# SNP HEDIS 2012 (Summary) Documentation for Reporting Year 2011

## General Information

This documentation presents (1) a description of each of the Special Needs Plan (SNP) HEDIS measures that CMS collected for 370 SNP plan benefit packages (PBPs) for health care provided in calendar year 2011 to Medicare SNP beneficiaries and (2) the location of the rates associated with each SNP HEDIS measure within the HEDIS workbook (HEDIS2012_SNP.XLS). CMS took the description and additional information for each measure from HEDIS 2012 Volume 2: Technical Specifications. This release contains only those rates, percentages, or averages for each measure and not the numerator or denominator used to create those measures.

CMS requires that all managed care organizations undergo an audit on all HEDIS measures. The summary data file includes all submitted data following the audit.

The HEDIS measure descriptions reprinted here are done so with the permission of the National Committee for Quality Assurance (NCQA). HEDIS is a registered trademark of NCQA, and a copyright for HEDIS 2012 is held by the National Committee for Quality Assurance, 1100 13th Street, NW, Suite 1000, Washington, DC 20005. All rights reserved.

## Medicare SNP HEDIS Reporting

The reporting unit for SNP HEDIS is the PBP. Each Medicare Advantage contract must have at least one PBP; many contracts offer more than one. SNP PBPs limit enrollment to special needs individuals, i.e., those who are dual-eligible, institutionalized, or have one or more severe or disabling chronic conditions. In 2012, CMS collected data from 226 Medicare Advantage contracts for health care delivered by 370 SNP PBPs in 2011.

The "Service_Area" sheet in the SNP HEDIS workbook identifies the state(s) and counties where services are offered for that PBP.

## HEDIS Technical Specifications

The description and related information provided for each measure in this documentation are taken from the HEDIS 2012 Technical Specifications, which are the specific instructions for calculating HEDIS measures that NCQA provides to Medicare managed care plans. For each measure, the Technical Specifications detail the precise method for sampling (when appropriate), identification of the numerator and denominator, measure calculation, and any other important considerations specific to that measure. The Technical Specifications also contain general guidelines that apply to all measures, such as the use of medical records and when a plan should not report a measure because its eligible membership is too small. Some measures require more detailed specifications than others.

## Missing Values

The HEDIS guidelines distinguish between three different types of missing values in the rate field: Not Applicable (NA), No Benefit (NB) and Not Reportable (NR). Health plans report NA when they: do not have a large enough population to calculate a representative rate (e.g., many measures require that rates be based on at least 30 members) or are not eligible for a measure (e.g., a health plan cannot calculate outpatient drug utilization if it does not offer an outpatient drug benefit; a health plan cannot calculate a measure requiring a year of continuous enrollment if its first enrollment began mid-way through the reporting year.) A value of NB is recorded when the health plan did not offer the health benefit required by the measure (e.g., Mental Health/Chemical Dependency). Health plans report NR when: they choose not to calculate and report a rate, or the health plans HEDIS Compliance Auditor determines that a rate is materially biased (applicable only to audited measures).

For measures reported as a percentage, material bias is defined as a deviation of more than five percentage points from the true rate. For other measures (e.g., procedures per 1,000 member years), material bias exists if the number of counted procedures deviates by more than ten percent from the true number of procedures.

##

## Suppression for Small Number

Under the Privacy Act, CMS cannot publish or otherwise disclose the data in a form raising unacceptable possibilities that an individual could be identified (i.e., the data must not be beneficiary-specific and must be aggregated to a level where no data cells have 10 or fewer beneficiaries). To ensure that no beneficiary can be identified, CMS has chosen not to report certain measures, specifically enrollment by age category, and has suppressed an extremely small number of rates. CMS has replaced suppressed rates with an NA.' Please see the section on missing values above for an explanation of missing value designations.

## Additional Variables

CMS includes our record of enrollment as of December of the measurement year in the "GENERAL" sheet in the HEDIS workbook. The HEDIS reported value is adjusted for individuals with partial-year enrollment and reflects the entire contract's enrollment as well as the PBP enrollment.

