the entire population, the process of sample selection must be such
that everyone in the eligible population has an equal chance of being selected. The HEDIS hybrid
method prescribes a systematic sampling process for selecting at least 411 members of the eligible
population. Health plans may use a 5 percent, 10 percent, 15 percent, or 20 percent oversample to
replace invalid cases (e.g., a male selected for Postpartum Care).
Figure 2-1 shows that if 411 health plan members are included in a measure, the margin of error is
approximately ± 4.9 percentage points. Note that the data in this figure are based on the assumption
that the size of the eligible population is greater than 2,000. The smaller the number included in the
measure, the larger the sampling error.
Figure 2-1—Relationship of Sample Size to Sample Error
40%
31.0%
30%
19.6%
20%
13.9%
Sample Error
11.3%
9.8%
10%
8.8%
8.0%
7.4%
6.9% 6.2%
5.7%
5.2% 4.9%
4.6% 4.4%
3.1%
3.0% 2.8%
2.7%
2.6% 2.5%
0%
-10%
-11.3%
-9.8%
-4.4%
-5.2% -4.9% -4.6%
-6.2% -5.7%
-7.4% -6.9%
-8.0%
-8.8%
-3.1% -3.0% -2.8% -2.7% -2.6% -2.5%
-13.9%
-20%
-19.6%
-30%
-31.0%
-40%
10
25
50
75
100
125
150
175
200
250
300
350
400
450
500 1,000 1,100 1,200 1,300 1,400 1,500
Sample Size
As Figure 2-1 shows, sample error gets smaller as the sample size gets larger. Consequently, when
sample sizes are very large and sampling errors are very small, almost any difference is statistically
significant. This does not mean that all such differences are important. On the other hand, the
difference between two measured rates may not be statistically significant, but may, nevertheless,
be important. The judgment of the reviewer is always a requisite for meaningful data interpretation.
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Health Plan Name Key
Figures in the following sections of the report show overall health plan performance for each of the
key measures. Below is the name key for each of the health plan abbreviations used in the figures.
Table 2-2—2007 Michigan MHPs
Code
Health Plan Name
CCM
Community Choice Michigan
GLH
Great Lakes Health Plan
HPM
Health Plan of Michigan, Inc.
HPP
HealthPlus Partners, Inc.
MCD
M-CAID
MCL
McLaren Health Plan
MID
Midwest Health Plan
MOL
Molina Healthcare of Michigan
OCH
OmniCare Health Plan
PMD
Physicians Health Plan of Mid-Michigan Family Care
PRI
Priority Health Government Programs, Inc.
THC
Total Health Care, Inc.
UPP
Upper Peninsula Health Plan
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3. Pediatric Care
Introduction
Pediatric primary health care is a vital part of the effort to prevent, recognize, and treat health
conditions that can result in significant developmental consequences for children and adolescents.
Timely immunizations and health checkups are particularly important for young children. Failure to
detect problems with growth, hearing, and vision in toddlers may adversely impact future abilities
and experiences. Early detection of developmental issues gives health care professionals the best
opportunity to intervene and provide children with the chance to grow and learn without healthrelated limitations.
The Michigan Care Improvement Registry (MCIR) gives health care providers access to
immunization records and allows them to more effectively identify children who are behind in their
immunizations. All health care providers in the State of Michigan who provide immunization
services to children born after December 31, 1993 are required to report each immunization to the
registry. Since 1996, the electronic database has grown to include more than 50 million vaccinations
provided to 4.2 million people. According to MCIR, 100 percent of the 45 local health departments
and 80 percent of 2,500 registered private provider sites reported immunization data in 2004.3-1
Increased provider participation has helped to identify major barriers to infant and childhood
immunizations, including missed opportunities to administer vaccines. In 2005, MCIR began
partnering with the Michigan Department of Education to document student immunizations and
track compliance rates for children registered in Michigan public schools.
Inappropriate use of antibiotic therapies is another issue that continues to require attention in the
area of pediatric primary health care. Antimicrobial resistance has become a common clinical
problem, and a significant public health concern. The Institute of Medicine has identified antibiotic
resistance as one of the key microbial threats to health in the United States, and has focused on
promoting appropriate use of antimicrobials as a primary means to address this threat. The Centers
for Disease Control and Prevention (CDC) has also cited antimicrobial resistance as one of its top
concerns. The CDC’s Get Smart: Know When Antibiotics Work campaign aims to reduce the rising
rate of antibiotic resistance by targeting the five respiratory conditions that in 1992 accounted for
more than 75 percent of all office-based prescribing for all ages combined: otitis media, sinusitis,
pharyngitis, bronchitis, and the common cold. Although antibiotic prescribing rates have decreased,
the CDC notes that patients of all ages are prescribed more than 10 million courses of antibiotics
annually for viral conditions that do not benefit from antibiotics.3-2
The Appropriate Treatment for Children With Upper Respiratory Infection and Appropriate Testing
for Children With Pharyngitis measures collect data on overuse of antibiotics for children diagnosed
with either an upper respiratory infection or pharyngitis.
3-1
3-2
Michigan Care Improvement Registry. Available at: http://www.mcir.org/accomplishments.html. Accessed on: July 17, 2007.
Centers for Disease Control and Prevention, Department of Health and Human Services. GET SMART: Know When Antibiotics Work.
Available at: http://www.cdc.gov/drugresistance/community/campaign_info.htm#3. Accessed on: July 25, 2007.
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PEDIATRIC CARE
The following pages provide detailed analysis of the Michigan MHPs’ performance, ranking, and
the data collection methodology used for these measures.
The Pediatric Care dimension encompasses the following MDCH key measures:
‹
‹
‹
‹
‹
Childhood Immunization Status
ƒ Childhood Immunization Status—Combination #2
ƒ Childhood Immunization Status—Combination #3
Adolescent Immunization Status
ƒ Adolescent Immunization Status—Combination #2
Well-Care Visits
ƒ Well-Child Visits in the First 15 Months of Life—Zero Visits
ƒ Well-Child Visits in the First 15 Months of Life—Six or More Visits
ƒ Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life
ƒ Adolescent Well-Care Visits
Appropriate Treatment for Children With Upper Respiratory Infection
ƒ Appropriate Treatment for Children With Upper Respiratory Infection
Appropriate Testing for Children With Pharyngitis
ƒ Appropriate Testing for Children With Pharyngitis
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
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PEDIATRIC CARE
Childhood Immunization Status
Childhood vaccination has led to dramatic declines in many life-threatening diseases such as polio,
tetanus, whooping cough, mumps, measles, and meningitis over the last 50 years. However, 20
percent of 2-year-olds in the United States have not received one or more of the recommended
vaccinations. The importance of immunizations goes beyond decreasing the burden of disease. In
addition to reducing disease incidence, immunizations also save on medical costs. Immunizations of
DTaP (diphtheria and tetanus toxoids and acellular pertussis vaccine); Hib (Haemophilus influenzae
type b vaccine); IPV (inactivated poliovirus vaccine); MMR (measles, mumps, and rubella vaccine);
hepatitis B; and VZV (varicella-zoster virus [chicken pox] vaccine) save $9.9 billion in direct
medical costs and $43.3 billion in indirect costs.3-3
In Michigan, 89 percent of children 6 years of age or younger have two or more doses recorded in
the MCIR; the national average for registries is 49 percent.3-4 Michigan’s progress in terms of
increasing immunization rates has been significant over the past several years. According to
National Immunization Survey results, the State of Michigan has gone from ranking lowest in the
country in 1994 to having the ninth-highest rates.3-5 In addition , according to NCQA’s The State of
Managed Care Quality, 2006 report, for its Medicaid population Michigan was the top-performing
state on the Childhood Immunization Status—Hepatitis B and Combination #2 measures.3-6
Key measures in this section include:
‹
‹
Childhood Immunization Status—Combination #2
Childhood Immunization Status—Combination #3
These key measures are also commonly referred to as Combo #2 and Combo #3.
HEDIS Specification: Childhood Immunization Status—Combination #2
Childhood Immunization Status—Combination #2 calculates the percentage of enrolled children
who turned 2 years of age during the measurement year, who were continuously enrolled for 12
months immediately preceding their second birthdays, and who were identified as having four
DTaP/DT, three IPV, one MMR, three Hib, three hepatitis B, and one VZV vaccination on or before
the child’s second birthday.
3-3
National Committee for Quality Assurance. The State of Managed Care Quality 2006. Standard Version. Washington, DC: National
Committee for Quality Assurance: 2006.
3-4
Michigan Public Health Institute. Information for Providers: Accomplishments. 2001 Michigan Childhood Immunization Registry.
Available at: http://www.mcir.org/accomplishments.html. Accessed on: July 27, 2007.
3-5
Michigan Department of Community Health. Critical Health Indicators: Childhood Immunizations. Available at:
http://www.michigan.gov/documents/mdch/32_ChldImmun_198933_7.pdf. Accessed on: July 27, 2007.
3-6
National Committee for Quality Assurance. The State of Managed Care Quality 2006. Standard Version. Washington, DC: National
Committee for Quality Assurance: 2006.
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Health Plan Ranking: Childhood Immunization Status—Combination #2
Figure 3-1—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Childhood Immunization Status—Combination #2
Childhood Immunization Combo 2
He alth Plan
Priority Health
335
N
88.7%
HealthPlus Partners, Inc.
411
85.2%
Health Plan of Michigan, Inc.
432
83.8%
High Performance Level
Rate
82.7%
PHP of Mid-Michigan
411
82.0%
Midwest Health Plan
411
81.5%
M-CAID
432
81.0%
Upper Peninsula Health Plan
797
80.7%
McLaren Health Plan
411
80.0%
OmniCare Health Plan
432
79.9%
Total Health Care, Inc.
432
77.8%
Great Lakes Health Plan
335
77.6%
Community Choice Michigan
411
74.9%
National 50th Percentile
72.4%
Molina Healthcare of Michigan
3,024
Low Performance Level
72.4%
62.7%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 80.2%
2006 Michigan Medicaid Weighted Average = 76.6%
2005 Michigan Medicaid Weighted Average = 71.7%
Twelve out of 13 health plans reported rates above the national HEDIS 2006 Medicaid 50th
percentile. Three health plans exceeded the HPL of 82.7 percent and one health plan reported a rate
nearly equal to the national HEDIS 2006 Medicaid 50th percentile rate of 72.4 percent.
The 2007 Michigan Medicaid weighted average increased by 3.6 percentage points over the 2006
Michigan Medicaid weighted average of 76.6 percent. The range of reported rates showed minimal
improvement from 2006 to 2007.
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Data Collection Analysis: Childhood Immunization Status—Combination #2
Figure 3-2—Michigan Medicaid HEDIS 2007
Data Collection Analysis:
Childhood Immunization Status—Combination #2
Childhood Immunization Combo 2
He alth Plan
Admin %
Priority Health
88.7%
HealthPlus Partners, Inc.
85.2%
Health Plan of Michigan, Inc.
83.8%
M RR %
79.7%
9.0%
83.7%
1.5%
80.6%
3.2%
High Performance Level
PHP of Mid-Michigan
82.0%
75.9%
6.1%
Midwest Health Plan
81.5%
48.9%
32.6%
M-CAID
81.0%
62.0%
19.0%
Upper Peninsula Health Plan
80.7%
80.7%
2007 Michigan Aggregate
80.3%
63.2%
17.1%
McLaren Health Plan
80.0%
1.2%
78.8%
OmniCare Health Plan
79.9%
47.5%
32.4%
-
Total Health Care, Inc.
77.8%
62.3%
15.5%
Great Lakes Health Plan
77.6%
70.7%
6.9%
59.1%
15.8%
Community Choice Michigan
74.9%
Molina Healthcare of Michigan
72.4%
72.4%
-
Low Performance Level
0%
20%
MRR=Medical Record Review
Admin=Administrative Data
40%
60%
Admin
80%
100%
MRR
The figure above shows how much of the final rate for each health plan was derived from the administrative method (Admin) and how
much was from medical record review (MRR). Note: Because of rounding differences, the sum of the Admin rate and the MRR rate may
not always be exactly equal to the final rate.
Eleven of the 13 health plans elected to use the hybrid method for this measure. The 2007 Michigan
aggregate administrative rate was 63.2 percent and the medical record review rate was 17.1 percent.
One health plan derived only 1.2 percent of the rate from administrative data, while 10 of the other
plans derived more than half of their rates from administrative data.
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PEDIATRIC CARE
HEDIS Specification: Childhood Immunization Status—Combination #3
Childhood Immunization Status—Combination #3 calculates the percentage of enrolled children
who turned 2 years of age during the measurement year, who were continuously enrolled for 12
months immediately preceding their second birthdays, and who were identified as having four
DTaP/DT, three IPV, one MMR, three Hib, three hepatitis B, one VZV, and four pneumococcal
conjugate vaccinations, on or before the child’s second birthday.
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Health Plan Ranking: Childhood Immunization Status—Combination #3
Figure 3-3—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Childhood Immunization Status—Combination #3
Childhood Immunization Combo 3
He alth Plan
Priority Health
N
335
81.2%
PHP of Mid-Michigan
411
73.5%
HealthPlus Partners, Inc.
411
71.5%
Health Plan of Michigan, Inc.
432
71.5%
McLaren Health Plan
411
66.7%
Upper Peninsula Health Plan
797
66.6%
Great Lakes Health Plan
335
63.3%
Community Choice Michigan
411
62.5%
Total Health Care, Inc.
432
62.0%
Midwest Health Plan
411
57.9%
High Performance Level
Rate
57.8%
M-CAID
432
56.7%
OmniCare Health Plan
432
51.9%
National 50th Percentile
42.3%
Molina Healthcare of Michigan
3,024
Low Performance Level
35.5%
33.8%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 62.3%
2006 Michigan Medicaid Weighted Average = 38.5%
Childhood Immunization Status––Combination #3 was a new measure in 2006; therefore, 2007 was
the first year that national performance data were available for comparison.
Ten health plans had rates above the HPL of 57.8 percent, and all 13 health plans’ rates were above
the LPL of 33.8 percent.
The 2007 Michigan Medicaid weighted average showed statistically significant improvement over
the 2006 Michigan Medicaid weighted average, with an increase of 23.8 percentage points.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
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Data Collection Analysis: Childhood Immunization Status—Combination #3
Figure 3-4—Michigan Medicaid HEDIS 2007
Data Collection Analysis:
Childhood Immunization Status—Combination #3
Childhood Immunization Combo 3
He alth Plan
Admin %
Priority Health
81.2%
PHP of Mid-Michigan
73.5%
M RR %
72.2%
9.0%
67.9%
5.6%
HealthPlus Partners, Inc.
71.5%
69.1%
2.4%
Health Plan of Michigan, Inc.
71.5%
67.6%
3.9%
65.7%
McLaren Health Plan
66.7%
1.0%
Upper Peninsula Health Plan
66.6%
66.6%
-
Great Lakes Health Plan
63.3%
57.3%
6.0%
2007 Michigan Aggregate
62.7%
49.3%
13.4%
Community Choice Michigan
62.5%
48.2%
14.4%
Total Health Care, Inc.
62.0%
48.6%
13.4%
35.5%
22.4%
43.1%
13.7%
34.5%
17.4%
Midwest Health Plan
57.9%
High Performance Level
M-CAID
56.7%
OmniCare Health Plan
51.9%
Molina Healthcare of Michigan
35.5%
35.5%
-
Low Performance Level
0%
20%
MRR=Medical Record Review
Admin=Administrative Data
40%
60%
Admin
80%
100%
MRR
The figure above shows the percent of the final rate for each health plan that was derived from the administrative method (Admin) and
from medical record review (MRR). Note: Because of rounding differences, the sum of the Admin rate and the MRR rate may not always
be exactly equal to the final rate.
Except for Upper Peninsula Health Plan, all the MHPs used the hybrid methodology for this
measure. The 2007 Michigan aggregate administrative rate was 49.3 percent and the medical record
review rate was 13.4 percent.
The results indicate that 78.6 percent of the aggregate rate was derived from administrative data and
21.4 percent from medical record review. These percentages were consistent with the Childhood
Immunization Status—Combination #2 findings.
All of the plans that used the hybrid methodology derived more than half of their rates from
administrative data.
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Adolescent Immunization Status
Although immunization programs that focus on infants and children have proven successful in
combating vaccine-preventable diseases, adolescents and young adults continue to be adversely
affected by varicella (chicken pox), hepatitis B, measles, rubella, and other infectious diseases. In
fact, most of the approximately 60,000 new hepatitis B infections that occur each year are in
adolescents and young adults, and of the 575 measles cases in 1996 in which the age of the person
was known, one-third were 10 to 19 years of age.3-7 This may be due in part to the fact that some
immunization programs have placed less emphasis on improving vaccination coverage among
adolescents compared to young children. Prior to 2005, the only routinely recommended
vaccination for adolescents was the tetanus and diphtheria toxoids (Td) booster. Currently, the CDC
recommends that adolescents receive three vaccines: hepatitis B, VZV, and MMR.3-8 The State of
Michigan has high performance in adolescent immunizations. Michigan was the top-performing
state on the Adolescent Immunization Status—VZV and Combination #2 measures for its Medicaid
population, according to NCQA’s The State of Managed Care Quality 2006 report.3-9
The key measure in this section is:
‹
Adolescent Immunization Status—Combination #2
This is also commonly referred to as Combo #2.
HEDIS Specification: Adolescent Immunization Status—Combination #2
The Adolescent Immunization Status—Combination #2 measure calculates the percentage of
enrolled adolescents who turned 13 years of age during the measurement year, who were
continuously enrolled for 12 months immediately prior to their 13th birthdays, and who were
identified as having the following vaccinations: second dose of MMR, three hepatitis B
vaccinations, and at least one VZV within the allowed time period and by the member’s 13th
birthday.
3-7
National Foundation for Infectious Diseases. Adolescent Immunization Questions & Answers. Available at:
http://www.nfid.org/pdf/factsheets/adolescentqa.pdf. Accessed on: July 27, 2007.
3-8
National Committee for Quality Assurance. The State of Managed Care Quality 2006. Standard Version. Washington, DC: National
Committee for Quality Assurance: 2006.
3-9
Ibid.
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Health Plan Ranking: Adolescent Immunization Status—Combination #2
Figure 3-5—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Adolescent Immunization Status—Combination #2
Adolescent Immunization Combo 2
He alth Plan
HealthPlus Partners, Inc.
N
348
79.0%
Priority Health
348
78.4%
PHP of Mid-Michigan
411
75.4%
Total Health Care, Inc.
424
71.2%
Health Plan of Michigan, Inc.
432
70.6%
Upper Peninsula Health Plan
408
70.1%
High Performance Level
Rate
69.8%
M-CAID
425
68.5%
Community Choice Michigan
401
67.1%
Great Lakes Health Plan
405
66.7%
McLaren Health Plan
411
64.2%
Midwest Health Plan
411
64.0%
OmniCare Health Plan
432
59.7%
4,042
54.6%
Molina Healthcare of Michigan
National 50th Percentile
44.3%
Low Performance Level
24.6%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 65.9%
2006 Michigan Medicaid Weighted Average = 58.9%
2005 Michigan Medicaid Weighted Average = 53.0%
All of the 13 health plans ranked above both the LPL and the national HEDIS 2006 Medicaid 50th
percentile, and six health plans ranked above the HPL of 69.8 percent.
The 2007 Michigan Medicaid weighted average of 65.9 percent increased by 7 percentage points
over the 2006 weighted average and was 21.6 percentage points above the national HEDIS 2006
50th percentile. Nine of the MHPs had rates above the 2007 weighted average.
The range of reported rates showed considerable improvement from 2006 to 2007. The topperforming health plan increased its rate by more than 8 percentage points in 2007.
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PEDIATRIC CARE
Data Collection Analysis: Adolescent Immunization Status—Combination #2
Figure 3-6—Michigan Medicaid HEDIS 2007
Data Collection Analysis:
Adolescent Immunization Status—Combination #2
Adolescent Immunization Combo 2
He alth Plan
Admin %
M RR %
HealthPlus Partners, Inc.
79.0%
68.4%
10.6%
Priority Health
78.4%
62.4%
16.1%
51.6%
23.8%
PHP of Mid-Michigan
75.4%
Total Health Care, Inc.
71.2%
45.5%
25.7%
Health Plan of Michigan, Inc.
70.6%
66.2%
4.4%
Upper Peninsula Health Plan
70.1%
60.3%
9.8%
High Performance Level
M-CAID
68.5%
42.6%
25.9%
2007 Michigan Aggregate
68.1%
46.2%
22.0%
Community Choice Michigan
67.1%
56.1%
11.0%
Great Lakes Health Plan
66.7%
48.9%
17.8%
McLaren Health Plan
64.2%
0.2%
64.0%
Midwest Health Plan
64.0%
0.5%
63.5%
47.7%
12.0%
OmniCare Health Plan
59.7%
Molina Healthcare of Michigan
54.6%
54.6%
-
Low Performance Level
0%
20%
MRR=Medical Record Review
Admin=Administrative Data
40%
60%
Admin
80%
100%
MRR
The figure above shows the percent of the final rate for each health plan that was derived from the administrative method (Admin) and
from medical record review (MRR). Note: Because of rounding differences, the sum of the Admin rate and the MRR rate may not always
be exactly equal to the final rate.
Twelve out of the 13 MHPs used the hybrid method to report this measure. The 2007 Michigan
aggregate administrative rate was 46.2 percent and the medical record review was 22.0 percent.
Two health plans, McLaren and Midwest, derived less that 1 percent of their data from
administrative data.
The results for Adolescent Immunization Status—Combination #2 illustrate that 67.8 percent of the
aggregate rate was derived from administrative data and 32.3 percent from medical record review.
The 2007 administrative rate increased by more that 7 percentage points from the 2006
administrative rate.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-11
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
Well-Child Visits in the First 15 Months of Life
The American Medical Association (AMA) and the American Academy of Pediatrics (AAP)
recommend timely, comprehensive well-child visits for children. In 2004, 85 percent of children
younger than 6 years of age received a well-child checkup during the previous year.3-10 These
periodic checkups allow clinicians to assess a child’s physical, behavioral, and developmental
status, and to provide any necessary treatment, intervention, or referral to a specialist. A study of
Medicaid children who were up–to-date with the AAP’s recommended well-child visit schedule
showed a significant reduction in risk of avoidable hospitalizations for that group.3-11
Michigan Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) requirements specify
the components of age-appropriate well-child visits. The required components include: review of
the child’s clinical history and immunization status, complete physical exam, sensory screening
(i.e., hearing and vision), developmental assessment, health guidance/education, dental checks, and
lab tests, including lead risk.3-12 These visits reduce a child’s risk of reaching his or her teenage
years with developmental problems that have not been addressed. Although the HEDIS well-child
visit measures do not directly collect performance data on individual EPSDT components rendered
during a visit, the measures provide an indication of the number of well-care visits delivered to
children of various age groups.
Key measures include the following rates:
‹
‹
Well-Child Visits in the First 15 Months of Life—Zero Visits
Well-Child Visits in the First 15 Months of Life—Six or More Visits
The following pages analyze in detail the performance profile, health plan rankings, and data
collection methodology used by the Michigan MHPs for the two rates reported for this key measure:
Zero Visits and Six or More Visits.
HEDIS Specification: Well-Child Visits in the First 15 Months of Life—Zero Visits
Well-Child Visits in the First 15 Months of Life—Zero Visits calculates the percentage of enrolled
members who turned 15 months of age during the measurement year, who were continuously
enrolled in the Michigan MHP from 31 days of age, and who received zero visits with a primary
care practitioner (PCP) during their first 15 months of life.
It should be noted that limitations within the NCQA Interactive Data Submission System (IDSS),
and differences in the way the health plans complete the IDSS, may potentially impact the findings
for data collection for this measure. Health plans may choose to attribute the finding of zero visits
solely to administrative data sources, solely to medical record review, or to a combination of these.
Any one of these approaches is acceptable; therefore, a comparison of data collection methods for
this measure is not relevant and has not been included in this report.
3-10
Child Trends Databank. Well-child visits. Available at: http://www.childtrendsdatabank.org/indicators/93WellChildVisits.cfm.
Accessed on: July 7, 2006.
3-11
Hakim RB, Bye BV. Effectiveness of Compliance With Pediatric Preventive Care Guidelines Among Medicaid Beneficiaries.
Pediatrics. 2001, 108 (1): 90-97.
3-12
Human Services Research Institute. EPSDT: Supporting Children with Disabilities. September 2004.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-12
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
Health Plan Ranking: Well-Child Visits in the First 15 Months of Life—Zero Visits
Figure 3-7—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Well-Child Visits in the First 15 Months of Life—Zero Visits
W ell-Child 1st 15 Months, 0 Visits
He alth Plan
Low Performance Level
N
Rate
3.9%
Midwest Health Plan
411
3.6%
Community Choice Michigan
411
3.4%
HealthPlus Partners, Inc.
395
2.3%
National 50th Percentile
2.0%
Molina Healthcare of Michigan
431
1.9%
PHP of Mid-Michigan
354
1.4%
Upper Peninsula Health Plan
801
1.4%
McLaren Health Plan
411
1.2%
Priority Health
411
1.2%
Total Health Care, Inc.
432
1.2%
Health Plan of Michigan, Inc.
432
0.9%
OmniCare Health Plan
432
0.9%
M-CAID
191
0.5%
High Performance Level
0.5%
Great Lakes Health Plan
380
0%
20%
40%
60%
80%
0.3%
100%
2007 Michigan Medicaid Weighted Average = 1.5%
2006 Michigan Medicaid Weighted Average = 2.1%
2005 Michigan Medicaid Weighted Average = 3.4%
For this key measure, a lower rate indicates better performance, since low rates of zero visits indicate better care.
Figure 3-7 shows the percentage of children who received no well-child visits by 15 months of age.
For this measure, a lower rate indicates better performance.
One health plan performed better than the HPL rate of 0.5 percent, and no plans performed worse
than the LPL rate of 3.9 percent.
The 2007 Michigan Medicaid weighted average of 1.5 percent was better than the national HEDIS
2006 Medicaid 50th percentile rate of 2.0 percent and showed statistically significant improvement
over the 2006 weighted average of 2.1 percent. The MHPs continue to show improvement in the
number of children who received no well-child visits.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-13
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
HEDIS Specification: Well-Child Visits in the First 15 Months of Life—Six or More Visits
Well-Child Visits in the First 15 Months of Life—Six or More Visits calculates the percentage of
enrolled members who turned 15 months of age during the measurement year, who were
continuously enrolled in the Michigan MHP from 31 days of age, and who received six or more
visits with a PCP during their first 15 months of life.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-14
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
Health Plan Ranking: Well-Child Visits in the First 15 Months of Life—Six or More Visits
Figure 3-8—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Well-Child Visits in the First 15 Months of Life—Six or More Visits
W ell-Child 1st 15 Months, 6+ Visits
He alth Plan
Great Lakes Health Plan
N
380
91.1%
Health Plan of Michigan, Inc.
432
69.9%
High Performance Level
Rate
68.6%
M-CAID
191
64.4%
McLaren Health Plan
411
62.8%
HealthPlus Partners, Inc.
395
61.8%
Midwest Health Plan
411
56.7%
Priority Health
411
53.5%
OmniCare Health Plan
432
50.9%
National 50th Percentile
50.0%
PHP of Mid-Michigan
354
49.2%
Total Health Care, Inc.
432
49.1%
Upper Peninsula Health Plan
801
44.6%
Molina Healthcare of Michigan
431
42.5%
Low Performance Level
41.6%
Community Choice Michigan
411
0%
20%
40%
60%
80%
37.5%
100%
2007 Michigan Medicaid Weighted Average = 59.3%
2006 Michigan Medicaid Weighted Average = 51.9%
2005 Michigan Medicaid Weighted Average = 43.0%
Two health plans reported rates above the HPL of 68.6 percent, and a total of eight health plans
reported rates above the national HEDIS 2006 Medicaid 50th percentile of 50.0 percent. Five
health plans had rates above the 2007 Michigan weighted average of 59.3 percent.
The 2007 Michigan weighted average increased by 7.4 percentage points from 2006 and by 16.3
percentage points since 2005. The health plans are showing improvement in the number of children
receiving six or more well-child visits.
One health plan’s reported rate of 37.5 percent fell below the LPL of 41.6 percent.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-15
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
Data Collection Analysis: Well-Child Visits in the First 15 Months of Life—Six or More
Visits
Figure 3-9—Michigan Medicaid HEDIS 2007
Data Collection Analysis:
Well-Child Visits in the First 15 Months of Life—Six or More Visits
W ell-Child 1st 15 Months, 6+ Visits
He alth Plan
Admin %
Great Lakes Health Plan
91.1%
Health Plan of Michigan, Inc.
69.9%
M RR %
89.2%
1.8%
69.4%
0.5%
31.4%
33.0%
High Performance Level
M-CAID
64.4%
McLaren Health Plan
62.8%
25.3%
37.5%
HealthPlus Partners, Inc.
61.8%
31.6%
30.1%
Midwest Health Plan
56.7%
24.3%
32.4%
2007 Michigan Aggregate
55.9%
38.5%
17.4%
30.7%
22.9%
36.1%
14.8%
Priority Health
53.5%
OmniCare Health Plan
50.9%
PHP of Mid-Michigan
49.2%
29.7%
19.5%
Total Health Care, Inc.
49.1%
35.2%
13.9%
Upper Peninsula Health Plan
44.6%
Molina Healthcare of Michigan
44.6%
42.5%
-
27.6%
14.8%
22.9%
14.6%
Low Performance Level
Community Choice Michigan
37.5%
0%
20%
MRR=Medical Record Review
Admin=Administrative Data
40%
60%
Admin
80%
100%
MRR
The figure above shows the percent of the final rate for each health plan that was derived from the administrative method (Admin) and
from medical record review (MRR). Note: Because of rounding differences, the sum of the Admin rate and the MRR rate may not always
be exactly equal to the final rate.
All health plans except one elected to use the hybrid method for this measure. The 2007 Michigan
aggregate administrative rate was 38.5 percent and the medical record review rate was 17.4 percent.
Results show that 68.9 percent of the aggregate rate was derived from administrative data and 31.1
percent from medical record review. The administrative rate increased by 5 percentage points from
last year.
The top two performing MHPs for this measure derived less than 2 percent of their rates from
medical record review. Ten of the health plans derived at least half of their rates from administrative
data.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-16
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life
AAP recommends annual well-child visits for children between 2 and 6 years of age.3-13 These
checkups during the preschool and early school years help clinicians detect vision, speech, and
language problems as early as possible. Early intervention in these areas can improve a child’s
communication skills and reduce language and learning problems.
The following pages analyze the performance profile, health plan rankings, and data collection
methodology used by the Michigan MHPs for Well-Child Visits in the Third, Fourth, Fifth, and
Sixth Years of Life.
HEDIS Specification: Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life
This key measure, Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life, reports the
percentage of members who were 3, 4, 5, or 6 years of age during the measurement year; who were
continuously enrolled during the measurement year; and who received one or more well-child visits
with a PCP during the measurement year.
3-13
American Academy of Pediatrics. Recommendations for Preventive Pediatric Health Care. Available at:
http://practice.aap.org/content.aspx?aid=1599. Accessed on: August 17, 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-17
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
Health Plan Ranking: Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life
Figure 3-10—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life
W ell-Child 3rd-6th Years of Life
He alth Plan
High Performance Level
N
Rate
77.5%
Midwest Health Plan
411
74.9%
OmniCare Health Plan
424
72.2%
McLaren Health Plan
411
69.8%
Great Lakes Health Plan
371
69.8%
PHP of Mid-Michigan
411
67.6%
M-CAID
408
67.4%
Total Health Care, Inc.
428
65.4%
Health Plan of Michigan, Inc.
432
65.3%
National 50th Percentile
64.8%
HealthPlus Partners, Inc.
403
64.8%
Priority Health
388
63.7%
Molina Healthcare of Michigan
431
62.2%
Upper Peninsula Health Plan
3,026
60.9%
Community Choice Michigan
411
56.9%
Low Performance Level
56.7%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 66.1%
2006 Michigan Medicaid Weighted Average = 64.2%
2005 Michigan Medicaid Weighted Average = 58.5%
None of the health plans reported rates above the HPL of 77.5 percent, and no health plans reported
rates below the LPL of 56.7 percent. Eight plans performed above the national HEDIS 2006
Medicaid 50th percentile of 64.8 percent.
The 2007 Michigan Medicaid weighted average of 66.1 percent was 1.9 percentage points above the
2006 weighted average and 1.3 percentage points above the national HEDIS 2006 Medicaid 50th
percentile.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-18
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
Data Collection Analysis: Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life
Figure 3-11—Michigan Medicaid HEDIS 2007
Data Collection Analysis:
Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life
W ell-Child 3rd-6th Years of Life
He alth Plan
Admin %
M RR %
High Performance Level
Midwest Health Plan
74.9%
OmniCare Health Plan
72.2%
59.1%
15.8%
62.3%
9.9%
McLaren Health Plan
69.8%
47.0%
22.9%
Great Lakes Health Plan
69.8%
65.8%
4.0%
PHP of Mid-Michigan
67.6%
57.7%
10.0%
M-CAID
67.4%
61.3%
6.1%
2007 Michigan Aggregate
66.2%
58.1%
8.1%
Total Health Care, Inc.
65.4%
53.3%
12.1%
Health Plan of Michigan, Inc.
65.3%
62.0%
3.2%
HealthPlus Partners, Inc.
64.8%
57.3%
7.4%
Priority Health
63.7%
57.7%
5.9%
57.1%
5.1%
Molina Healthcare of Michigan
62.2%
Upper Peninsula Health Plan
60.9%
Community Choice Michigan
60.9%
56.9%
54.3%
2.7%
Low Performance Level
0%
20%
MRR=Medical Record Review
Admin=Administrative Data
40%
60%
Admin
80%
100%
MRR
The figure above shows the percent of the final rate for each health plan that was derived from the administrative method (Admin) and
from medical record review (MRR). Note: Because of rounding differences, the sum of the Admin rate and the MRR rate may not always
be exactly equal to the final rate.
Twelve of the 13 health plans elected to use the hybrid method for this measure. The 2007
Michigan aggregate administrative rate was 58.1 percent and the medical record review rate was 8.1
percent.
For the health plans that used the hybrid method, more than half of their rates were derived from
administrative data.
The results showed that 87.8 percent of the aggregate rate was derived from administrative data and
12.2 percent was derived from medical record review.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-19
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
Adolescent Well-Care Visits
Among adolescents, unintentional injuries, homicide, and suicide are the leading causes of death.
Sexually transmitted diseases (STDs), substance abuse, pregnancy, and antisocial behavior are
important causes of physical, emotional, and social problems in this age group. The AMA’s
Guidelines for Adolescent Preventive Services (GAPS) recommends comprehensive annual health
care visits for adolescents.3-14 However, adolescents tend to have additional barriers to care that
must be addressed, such as access, cost, confidentiality, and participation in their own care.3-15
The following pages analyze the performance profile, health plan rankings, and data collection
methodology used by the Michigan MHPs for Adolescent Well-Care Visits.
HEDIS Specification: Adolescent Well-Care Visits
This key measure reports the percentage of enrolled members who were 12 to 21 years of age
during the measurement year, who were continuously enrolled during the measurement year, and
who had at least one comprehensive well-care visit with a PCP or an obstetrics/gynecology
(OB/GYN) practitioner during the measurement year.
3-14
American Medical Association. Guidelines for Adolescent Preventive Services (GAPS). 1997. Available at: http://www.amaassn.org/ama/upload/mm/39/gapsmono.pdf. Accessed on: August 17, 2007.
