# HEDIS® 2009 (Summary) Documentation for Reporting Year 2008

## General Information

This documentation presents (1) a description of each HEDIS® measure that CMS collected for 387 Medicare managed care contracts for health care provided in calendar year 2008 to Medicare beneficiaries and (2) the location of the rates associated with each HEDIS measure within the HEDIS workbook (HEDIS2009.XLS). CMS took the description and additional information for each measure from HEDIS 2009 Volume 2: Technical Specifications. This release contains only those rates, percentages, or averages for each measure and not the numerator or denominator used to create those measures. CMS 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.

For this measurement year, CMS required that all managed care organizations undergo an audit on all HEDIS measures. The summary data file includes all submitted data.

The HEDIS measure descriptions reprinted here are done so with the permission of the National Committee for Quality Assurance ("NCQA"). HEDIS (R) is a registered trademark of NCQA, and a copyright for HEDIS (R) 2009 is held by the National Committee for Quality Assurance, 1100 13th Street, NW, Suite 1000, Washington, DC 20005. All rights reserved.

## The Medicare HEDIS reporting unit is the contract

In 2009, CMS collected data from 387 Medicare managed care contracts for health care delivered in 2008. CMS considers the reporting unit for a health plan as the equivalent to a contract. CMS signs a contract with health plans to provide health care for a given geographic service area. One contract still divides its geographic service area in two and reports at the "market area" level. This makes the total number of reported submissions 388.

The "GENERAL" sheet in the HEDIS workbook identifies the state and counties for each submission. The contract that reports at the "market area" level is shown with the market area after the state (CA: Northern California" and "CA: Southern California.")

## 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 2009 Technical Specifications, which are the specific instructions for calculating HEDIS measures that NCQA provides to Medicare managed care plans. For each measure, the Technical Specifications detail the precise method for sampling (when appropriate), identification of the numerator and denominator, measure calculation, and any other important considerations specific to that measure. The technical specifications also contain general guidelines that apply to all measures, such as the use of medical records and when a plan should not report a measure because its eligible membership is too small. Some measures require more detailed specifications than others. 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 2009, 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 three types of missing values: NA, NB and NR

The HEDIS guidelines distinguish between three different types of missing values in the rate field: Not Applicable (NA), No Benefit (NB) and Not Report (NR). Health plans report NA when they: do not have a large enough population to calculate a representative rate (e.g., many measures require that rates be based on at least 30 members) or are not eligible for a measure (e.g., a health plan cannot calculate outpatient drug utilization if it does not offer an outpatient drug benefit; a health plan cannot calculate a measure requiring a year of continuous enrollment if its first enrollment began mid-way through the reporting year.)

A value of NB is recorded when the health plan did not offer the health benefit required by the measure (e.g., Mental Health/Chemical Dependency). Health plans report NR when: they choose not to calculate and report a rate, or the health plan’s HEDIS Compliance Auditor determines that a rate is materially biased (applicable only to audited measures).

For measures reported as a percentage, material bias is defined as a deviation of more than five percentage points from the true rate. For other measures (e.g., procedures per 1000 member years), material bias exists if the number of counted procedures deviates by more than ten percent from the true number of procedures.

## 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.

CMS includes our record of enrollment as of December of the measurement year in the "GENERAL" sheet in the HEDIS workbook. The HEDIS reported value is adjusted for individuals with partial-year enrollment and reflects the entire contract's enrollment. CMS's enrollment is now broken down by the number enrolled in the CMS approved contract market area.

We have included the Medicare Modernization Act plan type designations as well as indicators if the contract offers a Special Needs benefit packages or a Part D Drug benefit in 2008. These values can be found on the sheet named "GENERAL".

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 members 20 years and older who had an ambulatory or preventive care visit. The organization reports three separate percentages for each product line.

• Medicaid and Medicare members who had an ambulatory or preventive care visit during the measurement year

• Commercial members who had an ambulatory or preventive care visit during the measurement year or the two years prior to the measurement year.

(HEDIS 2009, Volume 2: Technical Specification, Pg. 206)

##### REPORTING LEVEL - Contract

AOC201-0010 Rate 20-44

AOC201-0020 Rate 45-64

AOC201-0030 Rate 65+

AOC201-0040 Lower Confidence Interval - 20-44

AOC201-0050 Upper Confidence Interval - 20-44

AOC201-0060 Lower Confidence Interval - 45-64

AOC201-0070 Upper Confidence Interval - 45-64

AOC201-0080 Lower Confidence Interval - 65+

AOC201-0090 Upper Confidence Interval - 65+

AOC201-0095 Rate - Total

AOC201-0100 Lower Confidence Interval - All

AOC201-0110 Upper Confidence Interval - All

#### AOC220 – Call Abandonment

DESCRIPTION - The percentage of calls received by the organization’s Member Services call centers (during operating hours) during the measurement year that were abandoned by the caller before being answered by a live voice. (HEDIS 2009, Volume 2: Technical Specification, Pg. 229)

##### REPORTING LEVEL - Contract

AOC220-0010 Reported rate

AOC220-0020 Lower Confidence Interval

AOC220-0030 Upper Confidence Interval

#### AOC225 – Call Answer Timeliness

DESCRIPTION - The percentage of calls received by the organization’s Member Services call centers (during operating hours) during the measurement year that were answered by a live voice within 30 seconds. (HEDIS 2009, Volume 2: Technical Specification, Pg. 231)

##### REPORTING LEVEL - Contract

AOC225-0010 Reported rate

AOC225-0020 Lower Confidence Interval

AOC225-0030 Upper Confidence Interval

#### AOC235 – Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

DESCRIPTION - The percentage of adolescent and adult members with a new episode of alcohol or other drug (AOD) dependence who received the following.

• Initiation of AOD Treatment. The percentage of members who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis.

• Engagement of AOD Treatment. The percentage of members who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit.

(HEDIS 2009, Volume 2: Technical Specification, Pg. 212)

##### REPORTING LEVEL - Contract

AOC235-0010 Rate - Engagement - Overall Year Olds

AOC235-0020 Lower Confidence Interval - Engagement - Overall Year Olds

AOC235-0030 Upper Confidence Interval - Engagement - Overall Year Olds

AOC235-0040 Rate - Initiation - Overall Year Olds

AOC235-0050 Lower Confidence Interval - Initiation - Overall Year Olds

AOC235-0060 Upper Confidence Interval - Initiation - Overall Year Olds

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

#### EOC003 – Breast Cancer Screening

DESCRIPTION - The percentage of women 40–69 years of age who had a mammogram to screen for breast cancer. (HEDIS 2009, Volume 2: Technical Specification, Pg. 76)

##### REPORTING LEVEL - Contract

EOC003-0040 Reported Rate - 42-51

EOC003-0050 Lower Confidence Interval - 42-51

EOC003-0060 Upper Confidence Interval - 42-51

EOC003-0070 Reported Rate - 52-69

EOC003-0080 Lower Confidence Interval - 52-69

EOC003-0090 Upper Confidence Interval - 52-69

EOC003-0100 Rate - Total

EOC003-0110 Lower Confidence Interval - tot

EOC003-0120 Upper Confidence Interval - tot

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

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

1. The percentage of members who received follow-up within 30 days of discharge

2. The percentage of members who received follow-up within 7 days of discharge

(HEDIS 2009, Volume 2: Technical Specification, Pg. 170)

##### REPORTING LEVEL - Contract

EOC010-0011 Rate - 7 Days

EOC010-0012 Rate - 30 Days

EOC010-0021 Upper Confidence Interval - 7 Days

EOC010-0022 Upper Confidence Interval - 30 Days

EOC010-0031 Lower Confidence Interval - 7 Days

EOC010-0032 Lower Confidence Interval - 30 Days

#### EOC020 – Comprehensive Diabetes Care

DESCRIPTION - The percentage of members 18–75 years of age with diabetes (type 1 and type 2) who had each of the following.

• Hemoglobin A1c (HbA1c) testing

• HbA1c poor control (>9.0%)

• HbA1c good control (<7.0%)

• Eye exam (retinal) performed

• LDL-C screening

• LDL-C control (<100 mg/dL)

• Medical attention for nephropathy

• Blood pressure control (<130/80 mm Hg)

• Blood pressure control (<140/90 mm Hg)

(HEDIS 2009, Volume 2: Technical Specifications, Pg. 134)

##### REPORTING LEVEL - Contract

EOC020-0010 Rate - HbA1c Testing

EOC020-0020 Lower Confidence Interval - HbA1c Testing

EOC020-0030 Upper Confidence Interval - HbA1c Testing

EOC020-0040 Rate - Poor HbA1c Control

EOC020-0050 Lower Confidence Interval - Poor HbA1c Control

EOC020-0060 Upper Confidence Interval - Poor HbA1c Control

EOC020-0070 Rate - Eye Exams

EOC020-0080 Lower Confidence Interval - Eye Exams

EOC020-0090 Upper Confidence Interval - Eye Exams

EOC020-0100 Rate - Lipid Profile

EOC020-0110 Lower Confidence Interval - Lipid Profile

EOC020-0120 Upper Confidence Interval - Lipid Profile

EOC020-0160 Rate - Monitoring Diabetic Nephropathy

EOC020-0170 Lower Confidence Interval - Monitoring Diabetic Nephropathy

EOC020-0180 Upper Confidence Interval - Monitoring Diabetic Nephropathy

EOC020-0220 Rate <100 LDL-C Level

EOC020-0230 Lower Confidence Interval <100 LDL-C Level

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

EOC020-0240 Upper Confidence Interval <100 LDL-C Level

EOC020-0250 Rate - Good HbA1c Control

EOC020-0260 Lower Confidence Interval - Good HbA1c Control

EOC020-0270 Upper Confidence Interval - Good HbA1c Control

EOC020-0280 Rate - Blood Press Cont <130/80

EOC020-0290 Lower Confidence Interval - Blood Press Cont <130/80

EOC020-0300 Upper Confidence Interval - Blood Press Cont <130/80

EOC020-0310 Rate - Blood Press Cont <140/90

EOC020-0320 Lower Confidence Interval - Blood Press Cont <140/90

EOC020-0330 Upper Confidence Interval - Blood Press Cont <140/90

EOC020-0340 Rate - HbA1c Control (<8.0%)

EOC020-0350 Lower Confidence Interval - HbA1c Control (<8.0%)

EOC020-0360 Upper Confidence Interval - HbA1c Control (<8.0%)

#### EOC026 – Cholesterol Management for Patients with Cardiovascular Conditions

DESCRIPTION - TThe percentage of members 18–75 years of age who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from January 1–November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to measurement year, who had each of the following during the measurement year.