We have included the Post Balanced Budget Amendment Naming of plan types as well as indicators if the contract offered a Special Needs benefit package or a Part D drug benefit in 2011. These values and others can be found on the sheet named "GENERAL". The full list of fields included on this sheet is described later in this document.

There is a separate sheet called "Service Area" in the SNP HEDIS workbook which contains the contract, state(s) and counties served by the PBPs reporting HEDIS. There is an additional field "EGHP" which indicates if the county is available only to beneficiaries in Employer Groups.

## National Enrollment Weighted Average Score

CMS has calculated and included a weighted national average for all of the Effectiveness of Care (EOC) measures. These rates are reported on a separate sheet called "National Rates" in the SNP HEDIS workbook. The rate for each of the EOC measures was calculated using the following formula:

((En1/TotE)*Sn1)+((En2/TotE)*Sn2)++((Enx/TotE)*Snx)=National Enrollment Weighted Average Score

Where: TotE = Total enrollment for all PBPs with a valid numeric rate in the measure
En1 = Enrollment in the first PBP with a valid numeric rate
Sn1 = Reported rate for the first PBP with a valid numeric rate
Enx = Enrollment in the last PBP with a valid numeric rate
Snx = Reported rate for the last PBP with a valid numeric rate

#### General - General Information

DESCRIPTION - General organization Information. These fields are not explicitly identified in the HEDIS Technical Specifications.

##### REPORTING LEVEL - N/A

General-0010 Type of Organization (Local CCP, 1876 Cost, etc.)

General-0011 Type of Plan (Post Balanced Budget Amendment Naming)

General-0014 Offers Special Needs Plans to beneficiaries (Yes or No)

General-0015 Offers Part D benefits (Yes or No)

General-0020 Line of Business (HMO, POS, etc.)

General-0050 12/2010 Contract Enrollment as reported by the Medicare Advantage Prescription Drug (MARx) system

General-0060 CMS Region Number

General-0070 CMS Region Name

General-0080 Patient Population

General-0090 Plan Benefit Package Identifier

General-0095 Plan Benefit Package Marketing Name

General-0100 Special Needs Plan Benefit Package Indicator (Yes or No)

General-0105 Type of Special Needs Plan Benefit Package

General-0110 Does the Plan Benefit Package offer drugs (Yes or No)

General-0115 Is the Plan Benefit Package offered to Employer Groups (Yes or No)

General-0120 The number of Non-Special Needs Plan Benefit Packages offered by the contract

General-0125 The number of Special Needs Plan Benefit Packages offered by the contract

General-0130 The total number of Plan Benefit Packages offered by the contract

General-0135 Full SNP - all Plan Benefit Packages offered by the contract are Special Needs Plans) (Yes or No)

General-0140 12/2010 Enrollment in the Plan Benefit Package as reported by the Medicare Advantage Prescription Drug (MARx) system

#### Service_Area - Contract Service Area

DESCRIPTION - The area where the contract provides services to Medicare care beneficiaries. This data comes from the Health Plan Management System (HPMS) as reported by the contract.

##### REPORTING LEVEL - N/A

SA-0005 Plan Benefit Package Identifier

SA-0030 Social Security Administration (SSA) State/County Code

SA-0040 American National Standards Institute (ANSI) State/County Code INCITS 31-2009 (formerly Federal Information Processing Standard [FIPS] State/County Codes)

SA-0050 State Abbreviation (United States Postal Service (USPS) State Code)

SA-0060 County Name

SA-0070 County serves only beneficiaries in an Employer Group Health Plan (Y = Yes, N = No)

#### National_Rates - National Rates

CMS has calculated and included a weighted national average for all of the Effectiveness of Care (EOC) measures. These rates are reported on a separate sheet called "National Rates" in the HEDIS workbook. The rate for each of the EOC measures was calculated using the following formula:

