Sioux Valley Health Plan
Plan Name
2005
Reporting Year
Submission #
Title
General Info
1
Last Refreshed:
21
10/7/2009 2:07:15 PM
Page
Disclaimers
Effectiveness of
Care Measures
Plan ID
2
Measure
Page
Use of Services
Measures
Page
Measure
Childhood Immunization Status
3
Well-Child Visits In The First 15 Months of Life
28
Adolescent Immunization Status
5
Well-Child Visits In The Third, Fourth, Fifth And Sixth Year of Life
30
Appropriate Treatment of Children w/ Upper Respiratory Infection
7
Adolescent Well-Care Visits
31
Colorectal Cancer Screening
9
Frequency of Selected Procedures
32
Breast Cancer Screening
10
Inpatient Utilization - General Hospital/Acute Care
34
Cervical Cancer Screening
11
Ambulatory Care
37
Chlamydia Screening in Women
12
Inpatient Utilization - Nonacute Care
39
Controlling High Blood Pressure
13
Mental Health Utilization - Inpatient Discharges and Average Length of Stay
42
Beta Blocker Treatment after a Heart Attack
14
Mental Health Utilization - % of Members Receiving Inpatient and Ambulatory Services
45
Persistence of Beta Blocker Treatment after a Heart Attack
14
Chemical Dependency Utilization - Inpatient Discharges and Average Length of Stay
49
Cholesterol Management for Patients with Cardiovascular Conditions
15
Identification of Alcohol and Other Drug Services
52
Comprehensive Diabetes Care
16
Outpatient Drug Utilization
56
Use of Appropriate Medications for People with Asthma
20
Antidepressant Medication Management
26
Osteoporosis Management in Women who had a Fracture
27
Glaucoma Screening in Older Adults
27
Access /
Availability of
Care
Measure
Measure
Page
Practitioner Turnover
69
Years in Business / Total Membership
70
Page
Adults' Access to Preventive/Ambulatory Health Services
58
Children's Access to Primary Care Practitioners
62
Prenatal and Postpartum Care
64
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
66
HEDIS 2006 (Reporting Year 2005)
Health Plan
Stability
Health Plan
Descriptive
Information
Measure
Enrollment by Product Line (Age & Sex)
Page
71
DISCLAIMERS
-1
0. Disclaimer Query located below
1. In October 2009, it was discoverd that the formulas in the Inpatient Utilization: General
Hospital/Acute Care measure contained error. The formula was fixed and the data displayed now
correctly reflects the rest of the data on the sheet.
HEDIS 2006 (Reporting Year 2005)
Page 2
Effectiveness of Care
Sioux Valley Health Plan
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
HiB
Hepatitis B
VZV
Combo 3
15
6.33%
14
5.91%
23
9.70%
18
7.59%
17
7.17%
20
8.44%
7
2.95%
13
5.49%
6
2.53%
15
6.33%
14
5.91%
23
9.70%
18
7.59%
17
7.17%
20
8.44%
7
2.95%
13
5.49%
6
2.53%
15
186
84.81%
80.03%
89.59%
14
208
93.67%
90.36%
96.98%
23
196
92.41%
88.82%
95.99%
18
209
95.78%
93.01%
98.55%
17
204
93.25%
89.84%
96.65%
20
172
81.01%
75.81%
86.22%
7
66
30.80%
24.71%
36.89%
13
164
74.68%
68.94%
80.43%
6
61
28.27%
22.33%
34.21%
237
0
Number of Records Excluded because of
Contraindications by Admin Data
0
Number of Records Excluded because of
Contraindications by Medical Record
Review
0
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
HEDIS 2006 (Reporting Year 2005)
MMR
237
0.00%
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
IPV
2005
HO
N
237
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Pneumococcal
Combo 2
Conjugate
DTaP/DT
237
Page 3
Effectiveness of Care
Sioux Valley Health Plan
Childhood Immunization Status
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicaid
Data Elements
General
Measure
Data
Pneumococcal
Combo 2
Conjugate
DTaP/DT
IPV
MMR
HiB
Hepatitis B
VZV
Combo 3
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of Records Excluded because of
Contraindications by Admin Data
Number of Records Excluded because of
Contraindications by Medical Record
Review
Number of employee/dependent records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 4
Effectiveness of Care
Sioux Valley Health Plan
Adolescent Immunization Status
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
Combo 2
54
19.08%
25
8.83%
8
2.83%
3
1.06%
54
19.08%
25
8.83%
8
2.83%
3
1.06%
54
160
76.70%
71.56%
81.84%
25
63
31.54%
25.91%
37.17%
8
53
21.86%
16.83%
26.89%
3
25
10.04%
6.33%
13.74%
283
283
Number of Records Excluded because of
Contraindications by Admin Data
2
Number of Records Excluded because of
Contraindications by Medical Record Review
2
Number of employee/dependent records
excluded
0
Records Added from the Oversample List
0
HEDIS 2006 (Reporting Year 2005)
VZV
283
0.00%
Number of Records Excluded Because of
Valid Data Errors
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
Hepatitis B
2005
HO
N
283
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
MMR
279
Page 5
Effectiveness of Care
Sioux Valley Health Plan
Adolescent Immunization Status
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicaid
Data Elements
General
Measure
Data
MMR
Hepatitis B
VZV
Combo 2
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of Records Excluded because of
Contraindications by Admin Data
Number of Records Excluded because of
Contraindications by Medical Record Review
Number of employee/dependent records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 6
Effectiveness of Care
Sioux Valley Health Plan
Appropriate Treatment for Children with Upper
Respiratory Infection
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
General
Measure
Data
2005
A
Eligible Member Population
570
Numerator Events by Admin Data
37
Reported Rate
93.51%
Lower 95% Confidence Interval
91.40%
Upper 95% Confidence Interval
95.62%
HEDIS 2006 (Reporting Year 2005)
Page 7
Effectiveness of Care
Sioux Valley Health Plan
Colorectal Cancer Screening
Data Elements
Measurement Year
Data collection methodology (administrative or hybrid)
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare
Advantage
MSHO
NR
NR
NR
NR
NR
NR
Commercial
2005
A
Sampling method used (see User's Guide for entry descriptions)
Eligible population
3388
Number of numerator events by administrative data in eligible
population (before exclusions)
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of valid data
errors
Records Excluded because of contraindications through Admin
Data
Records Excluded because of contraindications through Medical
Record Review
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
1409
FOBT by administrative data*
DCBE by administrative data*
Numerator events by medical records
Flexible sigmoidoscopy by medical records*
DCBE by medical records*
Colonoscopy by medical records*
Reported rate
NR
NR
NR
Lower 95% confidence interval
NR
NR
NR
Upper 95% confidence interval
NR
NR
NR
Data Elements with an Asterisk(*) are OPTIONAL and are not used in any calculation or total
HEDIS 2006 (Reporting Year 2005)
Page 8
Effectiveness of Care
Sioux Valley Health Plan
Breast Cancer Screening
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
2005
A
1630
1179
72.33%
70.13%
74.53%
Medicare
Advantage
Medicaid
NR
NR
NR
NR
NR
NR
Page 9
Effectiveness of Care
Sioux Valley Health Plan
Cervical Cancer Screening
Data Elements
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Measurement Year
Data Collection Methodology
Sampling Method Used
2004
A
Eligible Member Population
4024
Medicaid
Numerator Events by Admin Data on Eligible
Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
78.40%
NR
NR
NR
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin Rate on FSS
Records Excluded because of Valid Data Errors
Records Excluded because of contraindications
through Admin Data
Records Excluded because of contraindications
through Medical Record Review
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
3155
#VALUE!