3-15
National Adolescent Health Information Center. 1998. Assuring the Health of Adolescents in Managed Care: A Quality Checklist for
Planning and Evaluating Components of Adolescent Health Care. San Francisco, CA: University of California, San Francisco, National
Adolescent Health Information Center.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-20
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
Health Plan Ranking: Adolescent Well-Care Visits
Figure 3-12—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Adolescent Well-Care Visits
Adolescent W ell-Care Visits
He alth Plan
Great Lakes Health Plan
N
410
58.8%
Health Plan of Michigan, Inc.
432
55.1%
High Performance Level
Rate
54.5%
McLaren Health Plan
411
52.1%
M-CAID
432
51.4%
OmniCare Health Plan
432
50.2%
Midwest Health Plan
411
50.1%
HealthPlus Partners, Inc.
411
48.4%
Total Health Care, Inc.
432
47.9%
PHP of Mid-Michigan
411
47.7%
Priority Health
411
43.3%
Molina Healthcare of Michigan
432
39.6%
National 50th Percentile
39.4%
Upper Peninsula Health Plan
4,714
Low Performance Level
39.1%
32.8%
Community Choice Michigan
411
0%
20%
40%
60%
80%
31.1%
100%
2007 Michigan Medicaid Weighted Average = 47.7%
2006 Michigan Medicaid Weighted Average = 43.5%
2005 Michigan Medicaid Weighted Average = 38.0%
Two health plans ranked above the HPL rate of 54.5 percent and two plans ranked below the
national HEDIS 2006 Medicaid 50th percentile. One of the two plans below the national HEDIS
2006 Medicaid 50th percentile was also below the LPL of 32.8 percent.
The 2007 Michigan Medicaid weighted average of 47.7 percent was 4.2 percentage points above the
2006 Michigan Medicaid weighted average of 43.5 percent and almost 10 percentage points above
the 2005 weighted average.
Two health plans exceeded the HPL in 2007, while none reached the HPL in 2006. However, one
health plan fell below the LPL in 2007 and none were below the LPL in 2006.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-21
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
Data Collection Analysis: Adolescent Well-Care Visits
Figure 3-13—Michigan Medicaid HEDIS 2007
Data Collection Analysis:
Adolescent Well-Care Visits
Adolescent W ell-Care Visits
He alth Plan
Admin %
Great Lakes Health Plan
58.8%
Health Plan of Michigan, Inc.
55.1%
M RR %
47.6%
11.2%
48.8%
6.3%
High Performance Level
McLaren Health Plan
52.1%
24.6%
27.5%
M-CAID
51.4%
41.7%
9.7%
OmniCare Health Plan
50.2%
36.1%
14.1%
Midwest Health Plan
50.1%
33.3%
16.8%
HealthPlus Partners, Inc.
48.4%
31.4%
17.0%
Total Health Care, Inc.
47.9%
30.3%
17.6%
PHP of Mid-Michigan
47.7%
33.8%
13.9%
2007 Michigan Aggregate
47.3%
35.4%
11.9%
36.5%
6.8%
7.6%
Priority Health
43.3%
Molina Healthcare of Michigan
39.6%
31.9%
Upper Peninsula Health Plan
39.1%
39.1%
-
Low Performance Level
Community Choice Michigan
31.1%
0%
20%
MRR=Medical Record Review
Admin=Administrative Data
24.1%
40%
60%
Admin
80%
7.1%
100%
MRR
The figure above shows how much of the final rate for each health plan was derived from the administrative method (Admin) and how
much was from medical record review (MRR). Note: Because of rounding differences, the sum of the Admin rate and the MRR rate may
not always be exactly equal to the final rate.
Twelve out of 13 health plans used the hybrid method for reporting this measure. The 2007
Michigan aggregate administrative rate was 35.4 percent and the medical record rate was 11.9
percent.
In 2007, 74.8 percent of the aggregate rate was derived from administrative data and 25.2 percent
was derived from medical record review data. The administrative data rate increased by 2.4
percentage points, which was fairly consistent with last year’s percentages (75.0 percent from
administrative data and 24.8 percent from medical record review data).
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-22
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
Appropriate Treatment for Children With Upper Respiratory Infection
Upper respiratory infection (URI), more commonly known as the common cold, accounts for the
most missed school days of any childhood illness, and according the National Institutes of Health,
URI is also the leading cause of doctor visits for children.3-16 Most children have six to eight colds
per year, whereas adults average only two to four. Because URI is a viral infection, inappropriate
use of antibiotics is a concern. The concern is that a person will start to develop a resistance to
antibiotics over time if they are used inappropriately, making them ineffective when appropriately
used. In spite of the fact that antibiotics are not recommended for treatment of the common cold,
health care providers still prescribe more than 50 million antibiotics for this condition every year.3-17
HEDIS Specification: Appropriate Treatment for Children With Upper Respiratory
Infection
This key measure reports the percentage of enrolled members who were 3 months to 18 years of age
during the measurement year, who were given a diagnosis of URI, and who were not dispensed an
antibiotic prescription on or three days after the episode date.
3-16
Mayo Foundation for Medical Education and Research. Children’s Illness: Top 5 causes of missed school. Available at:
http://www.mayoclinic.com/health/childrens-conditions/cc00059. Accessed on: August 7, 2007.
3-17
Yale Health Education. An Overview of the Cold and Flu. Available at:
http://www.yale.edu/yhp/med_services/health_ed/ColdOverview.htm. Accessed on: August 7, 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-23
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
Health Plan Ranking: Appropriate Treatment for Children With Upper Respiratory Infection
Figure 3-14—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Appropriate Treatment For Children With Upper Respiratory Infection
Appropriate Treatment For Children W ith Upper Respiratory Infection
He alth Plan
High Performance Level
N
Rate
92.1%
M-CAID
1,206
90.5%
Priority Health
2,775
87.7%
National 50th Percentile
82.7%
Upper Peninsula Health Plan
1,718
81.1%
OmniCare Health Plan
2,099
79.7%
Molina Healthcare of Michigan
7,520
79.4%
Community Choice Michigan
2,419
79.4%
Health Plan of Michigan, Inc.
6,609
78.4%
Low Performance Level
76.7%
PHP of Mid-Michigan
1,451
76.6%
Total Health Care, Inc.
1,357
76.3%
Midwest Health Plan
4,938
75.2%
Great Lakes Health Plan
6,731
74.6%
HealthPlus Partners, Inc.
4,247
72.1%
McLaren Health Plan
3,938
67.2%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 77.1%
2006 Michigan Medicaid Weighted Average = 75.6%
2005 Michigan Medicaid Weighted Average = 75.0%
There were no health plans that reported rates above the HPL of 92.1 percent, and six health plans
ranked below the LPL of 76.7 percent. Similar to last year, two health plans reported rates above the
national HEDIS 2006 Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 77.1 percent was 1.5 percentage points above the
2006 Michigan Medicaid weighted average; however, the weighted average continues to be below
the national HEDIS Medicaid 50th percentile.
From 2006 to 2007, the number of health plans with rates above the HPL decreased, and the number
of health plans falling below the LPL also decreased. In 2006, one health plan reported a rate above
the HPL and eight health plans reported rates below the LPL. The range of reported rates showed
improvement from 2006 to 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-24
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
Appropriate Testing for Children With Pharyngitis
Pharyngitis, an infection or irritation of the throat and/or tonsils (sore throat), occurs most
commonly in children between 4 and 7 years of age.3-18 Children in the United States experience an
average of five sore throats per year and one streptococcal infection (strep throat) every four years.319
An estimated 10 percent of all children who see a health care provider will be evaluated for
pharyngitis.3-20
There are two types of pharyngitis: viral and bacterial. Only 35 percent of pharyngitis cases in
children are caused by bacteria. Determining the cause of the pharyngitis is vital for treatment since
antibiotics are ineffective against viral infections. In fact, the overuse of antibiotics can instead
increase the number of drug-resistant forms of bacteria, which can be very difficult to treat. To
diagnose a bacterial virus such as Group A streptococcal pharyngitis (GABHS), appropriate
laboratory tests should be used. Only 51 percent of physicians are performing the strep test on the
pediatric population.3-21 Strep throat, which is caused by GABHS, can be treated with antibiotics.
Treatments for viral pharyngitis may include throat lozenges, increased fluid intake, and
acetaminophen.3-22
HEDIS Specification: Appropriate Testing for Children With Pharyngitis
This key measure reports the percentage of enrolled members 2 to 18 years of age during the
measurement year who were diagnosed with pharyngitis, prescribed an antibiotic, and received a
Group A streptococcus (strep) test for the episode. A higher rate represents better performance (i.e.,
appropriate testing).
3-18
eMedicine. Pharyngitis. Available at: http://www.emedicine.com/emerg/topic419.htm. Accessed on: August 8, 2007.
Pulmonology Channel. Pharyngitis. Available at: http://www.pulmonologychannel.com/pharyngitis/. Accessed on: August 8, 2007.
3-20
National Committee for Quality Assurance. The State of Managed Care Quality 2006. Standard Version. Washington, DC: National
Committee for Quality Assurance: 2006.
3-21
Ibid.
3-22
Children’s Hospital of Michigan. Pharyngitis and Tonsillitis. Available at:
http://www.chmkids.org/healthlibrary/default.aspx?pageid=P02069&pt=Pharyngitis%20and%20Tonsillitis. Accessed on: August 8,
2007.
3-19
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-25
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
Health Plan Ranking: Appropriate Testing for Children With Pharyngitis
Figure 3-15—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Appropriate Testing for Children With Pharyngitis
Appropriate Testing for Children with Pharyngitis
He alth Plan
M-CAID
N
771
High Performance Level
Rate
80.8%
75.1%
Priority Health
1,387
68.9%
747
59.2%
PHP of Mid-Michigan
National 50th Percentile
56.2%
Upper Peninsula Health Plan
1,083
54.8%
Community Choice Michigan
1,834
54.5%
Health Plan of Michigan, Inc.
4,276
53.2%
McLaren Health Plan
2,452
48.7%
Molina Healthcare of Michigan
4,237
43.6%
Great Lakes Health Plan
4,247
41.5%
Low Performance Level
40.9%
HealthPlus Partners, Inc.
2,975
40.9%
Total Health Care, Inc.
1,510
37.5%
OmniCare Health Plan
1,085
32.3%
Midwest Health Plan
3,287
18.7%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 45.0%
2006 Michigan Medicaid Weighted Average = 39.1%
2005 Michigan Medicaid Weighted Average = 42.1%
One health plan reported a rate above the HPL of 75.1 percent, and four health plans had rates
below the LPL of 40.9. Three health plans’ rates, including the one health plan that exceeded the
HPL, had rates above the national HEDIS 2006 Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 45.0 percent was 11.2 percentage points below
the national HEDIS 2006 Medicaid 50th percentile. The 2007 Michigan Medicaid weighted average
did, however, improve by 5.9 percentage points over the 2006 Michigan Medicaid weighted
average.
Overall, the range of rates for this measure showed improvement from 2006 to 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-26
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
Pediatric Care Findings and Recommendations
All of the measures in the Pediatric Care dimension showed improvement from the previous year.
Two measures, Childhood Immunization Status—Combination #3 and Adolescent Immunization
Status—Combination #2, showed statistically significant improvement in the 2007 Michigan
Medicaid weighted averages when compared to the 2006 rates. The range of rates for the Pediatric
Care measures continued to show improvement, indicating that the health plans are striving to
increase performance among their providers. It was evident that the health plans focused efforts on
administrative data completeness due to the improved administrative data rates for the hybrid
measures. To eliminate the burden of medical record review, the health plans should continue their
efforts to improve administrative data rates.
All three of the immunization measures (Childhood Immunization Status—Combination #2 and
Combination #3, and Adolescent Immunization Status—Combination #2) had improvement in the
range of reported rates. The largest improvement was seen in Childhood Immunization Status—
Combination #3, for which the range went from 24.1 to 56.7 percent in 2006 to 35.5 to 81.2 percent
in 2007. The 23.8 percentage-point improvement in the weighted average for this measure from
2006 to 2007 was statistically significant. Adolescent Immunization Status—Combo #2 also
demonstrated statistically significant improvement in the weighted average from 2006 to 2007.
This is commendable in light of the fact that the State of Michigan was the highest-ranking state
nationwide for the Adolescent Immunization Status—Combo #2 last year for its Medicaid
population.
Next year, NCQA will be retiring Adolescent Immunization Status from the HEDIS measurement
set; however, the MHPs should continue their quality improvement efforts toward improving
adolescent immunizations because NCQA intends to bring back the measure for HEDIS 2009 with
refocused specifications.
The weighted averages for all of the well-care visit measures increased compared to the 2006
weighted averages. None of the increases in the 2007 weighted averages were statistically
significant. The rates for Well-Child Visits in the First 15 Months of Life—Zero Visits improved
from 2006 with no health plans performing below the LPL and one plan performing better than the
HPL by 0.2 percentage points. Two health plans performed above the HPL for Well-Child Visits in
the First 15-Months of Life—Six or More Visits, and one of those plans performed 22.5 percentage
points higher than the HPL of 68.6 percent. This MHP saw its rate increase by 26.9 percentage
points this year over last year’s rate. This health plan also derived more than 89 percent of its rate
from administrative data. It was determined that this health plan had implemented several
interventions, all of which contributed to its improved rate. Interventions included targeting lowperforming providers, performing educational visits with PCPs, encouraging providers to perform
well-child exams when children present for a sick visit, Web notifications and/or written reminders
to PCPs for children who need well-child services, and additional PCP incentives for well-child
services that were billed.
While the weighted averages for both the Appropriate Treatment for Children With Upper
Respiratory Infection and Appropriate Testing for Children With Pharyngitis measures improved
this year, there is still room for improvement. The low end of the range for Appropriate Testing for
Children With Pharyngitis improved from 9.1 percent in 2006 to 18.7 percent in 2007. One plan
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-27
MI2007_HEDIS_Aggr_F1_1207
PEDIATRIC CARE
performed above the HPL for this measure with a rate of 80.8 percent, which was 11.9 percentage
points above the highest-performing MHP in 2006.
The MHPs’ performance on the Pediatric Care measures continued to improve and demonstrate the
commitment of the health plans to work with providers to further enhance the delivery of care to
children. The efforts in place at the MHPs should be continued and the MHPs should work together
to share best practices to further improve the rates.
Although the two measures that target the misuse of antibiotics showed improvement during the
measurement year, they still have many opportunities for improvement, with more than half of the
health plans performing below the national HEDIS 2006 Medicaid 50th percentile. The MHPs
could focus interventions on provider education about the measure and the appropriate prescribing
of antibiotics. The MHPs should also ensure that pharmacy data are complete for reporting these
measures. If pharmacy data are missing, the rates for these measures could be misrepresented. Best
practices seen in higher-performing health plans should be shared with other health plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 3-28
MI2007_HEDIS_Aggr_F1_1207
4. Women's Care
Introduction
This section of the report addresses how well Michigan MHPs are performing to ensure that women
16 to 64 years of age are screened early for cancer and STDs, which are treatable if detected in the
early stages. It also addresses how well Michigan MHPs are monitoring the appropriateness of
prenatal and postpartum care.
The Women’s Care dimension encompasses the following MDCH key measures:
‹
Breast and Cervical Cancer Screening
ƒ
ƒ
ƒ
ƒ
‹
Breast Cancer Screening—Ages 42 to 51 Years
Breast Cancer Screening—Ages 52 to 69 Years
Breast Cancer Screening—Combined Rate
Cervical Cancer Screening
Chlamydia Screening
ƒ Chlamydia Screening in Women—Ages 16 to 20 Years
ƒ Chlamydia Screening in Women—Ages 21 to 25 Years
ƒ Chlamydia Screening in Women—Combined Rate
‹
Prenatal and Postpartum Care
ƒ Prenatal and Postpartum Care—Timeliness of Prenatal Care
ƒ Prenatal and Postpartum Care—Postpartum Care
The following pages provide detailed analysis of the Michigan MHPs’ performance and ranking, as
well as the data collection methodology used by the Michigan MHPs for these measures.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-1
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
Breast Cancer Screening
Breast cancer is the second-leading cause of cancer deaths among women nationally, as well as in
Michigan.4-1 In addition, it is the third most common diagnosis of cancer in the State of Michigan and
the most common diagnosis for women in Michigan.4-2 The American Cancer Society (ACS) estimates
that in 2007 there will be 178,480 new cases of breast cancer and 40,460 deaths from breast cancer for
women in the United States.4-3 The ACS also projects that 5,900 women will be newly diagnosed with
breast cancer in Michigan during 2007, a decrease of 1,170 cases from the previous year.4-4 While there
has been a decline in the overall breast cancer death rate in recent years, there is a significant racial
disparity. African-American women are almost 47 percent more likely than Caucasian women to die
from breast cancer, which can be partially attributed to diagnosis at a later stage of the disease.4-5
Today, nearly 90 percent of women diagnosed with breast cancer will survive for at least five years.4-6
A mammogram is the most effective method for detecting breast cancer in its early stages.
Mammograms can detect approximately 85 percent of breast cancers and can reduce mortality from
the disease by 30 percent in women 50 years of age and older.4-7 Michigan’s Breast & Cervical
Cancer Control Program helps in providing breast cancer screening services to low-income women;
however, costs only allow for 15 percent of the eligible population to receive these services. And
according to Breast Cancer in Michigan: Early Detection Is the Key to Survival, only 56 percent of
Michigan women 40 years of age and older were obtaining appropriately timed mammograms.4-8
HEDIS Specification: Breast Cancer Screening
The Breast Cancer Screening measure is reported using only the administrative method. The Breast
Cancer Screening measure calculates the percentage of women 42 through 69 years of age who
were continuously enrolled during the measurement year and the year prior to the measurement
year, and who had a mammogram during the measurement year or the year prior to the
measurement year. Previously, this measure was calculated using women ages 52 to 69 years of
age. This year the measure is reported using three age categories:
‹
‹
‹
Ages 42 to 51 Years
Ages 52 to 69 Years
Combined Rate
4-1
Michigan Department of Community Health. Breast Cancer Deaths. Available at:
http://www.michigan.gov/documents/mdch/12_BrstCanc_198882_7.pdf. Accessed on: July 17, 2007.
4-2
Michigan Cancer Consortium. Breast Cancer in Michigan: Early Detection Is the Key to Survival. January 2007. Available at:
http://www.michigancancer.org/PDFs/MDCHFactSheets/BrCAInMichFactSheet-Jan07.pdf. Accessed on: August 17, 2007.
4-3
American Cancer Society. Cancer Facts & Figures 2007. Available at:
http://www.cancer.org/downloads/STT/CAFF2007PWSecured.pdf. Accessed on: July 17, 2007.
4-4
American Cancer Society. Cancer Facts & Figures 2007. Available at:
http://www.cancer.org/downloads/STT/CAFF2007PWSecured.pdf. Accessed on: July 17, 2007.
4-5
Michigan Department of Community Health. Breast Cancer Deaths. April 2007. Available at:
http://www.michigan.gov/documents/mdch/12_BrstCanc_198882_7.pdf. Accessed on: July 17, 2007.
4-6
National Cancer Institute. Cancer Advances in Focus: Breast Cancer. Available at: http://www.cancer.gov/aboutnci/cancer-advances-infocus/breast. Accessed on: July 17, 2007.
4-7
National Committee for Quality Assurance. The State of Managed Care Quality 2006. Standard Version. Washington, DC: National
Committee for Quality Assurance: 2006.
4-8
Michigan Cancer Consortium. Breast Cancer in Michigan: Early Detection Is the Key to Survival. January 2007. Available at:
http://www.michigancancer.org/PDFs/MDCHFactSheets/BrCAInMichFactSheet-Jan07.pdf. Accessed on: August 17, 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-2
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
Health Plan Ranking: Breast Cancer Screening—Ages 42 to 51 Years
Figure 4-1—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Breast Cancer Screening—Ages 42 to 51 Years
Breast Cancer Screening, 42-51 Years
He alth Plan
N
Rate
HealthPlus Partners, Inc.
1,322
54.3%
Health Plan of Michigan, Inc.
1,472
53.9%
Upper Peninsula Health Plan
512
53.5%
Priority Health
623
53.0%
1,268
51.9%
PHP of Mid-Michigan
373
46.4%
McLaren Health Plan
933
45.3%
Molina Healthcare of Michigan
3,268
44.5%
Great Lakes Health Plan
2,475
43.8%
Total Health Care, Inc.
1,227
43.0%
300
42.0%
OmniCare Health Plan
1,467
40.1%
Community Choice Michigan
1,030
39.2%
Midwest Health Plan
M-CAID
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 46.4%
Breast Cancer Screening—Ages 42 to 51 Years was a new measure for 2007; therefore, national
performance data are not available for comparison.
The 2007 Michigan Medicaid weighted average was 46.4 percent. Six plans reported rates equal to
or above the weighted average.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-3
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
Health Plan Ranking: Breast Cancer Screening—Ages 52 to 69 Years
Figure 4-2—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Breast Cancer Screening—Ages 52 to 69 Years
Breast Cancer Screening, 52-69 Years
He alth Plan
Upper Peninsula Health Plan
N
444
High Performance Level
Rate
67.6%
65.4%
Health Plan of Michigan, Inc.
1,232
64.4%
HealthPlus Partners, Inc.
1,082
62.5%
Midwest Health Plan
1,232
57.5%
Priority Health
484
57.0%
McLaren Health Plan
784
56.9%
Great Lakes Health Plan
2,523
56.6%
Molina Healthcare of Michigan
2,757
54.2%
National 50th Percentile
53.9%
Community Choice Michigan
829
53.6%
Total Health Care, Inc.
1,120
52.8%
OmniCare Health Plan
1,379
52.6%
PHP of Mid-Michigan
313
52.4%
M-CAID
215
47.4%
Low Performance Level
47.1%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 56.6%
2006 Michigan Medicaid Weighted Average = 55.8%
2005 Michigan Medicaid Weighted Average = 53.7%
The 2007 Breast Cancer Screening—Ages 52 to 69 Years measure is directly comparable to the
Breast Cancer Screening rates from 2006 and 2005, as well as to the 2006 national performance
standards.
One health plan exceeded the HPL of 65.4 percent, and no health plans ranked below the LPL of
47.1 percent. A total of eight health plans, including the one above the HPL, reported rates above
the national HEDIS 2006 Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 56.6 percent was 2.7 percentage points above the
national HEDIS 2006 Medicaid 50th percentile of 53.9 percent.
The 2007 Michigan Medicaid weighted average was 0.8 percentage points higher than the 2006
Michigan Medicaid weighted average and 2.9 percentage points above the 2005 weighted average
of 53.7 percent.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-4
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
Health Plan Ranking: Breast Cancer Screening—Combined Rate
Figure 4-3—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Breast Cancer Screening—Combined Rate
Breast Cancer Screening, Combined
He alth Plan
N
Rate
Upper Peninsula Health Plan
956
60.0%
Health Plan of Michigan, Inc.
2,704
58.7%
HealthPlus Partners, Inc.
2,404
58.0%
Priority Health
1,107
54.7%
Midwest Health Plan
2,500
54.6%
McLaren Health Plan
1,717
50.6%
Great Lakes Health Plan
4,998
50.3%
686
49.1%
Molina Healthcare of Michigan
6,025
48.9%
Total Health Care, Inc.
2,347
47.6%
OmniCare Health Plan
2,846
46.1%
Community Choice Michigan
1,859
45.6%
515
44.3%
PHP of Mid-Michigan
M-CAID
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 51.2%
The Breast Cancer Screening—Combined Rate is considered a new measure for 2007 since it
contains a wider age span of women; therefore, national performance data are not available for
comparison.
The 2007 Michigan Medicaid weighted average was 51.2 percent. Five health plans reported rates
above the weighted average.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-5
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
Cervical Cancer Screening
Early detection and appropriate treatment of cervical cancer have been shown to have high treatment
success rates. In fact, it is estimated that screening reduces cervical cancer by 80 percent.4-9 Older
women are more likely to develop cervical cancer; therefore it is important that women continue to
have screenings as they age, even with prior negative tests. In Michigan, 93.6 percent of cervical
cancer cases are diagnosed in the early stages of the disease.4-10 Approximately 83 percent of
Michigan women 18 years of age and older have received a Pap test within the past three years, which
is the most effective way to detect cervical cancer.4-11 In 2007, an estimated 370 new cases of cervical
cancer will be diagnosed among women in Michigan, according to the ACS.4-12
HEDIS Specification: Cervical Cancer Screening
The Cervical Cancer Screening measure reports the percentage of women 21 to 64 years of age
who were continuously enrolled during the measurement year and who received one or more Pap
tests during the measurement year or the two years prior to the measurement year. There was a
minor change to this measure in 2007. The lower age range was raised from 18 to 21 years of age.
4-9
National Committee for Quality Assurance. The State of Managed Care Quality 2006. Standard Version. Washington, DC: National
Committee for Quality Assurance: 2006.
4-10
Michigan Department of Community Health. Cervical Cancer Deaths and Screening. April 2007. Available at:
http://www.michigan.gov/documents/mdch/14_CervCanc_198884_7.pdf. Accessed on: July 18, 2007.
4-11
Michigan Department of Community Health. Facts about Cervical Cancer. February 2007. Available at:
http://www.michigan.gov/documents/CervicalFacts_6648_7.pdf. Accessed on: July 18, 2007.
4-12
American Cancer Society. Cancer Facts & Figures 2007. Available at:
http://www.cancer.org/downloads/STT/CAFF2007PWSecured.pdf. Accessed on: July 17, 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-6
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
Health Plan Ranking: Cervical Cancer Screening
Figure 4-4—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Cervical Cancer Screening
Cervical Cancer Screening
He alth Plan
M-CAID
N
378
78.0%
HealthPlus Partners, Inc.
411
77.1%
Upper Peninsula Health Plan
478
76.8%
High Performance Level
Rate
76.6%
Priority Health
354
76.0%
Health Plan of Michigan, Inc.
420
71.0%
McLaren Health Plan
411
70.1%
PHP of Mid-Michigan
411
68.6%
OmniCare Health Plan
427
66.7%
Total Health Care, Inc.
435
66.2%
National 50th Percentile
66.1%
Community Choice Michigan
398
65.6%
Great Lakes Health Plan
398
64.6%
Midwest Health Plan
411
64.2%
Low Performance Level
59.7%
Molina Healthcare of Michigan
424
0%
20%
40%
60%
80%
58.0%
100%
2007 Michigan Medicaid Weighted Average = 67.1%
2006 Michigan Medicaid Weighted Average = 65.8%
2005 Michigan Medicaid Weighted Average = 63.4%
The revision of the Cervical Cancer Screening measure in 2007 should be considered when
comparing previously reported rates and national performance data. The lower age range was raised
from 18 to 21 years of age.
Three health plans exceeded the HPL of 76.6 percent and one health plan reported a rate below the
LPL of 59.7 percent. A total of nine health plans, including the three above the HPL, ranked above
the national HEDIS 2006 Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 67.1 percent was 1.0 percentage point above the
national HEDIS 2006 Medicaid 50th percentile of 66.1 percent.
The 2007 Michigan Medicaid weighted average was 1.3 percentage points higher than the 2006
Michigan Medicaid weighted average and 3.7 percentage points above the 2005 weighted average
of 63.4 percent.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-7
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
Data Collection Analysis: Cervical Cancer Screening
Figure 4-5—Michigan Medicaid HEDIS 2007
Data Collection Analysis:
Cervical Cancer Screening
Cervical Cancer Screening
He alth Plan
Admin %
M RR %
M-CAID
78.0%
77.0%
1.1%
HealthPlus Partners, Inc.
77.1%
71.5%
5.6%
Upper Peninsula Health Plan
76.8%
72.0%
4.8%
76.0%
72.9%
3.1%
High Performance Level
Priority Health
Health Plan of Michigan, Inc.
71.0%
70.0%
1.0%
McLaren Health Plan
70.1%
63.0%
7.1%
2007 Michigan Aggregate
69.4%
64.6%
4.8%
PHP of Mid-Michigan
68.6%
61.6%
7.1%
OmniCare Health Plan
66.7%
58.1%
8.7%
Total Health Care, Inc.
66.2%
56.8%
9.4%
Community Choice Michigan
65.6%
63.1%
2.5%
Great Lakes Health Plan
64.6%
61.8%
2.8%
Midwest Health Plan
64.2%
58.9%
5.4%
54.7%
3.3%
Low Performance Level
Molina Healthcare of Michigan
58.0%
0%
20%
MRR=Medical Record Review
Admin=Administrative Data
40%
60%
Admin
80%
100%
MRR
The figure above shows how much of the final rate for each health plan was derived from the administrative method (Admin) and how much
was from medical record review (MRR). Note: Because of rounding differences, the sum of the Admin rate and the MRR rate may not always
be exactly equal to the final rate.
All 13 health plans reported this measure using the hybrid method. The 2007 Michigan aggregate
administrative rate was 64.6 percent and the medical record review rate was 4.8 percent.
The results indicate that 93.1 percent of the aggregate rate was derived from administrative data and
6.9 percent was from medical record review. The 2007 administrative rate showed an increase of
3.4 percentage points over the 2006 administrative rate.
All of the health plans derived more than 85 percent of their rates from administrative data. The
health plans increased their overall rates by anywhere from 1.0 to 9.4 percentage points through
medical record review.
Analyses of the findings indicate that health plans’ administrative data for the Cervical Cancer
Screening measure was relatively complete.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-8
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
Chlamydia Screening in Women
Chlamydia is the most commonly reported STD in the United States, infecting approximately 2.8
million Americans each year.4-13 Chlamydia is sometimes referred to as a “silent” disease because
the majority of those who are infected have no symptoms. If left untreated, however, chlamydia can
spread into the uterus or fallopian tubes of women and cause pelvic inflammatory disease (PID).
Damage resulting from PID can cause chronic pelvic pain, infertility, and potentially fatal ectopic
pregnancy. In addition, women with chlamydia are up to five times more likely to become infected
with HIV in the event of an exposure.4-14 Screening all sexually active women 18 to 24 years of age
for chlamydia could potentially prevent 140,000 cases of PID annually and save $45 per woman
screened.4-15
Michigan reported 36,746 cases of chlamydia in 2006, with the highest rates occurring in women 15
to 19 years of age and 20 to 24 years of age.4-16 To improve detection of chlamydia, Michigan works
with the National Infertility Prevention Project, which targets young adults and adolescents.
Michigan’s efforts can be seen in the State’s performance in NCQA’s The State of Health Care
Quality, 2006 report. The State of Michigan was the highest-performing State (for its Medicaid
population) for the Chlamydia Screening in Women—Ages 21 to 25 Years measure.
HEDIS Specification: Chlamydia Screening in Women
The Chlamydia Screening in Women measure is reported using the administrative method only. The
measure is reported by three separate rates: Chlamydia Screening in Women—Ages 16 to 20 Years,
Chlamydia Screening in Women—Ages 21 to 25 Years, and Chlamydia Screening in Women—
Combined Rate (the total of both age groups, ages 16 to 25 years).
The Chlamydia Screening in Women—Ages 16 to 20 Years rate calculates the percentage of women
16 to 20 years of age who were identified as sexually active, who were continuously enrolled during
the measurement year, and who had at least one test for chlamydia during the measurement year.
Chlamydia Screening in Women—Ages 21 to 25 Years reports the percentage of women 21 to 25
years of age who were identified as sexually active, who were continuously enrolled during the
measurement year, and who had at least one test for chlamydia during the measurement year.
Chlamydia Screening in Women—Combined Rate reports the sum of both groups, i.e., the two
numerators divided by the sum of the denominators. Therefore, Chlamydia Screening in Women—
Combined Rate reports the percentage of women 16 to 25 years of age who were sexually active,
who were continuously enrolled during the measurement year, and who had at least one test for
chlamydia during the measurement year.
4-13
Centers for Disease Control and Prevention. Chlamydia—CDC Fact Sheet. April 2006. Available at:
http://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm. Accessed on: July 18, 2007.
4-14
Ibid.
4-15
National Committee for Quality Assurance. The State of Health Care Quality 2006. Available at:
http://www.ncqa.org/communications/sohc2006/sohc_2006.pdf. Accessed on: July 18, 2007.
4-16
Michigan Department of Community Health. Chlamydia. April 2007. Available at:
http://www.michigan.gov/documents/mdch/34_Chlamyd_198935_7.pdf. Accessed on: July 18, 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-9
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WOMEN'S CARE
Health Plan Ranking: Chlamydia Screening in Women—Ages 16 to 20 Years
Figure 4-6—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Chlamydia Screening in Women—Ages 16 to 20 Years
Chlamydia Screening, 16-20 Years
He alth Plan
PHP of Mid-Michigan
N
OmniCare Health Plan
Rate
314
67.2%
1,689
64.4%
High Performance Level
64.3%
Total Health Care, Inc.
1,285
61.8%
Priority Health
864
55.6%
Midwest Health Plan
913
52.8%
HealthPlus Partners, Inc.
1,443
52.7%
Molina Healthcare of Michigan
3,458
52.1%
318
51.6%
Health Plan of Michigan, Inc.
2,072
50.3%
Great Lakes Health Plan
2,287
49.8%
M-CAID
National 50th Percentile
49.1%
McLaren Health Plan
1,112
48.9%
Upper Peninsula Health Plan
610
48.4%
Community Choice Michigan
1,077
46.8%
Low Performance Level
41.0%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 53.3%
2006 Michigan Medicaid Weighted Average = 51.9%
2005 Michigan Medicaid Weighted Average = 47.6%
Two health plans had rates above the HPL of 64.3 percent, and none of the health plans had rates
below the LPL of 41.0 percent. Ten health plans, including the two with rates above the HPL,
ranked above the national HEDIS 2006 Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 53.3 percent was 4.2 percentage points above the
national HEDIS 2006 Medicaid 50th percentile of 49.1 percent.
The 2007 Michigan Medicaid weighted average of 53.3 percent was 1.4 percentage points above the
2006 Michigan Medicaid weighted average and 5.7 percentage points above the 2005 weighted
average.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-10
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
Health Plan Ranking: Chlamydia Screening in Women—Ages 21 to 25 Years
Figure 4-7—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Chlamydia Screening in Women—Ages 21 to 25 Years
Chlamydia Screening, 21-25 Years
He alth Plan
OmniCare Health Plan
N
1,161
72.4%
Total Health Care, Inc.
866
68.7%
High Performance Level
Rate
67.7%
PHP of Mid-Michigan
283
65.7%
Priority Health
916
62.4%
M-CAID
236
61.4%
1,222
61.2%
633
60.3%
1,717
60.2%
HealthPlus Partners, Inc.
Midwest Health Plan
Health Plan of Michigan, Inc.
McLaren Health Plan
925
58.8%
Molina Healthcare of Michigan
2,131
58.4%
Great Lakes Health Plan
1,556
57.5%
715
56.5%
Community Choice Michigan
National 50th Percentile
53.3%
Upper Peninsula Health Plan
403
Low Performance Level
49.4%
46.7%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 61.0%
2006 Michigan Medicaid Weighted Average = 57.6%
2005 Michigan Medicaid Weighted Average = 53.1%
Two health plans had rates above the HPL of 67.7 percent, and none of the health plans had
reported rates below the LPL of 46.7 percent. A total of 12 health plans, including the two above the
HPL, reported rates above the national HEDIS 2006 Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 61.0 percent was 7.7 percentage points above the
national HEDIS 2006 Medicaid 50th percentile of 53.3 percent.
The 2007 Michigan Medicaid weighted average showed an increase from 2006, up 3.4 percentage
points. The rate improved by 7.9 percentage points when compared to the 2005 Michigan Medicaid
weighted average of 53.1 percent.
The range of reported rates showed improvement from the previous year’s rates.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-11
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
Health Plan Ranking: Chlamydia Screening in Women—Combined Rate
Figure 4-8—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Chlamydia Screening in Women—Combined Rate
Chlamydia Screening, Combined
He alth Plan
OmniCare Health Plan
N
Rate
2,850
67.7%
597
66.5%
PHP of Mid-Michigan
High Performance Level
65.3%
Total Health Care, Inc.
2,151
64.6%
Priority Health
1,780
59.1%
HealthPlus Partners, Inc.