((En1/TotE)*Sn1)+((En2/TotE)*Sn2)+...+((Enx/TotE)*Snx)=National Weighted Average Score

Where:

TotE = Total enrollment for all contracts with a valid numeric rate in the measure

En1 = Enrollment in the first contract with a valid numeric rate

Sn1 = Reported rate for the first contract with a valid numeric rate

Enx = Enrollment in the last contract with a valid numeric rate

Snx = Reported rate for the last contract with a valid numeric rate

##### REPORTING LEVEL - National

NR-010 Measure from the SNP HEDIS Public Use File for which the national rate has been calculated

NR-020 Field from the SNP HEDIS Public Use File for which the national rate has been calculated

NR-030 The national rate for this measure and field

NR-040 The number of contracts that submitted a numeric SNP HEDIS rate for this measure and field

NR-050 The total number of enrollees in the contracts that submitted a numeric SNP HEDIS rate for this measure and field

#### EOC010 - Followup after Hospitalization for Mental Illness

DESCRIPTION - The percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental health disorders and who had an outpatient visit, an intensive outpatient encounter or partial hospitalization with a mental health practitioner. Two rates are reported.

1 - The percentage of discharges for which the member received follow-up within 30 days of discharge

2 - The percentage discharges for which the member received follow-up within 7 days of discharge

(HEDIS 2012, Volume 2: Technical Specification, Pg. 186)

##### REPORTING LEVEL - Contract

EOC010-0011 Rate - 7 Days

EOC010-0012 Rate - 30 Days

EOC010-0021 Upper Confidence Interval - 7 Days

EOC010-0022 Upper Confidence Interval - 30 Days

EOC010-0031 Lower Confidence Interval - 7 Days

EOC010-0032 Lower Confidence Interval - 30 Days

#### EOC030 - Antidepressant Medication Management

DESCRIPTION - The percentage of members 18 years of age and older who were diagnosed with a new episode of major depression and treated with antidepressant medication, and who remained on an antidepressant medication treatment. Two rates are reported.

Effective Acute Phase Treatment. The percentage of newly diagnosed and treated members who remained on an antidepressant medication for at least 84 days (12 weeks).

Effective Continuation Phase Treatment. The percentage of newly diagnosed and treated members who remained on an antidepressant medication for at least 180 days (6 months).

(HEDIS 2012, Volume 2: Technical Specifications, Pg. 176)

##### REPORTING LEVEL - Contract

EOC030-0010 Rate - Effect.Continuation Phase Treat.

EOC030-0020 Lower Confidence Interval - Effect.Continuation Phase Treat.

EOC030-0030 Upper Confidence Interval - Effect.Continuation Phase Treat.

EOC030-0040 Rate - Effect.Acute Phase Treatment

EOC030-0050 Lower Confidence Interval - Effect.Acute Phase Treatment

EOC030-0060 Upper Confidence Interval - Effect.Acute Phase Treatment

#### EOC035 - Controlling High Blood Pressure

DESCRIPTION - The percentage of members 1885 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled (<140/90) during the measurement year. Use the Hybrid Method for this measure. (HEDIS 2012, Volume 2: Technical Specification, Pg. 136)

##### REPORTING LEVEL - Contract

EOC035-0100 Rate - Total

EOC035-0110 Lower Confidence Interval tot

EOC035-0120 Upper Confidence Interval tot

#### EOC040 - Colorectal Cancer Screening

DESCRIPTION - The percentage of members 5075 years of age who had appropriate screening for colorectal cancer. (HEDIS 2012, Volume 2: Technical Specification, Pg. 84)

##### REPORTING LEVEL - Contract

EOC040-0010 Reported Rate

EOC040-0020 Lower Confidence Interval

EOC040-0030 Upper Confidence Interval

#### EOC045 - Osteoporosis Management in Women Who Had a Fracture

DESCRIPTION - The percentage of women 67 years of age and older who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat or prevent osteoporosis in the six months after the fracture. (HEDIS 2012, Volume 2: Technical Specification, Pg. 168)