• LDL-C screening

• LDL-C control (<100 mg/Dl)

(HEDIS 2009, Volume 2: Technical Specifications, Pg. 120)

##### REPORTING LEVEL - Contract

EOC026-0010 Rate - LDL-C Screening

EOC026-0020 Lower Confidence Interval - LDL-C Screening

EOC026-0030 Upper Confidence Interval - LDL-C Screening

EOC026-0070 Rate <100 LDL-C Level

EOC026-0080 Lower Confidence Interval <100 LDL-C Level

EOC026-0090 Upper Confidence Interval <100 LDL-C Level

#### EOC030 – Antidepressant Medication Management

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

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

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

(HEDIS 2009, Volume 2: Technical Specifications, Pg. 160)

##### REPORTING LEVEL - Contract

EOC030-0010 Rate - Effect.Continuation Phase Treat.

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

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

EOC030-0040 Rate - Effect.Acute Phase Treatment

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

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

EOC030-0070 Rate - Optimal Practioner Contacts for Medication Mngmnt.

EOC030-0080 Lower Confidence Interval - Contacts for Medication Mngmnt.

EOC030-0090 Upper Confidence Interval - Contacts for Medication Mngmnt.

#### EOC035 – Controlling High Blood Pressure

DESCRIPTION -The percentage of members 18–85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90) during the measurement year. Use the Hybrid Method for this measure. (HEDIS 2009, Volume 2: Technical Specification, Pg. 124)

##### REPORTING LEVEL - Contract

EOC035-0100 Rate - Total

EOC035-0110 Lower Confidence Interval tot

EOC035-0120 Upper Confidence Interval tot

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

#### EOC040 – Colorectal Cancer Screening

DESCRIPTION - The percentage of members 50–80 years of age who had appropriate screening for colorectal cancer. (HEDIS 2009, Volume 2: Technical Specification, Pg. 81)

##### REPORTING LEVEL - Contract

EOC040-0010 Rate

EOC040-0020 Lower Confidence Interval

EOC040-0030 Upper Confidence Interval

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

DESCRIPTION -The percentage of women 67 years of age and older who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat or prevent osteoporosis in the six months after the fracture. (HEDIS 2009, Volume 2: Technical Specification, Pg. 152)

##### REPORTING LEVEL - Contract

EOC045-0010 Reported rate

EOC045-0020 Lower Confidence Interval

EOC045-0030 Upper Confidence Interval

#### EOC050 – Glaucoma Screening in Older Adults

DESCRIPTION - The percentage of Medicare members 65 years and older, without a prior diagnosis of glaucoma or glaucoma suspect, who received a glaucoma eye exam by an eye care professional for early identification of glaucomatous conditions. (HEDIS 2009, Volume 2: Technical Specification, Pg. 88)

##### REPORTING LEVEL - Contract

EOC050-0010 Reported Rate

EOC050-0020 Lower Confidence Interval

EOC050-0030 Upper Confidence Interval

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

DESCRIPTION - The percentage of members 18 years of age and older during the measurement year who were hospitalized and discharged alive from July 1 of the year prior to the measurement year to June 30 of the measurement year with a diagnosis of acute myocardial infarction (AMI) and who received persistent beta-blocker treatment for six months after discharge. (HEDIS 2009, Volume 2: Technical Specification, Pg. 129)

##### REPORTING LEVEL - Contract

EOC055-0010 Reported rate

EOC055-0020 Lower Confidence Interval

EOC055-0030 Upper Confidence Interval

#### EOC060 – Management of Urinary Incontinence in Older Adults

DESCRIPTION - The following components of this measure assess the management of urinary incontinence in older adults.

Discussing Urinary Incontinence - The percentage of Medicare members 65 years of age and older who reported having a problem with urine leakage in the past six months and who discussed their urine leakage problem with their current practitioner.

Receiving Urinary Incontinence Treatment - The percentage of Medicare members 65 years of age and older who reported having a urine leakage problem in the past six months and who received treatment for their current urine leakage problem.

(HEDIS 2009, Volume 2: Technical Specification, Pg. 194)

##### REPORTING LEVEL - Contract

EOC060-0010 Discussing Urinary Incontinence Rate

EOC060-0020 Receiving Urinary Incontinence Treatment Rate

#### EOC065 – Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis

DESCRIPTION - The percentage of members who were diagnosed with rheumatoid arthritis and who were dispensed at least one ambulatory prescription for a disease modifying anti-rheumatic drug (DMARD). (HEDIS 2009, Volume 2: Technical Specification, Pg. 150)

##### REPORTING LEVEL - Contract

EOC065-0010 Reported rate

EOC065-0020 Lower Confidence Interval

EOC065-0030 Upper Confidence Interval

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

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

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

• The percentage of Medicare members 65 years of age and older who received at least two different high risk medications For both rates, a lower rate represents better performance

(HEDIS 2009, Volume 2: Technical Specification, Pg. 188)

##### REPORTING LEVEL - Contract

EOC070-0010 Rate - one prescription

EOC070-0020 Lower Confidence Interval - one prescription

EOC070-0030 Upper Confidence Interval - one prescription

EOC070-0040 Rate - at least 2 prescriptions

EOC070-0050 Lower Confidence Interval - at least 2 prescriptions

EOC070-0060 Upper Confidence Interval - at least 2 prescriptions

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

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

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

• Annual monitoring for members on digoxin

• Annual monitoring for members on diuretics

• Annual monitoring for members on anticonvulsants

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

(HEDIS 2009, Volume 2: Technical Specification, Pg. 174)

##### REPORTING LEVEL - Contract

EOC075-0010 Reported rate - ACE inhibitors or ARBs

EOC075-0020 Lower Confidence Interval - ACE inhibitors or ARBs

EOC075-0030 Upper Confidence Interval - ACE inhibitors or ARBs

EOC075-0040 Reported rate - Digoxin

EOC075-0050 Lower Confidence Interval - Digoxin

EOC075-0060 Upper Confidence Interval - Digoxin

EOC075-0070 Reported rate - Diuretics

EOC075-0080 Lower Confidence Interval - Diuretics

EOC075-0090 Upper Confidence Interval - Diuretics

EOC075-0100 Reported rate - Anticonvulsants

EOC075-0110 Lower Confidence Interval - Anticonvulsants

EOC075-0120 Upper Confidence Interval - Anticonvulsants

EOC075-0160 Reported rate - Total

EOC075-0170 Lower Confidence Interval - Total

EOC075-0180 Upper Confidence Interval - Total

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

DESCRIPTION - The percentage of members 40 years of age and older with a new diagnosis or newly active chronic obstructive pulmonary disease (COPD) who received appropriate spirometry testing to confirm the diagnosis. (HEDIS 2009, Volume 2: Technical Specification, Pg. 109)

##### REPORTING LEVEL - Contract

EOC080-0010 Reported rate

EOC080-0020 Lower Confidence Interval

EOC080-0030 Upper Confidence Interval

#### EOC085 – Physical Activity in Older Adults (HOS)

DESCRIPTION - The following components of this measure assess different facets of promoting physical activity in older adults.

Discussing Physical Activity - The percentage of Medicare members 65 years of age and older who had a doctor’s visit in the past 12 months and who spoke with a doctor or other health provider about their level of exercise or physical activity.

Advising Physical Activity - The percentage of Medicare members 65 years of age and older who had a doctor’s visit in the past 12 months and who received advice to start, increase or maintain their level exercise or physical activity. (HEDIS 2009, Volume 2: Technical Specification, Pg. 196)

##### REPORTING LEVEL - Contract

EOC085-0010 Discussing Physical Activity Rate

EOC085-0020 Advising Physical Activity Rate

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

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

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

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

• Dementia and a prescription for tricyclic antidepressants or anticholinergic agents

• Chronic renal failure and prescription for nonaspirin NSAIDs or Cox-2 Selective NSAIDs

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

Members with more than one disease or condition can appear in the measure multiple times (i.e., in each indicator for which they qualify). For all three rates, a lower rate represents better performance. (HEDIS 2009, Volume 2: Technical Specification, Pg. 182)

##### REPORTING LEVEL - Contract

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

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

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

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

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

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

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

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

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

EOC090-0100 Rate - Total

EOC090-0110 Lower Confidence Interval - Total

EOC090-0120 Upper Confidence Interval - Total

#### EOC095 – Fall Risk Management

DESCRIPTION - The following components of this measure assess different facets of fall risk management.

Discussing Fall Risk - The percentage of Medicare members 75 years of age and older or 65–74 years of age with balance or walking problems or a fall in the past 12 months, who were seen by a practitioner in the past 12 months and who discussed falls or problems with balance or walking with their current practitioner.