2,665
56.6%
Midwest Health Plan
1,546
55.9%
M-CAID
554
55.8%
Health Plan of Michigan, Inc.
3,789
54.8%
Molina Healthcare of Michigan
5,589
54.5%
McLaren Health Plan
2,037
53.4%
Great Lakes Health Plan
3,843
52.9%
National 50th Percentile
51.2%
Community Choice Michigan
1,792
50.7%
Upper Peninsula Health Plan
1,013
48.8%
Low Performance Level
44.5%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 56.6%
2006 Michigan Medicaid Weighted Average = 54.5%
2005 Michigan Medicaid Weighted Average = 50.3%
Two health plans reported rates above the HPL of 65.3 percent, and no health plans had rates below
the LPL. Eleven health plans, including the two above the HPL, had reported rates above the
national HEDIS 2006 Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 56.6 percent was 5.4 percentage points above the
national HEDIS 2006 Medicaid 50th percentile of 51.2 percent.
The 2007 Michigan Medicaid weighted average of 56.6 percent continued to show improvement
with an increase of 2.1 percentage points over the 2006 weighted average and 6.3 percentage points
over the 2005 weighted average.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-12
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
Prenatal and Postpartum Care
More than 4 million infants are born in the United States each year. Approximately 490,000 of these
infants are born preterm, and another 322,000 are of low birth weight each year. Low birth weight
increases the risk for neuron developmental handicaps, congenital abnormalities, and respiratory
illness compared to infants with a normal birth weight. With comprehensive prenatal care, the
incidence of low birth weight and infant mortality can be reduced. Additionally, mothers who do
not receive prenatal care are three to four times more likely to experience fatal complications related
to pregnancy than those who receive prenatal care.4-17
More than 127,000 live births occurred in Michigan during 2005. Of this number, 8.4 percent
resulted in low-birth-weight infants.4-18 In 2005, Michigan’s infant mortality rate was 8.2 deaths per
1,000 live births, which ranked 41st nationwide.4-19 Race continues to have a significant impact on
infant mortality rates in Michigan. Among African Americans the rate was 17.9 per 1,000 live
births, while for Caucasians it was 5.5 per 1,000 live births in 2005.4-20
While care strategies tend to emphasize the prenatal period, appropriate care during the postpartum
period can also prevent complications and deaths. For example, more than 60 percent of maternal
deaths occur during the postpartum period.4-21 Studies have also shown that women who receive
more postdelivery care have lower maternal, fetal, and neonatal illness and mortality.4-22
This measure examines whether or not care is available to members when needed and whether that
care is provided in a timely manner. The measure consists of the following two numerators:
‹
‹
Prenatal and Postpartum Care—Timeliness of Prenatal Care
Prenatal and Postpartum Care—Postpartum Care
HEDIS Specification: Prenatal and Postpartum Care—Timeliness of Prenatal Care
The Timeliness of Prenatal Care measure calculates the percentage of women who delivered a live
birth between November 6 of the year prior to the measurement year and November 5 of the
measurement year, who were continuously enrolled at least 45 days prior to delivery through 56
days after delivery, and who received a prenatal care visit as an MHP member in the first trimester
or within 42 days of enrollment in the MHP.
4-17
National Committee for Quality Assurance. The State of Health Care Quality 2006. Available at:
http://www.ncqa.org/communications/sohc2006/sohc_2006.pdf. Accessed on: July 18, 2007.
4-18
Michigan Department of Community Health. Numbers and Percents of Low Birthweight Live Births by Prenatal Care Index,
by Race and Ancestry of Mother Michigan Residents, 2005. Available at: http://www.mdch.state.mi.us/pha/osr/natality/tab1.10.asp.
Accessed on: July 25, 2007.
4-19
United Health Foundation. America’s Health. State Health Rankings. 2005 Edition. Available at:
http://www.unitedhealthfoundation.org/shr2005/components/infantmortality.html. Accessed on: July 25, 2007.
4-20
Michigan Department of Community Health. Michigan Resident Birth and Death Files, Vital Records & Health Data Development
Section. Available at: http://www.mdch.state.mi.us/pha/osr/InDxMain/Tab2.asp. Accessed on: July 25, 2007.
4-21
Family Health International. Better Postpartum Care Saves Lives. Network. Summer 1997, 17(4). Available at:
http://www.fhi.org/en/RH/Pubs/Network/v17_4/postpartum.htm. Accessed on: July 26, 2007.
4-22
National Committee for Quality Assurance. The State of Health Care Quality 2003. Available at:
http://www.ncqa.org/sohc2003/prenatal_and_postpartum_care.htm. Accessed on: July 26, 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-13
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
Health Plan Ranking: Prenatal and Postpartum Care—Timeliness of Prenatal Care
Figure 4-9—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Prenatal and Postpartum Care—Timeliness of Prenatal Care
Timeliness of Prenatal Care
He alth Plan
McLaren Health Plan
N
411
93.4%
HealthPlus Partners, Inc.
392
91.8%
High Performance Level
Rate
91.5%
Health Plan of Michigan, Inc.
412
90.0%
Upper Peninsula Health Plan
301
88.7%
Priority Health
371
86.8%
PHP of Mid-Michigan
382
85.6%
M-CAID
288
85.4%
Total Health Care, Inc.
406
84.2%
OmniCare Health Plan
428
84.1%
National 50th Percentile
83.3%
Community Choice Michigan
411
81.3%
Great Lakes Health Plan
411
78.3%
Midwest Health Plan
411
76.4%
Low Performance Level
74.2%
Molina Healthcare of Michigan
429
0%
20%
40%
60%
80%
67.4%
100%
2007 Michigan Medicaid Weighted Average = 83.2%
2006 Michigan Medicaid Weighted Average = 81.7%
2005 Michigan Medicaid Weighted Average = 77.5%
Two health plans had rates above the HPL of 91.5 percent and one health plan had a reported rate
below the LPL of 74.2 percent. Nine health plans, including the two above the HPL, had rates above
the national HEDIS 2006 Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 83.2 percent was 0.1 percentage points below
the national HEDIS 2006 Medicaid 50th percentile of 83.3 percent.
The 2007 Michigan Medicaid weighted average showed an increase from 2006, up 1.5 percentage
points. A gain of 5.7 percentage points was observed when the 2007 weighted average was
compared to the 2005 Michigan Medicaid weighted average of 77.5 percent.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-14
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
Data Collection Analysis: Prenatal and Postpartum Care—Timeliness of Prenatal Care
Figure 4-10—Michigan Medicaid HEDIS 2007
Data Collection Analysis:
Prenatal and Postpartum Care—Timeliness of Prenatal Care
Timeliness of Prenatal Care
He alth Plan
Admin % M RR %
McLaren Health Plan
93.4%
HealthPlus Partners, Inc.
91.8%
58.6% 34.8%
59.2% 32.7%
High Performance Level
Health Plan of Michigan, Inc.
90.0%
Upper Peninsula Health Plan
81.1%
88.7%
Priority Health
9.0%
30.6% 58.1%
86.8%
60.9% 25.9%
PHP of Mid-Michigan
85.6%
20.2% 65.4%
M-CAID
85.4%
35.8% 49.7%
Total Health Care, Inc.
84.2%
74.4%
OmniCare Health Plan
84.1%
39.0% 45.1%
2007 Michigan Aggregate
83.9%
49.8% 34.1%
Community Choice Michigan
81.3%
Great Lakes Health Plan
39.7% 41.6%
78.3%
Midwest Health Plan
9.9%
62.8% 15.6%
76.4%
37.7% 38.7%
Low Performance Level
Molina Healthcare of Michigan
67.4%
0%
20%
MRR=Medical Record Review
Admin=Administrative Data
40%
60%
Admin
80%
38.7% 28.7%
100%
MRR
The figure above shows how much of the final rate for each health plan was derived from the administrative method (Admin) and how much
was from medical record review (MRR). Note: Because of rounding differences, the sum of the Admin rate and the MRR rate may not always
be exactly equal to the final rate.
All of the health plans used the hybrid method to report this measure. The 2007 Michigan aggregate
administrative rate was 49.8 percent and the medical record review rate was 34.1 percent.
Overall, 59.4 percent of the aggregate rate was derived from administrative data and 40.6 percent
was derived from medical record review data. The administrative rate decreased by 0.8 percentage
points when compared to the 2006 rate.
Seven health plans derived more than half of their rates from administrative data, and one health
plan derived less than one-quarter of its rate from administrative data.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-15
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
HEDIS Specification: Prenatal and Postpartum Care—Postpartum Care
The Postpartum Care measure reports the percentage of women who delivered a live birth between
November 6 of the year prior to the measurement year and November 5 of the measurement year,
who were continuously enrolled at least 45 days prior to delivery through 56 days after delivery,
and who received a postpartum visit on or between 21 days and 56 days after delivery.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-16
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
Health Plan Ranking: Prenatal and Postpartum Care—Postpartum Care
Figure 4-11—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Prenatal and Postpartum Care—Postpartum Care
Postpartum Care
He alth Plan
McLaren Health Plan
N
411
High Performance Level
Rate
85.6%
71.0%
Upper Peninsula Health Plan
301
68.8%
Health Plan of Michigan, Inc.
412
67.0%
Priority Health
371
66.3%
HealthPlus Partners, Inc.
392
66.1%
M-CAID
288
66.0%
Community Choice Michigan
411
62.8%
PHP of Mid-Michigan
382
62.6%
National 50th Percentile
58.8%
Great Lakes Health Plan
411
58.6%
Total Health Care, Inc.
406
57.9%
Midwest Health Plan
411
50.9%
OmniCare Health Plan
428
50.7%
Low Performance Level
49.7%
Molina Healthcare of Michigan
429
0%
20%
40%
60%
80%
49.7%
100%
2007 Michigan Medicaid Weighted Average = 61.6%
2006 Michigan Medicaid Weighted Average = 57.7%
2005 Michigan Medicaid Weighted Average = 53.7%
One of the health plans reported a rate above the HPL of 71.0 percent, and one health plan reported
a rate equal to the LPL of 49.7 percent. A total of eight health plans’ rates, including the one above
the HPL, were above the national HEDIS 2006 Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 61.6 percent was 2.8 percentage points above the
national HEDIS 2006 Medicaid 50th percentile of 58.8 percent.
The 2007 Michigan Medicaid weighted average showed an increase over 2006, up 3.9 percentage
points. A gain of 7.9 percentage points was observed when the 2007 weighted average was
compared to the 2005 weighted average.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-17
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
Data Collection Analysis: Prenatal and Postpartum Care—Postpartum Care
Figure 4-12—Michigan Medicaid HEDIS 2007
Data Collection Analysis:
Prenatal and Postpartum Care—Postpartum Care
Postpartum Care
He alth Plan
Admin %
McLaren Health Plan
85.6%
M RR %
42.6%
43.1%
51.2%
17.6%
High Performance Level
Upper Peninsula Health Plan
68.8%
Health Plan of Michigan, Inc.
67.0%
60.2%
6.8%
Priority Health
66.3%
59.3%
7.0%
HealthPlus Partners, Inc.
66.1%
46.7%
19.4%
M-CAID
66.0%
59.7%
6.3%
Community Choice Michigan
62.8%
51.3%
11.4%
PHP of Mid-Michigan
62.6%
42.7%
19.9%
2007 Michigan Aggregate
62.2%
47.0%
15.2%
Great Lakes Health Plan
58.6%
47.0%
11.7%
Total Health Care, Inc.
57.9%
39.7%
18.2%
Midwest Health Plan
50.9%
43.3%
7.5%
OmniCare Health Plan
50.7%
35.5%
15.2%
49.7%
38.7%
11.0%
Low Performance Level
Molina Healthcare of Michigan
0%
20%
MRR=Medical Record Review
Admin=Administrative Data
40%
60%
Admin
80%
100%
MRR
The figure above shows how much of the final rate for each health plan was derived from the administrative method (Admin) and how much
was from medical record review (MRR). Note: Because of rounding differences, the sum of the Admin rate and the MRR rate may not always
be exactly equal to the final rate.
All of the health plans elected to report this measure using the hybrid method. The 2007 Michigan
aggregate administrative rate was 47.0 percent and the medical record review rate was 15.2 percent.
Overall, 75.6 percent of the aggregate rate was derived from administrative data and 24.4 percent
from medical record review. The 2007 administrative rate showed an increase of 5.5 percentage
points over the 2006 administrative rate. As seen in 2006, all but one health plan derived at least half
of its rate from administrative data in 2007.
This key measure is also susceptible to global billing payment arrangements. Unless an MHP
requires provider submission of postpartum care visit data, the health plan will need to rely more
heavily on labor-intensive medical record review.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-18
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
Women’s Care Findings and Recommendations
Performance in the Women’s Care dimension continues to be an area in which the MHPs should
focus more of their quality improvement efforts. Although all of the measures’ weighted averages
saw some improvement, none of the increases were statistically significant.
The technical specifications for the Breast Cancer Screening measure changed in 2007, shifting the
lower age range to 42 years of age instead of 52 years of age; therefore, there were no national
comparison data for the lower age cohort (42 to 51 years) and for the combined rate. A review of
the weighted averages for the Breast Cancer Screening age stratifications, 42 to 51 years of age and
52 to 69 years of age, showed where additional improvement efforts might need to be focused. The
weighted average for the younger age group was more than 10 percentage points less than the older
age group. This suggests that greater attention needs to be paid to the younger cohort to ensure that
its members are receiving the necessary screening.
The Cervical Cancer Screening measure exhibited a moderate increase in performance from 2006
to 2007. While only one health plan outperformed the HPL in 2006, three plans exceeded this rate
in 2007. Of particular concern, however, was that the same four health plans continued to perform
below the national HEDIS 2006 Medicaid 50th percentile. In fact, one health plan dropped below
the LPL. Therefore, these health plans’ interventions should be examined in order to determine
areas for improvement, and best practices from higher-performing MHPs should be shared.
Statewide performance for Chlamydia Screening in Women continued to improve and all of the
weighted averages for the measure remained above the national HEDIS Medicaid 50th percentile.
However, there were differences in rates for the younger and older age ranges that were similar to
the Breast Cancer Screening measures. The weighted average for the 16-to-20-year-old age group
was almost 8 percentage points lower than the weighted average of the 21-to-25-year-old age group.
Modest improvements were observed for the Prenatal and Postpartum Care measures. Of note was
the performance of McLaren Health Plan, which exceeded the HPL for both measures. Molina’s
performance, on the other hand, fell below the LPL for both of the measures. In fact, Molina’s rate
for Timeliness of Prenatal Care significantly decreased from 2006 to 2007 by 14.6 percentage
points, and its Postpartum Care rate decreased by 9.1 percentage points.
Historically, administrative data used to identify individual prenatal care visits has been negatively
impacted by the use of global billing practices by most health plans. Health plans that do not use
global billing payment mechanisms to reimburse providers for prenatal care services typically have
more complete administrative data, although this is not always linked to better performance. Health
plans that establish a mechanism to collect individual prenatal care dates of service, either through
global billing documentation requirements or the use of a prenatal care monitoring program, have
been successful not only in decreasing their reliance on medical record review but in actually
improving performance.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-19
MI2007_HEDIS_Aggr_F1_1207
WOMEN'S CARE
The following quality improvement activities have shown to be effective in improving Women’s
Care measures:
‹
‹
‹
‹
‹
‹
‹
‹
‹
Early identification of members requiring care
Identification of any racial or cultural barriers to accessing care
Patient education through brochures, newsletters, and health plan Web sites
Reminder postcards and telephone calls to members who have not received screening/care
Physician education on standards of care and appropriate methods for submitting
claims/encounter data
Physician-level reports that indicate a physician’s performance on HEDIS measures
Improvements to accessibility of care (e.g., providing transportation to appointments, providing
additional locations of service through a mobile unit)
Member and physician incentives for compliance with standards
A forum for MHPs to share best practices
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 4-20
MI2007_HEDIS_Aggr_F1_1207
5. Living With Illness
Introduction
Chronic illness afflicts 133 million people—nearly half of all Americans—and accounts for the vast
majority of health care spending.5-11 The measures in this section (asthma, diabetes, high blood
pressure, and smoking) focus on how health plans can help those with ongoing, chronic conditions
take care of themselves, control symptoms, avoid complications, and maintain daily activities.
Comprehensive programs implemented by health plans can help reduce the prevalence, impact, and
economic costs associated with these chronic illnesses.
According to the National Heart, Lung, and Blood Institute, approximately 20 million people in the
United States suffer from asthma, including nearly 9 million children. Asthma usually begins during
childhood and tends to affect more boys than girls, although the incidence of asthma is higher in
adult women than in adult men.5-22 The economic impact of asthma is considerable—the disease
costs $14 billion annually, including $4.6 billion in lost productivity.5-3 In Michigan, 654,100 adults
and 213,600 children have asthma; the prevalence of adult asthma in Michigan is nearly the same as
in the U.S. as a whole. However, asthma hospitalization rates for all age groups are lower in
Michigan compared to the rest of the country.5-4
The American Diabetes Association estimates that 7.0 percent of all U.S. citizens (20.8 million
people) suffer from diabetes, although only 14.6 million have been diagnosed with the disease.
Another 54 million have “pre-diabetes,” which refers to blood glucose levels above normal, but not
high enough for a formal diabetes diagnosis.5-5 Diabetes prevalence, mortality, and complication
rates have increased steadily in Michigan and in the nation over the last decade. In Michigan, an
estimated 593,200 adults have been diagnosed with diabetes, and another 292,000 have
undiagnosed diabetes. Additionally, more than 1.5 million Michigan adults have pre-diabetes. The
estimated direct medical costs associated with diabetes in Michigan residents was $4.5 billion in
2004. Indirect costs related to lost work days, restricted activity days, mortality, and disability
totaled $2.0 billion.5-6
The American Heart Association estimates that 72 million adults in the United States have high
blood pressure, although only 71 percent of those people are aware of their condition. Failure to
5-1
Partnership for Solutions. Chronic Conditions: Making the Case for Ongoing Care. Available at:
http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf. Accessed on: July 27, 2007.
5-2
National Heart, Lung, and Blood Institute. Who is at risk for Asthma? Available at:
http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhoIsAtRisk.html. Accessed on: July 27, 2007.
5-3
National Committee for Quality Assurance. The State of Health Care Quality 2006. Washington DC: National Committee for Quality
Assurance; 2006. Available at: http://www.ncqa.org/communications/sohc2006/sohc_2006.pdf. Accessed on: July 27, 2007.
5-4
Michigan Department of Community Health. Asthma and Preventable Asthma Hospitalizations. April 2007. Available at:
http://www.michigan.gov/documents/mdch/22_Asthma_198922_7.pdf. Accessed on: July 27, 2007.
5-5
American Diabetes Association. Diabetes Statistics. Available at: http://www.diabetes.org/diabetes-statistics/prevalence.jsp. Accessed
on: July 27, 2007.
5-6
Michigan Department of Community Health. Diabetes in Michigan. September 2006. Available at:
http://michigan.gov/documents/mdch/FactPageMichigan-Darline_2_172250_7.pdf. Accessed on: July 27, 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-1
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
control high blood pressure can lead to stroke, heart attack, heart failure, or kidney failure. The risk
of developing high blood pressure increases with age.5-7 In Michigan, cardiovascular disease is the
leading cause of death, causing approximately one of every three deaths.5-8
Cigarette smoking kills about half of all continuing smokers and is the most preventable cause of
premature death in the United States. According to the American Lung Association, smoking kills
almost 440,000 U.S. residents each year.5--9 Approximately 20 percent of U.S. adults were smokers
in 2005. Smoking is the major cause of many cancers, as well as other serious diseases, including
heart disease, bronchitis, emphysema, and strokes. The CDC estimates that in 2005, approximately
70 percent of smokers wanted to quit and approximately 19 million adult smokers had stopped
smoking for at least one day in the prior 12 months because they were trying to quit.5-10
In terms of health-related economic costs, smoking is responsible for more than $167 billion
annually.5-11 Smoking cessation interventions are less costly than other routine medical
interventions; the average cost per smoker for effective cessation treatment is $165.61.5-12 If the
overall prevalence of adult smoking in Michigan was reduced by 42 percent, and adult per-capita
consumption in the State was reduced by 25 percent, the Michigan Cancer Consortium estimates
that there would be 1,100 fewer lung cancer deaths each year among Michigan adults.5-13
The Living With Illness dimension encompasses the following MDCH key measures:
‹
‹
Comprehensive Diabetes Care
ƒ Comprehensive Diabetes Care—HbA1c Testing
ƒ Comprehensive Diabetes Care—Poor HbA1c Control
ƒ Comprehensive Diabetes Care—Eye Exam
ƒ Comprehensive Diabetes Care—LDL-C Screening
ƒ Comprehensive Diabetes Care—LDL-C Level <100
ƒ Comprehensive Diabetes Care—Medical Attention for Diabetic Nephropathy
Use of Appropriate Medications for People With Asthma
ƒ Use of Appropriate Medications for People With Asthma—Ages 5 to 9 Years
ƒ Use of Appropriate Medications for People With Asthma—Ages 10 to 17 Years
ƒ Use of Appropriate Medications for People With Asthma—Ages 18 to 56 Years
ƒ Use of Appropriate Medications for People With Asthma—Combined Rate
5-7
National Committee for Quality Assurance. The State of Health Care Quality, 2006. Washington DC: National Committee for Quality
Assurance; 2006. Available at: http://www.ncqa.org/communications/sohc2006/sohc_2006.pdf. Accessed on: July 27, 2007.
5-8
Michigan Department of Community Health. 2007 CVD Fact Sheet. Available at:
http://michigan.gov/documents/mdch/CVDFactsheet2007bcol_202765_7.pdf. Accessed on: July 30, 2007.
5-9
American Lung Association. Trends in Tobacco Use. June 2007. Available at: http://www.lungusa.org/atf/cf/%7B7A8D42C2-FCCA4604-8ADE-7F5D5E762256%7D/TREND_TOBACCO_JUNE07.PDF. Accessed on: July 30, 2007.
5-10
Centers for Disease Control and Prevention. Smoking & Tobacco Use Cessation. March 2007. Available at:
http://www.cdc.gov/tobacco/data_statistics/Factsheets/cessation2.htm#. Accessed on: July 30, 2007.
5-11
American Cancer Society. Tobacco-Related Cancers Fact Sheet. Available at:
http://www.cancer.org/docroot/PED/content/PED_10_2x_Tobacco-Related_Cancers_Fact_Sheet.asp?sitearea=PED. Accessed on: July
30, 2007.
5-12
U.S. Public Health Service. Treating Tobacco Use and Dependence—A Systems Approach. A Guide for Health Care Administrators, Insurers,
Managed Care Organizations, and Purchasers. November 2000. Available at: http://www.surgeongeneral.gov/tobacco/systems.htm.
Accessed on: July 30, 2007.
5-13
Michigan Department of Community Health. Facts About Lung Cancer. February 2007. Available at:
http://www.michigancancer.org/PDFs/MDCHFactSheets/LungCAFactSheet-Feb07.pdf. Accessed on: July 30, 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-2
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
‹
‹
Controlling High Blood Pressure
ƒ Controlling High Blood Pressure—Ages 18 to 45 Years
ƒ Controlling High Blood Pressure—Ages 46 to 85 Years
ƒ Controlling High Blood Pressure—Combined Rate
Medical Assistance With Smoking Cessation
ƒ Advising Smokers to Quit
ƒ Smoking Cessation Strategies
The following pages provide detailed analysis of Michigan MHP performance and rankings, as well
as the data collection methodology used for these measures.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-3
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LIVING WITH ILLNESS
Comprehensive Diabetes Care
Nearly 1.5 million Americans (20 years of age and older) were newly diagnosed with diabetes in
2005, contributing to a total prevalence of nearly 15 million people with diabetes. The annual percapita costs of health care for diabetics increased from $10,071 in 1997 to $13,243 in 2002. Overall,
one of every 10 dollars spent on health care in the U.S. is spent on diabetes and its complications.5-14
In 2004, diabetes was the leading cause of death for 2,954 people in Michigan and contributed to an
additional 5,462 deaths.5-15 In addition, diabetes is the leading cause of blindness and kidney failure in
Michigan and a major factor in hypertension, cardiovascular disease, and lower-extremity
amputations..5-16 However, control of blood glucose levels can significantly reduce the rate of these
complications and improve quality of life for diabetics. It is estimated that for every 1 percent
reduction in blood glucose levels, the risk of developing diabetic retinal (eye) disease, kidney/endstage renal disease, and nerve disease drops by 40 percent.5-17 Therefore, a comprehensive assessment
of diabetes care necessitates examination of multiple factors. This measure contains a variety of
indicators, each of which provides a critical element of information. When viewed simultaneously, the
components build a comprehensive picture of the quality of diabetes care.
The Comprehensive Diabetes Care measure is reported using nine separate rates; however, only six
were included in this report. The six rates listed below are considered key measures for reporting
purposes.
1.
2.
3.
4.
5.
6.
Comprehensive Diabetes Care—HbA1c Testing
Comprehensive Diabetes Care—Poor HbA1c Control
Comprehensive Diabetes Care—Eye Exam
Comprehensive Diabetes Care—LDL-C Screening
Comprehensive Diabetes Care—LDL-C Level <100
Comprehensive Diabetes Care—Medical Attention for Diabetic Nephropathy
The following pages show in detail the performance profile, health plan rankings, and analysis of
data collection methodology used by the Michigan MHPs for each of these measures.
5-14
American Diabetes Association. Direct and Indirect Costs of Diabetes in the United States. Available at:
http://www.diabetes.org/diabetes-statistics/cost-of-diabetes-in-us.jsp. Accessed on: July 30, 2007.
5-15
Michigan Department of Community Health. Diabetes in Michigan. September 2006. Available at:
http://www.michigan.gov/documents/mdch/FactPageMichigan-Darline_2_172250_7.pdf. Accessed on: July 30, 2007.
5-16
Michigan Department of Community Health. Michigan Diabetes Strategic Plan. October 2003. Available at:
http://www.michigan.gov/documents/DM_StrategicPlan_82795_7.pdf. Accessed on: July 30, 2007.
5-17
National Committee for Quality Assurance. The State of Health Care Quality 2006. Washington DC: National Committee for Quality
Assurance; 2005. Available at: http://www.ncqa.org/communications/sohc2006/sohc_2006.pdf. Accessed on: July 30, 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-4
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LIVING WITH ILLNESS
Comprehensive Diabetes Care—HbA1c Testing
The HbA1c test (hemoglobin A1c test or glycosylated hemoglobin test) shows the average blood
glucose level over a period of two to three months. Specifically, the test measures the number of
glucose molecules attached to hemoglobin in red blood cells. Although constantly replaced, individual
cells live for about four months. By measuring attached glucose in a current blood sample, average
blood sugar levels from the previous two to three months can be determined. HbA1c test results are
expressed as a percentage, with 4 percent to 6 percent considered normal. The HbA1c test
complements the day-to-day snapshots obtained from the self-monitoring of blood glucose levels
(mg/dL).
HEDIS Specification: Comprehensive Diabetes Care—HbA1c Testing
The Comprehensive Diabetes Care—HbA1c Testing rate reports the percentage of members with
diabetes (Type 1 and Type 2) 18 to 75 years of age who were continuously enrolled during the
measurement year and who had one or more HbA1c test(s) conducted during the measurement year
identified through either administrative data or medical record review.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-5
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LIVING WITH ILLNESS
Health Plan Ranking: Comprehensive Diabetes Care—HbA1c Testing
Figure 5-1—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Comprehensive Diabetes Care—HbA1c Testing
Diabetes Care HbA1c Testing
He alth Plan
Upper Peninsula Health Plan
436
N
89.7%
Priority Health
411
89.3%
M-CAID
256
89.1%
High Performance Level
Rate
88.8%
HealthPlus Partners, Inc.
411
86.6%
Health Plan of Michigan, Inc.
418
86.4%
McLaren Health Plan
411
84.4%
Community Choice Michigan
411
83.7%
PHP of Mid-Michigan
376
83.0%
OmniCare Health Plan
433
78.8%
National 50th Percentile
77.4%
Great Lakes Health Plan
411
77.1%
Total Health Care, Inc.
464
76.7%
Molina Healthcare of Michigan
429
74.1%
Low Performance Level
71.1%
Midwest Health Plan
411
0%
20%
40%
60%
80%
70.1%
100%
2007 Michigan Medicaid Weighted Average = 79.8%
2006 Michigan Medicaid Weighted Average = 79.6%
2005 Michigan Medicaid Weighted Average = 79.5%
Three health plans reported rates above the HPL of 88.8 percent, and one health plan had a rate
below the LPL of 71.1 percent. A total of nine health plans, including the three above the HPL, had
reported rates higher than the national HEDIS 2006 Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 79.8 percent was 2.4 percentage points above the
national HEDIS 2006 50th percentile of 77.4 percent.
The weighted average has not shown much change in the past three years. The 2007 Michigan
Medicaid weighted average of 79.8 percent is only 0.3 percentage points higher than the 2005
Michigan Medicaid weighted average.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-6
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Data Collection Analysis: Comprehensive Diabetes Care—HbA1c Testing
Figure 5-2—Michigan Medicaid HEDIS 2007
Data Collection Analysis:
Comprehensive Diabetes Care—HbA1c Testing
Diabetes Care HbA1c Testing
He alth Plan
Admin % M RR %
Upper Peninsula Health Plan
89.7%
89.0%
0.7%
Priority Health
89.3%
88.6%
0.7%
M-CAID
89.1%
88.3%
0.8%
High Performance Level
HealthPlus Partners, Inc.
86.6%
83.9%
2.7%
Health Plan of Michigan, Inc.
86.4%
82.8%
3.6%
McLaren Health Plan
84.4%
81.8%
2.7%
Community Choice Michigan
83.7%
81.5%
2.2%
PHP of Mid-Michigan
83.0%
83.0%
0.0%
2007 Michigan Aggregate
82.0%
77.4%
4.5%
OmniCare Health Plan
78.8%
68.4% 10.4%
Great Lakes Health Plan
77.1%
74.7%
2.4%
Total Health Care, Inc.
76.7%
70.3%
6.5%
71.8%
2.3%
Molina Healthcare of Michigan
74.1%
Low Performance Level
Midwest Health Plan
70.1%
0%
20%
MRR=Medical Record Review
Admin=Administrative Data
40%
60%
Admin
80%
48.2% 21.9%
100%
MRR
The figure above shows how much of the final rate for each health plan was derived from the administrative method (Admin) and how much
was from medical record review (MRR). Note that, because of rounding differences, the sum of the Admin rate and the MRR rate may not
always be exactly equal to the final rate.
All of the health plans used the hybrid method to calculate this measure. The 2007 Michigan
aggregate administrative rate was 77.4 percent and the medical record review rate was 4.5 percent.
In 2007, 94.4 percent of the aggregate rate was derived from administrative data and 5.5 percent
was from medical record review. The administrative rate increased by 1.9 percentage points from
2006 to 2007.
All of the health plans derived more than two-thirds of their rates from administrative data. One
health plan increased its overall rate by more than 20 percentage points from medical record review.
As seen in the figure above, administrative data completeness (i.e., claims and encounter data
submission) was not an issue for a majority of health plans for this measure. This implies that
providers and/or laboratories routinely submitted claims and encounter data for diabetic members
who received HbA1c testing.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-7
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Comprehensive Diabetes Care—Poor HbA1c Control
HbA1c control improves quality of life, increases work productivity, and decreases health care
utilization. Decreasing the HbA1c level lowers the risk of diabetes-related death. Controlling blood
glucose levels in people with diabetes significantly reduces the risk for blindness, end-stage renal
disease, and lower extremity amputation.
HEDIS Specification: Comprehensive Diabetes Care—Poor HbA1c Control
The Comprehensive Diabetes Care—Poor HbA1c Control rate reports the percentage of members
with diabetes (Type 1 and Type 2) 18 to 75 years of age who were continuously enrolled during the
measurement year and whose most recent HbA1c test conducted during the measurement year
showed an HbA1c level of more than 9 percent, as documented through automated laboratory data
and/or medical record review. If there was not an HbA1c level during the measurement year, the
level is considered to be greater than 9 percent (i.e., no test is counted as poor HbA1c control).
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-8
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Health Plan Ranking: Comprehensive Diabetes Care—Poor HbA1c Control
Figure 5-3—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Comprehensive Diabetes Care—Poor HbA1c Control
Diabetes Care Poor HbA1c Control
He alth Plan
Low Performance Level
N
Rate
Great Lakes Health Plan
411
50.6%
Molina Healthcare of Michigan
429
50.1%
OmniCare Health Plan
433
49.9%
Midwest Health Plan
411
48.2%
Total Health Care, Inc.
464
47.0%
60.1%
National 50th Percentile
45.2%
Community Choice Michigan
411
43.1%
McLaren Health Plan
411
41.8%
PHP of Mid-Michigan
376
38.0%
M-CAID
256
34.0%
Health Plan of Michigan, Inc.
418
33.0%
HealthPlus Partners, Inc.
411
32.8%
High Performance Level
30.3%
Upper Peninsula Health Plan
436
27.8%
Priority Health
411
27.3%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 43.7%
2006 Michigan Medicaid Weighted Average = 42.3%
2005 Michigan Medicaid Weighted Average = 44.6%
For this key measure, a lower rate indicates better performance since low rates of Poor HbA1c Control indicate better care.
Two health plans’ reported rates that outperformed the HPL of 30.3 percent, and no health plans
had rates above the LPL of 60.1 percent. A total of eight health plans performed better than the
national HEDIS 2006 Medicaid 50th percentile, indicating better performance.
The 2007 Michigan Medicaid weighted average of 43.7 percent was 1.5 percentage points below
the national HEDIS 2006 Medicaid 50th percentile of 45.2 percent. This suggests that the MHPs
performed slightly better than health plans nationally for this measure.
The 2007 Michigan Medicaid weighted average increased by 1.4 percentage points over the 2006
weighted average. This slight increase demonstrates a decline in performance from the previous
year.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-9
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Data Collection Analysis: Comprehensive Diabetes Care—Poor HbA1c Control
Figure 5-4—Michigan Medicaid HEDIS 2007
Data Collection Analysis:
Comprehensive Diabetes Care—Poor HbA1c Control
Diabetes Care Poor HbA1c Control
He alth Plan
Admin %
M RR %
Low Performance Level
Great Lakes Health Plan
50.6%
0.0%
50.6%
Molina Healthcare of Michigan
50.1%
0.0%
50.1%
OmniCare Health Plan
49.9%
33.0%
16.9%
Midwest Health Plan
48.2%
0.0%
48.2%
Total Health Care, Inc.
47.0%
31.5%
15.5%
43.1%
0.0%
0.0%
41.8%
13.5%
27.0%
0.0%
38.0%
Community Choice Michigan
43.1%
McLaren Health Plan
41.8%
2007 Michigan Aggregate
40.5%
PHP of Mid-Michigan
38.0%
M-CAID
34.0%
0.0%
34.0%
Health Plan of Michigan, Inc.
33.0%
0.0%
33.0%
HealthPlus Partners, Inc.
32.8%
32.8%
0.0%
High Performance Level
Upper Peninsula Health Plan
27.8%
0.0%
27.8%
Priority Health
27.3%
27.3%
0.0%
0%
20%
MRR=Medical Record Review
Admin=Administrative Data
40%
60%
Admin
80%
100%
MRR
The figure above shows how much of the final rate for each health plan was derived from the administrative method (Admin) and how
much was from medical record review (MRR). Note that, because of rounding differences, the sum of the Admin rate and the MRR rate
may not always be exactly equal to the final rate.
For this key measure, a lower rate indicates better performance since low rates of Poor HbA1c Control indicate better care.
Figure 5-4 presents the breakout rates that were derived from administrative data and medical
record review for Poor HbA1c Control. For this measure, a lower rate indicates better performance.
