# HEDIS 3.0 (Summary) Documentation for Reporting Year 1996

## General Information

This documentation presents (1) a description of each HEDIS® measure that CMS collected for 288 Medicare managed care contract markets on health care provided in calendar year 1996 to Medicare beneficiaries and (2) the location of the rates associated with each HEDIS measure within the HEDIS workbook (HEDIS1997.XLS). CMS took the description and additional information for each measure from HEDIS 3.0/1997 Volume II: Technical Specifications. This first release contains only those rates, percentages, or averages for each measure and not the numerator or denominator used to create those measures. CMS has made minor modifications to the original data. CMS confirmed that all reported rates are commensurate with the HEDIS general guidelines. For example, the HEDIS guidelines advise plans to report "not applicable" for measures that rely on a small number of observations, and CMS appropriately suppressed these rates. CMS also added two variables to the database. A brief discussion of each issue identified here appears below.

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® 3.0 is held by the National Committee for Quality Assurance, 2000 L Street, NW, Suite 500, Washington, DC 20036. All rights reserved.

## The Medicare HEDIS reporting unit is a "contract market"

In 1997, CMS collected 288 HEDIS submissions from Medicare managed care plans for health care delivered in 1996. The reporting unit for CMS is a "contract market." CMS signs contracts with health plans to provide health care for a given geographic area. A contract market is usually the entire contract area. However, CMS did not believe that HEDIS results would adequately represent local health care when a contract covers a large geographic region with high enrollment. For this reason, CMS broke large contracts covering several areas with high enrollment into smaller "market areas" containing at least 5,000 beneficiaries. The 288 submissions by contract market represent 266 contracts. The "GENERAL" sheet in the HEDIS workbook identifies the state and counties for each submission. If the submission is a "market area," the city designation appears next to the state. For example, the state variable for a contract in Oregon with two market areas might appear as "OR: Portland" and "OR: Eugene."

CMS collected most data at the contract market level. However, some reported information, such as financial data reflects the health plan, which could administer several contracts. This documentation indicates the reporting level for each measure.

## CMS copied the description of each measure from the HEDIS Technical Specifications

The description and related information provided for each measure in this documentation are taken from the HEDIS 3.0 Technical Specifications for 1997, 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. As opposed to the Beta Blocker measure described below, the calculation of the measure for the number of years a plan has had a commercial product is fairly straightforward. The technical specifications necessary to produce HEDIS measures are available from NCQA in HEDIS 3.0/1997, Volume 2: Technical Specifications."

The specifications for Beta Blocker Treatment After Heart Attack demonstrate the extent of detailed instructions provided for many measures. For this measure, the specifications describe the unit of measurement (members vs. procedures or discharges); data sources used to identify the numerator and denominator (membership, claims/encounter, hospital discharge, and pharmacy data); the period of time under consideration (the reporting year); age ranges for member inclusion in the measure (35 and older); diagnosis codes to identify acute myocardial infarction (AMI); diagnosis codes to identify exclusions for beta blocker; a list of beta blocker prescriptions; appropriate sample size if the plan chooses to use a sample; and other instructions, such as the appropriate interpretation of two AMI episodes for an individual member.

## HEDIS Guidelines identify two types of missing values: NA and NR

The HEDIS guidelines distinguish between two different types of missing values: Not Applicable (NA) and Not Reported (NR). Plans report NA when they do not have enough members to calculate a representative rate (n<30) or when they are not eligible for a measure, e.g. a plan cannot calculate outpatient drug utilization if it does not offer an outpatient drug benefit. Plans report NR (or leave a measure blank) when they choose not to calculate and report a rate. However, the criteria for reporting NA vs. NR were not consistently communicated or applied in report year 1996. This undermines the ability of missing value designations to accurately represent the appropriate reason for failing to report. In this data set, missing value designations should be considered suggestive and not definitive.

## CMS suppressed a small number of rates to meet privacy requirements.

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 reported enrollment by age category, and has suppressed an extremely small number of rates. CMS has replaced suppressed rates with a ‘NA.' Please see the section on missing values above for an explanation of missing value designations.

## CMS has added variables to the HEDIS data.

Two additional variables proved useful in our assessment of the data. We included our record of enrollment as of December 1996 in the "GENERAL" sheet in the HEDIS workbook. Unlike CMS's record of enrollment, HEDIS reported enrollment is adjusted for individuals with partial-year enrollment. Both CMS's enrollment and HEDIS reported enrollment reflect the entire contract and are not broken down by market area. We also identified those plans with four or more years previous experience reporting HEDIS data in the "GENERAL" sheet in the HEDIS workbook. We used this information in our internal analysis, which is presented in the accompanying report (report.wpd). CMS collected data on the number of years a health plan had reported HEDIS through the preliminary assessment of all plans completed as part of CMS's audit.

We have also changed the way we are reporting the area served by each contract. The states served by each contract used to be reported within every measure. Since this data is constant for the measurement year and the size of the areas covered by each contract have increased dramatically, we have moved the area served into its own separate reports. You will find a separate sheet called "Service Area" in the HEDIS workbook which contains the contract, state(s) and counties served by the contracts reporting HEDIS. There is additional field "EGHP" which indicates if the county is available only to beneficiaries in Employer Groups. The old "Service State" field in each measure now just lists the Market Area served by the contract for the contracts still reporting by market area.

## 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 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 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

### Measure Measure Name/Measure Description/Field Name/Field Description

#### AOC201 – Adults' Access to Preventive/Ambulatory Health Services

DESCRIPTION - The percentage of Medicare risk members age 20 through 44, 45 through 64 and 65 years and older who have had an ambulatory or preventive care visit during the reporting year. Enrollees who have had no more than one break in enrollment of up to 45 days per year should be included in this measure. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 69)

##### REPORTING LEVEL - Contract Market

AOC201-0010 Rate (Ages 20-44)

AOC201-0020 Rate (Ages 45-64)

AOC201-0030 Rate (Ages 65 and older)

#### AOC205 – Availability of Primary Care Providers

DESCRIPTION - Reports to be made separately by payer (Medicare risk) as of December 31 of the reporting year will indicate the number and percentage of primary care providers who: serve members of each population, accept new members with no restrictions, accept new members with some restrictions, accept no new members. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 75)

##### REPORTING LEVEL - Contract Market

AOC205-0010 Primary care providers currently serving this population

AOC205-0020 Primary care providers with no restrictions on number of new plan members accepted

AOC205-0030 Primary care providers with some restrictions on number of new plan members accepted

AOC205-0040 Primary care providers with no new plan members accepted

#### AOC206 – Availability of Mental Health/Chemical Dependency Providers

DESCRIPTION - Reports to be made separately by payer (Medicare risk) as of December 31 of the reporting year will indicate the number and percentage of mental health/chemical dependency providers who: serve members of each population, accept new members with no restrictions, accept new members with some restrictions, accept no new members. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 77)

##### REPORTING LEVEL - Contract Market

AOC206-0010 Mental health/chemical dependency providers currently serving this population

AOC206-0020 Mental health/chemical dependency providers with no restrictions on number of new plan members accepted

AOC206-0030 Mental health/chemical dependency providers with some restrictions on number of new plan members accepted

AOC206-0040 Mental health/chemical dependency providers with no new plan members accepted

#### AOC209a – Availability of Language Interpretation Services

DESCRIPTION - A description of out-of-plan interpreter services secured during the reporting year for Medicare risk members. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 97)

##### REPORTING LEVEL - Contract Market

AOC209-0010 Out-of-Plan interpreter services secured during the reporting year - Language 1 (Language)

AOC209-0020 Out-of-Plan interpreter services secured during the reporting year - Language 1 (Interpreter Services)

AOC209-0030 Out-of-Plan interpreter services secured during the reporting year - Language 1 (Description)

AOC209-0040 Out-of-Plan interpreter services secured during the reporting year - Language 1 (Type of Agreement)

AOC209-0050 Out-of-Plan interpreter services secured during the reporting year - Language 1 (Restrictions on Availability)

AOC209-0060 Out-of-Plan interpreter services secured during the reporting year - Language 2 (Language)

AOC209-0070 Out-of-Plan interpreter services secured during the reporting year - Language 2 (Interpreter Services)

AOC209-0080 Out-of-Plan interpreter services secured during the reporting year - Language 2 (Description)

AOC209-0090 Out-of-Plan interpreter services secured during the reporting year - Language 2 (Type of Agreement)

AOC209-0100 Out-of-Plan interpreter services secured during the reporting year - Language 2 (Restrictions on Availability)

AOC209-0110 Out-of-Plan interpreter services secured during the reporting year - Language 3 (Language)

AOC209-0120 Out-of-Plan interpreter services secured during the reporting year - Language 3 (Interpreter Services)

AOC209-0130 Out-of-Plan interpreter services secured during the reporting year - Language 3 (Description)

AOC209-0140 Out-of-Plan interpreter services secured during the reporting year - Language 3 (Type of Agreement)

AOC209-0150 Out-of-Plan interpreter services secured during the reporting year - Language 3 (Restrictions on Availability)

AOC209-0160 Out-of-Plan interpreter services secured during the reporting year - Language 4 (Language)

AOC209-0170 Out-of-Plan interpreter services secured during the reporting year - Language 4 (Interpreter Services)

AOC209-0180 Out-of-Plan interpreter services secured during the reporting year - Language 4 (Description)

AOC209-0190 Out-of-Plan interpreter services secured during the reporting year - Language 4 (Type of Agreement)

AOC209-0200 Out-of-Plan interpreter services secured during the reporting year - Language 4 (Restrictions on Availability)

AOC209-0210 Out-of-Plan interpreter services secured during the reporting year - Language 5 (Language)

### Measure Measure Name/Measure Description/Field Name/Field Description

AOC209-0220 Out-of-Plan interpreter services secured during the reporting year - Language 5 (Interpreter Services)

AOC209-0230 Out-of-Plan interpreter services secured during the reporting year - Language 5 (Description)

AOC209-0240 Out-of-Plan interpreter services secured during the reporting year - Language 5 (Type of Agreement)

AOC209-0250 Out-of-Plan interpreter services secured during the reporting year - Language 5 (Restrictions on Availability)

AOC209-0260 Out-of-Plan interpreter services secured during the reporting year - Language 6 (Language)

AOC209-0270 Out-of-Plan interpreter services secured during the reporting year - Language 6 (Interpreter Services)

AOC209-0280 Out-of-Plan interpreter services secured during the reporting year - Language 6 (Description)

AOC209-0290 Out-of-Plan interpreter services secured during the reporting year - Language 6 (Type of Agreement)

AOC209-0300 Out-of-Plan interpreter services secured during the reporting year - Language 6 (Restrictions on Availability)

AOC209-0310 Out-of-Plan interpreter services secured during the reporting year - Language 7 (Language)

AOC209-0320 Out-of-Plan interpreter services secured during the reporting year - Language 7 (Interpreter Services)

AOC209-0330 Out-of-Plan interpreter services secured during the reporting year - Language 7 (Description)

AOC209-0340 Out-of-Plan interpreter services secured during the reporting year - Language 7 (Type of Agreement)

AOC209-0350 Out-of-Plan interpreter services secured during the reporting year - Language 7 (Restrictions on Availability)