#VALUE!
#VALUE!
NR
NR
NR
Page 10
Effectiveness of Care
Sioux Valley Health Plan
Chlamydia Screening in Women
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
General
Measure Ages 16-20 Ages 21-25
Data
Medicaid
Total
General
Measure Ages 16-20 Ages 21-25
Data
Total
2005
A
321
72
22.43%
17.71%
27.15%
411
96
23.36%
19.15%
27.57%
732
168
22.95%
19.84%
26.07%
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 11
Effectiveness of Care
Sioux Valley Health Plan
Controlling High Blood Pressure
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Data Elements
Measurement Year
Data Collection Methodology (Hybrid)
Sampling Method Used
Eligible Member Population
Numerator Events by Admin Data on
Eligible Population (before exclusions)
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Commercial
2004
HO
S
781
0
0.00%
15.00%
427
0
0.00%
15
Records Excluded because of
contraindications through Admin Data
4
Records Excluded because of
contraindications through Medical Record
Review
0
Number of employee/dependent medical
records excluded
0
Records Added from the OverSample List
0
Numerator Events by Admin Data
Numerator Events by Medical Record
NR
371
Records Excluded because of Valid Data
Errors
Denominator
Medicare Advantage
NR
408
0
265
Reported Rate
64.95%
NR
Lower 95% Confidence Interval
60.20%
NR
Upper 95% Confidence Interval
69.70%
NR
HEDIS 2006 (Reporting Year 2005)
Page 12
Effectiveness of Care
Sioux Valley Health Plan
Beta Blocker Treatment after Heart Attack
Data Elements
Measurement Year
Data Collection Methodology
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Eligible Member Population
23
Numerator Events by Admin Data on
Eligible Population
18
Oversampling Rate
78.26%
NR
NR
NR
23
0.00%
Final Sample Size (FSS)
23
Numerator events by admin data in FSS
18
Admin rate on FSS
NR
HO
N
Minimum Required Sample Size
MSHO
2005
Sampling Method Used
Current Year's Admin Rate
Medicare Advantage
78.26%
Records Excluded because of Valid Data
Errors
0
Records Excluded because of
contraindications through Admin Data
0
Records Excluded because of
contraindications through Medical Record
Review
0
Number of employee/dependent medical
records excluded
0
Records Added from the Oversample List
0
Denominator
23
Numerator Events by Admin Data
18
Numerator Events by Medical Record
3
Reported Rate
NA
NR
NR
Lower 95% Confidence Interval
NA
NR
NR
Upper 95% Confidence Interval
NA
NR
NR
HEDIS 2006 (Reporting Year 2005)
Page 13
Effectiveness of Care
Sioux Valley Health Plan
Persistence of Beta Blocker Treatment After Hearth Attack
Data Elements
Measurement Year
Commercial
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
MSHO
2005
Data Collection Methodology
A
Eligible Member Population
10
Numerator Events by Admin Data on
Eligible Population
9
Reported Rate
NA
NR
NR
Lower 95% Confidence Interval
NA
NR
NR
Upper 95% Confidence Interval
NA
NR
NR
HEDIS 2006 (Reporting Year 2005)
Page 14
Effectiveness of Care
Sioux Valley Health Plan
Cholesterol Management for
Patients with Cardiovascular
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
4
Records Excluded because of contraindications
through Admin Data
1
Records Excluded because of contraindications
through Medical Record Review
0
Number of employee/dependent medical
records excluded
1
HEDIS 2006 (Reporting Year 2005)
LDL-C
screening
LDL-C Level of LDL-C Level of
<100 mg/dL
<130 mg/dL
53
6
7
30.81%
3.49%
4.07%
53
6
7
30.81%
3.49%
4.07%
53
80
6
81
7
104
80.12%
73.75%
86.49%
52.41%
44.51%
60.31%
66.87%
59.41%
74.33%
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
172
0.00%
172
Records Excluded because of Valid Data Errors
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
General
LDL-C Level of LDL-C Level of
Measure
<100 mg/dL
<130 mg/dL
Data
2005
HO
N
172
Numerator Events by Admin Data on Eligible
Population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
LDL-C
screening
Medicare Advantage
0
166
Page 15
Effectiveness of Care
Sioux Valley Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
HbA1c
Testing
Poor HbA1c
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<130 mg/dL
LDL-C Level
<100 mg/dL
Monitoring for
Diabetic
Nephropathy
2005
HO
S
681
2005
HO
S
681
2004
HO
S
599
2005
HO
S
681
2005
HO
S
681
2005
HO
S
681
2005
HO
S
681
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
206
30.25%
411
15%
473
206
43.55%
681
100.00%
411
15%
473
473
100.00%
178
29.72%
411
15%
473
178
37.63%
226
33.19%
411
15%
473
226
47.78%
12
1.76%
411
15%
473
12
2.54%
9
1.32%
411
15%
473
9
1.90%
133
19.53%
411
15%
473
133
28.12%
Number of Records Excluded Because of
Valid Data Errors
19
19
17
19
19
19
19
Records Excluded because of
contraindications through Admin Data
7
7
6
7
7
7
7
Records Excluded because of
contraindications through Medical Record
Review
0
0
0
0
0
0
0
Number of employee/dependent medical
records excluded
1
1
0
1
1
1
1
0
446
206
199
90.81%
88.01%
93.60%
0
446
0
97
21.75%
17.81%
25.69%
0
450
178
35
47.33%
42.61%
52.06%
0
446
226
166
87.89%
84.75%
91.03%
0
446
12
278
65.02%
60.48%
69.56%
0
446
9
173
40.81%
36.13%
45.48%
0
446
133
62
43.72%
39.01%
48.44%
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 16
Effectiveness of Care
Sioux Valley Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
Data Elements
HbA1c
Testing
Poor HbA1c
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<130 mg/dL
LDL-C Level
<100 mg/dL
Monitoring for
Diabetic
Nephropathy
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Records Excluded because of
contraindications through Admin Data
Records Excluded because of
contraindications through Medical Record
Review
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 17
Effectiveness of Care