##### REPORTING LEVEL - Contract

EOC045-0010 Reported rate

EOC045-0020 Lower Confidence Interval

EOC045-0030 Upper Confidence Interval

#### EOC050 - Glaucoma Screening in Older Adults

DESCRIPTION - The percentage of Medicare members 65 years and older who received a glaucoma eye exam by an eye care professional for early identification of glaucomatous conditions. (HEDIS 2012, Volume 2: Technical Specification, Pg. 92)

##### REPORTING LEVEL - Contract

EOC050-0010 Reported Rate

EOC050-0020 Lower Confidence Interval

EOC050-0030 Upper Confidence Interval

#### EOC055 - Persistence of Beta-Blocker Treatment After a Heart Attack

DESCRIPTION - The percentage of members 18 years of age and older during the measurement year who were hospitalized and discharged alive from July 1 of the year prior to the measurement year to June 30 of the measurement year with a diagnosis of AMI and who received persistent beta-blocker treatment for six months after discharge. (HEDIS 2012, Volume 2: Technical Specification, Pg. 141)

##### REPORTING LEVEL - Contract

EOC055-0010 Reported rate

EOC055-0020 Lower Confidence Interval

EOC055-0030 Upper Confidence Interval

#### EOC070 - Use of High-Risk Medications in the Elderly

DESCRIPTION - The percentage of Medicare members 65 years of age and older who received at least one high-risk medication.

The percentage of Medicare members 65 years of age and older who received at least two different high- risk medications.

For both rates, a lower rate represents better performance.

(HEDIS 2012, Volume 2: Technical Specification, Pg. 205)

##### REPORTING LEVEL - Contract

EOC070-0010 Rate - one prescription

EOC070-0020 Lower Confidence Interval - one prescription

EOC070-0030 Upper Confidence Interval - one prescription

EOC070-0040 Rate - at least 2 prescriptions

EOC070-0050 Lower Confidence Interval - at least 2 prescriptions

EOC070-0060 Upper Confidence Interval - at least 2 prescriptions

#### EOC075 - Annual Monitoring for Patients on Persistent Medications

DESCRIPTION - The percentage of members 18 years of age and older who received at least 180 treatment days of ambulatory medication therapy for a select therapeutic agent during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year. For each product line, report each of the four rates separately and as a total rate.

Annual monitoring for members on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB)

Annual monitoring for members on digoxin

Annual monitoring for members on diuretics

Annual monitoring for members on anticonvulsants

Total rate (the sum of the four numerators divided by the sum of the four denominators)

(HEDIS 2012, Volume 2: Technical Specification, Pg. 190)

##### REPORTING LEVEL - Contract

EOC075-0010 Reported rate - ACE inhibitors or ARBs

EOC075-0020 Lower Confidence Interval - ACE inhibitors or ARBs

EOC075-0030 Upper Confidence Interval - ACE inhibitors or ARBs

EOC075-0040 Reported rate - Digoxin

EOC075-0050 Lower Confidence Interval - Digoxin

EOC075-0060 Upper Confidence Interval - Digoxin

EOC075-0070 Reported rate - Diuretics

EOC075-0080 Lower Confidence Interval - Diuretics

EOC075-0090 Upper Confidence Interval - Diuretics

EOC075-0100 Reported rate - Anticonvulsants

EOC075-0110 Lower Confidence Interval - Anticonvulsants

EOC075-0120 Upper Confidence Interval - Anticonvulsants

EOC075-0160 Rate - Total

EOC075-0170 Lower Confidence Interval - Total

EOC075-0180 Upper Confidence Interval - Total

#### EOC080 - Use of Spirometry Testing in the Assessment and Diagnosis of COPD

DESCRIPTION - The percentage of members 40 years of age and older with a new diagnosis of COPD or newly active COPD, who received appropriate spirometry testing to confirm the diagnosis. (HEDIS 2012, Volume 2: Technical Specification, Pg. 115)

##### REPORTING LEVEL - Contract

EOC080-0010 Reported rate

EOC080-0020 Lower Confidence Interval

EOC080-0030 Upper Confidence Interval

#### EOC090 - Potentially Harmful Drug-Disease Interactions in the Elderly

DESCRIPTION - The percentage of Medicare members 65 years of age and older who have evidence of an underlying disease, condition or health concern and who were dispensed an ambulatory prescription for a contraindicated medication, concurrent with or after the diagnosis.