Managing Fall Risk - The percentage of Medicare members 65 years of age and older who had a fall or had problems with balance or walking in the past 12 months, who were seen by a practitioner in the past 12 months and who received fall risk intervention from their current practitioner.
(HEDIS 2009, Volume 2: Technical Specification, Pg. 193)

##### REPORTING LEVEL - Contract

EOC095-0010 Discussing Falls Risk Rate

EOC095-0020 Discussing Falls Risk Rate

#### EOC100 – Osteoporosis Testing in Older Women

DESCRIPTION - The percentage of Medicare women 65 years of age and older who report ever having received a bone density test to check for osteoporosis. (HEDIS 2009, Volume 2: Technical Specification, Pg. 195)

##### REPORTING LEVEL - Contract

EOC100-0010 Osteoporosis Testing Percent

#### EOC105 – Pharmacotherapy Management of COPD Exacerbation

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

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

2. Dispensed a bronchodilator within 30 days of the event

(HEDIS 2009, Volume 2: Technical Specification, Pg. 111)

##### REPORTING LEVEL - Contract

EOC105-0010 Reported rate - Systemic corticosteroid

EOC105-0020 Lower 95% confidence interval - Systemic corticosteroid

EOC105-0030 Upper 95% confidence interval - Systemic corticosteroid

EOC105-0040 Reported rate - Bronchodilator

EOC105-0050 Lower 95% confidence interval - Bronchodilator

EOC105-0060 Upper 95% confidence interval – Bronchodilator

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

#### EOC110 – Adult BMI Assessment

DESCRIPTION - The percentage of members 18–74 years of age who had an outpatient visit and who had their body mass index (BMI) documented during the measurement year or the year prior the measurement year.(HEDIS 2009, Volume 2: Technical Specification, Pg. 60)

##### REPORTING LEVEL - Contract

EOC110-0010 Reported rate

EOC110-0020 Lower Confidence Interval

EOC110-0030 Upper Confidence Interval

#### General – General Information

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

##### REPORTING LEVEL - N/A

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

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

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

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

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

General-0050 12/2007 Enrollment as reported by the Medicare Advantage Prescription Drug (MARx) system

General-0060 CMS Region Number

General-0070 CMS Region Name

General-0080 Patient Population

General-0085 Submitted summary level HEDIS 2008 data to NCQA

General-0087 Included in HOS data from NCQA

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

DESCRIPTION - The number of years since licensure (the number of years that each product line has existed) and the number of members enrolled as of December 31 of the measurement year. (HEDIS 2009, Volume 2: Technical Specification, Pg. 399)

##### REPORTING LEVEL - Contract

HPS403-0010 Years in Bus. HMO-Tot

HPS403-0020 Years in Bus. HMO-Medicaid

HPS403-0030 Years in Bus. HMO-Commercial

HPS403-0040 Years in Bus. HMO-Medicare Risk/Cost

HPS403-0060 Years in Bus. HMO-Self-insured

HPS403-0070 Years in Bus. HMO-Oth

HPS403-0080 Years in Bus. PPO-Tot

HPS403-0090 Years in Bus. PPO-Commercial

HPS403-0100 Years in Bus. PPO-Medicare Risk/Cost

HPS403-0120 Years in Bus. PPO-Self-insured

HPS403-0130 Years in Bus. PPO-Oth

HPS403-0140 Years in Bus. POS-Tot

HPS403-0150 Years in Bus. POS-Commercial

HPS403-0160 Years in Bus. POS-Medicare Risk/Cost

HPS403-0180 Years in Bus. POS-Self-insured

HPS403-0190 Years in Bus. POS-Oth

HPS403-0210 Membership HMO-Tot

HPS403-0220 Membership HMO-Medicaid

HPS403-0230 Membership HMO-Commercial

HPS403-0240 Membership HMO-Medicare Risk/Cost

HPS403-0260 Membership HMO-Self-insured

HPS403-0270 Membership HMO-Oth

HPS403-0280 Membership PPO-Tot

HPS403-0290 Membership PPO-Commercial

HPS403-0300 Membership PPO-Medicare Risk/Cost

HPS403-0320 Membership PPO-Self-insured

HPS403-0330 Membership PPO-Oth

HPS403-0340 Membership POS-Tot

HPS403-0350 Membership POS-Commercial

HPS403-0360 Membership POS-Medicare Risk/Cost

HPS403-0380 Membership POS-Self-insured

HPS403-0390 Membership POS-Oth

HPS403-0400 Tot Membership Tot

HPS403-0410 Years in Bus. PPO-Medicaid

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

HPS403-0420 Membership PPO-Medicaid

HPS403-0430 Years in Bus. POS-Medicaid

HPS403-0440 Membership POS-Medicaid

#### National_Rates – National Enrollment Weighted Average Score

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

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

Where:

TotE = Total enrollment for all contracts with a valid numeric rate in the measure
En1 = Enrollment in the first contract with a valid numeric rate
Sn1 = Reported rate for the first contract with a valid numeric rate
Enx = Enrollment in the last contract with a valid numeric rate
Snx = Reported rate for the last contract with a valid numeric rate

##### REPORTING LEVEL - National

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

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

NR-030 The National Rate for this measure and field

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

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

#### PDI801 – Board Certification/Residency Completion

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

• Family medicine physicians

• Internal medicine physicians

• Pediatricians

• OB/GYN physicians

• Geriatricians

• Other physician specialists

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

(HEDIS 2009, Volume 2: Technical Specification, Pg. 379)

##### REPORTING LEVEL - Contract

PDI801-0010 Family Medicine Board Cert Pct

PDI801-0030 Oth Specialists Board Cert Pct

PDI801-0050 Geriatricians Board Cert Pct

PDI801-0060 Internal Medicine Board Cert Pct

#### PDI806 – Enrollment by Product Line

DESCRIPTION - The total number of members enrolled in the product line, stratified by age and sex. (HEDIS 2006, Volume 2: Technical Specification, Pg. 383)

##### REPORTING LEVEL - Contract

PDI806-0010 Enr by Product Line Tot M

PDI806-0020 Enr by Product Line Tot F

PDI806-0030 Enr by Product Line Tot Tot

#### PDI807 – Language Diversity of Membership

DESCRIPTION - An unduplicated count and percentage of Medicaid and Medicare members enrolled at any time during the measurement year by demand for language interpreter services and spoken language. (HEDIS 2006, Volume 2: Technical Specification, Pg. 388)

##### REPORTING LEVEL - Contract

PDI807-0010 Demand for Interpretation Services Yes M Pct

PDI807-0020 Demand for Interpretation Services Yes F Pct

PDI807-0030 Demand for Interpretation Services Yes MF Tot Pct

PDI807-0040 Demand for Interpretation Services No M Pct

PDI807-0050 Demand for Interpretation Services No F Pct

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

PDI807-0060 Demand for Interpretation Services No MF Tot Pct

PDI807-0070 Demand for Interpretation Services Unknown M Pct

PDI807-0080 Demand for Interpretation Services Unknown F Pct

PDI807-0090 Demand for Interpretation Services Unknown MF Tot Pct

PDI807-0100 Demand for Interpretation Services M Total Pct

PDI807-0110 Demand for Interpretation Services F Total Pct

PDI807-0120 Demand for Interpretation Services MF Total Tot Pct

PDI807-0130 Percentage Members With Interpretation Needs

PDI807-0140 Spoken Language at Home English M Pct

PDI807-0150 Spoken Language at Home English F Pct

PDI807-0160 Spoken Language at Home English MF Tot Pct

PDI807-0170 Spoken Language at Home Spanish/Creole M Pct

PDI807-0180 Spoken Language at Home Spanish/Creole F Pct

PDI807-0190 Spoken Language at Home Spanish/Creole MF Tot Pct

PDI807-0200 Spoken Language at Home Oth Indo-European M Pct

PDI807-0210 Spoken Language at Home Oth Indo-European F Pct

PDI807-0220 Spoken Language at Home Oth Indo-European MF Tot Pct

PDI807-0230 Spoken Language at Home Asian & Pacific Island M Pct

PDI807-0240 Spoken Language at Home Asian & Pacific Island F Pct

PDI807-0250 Spoken Language at Home Asian & Pacific Island MF Tot Pct

PDI807-0260 Spoken Language at Home Other M Pct

PDI807-0270 Spoken Language at Home Other F Pct

PDI807-0280 Spoken Language at Home Other MF Tot Pct

PDI807-0290 Spoken Language at Home Unknown M Pct

PDI807-0300 Spoken Language at Home Unknown F Pct

PDI807-0310 Spoken Language at Home Unknown MF Tot Pct

PDI807-0320 Spoken Language at Home Total M Pct

PDI807-0330 Spoken Language at Home Total F Pct

PDI807-0340 Spoken Language at Home Total MF Tot Pct

PDI807-0350 Percentage Members with Known Spoken Language

#### PDI808 – Race/Ethnicity Diversity of Membership

DESCRIPTION - An unduplicated count and percentage of members enrolled any time during the measurement year by race and ethnicity. (HEDIS 2009, Volume 2: Technical Specification, Pg. 391)

##### REPORTING LEVEL - Contract

PDI808-0010 White M Hispanic (any) Pct

PDI808-0020 White F Hispanic (any) Pct

PDI808-0030 White MF Hispanic (any) Tot Pct

PDI808-0040 Black or African American M Hispanic (any) Pct

PDI808-0050 Black or African American F Hispanic (any) Pct

PDI808-0060 Black or African American MF Hispanic (any) Tot Pct

PDI808-0070 American-Indian & Alaska Native M Hispanic (any) Pct

PDI808-0080 American-Indian & Alaska Native F Hispanic (any) Pct

PDI808-0090 American-Indian & Alaska Native MF Hispanic (any) Tot Pct

PDI808-0100 Asian M Hispanic (any) Pct

PDI808-0110 Asian F Hispanic (any) Pct

PDI808-0120 Asian MF Hispanic (any) Tot Pct

PDI808-0130 Native Hawaiian & Oth Pac Islanders M Hispanic (any) Pct

PDI808-0140 Native Hawaiian & Oth Pac Islanders F Hispanic (any) Pct

PDI808-0150 Native Hawaiian & Oth Pac Islanders MF Hispanic (any) Tot Pct

PDI808-0160 Some Other Race M Hispanic (any) Pct

PDI808-0170 Some Other Race F Hispanic (any) Pct

PDI808-0180 Some Other Race MF Hispanic (any) Tot Pct

PDI808-0190 Two or More Races M Hispanic (any) Pct

PDI808-0200 Two or More Races F Hispanic (any) Pct

PDI808-0210 Two or More Races MF Hispanic (any) Tot Pct

PDI808-0220 Unknown M Hispanic (any) Pct

PDI808-0230 Unknown F Hispanic (any) Pct

PDI808-0240 Unknown MF Hispanic (any) Tot Pct

PDI808-0250 Total M Hispanic (any) Pct

PDI808-0260 Total F Hispanic (any) Pct

PDI808-0270 Total MF Hispanic (any) Tot Pct

PDI808-0280 White M Not Hispanic or Latino Pct

PDI808-0290 White F Not Hispanic or Latino Pct

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

PDI808-0300 White MF Not Hispanic or Latino Tot Pct

PDI808-0310 Black or African American M Not Hispanic or Latino Pct

PDI808-0320 Black or African American F Not Hispanic or Latino Pct

PDI808-0330 Black or African American MF Not Hispanic or Latino Tot Pct

PDI808-0340 American-Indian & Alaska Native M Not Hispanic or Latino Pct

PDI808-0350 American-Indian & Alaska Native F Not Hispanic or Latino Pct

PDI808-0360 American-Indian & Alaska Native MF Not Hispanic or Latino Tot Pct

PDI808-0370 Asian M Not Hispanic or Latino Pct

PDI808-0380 Asian F Not Hispanic or Latino Pct

PDI808-0390 Asian MF Not Hispanic or Latino Tot Pct

PDI808-0400 Native Hawaiian & Oth Pac Islanders M Not Hispanic or Latino Pct

PDI808-0410 Native Hawaiian & Oth Pac Islanders F Not Hispanic or Latino Pct

PDI808-0420 Native Hawaiian & Oth Pac Islanders MF Not Hispanic or Latino Tot Pct