AOC209-0360 Out-of-Plan interpreter services secured during the reporting year - Language 8 (Language)

AOC209-0370 Out-of-Plan interpreter services secured during the reporting year - Language 8 (Interpreter Services)

AOC209-0380 Out-of-Plan interpreter services secured during the reporting year - Language 8 (Description)

AOC209-0390 Out-of-Plan interpreter services secured during the reporting year - Language 8 (Type of Agreement)

AOC209-0400 Out-of-Plan interpreter services secured during the reporting year - Language 8 (Restrictions on Availability)

AOC209-0410 Out-of-Plan interpreter services secured during the reporting year - Language 9 (Language)

AOC209-0420 Out-of-Plan interpreter services secured during the reporting year - Language 9 (Interpreter Services)

AOC209-0430 Out-of-Plan interpreter services secured during the reporting year - Language 9 (Description)

AOC209-0440 Out-of-Plan interpreter services secured during the reporting year - Language 9 (Type of Agreement)

AOC209-0450 Out-of-Plan interpreter services secured during the reporting year - Language 9 (Restrictions on Availability)

AOC209-0460 Out-of-Plan interpreter services secured during the reporting year - Language 10 (Language)

AOC209-0470 Out-of-Plan interpreter services secured during the reporting year - Language 10 (Interpreter Services)

AOC209-0480 Out-of-Plan interpreter services secured during the reporting year - Language 10 (Description)

AOC209-0490 Out-of-Plan interpreter services secured during the reporting year - Language 10 (Type of Agreement)

AOC209-0500 Out-of-Plan interpreter services secured during the reporting year - Language 10 (Restrictions on Availability)

#### COC601 – Rate Trends

DESCRIPTION - An effective managed care organization is expected to control the rate of increase in premiums. This measure provides information on a health plan's actual expenses per member month (PMPM) and prospective rate trend assumptions for the reporting year and the two preceding years. Purchasers may compare the predicted increase in the cost to deliver health care (I.e., prospective rate trend assumptions) to actual costs incurred by the plan. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 211)

##### REPORTING LEVEL - Contract

COC601-0010 Actual expense PMPM (1994)

COC601-0020 Actual expense PMPM (1995)

COC601-0030 Actual expense PMPM (1996)

COC601-0040 % change (1994)

COC601-0050 % change (1995)

COC601-0060 % change (1996)

COC601-0070 Rate trend (1994)

COC601-0080 Rate trend (1995)

COC601-0090 Rate trend (1996)

#### COC602 – High-Occurrence/High-Cost DRGs

DESCRIPTION - Discharges per 1,000 members per year, average cost per discharge and average length of stay are reported for six high-occurrence/high-cost DRGs for the Medicare risk population. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 213)

##### REPORTING LEVEL - Contract

COC602-0010 DRG 127: Heart failure (Discharges Per 1000 Member Years)

COC602-0020 DRG 127: Heart failure (Average Cost/Discharge)

COC602-0030 DRG 127: Heart failure (Average Length of Stay)

COC602-0040 DRG 140: Angina pectoris (Discharges Per 1000 Member Years)

COC602-0050 DRG 140: Angina pectoris (Average Cost/Discharge)

COC602-0060 DRG 140: Angina pectoris (Average Length of Stay)

### Measure Measure Name/Measure Description/Field Name/Field Description

COC602-0070 Cardiac (Subtotal) (Discharges Per 1000 Member Years)

COC602-0080 Cardiac (Subtotal) (Average Cost/Discharge)

COC602-0090 Cardiac (Subtotal) (Average Length of Stay)

COC602-0100 DRG 89: Simple Pneumonia and pleurisy s/CC (Discharges Per 1000 Member Years)

COC602-0110 DRG 89: Simple Pneumonia and pleurisy s/CC (Average Cost/Discharge)

COC602-0120 DRG 89: Simple Pneumonia and pleurisy s/CC (Average Length of Stay)

COC602-0130 DRG 88: Chronic obstructive pulmonary disease (Discharges Per 1000 Member Years)

COC602-0140 DRG 88: Chronic obstructive pulmonary disease (Average Cost/Discharge)

COC602-0150 DRG 88: Chronic obstructive pulmonary disease (Average Length of Stay)

COC602-0160 Respiratory (Subtotal) (Discharges Per 1000 Member Years)

COC602-0170 Respiratory (Subtotal) (Average Cost/Discharge)

COC602-0180 Respiratory (Subtotal) (Average Length of Stay)

COC602-0190 DRG 14: Specific cerebrovascular disorders except TIA (Discharges Per 1000 Member Years)

COC602-0200 DRG 14: Specific cerebrovascular disorders except TIA (Average Cost/Discharge)

COC602-0210 DRG 14: Specific cerebrovascular disorders except TIA (Average Length of Stay)

COC602-0220 DRG 209: Major joint and limb reattachment (Discharges Per 1000 Member Years)

COC602-0230 DRG 209: Major joint and limb reattachment (Average Cost/Discharge)

COC602-0240 DRG 209: Major joint and limb reattachment (Average Length of Stay)

COC602-0250 Cerebrovascular & Reattachment Procedures (Subtotal) (Discharges Per 1000 Member Years)

COC602-0260 Cerebrovascular & Reattachment Procedures (Subtotal) (Average Cost/Discharge)

COC602-0270 Cerebrovascular & Reattachment Procedures (Subtotal) (Average Length of Stay)

#### EOC003 – Breast Cancer Screening

DESCRIPTION - The percentage of Medicare risk women age 52 through 69 years, who were continuously enrolled during the reporting year and the preceding year, and who had a mammogram during the reporting year or the preceding year. Members who have had no more than one break in enrollment of up to 45 days per year should be included in this measure. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 30)

##### REPORTING LEVEL - Contract Market

EOC003-0010 Rate

EOC003-0020 Lower 95% confidence interval

EOC003-0030 Upper 95% confidence interval

#### EOC008 – Beta Blocker Treatment

DESCRIPTION - The percentage of Medicare risk members age 35 years and older during the reporting year, who were hospitalized and discharged alive during the reporting year with a diagnosis of acute myocardial infarction (AMI) and who received a prescription for beta blockers upon discharge. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 54)

##### REPORTING LEVEL - Contract Market

EOC008-0010 Rate

EOC008-0020 Lower 95% confidence interval

EOC008-0030 Upper 95% confidence interval

#### EOC009 – Eye Exams for Diabetes

DESCRIPTION - The percentage of Medicare risk members with diabetes (Type I and Type II) age 31 years and older, who were continuously enrolled during the reporting year, and who had a retinal examination during the reporting year. Enrollees who have had no more than one break in enrollment of up to 45 days during the reporting year should be included in this measure. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 56)

##### REPORTING LEVEL - Contract Market

EOC009-0010 Rate

EOC009-0020 Lower 95% confidence interval

EOC009-0030 Upper 95% confidence interval

### Measure Measure Name/Measure Description/Field Name/Field Description

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

DESCRIPTION - The percentage of Medicare risk members age six years and older who were hospitalized for treatment of selected mental health disorders who were continuously enrolled without breaks for 30 days after discharge, and who were seen on an ambulatory basis or were in day/night treatment within 30 days of hospital discharge. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 64)

##### REPORTING LEVEL - Contract Market

EOC010-0010 Rate

EOC010-0020 Lower 95% confidence interval

EOC010-0030 Upper 95% confidence interval

#### GENERAL – General Information

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

##### REPORTING LEVEL - N/A

GENERAL-0010 Type of Plan (Risk, Cost)

GENERAL-0020 Line of Business (HMO, POS)

GENERAL-0030 Model Type (Group, IPA, Mixed, Network, Other, Staff)

GENERAL-0040 Plan has submitted HEDIS data for 4 or more years (Yes, No)

GENERAL-0050 1996 Enrollment as Reported by HCFA's Plan Information Control System (PICS)

GENERAL-0060 HCFA Region Number

GENERAL-0070 HCFA Region Name

GENERAL-0080 Patient Population

GENERAL-0090 Tax Status

GENERAL-0100 Number of Hospitals

GENERAL-0110 Alternate Plan Name

GENERAL-0120 Plan Short Name

#### HPS401 – Disenrollment

DESCRIPTION - This measure provides information on the number of health plan members who disenrolled during the reporting year. The disenrollment rate is reported in the aggregate by payer (Medicare risk). (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 109)

##### REPORTING LEVEL - Contract Market

HPS401-0010 Disenrollment

#### HPS402 – Provider Turnover

DESCRIPTION - The following two percentages should be reported for Medicare risk:

The percentage of primary care physicians affiliated with the health plan as of December 31 of the year preceding the reporting year who were NOT affiliated with the plan as of December 31 of the reporting year.

The percentage of non-physician primary care providers affiliated with the health plan as of December 31 of the year preceding the reporting year who were NOT affiliated with the plan as of December 31 of the reporting year.

(HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 111)

##### REPORTING LEVEL - Contract Market

HPS402-0010 Provider Turnover- Primary Care Physicians

HPS402-0020 Provider Turnover- Non-Physicians Primary Care Providers

#### HPS403 – Years In Business/Total Membership

DESCRIPTION - This table reports the number of years since licensure (I.e., the number of years each product line has existed) and the number of members enrolled as of December 31 of the reporting year. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 116)

##### REPORTING LEVEL - Contract Market

HPS403-0010 HMO Total (Years In Business)

HPS403-0020 HMO Medicaid (Years In Business)

HPS403-0030 HMO Commercial (Years In Business)

HPS403-0040 HMO Medicare Risk (Years In Business)

HPS403-0050 HMO Medicare Cost (Years In Business)

HPS403-0060 HMO Self-insured (Years In Business)

HPS403-0070 HMO Other (Years In Business)

### Measure Measure Name/Measure Description/Field Name/Field Description

HPS403-0080 PPO Total (Years In Business)

HPS403-0090 PPO Commercial (Years In Business)

HPS403-0100 PPO Medicare Risk (Years In Business)

HPS403-0110 PPO Medicare Cost (Years In Business)

HPS403-0120 PPO Self-insured (Years In Business)

HPS403-0130 PPO Other (Years In Business)

HPS403-0140 POS Total (Years In Business)

HPS403-0150 POS Commercial (Years In Business)

HPS403-0160 POS Medicare Risk (Years In Business)

HPS403-0170 POS Medicare Cost (Years In Business)

HPS403-0180 POS Self-insured (Years In Business)

HPS403-0190 POS Other (Years In Business)

HPS403-0200 Total Product Lines/Payers (Years In Business)

HPS403-0210 HMO Total (Members)

HPS403-0220 HMO Medicaid (Members)

HPS403-0230 HMO Commercial (Members)

HPS403-0240 HMO Medicare Risk (Members)

HPS403-0250 HMO Medicare Cost (Members)

HPS403-0260 HMO Self-insured (Members)

HPS403-0270 HMO Other (Members)

HPS403-0280 PPO Total (Members)

HPS403-0290 PPO Commercial (Members)

HPS403-0300 PPO Medicare Risk (Members)

HPS403-0310 PPO Medicare Cost (Members)

HPS403-0320 PPO Self-insured (Members)

HPS403-0330 PPO Other (Members)

HPS403-0340 POS Total (Members)