Sioux Valley Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 2:07 PM
MSHO
Data Elements
HbA1c
Testing
Poor HbA1c
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<130 mg/dL
LDL-C Level
<100 mg/dL
Monitoring for
Diabetic
Nephropathy
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Records Excluded because of
contraindications through Admin Data
Records Excluded because of
contraindications through Medical Record
Review
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 18
Effectiveness of Care
Sioux Valley Health Plan
Comprehensive Diabetes Care
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicaid
Data Elements
HbA1c
Testing
Poor HbA1c
Control
Eye Exam
LDL-C
Screening
LDL-C Level
<130 mg/dL
LDL-C Level
<100 mg/dL
Monitoring for
Diabetic
Nephropathy
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Current Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final Sample Size (FSS)
Numerator events by admin data in FSS
Admin rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Records Excluded because of
contraindications through Admin Data
Records Excluded because of
contraindications through Medical Record
Review
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 19
Effectiveness of Care
Sioux Valley Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
General
Measure Data
Ages 5-9
Ages 10-17
Ages 18-56
Total
17
17
NA
NA
NA
33
29
87.88%
75.23%
100.00%
118
99
83.90%
76.84%
90.95%
168
145
86.31%
80.81%
91.81%
2005
A
Page 20
Effectiveness of Care
Sioux Valley Health Plan
Use of Appropriate Medications for People with Asthma
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicaid
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
General
Measure Data
Ages 5-9
NR
NR
NR
Ages 10-17
NR
NR
NR
Ages 18-56
Total
NR
NR
NR
NR
NR
NR
NR
NR
Page 21
Effectiveness of Care
Sioux Valley Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
9
12.33%
4.10%
20.56%
54
73.97%
63.22%
84.72%
51
69.86%
58.65%
81.07%
2005
A
73
Page 22
Effectiveness of Care
Sioux Valley Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 23
Effectiveness of Care
Sioux Valley Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 2:07 PM
MSHO
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 24
Effectiveness of Care
Sioux Valley Health Plan
Antidepressant Medication Management
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicaid
Data Elements
General
Measure
Data
Optimal
Practitioner
Contacts for
Medication
Management
Effective Acute
Phase
Treatment
Effective
Continuation
Phase
Treatment
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 25
Effectiveness of Care
Sioux Valley Health Plan
Osteoporosis Management in
Women Who had a Fracture
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interva
HEDIS 2006 (Reporting Year 2005)
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare
Advantage
MSHO
NR
NR
NR
NR
NR
NR
Page 26
Effectiveness of Care
Sioux Valley Health Plan
Glaucoma Screening in Older Adults
Data Elements
Measurement Year
Data Collection Methodology
Eligible Member Population
Total Exclusions
Numerator Events by Admin Data
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interva
HEDIS 2006 (Reporting Year 2005)
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare
Advantage
MSHO
NR
NR
NR
NR
NR
NR
Page 27
Use of Services
Sioux Valley Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
General
Measure
Data
Zero Visits
1 visit
2 visits
3 visits
4 visits
5 visits
6 or more
visits
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
2
2
5
8
20
57
119
0.94%
0.00%
2.47%
0.94%
0.00%
2.47%
2.35%
0.08%
4.62%
3.76%
0.97%
6.54%
9.39%
5.24%
13.54%
26.76%
20.58%
32.94%
55.87%
48.97%
62.77%
2005
A
213
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of records excluded because of
contraindications identified through
administrative data
Number of records excluded because of
contraindications identified through medical
record review
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 28
Use of Services
Sioux Valley Health Plan
Well Child Visits in the First 15 Months of Life
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicaid
Data Elements
General
Measure
Data
Zero Visits
1 visit
2 visits
3 visits
4 visits
5 visits
6 or more
visits
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Numerator events by admin data in eligible
population
Currect Year's Administrative Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Number of Records Excluded Because of
Valid Data Errors
Number of records excluded because of
contraindications identified through
administrative data
Number of records excluded because of
contraindications identified through medical
record review
Number of employee/dependent medical
records excluded
Additional Records Added from the
Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
Page 29
Use of Services
Sioux Valley Health Plan
Well Child Visits in the 3rd, 4th,
5th and 6th Years of Life
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Medicaid
2005
A
1026
Numerator events by admin data in eligible
population
Current Year's Admin Rate
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Records Excluded because of Valid Data Errors
NR
NR
NR
NR
Records Excluded - Contraindications/Admin Data
Records Excluded - Contraindications/Medical
Record Review
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
455
44.35%
41.26%
47.44%
NR
NR
NR
Page 30
Use of Services
Sioux Valley Health Plan
Adolescent Well-Care Visits
Data Elements
Measurement Year
Data Collection Methodology
Sampling Method Used
Eligible Member Population
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Medicaid
2005
A
2957
Numerator events by admin data in eligible
population
Current Year's Admin Rate