PDI808-0430 Some Other Race M Not Hispanic or Latino Pct

PDI808-0440 Some Other Race F Not Hispanic or Latino Pct

PDI808-0450 Some Other Race MF Not Hispanic or Latino Tot Pct

PDI808-0460 Two or More Races M Not Hispanic or Latino Pct

PDI808-0470 Two or More Races F Not Hispanic or Latino Pct

PDI808-0480 Two or More Races MF Not Hispanic or Latino Tot Pct

PDI808-0490 Unknown M Not Hispanic or Latino Pct

PDI808-0500 Unknown F Not Hispanic or Latino Pct

PDI808-0510 Unknown MF Not Hispanic or Latino Tot Pct

PDI808-0520 Total M Not Hispanic or Latino Pct

PDI808-0530 Total F Not Hispanic or Latino Pct

PDI808-0540 Total MF Not Hispanic or Latino Tot Pct

PDI808-0550 White M Unknown Ethnicity Pct

PDI808-0560 White F Unknown Ethnicity Pct

PDI808-0570 White MF Unknown Ethnicity Tot Pct

PDI808-0580 Black or African American M Unknown Ethnicity Pct

PDI808-0590 Black or African American F Unknown Ethnicity Pct

PDI808-0600 Black or African American MF Unknown Ethnicity Tot Pct

PDI808-0610 American-Indian & Alaska Native M Unknown Ethnicity Pct

PDI808-0620 American-Indian & Alaska Native F Unknown Ethnicity Pct

PDI808-0630 American-Indian & Alaska Native MF Unknown Ethnicity Tot Pct

PDI808-0640 Asian M Unknown Ethnicity Pct

PDI808-0650 Asian F Unknown Ethnicity Pct

PDI808-0660 Asian MF Unknown Ethnicity Tot Pct

PDI808-0670 Native Hawaiian & Oth Pac Islanders M Unknown Ethnicity Pct

PDI808-0680 Native Hawaiian & Oth Pac Islanders F Unknown Ethnicity Pct

PDI808-0690 Native Hawaiian & Oth Pac Islanders MF Unknown Ethnicity Tot Pct

PDI808-0700 Some Other Race M Unknown Ethnicity Pct

PDI808-0710 Some Other Race F Unknown Ethnicity Pct

PDI808-0720 Some Other Race MF Unknown Ethnicity Tot Pct

PDI808-0730 Two or More Races M Unknown Ethnicity Pct

PDI808-0740 Two or More Races F Unknown Ethnicity Pct

PDI808-0750 Two or More Races MF Unknown Ethnicity Tot Pct

PDI808-0760 Unknown M Unknown Ethnicity Pct

PDI808-0770 Unknown F Unknown Ethnicity Pct

PDI808-0780 Unknown MF Unknown Ethnicity Tot Pct

PDI808-0790 Total M Unknown Ethnicity Pct

PDI808-0800 Total F Unknown Ethnicity Pct

PDI808-0810 Total MF Unknown Ethnicity Tot Pct

PDI808-0820 White M Total Pct

PDI808-0830 White F Total Pct

PDI808-0840 White MF Total Tot Pct

PDI808-0850 Black or African American M Total Pct

PDI808-0860 Black or African American F Total Pct

PDI808-0870 Black or African American MF Total Tot Pct

PDI808-0880 American-Indian & Alaska Native M Total Pct

PDI808-0890 American-Indian & Alaska Native F Total Pct

PDI808-0900 American-Indian & Alaska Native MF Total Tot Pct

PDI808-0910 Asian M Total Pct

PDI808-0920 Asian F Total Pct

PDI808-0930 Asian MF Total Tot Pct

PDI808-0940 Native Hawaiian & Oth Pac Islanders M Total Pct

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

PDI808-0950 Native Hawaiian & Oth Pac Islanders F Total Pct

PDI808-0960 Native Hawaiian & Oth Pac Islanders MF Total Tot Pct

PDI808-0970 Some Other Race M Total Pct

PDI808-0980 Some Other Race F Total Pct

PDI808-0990 Some Other Race MF Total Tot Pct

PDI808-1000 Two or More Races M Total Pct

PDI808-1010 Two or More Races F Total Pct

PDI808-1020 Two or More Races MF Total Tot Pct

PDI808-1030 Unknown M Total Pct

PDI808-1040 Unknown F Total Pct

PDI808-1050 Unknown MF Total Tot Pct

PDI808-1060 Race EthnicityM Total Pct

PDI808-1070 Race Ethnicity F Total Pct

PDI808-1080 Race Ethnicity MF Total Tot Pct

PDI808-1090 Percentage Known Ethnicity

#### PDI809 – Enrollment by State

DESCRIPTION - The number of members enrolled as of December 31 of the measurement year, by state. (HEDIS 2009, Volume 2: Technical Specification, Pg. 387)

##### REPORTING LEVEL - Contract

PDI809-0010 Alabama

PDI809-0020 Alaska

PDI809-0030 Arizona

PDI809-0040 Arkansas

PDI809-0050 California

PDI809-0060 Colorado

PDI809-0070 Connecticut

PDI809-0080 Delaware

PDI809-0090 District of Columbia

PDI809-0100 Florida

PDI809-0110 Georgia

PDI809-0120 Hawaii

PDI809-0130 Idaho

PDI809-0140 Illinois

PDI809-0150 Indiana

PDI809-0160 Iowa

PDI809-0170 Kansas

PDI809-0180 Kentucky

PDI809-0190 Louisiana

PDI809-0200 Maine

PDI809-0210 Maryland

PDI809-0220 Massachusetts

PDI809-0230 Michigan

PDI809-0240 Minnesota

PDI809-0250 Mississippi

PDI809-0260 Missouri

PDI809-0270 Montana

PDI809-0280 Nebraska

PDI809-0290 Nevada

PDI809-0300 New Hampshire

PDI809-0310 New Jersey

PDI809-0320 New Mexico

PDI809-0330 New York

PDI809-0340 North Carolina

PDI809-0350 North Dakota

PDI809-0360 Ohio

PDI809-0370 Oklahoma

PDI809-0380 Oregon

PDI809-0390 Pennsylvania

PDI809-0400 Rhode Island

PDI809-0410 South Carolina

PDI809-0420 South Dakota

PDI809-0430 Tennessee

PDI809-0440 Texas

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

PDI809-0450 Utah

PDI809-0460 Vermont

PDI809-0470 Virginia

PDI809-0480 Washington

PDI809-0490 West Virginia

PDI809-0500 Wisconsin

PDI809-0510 Wyoming

PDI809-0520 American Samoa

PDI809-0530 Federated States of Micronesia

PDI809-0540 Guam

PDI809-0550 Commonwealth of Northern Marianas

PDI809-0560 Puerto Rico

PDI809-0570 Virgin Islands

PDI809-0580 Other

PDI809-0590 Total

#### 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 summarizes the utilization of frequently performed procedures that often show wide regional variation and have generated concern regarding potentially inappropriate utilization.(HEDIS 2009, Volume 2: Technical Specification, Pg. 262)