All of the health plans used the hybrid method to calculate this measure. The 2007 Michigan
aggregate administrative rate was 13.5 percent and the medical record review rate was 27.0 percent.
The aggregate rate for this measure was derived from 33.3 percent administrative data and 66.7
percent medical record review data. The administrative rate decreased by 4.4 percent from 2006,
indicating that the health plans were relying more on medical record review to report this measure.
It appears that while the HbA1c Testing measure captured the actual test data from submitted claims
and encounters, the results of the test were not captured administratively. This continues to be a
challenge for health plans across the country.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-10
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Comprehensive Diabetes Care—Eye Exam
Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year, and it is the leading
cause of new cases of blindness in adults 20 to 74 years of age.5-118 According to the American
Academy of Ophthalmology, people with diabetes are 25 times more likely to lose their vision than
those who do not have diabetes.5-119 Blindness in diabetics younger than 65 years of age costs the
federal government more than $14,000 annually for each affected person, while screening for
diabetic retinopathy has been estimated to cost only $31 per patient.5-20 However, with timely and
appropriate intervention, which may include laser treatment and vitrectomy, blindness can be
reduced by up to 90 percent in patients with severe diabetic retinopathy.5-21
According to the National Eye Institute, approximately 184,589 Michigan residents have diabetic
retinopathy. This equates to approximately 36 percent of all Michigan diabetics.5-22
HEDIS Specification: Comprehensive Diabetes Care—Eye Exam
The Comprehensive Diabetes Care—Eye Exam rate reports the percentage of members with
diabetes (Type 1 and Type 2) 18 to 75 years of age who were continuously enrolled during the
measurement year and who had an eye screening for diabetic retinal diseases (i.e., a retinal exam by
an eye care professional), as documented through either administrative data or medical record
review.
5-18
National Diabetes Education Program. Eye Health and Diabetes. Available at: http://ndep.nih.gov/diabetes/WTMD/eye.htm. Accessed
on: July 30, 2007.
5-1
19
Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2003. Available at:
http://www.cdc.gov/DIABETES/pubs/pdf/ndfs_2003.pdf. Accessed on: June 22, 2006.
5-2
20
National Committee for Quality Assurance. The State of Managed Care Quality 2001. Standard Version. Washington, DC: National
Committee for Quality Assurance; 2001.
5-2
21
National Institutes of Health. Fact Sheet: Diabetic Retinopathy. Available at:
http://www.nih.gov/about/researchresultsforthepublic/DiabeticRetinopathy.pdf. Accessed on: July 30, 2007.
5-2
22
Michigan Department of Community Health. Michigan Diabetes Strategic Plan. Available at:
http://michigan.gov/documents/DM_StrategicPlan_82795_7.pdf. Accessed on: July 30, 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-11
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Health Plan Ranking: Comprehensive Diabetes Care—Eye Exam
Figure 5-5—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Comprehensive Diabetes Care—Eye Exam
Diabetes Care Eye Exam
He alth Plan
HealthPlus Partners, Inc.
411
N
74.0%
Upper Peninsula Health Plan
436
70.6%
Priority Health
411
70.6%
High Performance Level
Rate
68.1%
PHP of Mid-Michigan
376
67.8%
McLaren Health Plan
411
67.4%
Health Plan of Michigan, Inc.
418
67.0%
M-CAID
256
62.5%
Total Health Care, Inc.
464
57.3%
Midwest Health Plan
411
53.5%
Great Lakes Health Plan
411
53.3%
National 50th Percentile
50.8%
Molina Healthcare of Michigan
429
50.6%
OmniCare Health Plan
433
47.8%
Community Choice Michigan
411
43.8%
Low Performance Level
35.2%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 57.5%
2006 Michigan Medicaid Weighted Average = 54.2%
2005 Michigan Medicaid Weighted Average = 47.3%
Three health plans reported rates above the HPL of 68.1 percent, and none of the health plans
reported rates below the LPL of 35.2 percent. Ten health plans, including the three above the HPL,
had rates that exceeded the national HEDIS 2006 Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 57.5 percent was 6.7 percent above the national
HEDIS 2006 Medicaid 50th percentile of 50.8 percent.
The 2007 Michigan Medicaid weighted average increased by 3.3 percentage points over the 2006
weighted average and by 10.2 percentage points over the 2005 weighted average. The range of
reported rates showed improvement from 2006 to 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-12
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Data Collection Analysis: Comprehensive Diabetes Care—Eye Exam
Figure 5-6—Michigan Medicaid HEDIS 2007
Data Collection Analysis:
Comprehensive Diabetes Care—Eye Exam
Diabetes Care Eye Exam
He alth Plan
Admin %
HealthPlus Partners, Inc.
74.0%
M RR %
58.2%
15.8%
Upper Peninsula Health Plan
70.6%
63.8%
6.9%
Priority Health
70.6%
56.0%
14.6%
High Performance Level
PHP of Mid-Michigan
67.8%
51.6%
16.2%
McLaren Health Plan
67.4%
44.0%
23.4%
Health Plan of Michigan, Inc.
67.0%
56.9%
10.0%
52.7%
9.8%
48.0%
12.3%
42.9%
14.4%
M-CAID
62.5%
2007 Michigan Aggregate
60.3%
Total Health Care, Inc.
57.3%
Midwest Health Plan
53.5%
36.7%
16.8%
Great Lakes Health Plan
53.3%
45.3%
8.0%
45.9%
4.7%
37.6%
10.2%
34.3%
9.5%
Molina Healthcare of Michigan
50.6%
OmniCare Health Plan
47.8%
Community Choice Michigan
43.8%
Low Performance Level
0%
20%
MRR=Medical Record Review
Admin=Administrative Data
40%
60%
Admin
80%
100%
MRR
The figure above shows how much of the final rate for each health plan was derived from the administrative method (Admin) and how much
was from medical record review (MRR). Note that, because of rounding differences, the sum of the Admin rate and the MRR rate may not
always be exactly equal to the final rate.
All of the health plans used the hybrid method to calculate their rates for this measure. The 2007
Michigan aggregate administrative rate was 48.0 percent and the medical record review rate was
12.3 percent.
In 2007, 79.6 percent of the aggregate rate was derived from administrative data and 20.4 percent
was derived from medical record review. These rates have remained fairly consistent for the past
two years.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-13
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Comprehensive Diabetes Care—LDL-C Screening
Low-density lipoprotein (LDL) is a type of lipoprotein that carries cholesterol in the blood. LDL is
considered to be undesirable because it deposits excess cholesterol in the walls of blood vessels and
contributes to atherosclerosis (hardening of the arteries) and heart disease. Therefore, LDL
cholesterol is often termed “bad” cholesterol. The test for LDL measures the amount of LDL
cholesterol in the blood.
HEDIS Specification: Comprehensive Diabetes Care—LDL-C Screening
The Comprehensive Diabetes Care—LDL-C Screening rate reports the percentage of members with
diabetes (Type 1 and Type 2) 18 to 75 years of age who were continuously enrolled during the
measurement year and who had an LDL-C test during the measurement year, as determined by
claims/encounters or automated laboratory data or medical record review.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-14
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Health Plan Ranking: Comprehensive Diabetes Care—LDL-C Screening
Figure 5-7—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Comprehensive Diabetes Care—LDL-C Screening
Diabetes Care LDL-C Screening
He alth Plan
High Performance Level
N
Rate
90.8%
National 50th Percentile
83.3%
Health Plan of Michigan, Inc.
418
82.5%
Upper Peninsula Health Plan
436
81.7%
Priority Health
411
81.0%
M-CAID
256
80.9%
PHP of Mid-Michigan
376
77.1%
Great Lakes Health Plan
411
76.9%
Low Performance Level
76.2%
HealthPlus Partners, Inc.
411
75.4%
OmniCare Health Plan
433
74.8%
Molina Healthcare of Michigan
429
73.4%
Total Health Care, Inc.
464
72.8%
McLaren Health Plan
411
71.5%
Midwest Health Plan
411
70.1%
Community Choice Michigan
411
66.9%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 75.1%
2006 Michigan Medicaid Weighted Average = 85.4%
2005 Michigan Medicaid Weighted Average = 81.6%
It should be noted that changes were made to this indicator’s specifications that would result in
lower rates. In previous years, the specifications allowed for the LDL-C screening to occur in either
the measurement year or the year prior to the measurement year. In 2007, however, the
specifications were changed to require that the screening take place during the measurement year.
Therefore, these rates may not be directly comparable to previous years’ rates or national
benchmarks and are presented for informational purposes only.
There were no health plans that met or exceeded either the national HEDIS 2006 Medicaid 50th
percentile or the HPL. Seven health plans reported rates below the LPL of 76.2 percent.
The 2007 Michigan Medicaid weighted average showed a statistically significant decline from
2006, down 10.3 percentage points. This decline may be associated with the measure specification
changes.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-15
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Data Collection Analysis: Comprehensive Diabetes Care—LDL-C Screening
Figure 5-8—Michigan Medicaid HEDIS 2007
Data Collection Analysis:
Comprehensive Diabetes Care—LDL-C Screening
Diabetes Care LDL-C Screening
He alth Plan
Admin %
M RR %
High Performance Level
Health Plan of Michigan, Inc.
82.5%
79.4%
3.1%
Upper Peninsula Health Plan
81.7%
81.0%
0.7%
Priority Health
81.0%
80.3%
0.7%
M-CAID
80.9%
80.1%
0.8%
PHP of Mid-Michigan
77.1%
76.1%
1.1%
Great Lakes Health Plan
76.9%
71.5%
5.4%
Low Performance Level
2007 Michigan Aggregate
75.6%
65.3%
10.3%
HealthPlus Partners, Inc.
75.4%
70.1%
5.4%
OmniCare Health Plan
74.8%
63.7%
11.1%
Molina Healthcare of Michigan
73.4%
66.4%
7.0%
Total Health Care, Inc.
72.8%
62.3%
10.6%
39.7%
31.9%
37.5%
32.6%
46.5%
20.4%
McLaren Health Plan
71.5%
Midwest Health Plan
70.1%
Community Choice Michigan
66.9%
0%
20%
MRR=Medical Record Review
Admin=Administrative Data
40%
60%
Admin
80%
100%
MRR
The figure above shows how much of the final rate for each health plan was derived from the administrative method (Admin) and how much
was from medical record review (MRR). Note that, because of rounding differences, the sum of the Admin rate and the MRR rate may not
always be exactly equal to the final rate.
All of the health plans elected to use the hybrid method to report this measure. The 2007 Michigan
aggregate administrative rate was 65.3 percent and the medical record review rate was 10.3 percent.
In 2007, 86.4 percent of the aggregate rate was derived from administrative data and 13.6 percent
from medical record review. The 2007 administrative rate increased by 8.8 percentage points
compared to the 2006 rate, indicating that administrative data completeness is improving.
All 13 health plans derived more than half of their rates from administrative data.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-16
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
HEDIS Specification: Comprehensive Diabetes Care—LDL-C Level <100
The rate for Comprehensive Diabetes Care—LDL-C Level <100 calculates the percentage of
members with diabetes (Type 1 and Type 2) 18 to 75 years of age who were continuously enrolled
during the measurement year and whose most recent LDL-C test (performed during the
measurement) indicated an LDL-C level less than 100 mg/dL, as documented through automated
laboratory data and/or medical record review.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-17
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Health Plan Ranking: Comprehensive Diabetes Care—LDL-C Level <100
Figure 5-9—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Comprehensive Diabetes Care—LDL-C Level <100
Diabetes Care LDL-C Level<100
He alth Plan
Molina Healthcare of Michigan
N
429
High Performance Level
Rate
51.3%
46.5%
PHP of Mid-Michigan
376
46.0%
M-CAID
256
45.7%
Priority Health
411
39.4%
Upper Peninsula Health Plan
436
37.4%
HealthPlus Partners, Inc.
411
36.5%
Health Plan of Michigan, Inc.
418
35.2%
OmniCare Health Plan
433
34.9%
National 50th Percentile
34.1%
McLaren Health Plan
411
33.1%
Great Lakes Health Plan
411
30.9%
Midwest Health Plan
411
29.7%
Community Choice Michigan
411
29.2%
Total Health Care, Inc.
464
28.2%
Low Performance Level
26.5%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 36.7%
2006 Michigan Medicaid Weighted Average = 40.7%
2005 Michigan Medicaid Weighted Average = 37.8%
It should be noted that changes were made to this indicator’s specifications that would result in
lower rates. In previous years, the specifications allowed for the LDL-C screening to occur in either
the measurement year or the year prior to the measurement year. In 2007, however, the
specifications were changed to require that the screening take place during the measurement year.
Therefore, these rates may not be directly comparable to previous years’ rates or national
benchmarks and are presented for informational purposes only.
One health plan reported a rate above the HPL of 46.5 percent, and no health plans reported rates
below the LPL of 26.5 percent. Eight health plans, including the one above the HPL, reported rates
above the national HEDIS 2006 50th percentile.
The 2007 Michigan Medicaid weighted average of 36.7 percent was 2.6 percentage points above the
national HEDIS 2006 50th percentile of 34.1 percent.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-18
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
The 2007 Michigan Medicaid weighted average decreased below both the 2006 weighted average
and the 2005 weighted average by 4.0 and 1.1 percentage points, respectively. This decline was not
statistically significant and may be associated with the measure specification changes requiring
testing to occur within the measurement year.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-19
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Data Collection Analysis: Comprehensive Diabetes Care—LDL-C Level <100
Figure 5-10—Michigan Medicaid HEDIS 2007
Data Collection Analysis:
Comprehensive Diabetes Care—LDL-C Level <100
Diabetes Care LDL-C Level<100
He alth Plan
Admin %
Molina Healthcare of Michigan
51.3%
M RR %
39.6%
11.7%
High Performance Level
PHP of Mid-Michigan
46.0%
43.6%
2.4%
M-CAID
45.7%
32.4%
13.3%
22.6%
16.8%
Priority Health
39.4%
Upper Peninsula Health Plan
37.4%
31.4%
6.0%
HealthPlus Partners, Inc.
36.5%
30.7%
5.8%
2007 Michigan Aggregate
36.4%
18.7%
17.7%
Health Plan of Michigan, Inc.
35.2%
7.7%
27.5%
OmniCare Health Plan
34.9%
12.9%
21.9%
0.0%
33.1%
McLaren Health Plan
33.1%
Great Lakes Health Plan
30.9%
17.5%
13.4%
Midwest Health Plan
29.7%
6.1%
23.6%
Community Choice Michigan
29.2%
6.8%
22.4%
Total Health Care, Inc.
28.2%
0.0%
28.2%
Low Performance Level
0%
20%
MRR=Medical Record Review
Admin=Administrative Data
40%
60%
Admin
80%
100%
MRR
The figure above shows how much of the final rate for each health plan was derived from the administrative method (Admin) and how much
was from medical record review (MRR). Note that, because of rounding differences, the sum of the Admin rate and the MRR rate may not
always be exactly equal to the final rate.
All of the health plans used the hybrid method to report this measure. The 2007 Michigan Medicaid
aggregate administrative rate was 18.7 percent and the medical record review rate was 17.7 percent.
Overall, 51.4 percent of the aggregate rate was derived from administrative data and 48.6 percent
was derived from medical record review. The administrative rate increased by 9.3 percentage points
over the 2006 rate.
While administrative data submission continued to show improvement this year, the rates for this
measure still rely heavily on medical record review.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-20
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Comprehensive Diabetes Care—Medical Attention for Diabetic Nephropathy
Diabetes is the leading cause of end-stage renal disease (ESRD), a condition that must be treated by
dialysis or a kidney transplant. In the United States, diabetes causes more than 150,000 cases of
kidney failure. In 2003, health care for patients with kidney failure cost the United States more than
$27 billion.5-23 Diabetic nephropathy is a progressive kidney disease that takes years to develop and
progress; usually 15 to 25 years will pass after the onset of diabetes before kidney failure occurs.
Approximately 20 to 30 percent of patients with diabetes develop evidence of nephropathy, although
those with Type 2 diabetes are less likely to develop ESRD.5-24 In Michigan, 43.8 percent of people
newly diagnosed with ESRD in 2004 also had a primary diagnosis of diabetes.5-225
HEDIS Specification: Comprehensive Diabetes Care—Medical Attention for Diabetic
Nephropathy
The Comprehensive Diabetes Care—Medical Attention for Diabetic Nephropathy rate is intended to
assess whether diabetic patients are being monitored for nephropathy. It reports the percentage of
members with diabetes (Type 1 and Type 2) 18 to 75 years of age who were continuously enrolled
during the measurement year and who were screened for nephropathy, or who received treatment
for nephropathy, as documented through either administrative data or medical record review. The
rate includes patients who have been screened for nephropathy or who already have evidence of
nephropathy as demonstrated by medical attention for nephropathy, a positive microalbuminuria
test, or evidence of ACE inhibitor/ARB therapy.
5-23
National Kidney and Urologic Diseases Information Clearinghouse. Kidney Disease of Diabetes. Available at:
http://kidney.niddk.nih.gov/kudiseases/pubs/kdd/index.htm. Accessed on: July 31, 2007.
5-24
Nephropathy in Diabetes. Diabetes Care, 2004.Available at: http://care.diabetesjournals.org/cgi/content/full/27/suppl_1/s79. Accessed
on: July 31, 2007.
5-2
25
Michigan Department of Community Health. Diabetes in Michigan. September 2006. Available at:
http://www.michigan.gov/documents/mdch/FactPageMichigan-Darline_2_172250_7.pdf. Accessed on: July 30, 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-21
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Health Plan Ranking: Comprehensive Diabetes Care—Medical Attention for Diabetic
Nephropathy
Figure 5-11—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Comprehensive Diabetes Care—Medical Attention for Diabetic Nephropathy
Diabetes Care Nephropathy
He alth Plan
McLaren Health Plan
N
Rate
411
91.2%
HealthPlus Partners, Inc.
411
85.4%
M-CAID
256
84.8%
OmniCare Health Plan
433
83.4%
Priority Health
411
82.5%
Upper Peninsula Health Plan
436
81.4%
PHP of Mid-Michigan
376
78.2%
Health Plan of Michigan, Inc.
418
78.0%
Great Lakes Health Plan
411
77.9%
Midwest Health Plan
411
77.9%
Total Health Care, Inc.
464
77.6%
Molina Healthcare of Michigan
429
76.9%
Community Choice Michigan
411
76.6%
High Performance Level
65.6%
National 50th Percentile
49.3%
Low Performance Level
39.5%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 79.8%
2006 Michigan Medicaid Weighted Average = 50.7%
2005 Michigan Medicaid Weighted Average = 47.6%
There was a revision to the technical specifications for this indicator this year, which may have
resulted in higher rates. The use of ACE inhibitor/ARB therapy for numerator compliance was
added for compliance with medical attention to nephropathy. Therefore, direct comparisons with
previous years’ rates and national benchmarks are displayed for informational purposes only and for
future trending.
The 2007 Michigan Medicaid weighted average of 79.8 percent showed statistically significant
improvement with an increase of 29.1 percentage points above the 2006 weighted average.
Revisions to the measure specifications should be considered with respect to this increase.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-22
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Data Collection Analysis: Comprehensive Diabetes Care—Medical Attention for Diabetic
Nephropathy
Figure 5-12—Michigan Medicaid HEDIS 2007
Data Collection Analysis:
Comprehensive Diabetes Care—Medical Attention for Diabetic Nephropathy
Diabetes Care Nephropathy
He alth Plan
Admin %
McLaren Health Plan
HealthPlus Partners, Inc.
M-CAID
91.2%
M RR %
77.9%
13.4%
85.4%
82.0%
3.4%
84.8%
83.6%
1.2%
OmniCare Health Plan
83.4%
80.4%
3.0%
Priority Health
82.5%
79.3%
3.2%
Upper Peninsula Health Plan
81.4%
79.8%
1.6%
2007 Michigan Aggregate
80.8%
76.8%
3.9%
PHP of Mid-Michigan
78.2%
75.5%
2.7%
Health Plan of Michigan, Inc.
78.0%
74.9%
3.1%
Great Lakes Health Plan
77.9%
71.8%
6.1%
Midwest Health Plan
77.9%
71.0%
6.8%
Total Health Care, Inc.
77.6%
76.1%
1.5%
Molina Healthcare of Michigan
76.9%
74.1%
2.8%
Community Choice Michigan
76.6%
74.7%
1.9%
High Performance Level
Low Performance Level
0%
20%
MRR=Medical Record Review
Admin=Administrative Data
40%
60%
Admin
80%
100%
MRR
The figure above shows how much of the final rate for each health plan was derived from the administrative method (Admin) and how much
was from medical record review (MRR). Note that, because of rounding differences, the sum of the Admin rate and the MRR rate may not
always be exactly equal to the final rate.
All of the health plans elected to use the hybrid method for reporting this measure. The 2007
Michigan aggregate administrative rate was 76.8 percent and the medical record review rate was 3.9
percent.
Overall, 95.0 percent of the aggregate rate was derived from administrative data and 4.8 percent
was from medical record review. In 2006, 83.8 percent of the aggregate rate was derived from
administrative data. Health plans have greatly improved their administrative data completeness
from 2006 to 2007. This could be due in part to the addition of the ACE inhibitor/ARBs that are
obtained through pharmacy data, which are potentially more complete than lab data or capitated
service claims.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-23
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Use of Appropriate Medications for People With Asthma
In 2004, asthma accounted for more than 13.6 million physician visits, 1 million hospital outpatient
department visits, and 1.8 million emergency room (ER) visits in the United States.5-26 Asthma is one
of the most common chronic conditions in both children and adults, affecting approximately 9
million children and 11 million adults.5-27 The asthma prevalence rate reported for adults in
Michigan during 2005 was 9.1 percent, while the national rate was 9.0 percent.5-28 Management of
asthma is critical, and neglect of the condition frequently results in hospitalizations, ER visits, and
missed work and school days.
HEDIS Specification: Use of Appropriate Medications for People With Asthma
This measure is reported using the administrative method only. Rates are reported for three age
groups: 5 to 9 years of age, 10 to 17 years of age, and 18 to 56 years of age, as well as a combined
rate.
In addition to enrollment data, claims are used to identify the denominator. Members are identified for
each denominator based on age and a two-year continuous enrollment criterion (the measurement year
and the year prior to the measurement year). In addition, this measure requires that members be
identified as having persistent asthma. Persistent asthma is defined by the HEDIS specifications as
having any of the following events within the current and prior measurement year:
1.
2.
3.
4.
At least four asthma medication dispensing events
At least one ER visit with a principal diagnosis of asthma
At least one acute inpatient discharge with a principal diagnosis of asthma
At least four outpatient visits with a corresponding diagnosis of asthma and at least two asthma
medication dispensing events.
This measure evaluates whether members with persistent asthma are being prescribed medications
acceptable as primary therapy for long-term control of asthma during the measurement year. There
are a number of acceptable therapies for people with persistent asthma, although the best available
evidence demonstrates that inhaled corticosteroids are the preferred primary therapy. For people
with moderate to severe asthma, inhaled corticosteroids are the only recommended primary therapy.
While long-acting beta-agonists are a preferred adjunct therapy for long-term control of moderate to
severe asthma, their use is recommended as an add-on therapy to inhaled corticosteroids. Therefore,
they should not be included in this numerator.5-29
For this particular measure, NCQA requires that rates be calculated using the administrative
method; therefore, a data collection analysis is not presented.
5-26
American Lung Association Epidemiology & Statistics Unit. Trends in Asthma Morbidity and Mortality. July 2006. Available at:
http://www.lungusa.org. Accessed on: July 31, 2007.
5-27
National Heart, Lung, and Blood Institute. Who Is At Risk for Asthma? Available at:
http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhoIsAtRisk.html. Accessed on: July 31, 2007.
5-28
American Lung Association Epidemiology & Statistics Unit. Trends in Asthma Morbidity and Mortality. July 2006. Available at:
http://www.lungusa.org. Accessed on: July 31, 2007.
5-29
National Committee for Quality Assurance. HEDIS 2007 Technical Specifications. Volume 2. Washington, DC: National Committee
for Quality Assurance; 2006.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-24
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Use of Appropriate Medications for People With Asthma—Ages 5 to 9 Years
The Use of Appropriate Medications for People With Asthma—Ages 5 to 9 Years rate calculates the
percentage of members 5 to 9 years of age who had been continuously enrolled for the measurement
year and the year prior to the measurement year, were identified as having persistent asthma as a
result of any one of four specified events during the measurement year and the year prior to the
measurement year, and were prescribed medications that were acceptable as primary therapy for
long-term asthma control.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-25
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Health Plan Ranking: Use of Appropriate Medications for People With Asthma—Ages 5 to 9
Years
Figure 5-13—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Use of Appropriate Medications for People With Asthma—Ages 5 to 9 Years
Asthma, 5-9 Years
He alth Plan
M-CAID
N
104
99.0%
Priority Health
175
98.3%
Health Plan of Michigan, Inc.
217
98.2%
Upper Peninsula Health Plan
91
97.8%
182
96.7%
McLaren Health Plan
High Performance Level
Rate
95.8%
Community Choice Michigan
162
95.7%
HealthPlus Partners, Inc.
274
93.8%
94
90.4%
PHP of Mid-Michigan
National 50th Percentile
90.2%
Midwest Health Plan
188
Low Performance Level
86.7%
86.7%
Total Health Care, Inc.
172
86.6%
Great Lakes Health Plan
268
84.7%
Molina Healthcare of Michigan
373
83.1%
OmniCare Health Plan
253
77.9%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 89.9%
2006 Michigan Medicaid Weighted Average = 88.8%
2005 Michigan Medicaid Weighted Average = 65.1%
Five health plans reported rates above the HPL of 95.8 percent and four health plans had rates
below the LPL of 86.7 percent. Eight health plans, including the five above the HPL, reported rates
above the national HEDIS 2006 Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 89.9 percent was 0.3 percentage points below
the national HEDIS 2006 Medicaid 50th percentile of 90.2 percent.
The 2007 Michigan Medicaid weighted average increased by 1.1 percentage points above the 2006
weighted average of 88.8 percent.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-26
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Use of Appropriate Medications for People With Asthma—Ages 10 to 17 Years
The rate for Use of Appropriate Medications for People With Asthma—Ages 10 to 17 Years
calculates the percentage of members 10 to 17 years of age who had been continuously enrolled for
the measurement year and the year prior to the measurement year, were identified as having
persistent asthma as a result of any one of four specified events during the measurement year and
the year prior to the measurement year, and were prescribed medications that were acceptable as
primary therapy for long-term asthma control.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-27
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Health Plan Ranking: Use of Appropriate Medications for People With Asthma—Ages 10 to
17 Years
Figure 5-14—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Use of Appropriate Medications for People With Asthma—Ages 10 to 17 Years
Asthma, 10-17 Years
He alth Plan
Health Plan of Michigan, Inc.
260
N
97.3%
Priority Health
194
95.4%
High Performance Level
Rate
93.5%
Upper Peninsula Health Plan
133
92.5%
Community Choice Michigan
232
91.8%
HealthPlus Partners, Inc.
362
91.7%
M-CAID
113
91.2%
McLaren Health Plan
235
90.6%
PHP of Mid-Michigan
121
89.3%
National 50th Percentile
87.4%
Low Performance Level
83.3%
Molina Healthcare of Michigan
572
82.0%
Midwest Health Plan
225
81.8%
Great Lakes Health Plan
386
80.8%
Total Health Care, Inc.
283
80.2%
OmniCare Health Plan
382
75.1%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 86.0%
2006 Michigan Medicaid Weighted Average = 87.2%
2005 Michigan Medicaid Weighted Average = 64.2%
Two health plans reported rates above the HPL of 93.5 percent and five health plans had rates
below the LPL of 83.3 percent. Eight health plans, including the two above the HPL, reported rates
above the national HEDIS 2006 Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 86.0 percent was 1.4 percentage points below
the national HEDIS 2006 Medicaid 50th percentile of 87.4 percent. The 2007 Michigan Medicaid
weighted average was also 1.2 percentage points below the 2006 weighted average of 87.2 percent.
In 2006, all of the health plans reported rates above all of the national standards due to changes in
the specifications for this measure during that measurement year.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-28
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Use of Appropriate Medications for People With Asthma—Ages 18 to 56 Years
Use of Appropriate Medications for People With Asthma—Ages 18 to 56 Years measures the
percentage of members 18 to 56 years of age who had been continuously enrolled for the
measurement year and the year prior to the measurement year, were identified as having persistent
asthma as a result of any one of four specified events during the measurement year and the year
prior to the measurement year, and were prescribed medications that were acceptable as primary
therapy for long-term asthma control.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-29
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Health Plan Ranking: Use of Appropriate Medications for People With Asthma—Ages 18 to
56 Years
Figure 5-15—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Use of Appropriate Medications for People With Asthma—Ages 18 to 56 Years
Asthma, 18-56 Years
He alth Plan
PHP of Mid-Michigan
N
163
94.5%
Health Plan of Michigan, Inc.
487
94.5%
High Performance Level
Rate
90.8%
M-CAID
140
90.0%
Great Lakes Health Plan
911
89.9%
Community Choice Michigan
453
89.0%
HealthPlus Partners, Inc.
475
88.6%
Priority Health
226
88.5%
Upper Peninsula Health Plan
188
87.2%
OmniCare Health Plan
663
86.0%
McLaren Health Plan
452
85.2%
National 50th Percentile
84.9%
Molina Healthcare of Michigan
1,170
84.4%
Midwest Health Plan
518
83.4%
Total Health Care, Inc.
438
82.9%
Low Performance Level
80.3%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 87.3%
2006 Michigan Medicaid Weighted Average = 86.5%
2005 Michigan Medicaid Weighted Average = 71.8%
Two health plans reported rates above the HPL of 90.8 percent and no health plans had rates below
the LPL of 80.3 percent. Ten health plans, including the two above the HPL, reported rates above
the national HEDIS 2006 Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 87.3 percent was 2.4 percentage points above the
national HEDIS 2006 Medicaid 50th percentile of 84.9 percent. The 2007 Michigan Medicaid
weighted average increased by 0.8 percentage points above the 2006 weighted average of 86.5
percent.
In 2006, all of the health plans reported rates above all of the national standards due to changes in
the specifications for this measure during that measurement year.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-30
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Use of Appropriate Medications for People With Asthma—Combined Rate
The Use of Appropriate Medications for People With Asthma—Combined Rate calculates the sum
of the numerators from the three age groups divided by the sum of the three denominators.
Health Plan Ranking: Use of Appropriate Medications for People With Asthma—Combined
Rate
Figure 5-16—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Use of Appropriate Medications for People With Asthma—Combined Rate
Asthma, Combined Rate
He alth Plan
Health Plan of Michigan, Inc.
N
964
96.1%
Priority Health
595
93.6%
M-CAID
357
93.0%
High Performance Level
Rate
92.5%
PHP of Mid-Michigan
378
91.8%
Upper Peninsula Health Plan
412
91.3%
Community Choice Michigan
847
91.0%
1,111
90.9%
869
89.1%
HealthPlus Partners, Inc.
McLaren Health Plan
National 50th Percentile
87.1%
Great Lakes Health Plan
1,565
Low Performance Level
86.8%
84.0%
Midwest Health Plan
931
83.7%
2,115
83.5%
Total Health Care, Inc.
893
82.8%
OmniCare Health Plan
1,298
81.2%
Molina Healthcare of Michigan
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 87.5%
2006 Michigan Medicaid Weighted Average = 87.1%
2005 Michigan Medicaid Weighted Average = 67.9%
Three health plans reported rates above the HPL of 92.5 percent, and four health plans had rates
below the LPL of 84.0 percent. Eight health plans, including the three above the HPL, reported rates
above the national HEDIS 2006 Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 87.5 percent was 0.4 percentage points above the
national HEDIS 2006 Medicaid 50th percentile of 87.1 percent.
In 2006, all of the health plans reported rates above all of the national standards due to changes in
the specifications for this measure during that measurement year.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-31
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Controlling High Blood Pressure
Approximately 30 percent of those with high blood pressure do not know they have it, which
accounts for its reputation as a “silent killer.” Furthermore, 65 percent of people with high blood
pressure do not have it under control.5-30 High blood pressure is a major risk factor for developing
cardiovascular disease, kidney failure, stroke, and heart failure, although improvements in the
detection and treatment of this condition have led to decreasing death rates from cardiovascular
disease and stroke in recent years.5-31 A healthy blood pressure level is a critical factor in preserving
kidney function and can reduce the risk of stroke by up to 40 percent. In 2005, 27.8 percent of
Michigan adults reported having high blood pressure, and heart disease and stroke were responsible
for 30,147 deaths.5-32
HEDIS Specification: Controlling High Blood Pressure
The Controlling High Blood Pressure measure assesses if blood pressure was controlled for adults
with diagnosed hypertension. This measure calculates the percentage of members 18 to 85 years of
age who were continuously enrolled for the measurement year, who had an ambulatory claim or
encounter with a diagnosis of hypertension that was confirmed within the medical record, and
whose blood pressure was controlled below 140/90 mm Hg.
The age range of 18 to 45 years of age was added this year, lowering the age span from 46 to 18
years of age. This year the measure was reported in the following age bands:
‹
‹
‹
18 to 45 years of age
46 to 85 years of age (comparable to 2005, 2006, and the 2006 national performance standards)
Total
5-30
American Heart Association. World Hypertension Day Highlights Risk of “Silent Killer”. Journal Report. April 10, 2007. Available at:
http://www.americanheart.org/presenter.jhtml?identifier=3046938. Accessed on: August 20, 2007.
5-31
Healthy People 2010. Information Access Project Report on Heart Disease and Stroke. Available at:
http://www.healthypeople.gov/document/html/volume1/12heart.htm. Accessed on: August 1, 2007.
5-32
Michigan Department of Community Health. 2007 CVD Fact Sheet. Available at:
http://michigan.gov/documents/mdch/CVDFactsheet2007bcol_202765_7.pdf. Accessed on: August 1, 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-32
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Health Plan Ranking: Controlling High Blood Pressure
Figure 5-17—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Controlling High Blood Pressure—Ages 18 to 45 Years
Controlling High Blood Pressure, 18-45 Years
He alth Plan
N
McLaren Health Plan
Rate
168
70.8%
84
67.9%
Upper Peninsula Health Plan
172
65.7%
PHP of Mid-Michigan
140
62.9%
Priority Health
159
59.1%
Health Plan of Michigan, Inc.
279
58.8%
Community Choice Michigan
144
56.3%
Midwest Health Plan
126
53.2%
HealthPlus Partners, Inc.
146
52.7%
Great Lakes Health Plan
111
47.7%
Molina Healthcare of Michigan
139
45.3%
OmniCare Health Plan
131
43.5%
Total Health Care, Inc.
132
43.2%
M-CAID
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 52.5%
Controlling High Blood Pressure—Ages 18 to 45 Years was a new measure for 2007; therefore,
national performance data were not available for comparison.
The 2007 Michigan Medicaid weighted average was 52.5 percent. Nine health plans reported rates
above the weighted average.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
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Page 5-33
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Figure 5-18—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Controlling High Blood Pressure—Ages 46 to 85 Years
Controlling High Blood Pressure, 46-85 Years
He alth Plan
High Performance Level
N
Rate
73.0%
McLaren Health Plan
243
67.9%
M-CAID
191
65.4%
National 50th Percentile
65.3%
Upper Peninsula Health Plan
286
64.3%
Community Choice Michigan
267
59.9%
Priority Health
252
58.7%
HealthPlus Partners, Inc.
265
57.7%
PHP of Mid-Michigan
271
57.6%
Low Performance Level
55.4%
Midwest Health Plan
285
52.3%
Health Plan of Michigan, Inc.
155
52.3%
Great Lakes Health Plan
300
51.7%
Molina Healthcare of Michigan
310
45.2%
OmniCare Health Plan
312
44.2%
Total Health Care, Inc.