NR
NR
NR
NR
Minimum Required Sample Size
Oversampling Rate
Final sample size (FSS)
Numerator events by admin data in FSS
Administrative rate on FSS
Records Excluded because of Valid Data Errors
Records Excluded - Contraindications/Admin Data
Records Excluded - Contraindications/Medical
Record Review
Number of employee/dependent medical records
excluded
Records Added from the Oversample List
Denominator
Numerator Events by Admin Data
Numerator Events by Medical Record
Reported Rate
Lower 95% Confidence Interval
Upper 95% Confidence Interval
HEDIS 2006 (Reporting Year 2005)
759
25.67%
24.08%
27.26%
NR
NR
NR
Page 31
Use of Services
Sioux Valley Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Measurement Year
2005
Member Months
Total
Age
0-4
0-9
5-19
10-19
18909
39025
64815
44699
Total
Procedure
Myringotomy
Tonsillectomy
Age
15-44
20-44
30-64
45-64
65+
Age
0-4
5-19
0-9
10-19
Number of
Procedures
150
20
32
20
Procedures /
1,000 Member
Months
7.93
0.31
0.82
0.45
Member Months
Male
Female
68785
53056
57455
74511
40481
44503
1643
1391
Male
Procedure
Age
Dilation & Curettage 15-44
45-64
Hysterectomy,
15-44
Abdominal
45-64
65+
Hysterectomy,
15-44
Vaginal
45-64
65+
Cholecystectomy,
30-64
Open
15-44
45-64
65+
Cholecystectomy,
30-64
Closed
15-44
45-64
65+
Back Surgery
20-44
45-64
Angioplasty (PTCA) 45-64
65+
Cardiac
45-64
Catheterization
65+
CABG
45-64
65+
Prostatectomy
45-64
65+
Mastectomy
15-44
45-64
65+
Lumpectomy
15-44
45-64
65+
HEDIS 2006 (Reporting Year 2005)
Number of
Procedures
0
0
17
0
48
62
25
3
43
2
5
0
10
1
Female
Procedures /
1,000 Member
Months
Number of
Procedures
23
14
17
16
0
21
25
0
Procedures /
1,000 Member
Months
0.33
0.31
0.25
0.36
0.00
0.31
0.56
0.00
0.00
0.00
0.23
0.00
0.90
1.53
0.62
1.83
1.06
1.22
0.12
0.00
0.25
0.61
3
4
0
0.04
0.09
0.00
48
24
1
75
95
4
1
30
1
3
0
0.70
0.54
0.72
1.31
2.13
0.09
0.72
0.67
0.72
0.07
0.00
3
12
0
17
22
1
0.04
0.27
0.00
0.25
0.49
0.72
Page 32
Use of Services
Sioux Valley Health Plan
Frequency of Selected Procedures
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
Measurement Year
Age
< 65
65-74
75-84
85+
Member Months
Male
Female
Male
Procedure
CABG
Angioplasty
(PTCA)
Cardiac
Catheterization
Carotid
Endarterectomy
Reduction of
Fracture of Femur
Total Hip
Replacement
Total Knee
Replacement
Partial Excision of
Large Inestine
Cholecystectomy,
Open
Cholecystectomy,
Closed
(laparoscopic)
Hysterectomy
Abdominal
Hysterectomy,
Vaginal
Prostatectomy
Mastectomy
Lumpectomy
Age
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
<65
65-74
75-84
85+
HEDIS 2006 (Reporting Year 2005)
Number of
Procedures
Female
Procedures /
1,000 Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Number of
Procedures
Procedures /
1,000 Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 33
Use of Services
Sioux Valley Health Plan
Inpatient Utilization - General Hospital/Acute Care
Commercial
Measurement
Year
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
65-74
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 2:07 PM
2005
Member Months
3887
35138
44699
110511
84984
2907
123
4
0
282253
Discharges
Discharges /
1,000 Member
Months
43
68
75
651
523
29
5
0
0
1394
11.06
1.94
1.68
5.89
6.15
9.98
40.65
0.00
35
60
31
140
234
13
5
0
0
518
9.00
1.71
0.69
1.27
2.75
4.47
40.65
0.00
8
8
28
135
289
16
0
0
0
484
2.06
0.23
0.63
1.22
3.40
5.50
0.00
0.00
16
376
0
0
0
392
0.36
3.40
0.00
0.00
HEDIS 2006 (Reporting Year 2005)
4.94
1.84
1.71
1.61
Days
Days / 1,000
Member
Months
323
224
369
1634
1786
88
18
0
0
4442
83.10
6.37
8.26
14.79
21.02
30.27
146.34
0.00
228
178
225
363
768
37
18
0
0
1817
58.66
5.07
5.03
3.28
9.04
12.73
146.34
0.00
95
46
109
329
1018
51
0
0
0
1648
24.44
1.31
2.44
2.98
11.98
17.54
0.00
0.00
35
942
0
0
0
977
0.78
8.52
0.00
0.00
15.74
6.44
5.84
4.02
Average
Length of Stay
7.51
3.29
4.92
2.51
3.41
3.03
3.60
NA
NA
3.19
6.51
2.97
7.26
2.59
3.28
2.85
3.60
NA
NA
3.51
11.88
5.75
3.89
2.44
3.52
3.19
NA
NA
NA
3.40
2.19
2.51
NA
NA
NA
2.49
Page 34
Use of Services
Sioux Valley Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
Measurement
Year
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
65-74
Unknown
Total
Member Months
NR
Discharges
Discharges /
1,000 Member
Months
Days
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Days / 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
Average
Length of Stay
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 35
Use of Services
Sioux Valley Health Plan
Inpatient Utilization - General Hospital/Acute Care
Data Last Refreshed:
Oct 7, 2009 2:07 PM
MSHO
Measurement
Year
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Total Inpatient
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Medicine
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Surgery
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Maternity
10-19
20-44
45-64
65-74
Unknown
Total
Member Months
NR
Discharges
Discharges /
1,000 Member
Months
Days
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Days / 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
Average
Length of Stay
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 36
Use of Services
Sioux Valley Health Plan
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Measurement
Year
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
2005
Member
Months
3887
35138
44699
110511
84984
2907
123
4
0
282253
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
3476
9945
8364
24444
25221
1188
79
0
0
72717
HEDIS 2006 (Reporting Year 2005)
Visits/ 1,000
Member
Months
894.26
283.03
187.12
221.19
296.77
408.67
642.28
0.00
257.63
Emergency Room Visits
Visits
95
413
471
1172
712
22
2
0
0
2887
Visits/ 1,000
Member
Months
24.44
11.75
10.54
10.61
8.38
7.57
16.26
0.00
10.23
Ambulatory