##### REPORTING LEVEL - Contract

UOS505-0010 CABG M <65 Procs/1000

UOS505-0020 CABG M 65-74 Procs/1000

UOS505-0030 CABG M 75-84 Procs/1000

UOS505-0040 CABG M 85+ Procs/1000

UOS505-0050 Angioplasty (PTCA) M <65 Procs/1000

UOS505-0060 Angioplasty (PTCA)M 65-74 Procs/1000

UOS505-0070 Angioplasty (PTCA) M 75-84 Procs/1000

UOS505-0080 Angioplasty (PTCA) M 85+ Procs/1000

UOS505-0090 Carotid Endarterectomy M <65 Procs/1000

UOS505-0100 Carotid Endarterectomy M 65-74 Procs/1000

UOS505-0110 Carotid Endarterectomy M 75-84 Procs/1000

UOS505-0120 Carotid Endarterectomy M 85+ Procs/1000

UOS505-0130 Reduction of Fracture Femur M <65 Procs/1000

UOS505-0140 Reduction of Fracture Femur M 65-74 Procs/1000

UOS505-0150 Reduction of Fracture Femur M 75-84 Procs/1000

UOS505-0160 Reduction of Fracture Femur M 85+ Procs/1000

UOS505-0170 Total Hip Replacement M <65 Procs/1000

UOS505-0180 Total Hip Replacement M 65-74 Procs/1000

UOS505-0190 Total Hip Replacement M 75-84 Procs/1000

UOS505-0200 Total Hip Replacement M 85+ Procs/1000

UOS505-0210 Total Knee Replacement M <65 Procs/1000

UOS505-0220 Total Knee Replacement M 65-74 Procs/1000

UOS505-0230 Total Knee Replacement M 75-84 Procs/1000

UOS505-0240 Total Knee Replacement M 85+ Procs/1000

UOS505-0250 Partial Excision of Large Intestine M <65 Procs/1000

UOS505-0260 Partial Excision of Large Intestine M 65-74 Procs/1000

UOS505-0270 Partial Excision of Large Intestine M 75-84 Procs/1000

UOS505-0280 Partial Excision of Large Intestine M 85+ Procs/1000

UOS505-0290 Cholecystectomy opn M <65 Procs/1000

UOS505-0300 Cholecystectomy opn M 65-74 Procs/1000

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

UOS505-0310 Cholecystectomy opn M 75-84 Procs/1000

UOS505-0320 Cholecystectomy opn M 85+ Procs/1000

UOS505-0330 Cholecystectomy cld (laparoscopic) M <65 Procs/1000

UOS505-0340 Cholecystectomy cld (laparoscopic) M 65-74 Procs/1000

UOS505-0350 Cholecystectomy cld (laparoscopic) M 75-84 Procs/1000

UOS505-0360 Cholecystectomy cld (laparoscopic) M 85+ Procs/1000

UOS505-0370 Prostatectomy <65 Procs/1000

UOS505-0380 Prostatectomy 65-74 Procs/1000

UOS505-0390 Prostatectomy 75-84 Procs/1000

UOS505-0400 Prostatectomy 85+ Procs/1000

UOS505-0410 CABG F <65 Procs/1000

UOS505-0420 CABG F 65-74 Procs/1000

UOS505-0430 CABG F 75-84 Procs/1000

UOS505-0440 CABG F 85+ Procs/1000

UOS505-0450 Angioplasty (PTCA)F <65 Procs/1000

UOS505-0460 Angioplasty (PTCA)F 65-74 Procs/1000

UOS505-0470 Angioplasty (PTCA) F 75-84 Procs/1000

UOS505-0480 Angioplasty (PTCA) F 85+ Procs/1000

UOS505-0490 Carotid Endarterectomy F <65 Procs/1000

UOS505-0500 Carotid Endarterectomy F 65-74 Procs/1000

UOS505-0510 Carotid Endarterectomy F 75-84 Procs/1000

UOS505-0520 Carotid Endarterectomy F 85+ Procs/1000

UOS505-0530 Reduction of Fracture Femur F <65 Procs/1000

UOS505-0540 Reduction of Fracture Femur F 65-74 Procs/1000

UOS505-0550 Reduction of Fracture Femur F 75-84 Procs/1000

UOS505-0560 Reduction of Fracture Femur F 85+ Procs/1000

UOS505-0570 Total Hip Replacement F <65 Procs/1000

UOS505-0580 Total Hip Replacement F 65-74 Procs/1000

UOS505-0590 Total Hip Replacement F 75-84 Procs/1000

UOS505-0600 Total Hip Replacement F 85+ Procs/1000

UOS505-0610 Total Knee Replacement F <65 Procs/1000

UOS505-0620 Total Knee Replacement F 65-74 Procs/1000

UOS505-0630 Total Knee Replacement F 75-84 Procs/1000

UOS505-0640 Total Knee Replacement F 85+ Procs/1000

UOS505-0650 Partial Excision of Large Intestine F <65 Procs/1000

UOS505-0660 Partial Excision of Large Intestine F 65-74 Procs/1000

UOS505-0670 Partial Excision of Large Intestine F 75-84 Procs/1000

UOS505-0680 Partial Excision of Large Intestine F 85+ Procs/1000

UOS505-0690 Cholecystectomy opn F <65 Procs/1000

UOS505-0700 Cholecystectomy opn F 65-74 Procs/1000

UOS505-0710 Cholecystectomy opn F 75-84 Procs/1000

UOS505-0720 Cholecystectomy opn F 85+ Procs/1000

UOS505-0730 Cholecystectomy cld (laparoscopic) F <65 Procs/1000

UOS505-0740 Cholecystectomy cld (laparoscopic) F 65-74 Procs/1000

UOS505-0750 Cholecystectomy cld (laparoscopic) F 75-84 Procs/1000

UOS505-0760 Cholecystectomy cld (laparoscopic) F 85+ Procs/1000

UOS505-0771 Hysterectomy - Abdominal <65 Procs/1000

UOS505-0772 Hysterectomy - Vaginal <65 Procs/1000

UOS505-0781 Hysterectomy - Abdominal 65-74 Procs/1000

UOS505-0782 Hysterectomy - Vaginal 65-74 Procs/1000

UOS505-0791 Hysterectomy - Abdominal 75-84 Procs/1000

UOS505-0792 Hysterectomy - Vaginal 75-84 Procs/1000

UOS505-0801 Hysterectomy - Abdominal 85+ Procs/1000

UOS505-0802 Hysterectomy - Vaginal 85+ Procs/1000

UOS505-0810 Cardiac Catheterization M <65 Procs/1000

UOS505-0820 Cardiac Catheterization F <65 Procs/1000

UOS505-0830 Cardiac Catheterization M 65-74 Procs/1000

UOS505-0840 Cardiac Catheterization F 65-74 Procs/1000

UOS505-0850 Cardiac Catheterization M 75-84 Procs/1000

UOS505-0860 Cardiac Catheterization F 75-84 Procs/1000

UOS505-0870 Cardiac Catheterization M 85+ Procs/1000

UOS505-0880 Cardiac Catheterization F 85+ Procs/1000

UOS505-0890 Mastectomy F <65 Procs/1000

UOS505-0900 Mastectomy F 65-74 Procs/1000

UOS505-0910 Mastectomy F 75-84 Procs/1000

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

UOS505-0920 Mastectomy F 85+ Procs/1000

UOS505-0930 Lumpectomy F <65 Procs/1000

UOS505-0940 Lumpectomy F 65-74 Procs/1000

UOS505-0950 Lumpectomy F 75-84 Procs/1000

UOS505-0960 Lumpectomy F 85+ Procs/1000

UOS505-0970 Back Surgery M <65 Procs/1000

UOS505-0980 Back Surgery F <65 Procs/1000

UOS505-0990 Back Surgery M 65-74 Procs/1000

UOS505-1000 Back Surgery F 65-74 Procs/1000

UOS505-1010 Back Surgery M 75-84 Procs/1000

UOS505-1020 Back Surgery F 75-84 Procs/1000

UOS505-1030 Back Surgery M 85+ Procs/1000

UOS505-1040 Back Surgery F 85+ Procs/1000

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

DESCRIPTION - This measure summarizes utilization of acute inpatient care and services in the following categories.

• Total inpatient

• Medicine

• Surgery

• Maternity

(HEDIS 2009, Volume 2: Technical Specification, Pg. 277)

