2012 HEDIS 2012 A Detailed Data Set From the Year 2011 Commercial Product
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
Table of Contents Effectiveness of Care...3 Access/Availability...4 Satisfaction With the Experience of Care...4 Health Plan Stability...4 Use of Services...5-7 Plan Description...8 2
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 5-11 91.44% Ages 12-18 89.78% Ages 19-50 89.53% Ages 51-64 89.90% Combined 90.07% Adult BMI Assessment Adults 18-74 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 18-85 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 18-64 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 50-75 59.90% 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
Access/Availability Children s and adolescent s access to Primary Care Providers 12-24 months 98.15% 25 months - 6 years 93.90% 7-11 years 92.99% 12-19 years 87.75% Adults access to preventive/ambulatory health services Ages 20-44 93.01% Ages 45-64 95.91% Ages 65+ 97.13% 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 12-21 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
Use of Services Frequency of selected procedures Procedure Age Sex Number of procedures Procedures/1,000 members Tonsillectomy 0-9 M&F 183 6.10 10-19 M&F 111 2.82 Hysterectomy, abdominal 15-44 Female 220 3.21 45-64 Female 244 4.87 65+ Female 4 1.54 Hysterectomy, vaginal 15-44 Female 136 1.99 45-64 Female 232 4.63 65+ Female 7 2.70 Cholecystectomy, open 30-64 Male 11 0.14 15-44 Female 11 0.16 45-64 Female 12 0.24 65+ Male 4 1.20 65+ Female 0 0.00 Cholecystectomy, closed 30-64 Male 231 2.88 (Laparoscopic) 15-44 Female 385 5.62 45-64 Female 314 6.26 65+ Male 17 5.12 65+ Female 18 6.93 Back Surgery 20-44 Male 80 1.55 20-44 Female 89 1.53 45-64 Male 215 4.54 45-64 Female 165 3.29 65+ Male 19 5.72 65+ Female 18 6.93 PCI 45-64 Male 322 6.80 45-64 Female 104 2.07 65+ Male 55 16.56 65+ Female 21 8.09 Cardiac catheterization 45-64 Male 453 9.57 45-64 Female 317 6.32 65+ Male 79 23.78 65+ Female 32 12.32 Coronary Artery Bypass Graft 45-64 Male 79 1.67 45-64 Female 17 0.34 65+ Male 14 4.21 65+ Female 1 0.39 Prostatectomy 45-64 Male 122 2.58 65+ Male 20 6.02 Mastectomy 15-44 Female 47 0.69 45-64 Female 124 2.47 65+ Female 3 1.16 Lumpectomy 15-44 Female 146 2.13 45-64 Female 302 6.02 65+ Female 17 6.55 Bariatric Weight Loss Surgery 0-19 Male 7 0.20 0-19 Female 3 0.09 20-44 Male 28 0.54 20-44 Female 127 2.18 45-64 Male 17 0.36 45-64 Female 92 1.83 65+ Male 1 0.30 65+ Female 2 0.77 Use of Services 5
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 <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ 241 613 809 6,778 7,429 701 159 30 89.11 22.44 20.52 61.64 76.19 134.01 265.48 337.39 1,049 1,767 2,763 22,047 31,012 3,526 931 242 387.85 64.70 70.07 200.50 318.05 674.05 1,554.47 2,721.65 4.35 2.88 3.42 3.25 4.17 5.03 5.86 8.07 Total 16,760 59.26 63,337 223.94 3.78 Medicine <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ 225 520 491 1,973 4,281 416 97 25 83.19 19.04 12.45 17.94 43.90 79.52 161.96 281.16 815 1,440 1,660 6,711 16,759 1,883 494 135 301.33 52.72 42.10 61.03 171.88 359.96 824.82 1,518.28 3.62 2.77 3.38 3.40 3.91 4.53 5.09 5.40 Total 8,028 28.38 29,897 105.71 3.72 Surgery <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ 16 93 233 1,492 3,140 285 62 5 5.92 3.41 5.91 13.57 32.20 54.48 103.52 56.23 234 327 792 5,490 14,234 1,643 437 107 86.52 11.97 20.09 49.93 145.98 314.08 729.65 1,203.37 14.63 3.52 3.40 3.68 4.53 5.76 7.05 21.40 Total 5,326 18.83 23,264 82.25 4.37 6 Use of Services
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) 10-19 20-44 45-64 85 3,313 8 2.16 30.13 0.08 311 9,846 19 7.89 89.54 0.19 3.66 2.97 2.88 Total 3,406 13.80 10,176 41.22 2.99 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 <1 1-9 10-19 20-44 45-64 65-74 75-84 85+ 32,530 117,797 100,607 348,495 507,549 39,432 6,546 1,071 12,027.36 4,312.91 2,551.55 3,169.34 5,205.30 7,538.02 10.929.73 12,044.99 1,274 8,123 8,546 30,036 20,190 1,126 200 51 471.04 297.41 216.74 273.16 207.06 215.25 333.94 573.57 Total 1,154,027 4,080.28 69,546 245.89 Use of Services 7
Plan Description Member enrollment by age and sex Age Male Female Total <1 1-4 5-9 10-14 15-17 18-19 1,420 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 8,509 0-19 Subtotal 0-19 Subtotal % 35,621 25.81% 33,826 23.35% 69,447 24.55% 20-24 25-29 30-34 35-39 40-44 10,289 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 26,548 20-44 Subtotal 20-44 Subtotal % 51,685 37.46% 58,273 40.23% 109,958 38.88% 45-49 50-54 55-59 60-64 14,173 13,494 11,270 8,421 15,146 14,252 12,078 8,672 29,319 27,746 23,348 17,093 45-64 Subtotal 45-64 Subtotal % 47,359 34.32% 50,148 34.62% 97,506 34.48% 65-69 70-74 75-79 80-84 85-89 >=90 2,225 712 257 87 32 10 1,748 547 188 67 35 12 3,972 1,259 445 154 67 22 >=65 Subtotal >=65 Subtotal % 3,322 2.41% 2,597 1.79% 5,919 2.09% Total 137,987 144,844 282,830 8 Plan Description
2012 HEDIS 2012 AvMed Health Plans Corporate Offices 9400 South Dadeland Blvd. Miami, FL 33156 305-671-5437 4300 NW 89th Blvd. Gainesville, FL 32606 352-372-8400 Visit our Web Site: w w w. a v m e d. o r g MP-5871(4/13)