Surgery/Procedures
Procedures
33
162
160
831
1485
86
5
0
0
2762
Procedures/
1,000 Member
Months
8.49
4.61
3.58
7.52
17.47
29.58
40.65
0.00
9.79
Observation Room Stays
Resulting in Discharge
Stays
10
41
53
127
116
3
0
0
0
350
Stays/ 1,000
Member
Months
2.57
1.17
1.19
1.15
1.36
1.03
0.00
0.00
1.24
Page 37
Use of Services
Sioux Valley Health Plan
Ambulatory Care
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
Measurement
Year
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Member
Months
NR
Outpatient Visits
(Excludes MH/CD)
Age
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Visits
NR
HEDIS 2006 (Reporting Year 2005)
Visits/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Emergency Room Visits
Visits
NR
Visits/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Ambulatory
Surgery/Procedures
Procedures
NR
Procedures/
1,000 Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Observation Room Stays
Resulting in Discharge
Stays
NR
Stays/ 1,000
Member
Months
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 38
Use of Services
Sioux Valley Health Plan
Inpatient Utilization - Nonacute Care
Commercial
Measurement
Year
Age
2005
Member
Months
<1
3887
1-9
35138
10-19
44699
20-44
110511
45-64
84984
65-74
2907
75-84
123
85+
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 2:07 PM
4
0
282253
Discharges
Discharges /
1,000 Member
Months
Days
Days / 1,000
Member
Months
Average Length
of Stay
<1
0
1-9
0
0.00
0
0.00
NA
0.00
0
0.00
NA
10-19
2
0.04
47
1.05
23.50
20-44
2
0.02
11
0.10
5.50
45-64
18
0.21
174
2.05
9.67
65-74
0
0.00
0
0.00
NA
75-84
0
0.00
0
0.00
NA
85+
0
0.00
0
0.00
NA
Unknown
Total
0
22
0.08
0
232
0.82
NA
10.55
Age
HEDIS 2006 (Reporting Year 2005)
Page 39
Use of Services
Sioux Valley Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
Measurement
Year
Age
Member
Months
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
NR
Discharges
Discharges /
1,000 Member
Months
Days
Days / 1,000
Member
Months
Average Length
of Stay
<1
NR
NR
NR
1-9
NR
NR
NR
10-19
NR
NR
NR
20-44
NR
NR
NR
45-64
NR
NR
NR
65-74
NR
NR
NR
75-84
NR
NR
NR
85+
NR
NR
NR
NR
NR
NR
Unknown
Total
NR
HEDIS 2006 (Reporting Year 2005)
NR
NR
Page 40
Use of Services
Sioux Valley Health Plan
Inpatient Utilization - Nonacute Care
Data Last Refreshed:
Oct 7, 2009 2:07 PM
MSHO
Measurement
Year
Age
Member
Months
<1
1-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
NR
Discharges
Discharges /
1,000 Member
Months
Days
Days / 1,000
Member
Months
Average Length
of Stay
<1
NR
NR
NR
1-9
NR
NR
NR
10-19
NR
NR
NR
20-44
NR
NR
NR
45-64
NR
NR
NR
65-74
NR
NR
NR
75-84
NR
NR
NR
85+
NR
NR
NR
NR
NR
NR
Unknown
Total
NR
HEDIS 2006 (Reporting Year 2005)
NR
NR
Page 41
Use of Services
Sioux Valley Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Commercial
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 2:07 PM
2005
Male
Member Months
Female
Total
26874
11844
98067
1643
0
138428
24645
11628
106161
1391
0
143825
51519
23472
204228
3034
0
282253
Discharges
Discharges /
1,000 Member
Months
Age
0-12
Days*
Average
Length of Stay
Gender
M
6
0.22
51
8.50
F
2
0.08
13
6.50
Total
8
0.16
64
8.00
M
13-17
8
0.68
49
6.13
F
12
1.03
97
8.08
Total
20
0.85
146
7.30
M
18-64
23
0.23
121
5.26
F
35
0.33
137
3.91
Total
58
0.28
258
4.45
65+
M
0
0.00
0
NA
F
0
0.00
0
NA
Total
0
0.00
0
NA
Unknown
M
0
0
NA
F
0
0
NA
Total
0
0
NA
Total
M
37
0.27
221
5.97
F
49
0.34
247
5.04
TOTAL
86
0.30
468
5.44
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 42
Use of Services
Sioux Valley Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
Discharges
Age
0-12
Discharges /
1,000 Member
Months
Days*
Average
Length of Stay
Gender
M
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
13-17
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
18-64
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
65+
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
Unknown
NR
F
NR
Total
NR
NR
NR
Total
M
NR
NR
NR
NR
F
NR
NR
NR
NR
TOTAL
NR
NR
NR
NR
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 43
Use of Services
Sioux Valley Health Plan
Mental Health Utilization Inpatient Discharges and Average Length of Stay, by Age and Sex
Data Last Refreshed:
Oct 7, 2009 2:07 PM
MSHO
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
Discharges
Age
0-12
Discharges /
1,000 Member
Months
Days*
Average
Length of Stay
Gender
M
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
13-17
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
18-64
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
65+
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
Unknown
M
NR
F
NR
Total
NR
NR
NR
Total
M
NR
NR
NR
NR
F
NR
NR
NR
NR
TOTAL
NR
NR
NR
NR
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 44
Use of Services
Sioux Valley Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Servic
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Measurement Year
2005
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
0-12
26874
11844
24645
11628
51519
23472
26874
11844
24645
11628
51519
23472
26874
11844
24645
11628
51519
23472
26874
11844
24645
11628
51519
23472
98067
1643
0
138428
106161
1391
0
143825
204228
3034
0
282253
98067
1643
0
138428
106161
1391
0
143825
204228
3034
0
282253
98067
1643
0
138428
106161
1391
0
143825
204228
3034
0
282253
98067
1643
0
138428
106161
1391
0
143825
204228
3034
0
282253
Sex
M
F
Total
M
F
Total
18-64
M
F
Total
65+
M
F
Total
Unknown
M
F
Total
M
F
Total
Male
Female
Total
Male
Member Months (Ambulatory)
Female
13-17
Total
Member Months (Day/Night)
Male
Any Mental Health Services
Age
Member Months (Inpatient)
Total
Female
Total
Male
Female
Total
Number
Percent
Inpatient Mental Health Services
Percent
Number
Day/Night Mental Health Services
Percent
Number