##### REPORTING LEVEL - Contract

UOS506-0010 Tot IP Ds/1000 <1

UOS506-0020 Tot IP Days/1000 <1

UOS506-0030 Tot IP ALOS <1

UOS506-0040 Tot IP Ds/1000 1-9

UOS506-0050 Tot IP Days/1000 MM 1-9

UOS506-0060 Tot IP ALOS 1-9

UOS506-0070 Tot IP Ds/1000 MM 10-19

UOS506-0080 Tot IP Days/1000 MM 10-19

UOS506-0090 Tot IP ALOS 10-19

UOS506-0100 Tot IP 20-44 Ds/1000

UOS506-0110 Tot IP Days/1000 MM 20-44

UOS506-0120 Tot IP ALOS 20-44

UOS506-0130 Tot IP Ds/1000 MM 45-64

UOS506-0140 Tot IP Days/1000 MM 45-64

UOS506-0150 Tot IP ALOS 45-64

UOS506-0160 Tot IP Ds/1000 MM 65-74

UOS506-0170 Tot IP Days/1000 MM 65-74

UOS506-0180 Tot IP ALOS 65-74

UOS506-0190 Tot IP Ds/1000 MM 75-84

UOS506-0200 Tot IP Days/1000 MM 75-84

UOS506-0210 Tot IP ALOS 75-84

UOS506-0220 Tot IP Ds/1000 MM 85+

UOS506-0230 Tot IP Days/1000 MM 85+

UOS506-0240 Tot IP ALOS 85+

UOS506-0270 Tot IP Unk ALOS

UOS506-0280 Tot IP Tot Ds/1000 MM

UOS506-0290 Tot IP Tot Days/1000 MM

UOS506-0300 Tot IP Tot ALOS

UOS506-0310 Medicine <1 Ds/1000

UOS506-0320 Medicine <1 Days/1000 MM

UOS506-0330 Medicine <1 ALOS

UOS506-0340 Medicine 1-9 Ds/1000 MM

UOS506-0350 Medicine 1-9 Days/1000 MM

UOS506-0360 Medicine 1-9 ALOS

UOS506-0370 Medicine 10-19 Ds/1000 MM

UOS506-0380 Medicine 10-19 Days/1000 MM

UOS506-0390 Medicine 10-19 ALOS

UOS506-0400 Medicine 20-44 Ds/1000

UOS506-0410 Medicine 20-44 Days/1000 MM

UOS506-0420 Medicine 20-44 ALOS

UOS506-0430 Medicine 45-64 Days/1000 MM

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

UOS506-0440 Medicine 45-64 Ds/1000

UOS506-0450 Medicine 45-64 Days

UOS506-0460 Medicine 65-74 Ds/1000

UOS506-0470 Medicine 65-74 Days/1000 MM

UOS506-0480 Medicine 65-74 ALOS

UOS506-0490 Medicine 75-84 Ds/1000

UOS506-0500 Medicine 75-84 Days/1000 MM

UOS506-0510 Medicine 75-84 ALOS

UOS506-0520 Medicine 85+ Ds/1000

UOS506-0530 Medicine 85+ Days/1000 MM

UOS506-0540 Medicine 85+ ALOS

UOS506-0570 Medicine Unk ALOS

UOS506-0580 Medicine Tot Ds/1000

UOS506-0590 Medicine Tot Days/1000 MM

UOS506-0600 Medicine Tot ALOS

UOS506-0610 Surgery <1 Ds/1000

UOS506-0620 Surgery <1 Days/1000 MM

UOS506-0630 Surgery <1 ALOS

UOS506-0640 Surgery 1-9 Ds/1000 MM

UOS506-0650 Surgery 1-9 Days/1000 MM

UOS506-0660 Surgery 1-9 ALOS

UOS506-0670 Surgery 10-19 Ds/1000 MM

UOS506-0680 Surgery 10-19 Days/1000 MM

UOS506-0690 Surgery 10-19 ALOS

UOS506-0700 Surgery 20-44 Ds/1000

UOS506-0710 Surgery 20-44 Days/1000 MM

UOS506-0720 Surgery 20-44 ALOS

UOS506-0730 Surgery 45-64 Ds/1000

UOS506-0740 Surgery 45-64 Days/1000 MM

UOS506-0750 Surgery 45-64 ALOS

UOS506-0760 Surgery 65-74 Ds/1000

UOS506-0770 Surgery 65-74 Days/1000 MM

UOS506-0780 Surgery 65-74 ALOS

UOS506-0790 Surgery 75-84 Ds/1000

UOS506-0800 Surgery 75-84 Days/1000 MM

UOS506-0810 Surgery 75-84 ALOS

UOS506-0820 Surgery 85+ Ds/1000

UOS506-0830 Surgery 85+ Days/1000 MM

UOS506-0840 Surgery 85+ ALOS

UOS506-0870 Surgery Unk ALOS

UOS506-0880 Surgery Tot Ds/1000

UOS506-0890 Surgery Tot Days/1000 MM

UOS506-0900 Surgery Tot ALOS

UOS506-0910 Maternity 10-19 Ds/1000 MM

UOS506-0920 Maternity 10-19 Days/1000 MM

UOS506-0930 Maternity 10-19 ALOS

UOS506-0940 Maternity 20-44 Ds/1000

UOS506-0950 Maternity 20-44 Days/1000 MM

UOS506-0960 Maternity 20-44 ALOS

UOS506-0970 Maternity 45-64 Ds/1000

UOS506-0980 Maternity 45-64 Days/1000 MM

UOS506-0990 Maternity 45-64 ALOS

UOS506-1020 Maternity Unk ALOS

UOS506-1030 Maternity Tot Ds/1000

UOS506-1040 Maternity Tot Days/1000 MM

UOS506-1050 Maternity Tot ALOS

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

#### UOS507 – Ambulatory Care

DESCRIPTION - This measure summarizes utilization of ambulatory care in the following categories.

• Outpatient Visits

• ED Visits

• Ambulatory Surgery/Procedures

• Observation Room Stays

(HEDIS 2009, Volume 2: Technical Specification, Pg. 272)

##### REPORTING LEVEL - Contract

UOS507-0010 AMB Tot OP <1 Visit/1000

UOS507-0020 AMB Tot ER <1 Visit/1000

UOS507-0030 AMB Tot Amb <1 Surg/Procs Procs/1000

UOS507-0040 AMB Tot Observ Rm <1 Ds Stays/1000

UOS507-0050 AMB Tot OP 1-9 Visit/1000

UOS507-0060 AMB Tot ER 1-9 Visit/1000

UOS507-0070 AMB Tot Amb 1-9 Surg/Procs Procs/1000

UOS507-0080 AMB Tot Observ Rm 1-9 Ds Stays/1000

UOS507-0090 AMB Tot OP 10-19 Visit/1000

UOS507-0100 AMB Tot ER 10-19 Visit/1000

UOS507-0110 AMB Tot Amb 10-19 Surg/Procs Procs/1000

UOS507-0120 AMB Tot Observ Rm 10-19 Ds Stays/1000

UOS507-0130 AMB Tot OP 20-44 Visit/1000

UOS507-0140 AMB Tot ER 20-44 Visit/1000

UOS507-0150 AMB Tot Amb 20-44 Surg/Procs Procs/1000

UOS507-0160 AMB Tot Observ Rm 20-44 Ds Stays/1000

UOS507-0170 AMB Tot OP 45-64 Visit/1000

UOS507-0180 AMB Tot ER 45-64 Visit/1000

UOS507-0190 AMB Tot Amb 45-64 Surg/Procs Procs/1000

UOS507-0200 AMB Tot Observ Rm 45-64 Ds Stays/1000

UOS507-0210 AMB Tot OP 65-74 Visit/1000

UOS507-0220 AMB Tot ER 65-74 Visit/1000

UOS507-0230 AMB Tot Amb 65-74 Surg/Procs Procs/1000

UOS507-0240 AMB Tot Observ Rm 65-74 Ds Stays/1000

UOS507-0250 AMB Tot OP 75-84 Visit/1000

UOS507-0260 AMB Tot ER 75-84 Visit/1000

UOS507-0270 AMB Tot Amb 75-84 Surg/Procs Procs/1000

UOS507-0280 AMB Tot Observ Rm 75-84 Ds Stays/1000

UOS507-0290 AMB Tot OP 85+ Visit/1000

UOS507-0300 AMB Tot ER 85+ Visit/1000

UOS507-0310 AMB Tot Amb 85+ Surg/Procs Procs/1000

UOS507-0320 AMB Tot Observ Rm 85+ Ds Stays/1000

UOS507-0370 AMB Tot OP Tot Visit/1000

UOS507-0380 AMB Tot ER Tot Visit/1000

UOS507-0390 AMB Tot Amb Tot Surg/Procs Procs/1000

UOS507-0400 AMB Tot Observ Rm Tot Ds Stays/1000

#### UOS508 – Inpatient Utilization-NonAcute Care

DESCRIPTION - This measure summarizes utilization of nonacute inpatient care in hospice, nursing home, rehabilitation, SNF, transitional care and respite. (HEDIS 2009, Volume 2: Technical Specification, Pg. 283)

##### REPORTING LEVEL - Contract

UOS508-0010 Inpat Nonacute <1 Ds/1000

UOS508-0020 Inpat Nonacute <1 Days/1000

UOS508-0030 Inpat Nonacute <1 ALOS

UOS508-0040 Inpat Nonacute 1-9 Ds/1000

UOS508-0050 Inpat Nonacute 1-9 Days/1000

UOS508-0060 Inpat Nonacute 1-9 ALOS

UOS508-0070 Inpat Nonacute 10-19 Ds/1000

UOS508-0080 Inpat Nonacute 10-19 Days/1000

UOS508-0090 Inpat Nonacute 10-19 ALOS

UOS508-0100 Inpat Nonacute 20-44 Ds/1000

UOS508-0110 Inpat Nonacute 20-44 Days/1000

UOS508-0120 Inpat Nonacute 20-44 ALOS

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

UOS508-0130 Inpat Nonacute 45-64 Ds/1000

UOS508-0140 Inpat Nonacute 45-64 Days/1000

UOS508-0150 Inpat Nonacute 45-64 ALOS

UOS508-0160 Inpat Nonacute 65-74 Ds/1000

UOS508-0170 Inpat Nonacute 65-74 Days/1000

UOS508-0180 Inpat Nonacute 65-74 ALOS

UOS508-0190 Inpat Nonacute 75-84 Ds/1000

UOS508-0200 Inpat Nonacute 75-84 Days/1000

UOS508-0210 Inpat Nonacute 75-84 ALOS

UOS508-0220 Inpat Nonacute 85+ Ds/1000

UOS508-0230 Inpat Nonacute 85+ Days/1000

UOS508-0240 Inpat Nonacute 85+ ALOS

UOS508-0270 Inpat Nonacute Unk ALOS

UOS508-0280 Inpat Nonacute Tot Ds/1000

UOS508-0290 Inpat Nonacute Tot Days/1000

UOS508-0300 Inpat Nonacute Tot ALOS

#### UOS513 – Mental Health Utilization

DESCRIPTION - The number and percentage of members receiving the following mental health services during the measurement year.

• Any services

• Inpatient

• Intensive outpatient or partial hospitalization

• Outpatient or ED

(HEDIS 2006, Volume 2: Technical Specification, Pg. 291)