HPS403-0350 POS Commercial (Members)

HPS403-0360 POS Medicare Risk (Members)

HPS403-0370 POS Medicare Cost (Members)

HPS403-0380 POS Self-insured (Members)

HPS403-0390 POS Other (Members)

HPS403-0400 Total Product Lines/Payers (Members)

#### HPS404 – Indicators of Financial Stability

DESCRIPTION - This measure presents information commonly used to evaluate the financial stability of a health plan. The financial profiles and specific results of different plans are dependent on the type of operations involved (e.g., staff model HMO versus and IPA). For each measure, the description of the financial indicator, the definition of the financial indicator, the NAIC report location for the financial indicator (NAIC Annual Statement HMO-Association Edition, revised 1995), and the range by which to evaluate the financial indicator are provided. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 118)

##### REPORTING LEVEL - Legal Entity

HPS404-0010 Total membership (1994)

HPS404-0020 Total membership (1995)

HPS404-0030 Total membership (1996)

HPS404-0040 Total membership (Change from 1995 to 1996)

HPS404-0050 Total membership (Percent change from 1995 to 1996)

HPS404-0060 Total revenue (1994)

HPS404-0070 Total revenue (1995)

HPS404-0080 Total revenue (1996)

HPS404-0090 Total revenue (Change from 1995 to 1996)

HPS404-0100 Total revenue (Percent change from 1995 to 1996)

HPS404-0110 Net income (1994)

HPS404-0120 Net income (1995)

HPS404-0130 Net income (1996)

HPS404-0140 Net income (Change from 1995 to 1996)

HPS404-0150 Net income (Percent change from 1995 to 1996)

HPS404-0160 Net worth (1994)

### Measure Measure Name/Measure Description/Field Name/Field Description

HPS404-0170 Net worth (1995)

HPS404-0180 Net worth (1996)

HPS404-0190 Net worth (Change from 1995 to 1996)

HPS404-0200 Net worth (Percent change from 1995 to 1996)

HPS404-0210 Dept-to-service ratio (1994)

HPS404-0220 Dept-to-service ratio (1995)

HPS404-0230 Dept-to-service ratio (1996)

HPS404-0240 Dept-to-service ratio (Change from 1995 to 1996)

HPS404-0250 Dept-to-service ratio (Percent change from 1995 to 1996)

HPS404-0260 Overall loss ratio (1994)

HPS404-0270 Overall loss ratio (1995)

HPS404-0280 Overall loss ratio (1996)

HPS404-0290 Overall loss ratio (Change from 1995 to 1996)

HPS404-0300 Overall loss ratio (Percent change from 1995 to 1996)

HPS404-0310 Administrative loss ratio (1994)

HPS404-0320 Administrative loss ratio (1995)

HPS404-0330 Administrative loss ratio (1996)

HPS404-0340 Administrative loss ratio (Change from 1995 to 1996)

HPS404-0350 Administrative loss ratio (Percent change from 1995 to 1996)

HPS404-0360 Medical loss ratio (1994)

HPS404-0370 Medical loss ratio (1995)

HPS404-0380 Medical loss ratio (1996)

HPS404-0390 Medical loss ratio (Change from 1995 to 1996)

HPS404-0400 Medical loss ratio (Percent change from 1995 to 1996)

HPS404-0410 Operating profit margin (1994)

HPS404-0420 Operating profit margin (1995)

HPS404-0430 Operating profit margin (1996)

HPS404-0440 Operating profit margin (Change from 1995 to 1996)

HPS404-0450 Operating profit margin (Percent change from 1995 to 1996)

HPS404-0460 Overall profit margin (1994)

HPS404-0470 Overall profit margin (1995)

HPS404-0480 Overall profit margin (1996)

HPS404-0490 Overall profit margin (Change from 1995 to 1996)

HPS404-0500 Overall profit margin (Percent change from 1995 to 1996)

HPS404-0510 Days cash on hand (1994)

HPS404-0520 Days cash on hand (1995)

HPS404-0530 Days cash on hand (1996)

HPS404-0540 Days cash on hand (Change from 1995 to 1996)

HPS404-0550 Days cash on hand (Percent change from 1995 to 1996)

HPS404-0560 Ratio of cash to claims payable (1994)

HPS404-0570 Ratio of cash to claims payable (1995)

HPS404-0580 Ratio of cash to claims payable (1996)

HPS404-0590 Ratio of cash to claims payable (Change from 1995 to 1996)

HPS404-0600 Ratio of cash to claims payable (Percent change from 1995 to 1996)

HPS404-0610 Days in receivables (1994)

HPS404-0620 Days in receivables (1995)

HPS404-0630 Days in receivables (1996)

HPS404-0640 Days in receivables (Change from 1995 to 1996)

HPS404-0650 Days in receivables (Percent change from 1995 to 1996)

HPS404-0660 Days in unpaid claims (1994)

HPS404-0670 Days in unpaid claims (1995)

HPS404-0680 Days in unpaid claims (1996)

HPS404-0690 Days in unpaid claims (Change from 1995 to 1996)

HPS404-0700 Days in unpaid claims (Percent change from 1995 to 1996)

HPS404-0710 State minimum reserve requirements (1994)

HPS404-0720 State minimum reserve requirements (1995)

### Measure Measure Name/Measure Description/Field Name/Field Description

HPS404-0730 State minimum reserve requirements (1996)

HPS404-0740 State minimum reserve requirements (Change from 1995 to 1996)

HPS404-0750 State minimum reserve requirements (Percent change from 1995 to 1996)

HPS404-0760 Actual reserves held by plan (1994)

HPS404-0770 Actual reserves held by plan (1995)

HPS404-0780 Actual reserves held by plan (1996)

HPS404-0790 Actual reserves held by plan (Change from 1995 to 1996)

HPS404-0800 Actual reserves held by plan (Percent change from 1995 to 1996)

#### PDI801 – Board Certification

DESCRIPTION - This measure reports the percentage of the following providers that has completed residency training or fellowship training (in their respective specialties) and/or are board certified. Plans should report separately for each payer (Medicare risk): primary care physicians, OB/GYN providers, pediatric physician specialists, geriatricians, and all other physician specialists. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 219)

##### REPORTING LEVEL - Contract Market

PDI801-0010 Board Certification - Primary Care Physicians (Percentage)

PDI801-0020 Residency Completion - Primary Care Physicians (Percentage)

PDI801-0030 Board Certification - Physician Specialists (Percentage)

PDI801-0040 Residency Completion - Physician Specialists (Percentage)

PDI801-0050 Board Certification - Geriatricians (Percentage)

PDI801-0060 Residency Completion - Geriatricians (Percentage)

#### PDI802 – Physician Payment Arrangement

DESCRIPTION - This measure reports quantitative and qualitative information on the plan's compensation arrangements with primary care physicians. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 226)

##### REPORTING LEVEL - Contract

PDI802-0010 Salary without withhold or bonus (Lower range boundry)

PDI802-0020 Salary without withhold or bonus (Upper range boundry)

PDI802-0030 Salary without withhold or bonus (Number)

PDI802-0040 Salary without withhold or bonus (Percentage)

PDI802-0050 Salary without withhold or bonus (Basis for Bonus/Withhold)

PDI802-0060 Salary with withhold (Lower range boundry)

PDI802-0070 Salary with withhold (Upper range boundry)

PDI802-0080 Salary with withhold (Number)

PDI802-0090 Salary with withhold (Percentage)

PDI802-0100 Salary with withhold (Basis for Bonus/Withhold)

PDI802-0110 Salary with bonus (Lower range boundry)

PDI802-0120 Salary with bonus (Upper range boundry)

PDI802-0130 Salary with bonus (Number)

PDI802-0140 Salary with bonus (Percentage)

PDI802-0150 Salary with bonus (Basis for Bonus/Withhold)

PDI802-0160 Fee for service without withhold or bonus (Lower range boundry)

PDI802-0170 Fee for service without withhold or bonus (Upper range boundry)

PDI802-0180 Fee for service without withhold or bonus (Number)

PDI802-0190 Fee for service without withhold or bonus (Percentage)

PDI802-0200 Fee for service without withhold or bonus (Basis for Bonus/Withhold)

PDI802-0210 Fee for service with withhold (Lower range boundry)

PDI802-0220 Fee for service with withhold (Upper range boundry)

PDI802-0230 Fee for service with withhold (Number)

PDI802-0240 Fee for service with withhold (Percentage)

PDI802-0250 Fee for service with withhold (Basis for Bonus/Withhold)

PDI802-0260 Fee for service with bonus (Lower range boundry)

PDI802-0270 Fee for service with bonus (Upper range boundry)

PDI802-0280 Fee for service with bonus (Number)

PDI802-0290 Fee for service with bonus (Percentage)

PDI802-0300 Fee for service with bonus (Basis for Bonus/Withhold)

PDI802-0310 Capitated without withhold or bonus (Lower range boundry)

### Measure Measure Name/Measure Description/Field Name/Field Description

PDI802-0320 Capitated without withhold or bonus (Upper range boundry)

PDI802-0330 Capitated without withhold or bonus (Number)

PDI802-0340 Capitated without withhold or bonus (Percentage)

PDI802-0350 Capitated without withhold or bonus (Basis for Bonus/Withhold)

PDI802-0360 Capitated with withhold (Lower range boundry)

PDI802-0370 Capitated with withhold (Upper range boundry)

PDI802-0380 Capitated with withhold (Number)

PDI802-0390 Capitated with withhold (Percentage)

PDI802-0400 Capitated with withhold (Basis for Bonus/Withhold)

PDI802-0410 Capitated with bonus (Lower range boundry)

PDI802-0420 Capitated with bonus (Upper range boundry)

PDI802-0430 Capitated with bonus (Number)

PDI802-0440 Capitated with bonus (Percentage)

PDI802-0450 Capitated with bonus (Basis for Bonus/Withhold)

#### PDI803 – Preventive Care and Health Promotion Programs

DESCRIPTION - The percentage of Medicare risk members who participated in the health promotion/education programs provided by the health plan during the reporting year. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 237)

##### REPORTING LEVEL - Contract Market

PDI803-0010 Program 1 (Title)

PDI803-0020 Program 1 (Percentage participating)

PDI803-0030 Program 2 (Title)

PDI803-0040 Program 2 (Percentage participating)

PDI803-0050 Program 3 (Title)

PDI803-0060 Program 3 (Percentage participating)

PDI803-0070 Program 4 (Title)

PDI803-0080 Program 4 (Percentage participating)

PDI803-0090 Program 5 (Title)

PDI803-0100 Program 5 (Percentage participating)

PDI803-0110 Program 6 (Title)

PDI803-0120 Program 6 (Percentage participating)

PDI803-0130 Program 7 (Title)

PDI803-0140 Program 7 (Percentage participating)

PDI803-0150 Program 8 (Title)

PDI803-0160 Program 8 (Percentage participating)

PDI803-0170 Program 9 (Title)

PDI803-0180 Program 9 (Percentage participating)

PDI803-0190 Program 10 (Title)

PDI803-0200 Program 10 (Percentage participating)

#### PDI805 – Total Enrollment

DESCRIPTION - The percentage of the plan's total member months contributed by each payer (Medicaid, commercial, Medicare risk and other), reported separately by age and sex, during the reporting year. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 243)