Ambulatory Mental Health Services
Percent
Number
105
68
173
75
83
158
298
521
819
2
3
5
0
0
0
480
675
1155
4.69%
3.31%
4.03%
7.60%
8.57%
8.08%
3.65%
5.89%
4.81%
1.46%
2.59%
1.98%
NA
NA
NA
4.16%
5.63%
4.91%
5
2
7
7
9
16
20
30
50
0
0
0
0
0
0
32
41
73
0
0
0
2
0
2
4
7
11
0
0
0
0
0
0
6
7
13
105
67
172
73
83
156
294
515
809
2
3
5
0
0
0
474
668
1142
HEDIS 2006 (Reporting Year 2005)
0.22%
0.10%
0.16%
0.71%
0.93%
0.82%
0.24%
0.34%
0.29%
0.00%
0.00%
0.00%
NA
NA
NA
0.28%
0.34%
0.31%
0.00%
0.00%
0.00%
0.20%
0.00%
0.10%
0.05%
0.08%
0.06%
0.00%
0.00%
0.00%
NA
NA
NA
0.05%
0.06%
0.06%
4.69%
3.26%
4.01%
7.40%
8.57%
7.98%
3.60%
5.82%
4.75%
1.46%
2.59%
1.98%
NA
NA
NA
4.11%
5.57%
4.86%
Page 45
Use of Services
Sioux Valley Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Servic
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
Measurement Year
Member Months (Any)
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
NR
Female
NR
Member Months (Inpatient)
Total
0-12
Sex
M
F
Total
Number
NR
13-17
M
F
Total
NR
18-64
M
F
Total
NR
65+
M
F
Total
NR
Unknown
M
F
Total
M
F
Total
NR
NR
NR
NR
Total
HEDIS 2006 (Reporting Year 2005)
Female
Total
Male
Female
Total
Member Months (Ambulatory)
Male
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Any Mental Health Services
Age
Male
Member Months (Day/Night)
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Mental Health Services
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Day/Night Mental Health Services
Number
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Ambulatory Mental Health Services
Percent
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 46
Use of Services
Sioux Valley Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Servic
Data Last Refreshed:
Oct 7, 2009 2:07 PM
MSHO
Measurement Year
Member Months (Any)
Age
Male
Female
0-12
13-17
18-64
65+
Unknown
Total
NR
NR
Member Months (Inpatient)
Total
0-12
Sex
M
F
Total
Number
NR
13-17
M
F
Total
NR
18-64
M
F
Total
NR
65+
M
F
Total
NR
Unknown
M
F
Total
M
F
Total
NR
NR
NR
NR
Total
HEDIS 2006 (Reporting Year 2005)
Female
Total
Male
Female
Total
Member Months (Ambulatory)
Male
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Any Mental Health Services
Age
Male
Member Months (Day/Night)
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Mental Health Services
Percent
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Day/Night Mental Health Services
Percent
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Ambulatory Mental Health Services
Percent
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 47
Use of Services
Sioux Valley Health Plan
Mental Health Utilization -Percent of Members Receiving Inpatient, Day/Night and Ambulatory Servic
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicaid
Measurement Year
Member Months (Any)
Age
Male
Female
0-12
13-17
18-64
65+
Unknown
Total
NR
NR
Member Months (Inpatient)
Total
0-12
Sex
M
F
Total
Number
NR
13-17
M
F
Total
NR
18-64
M
F
Total
NR
65+
M
F
Total
NR
Unknown
M
F
Total
M
F
Total
NR
NR
NR
NR
Total
HEDIS 2006 (Reporting Year 2005)
Female
Total
Male
Female
Total
Member Months (Ambulatory)
Male
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Any Mental Health Services
Age
Male
Member Months (Day/Night)
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Mental Health Services
Percent
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Day/Night Mental Health Services
Percent
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Ambulatory Mental Health Services
Percent
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 48
Use of Services
Sioux Valley Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Commercial
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Data Last Refreshed:
Oct 7, 2009 2:07 PM
2005
Male
Member Months
Female
Total
26874
11844
98067
1643
0
138428
24645
11628
106161
1391
0
143825
51519
23472
204228
3034
0
282253
Discharges
Discharges /
1,000 Member
Months
Age
0-12
Days
Average
Length of Stay
M
0
0.00
0
NA
F
0
0.00
0
NA
Total
0
0.00
0
NA
13-17
M
5
0.42
121
24.20
F
6
0.52
173
28.83
Total
11
0.47
294
26.73
18-64
M
16
0.16
263
16.44
F
19
0.18
214
11.26
Total
35
0.17
477
13.63
65+
M
0
0.00
0
NA
F
0
0.00
0
NA
Total
0
0.00
0
NA
Unknown
M
0
0
NA
F
0
0
NA
Total
0
0
NA
M
Total
21
0.15
384
18.29
F
25
0.17
387
15.48
TOTAL
46
0.16
771
16.76
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 49
Use of Services
Sioux Valley Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
Discharges
Age
0-12
Discharges /
1,000 Member
Months
Days
Average
Length of Stay
M
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
13-17
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
18-64
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
65+
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
Unknown
NR
F
NR
Total
NR
NR
NR
Total
M
NR
NR
NR
NR
F
NR
NR
NR
NR
TOTAL
NR
NR
NR
NR
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 50
Use of Services
Sioux Valley Health Plan
Chemical Dependency Utilization Inpatient Discharges and Average Length of Stay
Data Last Refreshed:
Oct 7, 2009 2:07 PM
MSHO
Measurement
Year
Age
0-12
13-17
18-64
65+
Unknown
Total
Male
Member Months
Female
Total
NR
NR
NR
NR
NR
NR
NR
NR
Discharges
Age
0-12
Discharges /
1,000 Member
Months
Days
Average
Length of Stay
M
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
13-17
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
18-64
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
M
65+
NR
NR
F
NR
NR
Total
NR
NR
NR
NR
Unknown
M
NR
F
NR
Total
NR
NR
NR
Total
M
NR
NR
NR
NR
F
NR
NR
NR
NR
TOTAL
NR
NR
NR
NR
* This table should reflect inpatient days only. Days associated with day/night or partial hospitalization
should not be included in this table.