##### REPORTING LEVEL - Contract

UOS513-0010 MH Svs Any 0-12 M Pct

UOS513-0020 MH Svs Inpat 0-12 M Pct

UOS513-0030 MH Svs Day/Night 0-12 M Pct

UOS513-0040 MH Svs Amb 0-12 M Pct

UOS513-0050 MH Svs Any 13-17 M Pct

UOS513-0060 MH Svs Inpat13-17 M Pct

UOS513-0070 MH Svs Day/Night 13-17 M Pct

UOS513-0080 MH Svs Amb 13-17 M Pct

UOS513-0090 MH Svs Any 18-64 M Pct

UOS513-0100 MH Svs Inpat 18-64 M Pct

UOS513-0110 MH Svs Day/Night 18-64 M Pct

UOS513-0120 MH Svs Amb 18-64 M Pct

UOS513-0130 MH Svs Any 65+ M Pct

UOS513-0140 MH Svs Inpat 65+ M Pct

UOS513-0150 MH Svs Day/Night 65+ M Pct

UOS513-0160 MH Svs Amb 65+ M Pct

UOS513-0170 MH Svs Any Unk M Pct

UOS513-0180 MH Svs Inpat Unk M Pct

UOS513-0190 MH Svs Day/Night Unk M Pct

UOS513-0200 MH Svs Amb Unk M Pct

UOS513-0210 MH Svs Any Tot M Pct

UOS513-0220 MH Svs Inpat Tot M Pct

UOS513-0230 MH Svs Day/Night Tot M Pct

UOS513-0240 MH Svs Amb Tot M Pct

UOS513-0250 MH Svs Any 0-12 F Pct

UOS513-0260 MH Svs Inpat 0-12 F Pct

UOS513-0270 MH Svs Day/Night 0-12 F Pct

UOS513-0280 MH Svs Amb 0-12 F Pct

UOS513-0290 MH Svs Any 13-17 F Pct

UOS513-0300 MH Svs Inpat 13-17 F Pct

UOS513-0310 MH Svs Day/Night 13-17 F Pct

UOS513-0320 MH Svs Amb 13-17 F Pct

UOS513-0330 MH Svs Any 18-64 F Pct

UOS513-0340 MH Svs Inpat 18-64 F Pct

UOS513-0350 MH Svs Day/Night 18-64 F Pct

UOS513-0360 MH Svs Amb 18-64 F Pct

UOS513-0370 MH Svs Any 65+ F Pct

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

UOS513-0380 MH Svs Inpat 65+ F Pct

UOS513-0390 MH Svs Day/Night 65+ F Pct

UOS513-0400 MH Svs Amb 65+ F Pct

UOS513-0410 MH Svs Any Unk F Pct

UOS513-0420 MH Svs Inpat Unk F Pct

UOS513-0430 MH Svs Day/Night Unk F Pct

UOS513-0440 MH Svs Amb Unk F Pct

UOS513-0450 MH Svs Any Tot F Pct

UOS513-0460 MH Svs Inpat Tot Num

UOS513-0470 MH Svs Day/Night Tot F Pct

UOS513-0480 MH Svs Amb Tot F Pct

UOS513-0490 MH Svs Any 0-12 Tot Pct

UOS513-0500 MH Svs Inpat 0-12 Tot Pct

UOS513-0510 MH Svs Day/Night 0-12 Tot Pct

UOS513-0520 MH Svs Amb 0-12 Tot Pct

UOS513-0530 MH Svs Any 13-17 Tot Pct

UOS513-0540 MH Svs Inpat 13-17 Tot Pct

UOS513-0550 MH Svs Day/Night 13-17 Tot Pct

UOS513-0560 MH Svs Amb 13-17 Tot Pct

UOS513-0570 MH Svs Any 18-64 Tot Pct

UOS513-0580 MH Svs Inpat 18-64 Tot Pct

UOS513-0590 MH Svs Day/Night 18-64 Tot Pct

UOS513-0600 MH Svs Amb 18-64 Tot Pct

UOS513-0610 MH Svs Any 65+ Tot Pct

UOS513-0620 MH Svs Inpat 65+ Tot Pct

UOS513-0630 MH Svs Day/Night 65+ Tot Pct

UOS513-0640 MH Svs Amb 65+ Tot Pct

UOS513-0650 MH Svs Any Unk Tot Pct

UOS513-0660 MH Svs Inpat Unk Tot Pct

UOS513-0670 MH Svs Day/Night Unk Tot Pct

UOS513-0680 MH Svs Amb Unk Tot Pct

UOS513-0690 MH Svs Any Tot Pct

UOS513-0700 MH Svs Inpat Tot Pct

UOS513-0710 MH Svs Day/Night Tot Pct

UOS513-0720 MH Svs Amb Tot Pct

#### UOS518 – Outpatient Drug Utilization

DESCRIPTION - This measure summarizes data on outpatient utilization of drug prescriptions, stratified by age, during measurement year. The

following data are reported.

• Total cost of prescriptions

• Average cost of prescriptions PMPM

• Total number of prescriptions

• Average number of prescriptions PMPY

(HEDIS 2009, Volume 2: Technical Specification, Pg. 305)

##### REPORTING LEVEL - Contract

UOS518-0010 OP Rx 0-9 Avg Cst of Rx/Mem/Mnth

UOS518-0020 OP Rx 0-9 Avg Num of Rx/

UOS518-0030 OP Rx 10-19 Avg Cst of Rx/Mem/Mnth

UOS518-0032 OP Rx 10-17 Avg Cst of Rx/Mem/Mnth

UOS518-0040 OP Rx 10-19 Avg Num of Rx/

UOS518-0042 OP Rx 10-17 Avg Num of Rx/

UOS518-0050 OP Rx 20-44 Avg Cst of Rx/Mem/Mnth

UOS518-0052 OP Rx 18-34 Avg Cst of Rx/Mem/Mnth

UOS518-0060 OP Rx 20-44 Avg Num of Rx/

UOS518-0062 OP Rx 18-34 Avg Num of Rx/

UOS518-0070 OP Rx 45-64 Avg Cst of Rx/Mem/Mnth

UOS518-0072 OP Rx 35-49 Avg Cst of Rx/Mem/Mnth

UOS518-0080 OP Rx 45-64 Avg Num of Rx/

UOS518-0082 OP Rx 35-49 Avg Num of Rx/

UOS518-0084 OP Rx 50-64 Avg Cst of Rx/Mem/Mnth

UOS518-0086 OP Rx 50-64 Avg Num of Rx/

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

UOS518-0090 OP Rx 65-74 Avg Cst of Rx/Mem/Mnth

UOS518-0100 OP Rx 65-74 Avg Num of Rx/

UOS518-0110 OP Rx 75-84 Avg Cst of Rx/Mem/Mnth

UOS518-0120 OP Rx 75-84 Avg Num of Rx/

UOS518-0130 OP Rx 85+ Avg Cst of Rx/Mem/Mnth

UOS518-0140 OP Rx 85+ Avg Num of Rx/

UOS518-0170 OP Rx Tot Avg Cst of Rx/Mem/Mnth

UOS518-0180 OP Rx Tot Avg Num of Rx/

#### UOS520 – Identification of Alcohol and Other Drug Services

DESCRIPTION - This measure summarizes the number and percentage of members with an alcohol and other drug (AOD) claim who received the

following chemical dependency services during the measurement year.

• Any services

• Inpatient

• Intensive outpatient or partial hospitalization

• Outpatient or ED

An AOD claim contains a diagnosis of AOD abuse or dependence and a specific AOD-related service.

(HEDIS 2009, Volume 2: Technical Specification, Pg. 286)