##### REPORTING LEVEL - Contract

PDI805-0010 Percent of Plan's Total Member Months (Male - Commercial - Age < 1)

PDI805-0020 Percent of Plan's Total Member Months (Male - Medicaid - Age < 1)

PDI805-0030 Percent of Plan's Total Member Months (Male - Medicare - Age < 1)

PDI805-0040 Percent of Plan's Total Member Months (Male - Other - Age < 1)

PDI805-0050 Percent of Plan's Total Member Months (Male - Commercial - Age 1-4)

PDI805-0060 Percent of Plan's Total Member Months (Male - Medicaid - Age 1-4)

PDI805-0070 Percent of Plan's Total Member Months (Male - Medicare - Age 1-4)

PDI805-0080 Percent of Plan's Total Member Months (Male - Other - Age 1-4)

PDI805-0090 Percent of Plan's Total Member Months (Male - Commercial - Age 5-9)

PDI805-0100 Percent of Plan's Total Member Months (Male - Medicaid - Age 5-9)

PDI805-0110 Percent of Plan's Total Member Months (Male - Medicare - Age 5-9)

PDI805-0120 Percent of Plan's Total Member Months (Male - Other - Age 5-9)

### Measure Measure Name/Measure Description/Field Name/Field Description

PDI805-0130 Percent of Plan's Total Member Months (Male - Commercial - Age 10-14)

PDI805-0140 Percent of Plan's Total Member Months (Male - Medicaid - Age 10-14)

PDI805-0150 Percent of Plan's Total Member Months (Male - Medicare - Age 10-14)

PDI805-0160 Percent of Plan's Total Member Months (Male - Other - Age 10-14)

PDI805-0170 Percent of Plan's Total Member Months (Male - Commercial - Age 15-17)

PDI805-0180 Percent of Plan's Total Member Months (Male - Medicaid - Age 15-17)

PDI805-0190 Percent of Plan's Total Member Months (Male - Medicare - Age 15-17)

PDI805-0200 Percent of Plan's Total Member Months (Male - Other - Age 15-17)

PDI805-0210 Percent of Plan's Total Member Months (Male - Commercial - Age 18-19)

PDI805-0220 Percent of Plan's Total Member Months (Male - Medicaid - Age 18-19)

PDI805-0230 Percent of Plan's Total Member Months (Male - Medicare - Age 18-19)

PDI805-0240 Percent of Plan's Total Member Months (Male - Other - Age 18-19)

PDI805-0250 Percent of Plan's Total Member Months (Male - Commercial - Subtotal: Age 0-19)

PDI805-0260 Percent of Plan's Total Member Months (Male - Medicaid - Subtotal: Age 0-19)

PDI805-0270 Percent of Plan's Total Member Months (Male - Medicare - Age 0-19)

PDI805-0280 Percent of Plan's Total Member Months (Male - Other - Age 0-19)

PDI805-0290 Percent of Plan's Total Member Months (Male - Commercial - Age 20-24)

PDI805-0300 Percent of Plan's Total Member Months (Male - Medicaid - Age 20-24)

PDI805-0310 Percent of Plan's Total Member Months (Male - Medicare - Age 20-24)

PDI805-0320 Percent of Plan's Total Member Months (Male - Other - Age 20-24)

PDI805-0330 Percent of Plan's Total Member Months (Male - Commercial - Age 25-29)

PDI805-0340 Percent of Plan's Total Member Months (Male - Medicaid - Age 25-29)

PDI805-0350 Percent of Plan's Total Member Months (Male - Medicare - Age 25-29)

PDI805-0360 Percent of Plan's Total Member Months (Male - Other - Age 25-29)

PDI805-0370 Percent of Plan's Total Member Months (Male - Commercial - Age 30-34)

PDI805-0380 Percent of Plan's Total Member Months (Male - Medicaid - Age 30-34)

PDI805-0390 Percent of Plan's Total Member Months (Male - Medicare - Age 30-34)

PDI805-0400 Percent of Plan's Total Member Months (Male - Other - Age 30-34)

PDI805-0410 Percent of Plan's Total Member Months (Male - Commercial - Age 35-39)

PDI805-0420 Percent of Plan's Total Member Months (Male - Medicaid - Age 35-39)

PDI805-0430 Percent of Plan's Total Member Months (Male - Medicare - Age 35-39)

PDI805-0440 Percent of Plan's Total Member Months (Male - Other - Age 35-39)

PDI805-0450 Percent of Plan's Total Member Months (Male - Commercial - Age 40-44)

PDI805-0460 Percent of Plan's Total Member Months (Male - Medicaid - Age 40-44)

PDI805-0470 Percent of Plan's Total Member Months (Male - Medicare - Age 40-44)

PDI805-0480 Percent of Plan's Total Member Months (Male - Other - Age 40-44)

PDI805-0490 Percent of Plan's Total Member Months (Male - Commercial - Subtotal: Age 20-44)

PDI805-0500 Percent of Plan's Total Member Months (Male - Medicaid - Subtotal: Age 20-44)

PDI805-0510 Percent of Plan's Total Member Months (Male - Medicare - Age 20-44)

PDI805-0520 Percent of Plan's Total Member Months (Male - Other - Age 20-44)

PDI805-0530 Percent of Plan's Total Member Months (Male - Commercial - Age 45-49)

PDI805-0540 Percent of Plan's Total Member Months (Male - Medicaid - Age 45-49)

PDI805-0550 Percent of Plan's Total Member Months (Male - Medicare - Age 45-49)

PDI805-0560 Percent of Plan's Total Member Months (Male - Other - Age 45-49)

PDI805-0570 Percent of Plan's Total Member Months (Male - Commercial - Age 50-54)

PDI805-0580 Percent of Plan's Total Member Months (Male - Medicaid - Age 50-54)

PDI805-0590 Percent of Plan's Total Member Months (Male - Medicare - Age 50-54)

PDI805-0600 Percent of Plan's Total Member Months (Male - Other - Age 50-54)

PDI805-0610 Percent of Plan's Total Member Months (Male - Commercial - Age 55-59)

PDI805-0620 Percent of Plan's Total Member Months (Male - Medicaid - Age 55-59)

PDI805-0630 Percent of Plan's Total Member Months (Male - Medicare - Age 55-59)

PDI805-0640 Percent of Plan's Total Member Months (Male - Other - Age 55-59)

PDI805-0650 Percent of Plan's Total Member Months (Male - Commercial - Age 60-64)

PDI805-0660 Percent of Plan's Total Member Months (Male - Medicaid - Age 60-64)

PDI805-0670 Percent of Plan's Total Member Months (Male - Medicare - Age 60-64)

PDI805-0680 Percent of Plan's Total Member Months (Male - Other - Age 60-64)

### Measure Measure Name/Measure Description/Field Name/Field Description

PDI805-0690 Percent of Plan's Total Member Months (Male - Commercial - Subtotal: Age 45-64)

PDI805-0700 Percent of Plan's Total Member Months (Male - Medicaid - Subtotal: Age 45-64)

PDI805-0710 Percent of Plan's Total Member Months (Male - Medicare - Age 45-64)

PDI805-0720 Percent of Plan's Total Member Months (Male - Other - Age 45-64)

PDI805-0730 Percent of Plan's Total Member Months (Male - Commercial - Age 65-69)

PDI805-0740 Percent of Plan's Total Member Months (Male - Medicaid - Age 65-69)

PDI805-0750 Percent of Plan's Total Member Months (Male - Medicare - Age 65-69)

PDI805-0760 Percent of Plan's Total Member Months (Male - Other - Age 65-69)

PDI805-0770 Percent of Plan's Total Member Months (Male - Commercial - Age 70-74)

PDI805-0780 Percent of Plan's Total Member Months (Male - Medicaid - Age 70-74)

PDI805-0790 Percent of Plan's Total Member Months (Male - Medicare - Age 70-74)

PDI805-0800 Percent of Plan's Total Member Months (Male - Other - Age 70-74)

PDI805-0810 Percent of Plan's Total Member Months (Male - Commercial - Age 75-79)

PDI805-0820 Percent of Plan's Total Member Months (Male - Medicaid - Age 75-79)

PDI805-0830 Percent of Plan's Total Member Months (Male - Medicare - Age 75-79)

PDI805-0840 Percent of Plan's Total Member Months (Male - Other - Age 75-79)

PDI805-0850 Percent of Plan's Total Member Months (Male - Commercial - Age 80-84)

PDI805-0860 Percent of Plan's Total Member Months (Male - Medicaid - Age 80-84)

PDI805-0870 Percent of Plan's Total Member Months (Male - Medicare - Age 80-84)

PDI805-0880 Percent of Plan's Total Member Months (Male - Other - Age 80-84)

PDI805-0890 Percent of Plan's Total Member Months (Male - Commercial - Age 85-89)

PDI805-0900 Percent of Plan's Total Member Months (Male - Medicaid - Age 85-89)

PDI805-0910 Percent of Plan's Total Member Months (Male - Medicare - Age 85-89)

PDI805-0920 Percent of Plan's Total Member Months (Male - Other - Age 85-89)

PDI805-0930 Percent of Plan's Total Member Months (Male - Commercial - Age >=90)

PDI805-0940 Percent of Plan's Total Member Months (Male - Medicaid - Age >=90)

PDI805-0950 Percent of Plan's Total Member Months (Male - Medicare - Age >=90)

PDI805-0960 Percent of Plan's Total Member Months (Male - Other - Age >=90)

PDI805-0970 Percent of Plan's Total Member Months (Male - Commercial - Subtotal: Age >=65)

PDI805-0980 Percent of Plan's Total Member Months (Male - Medicaid - Subtotal: Age >=65)

PDI805-0990 Percent of Plan's Total Member Months (Male - Medicare - Age >=65)

PDI805-1000 Percent of Plan's Total Member Months (Male - Other - Age >=65)

PDI805-1010 Percent of Plan's Total Member Months (Female - Commercial - Age < 1)

PDI805-1020 Percent of Plan's Total Member Months (Female - Medicaid - Age < 1)

PDI805-1030 Percent of Plan's Total Member Months (Female - Medicare - Age < 1)

PDI805-1040 Percent of Plan's Total Member Months (Female - Other - Age < 1)

PDI805-1050 Percent of Plan's Total Member Months (Female - Commercial - Age 1-4)

PDI805-1060 Percent of Plan's Total Member Months (Female - Medicaid - Age 1-4)

PDI805-1070 Percent of Plan's Total Member Months (Female - Medicare - Age 1-4)

PDI805-1080 Percent of Plan's Total Member Months (Female - Other - Age 1-4)

PDI805-1090 Percent of Plan's Total Member Months (Female - Commercial - Age 5-9)

PDI805-1100 Percent of Plan's Total Member Months (Female - Medicaid - Age 5-9)

PDI805-1110 Percent of Plan's Total Member Months (Female - Medicare - Age 5-9)

PDI805-1120 Percent of Plan's Total Member Months (Female - Other - Age 5-9)

PDI805-1130 Percent of Plan's Total Member Months (Female - Commercial - Age 10-14)

PDI805-1140 Percent of Plan's Total Member Months (Female - Medicaid - Age 10-14)