325
40.9%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 51.5%
2006 Michigan Medicaid Weighted Average = 60.0%
2005 Michigan Medicaid Weighted Average = 56.1%
None of the health plans reported rates above the HPL of 73.0 percent, and six health plans reported
rates below the LPL of 55.4 percent. Two plans reported rates above the national HEDIS 2006
Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 51.5 percent was 13.8 percentage points below
the national HEDIS 2006 Medicaid 50th percentile of 65.3 percent. Although there were changes to
the specification for the Controlling High Blood Pressure measure, this rate can be compared to the
2006 Michigan Medicaid weighted average and the 2006 national performance standards.
The 2007 Michigan Medicaid weighted average showed a statistically significant decline of 8.5
percentage points from the 2006 Michigan Medicaid weighed average of 60.0 percent. The 2007
weighted average was 4.6 percentage points below the 2005 weighed average. Eleven of the 13
health plans saw a decrease in their 2007 rates, with four of the declines being greater than 10
percentage points.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-34
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Figure 5-19—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Controlling High Blood Pressure—Combined Rate
Controlling High Blood Pressure, Combined
He alth Plan
N
Rate
McLaren Health Plan
411
69.1%
M-CAID
275
66.2%
Upper Peninsula Health Plan
458
64.8%
PHP of Mid-Michigan
411
59.4%
Priority Health
411
58.9%
Community Choice Michigan
411
58.6%
Health Plan of Michigan, Inc.
434
56.5%
HealthPlus Partners, Inc.
411
56.0%
Midwest Health Plan
411
52.6%
Great Lakes Health Plan
411
50.6%
Molina Healthcare of Michigan
449
45.2%
OmniCare Health Plan
443
44.0%
Total Health Care, Inc.
457
41.6%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 51.9%
Controlling High Blood Pressure—Combined Rate was considered a new measure for 2007 because
the lower age span decreased; therefore, national performance data were not available for
comparison.
The 2007 Michigan Medicaid weighted average was 51.9 percent. Nine health plans reported rates
that exceeded the weighted average.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-35
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Medical Assistance With Smoking Cessation
Approximately 45.1 million adults in the United States were smokers in 2005. Excluding adult
deaths due to secondhand smoke, males and females lost an average of 13.2 and 14.5 years of life,
respectively, from smoking.5-33 Discontinuing the use of tobacco is the most cost-effective method
of preventing disease in adults. An economic assessment found that a health plan’s annual cost of
covering treatment to help people quit smoking ranged from $0.89 to $4.92 per smoker, while the
annual cost of treating smoking-related illnesses ranged from $6 to $33 per smoker.5-34
Michigan’s smoking rate has shown a slight increase recently; data show that 22.4 percent of adults
were current smokers in 2006 compared to 22.0 percent in 2005. African Americans accounted for
the highest rate among ethnic groups at 32.3 percent, and the 25-to-34-year-old age group was the
highest at 30.2 percent. The smoking rate for all U.S. adults was 20.1 percent in 2006.5-35
MDCH has many initiatives designed to decrease tobacco use, including free self-help smoking
cessation kits and a statewide task force to assist with regulations and ordinances aimed at clean
indoor air. Ongoing efforts also include smoking cessation programs for pregnant women,
counseling for Michigan’s Women, Infants & Children program enrollees on the dangers of
smoking and secondhand smoke, college initiatives, community education programs, and the
support of activities related to the Youth Tobacco Act. In fact, according to NCQA’s The State of
Health Care Quality 2006 report, Michigan ranked as the top-performing state for its Medicaid
population for this measure.5-336
Many smokers are unable to quit, even when they are educated about the negative health effects of
smoking and informed that eliminating tobacco is the most important step they can take to improve
their health. Studies have shown that when physicians advise smokers to quit it can have positive
results.5-37
HEDIS Specification—Advising Smokers to Quit
The Medical Assistance With Smoking Cessation measure is collected using the Consumer
Assessment of Healthcare Providers and Systems (CAHPS) survey. Advising Smokers to Quit is one
component (or rate) reported for the measure. Advising Smokers to Quit calculates the percentage of
members 18 years of age or older who were continuously enrolled during the last six months of the
measurement year, were smokers, were seen by an MHP practitioner in the six months prior to
completing the CAHPS survey, and received advice to quit smoking in the six months prior to
completing the CAHPS survey.
5-33
American Lung Association. Trends in Tobacco Use. June 2007. Available at: http://www.lungusa.org/atf/cf/%7B7A8D42C2-FCCA4604-8ADE-7F5D5E762256%7D/TREND_TOBACCO_JUNE07.PDF. Accessed on: July 30, 2007.
5-34
Centers for Disease Control and Prevention. Preventing Tobacco Use. August 2005. Available at:
http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/tobacco.pdf. Accessed on: August 1, 2007.
5-35
Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System (BRFSS). Available at:
http://www.cdc.gov/brfss/. Accessed on: August 1, 2007.
5-3
36
National Committee for Quality Assurance. The State of Health Care Quality 2006. Washington DC: National Committee for Quality
Assurance; 2005. Available at: http://www.ncqa.org/communications/sohc2006/sohc_2006.pdf. Accessed on: July 30, 2007.
5-37
Ibid.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-36
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
HEDIS Specification—Discussing Smoking Cessation Strategies
The Medical Assistance With Smoking Cessation measure is collected using the CAHPS survey.
Discussing Smoking Cessation Strategies is another component (or rate) reported for the measure.
Discussing Smoking Cessation Strategies calculates the percentage of members 18 years of age or
older who were continuously enrolled during the last six months of the measurement year, were
smokers, were seen by an MHP practitioner in the six months prior to completing the CAHPS
survey, and for whom smoking cessation medications were recommended or discussed.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-37
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Health Plan Ranking: Medical Assistance With Smoking Cessation—Advising Smokers to
Quit
Figure 5-20—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Medical Assistance With Smoking Cessation—Advising Smokers to Quit
Advising Smokers to Quit
He alth Plan
Rate
PHP of Mid-Michigan
77.5%
Community Choice Michigan
77.1%
M-CAID
76.4%
Priority Health
76.1%
Health Plan of Michigan, Inc.
75.4%
Upper Peninsula Health Plan
72.9%
2007 Michigan Medicaid Average
72.1%
HealthPlus Partners, Inc.
70.9%
OmniCare Health Plan
69.9%
McLaren Health Plan
69.6%
Molina Healthcare of Michigan
69.1%
Great Lakes Health Plan
68.9%
Midwest Health Plan
68.3%
Total Health Care, Inc.
65.6%
0%
20%
40%
60%
80%
100%
For this measure, 6 of the 13 health plans had rates above the 2007 Michigan Medicaid average of
72.1 percent. The 2007 Michigan Medicaid average increased 2.4 percentage points when compared
to the 2006 average of 69.7 percent. In 2006, four of the health plans reported rates above the 2006
Michigan Medicaid average.
The rates reported by the 13 health plans ranged from 65.6 percent to 77.5 percent. The range of
reported rates showed little improvement from 2006 to 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-38
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Figure 5-21—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Medical Assistance With Smoking Cessation—Discussing Smoking Cessation Strategies
Discussing Smoking Cessation Strategies
He alth Plan
Rate
PHP of Mid-Michigan
48.8%
M-CAID
47.9%
Priority Health
43.3%
Health Plan of Michigan, Inc.
40.0%
Upper Peninsula Health Plan
38.5%
2007 Michigan Medicaid Average
38.1%
McLaren Health Plan
37.2%
Midwest Health Plan
37.1%
Molina Healthcare of Michigan
36.2%
Community Choice Michigan
36.1%
OmniCare Health Plan
34.6%
HealthPlus Partners, Inc.
33.1%
Great Lakes Health Plan
31.9%
Total Health Care, Inc.
30.9%
0%
20%
40%
60%
80%
100%
For this measure, 5 of the 13 health plans had rates above the 2007 Michigan Medicaid average of
38.1 percent. The rates reported by the 13 health plans ranged from 30.9 percent to 48.8 percent.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-39
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
Living With Illness Findings and Recommendations
The measures in the Living With Illness dimension showed relatively flat improvement compared to
2006 rates, except for Comprehensive Diabetes Care—Medical Attention for Diabetic Nephropathy,
which showed improvement from 2006. A decline of 10.3 percentage points was seen in the
Comprehensive Diabetes Care—LDL-C Screening measure. There were significant changes made to
the HEDIS 2007 Technical Specifications for both the Nephropathy and LDL-C Screening measures,
which may have contributed to the dramatic changes in those rates; therefore, caution should be
exercised when interpreting these results. Other Comprehensive Diabetes Care measures that reported
a decline in their weighted averages were Poor HbA1c Control and LDL-C Level <100. The
administrative rates for data collection improved for all measure except Poor HbA1c Control. While
the actual test data can be collected administratively for this measure, the health plans are still relying
on medical record review to capture the test result.
There were increases in all of the Use of Appropriate Medications for People With Asthma
indicators except the Ages 10 to 17 Years age band. This specific indicator saw a decline in its
weighted average by 1.2 percentage points. This was the first year of reporting for this measure
since the specifications changed in 2006.
The Controlling High Blood Pressure measure was split into three indicators for 2007 reporting.
Two of the indicators were considered new for this year (Controlling High Blood Pressure—Ages
18 to 45 Years and Controlling High Blood Pressure—Combined Rate); therefore, there were no
national standards for comparison. The 2007 Controlling High Blood Pressure—Ages 46 to 85
Years rate showed a statistically significant decline compared to the 2006 Controlling High Blood
Pressure measure. While there were changes to the HEDIS 2007 Technical Specifications for this
measure, the changes should not have contributed to the decline of 8.5 percentage points. The rate
for one health plan fell nearly 20 percentage points, which would cause a decline in the overall
weighted average. The MHPs should further investigate possible reasons for this decline. This
measure relies solely on medical record review for reporting purposes. The health plans should
ensure that all specification changes for this measure were implemented.
The MHPs’ performance on the Medical Assistance With Smoking Cessation measures do not have
national means and percentiles for benchmarking purposes; therefore, comparing rates between
health plans is not possible. The 2007 Michigan Medicaid average for the Advising Smokers to Quit
measure increased by 2.4 percentage points compared to the 2006 average. This was the first year
that Discussing Smoking Cessation Strategies was reported. Five MHPs reported rates higher than
the Michigan Medicaid average of 38.1 percent.
Several of the measures in the Living With Illness section rely on data that are typically received
from outside sources or vendors, such as pharmacy and lab. The MHPs should continue to work
with their vendors to enhance the completeness of these data. Improving administrative data rates
will minimize the burden of medical record review.
The MHPs should ensure that their providers are current on all changes to the technical
specifications for the reported measures. NCQA annually updates the specifications for measures;
therefore, providers should continually be aware of these updates and changes.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-40
MI2007_HEDIS_Aggr_F1_1207
LIVING WITH ILLNESS
The MHPs should consider implementing established quality improvement interventions to improve
diabetes rates. The following list contains examples of some interventions:
‹
‹
‹
‹
‹
‹
‹
‹
‹
Provide reminders for diabetes services to providers and members through newsletters,
postcards, birthday cards, phone calls, and management tools.
Educate providers on diabetes health guidelines and publish guidelines in multiple places such
as an MHP’s Web site.
Create a diabetes and/or case management registry to access information such as laboratory
screening and results data, most recent blood pressure results, etc.
Provide incentives to providers with diabetic members who receive required labs, exams, and
screenings.
Provide incentives to providers who meet performance thresholds on HEDIS measures.
Educate/alert physicians with patients who are not receiving recommended services.
Secure contracts with lab vendors for enhanced lab data.
Provide member incentives for obtaining necessary diabetic services.
Conduct a medical record review to identify members who are in need of services.
In the future, MDCH may want to consider using the cost-of-care HEDIS indicators that are
pertinent to diabetes. The Relative Resource Use for People With Diabetes measure provides more
information about the efficiency or value of services rendered by a health plan. This measure uses
standard costs to evaluate the cost of care for patients in the Comprehensive Diabetes Care
denominator. The relative resource measures focus on high-cost conditions, differentiate between
unit price and utilization variation, and rely on a transparent risk-adjustment methodology.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 5-41
MI2007_HEDIS_Aggr_F1_1207
6. Access to Care
Introduction
Access to care is an essential component in the effort to diagnose and treat health problems and to
increase the quality and duration of healthy life. Establishing a relationship with a primary care
practitioner is necessary to improve access to care for both adults and children. In order to increase
access to quality care, the public health system, health plans, and health care researchers focus on
identifying barriers to existing health services and eliminating disparities. Through this process,
health plans can increase preventive care and implement successful disease management programs.
The Center for Studying Health System Change (HSC) reported an increase in access to needed
medical care from 2001 to 2003 among Americans.6-1 Statistics related to access to care often vary
considerably by race. The CDC reports that during 2004, Whites had significantly more officebased visits to physicians than Blacks and Hispanics (333.6 versus 271.3 and 226.4 per 100 persons,
respectively).6-2
An article in the Journal of the American Medical Association (JAMA) noted that the type of
insurance coverage (or lack of insurance) had a significant impact on the ability to obtain timely
access to care. Individuals with Medicaid coverage were found to be less likely to receive an
appointment than those with private coverage (34.2 percent for Medicaid compared with 63.3
percent for private insurance).6-3
Although this is a vitally important issue, there are relatively few examples of effective
improvement strategies that target access-to-care issues. Few health plans identify access to care as
a specific quality improvement topic, and even a literature search yielded minimal sources of
information on improvement efforts.
The following pages provide detailed analysis of Michigan MHP performance and ranking. For all
measures in this dimension, HEDIS methodology requires that the rates be derived using only the
administrative method. Medical record review is not permitted; therefore, a data collection analysis
is not relevant.
6-1
Strunk BC, Cunningham PJ. Trends in Americans’ Access to Needed Medical Care, 2001–2003. Center for Studying Health System
Change: Tracking Report No. 10. August 2004. Available at: http://hschange.org/CONTENT/701/?topic=topic02. Accessed on: July 31,
2007.
6-2
Centers for Disease Control and Prevention. National Center for Health Statistics. NCHS Data on Health Insurance and Access to Care.
October 2006. Available at: http://www.cdc.gov/nchs/data/factsheets/healthinsurance.pdf. Accessed on: August 1, 2007.
6-3
Asplin BR, Rhodes KV, Levy H, et al. Insurance Status and Access to Urgent Ambulatory Care Follow-up Appointments. Journal of the
American Medical Association. 2005; 294:1248–1254.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 6-1
MI2007_HEDIS_Aggr_F1_1207
ACCESS TO CARE
The Access to Care dimension encompasses the following MDCH key measures:
‹
Children’s and Adolescents’ Access to Primary Care Practitioners
ƒ Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 12 to 24 Months
ƒ Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 25 Months
to 6 Years
ƒ Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 7 to 11 Years
ƒ Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 12 to 19 Years
‹
Adults’ Access to Preventive/Ambulatory Health Services
ƒ Adults’ Access to Preventive/Ambulatory Health Services—Ages 20 to 44 Years
ƒ Adults’ Access to Preventive/Ambulatory Health Services—Ages 45 to 64 Years
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
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Page 6-2
MI2007_HEDIS_Aggr_F1_1207
ACCESS TO CARE
Children’s and Adolescents’ Access to Primary Care Practitioners
The Children’s and Adolescents’ Access to Primary Care Practitioners measure looks at visits to
pediatricians, family physicians, and other primary care providers as a way to assess general access
to care for children. Rates for four age groups are provided: 12 to 24 months, 25 months to 6 years,
7 to 11 years, and 12 to 19 years.
HEDIS Specification: Children’s and Adolescents’ Access to Primary Care
Practitioners—Ages 12 to 24 Months
Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 12 to 24 Months
calculates the percentage of members 12 to 24 months of age who were continuously enrolled
during the measurement year and who had a visit with an MHP PCP during the measurement year.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 6-3
MI2007_HEDIS_Aggr_F1_1207
ACCESS TO CARE
Health Plan Ranking: Children’s and Adolescents’ Access to Primary Care Practitioners
—Ages 12 to 24 Months
Figure 6-1—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 12 to 24 Months
Children's Access 12-24 Months
He alth Plan
High Performance Level
N
Rate
98.2%
Upper Peninsula Health Plan
992
97.7%
3,428
97.6%
662
97.3%
Priority Health
2,159
96.9%
Health Plan of Michigan, Inc.
3,972
96.8%
HealthPlus Partners, Inc.
Great Lakes Health Plan
M-CAID
2,117
95.3%
PHP of Mid-Michigan
538
95.0%
McLaren Health Plan
1,860
94.9%
National 50th Percentile
94.8%
Molina Healthcare of Michigan
3,390
94.4%
Community Choice Michigan
1,129
93.2%
Midwest Health Plan
1,562
92.1%
Total Health Care, Inc.
1,354
91.8%
Low Performance Level
91.2%
OmniCare Health Plan
1,412
0%
20%
40%
60%
80%
90.2%
100%
2007 Michigan Medicaid Weighted Average = 95.2%
2006 Michigan Medicaid Weighted Average = 92.9%
2005 Michigan Medicaid Weighted Average = 92.2%
Eight of the 13 health plans reported rates above the national HEDIS 2006 Medicaid 50th percentile
of 94.8 percent. Furthermore, one of the health plans reported a rate below the LPL of 91.2 percent.
The 2007 Michigan Medicaid weighted average of 95.2 percent improved by 2.3 percentage points
compared to 2006. In addition, the rate exceeded the national HEDIS 2006 Medicaid 50th percentile
by 0.4 percentage points. The range of reported rates also showed improvement. In 2006, the
difference between the highest and lowest rates was 15.1 percentage points. In 2007, the range
narrowed by 7.5 percentage points, suggesting that the lower-performing health plans are improving
their rates.
Last year one of the health plans exceeded the HPL and four of the health plans performed below
the LPL. This year, however, none of the health plans exceeded the HPL of 98.2 percent and only
one fell below the LPL.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
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Page 6-4
MI2007_HEDIS_Aggr_F1_1207
ACCESS TO CARE
HEDIS Specification: Children’s and Adolescents’ Access to Primary Care Practitioners
—Ages 25 Months to 6 Years
Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 25 Months to 6 Years
reports the percentage of members 25 months to 6 years of age who were continuously enrolled
during the measurement year and who had a visit with an MHP PCP during the measurement year.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 6-5
MI2007_HEDIS_Aggr_F1_1207
ACCESS TO CARE
Health Plan Ranking: Children’s and Adolescents’ Access to Primary Care Practitioners
—Ages 25 Months to 6 Years
Figure 6-2—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 25 Months to 6 Years
Children's Access 25 Months-6 Years
He alth Plan
High Performance Level
N
Rate
91.5%
M-CAID
2,642
89.5%
Upper Peninsula Health Plan
3,760
88.1%
Health Plan of Michigan, Inc.
15,585
87.6%
Great Lakes Health Plan
14,837
86.5%
National 50th Percentile
85.4%
HealthPlus Partners, Inc.
9,630
84.2%
Priority Health
7,507
83.7%
Molina Healthcare of Michigan
18,131
82.0%
Midwest Health Plan
8,052
81.4%
PHP of Mid-Michigan
2,421
81.2%
Community Choice Michigan
6,394
80.0%
Low Performance Level
79.9%
McLaren Health Plan
7,571
78.1%
Total Health Care, Inc.
6,926
75.0%
OmniCare Health Plan
7,240
73.7%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 82.7%
2006 Michigan Medicaid Weighted Average = 81.4%
2005 Michigan Medicaid Weighted Average = 78.2%
None of the health plans exceeded the HPL of 91.5 percent, while three health plans reported rates
below the LPL of 79.9 percent. Four health plans did, however, exceed the national HEDIS 2006
Medicaid 50th percentile of 85.4 percent.
The 2007 Michigan Medicaid weighted average of 82.7 percent fell below the national HEDIS 2006
Medicaid 50th percentile by 2.7 percentage points. The Michigan Medicaid weighted average
increased by 1.3 percentage points from 2006 to 2007. A gain of 4.5 percentage points was
observed when the 2007 weighted average was compared with the 2005 weighted average.
In 2006, four health plans fell below the LPL. Three of those four plans were still below the LPL in
2007. Furthermore in 2006, five health plans exceeded the national 50th percentile; however, only
four of those five health plans exceeded the national 50th percentile in 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 6-6
MI2007_HEDIS_Aggr_F1_1207
ACCESS TO CARE
HEDIS Specification: Children’s and Adolescents’ Access to Primary Care Practitioners
—Ages 7 to 11 Years
Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 7 to 11 Years reports the
percentage of members 7 to 11 years of age who were continuously enrolled during the
measurement year and the year prior to the measurement year, and who had a visit with an MHP
PCP during the measurement year or the year prior to the measurement year.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 6-7
MI2007_HEDIS_Aggr_F1_1207
ACCESS TO CARE
Health Plan Ranking: Children’s and Adolescents’ Access to Primary Care Practitioners
—Ages 7 to 11 Years
Figure 6-3—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 7 to 11 Years
Children's Access 7-11 Years
He alth Plan
High Performance Level
N
Rate
92.0%
M-CAID
1,689
89.8%
Health Plan of Michigan, Inc.
8,295
87.7%
Priority Health
4,288
87.4%
Upper Peninsula Health Plan
2,679
87.2%
National 50th Percentile
84.9%
Great Lakes Health Plan
10,514
84.7%
HealthPlus Partners, Inc.
7,142
84.5%
PHP of Mid-Michigan
1,743
84.5%
Community Choice Michigan
5,031
81.6%
Midwest Health Plan
5,384
81.2%
13,996
80.5%
Molina Healthcare of Michigan
Low Performance Level
79.0%
Total Health Care, Inc.
5,350
78.3%
McLaren Health Plan
4,667
77.0%
OmniCare Health Plan
6,490
73.8%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 82.3%
2006 Michigan Medicaid Weighted Average = 80.0%
2005 Michigan Medicaid Weighted Average = 78.2%
None of the health plans met the HPL of 92.0 percent, while 4 of the 13 health plans had rates that
exceeded the national HEDIS 2006 Medicaid 50th percentile of 84.9 percent. Three health plans
performed below the LPL of 79.0 percent.
The 2007 Michigan Medicaid weighted average of 82.3 percent was below the national HEDIS
2006 Medicaid 50th percentile. The 2007 weighted average did, however, show improvement from
2006 to 2007 with an increase of 2.3 percentage points.
Three health plans fell below the LPL in 2007, while only two health plans had rates below the LPL
in 2006. The range of reported rates showed a slight improvement in 2007 compared to 2006.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 6-8
MI2007_HEDIS_Aggr_F1_1207
ACCESS TO CARE
HEDIS Specification: Children’s and Adolescents’ Access to Primary Care Practitioners
—Ages 12 to 19 Years
Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 12 to 19 Years reports the
percentage of members 12 to 19 years of age who were continuously enrolled during the
measurement year and the year prior to the measurement year, and who had a visit with an MHP
PCP during the measurement year or the year prior to the measurement year.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 6-9
MI2007_HEDIS_Aggr_F1_1207
ACCESS TO CARE
Health Plan Ranking: Children’s and Adolescents’ Access to Primary Care Practitioners
—Ages 12 to 19 Years
Figure 6-4—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Children’s and Adolescents’ Access to Primary Care Practitioners—Ages 12 to 19 Years
Adolescents' Access 12-19 Years
He alth Plan
High Performance Level
N
Rate
90.2%
Upper Peninsula Health Plan
3,558
90.0%
Health Plan of Michigan, Inc.
10,115
87.9%
M-CAID
2,054
87.8%
Priority Health
4,506
85.5%
14,630
84.7%
Great Lakes Health Plan
National 50th Percentile
83.4%
HealthPlus Partners, Inc.
8,841
82.2%
PHP of Mid-Michigan
2,300
81.8%
Community Choice Michigan
6,639
78.4%
21,409
78.0%
Total Health Care, Inc.
8,333
77.4%
Midwest Health Plan
7,432
76.8%
McLaren Health Plan
5,989
76.5%
Molina Healthcare of Michigan
Low Performance Level
76.2%
OmniCare Health Plan
10,236
0%
20%
40%
60%
80%
70.8%
100%
2007 Michigan Medicaid Weighted Average = 80.3%
2006 Michigan Medicaid Weighted Average = 78.3%
2005 Michigan Medicaid Weighted Average = 77.1%
None of the health plans reached the HPL rate of 90.2 percent, while five health plans exceeded the
national HEDIS 2006 Medicaid 50th percentile of 83.4 percent. One of the health plans performed
below the LPL of 76.2 percent.
The 2007 Michigan Medicaid weighted average of 80.3 percent was 3.1 percentage points below
the national HEDIS 2006 Medicaid 50th percentile and 2.0 percentage points above the 2006
weighted average. Almost no difference was observed for the range of reported rates between 2006
and 2007.
Four health plans exceeded the national HEDIS Medicaid 50th percentile in 2006, and in 2007, all
four continued to exceed the 50th percentile. In 2006, two health plans fell below the LPL. One of
the health plans continued to be below the LPL in 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 6-10
MI2007_HEDIS_Aggr_F1_1207
ACCESS TO CARE
Adults’ Access to Preventive/Ambulatory Health Services
The majority of adults have relatively frequent contact with their health care providers. In 2004,
approximately 910 million visits were made to physician offices in the United States.6-4 Of these,
about 16 percent were for preventive care. Females had a visit rate of 67.6 visits per 100 people for
preventive care, which was significantly higher than the rate for males (33.6 visits per 100 people).
HEDIS Specification: Adults’ Access to Preventive/Ambulatory Health Services
—Ages 20 to 44 Years
The Adults’ Access to Preventive/Ambulatory Health Services—Ages 20 to 44 Years measure
calculates the percentage of adults 20 to 44 years of age who were continuously enrolled during the
measurement year and who had an ambulatory or preventive care visit during the measurement
year.
6-4
Hing E, Cherry D, and Woodwell, D. National Ambulatory Medical Care Survey: 2004 Summary. Advance Data. Centers for Disease
Control and Prevention. June 23, 2006. Number 374. Available at: http://www.cdc.gov/nchs/data/ad/ad374.pdf. Accessed on: August 2,
2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 6-11
MI2007_HEDIS_Aggr_F1_1207
ACCESS TO CARE
Health Plan Ranking: Adults’ Access to Preventive/Ambulatory Health Services
—Ages 20 to 44 Years
Figure 6-5—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Adults’ Access to Preventive/Ambulatory Health Services—Ages 20 to 44 Years
Adults' Access 20-44 Years
He alth Plan
Upper Peninsula Health Plan
N
3,093
High Performance Level
Rate
89.5%
87.0%
Priority Health
5,153
86.5%
11,716
85.1%
HealthPlus Partners, Inc.
8,583
84.0%
M-CAID
1,795
83.9%
McLaren Health Plan
7,135
81.0%
13,661
80.6%
2,158
80.5%
Health Plan of Michigan, Inc.
Great Lakes Health Plan
PHP of Mid-Michigan
National 50th Percentile
79.0%
Community Choice Michigan
5,967
78.5%
Midwest Health Plan
6,842
78.2%
18,321
77.2%
Total Health Care, Inc.
6,979
74.9%
OmniCare Health Plan
8,776
74.5%
Molina Healthcare of Michigan
Low Performance Level
72.7%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 80.2%
2006 Michigan Medicaid Weighted Average = 78.1%
2005 Michigan Medicaid Weighted Average = 76.7%
One health plan exceeded the HPL of 87.0 percent, while none of the health plans fell below the
LPL of 72.7 percent. Eight of the 13 health plans reported rates above the national HEDIS 2006
Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 80.2 percent was 1.2 percentage points above the
national HEDIS 2006 Medicaid 50th percentile of 79.0 percent. In addition, the Michigan Medicaid
weighted average increased by 2.1 percentage points from 2006 to 2007.
Similar to this year’s results, in 2006, none of the health plans had a rate below the LPL. However,
in 2006, two health plans exceeded the HPL. Only one of the two health plans outperformed the
HPL in 2007.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 6-12
MI2007_HEDIS_Aggr_F1_1207
ACCESS TO CARE
HEDIS Specification: Adults’ Access to Preventive/Ambulatory Health Services
—Ages 45 to 64 Years
The Adults’ Access to Preventive/Ambulatory Health Services—Ages 45 to 64 Years measure
calculates the percentage of adults 45 to 64 years of age who were continuously enrolled during the
measurement year and who had an ambulatory or preventive care visit during the measurement
year.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 6-13
MI2007_HEDIS_Aggr_F1_1207
ACCESS TO CARE
Health Plan Ranking: Adults’ Access to Preventive/Ambulatory Health Services
—Ages 45 to 64 Years
Figure 6-6—Michigan Medicaid HEDIS 2007
Health Plan Ranking:
Adults’ Access to Preventive/Ambulatory Health Services—Ages 45 to 64 Years
Adults' Access 45-64 Years
He alth Plan
Priority Health
1,749
N
93.1%
Upper Peninsula Health Plan
1,513
91.2%
Health Plan of Michigan, Inc.
4,836
90.6%
HealthPlus Partners, Inc.
3,426
90.0%
High Performance Level
Rate
89.4%
M-CAID
787
88.6%
Great Lakes Health Plan
8,317
88.1%
McLaren Health Plan
2,867
87.0%
PHP of Mid-Michigan
1,007
86.1%
Community Choice Michigan
3,135
85.8%
Midwest Health Plan
4,198
85.5%
National 50th Percentile
84.5%
Molina Healthcare of Michigan
9,517
83.8%
OmniCare Health Plan
4,465
81.7%
Total Health Care, Inc.
3,713
80.4%
Low Performance Level
79.0%
0%
20%
40%
60%
80%
100%
2007 Michigan Medicaid Weighted Average = 86.3%
2006 Michigan Medicaid Weighted Average = 84.7%
2005 Michigan Medicaid Weighted Average = 83.4%
Four health plans exceeded the HPL of 89.4 percent, and none of the health plans had a rate below
the LPL of 79.0 percent. In addition, a majority of the health plans (10 out of 13) exceeded the
national HEDIS 2006 Medicaid 50th percentile.
The 2007 Michigan Medicaid weighted average of 86.3 percent was 1.8 percentage points above the
national HEDIS 2006 Medicaid 50th percentile of 84.5 percent. In addition, the 2007 weighted
average improved by 1.6 percentage points when compared to the 2006 weighted average. The
range of reported rates showed a slight improvement in 2007 compared to 2006.
In 2006, five health plans exceeded the HPL; however, only four of those health plans continued to
have performance above the HPL in 2007. Three health plans had rates below the national HEDIS
2006 Medicaid 50th percentile in 2007, while five health plans fell below the 50th percentile in
2006.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 6-14
MI2007_HEDIS_Aggr_F1_1207
ACCESS TO CARE
Access to Care Findings and Recommendations
Although increases from 2006 to 2007 were observed for all of the Access to Care measures’
weighted averages, none of the measures showed statistically significant improvement. It appeared
that the greatest challenge for the health plans was the younger population. While both of the
Adults’ Access to Preventive/Ambulatory Health Services measures’ weighted averages were above
the national HEDIS 2006 Medicaid 50th percentile, only one out of the four weighted averages for
the Children’s and Adolescent’s Access to Primary Care Physicians indicators (Children’s Access
12–24 Months) exceeded the 50th percentile. In addition, most of the ranges of rates only
moderately improved across the measures. Furthermore, many of the health plans that were low
performers in 2006 remained low-performing health plans in 2007, suggesting that these health
plans need to focus more improvement efforts on access to care.
The MHPs should investigate whether or not their rates for access to care reflect that members are
not accessing their PCPs or that the MHPs are not receiving all of the encounter data from providers
for members who receive captitated services. This will help the MHPs focus on areas for
improvement specific to the where problems exist.
The health plans should work together to brainstorm and share other opportunities for improvement
for these measures. Sharing best practices between MHPs would help lower-performing health plans
implement interventions that are showing success in the higher-performing plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 6-15
MI2007_HEDIS_Aggr_F1_1207
7. HEDIS Reporting Capabilities
Key Findings
No major issues with HEDIS reporting were identified after a review of each health plan’s Final
Audit Report and Interactive Data Submission Systems results. Similar to previous years’ findings,
HSAG determined that the MHPs had no major issues that impacted HEDIS reporting and all of the
health plans achieved Report status for all measures presented in this report.
Twelve of the 13 MHPs used an NCQA-certified software vendor to produce rates for the key
measures they reported. All of the software vendors used by the MHPs achieved full certification
for the HEDIS measures. One MHP produced its own measures with internally developed source
code and programming logic.
The HEDIS audits were performed by three NCQA-licensed audit organizations (LOs). Ten MHPs
used the same LO as last year. Nine of the 13 audits were performed by one LO, another LO
performed three of the audits, and a third organization performed one audit. Since a majority of the
audits were performed by one LO, the reports were very consistent. The audit reports provided
sufficient detail to allow HSAG to evaluate the MHPs’ information systems (IS) capabilities.
IS Standards 3.0, 5.0, and 6.0 were determined to be fully compliant for all 13 MHPs. The auditors
did not find any issues with membership data processing, the integration of data for HEDIS
reporting, or the control procedures to ensure HEDIS data integrity.
Ten of the MHPs were fully compliant with IS Standard 1.0 and three MHPs were considered
substantially compliant with IS Standard 1.0. The issues that were noted for these three MHPs were
minor and did not result in a bias to any of the HEDIS rates. In addition, some auditors suggested
that the MHPs modify their systems to accommodate Current Procedural Terminology (CPT)
Category II codes.
Twelve of the 13 MHPs were fully compliant with IS Standard 2.0, and one was considered
substantially compliant with this standard, specifically IS 2.5. There were issues with this MHP
receiving encounter data from one of its contracted providers. The MHP continues to move toward
more fee-for-service contracts, and it was also noted that the MHP initiated a provider pay-forperformance program in 2005.
One MHP was not fully compliant with IS Standard 4.2. Issues were identified with procedures for
updating board certification status.
A similar recommendation made across all of the MHPs was to continue to work to get lab results
and match them to lab claims and encounter data. This will further enhance the completeness of
measures that rely on lab data for reporting.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 7-1
MI2007_HEDIS_Aggr_F1_1207
HEDIS REPORTING CAPABILITIES
Conclusions and Recommendations
The Michigan MHPs’ IS capabilities pertaining to accurate and valid HEDIS reporting have
continued to improve over the past seven years. The MHPs should continue to explore ways to
improve their rates. One way is to assess whether or not providers are submitting claims or
encounter data for services rendered to their patients. This is particularly important for capitated
providers. Although this was an area where all of the MHPs focused, there is room for
improvement. The MHPs should also investigate other possible missing capitated service data or
service data for which there is a low fee-for-service reimbursement. Along these lines, the MHPs
should work with their contracted labs to obtain lab values, thereby decreasing the need for medical
record review for measures that require a lab value. The MHPs should ensure that their data systems
are able to capture the CPT Category II codes that were recently added to several of the HEDIS
measures and should work to educate their providers on the use of them.
Several best-practice were noted in the MHPs’ final audit reports by their HEDIS compliance auditor.
It would be beneficial for the MHPs that were identified as having best practices to share these
activities with the other MHPs. Some of the best practices identified were:
‹
One MHP was noted for two best practices by its HEDIS compliance auditor. The MHP’s data
completeness program was noted as a best practice since it linked data submission with quality
improvement activities and physician bonus payments. The MHP had a very active and
productive pay-for-performance program that rewarded submission of claims and encounter
data.7-11 The MHP also received a best practice for its provider data system since the provider
credentialing module electronically linked to all tables within the system, eliminating the need
for dual data entry.7-22
‹
One MHP received a best-practice commendation from its HEDIS compliance auditor related to
its claims preprocessing edits, which were designed to maximize auto-adjudication of the claims
in order to reduce processing time.7-33
‹
Another MHP received a best-practice commendation for setting up an internal audit office that
randomly samples and reviews all claims and encounters it processes. The office provided
results of the analysis to managers for any necessary corrective actions. The audit team noted
that this process allowed for early identification of coding and submission problems.7-44
Although not all the MHPs received best-practice commendations in a particular area, there were
many positive notations and feedback provided to the MHPs. Several MHPs were starting or
already participating in pay-for-performance programs, and some MHPs are developing various
administrative databases that could be used to supplement claims and encounter data. NCQA has
outlined updated processes and standards for building, maintaining, and validating both internal and
external administrative databases and the MHPs should be directed to the latest version of NCQA’s
technical specifications.