HEDIS 2006 (Reporting Year 2005)
Page 51
Use of Services
Sioux Valley Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Measurement Year
2005
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
26874
11844
13739
19728
64600
1643
0
138428
Female
24645
11628
14112
21959
70090
1391
0
143825
Total
51519
23472
27851
41687
134690
3034
0
282253
Any Chemical Dependency
Services
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
0
0
0
6
9
15
11
8
19
15
6
21
19
17
36
0
0
0
0
0
0
51
40
91
HEDIS 2006 (Reporting Year 2005)
Percent
0.00%
0.00%
0.00%
0.61%
0.93%
0.77%
NR
NR
NA
0.67%
0.29%
0.49%
0.35%
0.29%
0.32%
0.00%
0.00%
0.00%
NA
NA
NA
0.44%
0.33%
0.39%
Member Months (Inpatient)
Male
26874
11844
13739
19728
64600
1643
0
138428
Female
24645
11628
14112
21959
70090
1391
0
143825
Total
51519
23472
27851
41687
134690
3034
0
282253
Member Months (Day/Night)
Male
26874
11844
13739
19728
64600
1643
0
138428
Female
24645
11628
14112
21959
70090
1391
0
143825
Total
51519
23472
27851
41687
134690
3034
0
282253
Member Months (Ambulatory)
Male
26874
11844
13739
19728
64600
1643
0
138428
Female
24645
11628
14112
21959
70090
1391
0
143825
Total
51519
23472
27851
41687
134690
3034
0
282253
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
0
0
0
4
5
9
2
3
5
5
3
8
10
11
21
0
0
0
0
0
0
21
22
43
Number
0
0
0
0
4
4
4
0
4
4
1
5
1
1
2
0
0
0
0
0
0
9
6
15
Number
0
0
0
5
6
11
7
6
13
8
2
10
9
10
19
0
0
0
0
0
0
29
24
53
Percent
0.00%
0.00%
0.00%
0.41%
0.52%
0.46%
NR
NR
NA
0.22%
0.15%
0.19%
0.19%
0.19%
0.19%
0.00%
0.00%
0.00%
NA
NA
NA
0.18%
0.18%
0.18%
Percent
0.00%
0.00%
0.00%
0.00%
0.41%
0.20%
NR
NR
NA
0.18%
0.05%
0.12%
0.02%
0.02%
0.02%
0.00%
0.00%
0.00%
NA
NA
NA
0.08%
0.05%
0.06%
Percent
0.00%
0.00%
0.00%
0.51%
0.62%
0.56%
NR
NR
NA
0.36%
0.10%
0.23%
0.17%
0.17%
0.17%
0.00%
0.00%
0.00%
NA
NA
NA
0.25%
0.20%
0.23%
Page 52
Use of Services
Sioux Valley Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
Measurement Year
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Any Chemical Dependency
Services
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Inpatient)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Day/Night)
Member Months (Ambulatory)
Male
Female
Male
Female
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
Number
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 53
Use of Services
Sioux Valley Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 2:07 PM
MSHO
Measurement Year
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Any Chemical Dependency
Services
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Inpatient)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Day/Night)
Member Months (Ambulatory)
Male
Female
Male
Female
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
Number
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 54
Use of Services
Sioux Valley Health Plan
Identification of Alcohol and Other Drug Services
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicaid
Measurement Year
Member Months (Any)
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Any Chemical Dependency
Services
Age
0-12
13-17
18-24
25-34
35-64
65+
Unknown
Total
Sex
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
M
F
Total
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Inpatient)
Male
Female
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Member Months (Day/Night)
Member Months (Ambulatory)
Male
Female
Male
Female
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Total
NR
NR
NR
NR
NR
NR
NR
NR
Inpatient Chemical Dependency
Services
Day/Night Chemical Dependency
Services
Ambulatory Chemical Dependency
Services
Number
Number
Number
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Percent
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 55
Use of Services
Sioux Valley Health Plan
Outpatient Drug Utilization
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Measurement
Year
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
2005
Member Months
39025
44699
110511
84984
2907
123
4
0
282253
Total Cost of
Prescriptions
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
$542,421.51
$901,076.51
$3,357,996.07
$5,923,151.66
$283,588.59
$17,276.66
$248.72
$0.00
$11,025,759.72
HEDIS 2006 (Reporting Year 2005)
Avg. Cost of
Prescriptions /
Per Member Per
Month
$13.90
$20.16
$30.39
$69.70
$97.55
$140.46
$62.18
$39.06
Total Number of
Prescriptions
12426
14490
63580
109893
5612
401
5
0
206407
Avg. Num. Of
Prescriptions /
Per Member Per
Year
3.82
3.89
6.90
15.52
23.17
39.12
15.00
8.78
Page 56
Use of Services
Sioux Valley Health Plan
Outpatient Drug Utilization
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
Measurement
Year
Age
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Age
Member Months
NR
Total Cost of
Prescriptions
0-9
10-19
20-44
45-64
65-74
75-84
85+
Unknown
Total
Avg. Cost of
Prescriptions /
Per Member Per
Month
Total Number of
Prescriptions
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
NR
Avg. Num. Of
Prescriptions /
Per Member Per
Year
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 57
Access/Availability of Care
Sioux Valley Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Data Elements
General Measure
Data
Measurement Year
Data collection methodology (Administrativ
only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Ages 20-44
Ages 45-64
Ages 65+
3330
4029
201
3142
3797
194
94.35%
93.56%
95.15%
94.24%
93.51%
94.97%
96.52%
93.73%
99.30%
2005
A
Page 58
Access/Availability of Care
Sioux Valley Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
Data Elements
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data collection methodology (Administrativ
only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Page 59
Access/Availability of Care
Sioux Valley Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 2:07 PM
MSHO
Data Elements
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data collection methodology (Administrativ
only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Page 60
Access/Availability of Care
Sioux Valley Health Plan
Adult's Access to Preventive/Ambulatory Health Services
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicaid
Data Elements
General Measure
Data
Ages 20-44
Ages 45-64
Ages 65+
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data collection methodology (Administrativ
only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Page 61
Access/Availability of Care
Sioux Valley Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Data Elements
Measurement Year
Data collection methodology (Administrativ
only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
General Measure
Data
12-24 months
25 months - 6
yrs.
7-11 yrs.
12-19 yrs.
273
1268
1005
1820
268
1113
838
1576
98.17%
96.39%
99.94%
87.78%
85.93%
89.62%
83.38%
81.03%
85.73%
86.59%
85.00%
88.19%
2005
A
Page 62
Access/Availability of Care
Sioux Valley Health Plan
Children's and Adolescents' Access to Primary Care Practitioners
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicaid
Data Elements
General Measure
Data
12-24 months
25 months - 6
yrs.
7-11 yrs.
12-19 yrs.