PDI805-1150 Percent of Plan's Total Member Months (Female - Medicare - Age 10-14)

PDI805-1160 Percent of Plan's Total Member Months (Female - Other - Age 10-14)

PDI805-1170 Percent of Plan's Total Member Months (Female - Commercial - Age 15-17)

PDI805-1180 Percent of Plan's Total Member Months (Female - Medicaid - Age 15-17)

PDI805-1190 Percent of Plan's Total Member Months (Female - Medicare - Age 15-17)

PDI805-1200 Percent of Plan's Total Member Months (Female - Other - Age 15-17)

PDI805-1210 Percent of Plan's Total Member Months (Female - Commercial - Age 18-19)

PDI805-1220 Percent of Plan's Total Member Months (Female - Medicaid - Age 18-19)

PDI805-1230 Percent of Plan's Total Member Months (Female - Medicare - Age 18-19)

PDI805-1240 Percent of Plan's Total Member Months (Female - Other - Age 18-19)

### Measure Measure Name/Measure Description/Field Name/Field Description

PDI805-1250 Percent of Plan's Total Member Months (Female - Commercial - Subtotal: Age 0-19)

PDI805-1260 Percent of Plan's Total Member Months (Female - Medicaid - Subtotal: Age 0-19)

PDI805-1270 Percent of Plan's Total Member Months (Female - Medicare - Age 0-19)

PDI805-1280 Percent of Plan's Total Member Months (Female - Other - Age 0-19)

PDI805-1290 Percent of Plan's Total Member Months (Female - Commercial - Age 20-24)

PDI805-1300 Percent of Plan's Total Member Months (Female - Medicaid - Age 20-24)

PDI805-1310 Percent of Plan's Total Member Months (Female - Medicare - Age 20-24)

PDI805-1320 Percent of Plan's Total Member Months (Female - Other - Age 20-24)

PDI805-1330 Percent of Plan's Total Member Months (Female - Commercial - Age 25-29)

PDI805-1340 Percent of Plan's Total Member Months (Female - Medicaid - Age 25-29)

PDI805-1350 Percent of Plan's Total Member Months (Female - Medicare - Age 25-29)

PDI805-1360 Percent of Plan's Total Member Months (Female - Other - Age 25-29)

PDI805-1370 Percent of Plan's Total Member Months (Female - Commercial - Age 30-34)

PDI805-1380 Percent of Plan's Total Member Months (Female - Medicaid - Age 30-34)

PDI805-1390 Percent of Plan's Total Member Months (Female - Medicare - Age 30-34)

PDI805-1400 Percent of Plan's Total Member Months (Female - Other - Age 30-34)

PDI805-1410 Percent of Plan's Total Member Months (Female - Commercial - Age 35-39)

PDI805-1420 Percent of Plan's Total Member Months (Female - Medicaid - Age 35-39)

PDI805-1430 Percent of Plan's Total Member Months (Female - Medicare - Age 35-39)

PDI805-1440 Percent of Plan's Total Member Months (Female - Other - Age 35-39)

PDI805-1450 Percent of Plan's Total Member Months (Female - Commercial - Age 40-44)

PDI805-1460 Percent of Plan's Total Member Months (Female - Medicaid - Age 40-44)

PDI805-1470 Percent of Plan's Total Member Months (Female - Medicare - Age 40-44)

PDI805-1480 Percent of Plan's Total Member Months (Female - Other - Age 40-44)

PDI805-1490 Percent of Plan's Total Member Months (Female - Commercial - Subtotal: Age 20-44)

PDI805-1500 Percent of Plan's Total Member Months (Female - Medicaid - Subtotal: Age 20-44)

PDI805-1510 Percent of Plan's Total Member Months (Female - Medicare - Age 20-44)

PDI805-1520 Percent of Plan's Total Member Months (Female - Other - Age 20-44)

PDI805-1530 Percent of Plan's Total Member Months (Female - Commercial - Age 45-49)

PDI805-1540 Percent of Plan's Total Member Months (Female - Medicaid - Age 45-49)

PDI805-1550 Percent of Plan's Total Member Months (Female - Medicare - Age 45-49)

PDI805-1560 Percent of Plan's Total Member Months (Female - Other - Age 45-49)

PDI805-1570 Percent of Plan's Total Member Months (Female - Commercial - Age 50-54)

PDI805-1580 Percent of Plan's Total Member Months (Female - Medicaid - Age 50-54)

PDI805-1590 Percent of Plan's Total Member Months (Female - Medicare - Age 50-54)

PDI805-1600 Percent of Plan's Total Member Months (Female - Other - Age 50-54)

PDI805-1610 Percent of Plan's Total Member Months (Female - Commercial - Age 55-59)

PDI805-1620 Percent of Plan's Total Member Months (Female - Medicaid - Age 55-59)

PDI805-1630 Percent of Plan's Total Member Months (Female - Medicare - Age 55-59)

PDI805-1640 Percent of Plan's Total Member Months (Female - Other - Age 55-59)

PDI805-1650 Percent of Plan's Total Member Months (Female - Commercial - Age 60-64)

PDI805-1660 Percent of Plan's Total Member Months (Female - Medicaid - Age 60-64)

PDI805-1670 Percent of Plan's Total Member Months (Female - Medicare - Age 60-64)

PDI805-1680 Percent of Plan's Total Member Months (Female - Other - Age 60-64)

PDI805-1690 Percent of Plan's Total Member Months (Female - Commercial - Subtotal: Age 45-64)

PDI805-1700 Percent of Plan's Total Member Months (Female - Medicaid - Subtotal: Age 45-64)

PDI805-1710 Percent of Plan's Total Member Months (Female - Medicare - Age 45-64)

PDI805-1720 Percent of Plan's Total Member Months (Female - Other - Age 45-64)

PDI805-1730 Percent of Plan's Total Member Months (Female - Commercial - Age 65-69)

PDI805-1740 Percent of Plan's Total Member Months (Female - Medicaid - Age 65-69)

PDI805-1750 Percent of Plan's Total Member Months (Female - Medicare - Age 65-69)

PDI805-1760 Percent of Plan's Total Member Months (Female - Other - Age 65-69)

PDI805-1770 Percent of Plan's Total Member Months (Female - Commercial - Age 70-74)

PDI805-1780 Percent of Plan's Total Member Months (Female - Medicaid - Age 70-74)

PDI805-1790 Percent of Plan's Total Member Months (Female - Medicare - Age 70-74)

PDI805-1800 Percent of Plan's Total Member Months (Female - Other - Age 70-74)

### Measure Measure Name/Measure Description/Field Name/Field Description

PDI805-1810 Percent of Plan's Total Member Months (Female - Commercial - Age 75-79)

PDI805-1820 Percent of Plan's Total Member Months (Female - Medicaid - Age 75-79)

PDI805-1830 Percent of Plan's Total Member Months (Female - Medicare - Age 75-79)

PDI805-1840 Percent of Plan's Total Member Months (Female - Other - Age 75-79)

PDI805-1850 Percent of Plan's Total Member Months (Female - Commercial - Age 80-84)

PDI805-1860 Percent of Plan's Total Member Months (Female - Medicaid - Age 80-84)

PDI805-1870 Percent of Plan's Total Member Months (Female - Medicare - Age 80-84)

PDI805-1880 Percent of Plan's Total Member Months (Female - Other - Age 80-84)

PDI805-1890 Percent of Plan's Total Member Months (Female - Commercial - Age 85-89)

PDI805-1900 Percent of Plan's Total Member Months (Female - Medicaid - Age 85-89)

PDI805-1910 Percent of Plan's Total Member Months (Female - Medicare - Age 85-89)

PDI805-1920 Percent of Plan's Total Member Months (Female - Other - Age 85-89)

PDI805-1930 Percent of Plan's Total Member Months (Female - Commercial - Age >=90)

PDI805-1940 Percent of Plan's Total Member Months (Female - Medicaid - Age >=90)

PDI805-1950 Percent of Plan's Total Member Months (Female - Medicare - Age >=90)

PDI805-1960 Percent of Plan's Total Member Months (Female - Other - Age >=90)

PDI805-1970 Percent of Plan's Total Member Months (Female - Commercial - Subtotal: Age >=65)

PDI805-1980 Percent of Plan's Total Member Months (Female - Medicaid - Subtotal: Age >=65)

PDI805-1990 Percent of Plan's Total Member Months (Female - Medicare - Age >=65)

PDI805-2000 Percent of Plan's Total Member Months (Female - Other - Age >=65)

PDI805-2010 Percent of Plan's Total Member Months (Total - Commercial - Subtotal: Age 0-19)

PDI805-2020 Percent of Plan's Total Member Months (Total - Medicaid - Subtotal: Age 0-19)

PDI805-2030 Percent of Plan's Total Member Months (Total - Medicare - Subtotal: Age 0-19)

PDI805-2040 Percent of Plan's Total Member Months (Total - Other - Subtotal: Age 0-19)

PDI805-2050 Percent of Plan's Total Member Months (Total - Commercial - Subtotal: Age 20-44)

PDI805-2060 Percent of Plan's Total Member Months (Total - Medicaid - Subtotal: Age 20-44)

PDI805-2070 Percent of Plan's Total Member Months (Total - Medicare - Subtotal: Age 20-44)

PDI805-2080 Percent of Plan's Total Member Months (Total - Other - Subtotal: Age 20-44)

PDI805-2090 Percent of Plan's Total Member Months (Total - Commercial - Subtotal: Age 45-64)

PDI805-2100 Percent of Plan's Total Member Months (Total - Medicaid - Subtotal: Age 45-64)

PDI805-2110 Percent of Plan's Total Member Months (Total - Medicare - Subtotal: Age 45-64)

PDI805-2120 Percent of Plan's Total Member Months (Total - Other - Subtotal: Age 45-64)

PDI805-2130 Percent of Plan's Total Member Months (Total - Commercial - Subtotal: Age >=65)

PDI805-2140 Percent of Plan's Total Member Months (Total - Medicaid - Subtotal: Age >=65)

PDI805-2150 Percent of Plan's Total Member Months (Total - Medicare - Subtotal: Age >=65)

PDI805-2160 Percent of Plan's Total Member Months (Total - Other - Subtotal: Age >=65)

PDI805-2170 Percent of Plan's Total Member Months (Total - Commercial - Subtotal: Age Unknown)

PDI805-2180 Percent of Plan's Total Member Months (Total - Medicaid - Subtotal: Age Unknown)

PDI805-2190 Percent of Plan's Total Member Months (Total - Medicare - Subtotal: Age Unknown)

PDI805-2200 Percent of Plan's Total Member Months (Total - Other - Subtotal: Age Unknown)

PDI805-2210 Percent of Plan's Total Member Months (Total - Commercial)

PDI805-2220 Percent of Plan's Total Member Months (Total - Medicaid)

PDI805-2230 Percent of Plan's Total Member Months (Total - Medicare)

PDI805-2240 Percent of Plan's Total Member Months (Total - Other)

#### PDI806 – Enrollment by Payer

DESCRIPTION - Total number of member years for Medicare risk enrollees during the reporting year, stratified by payer, age and sex. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 247)

##### REPORTING LEVEL - Contract

PDI806-0010 Member Years of Enrollment: Medicare Risk (Male)