7-1
Health Plan of Michigan, Inc. NCQA HEDIS Compliance Audit, Final Audit Report. July 2007, p. 7
Health Plan of Michigan, Inc. NCQA HEDIS Compliance Audit, Final Audit Report. July 2007, p. 9
7-3
OmniCare Health Plan, Inc., NCQA HEDIS Compliance Audit, Final Audit Report. July 2007, p. 9
7-4
Total Health Care, Inc. NCQA HEDIS Compliance Audit, Final Audit Report. July 2007, p.5
7-2
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page 7-2
MI2007_HEDIS_Aggr_F1_1207
Appendix A.
Tabular Results for Key Measures by Health Plan
Appendix A presents tables showing results for the key measures by health plan. Where applicable,
the results provided for each measure include the eligible population and rate for each MHP; the
2005, 2006, and 2007 Michigan Medicaid weighted averages; and the national HEDIS 2006
Medicaid 50th percentile. The following is a list of the tables and the key measures presented for
each health plan.
‹
Table A-1—Immunization Status
‹
Table A-2—Well-Child Visits in the First 15 Months of Life
‹
Table A-3—Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life and Adolescent
Well-Care Visits
‹
Table A-4—Appropriate Treatment for Children With Upper Respiratory Infection
‹
Table A-5—Appropriate Testing for Children With Pharyngitis
‹
Table A-6—Cancer Screening in Women
‹
Table A-7—Chlamydia Screening in Women
‹
Table A-8—Prenatal and Postpartum Care
‹
Table A-9—Comprehensive Diabetes Care
‹
Table A-10—Use of Appropriate Medications for People With Asthma
‹
Table A-11—Controlling High Blood Pressure
‹
Table A-12—Children’s and Adolescents’ Access to Primary Care Practitioners
‹
Table A-13—Adults’ Access to Preventive/Ambulatory Health Services
‹
Table A-14—Medical Assistance With Smoking Cessation—Numerator 1 and Numerator 3
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page A-1
MI2007_HEDIS_Aggr_F1_1207
APPENDIX A. TABULAR RESULTS FOR KEY MEASURES BY HEALTH PLAN
Table A-1—Tabular Results for Key Measures by Health Plan:
Immunization Status
Childhood Immunization Status
IDSS
Plan Name
Code
Adolescent
Immunization Status
Eligible
Combo 2 Combo 3 Eligible
Combo 2
Population
Rate
Rate
Population
Rate
4265
Community Choice Michigan
CCM
1,032
74.9%
62.5%
1,292
67.1%
4133
Great Lakes Health Plan
GLH
3,116
77.6%
63.3%
2,794
66.7%
4291
Health Plan of Michigan, Inc.
HPM
3,442
83.8%
71.5%
2,122
70.6%
4056
HealthPlus Partners, Inc.
HPP
1,992
85.2%
71.5%
1,665
79.0%
4243
M-CAID
MCD
485
81.0%
56.7%
425
68.5%
4312
McLaren Health Plan
MCL
1,602
80.0%
66.7%
1,279
64.2%
4131
Midwest Health Plan
MID
1,602
81.5%
57.9%
1,470
64.0%
4151
Molina Healthcare of Michigan
MOL
3,024
72.4%
35.5%
4,042
54.6%
4055
OmniCare Health Plan
OCH
1,343
79.9%
51.9%
1,904
59.7%
4282
Physicians Health Plan of Mid-Michigan Family Care
PMD
550
82.0%
73.5%
451
75.4%
4054
Priority Health Government Programs, Inc.
PRI
1,828
88.7%
81.2%
957
78.4%
4268
Total Health Care, Inc.
THC
1,359
77.8%
62.0%
1,385
71.2%
4348
Upper Peninsula Health Plan
UPP
797
80.7%
66.6%
686
70.1%
2007 Michigan Medicaid Weighted Average
--
80.2%
62.3%
--
65.9%
2006 Michigan Medicaid Weighted Average
--
76.6%
38.5%
--
58.9%
2005 Michigan Medicaid Weighted Average
--
71.7%
--
--
53.0%
National HEDIS 2006 Medicaid 50th Percentile
--
72.4%
42.3%
--
44.3%
Notes: The 2005 and 2006 Michigan Medicaid weighted averages included 15 health plans, and the 2007 Medicaid weighted average included 13
health plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page A-2
MI2007_HEDIS_Aggr_F1_1207
APPENDIX A. TABULAR RESULTS FOR KEY MEASURES BY HEALTH PLAN
Table A-2—Tabular Results for Key Measures by Health Plan:
Well-Child Visits in the First 15 Months of Life
IDSS
Plan Name
Code
Eligible
Population
0 Visits
6 or More Visits
Rate
Rate
4265
Community Choice Michigan
CCM
665
3.4%
37.5%
4133
Great Lakes Health Plan
GLH
1,876
0.3%
91.1%
4291
Health Plan of Michigan, Inc.
HPM
1,665
0.9%
69.9%
4056
HealthPlus Partners, Inc.
HPP
1,302
2.3%
61.8%
4243
M-CAID
MCD
191
0.5%
64.4%
4312
McLaren Health Plan
MCL
1,023
1.2%
62.8%
4131
Midwest Health Plan
MID
874
3.6%
56.7%
4151
Molina Healthcare of Michigan
MOL
1,708
1.9%
42.5%
4055
OmniCare Health Plan
OCH
907
0.9%
50.9%
4282
Physicians Health Plan of Mid-Michigan Family Care
PMD
354
1.4%
49.2%
4054
Priority Health Government Programs, Inc.
PRI
1,296
1.2%
53.5%
4268
Total Health Care, Inc.
THC
812
1.2%
49.1%
4348
Upper Peninsula Health Plan
UPP
801
1.4%
44.6%
2007 Michigan Medicaid Weighted Average
--
1.5%
59.3%
2006 Michigan Medicaid Weighted Average
--
2.1%
51.9%
2005 Michigan Medicaid Weighted Average
--
3.4%
43.0%
National HEDIS 2006 Medicaid 50th Percentile
--
2.0%
50.0%
Note: The 2005 and 2006 Michigan Medicaid weighted averages included 15 health plans, and the 2007 Medicaid weighted average included 13
health plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page A-3
MI2007_HEDIS_Aggr_F1_1207
APPENDIX A. TABULAR RESULTS FOR KEY MEASURES BY HEALTH PLAN
Table A-3—Tabular Results for Key Measures by Health Plan:
Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life, and Adolescent Well-Care Visits
3rd–6th Years of Life
IDSS
Plan Name
Code
Eligible
Population
Adolescent
Rate
Eligible
Population
Rate
4265
Community Choice Michigan
CCM
5,372
56.9%
9,265
31.1%
4133
Great Lakes Health Plan
GLH
11,956
69.8%
20,330
58.8%
4291
Health Plan of Michigan, Inc.
HPM
12,281
65.3%
16,515
55.1%
4056
HealthPlus Partners, Inc.
HPP
7,767
64.8%
11,614
48.4%
4243
M-CAID
MCD
2,129
67.4%
2,776
51.4%
4312
McLaren Health Plan
MCL
6,046
69.8%
9,119
52.1%
4131
Midwest Health Plan
MID
6,558
74.9%
10,251
50.1%
4151
Molina Healthcare of Michigan
MOL
17,282
62.2%
29,023
39.6%
4055
OmniCare Health Plan
OCH
6,004
72.2%
13,336
50.2%
4282
Physicians Health Plan of Mid-Michigan Family Care
PMD
2,288
67.6%
3,445
47.7%
4054
Priority Health Government Programs, Inc.
PRI
5,824
63.7%
7,055
43.3%
4268
Total Health Care, Inc.
THC
5,691
65.4%
10,884
47.9%
4348
Upper Peninsula Health Plan
UPP
3,026
60.9%
4,714
39.1%
2007 Michigan Medicaid Weighted Average
--
66.1%
--
47.7%
2006 Michigan Medicaid Weighted Average
--
64.2%
--
43.5%
2005 Michigan Medicaid Weighted Average
--
58.5%
--
38.0%
National HEDIS 2006 Medicaid 50th Percentile
--
64.8%
--
39.4%
Note: The 2005 and 2006 Michigan Medicaid weighted averages included 15 health plans, and the 2007 Medicaid weighted average included 13
health plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page A-4
MI2007_HEDIS_Aggr_F1_1207
APPENDIX A. TABULAR RESULTS FOR KEY MEASURES BY HEALTH PLAN
Table A-4—Tabular Results for Key Measures by Health Plan:
Appropriate Treatment for Children With Upper Respiratory Infection
IDSS
Plan Name
Code
Eligible
Population
Rate
4265
Community Choice Michigan
CCM
2,419
79.4%
4133
Great Lakes Health Plan
GLH
6,731
74.6%
4291
Health Plan of Michigan, Inc.
HPM
6,609
78.4%
4056
HealthPlus Partners, Inc.
HPP
4,247
72.1%
4243
M-CAID
MCD
1,206
90.5%
4312
McLaren Health Plan
MCL
3,938
67.2%
4131
Midwest Health Plan
MID
4,938
75.2%
4151
Molina Healthcare of Michigan
MOL
7,520
79.4%
4055
OmniCare Health Plan
OCH
2,099
79.7%
4282
Physicians Health Plan of Mid-Michigan Family Care
PMD
1,451
76.6%
4054
Priority Health Government Programs, Inc.
PRI
2,775
87.7%
4268
Total Health Care, Inc.
THC
1,357
76.3%
4348
Upper Peninsula Health Plan
UPP
1,718
81.1%
2007 Michigan Medicaid Weighted Average
--
77.1%
2006 Michigan Medicaid Weighted Average
--
75.6%
2005 Michigan Medicaid Weighted Average
--
75.0%
National HEDIS 2006 Medicaid 50th Percentile
--
82.7%
Note: The 2005 and 2006 Michigan Medicaid weighted averages included 15 health plans, and the 2007 Medicaid weighted average included 13
health plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page A-5
MI2007_HEDIS_Aggr_F1_1207
APPENDIX A. TABULAR RESULTS FOR KEY MEASURES BY HEALTH PLAN
Table A-5—Tabular Results for Key Measures by Health Plan:
Appropriate Testing for Children With Pharyngitis
IDSS
Plan Name
Code
Eligible
Population
Rate
4265
Community Choice Michigan
CCM
1,834
54.5%
4133
Great Lakes Health Plan
GLH
4,247
41.5%
4291
Health Plan of Michigan, Inc.
HPM
4,276
53.2%
4056
HealthPlus Partners, Inc.
HPP
2,975
40.9%
4243
M-CAID
MCD
771
80.8%
4312
McLaren Health Plan
MCL
2,452
48.7%
4131
Midwest Health Plan
MID
3,287
18.7%
4151
Molina Healthcare of Michigan
MOL
4,237
43.6%
4055
OmniCare Health Plan
OCH
1,085
32.3%
4282
Physicians Health Plan of Mid-Michigan Family Care
PMD
747
59.2%
4054
Priority Health Government Programs, Inc.
PRI
1,387
68.9%
4268
Total Health Care, Inc.
THC
1,510
37.5%
4348
Upper Peninsula Health Plan
UPP
1,083
54.8%
2007 Michigan Medicaid Weighted Average
--
45.0%
2006 Michigan Medicaid Weighted Average
--
39.1%
2005 Michigan Medicaid Weighted Average
--
42.1%
National HEDIS 2006 Medicaid 50th Percentile
--
56.2%
Note: The 2005 and 2006 Michigan Medicaid weighted averages included 15 health plans, and the 2007 Medicaid weighted average included 13
health plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page A-6
MI2007_HEDIS_Aggr_F1_1207
APPENDIX A. TABULAR RESULTS FOR KEY MEASURES BY HEALTH PLAN
Table A-6—Tabular Results for Key Measures by Health Plan:
Cancer Screening in Women
Breast Cancer Screening
Ages 42–51 Years Ages 52–69 Years
IDSS
Plan Name
Eligible
Code Population
Rate
Cervical Cancer
Screening
Combined
Eligible
Population
Rate
Eligible
Population
Rate
Eligible
Population
Rate
4265
Community Choice Michigan
CCM
1,030
39.2%
829
53.6%
1,859
45.6%
5,608
65.6%
4133
Great Lakes Health Plan
GLH
2,475
43.8%
2,523
56.6%
4,998
50.3%
13,937
64.6%
4291
Health Plan of Michigan, Inc.
HPM
1,472
53.9%
1,232
64.4%
2,704
58.7%
10,300
71.0%
4056
HealthPlus Partners, Inc.
HPP
1,322
54.3%
1,082
62.5%
2,404
58.0%
7,913
77.1%
4243
M-CAID
MCD
300
42.0%
215
47.4%
515
44.3%
1,713
78.0%
4312
McLaren Health Plan
MCL
933
45.3%
784
56.9%
1,717
50.6%
6,281
70.1%
4131
Midwest Health Plan
MID
1,268
51.9%
1,232
57.5%
2,500
54.6%
6,928
64.2%
4151
Molina Healthcare of Michigan
MOL
3,268
44.5%
2,757
54.2%
6,025
48.9%
17,374
58.0%
4055
OmniCare Health Plan
OCH
1,467
40.1%
1,379
52.6%
2,846
46.1%
8,698
66.7%
4282
Physicians Health Plan of Mid-Michigan Family Care
PMD
373
46.4%
313
52.4%
686
49.1%
2,018
68.6%
4054
Priority Health Government Programs, Inc.
PRI
623
53.0%
484
57.0%
1,107
54.7%
4,586
76.0%
4268
Total Health Care, Inc.
THC
1,227
43.0%
1,120
52.8%
2,347
47.6%
6,852
66.2%
4348
Upper Peninsula Health Plan
UPP
512
53.5%
444
67.6%
956
60.0%
2,727
76.8%
2007 Michigan Medicaid Weighted Average
--
46.4%
--
56.6%
--
51.2%
--
67.1%
2006 Michigan Medicaid Weighted Average
--
--
--
55.8%
--
--
--
65.8%
2005 Michigan Medicaid Weighted Average
--
--
--
53.7%
--
--
--
63.4%
National HEDIS 2006 Medicaid 50th Percentile
--
--
--
53.9%
--
--
--
66.1%
Note: The 2005 and 2006 Michigan Medicaid weighted averages included 15 health plans, and the 2007 Medicaid weighted averages included 13 health plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page A-7
MI2007_HEDIS_Aggr_F1_1207
APPENDIX A. TABULAR RESULTS FOR KEY MEASURES BY HEALTH PLAN
Table A-7—Tabular Results for Key Measures by Health Plan:
Chlamydia Screening in Women
Ages 16 to 20 Years
IDSS
Plan Name
Code
Eligible
Population
Rate
Ages 21 to 25 Years
Combined Rate
Eligible
Population
Rate
Eligible
Population
Rate
4265
Community Choice Michigan
CCM
1,077
46.8%
715
56.5%
1,792
50.7%
4133
Great Lakes Health Plan
GLH
2,287
49.8%
1,556
57.5%
3,843
52.9%
4291
Health Plan of Michigan, Inc.
HPM
2,072
50.3%
1,717
60.2%
3,789
54.8%
4056
HealthPlus Partners, Inc.
HPP
1,443
52.7%
1,222
61.2%
2,665
56.6%
4243
M-CAID
MCD
318
51.6%
236
61.4%
554
55.8%
4312
McLaren Health Plan
MCL
1,112
48.9%
925
58.8%
2,037
53.4%
4131
Midwest Health Plan
MID
913
52.8%
633
60.3%
1,546
55.9%
4151
Molina Healthcare of Michigan
MOL
3,458
52.1%
2,131
58.4%
5,589
54.5%
4055
OmniCare Health Plan
OCH
1,689
64.4%
1,161
72.4%
2,850
67.7%
4282
Physicians Health Plan of Mid-Michigan Family Care
PMD
314
67.2%
283
65.7%
597
66.5%
4054
Priority Health Government Programs, Inc.
PRI
864
55.6%
916
62.4%
1,780
59.1%
4268
Total Health Care, Inc.
THC
1,285
61.8%
866
68.7%
2,151
64.6%
4348
Upper Peninsula Health Plan
UPP
610
48.4%
403
49.4%
1,013
48.8%
2007 Michigan Medicaid Weighted Average
--
53.3%
--
61.0%
--
56.6%
2006 Michigan Medicaid Weighted Average
--
51.9%
--
57.6%
--
54.5%
2005 Michigan Medicaid Weighted Average
--
47.6%
--
53.1%
--
50.3%
National HEDIS 2006 Medicaid 50th Percentile
--
49.1%
--
53.3%
--
51.2%
Note: The 2005 and 2006 Michigan Medicaid weighted averages included 15 health plans, and the 2007 Medicaid weighted average included 13 health plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page A-8
MI2007_HEDIS_Aggr_F1_1207
APPENDIX A. TABULAR RESULTS FOR KEY MEASURES BY HEALTH PLAN
Table A-8—Tabular Results for Key Measures by Health Plan:
Prenatal and Postpartum Care
IDSS
Plan Name
Code
Eligible
Population
Timeliness of Prenatal Care
Postpartum Care
Rate
Rate
4265
Community Choice Michigan
CCM
860
81.3%
62.8%
4133
Great Lakes Health Plan
GLH
2,207
78.3%
58.6%
4291
Health Plan of Michigan, Inc.
HPM
2,275
90.0%
67.0%
4056
HealthPlus Partners, Inc.
HPP
1,430
91.8%
66.1%
4243
M-CAID
MCD
292
85.4%
66.0%
4312
McLaren Health Plan
MCL
1,200
93.4%
85.6%
4131
Midwest Health Plan
MID
997
76.4%
50.9%
4151
Molina Healthcare of Michigan
MOL
1,970
67.4%
49.7%
4055
OmniCare Health Plan
OCH
1,247
84.1%
50.7%
4282
Physicians Health Plan of Mid-Michigan Family Care
PMD
382
85.6%
62.6%
4054
Priority Health Government Programs, Inc.
PRI
1,269
86.8%
66.3%
4268
Total Health Care, Inc.
THC
1,005
84.2%
57.9%
4348
Upper Peninsula Health Plan
UPP
309
88.7%
68.8%
2007 Michigan Medicaid Weighted Average
--
83.2%
61.6%
2006 Michigan Medicaid Weighted Average
--
81.7%
57.7%
2005 Michigan Medicaid Weighted Average
--
77.5%
53.7%
National HEDIS 2006 Medicaid 50th Percentile
--
83.3%
58.8%
Note: The 2005 and 2006 Michigan Medicaid weighted averages included 15 health plans, and the 2007 Medicaid weighted average included 13 health plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page A-9
MI2007_HEDIS_Aggr_F1_1207
APPENDIX A. TABULAR RESULTS FOR KEY MEASURES BY HEALTH PLAN
Table A-9—Tabular Results for Key Measures by Health Plan:
Comprehensive Diabetes Care
IDSS
Plan Name
Code
Eligible
Population
HbA1c
Testing
Poor HbA1c
Control
Rate
Rate
Eye Exam
Rate
4265
Community Choice Michigan
CCM
1,263
83.7%
43.1%
43.8%
4133
Great Lakes Health Plan
GLH
3,264
77.1%
50.6%
53.3%
4291
Health Plan of Michigan, Inc.
HPM
2,035
86.4%
33.0%
67.0%
4056
HealthPlus Partners, Inc.
HPP
1,400
86.6%
32.8%
74.0%
4243
M-CAID
MCD
279
89.1%
34.0%
62.5%
4312
McLaren Health Plan
MCL
1,119
84.4%
41.8%
67.4%
4131
Midwest Health Plan
MID
1,503
70.1%
48.2%
53.5%
4151
Molina Healthcare of Michigan
MOL
3,496
74.1%
50.1%
50.6%
4055
OmniCare Health Plan
OCH
1,505
78.8%
49.9%
47.8%
4282
Physicians Health Plan of Mid-Michigan Family Care
PMD
384
83.0%
38.0%
67.8%
4054
Priority Health Government Programs, Inc.
PRI
805
89.3%
27.3%
70.6%
4268
Total Health Care, Inc.
THC
1,308
76.7%
47.0%
57.3%
4348
Upper Peninsula Health Plan
UPP
508
89.7%
27.8%
70.6%
2007 Michigan Medicaid Weighted Average
--
79.8%
43.7%
57.5%
2006 Michigan Medicaid Weighted Average
--
79.6%
42.3%
54.2%
2005 Michigan Medicaid Weighted Average
--
79.5%
44.6%
47.3%
National HEDIS 2006 Medicaid 50th Percentile
--
77.4%
45.2%
50.8%
Notes: The 2005 and 2006 Michigan Medicaid weighted averages included 15 health plans, and the 2007 Medicaid weighted average included 13
health plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page A-10
MI2007_HEDIS_Aggr_F1_1207
APPENDIX A. TABULAR RESULTS FOR KEY MEASURES BY HEALTH PLAN
Table A-9—Tabular Results for Key Measures by Health Plan:
Comprehensive Diabetes Care (continued)
IDSS
Plan Name
Code
Eligible
Population
LDL-C
Screening
Rate
LDL-C Level <100
Rate
Medical Attention
for Nephropathy
Rate
4265
Community Choice Michigan
CCM
1,263
66.9%
29.2%
76.6%
4133
Great Lakes Health Plan
GLH
3,264
76.9%
30.9%
77.9%
4291
Health Plan of Michigan, Inc.
HPM
2,035
82.5%
35.2%
78.0%
4056
HealthPlus Partners, Inc.
HPP
1,400
75.4%
36.5%
85.4%
4243
M-CAID
MCD
279
80.9%
45.7%
84.8%
4312
McLaren Health Plan
MCL
1,119
71.5%
33.1%
91.2%
4131
Midwest Health Plan
MID
1,503
70.1%
29.7%
77.9%
4151
Molina Healthcare of Michigan
MOL
3,496
73.4%
51.3%
76.9%
4055
OmniCare Health Plan
OCH
1,505
74.8%
34.9%
83.4%
4282
Physicians Health Plan of Mid-Michigan Family Care
PMD
384
77.1%
46.0%
78.2%
4054
Priority Health Government Programs, Inc.
PRI
805
81.0%
39.4%
82.5%
4268
Total Health Care, Inc.
THC
1,308
72.8%
28.2%
77.6%
4348
Upper Peninsula Health Plan
UPP
508
81.7%
37.4%
81.4%
2007 Michigan Medicaid Weighted Average
--
75.1%
36.7%
79.8%
2006 Michigan Medicaid Weighted Average
--
85.4%
40.7%
50.7%
2005 Michigan Medicaid Weighted Average
--
81.6%
37.8%
47.6%
National HEDIS 2006 Medicaid 50th Percentile
--
83.3%
34.1%
49.3%
Notes: The 2005 and 2006 Michigan Medicaid weighted averages included 15 health plans, and the 2007 Medicaid weighted average included 13 health plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page A-11
MI2007_HEDIS_Aggr_F1_1207
APPENDIX A. TABULAR RESULTS FOR KEY MEASURES BY HEALTH PLAN
Table A-10—Tabular Results for Key Measures by Health Plan:
Use of Appropriate Medications for People With Asthma
Ages 5 to 9 Years
IDSS
Plan Name
Code
Eligible
Population
Ages 10 to 17 Years
Rate
Eligible
Population
Ages 18 to 56 Years
Rate
Eligible
Population
Rate
Combined Rate
Eligible
Population
Rate
4265
Community Choice Michigan
CCM
162
95.7%
232
91.8%
453
89.0%
847
91.0%
4133
Great Lakes Health Plan
GLH
268
84.7%
386
80.8%
911
89.9%
1,565
86.8%
4291
Health Plan of Michigan, Inc.
HPM
217
98.2%
260
97.3%
487
94.5%
964
96.1%
4056
HealthPlus Partners, Inc.
HPP
274
93.8%
362
91.7%
475
88.6%
1,111
90.9%
4243
M-CAID
MCD
104
99.0%
113
91.2%
140
90.0%
357
93.0%
4312
McLaren Health Plan
MCL
182
96.7%
235
90.6%
452
85.2%
869
89.1%
4131
Midwest Health Plan
MID
188
86.7%
225
81.8%
518
83.4%
931
83.7%
4151
Molina Healthcare of Michigan
MOL
373
83.1%
572
82.0%
1,170
84.4%
2,115
83.5%
4055
OmniCare Health Plan
OCH
253
77.9%
382
75.1%
663
86.0%
1,298
81.2%
4282
Physicians Health Plan of Mid-Michigan Family Care
PMD
94
90.4%
121
89.3%
163
94.5%
378
91.8%
4054
Priority Health Government Programs, Inc.
PRI
175
98.3%
194
95.4%
226
88.5%
595
93.6%
4268
Total Health Care, Inc.
THC
172
86.6%
283
80.2%
438
82.9%
893
82.8%
4348
Upper Peninsula Health Plan
UPP
91
97.8%
133
92.5%
188
87.2%
412
91.3%
2007 Michigan Medicaid Weighted Average
--
89.9%
--
86.0%
--
87.3%
--
87.5%
2006 Michigan Medicaid Weighted Average
--
88.8%
--
87.2%
--
86.5%
--
87.1%
2005 Michigan Medicaid Weighted Average
--
65.1%
--
64.2%
--
71.8%
--
67.9%
National HEDIS 2006 Medicaid 50th Percentile
--
90.2%
--
87.4%
--
84.9%
--
87.1%
Note: The 2005 and 2006 Michigan Medicaid weighted averages included 15 health plans, and the 2007 Medicaid weighted average included 13 health plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page A-12
MI2007_HEDIS_Aggr_F1_1207
APPENDIX A. TABULAR RESULTS FOR KEY MEASURES BY HEALTH PLAN
Table A-11—Tabular Results for Key Measures by Health Plan:
Controlling High Blood Pressure
Ages 18–45 Years Ages 46–85 Years
IDSS
Plan Name
Combined
Eligible
Code Population
Rate
Eligible
Population
Rate
Eligible
Population
Rate
4265
Community Choice Michigan
CCM
538
56.3%
956
59.9%
1,494
58.6%
4133
Great Lakes Health Plan
GLH
1,290
47.7%
2,992
51.7%
4,282
50.6%
4291
Health Plan of Michigan, Inc.
HPM
1,332
58.8%
691
52.3%
2,023
56.5%
4056
HealthPlus Partners, Inc.
HPP
762
52.7%
1,104
57.7%
1,866
56.0%
4243
M-CAID
MCD
96
67.9%
210
65.4%
306
66.2%
4312
McLaren Health Plan
MCL
564
70.8%
847
67.9%
1,411
69.1%
4131
Midwest Health Plan
MID
474
53.2%
1,173
52.3%
1,647
52.6%
4151
Molina Healthcare of Michigan
MOL
1,312
45.3%
2,682
45.2%
3,994
45.2%
4055
OmniCare Health Plan
OCH
853
43.5%
1,725
44.2%
2,578
44.0%
4282
Physicians Health Plan of Mid-Michigan Family Care
PMD
158
62.9%
307
57.6%
465
59.4%
4054
Priority Health Government Programs, Inc.
PRI
355
59.1%
559
58.7%
914
58.9%
4268
Total Health Care, Inc.
THC
608
43.2%
1,263
40.9%
1,871
41.6%
4348
Upper Peninsula Health Plan
UPP
182
65.7%
291
64.3%
473
64.8%
2007 Michigan Medicaid Weighted Average
--
52.5%
--
51.5%
--
51.9%
2006 Michigan Medicaid Weighted Average
--
--
--
60.0%
--
--
2005 Michigan Medicaid Weighted Average
--
--
--
56.1%
--
--
National HEDIS 2006 Medicaid 50th Percentile
--
--
--
65.3%
--
--
Note: The 2005 and 2006 Michigan Medicaid weighted averages included 15 health plans, and the 2007 Medicaid weighted average included 13
health plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page A-13
MI2007_HEDIS_Aggr_F1_1207
APPENDIX A. TABULAR RESULTS FOR KEY MEASURES BY HEALTH PLAN
Table A-12—Tabular Results for Key Measures by Health Plan:
Children’s and Adolescents’ Access to Primary Care Practitioners
Ages 12 to 24 Months
IDSS
Plan Name
Ages 25 Months
to 6 Years
Ages 7 to 11 Years
Ages 12 to 19 Years
Code
Eligible
Population
Rate
Eligible
Population
Rate
Eligible
Population
Rate
Eligible
Population
Rate
4265
Community Choice Michigan
CCM
1,129
93.2%
6,394
80.0%
5,031
81.6%
6,639
78.4%
4133
Great Lakes Health Plan
GLH
3,428
97.6%
14,837
86.5%
10,514
84.7%
14,630
84.7%
4291
Health Plan of Michigan, Inc.
HPM
3,972
96.8%
15,585
87.6%
8,295
87.7%
10,115
87.9%
4056
HealthPlus Partners, Inc.
HPP
2,117
95.3%
9,630
84.2%
7,142
84.5%
8,841
82.2%
4243
M-CAID
MCD
662
97.3%
2,642
89.5%
1,689
89.8%
2,054
87.8%
4312
McLaren Health Plan
MCL
1,860
94.9%
7,571
78.1%
4,667
77.0%
5,989
76.5%
4131
Midwest Health Plan
MID
1,562
92.1%
8,052
81.4%
5,384
81.2%
7,432
76.8%
4151
Molina Healthcare of Michigan
MOL
3,390
94.4%
18,131
82.0%
13,996
80.5%
21,409
78.0%
4055
OmniCare Health Plan
OCH
1,412
90.2%
7,240
73.7%
6,490
73.8%
10,236
70.8%
4282
Physicians Health Plan of Mid-Michigan Family Care
PMD
538
95.0%
2,421
81.2%
1,743
84.5%
2,300
81.8%
4054
Priority Health Government Programs, Inc.
PRI
2,159
96.9%
7,507
83.7%
4,288
87.4%
4,506
85.5%
4268
Total Health Care, Inc.
THC
1,354
91.8%
6,926
75.0%
5,350
78.3%
8,333
77.4%
4348
Upper Peninsula Health Plan
UPP
992
97.7%
3,760
88.1%
2,679
87.2%
3,558
90.0%
2007 Michigan Medicaid Weighted Average
--
95.2%
--
82.7%
--
82.3%
--
80.3%
2006 Michigan Medicaid Weighted Average
--
92.9%
--
81.4%
--
80.0%
--
78.3%
2005 Michigan Medicaid Weighted Average
--
92.2%
--
78.2%
--
78.2%
--
77.1%
National HEDIS 2006 Medicaid 50th Percentile
--
94.8%
--
85.4%
--
84.9%
--
83.4%
Note: The 2005 and 2006 Michigan Medicaid weighted averages included 15 health plans, and the 2007 Medicaid weighted average included 13 health plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page A-14
MI2007_HEDIS_Aggr_F1_1207
APPENDIX A. TABULAR RESULTS FOR KEY MEASURES BY HEALTH PLAN
Table A-13—Tabular Results for Key Measures by Health Plan:
Adults’ Access to Preventive/Ambulatory Health Services
Ages 20 to 44 Years
IDSS
Plan Name
Code
Eligible
Population
Ages 45 to 64 Years
Rate
Eligible
Population
Rate
4265
Community Choice Michigan
CCM
5,967
78.5%
3,135
85.8%
4133
Great Lakes Health Plan
GLH
13,661
80.6%
8,317
88.1%
4291
Health Plan of Michigan, Inc.
HPM
11,716
85.1%
4,836
90.6%
4056
HealthPlus Partners, Inc.
HPP
8,583
84.0%
3,426
90.0%
4243
M-CAID
MCD
1,795
83.9%
787
88.6%
4312
McLaren Health Plan
MCL
7,135
81.0%
2,867
87.0%
4131
Midwest Health Plan
MID
6,842
78.2%
4,198
85.5%
4151
Molina Healthcare of Michigan
MOL
18,321
77.2%
9,517
83.8%
4055
OmniCare Health Plan
OCH
8,776
74.5%
4,465
81.7%
4282
Physicians Health Plan of Mid-Michigan Family Care
PMD
2,158
80.5%
1,007
86.1%
4054
Priority Health Government Programs, Inc.
PRI
5,153
86.5%
1,749
93.1%
4268
Total Health Care, Inc.
THC
6,979
74.9%
3,713
80.4%
4348
Upper Peninsula Health Plan
UPP
3,093
89.5%
1,513
91.2%
2007 Michigan Medicaid Weighted Average
--
80.2%
--
86.3%
2006 Michigan Medicaid Weighted Average
--
78.1%
--
84.7%
2005 Michigan Medicaid Weighted Average
--
76.7%
--
83.4%
National HEDIS 2006 Medicaid 50th Percentile
--
79.0%
--
84.5%
Note: The 2005 and 2006 Michigan Medicaid weighted averages included 15 health plans, and the 2007 Medicaid weighted average included 13
health plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page A-15
MI2007_HEDIS_Aggr_F1_1207
APPENDIX A. TABULAR RESULTS FOR KEY MEASURES BY HEALTH PLAN
Table A-14—Tabular Results for Key Measures by Health Plan:
Medical Assistance With Smoking Cessation
IDSS
Plan Name
Code
Advising Smokers
to Quit
Rate
Discussing Smoking
Cessation
Strategies
Rate
4265
Community Choice Michigan
CCM
77.1%
36.1%
4133
Great Lakes Health Plan
GLH
68.9%
31.9%
4291
Health Plan of Michigan, Inc.
HPM
75.4%
40.0%
4056
HealthPlus Partners, Inc.
HPP
70.9%
33.1%
4243
M-CAID
MCD
76.4%
47.9%
4312
McLaren Health Plan
MCL
69.6%
37.2%
4131
Midwest Health Plan
MID
68.3%
37.1%
4151
Molina Healthcare of Michigan
MOL
69.1%
36.2%
4055
OmniCare Health Plan
OCH
69.9%
34.6%
4282
Physicians Health Plan of Mid-Michigan Family Care
PMD
77.5%
48.8%
4054
Priority Health Government Programs, Inc.
PRI
76.1%
43.3%
4268
Total Health Care, Inc.
THC
65.6%
30.9%
4348
Upper Peninsula Health Plan
UPP
72.9%
38.5%
2007 Michigan Medicaid Average
72.1%
38.1%
2006 Michigan Medicaid Average
69.7%
36.2%
2005 Michigan Medicaid Average
68.5%
34.0%
Note: The 2005 and 2006 Michigan Medicaid weighted averages included 15 health plans, and the 2007 Medicaid weighted average
included 13 health plans.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page A-16
MI2007_HEDIS_Aggr_F1_1207
Appendix B.
National HEDIS 2006 Medicaid Percentiles
Appendix B provides the national HEDIS Medicaid percentiles published by NCQA using prioryear’s rates. This information is helpful to evaluate the current rates of the MHPs. The rates are
presented for the 10th, 25th, 50th, 75th, and 90th percentiles. Rates in red represent below-average
performance, rates in blue represent average performance, and rates in green represent aboveaverage performance. The rates are presented in tables by dimension.