Report each of the three rates separately and as a total rate.

A history of falls and a prescription for tricyclic antidepressants, antipsychotics or sleep agents

Dementia and a prescription for tricyclic antidepressants or anticholinergic agents

CRF and prescription for nonaspirin NSAIDs or Cox-2 Selective NSAIDs

Total rate (the sum of the three numerators divided by the sum of the three denominators)

Members with more than one disease or condition may appear in the measure multiple times (i.e., in each indicator for which they qualify). A lower rate represents better performance for all three rates.

(HEDIS 2012, Volume 2: Technical Specification, Pg. 199)

##### REPORTING LEVEL - Contract

EOC090-0010 Rate - DDI Falls + Tricyclic Antidepress or Antipsych

EOC090-0020 Lower Confidence Interval - DDI Falls + Tricyclic Antidepress or Antipsych

EOC090-0030 Upper Confidence Interval - DDI Falls + Tricyclic Antidepress or Antipsych

EOC090-0040 Rate - DDI Dementia + Tricyclic Antidepress or Anticholl

EOC090-0050 Lower Confidence Interval - DDI Dementia + Tricyclic Antidepress or Anticholl

EOC090-0060 Upper Confidence Interval - DDI Dementia + Tricyclic Antidepress or Anticholl

EOC090-0070 Rate - DDI Chronic Renal Failure + Non Asp NSAIDs or Cox-2

EOC090-0080 Lower Confidence Interval - DDI Chronic Renal Failure + Non Asp NSAIDs or Cox-2

EOC090-0090 Upper Confidence Interval - DDI Chronic Renal Failure + Non Asp NSAIDs or Cox-2

EOC090-0100 Rate - Total

EOC090-0110 Lower Confidence Interval - Total

EOC090-0120 Upper Confidence Interval - Total

#### EOC105 - Pharmacotherapy Management of COPD Exacerbation

DESCRIPTION - The percentage of COPD exacerbations for members 40 years of age and older who had an acute inpatient discharge or ED encounter on or between January 1November 30 of the measurement year and who were dispensed appropriate medications. Two rates are reported.

1. Dispensed a systemic corticosteroid within 14 days of the event

2. Dispensed a bronchodilator within 30 days of the event

Note: The eligible population for this measure is based on acute inpatient discharges and ED visits, not on members. It is possible for the denominator to include multiple events for the same individual.

(HEDIS 2012, Volume 2: Technical Specification, Pg. 118)

##### REPORTING LEVEL - Contract

EOC105-0010 Reported rate - Systemic corticosteroid

EOC105-0020 Lower 95% confidence interval - Systemic corticosteroid

EOC105-0030 Upper 95% confidence interval - Systemic corticosteroid

EOC105-0040 Reported rate - Bronchodilator

EOC105-0050 Lower 95% confidence interval - Bronchodilator

EOC105-0060 Upper 95% confidence interval - Bronchodilator

#### EOC115 - Care for Older Adults

DESCRIPTION - The percentage of adults 66 years and older who had each of the following during the measurement year.