##### REPORTING LEVEL - Contract

UOS520-0010 ID Svs Any 0-12 M Pct

UOS520-0020 ID Svs Any 0-12 F Pct

UOS520-0030 ID Svs Any 0-12 Tot Pct

UOS520-0040 ID Svs Any 13-17 M Pct

UOS520-0050 ID Svs Any 13-17 F Pct

UOS520-0060 ID Svs Any 13-17 Tot Pct

UOS520-0072 ID Svs Any 18-24 M Pct

UOS520-0074 ID Svs Any 18-24 F Pct

UOS520-0076 ID Svs Any 18-24 Tot Pct

UOS520-0078 ID Svs Any 25-34 M Pct

UOS520-0082 ID Svs Any 25-34 F Pct

UOS520-0084 ID Svs Any 25-34 Tot Pct

UOS520-0086 ID Svs Any 35-64 M Pct

UOS520-0088 ID Svs Any 35-64 F Pct

UOS520-0092 ID Svs Any 35-64 Tot Pct

UOS520-0100 ID Svs Any 65+ M Pct

UOS520-0110 ID Svs Any 65+ F Pct

UOS520-0120 ID Svs Any 65+ Tot Pct

UOS520-0130 ID Svs Any Unk M Pct

UOS520-0140 ID Svs Any Unk F Pct

UOS520-0150 ID Svs Any Unk Tot Pct

UOS520-0160 ID Svs Any Tot M Pct

UOS520-0170 ID Svs Any Tot F Pct

UOS520-0180 ID Svs Any Tot Pct

UOS520-0190 ID Svs Inpat 0-12 M Pct

UOS520-0200 ID Svs Inpat 0-12 F Pct

UOS520-0210 ID Svs Inpat 0-12 Tot Pct

UOS520-0220 ID Svs Inpat 13-17 M Pct

UOS520-0230 ID Svs Inpat 13-17 F Pct

UOS520-0240 ID Svs Inpat 13-17 Tot Pct

UOS520-0252 ID Svs Inpat 18-24 M Pct

UOS520-0254 ID Svs Inpat 18-24 F Pct

UOS520-0256 ID Svs Inpat 18-24 Tot Pct

UOS520-0258 ID Svs Inpat 25-34 M Pct

UOS520-0262 ID Svs Inpat 25-34 F Pct

UOS520-0264 ID Svs Inpat 25-34 Tot Pct

UOS520-0266 ID Svs Inpat 35-64 M Pct

UOS520-0268 ID Svs Inpat 35-64 F Pct

UOS520-0270 ID Svs Inpat 35-64 Tot Pct

UOS520-0280 ID Svs Inpat 65+ M Pct

UOS520-0290 ID Svs Inpat 65+ F Pct

UOS520-0300 ID Svs Inpat 65+ Tot Pct

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

UOS520-0310 ID Svs Inpat Unk M Pct

UOS520-0320 ID Svs Inpat Unk F Pct

UOS520-0330 ID Svs Inpat Unk Tot Pct

UOS520-0340 ID Svs Inpat Tot M Pct

UOS520-0350 ID Svs Inpat Tot F Pct

UOS520-0360 ID Svs Inpat Tot Pct

UOS520-0370 ID Svs Day/Night 0-12 M Pct

UOS520-0380 ID Svs Day/Night 0-12 F Pct

UOS520-0390 ID Svs Day/Night 0-12 Tot Pct

UOS520-0400 ID Svs Day/Night 13-17 M Pct

UOS520-0410 ID Svs Day/Night 13-17 F Pct

UOS520-0420 ID Svs Day/Night 13-17 Tot Pct

UOS520-0432 ID Svs Intermediate 18-24 M Pct

UOS520-0434 ID Svs Intermediate 18-24 F Pct

UOS520-0436 ID Svs Intermediate 18-24 Tot Pct

UOS520-0438 ID Svs Intermediate 25-34 M Pct

UOS520-0442 ID Svs Intermediate 25-34 F Pct

UOS520-0444 ID Svs Intermediate 25-34 Tot Pct

UOS520-0446 ID Svs Intermediate 35-64 M Pct

UOS520-0448 ID Svs Intermediate 35-64 F Pct

UOS520-0452 ID Svs Intermediate 35-64 Tot Pct

UOS520-0460 ID Svs Day/Night 65+ M Pct

UOS520-0470 ID Svs Day/Night 65+ F Pct

UOS520-0480 ID Svs Day/Night 65+ Tot Pct

UOS520-0490 ID Svs Day/Night Unk M Pct

UOS520-0500 ID Svs Day/Night Unk F Pct

UOS520-0510 ID Svs Day/Night Unk Tot Pct

UOS520-0520 ID Svs Day/Night Tot M Pct

UOS520-0530 ID Svs Day/Night Tot F Pct

UOS520-0540 ID Svs Day/Night Tot Pct

UOS520-0550 ID Svs Amb 0-12 M Pct

UOS520-0560 ID Svs Amb 0-12 F Pct

UOS520-0570 ID Svs Amb 0-12 Tot Pct

UOS520-0580 ID Svs Amb 13-17 M Pct

UOS520-0590 ID Svs Amb 13-17 F Pct

UOS520-0600 ID Svs Amb 13-17 Tot Pct

UOS520-0612 ID Svs Amb 18-24 M Pct

UOS520-0614 ID Svs Amb 18-24 F Pct

UOS520-0616 ID Svs Amb 18-24 Tot Pct

UOS520-0618 ID Svs Amb 25-34 M Pct

UOS520-0622 ID Svs Amb 25-34 F Pct

UOS520-0624 ID Svs Amb 25-34 Tot Pct

UOS520-0626 ID Svs Amb 35-64 M Pct

UOS520-0628 ID Svs Amb 35-64 F Pct

UOS520-0632 ID Svs Amb 35-64 Tot Pct

UOS520-0640 ID Svs Amb 65+ M Pct

UOS520-0650 ID Svs Amb 65+ F Pct

UOS520-0660 ID Svs Amb 65+ Tot Pct

UOS520-0670 ID Svs Amb Unk M Pct

UOS520-0680 ID Svs Amb Unk F Pct

UOS520-0690 ID Svs Amb Unk Tot Pct

UOS520-0700 ID Svs Amb Tot M Pct

UOS520-0710 ID Svs Amb Tot F Pct

UOS520-0720 ID Svs Amb Tot Pct

#### UOS522 – Antibiotic Utilization

DESCRIPTION - This measure summarizes the following data on outpatient utilization of antibiotic prescriptions during the measurement year, stratified by age and gender.

• Total number of antibiotic prescriptions

• Average number of antibiotic prescriptions per member per year (PMPY)

• Total days supplied for all antibiotic prescriptions

• Average days supplied per antibiotic prescription

• Total number of prescriptions for antibiotics of concern

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

• Average number of prescriptions PMPY for antibiotics of concern

• Percentage of antibiotics of concern for all antibiotic prescriptions

• Average number of antibiotics PMPY reported by drug class:

– For selected “antibiotics of concern”

– For all other antibiotics

(HEDIS 2009, Volume 2: Technical Specification, Pg. 295)

##### REPORTING LEVEL - Contract

UOS522-0010 AU Antibiotic Scrips PMPY M Tot Avg

UOS522-0020 AU Antibiotic Scrips PMPY F Tot Avg

UOS522-0030 AU Antibiotic Scrips PMPY MF Tot Avg

UOS522-0040 AU Days Supplied per Antibiotic Scrip M Tot Avg

UOS522-0050 AU Days Supplied per Antibiotic Scrip F Tot Avg

UOS522-0060 AU Days Supplied per Antibiotic Scrip MF Tot Avg

UOS522-0070 AU Scrips PMPY for Anitbiotics of Concern M Tot Avg

UOS522-0080 AU Scrips PMPY for Anitbiotics of Concern F Tot Avg

UOS522-0090 AU Scrips PMPY for Anitbiotics of Concern MF Tot Avg

UOS522-0100 AU Pct Antibiotics of All Antibiotic Scrips M Tot

UOS522-0110 AU Pct Antibiotics of All Antibiotic Scrips F Tot

UOS522-0120 AU Pct Antibiotics of All Antibiotic Scrips MF Tot

UOS522-0130 AC Quinolones PMPY M Tot

UOS522-0140 AC Quinolones PMPY F Tot

UOS522-0150 AC Quinolones PMPY MF Tot

UOS522-0160 AC Cephalosporins 2nd-4th Generation PMPY M Tot

UOS522-0170 AC Cephalosporins 2nd-4th Generation PMPY F Tot

UOS522-0180 AC Cephalosporins 2nd-4th Generation PMPY MF Tot

UOS522-0190 AC Azithromycin and Clarithromycin PMPY M Tot

UOS522-0200 AC Azithromycin and Clarithromycin PMPY F Tot

UOS522-0210 AC Azithromycin and Clarithromycin PMPY MF Tot

UOS522-0220 AC Amoxicillin/Clavulanate PMPY M Tot

UOS522-0230 AC Amoxicillin/Clavulanate PMPY F Tot

UOS522-0240 AC Amoxicillin/Clavulanate PMPY MF Tot

UOS522-0250 AC Ketolides PMPY M Tot

UOS522-0260 AC Ketolides PMPY F Tot

UOS522-0270 AC Ketolides PMPY MF Tot

UOS522-0280 AC Clindamycin PMPY M Tot

UOS522-0290 AC Clindamycin PMPY F Tot

UOS522-0300 AC Clindamycin PMPY MF Tot

UOS522-0310 AC Misc Antibiotics of Concern PMPY M Tot

UOS522-0320 AC Misc Antibiotics of Concern PMPY F Tot

UOS522-0330 AC Misc Antibiotics of Concern PMPY MF Tot

UOS522-0340 AO Absorbable Sulfonamides PMPY M Tot

UOS522-0350 AO Absorbable Sulfonamides PMPY F Tot

UOS522-0360 AO Absorbable Sulfonamides PMPY MF Tot

UOS522-0370 AO Aminoglycosides PMPY M Tot

UOS522-0380 AO Aminoglycosides PMPY F Tot

UOS522-0390 AO Aminoglycosides PMPY MF Tot

UOS522-0400 AO 1st Generation Cephalosporins PMPY M Tot

UOS522-0410 AO 1st Generation Cephalosporins PMPY F Tot

UOS522-0420 AO 1st Generation Cephalosporins PMPY MF Tot

UOS522-0430 AO Lincosamides PMPY M Tot

UOS522-0440 AO Lincosamides PMPY F Tot

UOS522-0450 AO Lincosamides PMPY MF Tot

UOS522-0460 AO Macrolides (not azith or clarith) PMPY M Tot

UOS522-0470 AO Macrolides (not azith or clarith) PMPY F Tot

UOS522-0480 AO Macrolides (not azith or clarith) PMPY MF Tot

UOS522-0490 AO Penicillins PMPY M Tot

UOS522-0500 AO Penicillins PMPY F Tot

UOS522-0510 AO Penicillins PMPY MF Tot

UOS522-0520 AO Tetracyclines PMPY M Tot

UOS522-0530 AO Tetracyclines PMPY F Tot

UOS522-0540 AO Tetracyclines PMPY MF Tot

UOS522-0550 AO Misc Antibiotics PMPY M Tot

UOS522-0560 AO Misc Antibiotics PMPY F Tot

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

UOS522-0570 AO Misc Antibiotics PMPY MF Tot

UOS522-0580 AC Quinolone Scrips M Tot Num

UOS522-0590 AC Quinolone Scrips F Tot Num

UOS522-0600 AC Quinolone Scrips MF Tot Num

UOS522-0610 AC Cephalosporin Scrips 2nd-4th Generation M Tot Num

UOS522-0620 AC Cephalosporin Scrips 2nd-4th Generation F Tot Num

UOS522-0630 AC Cephalosporin Scrips 2nd-4th Generation MF Tot Num

UOS522-0640 AC Azithromycin and Clarithromycin Scrips M Tot Num

UOS522-0645 AC Azithromycin and Clarithromycin Scrips F Tot Num

UOS522-0650 AC Azithromycin and Clarithromycin Scrips MF Tot Num

UOS522-0660 AC Amoxicillin/Clavulanate Scrips M Tot Num

UOS522-0670 AC Amoxicillin/Clavulanate Scrips F Tot Num

UOS522-0680 AC Amoxicillin/Clavulanate Scrips MF Tot Num

UOS522-0690 AC Ketolide Scrips M Tot Num

UOS522-0700 AC Ketolide Scrips F Tot Num

UOS522-0710 AC Ketolide Scrips MF Tot Num

UOS522-0720 AC Clindamycin Scrips M Tot Num

UOS522-0730 AC Clindamycin Scrips F Tot Num

UOS522-0740 AC Clindamycin Scrips MF Tot Num

UOS522-0750 AC Misc Antibiotics of Concern Scrips M Tot Num

UOS522-0760 AC Misc Antibiotics of Concern Scrips F Tot Num

UOS522-0770 AC Misc Antibiotics of Concern Scrips MF Tot Num

UOS522-0780 AO Absorbable Sulfonamide Scrips M Tot Num

UOS522-0790 AO Absorbable Sulfonamide Scrips F Tot Num

UOS522-0800 AO Absorbable Sulfonamide Scrips MF Tot Num

UOS522-0810 AO Aminoglycoside Scrips M Tot Num

UOS522-0820 AO Aminoglycoside Scrips F Tot Num

UOS522-0830 AO Aminoglycoside Scrips MF Tot Num

UOS522-0840 AO 1st Generation Cephalosporin Scrips M Tot Num

UOS522-0850 AO 1st Generation Cephalosporin Scrips F Tot Num

UOS522-0860 AO 1st Generation Cephalosporin Scrips MF Tot Num

UOS522-0870 AO Lincosamide Scrips M Tot Num

UOS522-0880 AO Lincosamide Scrips F Tot Num

UOS522-0890 AO Lincosamide Scrips MF Tot Num

UOS522-0900 AO Macrolide (not azith or clarith) Scrips M Tot Num

UOS522-0910 AO Macrolide (not azith or clarith) Scrips F Tot Num

UOS522-0920 AO Macrolide (not azith or clarith) Scrips MF Tot Num

UOS522-0930 AO Penicillin Scrips M Tot Num

UOS522-0940 AO Penicillin Scrips F Tot Num

UOS522-0950 AO Penicillin Scrips MF Tot Num

UOS522-0960 AO Tetracycline Scrips M Tot Num

UOS522-0970 AO Tetracycline Scrips F Tot Num

UOS522-0980 AO Tetracycline Scrips MF Tot Num

UOS522-0990 AO Misc Antibiotic Scrips M Tot Num

UOS522-1000 AO Misc Antibiotic Scrips F Tot Num

UOS522-1010 AO Misc Antibiotic Scrips MF Tot Num