‹
Table B-1—Pediatric Care
‹
Table B-2—Women’s Care
‹
Table B-3—Living With Illness
‹
Table B-4—Access to Care
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page B-1
MI2007_HEDIS_Aggr_F1_1207
APPENDIX B. NATIONAL HEDIS 2006 MEDICAID PERCENTILES
Table B-1—National HEDIS 2006 Medicaid Percentiles—Pediatric Care
10th
Percentile
25th
Percentile
50th
Percentile
75th
Percentile
90th
Percentile
Childhood Immunization Status—
Combination #2
53.8%
62.7%
72.4%
78.5%
82.7%
Childhood Immunization Status—
Combination #3
25.1%
33.8%
42.3%
49.8%
57.8%
Adolescent Immunization Status—
Combination #2
13.7%
24.6%
44.3%
58.2%
69.8%
Well-Child Visits in the First 15 Months—
Zero Visits*
0.5%
1.1%
2.0%
3.9%
10.0%
Well-Child Visits in the First 15 Months—
Six or More Visits
22.4%
41.6%
50.0%
59.2%
68.6%
Well-Child in the Third, Fourth, Fifth, and
Sixth Years of Life
50.1%
56.7%
64.8%
70.8%
77.5%
Adolescent Well-Care Visits
28.0%
32.8%
39.4%
47.9%
54.5%
Appropriate Treatment for Children With
Upper Respiratory Infection
71.3%
76.7%
82.7%
89.6%
92.1%
Appropriate Testing for Children With
Pharyngitis
20.3%
40.9%
56.2%
64.3%
75.1%
Measure
* For this key measure, a lower rate indicates better performance.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page B-2
MI2007_HEDIS_Aggr_F1_1207
APPENDIX B. NATIONAL HEDIS 2006 MEDICAID PERCENTILES
Table B-2—National HEDIS 2006 Medicaid Percentiles—Women’s Care
10th
Percentile
25th
Percentile
50th
Percentile
75th
Percentile
90th
Percentile
Breast Cancer Screening (52–69 years)
42.9%
47.1%
53.9%
59.2%
65.4%
Cervical Cancer Screening
49.9%
59.7%
66.1%
73.0%
76.6%
Chlamydia Screening in Women—
Ages 16–20 Years
35.3%
41.0%
49.1%
57.3%
64.3%
Chlamydia Screening in Women—
Ages 21–25 Years
36.1%
46.7%
53.3%
60.3%
67.7%
Chlamydia Screening in Women—
Combined Rate
36.5%
44.5%
51.2%
59.0%
65.3%
Prenatal and Postpartum Care—
Timeliness of Prenatal Care
61.1%
74.2%
83.3%
88.1%
91.5%
Prenatal and Postpartum Care—
Postpartum Care
41.8%
49.7%
58.8%
65.9%
71.0%
Measure
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page B-3
MI2007_HEDIS_Aggr_F1_1207
APPENDIX B. NATIONAL HEDIS 2006 MEDICAID PERCENTILES
Table B-3—National HEDIS 2006 Medicaid Percentiles—Living With Illness
10th
Percentile
25th
Percentile
50th
Percentile
75th
Percentile
90th
Percentile
Comprehensive Diabetes Care—
HbA1c Testing
64.0%
71.1%
77.4%
84.9%
88.8%
Comprehensive Diabetes Care—
Poor HbA1c Control*
30.3%
37.3%
45.2%
60.1%
74.3%
Comprehensive Diabetes Care—
Eye Exam
25.5%
35.2%
50.8%
61.5%
68.1%
Comprehensive Diabetes Care—
LDL-C Screening
66.3%
76.2%
83.3%
88.1%
90.8%
Comprehensive Diabetes Care—
LDL-C Level <100
14.4%
26.5%
34.1%
41.0%
46.5%
Comprehensive Diabetes Care—
Medical Attention for Nephropathy
30.2%
39.5%
49.3%
59.7%
65.6%
Use of Appropriate Medications for People
With Asthma—Ages 5–9 Years
80.2%
86.7%
90.2%
93.4%
95.8%
Use of Appropriate Medications for People
With Asthma—Ages 10–17 Years
75.3%
83.3%
87.4%
91.1%
93.5%
Use of Appropriate Medications for People
With Asthma—Ages 18–56 Years
74.0%
80.3%
84.9%
88.0%
90.8%
Use of Appropriate Medications for People
With Asthma—Combined Rate
78.4%
84.0%
87.1%
89.7%
92.5%
Controlling High Blood Pressure
(46–85 years)
43.1%
55.4%
65.3%
68.5%
73.0%
Measure
* For this key measure, a lower rate indicates better performance.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page B-4
MI2007_HEDIS_Aggr_F1_1207
APPENDIX B. NATIONAL HEDIS 2006 MEDICAID PERCENTILES
Table B-4—National HEDIS 2006 Medicaid Percentiles—Access to Care
10th
Percentile
25th
Percentile
50th
Percentile
75th
Percentile
90th
Percentile
Children’s Access to Primary Care
Practitioners—Ages 12–24 Months
84.9%
91.2%
94.8%
97.5%
98.2%
Children’s Access to Primary Care
Practitioners—Ages 25 Months–6 Years
71.6%
79.9%
85.4%
88.6%
91.5%
Children’s Access to Primary Care
Practitioners—Ages 7–11 Years
72.9%
79.0%
84.9%
89.3%
92.0%
Adolescents’ Access to Primary Care
Practitioners—Ages 12–19 Years
69.2%
76.2%
83.4%
87.7%
90.2%
Adults’ Access to
Preventive/Ambulatory Services—
Ages 20–44 Years
59.3%
72.7%
79.0%
83.7%
87.0%
Adults’ Access to Preventive/
Ambulatory Services—
Ages 45–64 Years
66.7%
79.0%
84.5%
87.4%
89.4%
Measure
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page B-5
MI2007_HEDIS_Aggr_F1_1207
Appendix C.
Trend Tables
Appendix C includes trend tables for each of the MHPs. Where applicable, each measure’s rate for
2005, 2006, and 2007 is presented along with a trend analysis that compares a measure’s 2006 rate
to its 2007 rate in order to assess whether there was any significant change in the rate.
Rates that were significantly higher in 2007 than in 2006 (improved by more than 10 percent) are
noted with upward arrows (©). Rates that were significantly lower in 2007 than in 2006 (decreased
by more than 10 percent) are noted with downward arrows (ª). Rates in 2007 that were not
significantly different than in 2006 (did not change more than 10 percent) are noted with parallel
arrows (§¨). For two measures, Well-Child Visits in the First 15 Months of Life—Zero Visits and
Comprehensive Diabetes Care—Poor HbA1c Control, where a lower rate indicates better
performance, an upward triangle (c) indicates performance improvement (the rate decreased by
more than 10 percent) and a downward triangle (d) indicates a decline in performance (the rate
increased by more than 10 percent).
The MHP trend tables are presented as follows:
‹
Table C-1—CCM
‹
Table C-2—GLH
‹
Table C-3—HPM
‹
Table C-4—HPP
‹
Table C-5—MCD
‹
Table C-6—MCL
‹
Table C-7—MID
‹
Table C-8—MOL
‹
Table C-9—OCH
‹
Table C-10—PMD
‹
Table C-11—PRI
‹
Table C-12—THC
‹
Table C-13—UPP
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page C-1
MI2007_HEDIS_Aggr_F1_1207
APPENDIX C. TREND TABLES
Table C-1—Michigan Medicaid HEDIS 2007 Trend Table: CCM
Dimension of Care
Pediatric Care
Women’s Care
Living With Illness
Access to Care
Measure
Childhood Immunization Combo 2
Childhood Immunization Combo 3
Adolescent Immunization Combo 2
Well-Child 1st 15 Mos, 0 Visit
Well-Child 1st 15 Mos, 6+ Visits
Well-Child 3rd-6th Years of Life
Adolescent Well-Care Visits
Appropriate Treatment of URI
Children with Pharyngitis
Breast Cancer Screening, 42-51 Years
Breast Cancer Screening, 52-69 Years
Breast Cancer Screening, Combined
Cervical Cancer Screening
Chlamydia Screening, 16-20 Years
Chlamydia Screening, 21-25 Years
Chlamydia Screening, Combined
Timeliness of Prenatal Care
Postpartum Care
Diabetes Care HbA1c Testing
Diabetes Care Poor HbA1c Control
Diabetes Care Eye Exam
Diabetes Care LDL-C Screening
Diabetes Care LDL-C Level <100
Diabetes Care Nephropathy
Asthma 5-9 Years
Asthma 10-17 Years
Asthma 18-56 Years
Asthma Combined Rate
Controlling High Blood Pressure, 18-45 Years
Controlling High Blood Pressure, 46-85 Years
Controlling High Blood Pressure, Combined
Advising Smokers to Quit
Discussing Smoking Cessation Strategies
Children's Access 12-24 Months
Children's Access 25 Mos-6 Years
Children's Access 7-11 Years
Adolescents' Access 12-19 Years
Adults' Access 20-44 Years
Adults' Access 45-64 Years
2005
2006
2007
69.3%
-54.0%
5.4%
41.4%
54.3%
33.3%
77.5%
41.1%
-49.9%
-67.6%
48.7%
55.6%
52.0%
75.7%
58.9%
83.7%
41.6%
38.4%
71.8%
32.6%
43.1%
70.0%
65.4%
74.0%
70.9%
-65.0%
-69.1%
30.1%
84.8%
77.1%
77.1%
75.4%
76.2%
83.2%
75.7%
33.6%
62.6%
3.9%
41.6%
54.6%
37.0%
75.9%
49.0%
-47.1%
-67.6%
48.1%
52.9%
50.2%
76.6%
60.1%
81.5%
46.2%
41.8%
76.4%
34.1%
46.2%
89.2%
90.1%
88.7%
89.1%
-65.3%
-71.8%
29.3%
90.4%
77.8%
78.1%
74.9%
75.2%
82.7%
74.9%
62.5%
67.1%
3.4%
37.5%
56.9%
31.1%
79.4%
54.5%
39.2%
53.6%
45.6%
65.6%
46.8%
56.5%
50.7%
81.3%
62.8%
83.7%
43.1%
43.8%
66.9%
29.2%
76.6%
95.7%
91.8%
89.0%
91.0%
56.3%
59.9%
58.6%
77.1%
36.1%
93.2%
80.0%
81.6%
78.4%
78.5%
85.8%
2006–2007
Health Plan
Trend
§¨
©
§¨
§¨
§¨
§¨
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
©
§¨
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
Notes
A rotated measure is one for which the MHP exercised the NCQA-approved option to use the audited and reportable rate
from the prior year.
©
§¨
ª
--
=
Performance improvement (rate increase >10%)*
=
No significant performance change (rate change ≤10%)
=
Performance decline (rate decrease >10%)*
=
No data available
*For two measures—Well-Child 1st 15 Mos., 0 Visits and Diabetes Care, Poor HbA1c Control:
=
d
Performance decline (rate increase >10%)
=
c
Performance improvement (rate decrease >10%)
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page C-2
MI2007_HEDIS_Aggr_F1_1207
APPENDIX C. TREND TABLES
Table C-2—Michigan Medicaid HEDIS 2007 Trend Table: GLH
Dimension of Care
Pediatric Care
Women’s Care
Living With Illness
Access to Care
Measure
2005
2006
2007
Childhood Immunization Combo 2
Childhood Immunization Combo 3
Adolescent Immunization Combo 2
Well-Child 1st 15 Mos, 0 Visit
Well-Child 1st 15 Mos, 6+ Visits
Well-Child 3rd-6th Years of Life
Adolescent Well-Care Visits
Appropriate Treatment of URI
Children with Pharyngitis
Breast Cancer Screening, 42-51 Years
Breast Cancer Screening, 52-69 Years
Breast Cancer Screening, Combined
Cervical Cancer Screening
Chlamydia Screening, 16-20 Years
Chlamydia Screening, 21-25 Years
Chlamydia Screening, Combined
Timeliness of Prenatal Care
Postpartum Care
Diabetes Care HbA1c Testing
Diabetes Care Poor HbA1c Control
Diabetes Care Eye Exam
Diabetes Care LDL-C Screening
Diabetes Care LDL-C Level <100
Diabetes Care Nephropathy
Asthma 5-9 Years
Asthma 10-17 Years
Asthma 18-56 Years
Asthma Combined Rate
Controlling High Blood Pressure, 18-45 Years
Controlling High Blood Pressure, 46-85 Years
Controlling High Blood Pressure, Combined
Advising Smokers to Quit
Discussing Smoking Cessation Strategies
Children's Access 12-24 Months
Children's Access 25 Mos-6 Years
Children's Access 7-11 Years
Adolescents' Access 12-19 Years
Adults' Access 20-44 Years
Adults' Access 45-64 Years
68.3%
-51.8%
3.5%
39.4%
60.8%
40.4%
70.6%
37.6%
-54.3%
-59.6%
47.2%
52.1%
49.4%
72.0%
51.1%
79.0%
46.3%
45.0%
81.4%
60.1%
47.0%
57.0%
57.9%
73.7%
65.9%
-47.4%
-64.5%
28.7%
91.4%
79.5%
78.5%
77.5%
74.7%
83.2%
72.0%
37.2%
56.4%
0.7%
64.2%
66.9%
52.1%
70.7%
35.6%
-59.3%
-60.1%
47.2%
55.8%
51.0%
75.4%
51.3%
73.5%
47.4%
52.6%
88.1%
62.0%
45.7%
85.9%
83.0%
88.4%
86.7%
-51.1%
-66.8%
28.7%
96.7%
85.4%
82.1%
81.4%
78.7%
86.8%
77.6%
63.3%
66.7%
0.3%
91.1%
69.8%
58.8%
74.6%
41.5%
43.8%
56.6%
50.3%
64.6%
49.8%
57.5%
52.9%
78.3%
58.6%
77.1%
50.6%
53.3%
76.9%
30.9%
77.9%
84.7%
80.8%
89.9%
86.8%
47.7%
51.7%
50.6%
68.9%
31.9%
97.6%
86.5%
84.7%
84.7%
80.6%
88.1%
2006–2007
Health Plan
Trend
§¨
©
©
§¨
©
§¨
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
ª
ª
©
§¨
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
Notes
A rotated measure is one for which the MHP exercised the NCQA-approved option to use the audited and reportable
rate from the prior year.
©
§¨
ª
--
=
=
=
=
Performance improvement (rate increase >10%)*
No significant performance change (rate change ≤10%)
Performance decline (rate decrease >10%)*
No data available
*For two measures—Well-Child 1st 15 Mos., 0 Visits and Diabetes Care, Poor HbA1c Control:
= Performance decline (rate increase >10%)
d
= Performance improvement (rate decrease >10%)
c
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page C-3
MI2007_HEDIS_Aggr_F1_1207
APPENDIX C. TREND TABLES
Table C-3—Michigan Medicaid HEDIS 2007 Trend Table: HPM
Dimension of Care
Pediatric Care
Women’s Care
Living With Illness
Access to Care
Measure
2005
2006
2007
Childhood Immunization Combo 2
Childhood Immunization Combo 3
Adolescent Immunization Combo 2
Well-Child 1st 15 Mos, 0 Visit
Well-Child 1st 15 Mos, 6+ Visits
Well-Child 3rd-6th Years of Life
Adolescent Well-Care Visits
Appropriate Treatment of URI
Children with Pharyngitis
Breast Cancer Screening, 42-51 Years
Breast Cancer Screening, 52-69 Years
Breast Cancer Screening, Combined
Cervical Cancer Screening
Chlamydia Screening, 16-20 Years
Chlamydia Screening, 21-25 Years
Chlamydia Screening, Combined
Timeliness of Prenatal Care
Postpartum Care
Diabetes Care HbA1c Testing
Diabetes Care Poor HbA1c Control
Diabetes Care Eye Exam
Diabetes Care LDL-C Screening
Diabetes Care LDL-C Level <100
Diabetes Care Nephropathy
Asthma 5-9 Years
Asthma 10-17 Years
Asthma 18-56 Years
Asthma Combined Rate
Controlling High Blood Pressure, 18-45 Years
Controlling High Blood Pressure, 46-85 Years
Controlling High Blood Pressure, Combined
Advising Smokers to Quit
Discussing Smoking Cessation Strategies
Children's Access 12-24 Months
Children's Access 25 Mos-6 Years
Children's Access 7-11 Years
Adolescents' Access 12-19 Years
Adults' Access 20-44 Years
Adults' Access 45-64 Years
68.5%
-54.9%
2.0%
59.0%
56.9%
41.2%
74.4%
58.9%
-56.9%
-61.6%
47.6%
52.2%
49.9%
78.3%
57.4%
79.2%
47.5%
54.9%
85.4%
27.8%
49.8%
67.7%
66.1%
70.7%
68.5%
-61.2%
-65.6%
30.5%
93.9%
81.5%
82.5%
82.4%
80.0%
88.0%
78.0%
38.9%
58.8%
1.7%
68.4%
67.8%
52.5%
79.3%
50.9%
-58.0%
-66.8%
49.1%
54.7%
51.7%
82.9%
56.8%
78.7%
39.2%
58.6%
85.8%
30.7%
48.2%
94.9%
93.5%
93.1%
93.6%
-69.5%
-69.3%
33.0%
95.4%
85.9%
84.3%
84.3%
82.9%
88.7%
83.8%
71.5%
70.6%
0.9%
69.9%
65.3%
55.1%
78.4%
53.2%
53.9%
64.4%
58.7%
71.0%
50.3%
60.2%
54.8%
90.0%
67.0%
86.4%
33.0%
67.0%
82.5%
35.2%
78.0%
98.2%
97.3%
94.5%
96.1%
58.8%
52.3%
56.5%
75.4%
40.0%
96.8%
87.6%
87.7%
87.9%
85.1%
90.6%
2006–2007
Health Plan
Trend
§¨
©
©
§¨
§¨
§¨
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
©
§¨
§¨
§¨
§¨
§¨
©
§¨
§¨
§¨
§¨
-ª
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
Notes
A rotated measure is one for which the MHP exercised the NCQA-approved option to use the audited and reportable
rate from the prior year.
©
§¨
ª
--
= Performance improvement (rate increase >10%)*
= No significant performance change (rate change ≤10%)
= Performance decline (rate decrease >10%)*
= No data available
*For two measures—Well-Child 1st 15 Mos., 0 Visits and Diabetes Care, Poor HbA1c Control:
= Performance decline (rate increase >10%)
d
= Performance improvement (rate decrease >10%)
c
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page C-4
MI2007_HEDIS_Aggr_F1_1207
APPENDIX C. TREND TABLES
Table C-4—Michigan Medicaid HEDIS 2007 Trend Table: HPP
Dimension of Care
Pediatric Care
Women’s Care
Living With Illness
Access to Care
Measure
Childhood Immunization Combo 2
Childhood Immunization Combo 3
Adolescent Immunization Combo 2
Well-Child 1st 15 Mos, 0 Visit
Well-Child 1st 15 Mos, 6+ Visits
Well-Child 3rd-6th Years of Life
Adolescent Well-Care Visits
Appropriate Treatment of URI
Children with Pharyngitis
Breast Cancer Screening, 42-51 Years
Breast Cancer Screening, 52-69 Years
Breast Cancer Screening, Combined
Cervical Cancer Screening
Chlamydia Screening, 16-20 Years
Chlamydia Screening, 21-25 Years
Chlamydia Screening, Combined
Timeliness of Prenatal Care
Postpartum Care
Diabetes Care HbA1c Testing
Diabetes Care Poor HbA1c Control
Diabetes Care Eye Exam
Diabetes Care LDL-C Screening
Diabetes Care LDL-C Level <100
Diabetes Care Nephropathy
Asthma 5-9 Years
Asthma 10-17 Years
Asthma 18-56 Years
Asthma Combined Rate
Controlling High Blood Pressure, 18-45 Years
Controlling High Blood Pressure, 46-85 Years
Controlling High Blood Pressure, Combined
Advising Smokers to Quit
Discussing Smoking Cessation Strategies
Children's Access 12-24 Months
Children's Access 25 Mos-6 Years
Children's Access 7-11 Years
Adolescents' Access 12-19 Years
Adults' Access 20-44 Years
Adults' Access 45-64 Years
2005
2006
2007
76.7%
-64.0%
2.9%
43.8%
57.2%
37.5%
71.3%
33.7%
-59.6%
-70.4%
45.6%
52.9%
49.4%
82.9%
57.4%
83.9%
33.6%
57.4%
86.6%
34.1%
56.4%
75.0%
69.3%
75.3%
73.3%
-65.8%
-73.1%
31.2%
94.7%
80.8%
81.8%
79.4%
82.0%
89.6%
83.9%
44.8%
70.3%
2.2%
60.1%
58.5%
43.8%
71.4%
36.2%
-61.8%
-70.4%
50.5%
57.9%
54.1%
87.4%
62.0%
86.1%
29.7%
70.3%
89.8%
43.1%
56.4%
93.8%
92.3%
89.1%
91.2%
-65.8%
-69.2%
32.8%
96.0%
83.5%
82.0%
79.4%
83.7%
91.3%
85.2%
71.5%
79.0%
2.3%
61.8%
64.8%
48.4%
72.1%
40.9%
54.3%
62.5%
58.0%
77.1%
52.7%
61.2%
56.6%
91.8%
66.1%
86.6%
32.8%
74.0%
75.4%
36.5%
85.4%
93.8%
91.7%
88.6%
90.9%
52.7%
57.7%
56.0%
70.9%
33.1%
95.3%
84.2%
84.5%
82.2%
84.0%
90.0%
2006–2007
Health Plan
Trend
§¨
©
§¨
§¨
§¨
§¨
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
ª
§¨
©
§¨
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
Notes
A rotated measure is one for which the MHP exercised the NCQA-approved option to use the audited and reportable rate
from the prior year.
©
§¨
ª
--
= Performance improvement (rate increase >10%)*
= No significant performance change (rate change ≤10%)
= Performance decline (rate decrease >10%)*
= No data available
*For two measures—Well-Child 1st 15 Mos., 0 Visits and Diabetes Care, Poor HbA1c Control:
= Performance decline (rate increase >10%)
d
= Performance improvement (rate decrease >10%)
c
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page C-5
MI2007_HEDIS_Aggr_F1_1207
APPENDIX C. TREND TABLES
Table C-5—Michigan Medicaid HEDIS 2007 Trend Table: MCD
Dimension of Care
Pediatric Care
Women’s Care
Living With Illness
Access to Care
Measure
Childhood Immunization Combo 2
Childhood Immunization Combo 3
Adolescent Immunization Combo 2
Well-Child 1st 15 Mos, 0 Visit
Well-Child 1st 15 Mos, 6+ Visits
Well-Child 3rd-6th Years of Life
Adolescent Well-Care Visits
Appropriate Treatment of URI
Children with Pharyngitis
Breast Cancer Screening, 42-51 Years
Breast Cancer Screening, 52-69 Years
Breast Cancer Screening, Combined
Cervical Cancer Screening
Chlamydia Screening, 16-20 Years
Chlamydia Screening, 21-25 Years
Chlamydia Screening, Combined
Timeliness of Prenatal Care
Postpartum Care
Diabetes Care HbA1c Testing
Diabetes Care Poor HbA1c Control
Diabetes Care Eye Exam
Diabetes Care LDL-C Screening
Diabetes Care LDL-C Level <100
Diabetes Care Nephropathy
Asthma 5-9 Years
Asthma 10-17 Years
Asthma 18-56 Years
Asthma Combined Rate
Controlling High Blood Pressure, 18-45 Years
Controlling High Blood Pressure, 46-85 Years
Controlling High Blood Pressure, Combined
Advising Smokers to Quit
Discussing Smoking Cessation Strategies
Children's Access 12-24 Months
Children's Access 25 Mos-6 Years
Children's Access 7-11 Years
Adolescents' Access 12-19 Years
Adults' Access 20-44 Years
Adults' Access 45-64 Years
2005
2006
2007
72.5%
-46.7%
1.5%
46.3%
62.0%
47.6%
88.5%
74.8%
-47.2%
-73.8%
56.9%
56.9%
56.9%
89.5%
60.7%
88.4%
33.8%
55.1%
91.6%
50.2%
60.0%
77.6%
75.0%
69.6%
73.6%
-76.0%
-74.3%
46.7%
96.8%
86.3%
83.7%
81.5%
82.0%
85.5%
81.0%
56.7%
68.5%
0.5%
64.4%
67.4%
51.4%
90.3%
58.8%
-45.0%
-73.8%
52.8%
60.0%
56.2%
89.5%
60.7%
88.4%
33.8%
55.1%
91.6%
50.2%
60.0%
94.6%
91.8%
91.2%
92.2%
-76.0%
-75.7%
50.2%
98.8%
89.0%
87.5%
85.8%
82.2%
85.1%
81.0%
56.7%
68.5%
0.5%
64.4%
67.4%
51.4%
90.5%
80.8%
42.0%
47.4%
44.3%
78.0%
51.6%
61.4%
55.8%
85.4%
66.0%
89.1%
34.0%
62.5%
80.9%
45.7%
84.8%
99.0%
91.2%
90.0%
93.0%
67.9%
65.4%
66.2%
76.4%
47.9%
97.3%
89.5%
89.8%
87.8%
83.9%
88.6%
2006–2007
Health Plan
Trend
§¨
§¨
Rotated Measure
Rotated Measure
Rotated Measure
Rotated Measure
Rotated Measure
§¨
©
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
ª
§¨
©
§¨
§¨
§¨
§¨
-ª
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
Notes
A rotated measure is one for which the MHP exercised the NCQA-approved option to use the audited and reportable rate from
the prior year.
©
§¨
ª
--
=
Performance improvement (rate increase >10%)*
=
No significant performance change (rate change ≤10%)
=
Performance decline (rate decrease >10%)*
=
No data available
*For two measures—Well-Child 1st 15 Mos., 0 Visits and Diabetes Care, Poor HbA1c Control:
=
d
Performance decline (rate increase >10%)
=
c
Performance improvement (rate decrease >10%)
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page C-6
MI2007_HEDIS_Aggr_F1_1207
APPENDIX C. TREND TABLES
Table C-6—Michigan Medicaid HEDIS 2007 Trend Table: MCL
Dimension of Care
Pediatric Care
Women’s Care
Living With Illness
Access to Care
Measure
Childhood Immunization Combo 2
Childhood Immunization Combo 3
Adolescent Immunization Combo 2
Well-Child 1st 15 Mos, 0 Visit
Well-Child 1st 15 Mos, 6+ Visits
Well-Child 3rd-6th Years of Life
Adolescent Well-Care Visits
Appropriate Treatment of URI
Children with Pharyngitis
Breast Cancer Screening, 42-51 Years
Breast Cancer Screening, 52-69 Years
Breast Cancer Screening, Combined
Cervical Cancer Screening
Chlamydia Screening, 16-20 Years
Chlamydia Screening, 21-25 Years
Chlamydia Screening, Combined
Timeliness of Prenatal Care
Postpartum Care
Diabetes Care HbA1c Testing
Diabetes Care Poor HbA1c Control
Diabetes Care Eye Exam
Diabetes Care LDL-C Screening
Diabetes Care LDL-C Level <100
Diabetes Care Nephropathy
Asthma 5-9 Years
Asthma 10-17 Years
Asthma 18-56 Years
Asthma Combined Rate
Controlling High Blood Pressure, 18-45 Years
Controlling High Blood Pressure, 46-85 Years
Controlling High Blood Pressure, Combined
Advising Smokers to Quit
Discussing Smoking Cessation Strategies
Children's Access 12-24 Months
Children's Access 25 Mos-6 Years
Children's Access 7-11 Years
Adolescents' Access 12-19 Years
Adults' Access 20-44 Years
Adults' Access 45-64 Years
2005
2006
2007
73.7%
-46.7%
2.2%
45.4%
51.6%
36.7%
64.8%
45.8%
-57.8%
-67.9%
48.4%
52.3%
50.4%
88.1%
65.5%
79.3%
41.1%
51.6%
75.4%
31.1%
52.8%
82.9%
71.9%
75.7%
76.5%
-59.6%
-69.4%
32.4%
93.9%
79.2%
80.0%
76.5%
80.4%
88.0%
78.8%
39.9%
54.3%
1.2%
68.6%
63.3%
45.7%
65.4%
42.4%
-56.9%
-67.4%
53.3%
54.3%
53.7%
91.5%
76.6%
84.8%
37.4%
69.9%
83.8%
39.9%
59.3%
97.3%
90.3%
87.9%
90.5%
-64.1%
-69.5%
32.4%
93.0%
78.2%
81.0%
78.9%
79.7%
87.2%
80.0%
66.7%
64.2%
1.2%
62.8%
69.8%
52.1%
67.2%
48.7%
45.3%
56.9%
50.6%
70.1%
48.9%
58.8%
53.4%
93.4%
85.6%
84.4%
41.8%
67.4%
71.5%
33.1%
91.2%
96.7%
90.6%
85.2%
89.1%
70.8%
67.9%
69.1%
69.6%
37.2%
94.9%
78.1%
77.0%
76.5%
81.0%
87.0%
2006–2007
Health Plan
Trend
§¨
©
§¨
§¨
§¨
§¨
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
ª
§¨
©
§¨
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
Notes
A rotated measure is one for which the MHP exercised the NCQA-approved option to use the audited and reportable rate
from the prior year.
©
§¨
ª
--
=
=
=
=
Performance improvement (rate increase >10%)*
No significant performance change (rate change ≤10%)
Performance decline (rate decrease >10%)*
No data available
*For two measures—Well-Child 1st 15 Mos., 0 Visits and Diabetes Care, Poor HbA1c Control:
= Performance decline (rate increase >10%)
d
= Performance improvement (rate decrease >10%)
c
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page C-7
MI2007_HEDIS_Aggr_F1_1207
APPENDIX C. TREND TABLES
Table C-7—Michigan Medicaid HEDIS 2007 Trend Table: MID
Dimension of Care
Pediatric Care
Women’s Care
Living With Illness
Access to Care
Measure
Childhood Immunization Combo 2
Childhood Immunization Combo 3
Adolescent Immunization Combo 2
Well-Child 1st 15 Mos, 0 Visit
Well-Child 1st 15 Mos, 6+ Visits
Well-Child 3rd-6th Years of Life
Adolescent Well-Care Visits
Appropriate Treatment of URI
Children with Pharyngitis
Breast Cancer Screening, 42-51 Years
Breast Cancer Screening, 52-69 Years
Breast Cancer Screening, Combined
Cervical Cancer Screening
Chlamydia Screening, 16-20 Years
Chlamydia Screening, 21-25 Years
Chlamydia Screening, Combined
Timeliness of Prenatal Care
Postpartum Care
Diabetes Care HbA1c Testing
Diabetes Care Poor HbA1c Control
Diabetes Care Eye Exam
Diabetes Care LDL-C Screening
Diabetes Care LDL-C Level <100
Diabetes Care Nephropathy
Asthma 5-9 Years
Asthma 10-17 Years
Asthma 18-56 Years
Asthma Combined Rate
Controlling High Blood Pressure, 18-45 Years
Controlling High Blood Pressure, 46-85 Years
Controlling High Blood Pressure, Combined
Advising Smokers to Quit
Discussing Smoking Cessation Strategies
Children's Access 12-24 Months
Children's Access 25 Mos-6 Years
Children's Access 7-11 Years
Adolescents' Access 12-19 Years
Adults' Access 20-44 Years
Adults' Access 45-64 Years
2005
2006
2007
72.0%
-51.8%
5.0%
46.1%
65.9%
48.4%
75.7%
7.6%
-49.6%
-58.9%
32.1%
37.8%
34.8%
66.7%
41.8%
71.5%
47.7%
44.3%
79.8%
40.1%
43.6%
52.9%
56.3%
67.0%
61.3%
-56.7%
-63.3%
30.0%
91.2%
79.2%
80.9%
78.4%
72.6%
82.6%
75.9%
32.8%
55.0%
4.9%
50.6%
73.5%
48.9%
75.7%
13.4%
-58.3%
-62.3%
40.0%
48.2%
43.6%
68.4%
46.5%
71.5%
47.7%
49.1%
81.5%
40.1%
46.7%
79.6%
78.5%
82.9%
81.1%
-56.7%
-67.8%
34.9%
93.6%
82.9%
82.4%
80.0%
76.5%
85.4%
81.5%
57.9%
64.0%
3.6%
56.7%
74.9%
50.1%
75.2%
18.7%
51.9%
57.5%
54.6%
64.2%
52.8%
60.3%
55.9%
76.4%
50.9%
70.1%
48.2%
53.5%
70.1%
29.7%
77.9%
86.7%
81.8%
83.4%
83.7%
53.2%
52.3%
52.6%
68.3%
37.1%
92.1%
81.4%
81.2%
76.8%
78.2%
85.5%
2006–2007
Health Plan
Trend
§¨
©
§¨
§¨
§¨
§¨
§¨
§¨
§¨
-§¨
-§¨
©
©
©
§¨
§¨
§¨
§¨
§¨
ª
ª
©
§¨
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
Notes
A rotated measure is one for which the MHP exercised the NCQA-approved option to use the audited and reportable rate
from the prior year.
©
§¨
ª
--
= Performance improvement (rate increase >10%)*
= No significant performance change (rate change ≤10%)
= Performance decline (rate decrease >10%)*
= No data available
*For two measures—Well-Child 1st 15 Mos., 0 Visits and Diabetes Care, Poor HbA1c Control:
= Performance decline (rate increase >10%)
d
= Performance improvement (rate decrease >10%)
c
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page C-8
MI2007_HEDIS_Aggr_F1_1207
APPENDIX C. TREND TABLES
Table C-8—Michigan Medicaid HEDIS 2007 Trend Table: MOL
Dimension of Care
Pediatric Care
Women’s Care
Living With Illness
Access to Care
Measure
Childhood Immunization Combo 2
Childhood Immunization Combo 3
Adolescent Immunization Combo 2
Well-Child 1st 15 Mos, 0 Visit
Well-Child 1st 15 Mos, 6+ Visits
Well-Child 3rd-6th Years of Life
Adolescent Well-Care Visits
Appropriate Treatment of URI
Children with Pharyngitis
Breast Cancer Screening, 42-51 Years
Breast Cancer Screening, 52-69 Years
Breast Cancer Screening, Combined
Cervical Cancer Screening
Chlamydia Screening, 16-20 Years
Chlamydia Screening, 21-25 Years
Chlamydia Screening, Combined
Timeliness of Prenatal Care
Postpartum Care
Diabetes Care HbA1c Testing
Diabetes Care Poor HbA1c Control
Diabetes Care Eye Exam
Diabetes Care LDL-C Screening
Diabetes Care LDL-C Level <100
Diabetes Care Nephropathy
Asthma 5-9 Years
Asthma 10-17 Years
Asthma 18-56 Years
Asthma Combined Rate
Controlling High Blood Pressure, 18-45 Years
Controlling High Blood Pressure, 46-85 Years
Controlling High Blood Pressure, Combined
Advising Smokers to Quit
Discussing Smoking Cessation Strategies
Children's Access 12-24 Months
Children's Access 25 Mos-6 Years
Children's Access 7-11 Years
Adolescents' Access 12-19 Years
Adults' Access 20-44 Years
Adults' Access 45-64 Years
2005
2006
2007
69.9%
-46.6%
5.4%
35.2%
55.3%
33.6%
76.5%
52.0%
-57.0%
-59.0%
44.1%
51.1%
47.5%
82.0%
58.8%
88.8%
43.0%
52.3%
84.5%
33.9%
49.6%
65.3%
63.5%
70.9%
67.9%
-62.1%
-67.9%
36.1%
91.4%
77.1%
72.9%
73.4%
78.8%
84.6%
72.4%
35.5%
51.1%
2.3%
43.3%
62.2%
34.5%
76.5%
44.2%
-58.6%
-62.1%
56.3%
59.9%
57.9%
82.0%
58.8%
88.8%
43.0%
52.3%
84.5%
33.9%
55.6%
90.2%
89.6%
84.3%
86.8%
-62.6%
-69.3%
41.7%
83.7%
79.2%
79.6%
78.5%
75.3%
81.5%
72.4%
35.5%
54.6%
1.9%
42.5%
62.2%
39.6%
79.4%
43.6%
44.5%
54.2%
48.9%
58.0%
52.1%
58.4%
54.5%
67.4%
49.7%
74.1%
50.1%
50.6%
73.4%
51.3%
76.9%
83.1%
82.0%
84.4%
83.5%
45.3%
45.2%
45.2%
69.1%
36.2%
94.4%
82.0%
80.5%
78.0%
77.2%
83.8%
2006–2007
Health Plan
Trend
Rotated Measure
Rotated Measure
§¨
§¨
§¨
Rotated Measure
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
ª
§¨
ª
§¨
§¨
ª
©
©
§¨
§¨
§¨
§¨
-ª
-§¨
§¨
©
§¨
§¨
§¨
§¨
§¨
Notes
A rotated measure is one for which the MHP exercised the NCQA-approved option to use the audited and reportable rate from
the prior year.
