A Detailed Data Set From the Year 2011

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1 2012 HEDIS 2012 A Detailed Data Set From the Year 2011 Commercial Product

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3 We are pleased to present the AvMed HEDIS 2012 Report, a detailed data set designed to give employers and consumers an objective look at how we re keeping members well and how we re caring for members when they re sick. The National Committee for Quality Assurance developed HEDIS (Healthcare Effectiveness Data and Information Set) as a framework for health plans to collect, analyze and report identical performance measurements each year. In fact, more than 90 percent of America s health plans utilize HEDIS to measure performance on important dimensions of care and service. Quality health care can be defined as the extent to which members get the care they need in a manner that most effectively protects or restores their health. The performance measures in HEDIS are related to many significant public health issues such as cancer, heart disease, smoking, asthma and diabetes. HEDIS allows objective assessment of a health plan s value in comparison with other health plans. HEDIS has gone a long way in showing employers how their employees will be treated in various areas of health care services. Choosing a highquality health plan plays a significant role in determining whether employees will get high-quality care. The scope of the NCQA HEDIS Compliance Audit includes the following domains: Effectiveness of Care; Access/Availability of Care; Satisfaction with the Experience of Care; Health Plan Stability; Use of Services; Cost of Care; and, Health Plan Descriptive Information. AvMed Health Plans has undergone a Full Audit. 1

4 Table of Contents Effectiveness of Care...3 Access/Availability...4 Satisfaction With the Experience of Care...4 Health Plan Stability...4 Use of Services Plan Description...8 2

5 Effectiveness of Care Childhood immunization status 4 DTaP by 2nd birthday 85.64% 3 IPV by 2nd birthday 91.48% 1 MMR between 1st and 2nd birthday 91.48% 3 HiB by 2nd birthday 94.16% 2 Hep A by 2nd birthday 33.58% 3 HepB by 2nd birthday 90.51% 2 or 3 Rotavirus by 2nd birthday 70.56% 2 Influenza by 2nd birthday 35.52% 1 VZV between 1st and 2nd birthday 92.21% 4 Pneumococcal conjugate 85.89% Combo 2 (DTaP, IPV, MMR, HiB, Hep B, VZV) 78.10% Combo 3 (All of Combo 2 plus pneumococcal conjugate) 75.18% Immunizations for Adolescents Meningococcal between 11th and 13th birthday 61.81% Tdap/TD between 10th and 13th birthday 86.68% Combo 1 (Meningococcal & Tdap/TD) 61.06% Appropriate testing for children with pharyngitis Children, ages 2-18, diagnosed with pharyngitits and on an antibiotic who received a group A strep test 86.32% Appropriate treatment for children with URI Children, ages 3 months to 18 years, with a diagnosis of upper respiratory infection who were not dispensed an antibiotic 85.34% Appropriate asthma medication management Ages % Ages % Ages % Ages % Combined 90.07% Adult BMI Assessment Adults who had their body mass index (BMI) documented during an outpatient visit 38.44% Breast cancer screening Women, continuously enrolled for 2 years, who have received a mammogram within a two-year period 70.83% Cervical cancer screening Women ages 21-64, continuously enrolled for three years, who have received a Pap test within a three-year period 79.10% Comprehensive diabetes care HbA1c testing 84.67% HbA1c poor control (>9.0%) 30.17% HbA1c control (<8.0%) 60.83% Eye exam 44.04% LDL-C screening 82.73% LDL-C level <100 mg/dl 40.39% Monitoring for diabetic nephropathy 80.78% Blood pressure controlled <140/80 mm Hg 33.82% Blood pressure controlled <140/90 mm Hg 54.74% Antidepressant medication management Effective acute phase treatment 56.38% Effective continuation phase treatment 38.73% Follow-up After Hospitalization for Mental Illness Received follow-up within 7 days of discharge 31.57% Received follow-up within 30 days of discharge 52.92% Controlling High Blood Pressure Adults with hypertension who controlled blood pressure to <140/90 mm HG 56.46% Cholesterol management after acute cardiovascular events LDL-C screening during the year following the event 89.29% LDL-C level <100 mg/dl during the year following the event 58.39% Persistent beta blocker treatment after a heart attack 72.88% Avoidance of antibiotic treatment in adults with acute bronchitis Adults diagnosed with acute bronchitis who were not dispensed an antibiotic 26.48% Use of spirometry testing in the assessment and diagnosis of COPD Ages 40 and older with new diagnosis of, or newly active, COPD who received spirometry testing to confirm the diagnosis 42.44% Pharmacotherapy management of COPD exacerbation Use of systemic corticosteroid 73.33% Use of bronchodilator 77.04% Disease modifying anti-rheumatic drug therapy in rheumatoid arthritis Ages 18 and older diagnosed with rheumatoid arthritis and have a prescription for a disease modifying anti-rheumatic drug (DMARD) 81.92% Use of imaging studies for low back pain Percentage of members who were diagnosed with low back pain who did not have X-ray, MRI or CT scan 66.93% Colorectal cancer screening Ages % Annual monitoring for patients on persistent medications Ages 18 and older who have at least a 180 days supply of the medication and at least one monitoring test for the medication ACE inhibitors or ARBs 83.19% Digoxin 85.02% Diuretics 83.57% Anti-convulsants 61.90% TOTAL 83.03% Effectiveness of Care 3