PDI806-0020 Member Years of Enrollment: Medicare Risk (Female)

PDI806-0030 Member Years of Enrollment: Medicare Risk (Total)

### Measure Measure Name/Measure Description/Field Name/Field Description

#### 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-0010 Market Area Name

SA-0020 Market Area Code

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)

#### UOS505 – Frequency of Selected Procedures

DESCRIPTION - This measure provides a summary of the number and rate of several frequently performed procedures. These procedures often show wide regional variation and have generated concern regarding potentially inappropriate utilization. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 145)

##### REPORTING LEVEL - Contract Market

UOS505-0010 CABG <65 (Male)

UOS505-0020 CABG 65-74 (Male)

UOS505-0030 CABG 75-84 (Male)

UOS505-0040 CABG 85+ (Male)

UOS505-0050 Angioplasty(PTCA) <65 (Male)

UOS505-0060 Angioplasty(PTCA) 65-74 (Male)

UOS505-0070 Angioplasty(PTCA) 75-84 (Male)

UOS505-0080 Angioplasty(PTCA) 85+ (Male)

UOS505-0090 Carotid Endarterectomy <65 (Male)

UOS505-0100 Carotid Endarterectomy 65-74 (Male)

UOS505-0110 Carotid Endarterectomy 75-84 (Male)

UOS505-0120 Carotid Endarterectomy 85+ (Male)

UOS505-0130 Reduction of Fracture of Femur <65 (Male)

UOS505-0140 Reduction of Fracture of Femur 65-74 (Male)

UOS505-0150 Reduction of Fracture of Femur 75-84 (Male)

UOS505-0160 Reduction of Fracture of Femur 85+ (Male)

UOS505-0170 Total Hip Replacement <65 (Male)

UOS505-0180 Total Hip Replacement 65-74 (Male)

UOS505-0190 Total Hip Replacement 75-84 (Male)

UOS505-0200 Total Hip Replacement 85+ (Male)

UOS505-0210 Total Knee Replacement <65 (Male)

UOS505-0220 Total Knee Replacement 65-74 (Male)

UOS505-0230 Total Knee Replacement 75-84 (Male)

UOS505-0240 Total Knee Replacement 85+ (Male)

UOS505-0250 Partial Excision of Large Intestine <65 (Male)

UOS505-0260 Partial Excision of Large Intestine 65-74 (Male)

UOS505-0270 Partial Excision of Large Intestine 75-84 (Male)

UOS505-0280 Partial Excision of Large Intestine 85+ (Male)

UOS505-0290 Cholecystectomy -open <65 (Male)

UOS505-0300 Cholecystectomy -open 65-74 (Male)

UOS505-0310 Cholecystectomy -open 75-84 (Male)

UOS505-0320 Cholecystectomy -open 85+ (Male)

UOS505-0330 Cholecystectomy -closed(laparoscopic) <65 (Male)

UOS505-0340 Cholecystectomy -closed(laparoscopic) 65-74 (Male)

UOS505-0350 Cholecystectomy -closed(laparoscopic) 75-84 (Male)

UOS505-0360 Cholecystectomy -closed(laparoscopic) 85+ (Male)

UOS505-0370 Prostatectomy <65 (Male)

UOS505-0380 Prostatectomy 65-74 (Male)

### Measure Measure Name/Measure Description/Field Name/Field Description

UOS505-0390 Prostatectomy 75-84 (Male)

UOS505-0400 Prostatectomy 85+ (Male)

UOS505-0410 CABG <65 (Female)

UOS505-0420 CABG 65-74 (Female)

UOS505-0430 CABG 75-84 (Female)

UOS505-0440 CABG 85+ (Female)

UOS505-0450 Angioplasty(PTCA) <65 (Female)

UOS505-0460 Angioplasty(PTCA) 65-74 (Female)

UOS505-0470 Angioplasty(PTCA) 75-84 (Female)

UOS505-0480 Angioplasty(PTCA) 85+ (Female)

UOS505-0490 Carotid Endarterectomy <65 (Female)

UOS505-0500 Carotid Endarterectomy 65-74 (Female)

UOS505-0510 Carotid Endarterectomy 75-84 (Female)

UOS505-0520 Carotid Endarterectomy 85+ (Female)

UOS505-0530 Reduction of Fracture of Femur <65 (Female)

UOS505-0540 Reduction of Fracture of Femur 65-74 (Female)

UOS505-0550 Reduction of Fracture of Femur 75-84 (Female)

UOS505-0560 Reduction of Fracture of Femur 85+ (Female)

UOS505-0570 Total Hip Replacement <65 (Female)

UOS505-0580 Total Hip Replacement 65-74 (Female)

UOS505-0590 Total Hip Replacement 75-84 (Female)

UOS505-0600 Total Hip Replacement 85+ (Female)

UOS505-0610 Total Knee Replacement <65 (Female)

UOS505-0620 Total Knee Replacement 65-74 (Female)

UOS505-0630 Total Knee Replacement 75-84 (Female)

UOS505-0640 Total Knee Replacement 85+ (Female)

UOS505-0650 Partial Excision of Large Intestine <65 (Female)

UOS505-0660 Partial Excision of Large Intestine 65-74 (Female)

UOS505-0670 Partial Excision of Large Intestine 75-84 (Female)

UOS505-0680 Partial Excision of Large Intestine 85+ (Female)

UOS505-0690 Cholecystectomy -open <65 (Female)

UOS505-0700 Cholecystectomy -open 65-74 (Female)

UOS505-0710 Cholecystectomy -open 75-84 (Female)

UOS505-0720 Cholecystectomy -open 85+ (Female)

UOS505-0730 Cholecystectomy -closed(laparoscopic) <65 (Female)

UOS505-0740 Cholecystectomy -closed(laparoscopic) 65-74 (Female)

UOS505-0750 Cholecystectomy -closed(laparoscopic) 75-84 (Female)

UOS505-0760 Cholecystectomy -closed(laparoscopic) 85+ (Female)

UOS505-0770 Hysterectomy <65 (Female)

UOS505-0780 Hysterectomy 65-74 (Female)

UOS505-0790 Hysterectomy 75-84 (Female)

UOS505-0800 Hysterectomy 85+ (Female)

#### UOS506 – Inpatient Utilization-General Hospital/Acute Care

DESCRIPTION - This table summarizes utilization of acute inpatient services in the following categories: total services, medicine, surgery and maternity. Nonacute care, mental health and chemical dependency services, as well as newborns, are excluded. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 155)

##### REPORTING LEVEL - Contract Market

UOS506-0010 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age < 1)

UOS506-0020 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age < 1)

UOS506-0030 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age < 1)

UOS506-0040 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 1-9)

UOS506-0050 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 1-9)

UOS506-0060 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 1-9)

### Measure Measure Name/Measure Description/Field Name/Field Description

UOS506-0070 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 10-19)

UOS506-0080 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 10-19)

UOS506-0090 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 10-19)

UOS506-0100 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 20-44)

UOS506-0110 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 20-44)

UOS506-0120 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 20-44)

UOS506-0130 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 45-64)

UOS506-0140 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 45-64)

UOS506-0150 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 45-64)

UOS506-0160 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 65-74)

UOS506-0170 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 65-74)

UOS506-0180 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 65-74)

UOS506-0190 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 75-84)

UOS506-0200 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 75-84)

UOS506-0210 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 75-84)

UOS506-0220 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age 85+)

UOS506-0230 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age 85+)

UOS506-0240 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age 85+)

UOS506-0250 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Age Unknown)

UOS506-0260 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Age Unknown)

UOS506-0270 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Age Unknown)

UOS506-0280 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Total Inpatient - Total)

UOS506-0290 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Total Inpatient - Total)

UOS506-0300 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Total Inpatient - Total)

UOS506-0310 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age < 1)

UOS506-0320 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age < 1)

UOS506-0330 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age < 1)

UOS506-0340 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 1-9)

UOS506-0350 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 1-9)

UOS506-0360 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 1-9)

UOS506-0370 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 10-19)

UOS506-0380 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 10-19)

UOS506-0390 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 10-19)

UOS506-0400 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 20-44)

UOS506-0410 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 20-44)

UOS506-0420 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 20-44)

UOS506-0430 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 45-64)

UOS506-0440 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 45-64)

### Measure Measure Name/Measure Description/Field Name/Field Description

UOS506-0450 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 45-64)

UOS506-0460 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 65-74)

UOS506-0470 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 65-74)

UOS506-0480 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 65-74)

UOS506-0490 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 75-84)

UOS506-0500 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 75-84)

UOS506-0510 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 75-84)

UOS506-0520 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age 85+)

UOS506-0530 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age 85+)

UOS506-0540 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age 85+)

UOS506-0550 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Age Unknown)

UOS506-0560 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Age Unknown)

UOS506-0570 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Age Unknown)

UOS506-0580 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Medicine - Total)

UOS506-0590 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Medicine - Total)

UOS506-0600 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Medicine - Total)

UOS506-0610 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age < 1)

UOS506-0620 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age < 1)

UOS506-0630 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age < 1)

UOS506-0640 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 1-9)

UOS506-0650 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 1-9)

UOS506-0660 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 1-9)

UOS506-0670 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 10-19)

UOS506-0680 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 10-19)

UOS506-0690 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 10-19)

UOS506-0700 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 20-44)

UOS506-0710 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 20-44)

UOS506-0720 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 20-44)

UOS506-0730 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 45-64)

UOS506-0740 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 45-64)

UOS506-0750 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 45-64)

UOS506-0760 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 65-74)

UOS506-0770 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 65-74)

UOS506-0780 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 65-74)

UOS506-0790 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 75-84)

UOS506-0800 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 75-84)

UOS506-0810 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 75-84)

UOS506-0820 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age 85+)

UOS506-0830 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age 85+)

UOS506-0840 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age 85+)

UOS506-0850 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Age Unknown)

UOS506-0860 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Age Unknown)

UOS506-0870 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Age Unknown)

UOS506-0880 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Surgery - Total)

UOS506-0890 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Surgery - Total)

UOS506-0900 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Surgery - Total)

### Measure Measure Name/Measure Description/Field Name/Field Description

UOS506-0910 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Age 10-19)

UOS506-0920 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Age 10-19)

UOS506-0930 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Age 10-19)

UOS506-0940 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Age 20-44)

UOS506-0950 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Age 20-44)

UOS506-0960 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Age 20-44)

UOS506-0970 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Age 45-64)

UOS506-0980 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Age 45-64)

UOS506-0990 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Age 45-64)

UOS506-1000 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Age Unknown)

UOS506-1010 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Age Unknown)

UOS506-1020 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Age Unknown)

UOS506-1030 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Discharges/1000 (Maternity - Total)

UOS506-1040 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Days/1000 (Maternity - Total)

UOS506-1050 Inpatient Utilization - General Hospital/Acute Care- Total Inpatient Average Length of Stay (Maternity - Total)

#### UOS507 – Ambulatory Care

DESCRIPTION - This table summarizes utilization of ambulatory services in the following categories: Outpatient Visits (excluding mental health and chemical dependency), Emergency Room Visits, Ambulatory Surgery/Procedures performed in hospital outpatient facilities or freestanding surgical centers, and Observation Room Stays that result in discharge (Observation Room Stays resulting in an inpatient admission are counted in the Inpatient Utilization - General Hospital Acute Care measure. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 162)