©
§¨
ª
--
=
Performance improvement (rate increase >10%)*
=
No significant performance change (rate change ≤10%)
=
Performance decline (rate decrease >10%)*
=
No data available
*For two measures—Well-Child 1st 15 Mos., 0 Visits and Diabetes Care, Poor HbA1c Control:
=
d
Performance decline (rate increase >10%)
=
c
Performance improvement (rate decrease >10%)
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page C-9
MI2007_HEDIS_Aggr_F1_1207
APPENDIX C. TREND TABLES
Table C-9—Michigan Medicaid HEDIS 2007 Trend Table: OCH
Dimension of Care
Pediatric Care
Women’s Care
Living With Illness
Access to Care
Measure
Childhood Immunization Combo 2
Childhood Immunization Combo 3
Adolescent Immunization Combo 2
Well-Child 1st 15 Mos, 0 Visit
Well-Child 1st 15 Mos, 6+ Visits
Well-Child 3rd-6th Years of Life
Adolescent Well-Care Visits
Appropriate Treatment of URI
Children with Pharyngitis
Breast Cancer Screening, 42-51 Years
Breast Cancer Screening, 52-69 Years
Breast Cancer Screening, Combined
Cervical Cancer Screening
Chlamydia Screening, 16-20 Years
Chlamydia Screening, 21-25 Years
Chlamydia Screening, Combined
Timeliness of Prenatal Care
Postpartum Care
Diabetes Care HbA1c Testing
Diabetes Care Poor HbA1c Control
Diabetes Care Eye Exam
Diabetes Care LDL-C Screening
Diabetes Care LDL-C Level <100
Diabetes Care Nephropathy
Asthma 5-9 Years
Asthma 10-17 Years
Asthma 18-56 Years
Asthma Combined Rate
Controlling High Blood Pressure, 18-45 Years
Controlling High Blood Pressure, 46-85 Years
Controlling High Blood Pressure, Combined
Advising Smokers to Quit
Discussing Smoking Cessation Strategies
Children's Access 12-24 Months
Children's Access 25 Mos-6 Years
Children's Access 7-11 Years
Adolescents' Access 12-19 Years
Adults' Access 20-44 Years
Adults' Access 45-64 Years
2005
2006
2007
65.0%
-35.7%
1.6%
48.5%
59.3%
30.1%
74.7%
25.8%
-47.4%
-58.4%
56.7%
63.9%
60.0%
64.7%
40.5%
69.1%
62.9%
27.9%
72.1%
31.1%
37.1%
55.1%
61.0%
70.9%
64.3%
-39.2%
-67.0%
29.5%
89.0%
68.1%
70.2%
70.8%
70.3%
78.2%
72.0%
24.1%
47.9%
0.9%
45.1%
65.8%
39.6%
77.8%
28.3%
-49.2%
-65.4%
62.3%
70.8%
65.9%
81.9%
47.2%
71.0%
53.7%
33.1%
80.5%
34.5%
37.9%
81.7%
82.1%
85.8%
84.0%
-47.0%
-67.3%
32.9%
86.8%
69.9%
68.9%
67.5%
70.8%
79.8%
79.9%
51.9%
59.7%
0.9%
50.9%
72.2%
50.2%
79.7%
32.3%
40.1%
52.6%
46.1%
66.7%
64.4%
72.4%
67.7%
84.1%
50.7%
78.8%
49.9%
47.8%
74.8%
34.9%
83.4%
77.9%
75.1%
86.0%
81.2%
43.5%
44.2%
44.0%
69.9%
34.6%
90.2%
73.7%
73.8%
70.8%
74.5%
81.7%
2006–2007
Health Plan
Trend
§¨
©
©
§¨
§¨
§¨
©
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
©
§¨
§¨
©
§¨
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
Notes
A rotated measure is one for which the MHP exercised the NCQA-approved option to use the audited and reportable rate
from the prior year.
©
§¨
ª
--
= Performance improvement (rate increase >10%)*
= No significant performance change (rate change ≤10%)
= Performance decline (rate decrease >10%)*
= No data available
*For two measures—Well-Child 1st 15 Mos., 0 Visits and Diabetes Care, Poor HbA1c Control:
= Performance decline (rate increase >10%)
d
= Performance improvement (rate decrease >10%)
c
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page C-10
MI2007_HEDIS_Aggr_F1_1207
APPENDIX C. TREND TABLES
Table C-10—Michigan Medicaid HEDIS 2007 Trend Table: PMD
Dimension of Care
Pediatric Care
Women’s Care
Living With Illness
Access to Care
Measure
Childhood Immunization Combo 2
Childhood Immunization Combo 3
Adolescent Immunization Combo 2
Well-Child 1st 15 Mos, 0 Visit
Well-Child 1st 15 Mos, 6+ Visits
Well-Child 3rd-6th Years of Life
Adolescent Well-Care Visits
Appropriate Treatment of URI
Children with Pharyngitis
Breast Cancer Screening, 42-51 Years
Breast Cancer Screening, 52-69 Years
Breast Cancer Screening, Combined
Cervical Cancer Screening
Chlamydia Screening, 16-20 Years
Chlamydia Screening, 21-25 Years
Chlamydia Screening, Combined
Timeliness of Prenatal Care
Postpartum Care
Diabetes Care HbA1c Testing
Diabetes Care Poor HbA1c Control
Diabetes Care Eye Exam
Diabetes Care LDL-C Screening
Diabetes Care LDL-C Level <100
Diabetes Care Nephropathy
Asthma 5-9 Years
Asthma 10-17 Years
Asthma 18-56 Years
Asthma Combined Rate
Controlling High Blood Pressure, 18-45 Years
Controlling High Blood Pressure, 46-85 Years
Controlling High Blood Pressure, Combined
Advising Smokers to Quit
Discussing Smoking Cessation Strategies
Children's Access 12-24 Months
Children's Access 25 Mos-6 Years
Children's Access 7-11 Years
Adolescents' Access 12-19 Years
Adults' Access 20-44 Years
Adults' Access 45-64 Years
2005
2006
2007
73.0%
-64.7%
2.8%
38.1%
57.4%
37.7%
78.5%
49.3%
-57.5%
-66.2%
66.6%
64.5%
65.5%
79.6%
63.3%
84.8%
36.1%
63.3%
91.6%
42.4%
64.8%
76.5%
70.1%
74.4%
73.4%
-64.2%
-69.0%
42.8%
91.7%
78.8%
77.4%
79.1%
76.3%
84.3%
77.6%
41.6%
72.3%
1.3%
43.3%
67.6%
47.7%
79.8%
48.0%
-54.8%
-74.5%
64.4%
64.2%
64.3%
86.4%
62.5%
82.5%
34.3%
68.1%
89.8%
47.0%
64.8%
92.7%
90.3%
86.4%
89.0%
-65.4%
-74.7%
49.4%
93.2%
81.9%
80.8%
80.7%
79.6%
85.7%
82.0%
73.5%
75.4%
1.4%
49.2%
67.6%
47.7%
76.6%
59.2%
46.4%
52.4%
49.1%
68.6%
67.2%
65.7%
66.5%
85.6%
62.6%
83.0%
38.0%
67.8%
77.1%
46.0%
78.2%
90.4%
89.3%
94.5%
91.8%
62.9%
57.6%
59.4%
77.5%
48.8%
95.0%
81.2%
84.5%
81.8%
80.5%
86.1%
2006–2007
Health Plan
Trend
§¨
©
§¨
§¨
§¨
Rotated Measure
Rotated Measure
§¨
©
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
ª
§¨
©
§¨
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
Notes
A rotated measure is one for which the MHP exercised the NCQA-approved option to use the audited and reportable rate from
the prior year.
©
§¨
ª
--
=
Performance improvement (rate increase >10%)*
=
No significant performance change (rate change ≤10%)
=
Performance decline (rate decrease >10%)*
=
No data available
*For two measures—Well-Child 1st 15 Mos., 0 Visits and Diabetes Care, Poor HbA1c Control:
=
d
Performance decline (rate increase >10%)
=
c
Performance improvement (rate decrease >10%)
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page C-11
MI2007_HEDIS_Aggr_F1_1207
APPENDIX C. TREND TABLES
Table C-11—Michigan Medicaid HEDIS 2007 Trend Table: PRI
Dimension of Care
Pediatric Care
Women’s Care
Living With Illness
Access to Care
Measure
Childhood Immunization Combo 2
Childhood Immunization Combo 3
Adolescent Immunization Combo 2
Well-Child 1st 15 Mos, 0 Visit
Well-Child 1st 15 Mos, 6+ Visits
Well-Child 3rd-6th Years of Life
Adolescent Well-Care Visits
Appropriate Treatment of URI
Children with Pharyngitis
Breast Cancer Screening, 42-51 Years
Breast Cancer Screening, 52-69 Years
Breast Cancer Screening, Combined
Cervical Cancer Screening
Chlamydia Screening, 16-20 Years
Chlamydia Screening, 21-25 Years
Chlamydia Screening, Combined
Timeliness of Prenatal Care
Postpartum Care
Diabetes Care HbA1c Testing
Diabetes Care Poor HbA1c Control
Diabetes Care Eye Exam
Diabetes Care LDL-C Screening
Diabetes Care LDL-C Level <100
Diabetes Care Nephropathy
Asthma 5-9 Years
Asthma 10-17 Years
Asthma 18-56 Years
Asthma Combined Rate
Controlling High Blood Pressure, 18-45 Years
Controlling High Blood Pressure, 46-85 Years
Controlling High Blood Pressure, Combined
Advising Smokers to Quit
Discussing Smoking Cessation Strategies
Children's Access 12-24 Months
Children's Access 25 Mos-6 Years
Children's Access 7-11 Years
Adolescents' Access 12-19 Years
Adults' Access 20-44 Years
Adults' Access 45-64 Years
2005
2006
2007
88.8%
-73.2%
0.6%
52.1%
64.2%
36.7%
87.8%
76.2%
-57.4%
-81.1%
54.8%
58.7%
56.9%
86.9%
58.4%
88.8%
31.6%
58.4%
87.8%
39.4%
47.0%
75.9%
80.4%
77.2%
78.1%
-63.8%
-73.0%
35.5%
97.2%
83.4%
83.5%
82.0%
84.3%
91.7%
88.3%
56.0%
69.8%
0.7%
50.0%
61.6%
41.8%
88.6%
68.9%
-56.1%
-77.7%
51.7%
59.2%
55.7%
90.6%
66.3%
88.1%
30.7%
65.9%
91.5%
43.1%
53.8%
93.3%
95.6%
85.9%
91.1%
-68.4%
-73.4%
39.3%
96.5%
83.5%
85.1%
83.2%
86.1%
92.2%
88.7%
81.2%
78.4%
1.2%
53.5%
63.7%
43.3%
87.7%
68.9%
53.0%
57.0%
54.7%
76.0%
55.6%
62.4%
59.1%
86.8%
66.3%
89.3%
27.3%
70.6%
81.0%
39.4%
82.5%
98.3%
95.4%
88.5%
93.6%
59.1%
58.7%
58.9%
76.1%
43.3%
96.9%
83.7%
87.4%
85.5%
86.5%
93.1%
2006–2007
Health Plan
Trend
§¨
©
§¨
§¨
§¨
§¨
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
ª
§¨
©
§¨
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
Notes
A rotated measure is one for which the MHP exercised the NCQA-approved option to use the audited and reportable rate
from the prior year.
©
§¨
ª
--
= Performance improvement (rate increase >10%)*
= No significant performance change (rate change ≤10%)
= Performance decline (rate decrease >10%)*
= No data available
*For two measures—Well-Child 1st 15 Mos., 0 Visits and Diabetes Care, Poor HbA1c Control:
= Performance decline (rate increase >10%)
d
= Performance improvement (rate decrease >10%)
c
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page C-12
MI2007_HEDIS_Aggr_F1_1207
APPENDIX C. TREND TABLES
Table C-12—Michigan Medicaid HEDIS 2007 Trend Table: THC
Dimension of Care
Pediatric Care
Women’s Care
Living With Illness
Access to Care
Measure
Childhood Immunization Combo 2
Childhood Immunization Combo 3
Adolescent Immunization Combo 2
Well-Child 1st 15 Mos, 0 Visit
Well-Child 1st 15 Mos, 6+ Visits
Well-Child 3rd-6th Years of Life
Adolescent Well-Care Visits
Appropriate Treatment of URI
Children with Pharyngitis
Breast Cancer Screening, 42-51 Years
Breast Cancer Screening, 52-69 Years
Breast Cancer Screening, Combined
Cervical Cancer Screening
Chlamydia Screening, 16-20 Years
Chlamydia Screening, 21-25 Years
Chlamydia Screening, Combined
Timeliness of Prenatal Care
Postpartum Care
Diabetes Care HbA1c Testing
Diabetes Care Poor HbA1c Control
Diabetes Care Eye Exam
Diabetes Care LDL-C Screening
Diabetes Care LDL-C Level <100
Diabetes Care Nephropathy
Asthma 5-9 Years
Asthma 10-17 Years
Asthma 18-56 Years
Asthma Combined Rate
Controlling High Blood Pressure, 18-45 Years
Controlling High Blood Pressure, 46-85 Years
Controlling High Blood Pressure, Combined
Advising Smokers to Quit
Discussing Smoking Cessation Strategies
Children's Access 12-24 Months
Children's Access 25 Mos-6 Years
Children's Access 7-11 Years
Adolescents' Access 12-19 Years
Adults' Access 20-44 Years
Adults' Access 45-64 Years
2005
2006
2007
70.0%
-57.9%
6.7%
24.0%
55.6%
39.1%
73.3%
29.0%
-46.5%
-59.8%
50.1%
63.5%
56.2%
86.3%
46.9%
76.4%
47.7%
47.9%
79.6%
32.6%
56.7%
56.3%
62.9%
72.7%
65.6%
-52.1%
-71.7%
33.0%
88.2%
72.5%
71.5%
72.5%
70.6%
76.1%
71.5%
34.3%
71.2%
3.5%
35.4%
65.4%
47.9%
69.6%
29.3%
-47.1%
-67.5%
52.1%
62.8%
56.8%
87.5%
62.1%
82.4%
42.3%
53.0%
84.6%
34.5%
65.9%
76.9%
81.3%
78.1%
78.9%
-60.1%
-66.9%
32.4%
89.0%
75.9%
75.2%
75.1%
73.4%
78.9%
77.8%
62.0%
71.2%
1.2%
49.1%
65.4%
47.9%
76.3%
37.5%
43.0%
52.8%
47.6%
66.2%
61.8%
68.7%
64.6%
84.2%
57.9%
76.7%
47.0%
57.3%
72.8%
28.2%
77.6%
86.6%
80.2%
82.9%
82.8%
43.2%
40.9%
41.6%
65.6%
30.9%
91.8%
75.0%
78.3%
77.4%
74.9%
80.4%
2006–2007
Health Plan
Trend
§¨
©
Rotated Measure
§¨
©
Rotated Measure
Rotated Measure
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
ª
§¨
©
§¨
§¨
§¨
§¨
-ª
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
Notes
A rotated measure is one for which the MHP exercised the NCQA-approved option to use the audited and reportable rate from
the prior year.
©
§¨
ª
--
=
Performance improvement (rate increase >10%)*
=
No significant performance change (rate change ≤10%)
=
Performance decline (rate decrease >10%)*
=
No data available
*For two measures—Well-Child 1st 15 Mos., 0 Visits and Diabetes Care, Poor HbA1c Control:
=
d
Performance decline (rate increase >10%)
=
c
Performance improvement (rate decrease >10%)
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page C-13
MI2007_HEDIS_Aggr_F1_1207
APPENDIX C. TREND TABLES
Table C-13—Michigan Medicaid HEDIS 2007 Trend Table: UPP
Dimension of Care
Pediatric Care
Women’s Care
Living With Illness
Access to Care
Measure
Childhood Immunization Combo 2
Childhood Immunization Combo 3
Adolescent Immunization Combo 2
Well-Child 1st 15 Mos, 0 Visit
Well-Child 1st 15 Mos, 6+ Visits
Well-Child 3rd-6th Years of Life
Adolescent Well-Care Visits
Appropriate Treatment of URI
Children with Pharyngitis
Breast Cancer Screening, 42-51 Years
Breast Cancer Screening, 52-69 Years
Breast Cancer Screening, Combined
Cervical Cancer Screening
Chlamydia Screening, 16-20 Years
Chlamydia Screening, 21-25 Years
Chlamydia Screening, Combined
Timeliness of Prenatal Care
Postpartum Care
Diabetes Care HbA1c Testing
Diabetes Care Poor HbA1c Control
Diabetes Care Eye Exam
Diabetes Care LDL-C Screening
Diabetes Care LDL-C Level <100
Diabetes Care Nephropathy
Asthma 5-9 Years
Asthma 10-17 Years
Asthma 18-56 Years
Asthma Combined Rate
Controlling High Blood Pressure, 18-45 Years
Controlling High Blood Pressure, 46-85 Years
Controlling High Blood Pressure, Combined
Advising Smokers to Quit
Discussing Smoking Cessation Strategies
Children's Access 12-24 Months
Children's Access 25 Mos-6 Years
Children's Access 7-11 Years
Adolescents' Access 12-19 Years
Adults' Access 20-44 Years
Adults' Access 45-64 Years
2005
2006
2007
72.1%
-62.7%
0.9%
52.0%
58.6%
37.2%
82.1%
53.3%
-67.8%
-73.0%
43.2%
42.0%
42.7%
85.2%
53.5%
91.6%
23.9%
60.3%
92.3%
37.1%
64.0%
66.0%
70.6%
69.1%
68.8%
-73.0%
-66.2%
33.3%
97.7%
85.2%
84.0%
85.0%
83.7%
88.4%
79.4%
38.8%
70.1%
1.9%
41.6%
59.7%
37.0%
81.1%
52.3%
-70.0%
-73.0%
47.9%
45.3%
46.8%
85.2%
53.5%
91.6%
23.9%
68.6%
92.3%
37.1%
64.0%
95.1%
86.2%
86.8%
88.2%
-73.0%
-69.6%
34.7%
98.0%
88.1%
84.2%
86.9%
86.6%
91.0%
80.7%
66.6%
70.1%
1.4%
44.6%
60.9%
39.1%
81.1%
54.8%
53.5%
67.6%
60.0%
76.8%
48.4%
49.4%
48.8%
88.7%
68.8%
89.7%
27.8%
70.6%
81.7%
37.4%
81.4%
97.8%
92.5%
87.2%
91.3%
65.7%
64.3%
64.8%
72.9%
38.5%
97.7%
88.1%
87.2%
90.0%
89.5%
91.2%
2006–2007
Health Plan
Trend
§¨
©
Rotated Measure
§¨
§¨
§¨
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
©
§¨
§¨
§¨
ª
§¨
©
§¨
§¨
§¨
§¨
-§¨
-§¨
§¨
§¨
§¨
§¨
§¨
§¨
§¨
Notes
A rotated measure is one for which the MHP exercised the NCQA-approved option to use the audited and reportable rate from
the prior year.
©
§¨
ª
--
=
Performance improvement (rate increase >10%)*
=
No significant performance change (rate change ≤10%)
=
Performance decline (rate decrease >10%)*
=
No data available
*For two measures—Well-Child 1st 15 Mos., 0 Visits and Diabetes Care, Poor HbA1c Control:
=
d
Performance decline (rate increase >10%)
=
c
Performance improvement (rate decrease >10%)
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page C-14
MI2007_HEDIS_Aggr_F1_1207
Appendix D.
Glossary
Appendix D includes terms, acronyms, and abbreviations that are commonly used in HEDIS and
NCQA literature and text. This glossary can be used as a reference and guide to explain common
HEDIS language used throughout the report.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page D-1
MI2007_HEDIS_Aggr_F1_1207
APPENDIX D. GLOSSARY
Terms, Acronyms, and Abbreviations
Administrative Data
Any automated data within a health plan (e.g., claims/encounter data, member data, provider data,
hospital billing data, pharmacy data, and laboratory data).
Administrative Method
The administrative method requires health plans to identify the eligible population (i.e., the
denominator) using administrative data. In addition, the numerator(s), or services provided to the
members who are in the eligible population, are solely derived from administrative data. Medical
records cannot be used to retrieve information. When using the administrative method, the entire
eligible population becomes the denominator, and sampling is not allowed.
The administrative method is cost-efficient but can produce lower rates due to incomplete data
submission by capitated providers. For example, a health plan has 10,000 members who qualify for
the Prenatal and Postpartum Care measure. The health plan chooses to perform the administrative
method and finds that 4,000 members out of the 10,000 had evidence of a postpartum visit using
administrative data. The final rate for this measure, using the administrative method, would
therefore be 4,000/10,000, or 40 percent.
Audit Finding
The auditor’s final determination, based on audit findings, of the appropriateness of the health plan
publicly reporting its HEDIS measure rates. Each measure included in the HEDIS audit receives
either a Report, Not Applicable, No Benefit, or Not Report audit finding.
Baseline Assessment Tool (BAT) Review
The BAT, completed by each health plan undergoing the HEDIS audit process, provides
information to auditors regarding the health plan’s systems for collecting and processing data for
HEDIS reporting. Auditors review the BAT prior to the scheduled on-site health plan visit to gather
preliminary information for planning/targeting on-site visit assessment activities; determining the
core set of measures to be reviewed; determining which hybrid measures will be included in
medical record validation; requesting core measures source code, as needed; identifying areas that
require additional clarification during the on-site visit; and determining whether the core set of
measures needs to be expanded.
BRFSS
Behavioral Risk Factor Surveillance System.
CAHPS
Consumer Assessment of Healthcare Providers and Systems is a set of standardized surveys that
assess patient satisfaction with experience of care.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page D-2
MI2007_HEDIS_Aggr_F1_1207
APPENDIX D. GLOSSARY
Capitation
A method of payment for providers. Under a capitated payment arrangement, providers are
reimbursed on a per-member/per-month basis. The provider receives payment each month,
regardless of whether the member needs services or not. Therefore, there is little incentive for
providers to submit individual encounters, knowing that payment is not dependent on such
submission.
Certified HEDIS Software Vendor
A third party, whose source code has been certified by NCQA, that contracts with a health plan to
write source code for HEDIS measures. For a vendor’s software to be certified by NCQA, all of the
vendor’s programmed HEDIS measures must be submitted to NCQA for automated testing of
program logic, and a minimum of 70 percent of the measures must receive a “Pass” or “Pass with
Qualifications” designation.
Claims-Based Denominator
When the eligible population for a measure is obtained from claims data. For hybrid measures with
a claims-based denominator, health plans must identify their eligible population and draw their
sample no earlier than January of the year following the measurement year to ensure all claims
incurred through December 31 of the measurement year are captured in their systems.
CMS
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the U.S.
Department of Health and Human Services (DHHS) that regulates requirements and procedures for
external quality review of managed care organizations. CMS provides health insurance to
individuals through Medicare, Medicaid, and the State Children’s Health Insurance Program
(SCHIP). In addition, CMS regulates laboratory testing through Clinical Laboratory Improvement
Amendments (CLIA), develops coverage policies, and initiates quality-of-care improvement
activities. CMS also maintains oversight of nursing homes and continuing care providers. This
includes home health agencies, intermediate care facilities for the mentally retarded, and hospitals.
CMS 1500
A type of health insurance claim form used to bill professional services (formerly HCFA 1500).
Cohorts
Population components of a measure based on the age of the member at a particular point in time. A
separate HEDIS rate is calculated for each cohort in a measure. For example, the Children’s and
Adolescents’ Access to Primary Care Practitioners measure has four cohorts: Cohort 1, children
12–24 months of age as of December 31 of the measurement year; Cohort 2, children 25 months to
6 years of age as of December 31 of the measurement year; Cohort 3, children 7–11 years of age as
of December 31 of the measurement year; and Cohort 4, adolescents 12–19 years of age as of
December 31 of the measurement year.
Michigan Medicaid HEDIS 2007 Results Statewide Aggregate Report
State of Michigan
Page D-3
MI2007_HEDIS_Aggr_F1_1207
APPENDIX D. GLOSSARY
Computer Logic
A programmed, step-by-step sequence of instructions to perform a given task.
Continuous Enrollment Requirement
The minimum amount of time that a member must be enrolled in a health plan to be eligible for
inclusion in a measure to ensure that the health plan has a sufficient amount of time to be held
accountable for providing services to that member.
Core Set
Because of the large number of measures and the required level of assessment, the selection of a
core set of measures allows for the findings of the review to be projected to the remaining measures.
The core set of measures must include 15 measures, plus the adult and child surveys, when
applicable. In addition, the core set must focus on any health plan weaknesses identified during the
BAT review. The core set can be expanded to more than 15 measures, but cannot be less than 13
measures. Rotated measures are not included in the core set.
CPT
®
Current Procedural Terminology (CPT ) is a listing of billing codes generated by the American
Medical Association used to report the provision of medical services and procedures.
CVO
Credentials verification organization.
Data Completeness
The degree to which occurring services/diagnoses appear in the health plan’s administrative data
systems.
Data Completeness Study
An internal assessment developed and performed by a health plan, using a statistically sound
methodology, to quantify the degree to which occurring services/diagnoses appear or do not appear
in the health plan’s administrative data systems.
Denominator
The number of members who meet all criteria specified in the measure for inclusion in the eligible
population. When using the administrative method, the entire eligible population becomes the
denominator. When using the hybrid method, a sample of the eligible population becomes the
denominator.
DRG Coding
Diagnosis-related group coding sorts diagnoses and procedures for inpatient encounters by groups
under major diagnostic categories with defined reimbursement limits.
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APPENDIX D. GLOSSARY
DTaP
Diphtheria and tetanus toxoids and acellular pertussis vaccine.
DT
Diphtheria and tetanus toxoids vaccine.
EDI
Electronic data interchange is the direct, computer-to-computer transfer of data.
Electronic Data
Data that are maintained in a computer environment versus a paper environment.
Encounter Data
Billing data received from a capitated provider. Although the health plan does not reimburse the
provider for each individual encounter, submission of the encounter data to the health plan allows
the health plan to collect the data for future HEDIS reporting.
Exclusions
Conditions outlined in HEDIS measure specifications that describe when a member should not be
included in the denominator.
FACCT
Foundation for Accountability.
FFS
Fee for service: A reimbursement mechanism in which the provider is paid for services billed.
Final Audit Report
Following the health plan’s completion of any corrective actions, the written report that is
completed by the auditor documenting all final findings and results of the HEDIS audit. The final
report includes the Summary Report, IS Capabilities Assessment, Medical Record Review
Validation Findings, Measure Designations, and Audit Opinion (Final Audit Statement).
Global Billing Practices
The practice of billing multiple services provided over a period of time in one inclusive bill,
commonly used by obstetrics (OB) providers to bill prenatal and postpartum care.
HbA1c
The HbA1c test (hemoglobin A1c test or glycosylated hemoglobin test) is a lab test that reveals
average blood glucose over a period of two to three months.
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APPENDIX D. GLOSSARY
HCFA 1500
A type of claim form that was used to bill professional services. The claim form has been changed
to the CMS 1500.
HCPCS
Healthcare Common Procedure Coding System: A standardized alphanumeric coding system that
maps to certain CPT codes (see also CPT).
HEDIS
The Healthcare Effectiveness Data and Information Set (HEDIS),* developed and maintained by
NCQA, is a set of performance measures used to assess the quality of care provided by managed
health care organizations.
*Formerly the Health Plan Employer Data and Information Set.
HEDIS Measure Determination Standards (HD)
The standards that auditors use during the audit process to assess a health plan’s adherence to
HEDIS measure specifications.
HEDIS Repository
The data warehouse where all data used for HEDIS reporting are stored.
HEDIS Warehouse
See HEDIS repository.
Hib Vaccine
Haemophilus influenzae type b vaccine.
HPL
High performance level: MDCH has defined the HPL as the most recent national HEDIS Medicaid
90th percentile, except for two key measures (Well-Child Visits in the First 15 Months of Life—Zero
Visits and Comprehensive Diabetes Care—Poor HbA1c Control) for which lower rates indicate
better performance. For these two measures, the 10th percentile (rather than the 90th) shows
excellent performance.
HSAG
Health Services Advisory Group, Inc.
Hybrid Measures
Measures that can be reported using the hybrid method.
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APPENDIX D. GLOSSARY
Hybrid Method
The hybrid method requires health plans to identify the eligible population using administrative
data, and then extract a systematic sample of 411 members from the eligible population, which
becomes the denominator. Administrative data are then used to identify services provided to those
411 members. Medical records must then be reviewed for those members who do not have evidence
of a service being provided using administrative data.
The hybrid method generally produces higher results but is considerably more labor intensive. For
example, a health plan has 10,000 members who qualify for the Prenatal and Postpartum Care
measure. The health plan chooses to perform the hybrid method. After randomly selecting 411
eligible members, the health plan finds that 161 members had evidence of a postpartum visit using
administrative data. The health plan then obtains and reviews medical records for the 250 members
who did not have evidence of a postpartum visit using administrative data. Of those 250 members,
54 were found to have a postpartum visit recorded in the medical record. The final rate for this
measure, using the hybrid method, would therefore be (161 + 54) /411, or 52 percent.
ICD-9-CM
ICD-9-CM, the acronym for the International Classification of Diseases, 9th Revision, Clinical
Modification, is the classification of diseases and injuries into groups according to established
criteria that is used for reporting morbidity, mortality, and utilization rates as well as for billing
purposes.
IDSS
Interactive Data Submission System—a tool used to submit data to NCQA.
Inpatient Data
Data derived from an inpatient hospital stay.
IRR
Interrater reliability: The degree of agreement exhibited when a measurement is repeated under the
same conditions by different raters.
IS
Information system: An automated system for collecting, processing, and transmitting data.
IPV
Inactivated poliovirus vaccine.
IT
Information technology: The technology used to create, store, exchange, and use information in its
various forms.
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APPENDIX D. GLOSSARY
Key Data Elements
The data elements that must be captured to be able to report HEDIS measures.
Key Measures
The HEDIS measures selected by MDCH that health plans use for HEDIS reporting.
LDL-C
Low-density lipoprotein cholesterol.
Logic Checks
Evaluations of programming logic to determine its accuracy.
LPL
Low performance level: For most key measures, MDCH has defined the LPL as the most recent national
HEDIS Medicaid 25th percentile. For two key measures (Well-Child Visits in the First 15 Months of
Life—Zero Visits and Comprehensive Diabetes Care—Poor HbA1c Control) lower rates indicate better
performance, and the LPL for these measures is the 75th percentile rather than the 25th.
Manual Data Collection
Collection of data through a paper versus an automated process.
Mapping Codes
The process of translating a health plan’s propriety or nonstandard billing codes to industry standard
codes specified in HEDIS measures. Mapping documentation should include a crosswalk of relevant
codes, descriptions, and clinical information, as well as the policies and procedures for
implementing the codes.
Material Bias
For most measures reported as a rate (which includes all of the key measures except Advising
Smokers to Quit), any error that causes a ± 5 percent difference in the reported rate is considered
materially biased. For non-rate measures or measures collected via the CAHPS survey, (such as the
key measure Advising Smokers to Quit), any error that causes a ± 10 percent difference in the
reported rate or calculation.
MCIR
Michigan Care Improvement Registry.
MCO
Managed care organization.
MDCH
Michigan Department of Community Health.
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APPENDIX D. GLOSSARY
Medical Record Validation
The process that auditors follow to verify that the health plan’s medical record abstraction meets
industry standards and that abstracted data are accurate.
Medicaid Percentiles
The NCQA national percentiles for each HEDIS measure for the Medicaid product line, used to
compare health plan performance and assess the reliability of a health plan’s HEDIS rates.
Membership Data
Electronic health plan files containing information about members, such as name, date of birth,
gender, current address, and enrollment (i.e., when the member joined the health plan).
Mg/dL
Milligrams per deciliter.
MHP
Medicaid health plan.
Modifier Codes
Two- or five-digit extensions added to CPT
services/procedures.
®
codes to provide additional information about
MMR
Measles, mumps, and rubella vaccine.
MUPC Codes
Michigan Uniform Procedure Codes: procedure codes developed by the State of Michigan for
billing services performed.
NA
Not applicable: The health plan’s denominator for a measure was too small (i.e., less than 30) to
report a valid rate; the result/rate is NA.
NB
No benefit: The health plan did not offer the health benefits required by the measure.
NCQA
The National Committee for Quality Assurance (NCQA) is a not-for-profit organization that
assesses, through accreditation reviews and standardized measures, the quality of care provided by
managed health care delivery systems; reports results of those assessments to employers,
consumers, public purchasers, and regulators; and ultimately seeks to improve the health care
provided within the managed care industry.
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APPENDIX D. GLOSSARY
NDC
National Drug Codes used for billing pharmacy services.
NR
The Not Report HEDIS audit finding.
A measure has an NR audit finding for one of two reasons:
1. The health plan chose not to report the measure
2. The health plan calculated the measure but the result was materially biased
Numerator
The number of members in the denominator who received all the services as specified in the measure.
OPV
Oral polio vaccine.
Over-Read Process
The process of re-reviewing a sample of medical records by a different abstractor to assess the degree
of agreement between two different abstractors and ensure the accuracy of abstracted data. The overread process should be conducted by the health plan as part of its medical record review process.
Auditors overread a sample of the health plan’s medical records as part of the audit process.
PCV
Pneumococcal conjugate vaccine
Pharmacy Data
Data derived from the provision of pharmacy services.
Primary Source Verification
The practice of reviewing the processes and procedures to input, transmit, and track data from its
originating source to the HEDIS repository to verify that the originating information matches the
output information for HEDIS reporting.
Proprietary Codes
Unique billing codes developed by a health plan that have to be mapped to industry standard codes
for HEDIS reporting.
Provider Data
Electronic files containing information about physicians, such as the type of physician, specialty,
reimbursement arrangement, and office location.
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APPENDIX D. GLOSSARY
Retroactive Enrollment
The effective date of a member’s enrollment in a health plan occurs prior to the date that the health
plan is notified of that member’s enrollment. Medicaid members who are retroactively enrolled in a
health plan must be excluded from a HEDIS measure denominator if the time period from the date
of enrollment to the date of notification exceeds the measure’s allowable gap specifications.
Revenue Codes
Cost codes for facilities to bill by category, services, procedures, supplies, and materials.
Sample Frame
The eligible population that meets all criteria specified in the measure from which a systematic
sample is drawn.
Source Code
The written computer programming logic for determining the eligible population and the
denominators/numerators for calculating the rate for each measure.
Standard Codes
®
Industry standard billing codes such as ICD-9-CM, CPT , DRG, Revenue, and UB-92 codes used
for billing inpatient and outpatient health care services.
T-test Validation
A statistical validation of a health plan’s positive medical record numerator events.
UB-92 Claims
A type of claim form used to bill facility-based services (inpatient, outpatient, emergency room) as
well as drugs and supplies. UB-92 codes are primarily Type of Bill and revenue codes.
Vendor
Any third party that contracts with a health plan to perform services. The most common delegated
services are pharmacy vendors, vision care services, laboratory services, claims processing, HEDIS
software vendors, and provider credentialing.
VZV
Varicella-zoster virus (chicken pox) vaccine.
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