6 Access/Availability Children s and adolescent s access to Primary Care Providers months 98.15% 25 months - 6 years 93.90% 7-11 years 92.99% years 87.75% Adults access to preventive/ambulatory health services Ages % Ages % Ages % Prenatal and postpartum care Timely prenatal care in first trimester 95.83% Postpartum care between 21 and 56 days after delivery 83.84% Well-child visits in the first 15 months of life Six visits or more 80.69% Five visits 9.84% Four visits 4.87% Three visits 2.12% Two visits 0.90% One visit 0.74% No visits 0.85% Well-child visits in the third, fourth, fifth and sixth years of life Percentage of children aged 3-6 receiving one or more visits during the year 76.66% Adolescent well-care visits Percentage of adolescents aged with one or more visits during the year 45.09% Satisfaction With the Experience of Care The following results are from the National Committee for Quality Assurance s standardized member satisfaction survey, administered by DSS Research, an independent vendor. Participants responding usually and always Doctors communicate well 93.87% Easy to get care quickly 82.41% Claims processing efficient 92.52% Customer service at AvMed N/A Getting needed care 82.05% Participants who rated AvMed 8, 9, or 10 on a 10-point scale with 10 being highest Overall satisfaction with AvMed 74.36% Health Plan Stability Total membership Product/product line members* HMO total 274,322 Commercial 245,788 Medicare 28,534 POS total 29,571 Commercial 29,571 Medicare 0 TOTAL 303,893 *Enrollment as of Dec. 31, 2011 Call answer timeliness/abandonment Percentage of calls that were answered by a live voice within 30 seconds 71.40% Percentage of calls that were abandoned by the caller before being answered by a live voice 4.02% 4 Satisfaction, Call Answer, Health Plan Stability, Access/Availability

7 Use of Services Frequency of selected procedures Procedure Age Sex Number of procedures Procedures/1,000 members Tonsillectomy 0-9 M&F M&F Hysterectomy, abdominal Female Female Female Hysterectomy, vaginal Female Female Female Cholecystectomy, open Male Female Female Male Female Cholecystectomy, closed Male (Laparoscopic) Female Female Male Female Back Surgery Male Female Male Female Male Female PCI Male Female Male Female Cardiac catheterization Male Female Male Female Coronary Artery Bypass Graft Male Female Male Female Prostatectomy Male Male Mastectomy Female Female Female Lumpectomy Female Female Female Bariatric Weight Loss Surgery 0-19 Male Female Male Female Male Female Male Female Use of Services 5

8 Use of Services Inpatient utilization - general hospital/acute care Inpatient type Age Discharges Discharges/ Days Days/ Average length 1,000 members 1,000 members of stay Inpatient < ,778 7, ,049 1,767 2,763 22,047 31,012 3, , , Total 16, , Medicine < ,973 4, ,440 1,660 6,711 16,759 1, , Total 8, , Surgery < ,492 3, ,490 14,234 1, , Total 5, , Use of Services

9 Use of Services Inpatient utilization - general hospital/acute care (cont.) Inpatient type Age Discharges Discharges/ Days Days/ Average length 1,000 members 1,000 members of stay Maternity (includes gynecology) , , Total 3, , Ambulatory care: excludes mental health and chemical dependency Outpatient visits procedures Emergency room visits resulting in discharge Age Visits Visits/ Visits Visits/ 1,000 members 1,000 members < , , , , ,549 39,432 6,546 1,071 12, , , , , , , ,274 8,123 8,546 30,036 20,190 1, Total 1,154,027 4, , Use of Services 7

10 Plan Description Member enrollment by age and sex Age Male Female Total < ,420 5,872 8,138 9,673 6,250 4,267 1,284 5,571 7,731 9,022 5,975 4,242 2,705 11,443 15,870 18,696 12,225 8, Subtotal 0-19 Subtotal % 35, % 33, % 69, % ,289 8,531 9,151 11,051 12,663 10,770 10,132 11,182 12,305 13,885 21,059 18,663 20,332 23,356 26, Subtotal Subtotal % 51, % 58, % 109, % ,173 13,494 11,270 8,421 15,146 14,252 12,078 8,672 29,319 27,746 23,348 17, Subtotal Subtotal % 47, % 50, % 97, % >=90 2, , ,972 1, >=65 Subtotal >=65 Subtotal % 3, % 2, % 5, % Total 137, , ,830 8 Plan Description

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12 2012 HEDIS 2012 AvMed Health Plans Corporate Offices 9400 South Dadeland Blvd. Miami, FL NW 89th Blvd. Gainesville, FL Visit our Web Site: w w w. a v m e d. o r g MP-5871(4/13)

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