Advance care planning

Medication review

Functional status assessment

Pain screening

(HEDIS 2012, Volume 2: Technical Specification, Pg. 94)

##### REPORTING LEVEL - Plan Benefit Package

EOC115-0010 Reported Rate - Advance Care Planning

EOC115-0020 Lower Confidence Interval - Advance Care Planning

EOC115-0030 Upper Confidence Interval - Advance Care Planning

EOC115-0040 Reported Rate - Medication Review

EOC115-0050 Lower Confidence Interval - Medication Review

EOC115-0060 Upper Confidence Interval - Medication Review

EOC115-0070 Reported Rate - Functional Status Assessment

EOC115-0080 Lower Confidence Interval - Functional Status Assessment

EOC115-0090 Upper Confidence Interval - Functional Status Assessment

EOC115-0100 Reported Rate - Pain Screening

EOC115-0110 Lower Confidence Interval - Pain Screening

EOC115-0120 Upper Confidence Interval - Pain Screening

#### EOC120 - Medication Reconciliation Post-Discharge

DESCRIPTION - The percentage of discharges from January 1 - December 1 of the measurement year for members 66 years of age and older for whom medications were reconciled on or within 30 days of discharge.

(HEDIS 2012, Volume 2: Technical Specification, Pg. 196)

##### REPORTING LEVEL - Plan Benefit Package

EOC120-0010 Reported Rate

EOC120-0020 Lower Confidence Interval

EOC120-0030 Upper Confidence Interval

#### PDI801 - Board Certification/Residency Completion

DESCRIPTION - The percentage of the following physicians whose board certification is active as of December 31 of the measurement year.

Family medicine physicians

Internal medicine physicians

Pediatricians

OB/GYN physicians

Geriatricians

Other physician specialists

Board certification refers to the various specialty certification programs of the American Board of Medical Specialties and the American Osteopathic Association. Report each product separately as of December 31 of the measurement year.

(HEDIS 2012, Volume 2: Technical Specification, Pg. 377)

##### REPORTING LEVEL - Contract

PDI801-0010 Family Medicine Board Cert Pct

PDI801-0030 Oth Specialists Board Cert Pct

PDI801-0050 Geriatricians Board Cert Pct

PDI801-0060 Internal Medicine Board Cert Pct

#### UOS524 - Plan All-Cause Readmissions

DESCRIPTION - For members 18 years of age and older, the number of acute inpatient stays during the measurement year that were followed by an acute readmission for any diagnosis within 30 days and the predicted probability of an acute readmission. Data are reported in the following categories:

1. Count of Index Hospital Stays (IHS) (denominator)

2. Count of 30-Day Readmissions (numerator)

3. Average Adjusted Probability of Readmission

(HEDIS 2012, Volume 2: Technical Specification, Pg. 317)

##### REPORTING LEVEL - Contract

UOS524-0010 Count of Index Stays (Denominator) Total 65-74 Num

UOS524-0020 Count of 30-Day readmissions (Numerator) Total 65-74 Num

UOS524-0025 Observed Readmission (Num/Den) Total 65-74

UOS524-0030 Average Adjusted Probability Total 65-74 Num

UOS524-0035 Total Variance Total 65-74

UOS524-0040 Count of Index Stays (Denominator) Total 75-84 Num

UOS524-0050 Count of 30-Day readmissions (Numerator) Total 75-84 Num

UOS524-0055 Observed Readmission (Num/Den) Total 75-84

UOS524-0060 Average Adjusted Probability Total 75-84 Num

UOS524-0065 Total Variance Total 75-84

UOS524-0070 Count of Index Stays (Denominator) Total 85+ Num

UOS524-0080 Count of 30-Day readmissions (Numerator) Total 85+ Num

UOS524-0085 Observed Readmission (Num/Den) Total 85+

UOS524-0090 Average Adjusted Probability Total 85+ Num

UOS524-0095 Total Variance Total 85+

UOS524-0100 Count of Index Stays (Denominator) Total Total Num

UOS524-0110 Count of 30-Day readmissions (Numerator) Total Num

UOS524-0120 Observed Readmission (Num/Den) Total Total

UOS524-0130 Average Adjusted Probability Total Total Num

UOS524-0140 Total Variance Total Total

UOS524-0150 Observed-to-Expected Ratio

UOS524-0160 Lower Confidence Interval

UOS524-0170 Upper Confidence Interval