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data collection methodology (Administrativ
only)
Eligible member population (i.e. members who
meet all denominator criteria)
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Page 63
Access/Availability of Care
Sioux Valley Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
Timeliness of
Prenatal Care
Postpartum
Care
2005
HO
2005
HO
S
S
Eligible member population (i.e. members who meet all
denominator criteria)
328
328
Number of numerator events by administrative data in
eligible population (before exclusions)
53
186
Current year's administrative rate (before exclusions)
Measurement Year
Data collection methodology (Administrative or Hybrid)
Sampling method used (see User's Guide for entry
descriptions)
16.16%
56.71%
Minimum required sample size (MRSS) or other sample
size
328
328
Oversampling rate
Final sample size (FSS)
5%
293
5%
293
Number of numerator events by administrative data in FSS
53
186
18.09%
63.48%
Number of original sample records excluded because of
valid data errors
1
1
Number of employee/dependent medical records
excluded
2
2
0
290
53
222
0
290
186
50
94.83%
92.11%
97.55%
81.38%
76.73%
86.03%
Administrative rate on FSS
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Page 64
Access/Availability of Care
Sioux Valley Health Plan
Prenatal and Postpartum Care
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicaid
Timeliness of
Prenatal Care
Postpartum
Care
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Measurement Year
Data collection methodology (Administrative or Hybrid)
Sampling method used (see User's Guide for entry
descriptions)
Eligible member population (i.e. members who meet all
denominator criteria)
Number of numerator events by administrative data in
eligible population (before exclusions)
Current year's administrative rate (before exclusions)
Minimum required sample size (MRSS) or other sample
size
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Administrative rate on FSS
Number of original sample records excluded because of
valid data errors
Number of employee/dependent medical records
excluded
Records added from the oversample list
Denominator
Numerator events by administrative data
Numerator events by medical record
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval
HEDIS 2006 (Reporting Year 2005)
Page 65
Access/Availability of Care
Sioux Valley Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Commercial
13-17 Year Olds
Data Elements
Measurement Year
Data collection methodology
(Administrative only)
General
Measure
Data
Initiation of
AOD
Treatment
26-34 Year Olds
35-64 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
3
7
4
65+ Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Overall Rate
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement
of AOD
Treatment
2005
A
Eligible member population (i.e. members
who meet all denominator criteria)
Numerator events by administrative data
18-25 Year Olds
32
0
46
0
0
2
1
1
0
16
2
0
0
19
3
Reported rate
NA
NA
NA
NA
NA
NA
50.00%
6.25%
NA
NA
41.30%
6.52%
Lower 95% confidence interval
NA
NA
NA
NA
NA
NA
31.11%
0.00%
NA
NA
25.99%
0.00%
Upper 95% confidence interval
NA
NA
NA
NA
NA
NA
68.89%
16.20%
NA
NA
56.62%
14.74%
HEDIS 2006 (Reporting Year 2005)
Page 66
Access/Availability of Care
Sioux Valley Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
13-17 Year Olds
Data Elements
General
Measure
Data
Initiation of
AOD
Treatment
18-25 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
26-34 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
35-64 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
65+ Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Overall Rate
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement
of AOD
Treatment
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
NR
NR
NR
Reported rate
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Lower 95% confidence interval
Upper 95% confidence interval
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Numerator events by administrative data
HEDIS 2006 (Reporting Year 2005)
Page 67
Access/Availability of Care
Sioux Valley Health Plan
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Data Last Refreshed:
Oct 7, 2009 2:07 PM
MSHO
13-17 Year Olds
Data Elements
General
Measure
Data
Initiation of
AOD
Treatment
18-25 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
26-34 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
35-64 Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
65+ Year Olds
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Overall Rate
Engagement Initiation of
of AOD
AOD
Treatment
Treatment
Engagement
of AOD
Treatment
Measurement Year
Data collection methodology
(Administrative only)
Eligible member population (i.e. members
who meet all denominator criteria)
NR
Numerator events by administrative data
NR
NR
Reported rate
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Lower 95% confidence interval
Upper 95% confidence interval
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
Page 68
Health Plan Stability
Sioux Valley Health Plan
Practitioner Turnover
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
Measurement Year
Practitioner Types
Number of
Practitioners
as of
12/31/2004
Number of
Practitioners who
were not affiliated
with the plan as of
12/31/2005
Practitioner
Turnover Rate
Practitioner
Retention Rate
Primary Care
Physicians
NR
NR
Non-Physician Primary
Care Practitioners
NR
NR
HEDIS 2006 (Reporting Year 2005)
Page 69
Health Plan Stability
Sioux Valley Health Plan
Years in Business / Total Membership
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
Measurement Year
Product/Product Line
Years in Business
Members*
NR
NR
NR
NR
NR
NR
HMO (Total)
Medicaid
Commercial
Medicare (cost or risk)
Self-insured
Other
PPO (Total)
Commercial
Medicare (cost or risk)
Self-insured
Other
POS (Total)
Commercial
Medicare (cost or risk)
Self-insured
Other
NR
Total
* Total number of members in each category as of December 31, 2005
HEDIS 2006 (Reporting Year 2005)
Page 70
Health Plan Descriptive Information
Sioux Valley Health Plan
Enrollment by Product Line (Age & Sex)
Commercial
Measurement Year
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Data Last Refreshed:
Oct 7, 2009 2:07 PM
2005
Male
2028
7992
10344
11076
7308
4536
Member Months
Female
1872
7032
9780
10476
7128
4212
43284
31.24%
9216
9828
9912
11052
13080
40500
28.14%
9912
10740
11232
11628
13980
53088
38.32%
12936
12348
9180
6048
57492
39.94%
14316
13104
10560
6552
40512
29.24%
1332
252
48
24
12
0
44532
30.94%
1080
252
72
12
0
0
1668
1.20%
0
1416
0.98%
0
138552
143940
HEDIS 2006 (Reporting Year 2005)
Total
3900
15024
20124
21552
14436
8748
83784
29.66%
19128
20568
21144
22680
27060
110580
39.14%
27252
25452
19740
12600
85044
30.10%
2412
504
120
36
12
0
3084
1.09%
0
282492
Page 71
Health Plan Descriptive Information
Sioux Valley Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicare Advantage
Measurement Year
Male
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Member Months
Female
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 72
Health Plan Descriptive Information
Sioux Valley Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 2:07 PM
MSHO
Measurement Year
Male
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Member Months
Female
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 73
Health Plan Descriptive Information
Sioux Valley Health Plan
Enrollment by Product Line (Age & Sex)
Data Last Refreshed:
Oct 7, 2009 2:07 PM
Medicaid
Measurement Year
Male
<1
1-4
5-9
10-14
15-17
18-19
0-19 Subtotal
0-19 Subtotal: %
20-24
25-29
30-34
35-39
40-44
20-44 Subtotal
20-44 Subtotal: %
45-49
50-54
55-59
60-64
45-64 Subtotal
45-64 Subtotal: %
65-69
70-74
75-79
80-84
85-89
>=90
>=65 Subtotal
>=65 Subtotal: %
Age Unknown
Total
Member Months
Female
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
HEDIS 2006 (Reporting Year 2005)
Total
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
Page 74