##### REPORTING LEVEL - Contract Market

UOS507-0010 Ambulatory Care- Total Outpatient Visits/1000 (Age < 1)

UOS507-0020 Ambulatory Care- Total Emergency Room Visits/1000 (Age < 1)

UOS507-0030 Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age < 1)

UOS507-0040 Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age < 1)

UOS507-0050 Ambulatory Care- Total Outpatient Visits/1000 (Age 1-9)

UOS507-0060 Ambulatory Care- Total Emergency Room Visits/1000 (Age 1-9)

UOS507-0070 Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 1-9)

UOS507-0080 Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 1-9)

UOS507-0090 Ambulatory Care- Total Outpatient Visits/1000 (Age 10-19)

UOS507-0100 Ambulatory Care- Total Emergency Room Visits/1000 (Age 10-19)

UOS507-0110 Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 10-19)

UOS507-0120 Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 10-19)

UOS507-0130 Ambulatory Care- Total Outpatient Visits/1000 (Age 20-44)

UOS507-0140 Ambulatory Care- Total Emergency Room Visits/1000 (Age 20-44)

UOS507-0150 Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 20-44)

UOS507-0160 Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 20-44)

UOS507-0170 Ambulatory Care- Total Outpatient Visits/1000 (Age 45-64)

UOS507-0180 Ambulatory Care- Total Emergency Room Visits/1000 (Age 45-64)

UOS507-0190 Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 45-64)

UOS507-0200 Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 45-64)

UOS507-0210 Ambulatory Care- Total Outpatient Visits/1000 (Age 65-74)

UOS507-0220 Ambulatory Care- Total Emergency Room Visits/1000 (Age 65-74)

UOS507-0230 Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 65-74)

UOS507-0240 Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 65-74)

UOS507-0250 Ambulatory Care- Total Outpatient Visits/1000 (Age 75-84)

UOS507-0260 Ambulatory Care- Total Emergency Room Visits/1000 (Age 75-84)

UOS507-0270 Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 75-84)

UOS507-0280 Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 75-84)

UOS507-0290 Ambulatory Care- Total Outpatient Visits/1000 (Age 85+)

UOS507-0300 Ambulatory Care- Total Emergency Room Visits/1000 (Age 85+)

### Measure Measure Name/Measure Description/Field Name/Field Description

UOS507-0310 Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age 85+)

UOS507-0320 Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age 85+)

UOS507-0330 Ambulatory Care- Total Outpatient Visits/1000 (Age Unknown)

UOS507-0340 Ambulatory Care- Total Emergency Room Visits/1000 (Age Unknown)

UOS507-0350 Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Age Unknown)

UOS507-0360 Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Age Unknown)

UOS507-0370 Ambulatory Care- Total Outpatient Visits/1000 (Total)

UOS507-0380 Ambulatory Care- Total Emergency Room Visits/1000 (Total)

UOS507-0390 Ambulatory Care- Total Ambulatory Surgery Procedures/1000 (Total)

UOS507-0400 Ambulatory Care- Observation Room Stays Resulting in Discharge/1000 (Total)

#### UOS508 – Inpatient Utilization-NonAcute Care

DESCRIPTION - This table summarizes utilization of nonacute inpatient care in the following facilities: hospice, nursing home, rehabilitation, SNF, transitional care and respite. These data excludes mental health and chemical dependency. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 170)

##### REPORTING LEVEL - Contract Market

UOS508-0010 Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age < 1)

UOS508-0020 Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age < 1)

UOS508-0030 Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age < 1)

UOS508-0040 Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 1-9)

UOS508-0050 Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age 1-9)

UOS508-0060 Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age 1-9)

UOS508-0070 Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 10-19)

UOS508-0080 Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age 10-19)

UOS508-0090 Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age 10-19)

UOS508-0100 Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 20-44)

UOS508-0110 Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age 20-44)

UOS508-0120 Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age 20-44)

UOS508-0130 Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 45-64)

UOS508-0140 Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age 45-64)

UOS508-0150 Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age 45-64)

UOS508-0160 Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 65-74)

UOS508-0170 Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age 65-74)

UOS508-0180 Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age 65-74)

UOS508-0190 Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 75-84)

UOS508-0200 Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age 75-84)

UOS508-0210 Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age 75-84)

UOS508-0220 Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age 85+)

UOS508-0230 Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age 85+)

UOS508-0240 Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age 85+)

UOS508-0250 Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Age Unknown)

UOS508-0260 Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Age Unknown)

UOS508-0270 Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Age Unknown)

UOS508-0280 Inpatient Utilization - Non-Acute Care- Total Inpatient Discharges/1000 (Total)

UOS508-0290 Inpatient Utilization - Non-Acute Care- Total Inpatient Days/1000 (Total)

UOS508-0300 Inpatient Utilization - Non-Acute Care- Total Inpatient Average Length of Stay (Total)

#### UOS512 – Mental Health Utilization-Inpatient Discharges/Average Length of Stay

DESCRIPTION - This table summarizes utilization of inpatient mental health services, stratified by age and sex. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 185)

##### REPORTING LEVEL - Contract Market

UOS512-0010 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Male - Age 0-12)

UOS512-0020 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Age 0-12)

UOS512-0030 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Male - Age 13-17)

### Measure Measure Name/Measure Description/Field Name/Field Description

UOS512-0040 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Age 13-17)

UOS512-0050 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Male - Age 18-64)

UOS512-0060 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Age 18-64)

UOS512-0070 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Male - Age 65+)

UOS512-0080 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Age 65+)

UOS512-0090 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Male - Age Uknown)

UOS512-0100 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Age Uknown)

UOS512-0110 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Male - Total)

UOS512-0120 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Male - Total)

UOS512-0130 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Female - Age 0-12)

UOS512-0140 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Age 0-12)

UOS512-0150 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Female - Age 13-17)

UOS512-0160 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Age 13-17)

UOS512-0170 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Female - Age 18-64)

UOS512-0180 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Age 18-64)

UOS512-0190 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Female - Age 65+)

UOS512-0200 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Age 65+)

UOS512-0210 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Female - Age Uknown)

UOS512-0220 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Age Uknown)

UOS512-0230 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Female - Total)

UOS512-0240 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Female - Total)

UOS512-0250 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Total - Age 0-12)

UOS512-0260 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Age 0-12)

UOS512-0270 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Total - Age 13-17)

UOS512-0280 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Age 13-17)

UOS512-0290 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Total - Age 18-64)

UOS512-0300 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Age 18-64)

UOS512-0310 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Total - Age 65+)

UOS512-0320 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Age 65+)

### Measure Measure Name/Measure Description/Field Name/Field Description

UOS512-0330 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Total - Age Uknown)

UOS512-0340 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Age Uknown)

UOS512-0350 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Discharges/1000 (Total - Total)

UOS512-0360 Mental Health Utilization -- Inpatient Discharges And Average Length of Stay- Total Average Length of Stay (Total - Total)

#### UOS513 – Mental Health Utilization-% of Members Receiving Inpatient, Day/Night, and Ambulatory Services

DESCRIPTION - This measure reports the number and percentage of members receiving mental health services during the reporting year in the following categories: Any Mental Health Services (inpatient, day/night, ambulatory), Inpatient Mental Health Services, Day/Night Mental health Services and Ambulatory Mental Health Services. Report in each category the number of members who received the respective service and , of all enrollees with a mental health benefit, the percentage who received the respective service. This information is reported by age and sex.

This table is intended to give an overview of the extent to which the plan uses the different levels of mental health care.

(HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 188)

##### REPORTING LEVEL - Contract Market

UOS513-0010 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 0-12)

UOS513-0020 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 0-12)

UOS513-0030 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 0-12)

UOS513-0040 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 0-12)

UOS513-0050 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 13-17)

UOS513-0060 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 13-17)

UOS513-0070 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 13-17)

UOS513-0080 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 13-17)

UOS513-0090 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 18-64)

UOS513-0100 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 18-64)

UOS513-0110 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 18-64)

UOS513-0120 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 18-64)

UOS513-0130 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 65+)

UOS513-0140 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 65+)

UOS513-0150 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 65+)

UOS513-0160 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 65+)

UOS513-0170 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age Unknown)

UOS513-0180 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age Unknown)

UOS513-0190 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age Unknown)

### Measure Measure Name/Measure Description/Field Name/Field Description

UOS513-0200 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age Unknown)

UOS513-0210 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Total)

UOS513-0220 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Total)

UOS513-0230 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Total)

UOS513-0240 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male -Total)

UOS513-0250 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 0-12)

UOS513-0260 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 0-12)

UOS513-0270 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 0-12)

UOS513-0280 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 0-12)

UOS513-0290 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 13-17)

UOS513-0300 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 13-17)

UOS513-0310 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 13-17)

UOS513-0320 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 13-17)

UOS513-0330 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 18-64)

UOS513-0340 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 18-64)

UOS513-0350 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 18-64)

UOS513-0360 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 18-64)

UOS513-0370 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 65+)

UOS513-0380 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 65+)

UOS513-0390 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 65+)

UOS513-0400 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 65+)

UOS513-0410 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age Unknown)

UOS513-0420 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age Unknown)

UOS513-0430 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age Unknown)

UOS513-0440 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age Unknown)

UOS513-0450 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Total)

UOS513-0460 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Total)

UOS513-0470 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Total)

UOS513-0480 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female -Total)

### Measure Measure Name/Measure Description/Field Name/Field Description

UOS513-0490 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 0-12)

UOS513-0500 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 0-12)

UOS513-0510 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 0-12)

UOS513-0520 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 0-12)

UOS513-0530 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 13-17)

UOS513-0540 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 13-17)

UOS513-0550 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 13-17)

UOS513-0560 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 13-17)

UOS513-0570 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 18-64)

UOS513-0580 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 18-64)

UOS513-0590 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 18-64)

UOS513-0600 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 18-64)

UOS513-0610 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 65+)

UOS513-0620 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 65+)

UOS513-0630 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 65+)

UOS513-0640 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 65+)

UOS513-0650 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age Unknown)

UOS513-0660 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age Unknown)

UOS513-0670 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age Unknown)

UOS513-0680 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age Unknown)

UOS513-0690 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Total)

UOS513-0700 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Total)

UOS513-0710 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Total)

UOS513-0720 Mental Health Utilization -- Percentage Of Members Receiving Inpatient And Day/Night And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total -Total)

### Measure Measure Name/Measure Description/Field Name/Field Description

#### UOS514 – Readmission for specified mental health disorders

DESCRIPTION - The number of members readmitted within 90 and 365 days of hospitalization for selected mental health disorders and the percentages of those rehospitalized versus the number of all members hospitalized for these mental health disorders in the year before the reporting year. This information is reported by age and sex.

This measure is intended to help assess the extent of rehospitalization required after inpatient mental health treatment.

(HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 194)

##### REPORTING LEVEL - Contract Market

UOS514-0010 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Male - Age 0-12)

UOS514-0020 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Male - Age 0-12)

UOS514-0030 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Male - Age 13-17)

UOS514-0040 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Male - Age 13-17)

UOS514-0050 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Male - Age 18-64)

UOS514-0060 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Male - Age 18-64)

UOS514-0070 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Male - Age 65+)

UOS514-0080 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Male - Age 18-65+)

UOS514-0090 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Male - Age Unknown)

UOS514-0100 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Male - Age Unknown)

UOS514-0110 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Male - Total)

UOS514-0120 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Male - Total)

UOS514-0130 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Female - Age 0-12)

UOS514-0140 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Female - Age 0-12)

UOS514-0150 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Female - Age 13-17)

UOS514-0160 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Female - Age 13-17)

UOS514-0170 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Female - Age 18-64)

UOS514-0180 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Female - Age 18-64)

UOS514-0190 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Female - Age 65+)

UOS514-0200 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Female - Age 18-65+)

UOS514-0210 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Female - Age Unknown)

UOS514-0220 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Female - Age Unknown)

UOS514-0230 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Female - Total)

UOS514-0240 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Female - Total)

UOS514-0250 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Total - Age 0-12)

### Measure Measure Name/Measure Description/Field Name/Field Description

UOS514-0260 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Total - Age 0-12)

UOS514-0270 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Total - Age 13-17)

UOS514-0280 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Total - Age 13-17)

UOS514-0290 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Total - Age 18-64)

UOS514-0300 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Total - Age 18-64)

UOS514-0310 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Total - Age 65+)

UOS514-0320 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Total - Age 65+)

UOS514-0330 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Total - Age Unknown)

UOS514-0340 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Total - Age Unknown)

UOS514-0350 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 90 Days (Total - Total)

UOS514-0360 Readmission For Specified Mental Health Disorders- Total Percentage Readmitted within 365 Days (Total - Total)

#### UOS515 – Chemical Dependency utilization-Inpatient Discharges/Average Length of Stay

DESCRIPTION - This table summarizes utilization of inpatient chemical dependency services, stratified by age and sex. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 197)

##### REPORTING LEVEL - Contract Market

UOS515-0010 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Male - Age 0-12)

UOS515-0020 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Age 0-12)

UOS515-0030 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Male - Age 13-17)

UOS515-0040 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Age 13-17)

UOS515-0050 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Male - Age 18-64)

UOS515-0060 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Age 18-64)

UOS515-0070 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Male - Age 65+)

UOS515-0080 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Age 65+)

UOS515-0090 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Male - Age Unknown)

UOS515-0100 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Age Unknown)

UOS515-0110 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Male - Total)

UOS515-0120 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Male - Total)

UOS515-0130 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Female - Age 0-12)

UOS515-0140 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Age 0-12)

UOS515-0150 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Female - Age 13-17)

### Measure Measure Name/Measure Description/Field Name/Field Description

UOS515-0160 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Age 13-17)

UOS515-0170 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Female - Age 18-64)

UOS515-0180 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Age 18-64)

UOS515-0190 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Female - Age 65+)

UOS515-0200 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Age 65+)

UOS515-0210 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Female - Age Unknown)

UOS515-0220 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Age Unknown)

UOS515-0230 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Female - Total)

UOS515-0240 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Female - Total)

UOS515-0250 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Total - Age 0-12)

UOS515-0260 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Age 0-12)

UOS515-0270 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Total - Age 13-17)

UOS515-0280 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Age 13-17)

UOS515-0290 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Total - Age 18-64)

UOS515-0300 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Age 18-64)

UOS515-0310 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Total - Age 65+)

UOS515-0320 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Age 65+)

UOS515-0330 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Total - Age Unknown)

UOS515-0340 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Age Unknown)

UOS515-0350 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Discharges/1000 (Total - Total)

UOS515-0360 Chemical Dependency Utilization -- Inpatient Discharges And Average Length Of Stay- Total Average Length of Stay (Total - Total)

#### UOS516 – Chemical Dependency utilization-% of members Receiving Inpatient, Day/Night, and Ambulatory Services

DESCRIPTION - This measure reports the number and percentage of members receiving chemical dependency services during the reporting year in the following categories: Any Chemical Dependency Services (inpatient, day/night, ambulatory), Inpatient Chemical Dependency Services, Day/Night Chemical Dependency Services and Ambulatory Chemical Depencdency Services. Report in each category the number of members who received the respective service and, of all enrollees with a chemical dependency benefit, the percentage that received the respective service, This information is reported by age and sex.

This table is intended to give an overview of the extent to which the plan uses the different levels of chemical dependency care.

(HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 200)

##### REPORTING LEVEL - Contract Market

UOS516-0010 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 0-12)

UOS516-0020 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 0-12)

### Measure Measure Name/Measure Description/Field Name/Field Description

UOS516-0030 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 0-12)

UOS516-0040 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 0-12)

UOS516-0050 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 13-17)

UOS516-0060 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 13-17)

UOS516-0070 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 13-17)

UOS516-0080 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 13-17)

UOS516-0090 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 18-64)

UOS516-0100 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 18-64)

UOS516-0110 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 18-64)

UOS516-0120 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 18-64)

UOS516-0130 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age 65+)

UOS516-0140 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age 65+)

UOS516-0150 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age 65+)

UOS516-0160 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age 65+)

UOS516-0170 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Age Uknown)

UOS516-0180 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Age Unknown)

UOS516-0190 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Age Unknown)

UOS516-0200 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Age Unknown)

UOS516-0210 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Male - Total)

UOS516-0220 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Male - Total)

UOS516-0230 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Male - Total)

UOS516-0240 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Male - Total)

UOS516-0250 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 0-12)

UOS516-0260 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 0-12)

UOS516-0270 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 0-12)

UOS516-0280 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 0-12)

UOS516-0290 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 13-17)

UOS516-0300 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 13-17)

UOS516-0310 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 13-17)

### Measure Measure Name/Measure Description/Field Name/Field Description

UOS516-0320 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 13-17)

UOS516-0330 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 18-64)

UOS516-0340 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 18-64)

UOS516-0350 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 18-64)

UOS516-0360 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 18-64)

UOS516-0370 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age 65+)

UOS516-0380 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age 65+)

UOS516-0390 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age 65+)

UOS516-0400 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age 65+)

UOS516-0410 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Age Uknown)

UOS516-0420 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Age Unknown)

UOS516-0430 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Age Unknown)

UOS516-0440 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Age Unknown)

UOS516-0450 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Female - Total)

UOS516-0460 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Female - Total)

UOS516-0470 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Female - Total)

UOS516-0480 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Female - Total)

UOS516-0490 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 0-12)

UOS516-0500 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 0-12)

UOS516-0510 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 0-12)

UOS516-0520 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 0-12)

UOS516-0530 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 13-17)

UOS516-0540 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 13-17)

UOS516-0550 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 13-17)

UOS516-0560 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 13-17)

UOS516-0570 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 18-64)

UOS516-0580 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 18-64)

UOS516-0590 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 18-64)

UOS516-0600 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 18-64)

### Measure Measure Name/Measure Description/Field Name/Field Description

UOS516-0610 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age 65+)

UOS516-0620 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age 65+)

UOS516-0630 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age 65+)

UOS516-0640 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age 65+)

UOS516-0650 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Age Uknown)

UOS516-0660 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Age Unknown)

UOS516-0670 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Age Unknown)

UOS516-0680 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Age Unknown)

UOS516-0690 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Any Mental Health Services (Total - Total)

UOS516-0700 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Inpatient Mental Health Services (Total - Total)

UOS516-0710 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Day/Night Mental Health Services (Total - Total)

UOS516-0720 Chemical Dependency Utilization -- Percentage Of Members Receiving Inpatient And Day/Night Care And Ambulatory Services- Total Percentage Receiving Ambulatory Mental Health Services (Total - Total)

#### UOS517 – Readmission for specified Chemical Dependency disorders

DESCRIPTION - This measure reports the number of members readmitted within 90 and 365 days of hospitalization for chemical dependency treatment and the percentages of those rehospitalized versus the number of all members hospitalized for chemical dependency treatment in the year before the reporting year. This information is reported by age and sex.

This table is intended to help assess the extent of rehospitalization required after inpatient chemical dependency treatment.

(HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 206)

##### REPORTING LEVEL - Contract Market

UOS517-0010 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Male - Age 0-12)

UOS517-0020 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Male - Age 0-12)

UOS517-0030 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Male - Age 13-17)

UOS517-0040 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Male - Age 13-17)

UOS517-0050 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Male - Age 18-64)

UOS517-0060 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Male - Age 18-64)

UOS517-0070 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Male - Age 65+)

UOS517-0080 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Male - Age 65+)

UOS517-0090 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Male - Age Unknown)

UOS517-0100 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Male - Age Unknown)

UOS517-0110 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Male - Total)

UOS517-0120 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Male - Total)

UOS517-0130 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Female - Age 0-12)

UOS517-0140 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Female - Age 0-12)

UOS517-0150 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Female - Age 13-17)

UOS517-0160 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Female - Age 13-17)

UOS517-0170 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Female - Age 18-64)

UOS517-0180 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Female - Age 18-64)

UOS517-0190 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Female - Age 65+)

UOS517-0200 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Female - Age 65+)

UOS517-0210 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Female - Age Unknown)

UOS517-0220 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Female - Age Unknown)

### Measure Measure Name/Measure Description/Field Name/Field Description

UOS517-0230 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Female - Total)

UOS517-0240 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Female - Total)

UOS517-0250 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Total - Age 0-12)

UOS517-0260 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Total - Age 0-12)

UOS517-0270 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Total - Age 13-17)

UOS517-0280 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Total - Age 13-17)

UOS517-0290 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Total - Age 18-64)

UOS517-0300 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Total - Age 18-64)

UOS517-0310 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Total - Age 65+)

UOS517-0320 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Total - Age 65+)

UOS517-0330 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Total - Unknown)

UOS517-0340 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Total - Unknown)

UOS517-0350 Readmission For Chemical Dependency- Total Percentage Readmitted within 90 Days (Total)

UOS517-0360 Readmission For Chemical Dependency- Total Percentage Readmitted within 365 Days (Total)

#### UOS518 – Outpatient Drug Utilization

DESCRIPTION - This measure summarizes data on outpatient utilization of drug prescriptions (Total Cost of Prescriptions, Average Cost of Prescriptions per Member per Month, Total Number of Prescriptions and Average Number of Prescriptions per Member per Year) during the reporting year, stratified by age. (HEDIS 3.0/1997, Volume 2: Technical Specification, Pg. 208)

##### REPORTING LEVEL - Contract Market

UOS518-0010 Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 0-9)

UOS518-0020 Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 0-9)

UOS518-0030 Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 10-19)

UOS518-0040 Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 10-19)

UOS518-0050 Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 20-44)

UOS518-0060 Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 20-44)

UOS518-0070 Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 45-64)

UOS518-0080 Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 45-64)

UOS518-0090 Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 65-74)

UOS518-0100 Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 65-74)

UOS518-0110 Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 75-84)

UOS518-0120 Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 75-84)

UOS518-0130 Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age 85+)

UOS518-0140 Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age 85+)

UOS518-0150 Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Age Unknown)

UOS518-0160 Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Age Unknown)

UOS518-0170 Outpatient Drug Utilization- Total Average Cost of Prescriptions Per Member Per Month (Total)

UOS518-0180 Outpatient Drug Utilization- Total Average Number of Prescriptions Per Member Per Year (Total)