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Plan Name Plan ID 38
Reporting Year 2006 Submission # Last Refreshed: 10/7/2009 1:21:32 PM
Page Page2 23 41
24 43
Page 25 44
3 26 45
5 27 48
7 28 51
8 29 54
9 3013
14 3115
16 3217
18 33 67
19 34 71
22
26 Page28 35 75
36 79
37 81
33 38 83
34
38 Page39 39 87
Page
40 91Enrollment by Product Line (Age & Sex)
Outpatient Drug Utilization
Initiation/Engagement of Alcohol & Other Drug Dependence Treatment
Mental Health Utilization - Inpatient Discharges and Average Length of Stay, by Age and Sex
Mental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory Services
Chemical Dependency Utilization - Inpatient Discharges and Average Length of Stay
Use of Appropriate Medications for People with Asthma
Comprehensive Diabetes Care
Cholesterol Management for Patients with Cardiovascular Conditions
Glaucoma Screening in Older Adults
Effectiveness of Care Measures
Use of Services Measures
Access / Availability of Care Measures
Health Plan Stability Measures
Disclaimers
Childhood Immunization Status
Adolescent Immunization Status
Appropriate Treatment for Children with Upper Respiratory Infection
Colorectal Cancer Screening
Breast Cancer Screening
32
General Info
Cervical Cancer Screening
Chlamydia Screening in Women
Osteoporosis Management in Women Who had a Fracture
Controlling High Blood Pressure
Beta Blocker Treatment after Heart Attack
Persistence of Beta Blocker Treatment After Hearth Attack
Follow-Up Care for Children PrescribedAttention-Deficit/Hyperactivity Disorder (ADHD) Medication
Antidepressant Medication Management
Sanford Health Plan
1
Health Plan Descriptive Information Measures
Annual Monitoring for Patients on Persistent Medications
Drugs to Be Avoided in the Elderly
Potentially Harmful Drug-Disease Interactions in the Elderly
Children's and Adolescents' Access to Primary Care Practitioners
Prenatal and Postpartum Care
Adult's Access to Preventive/Ambulatory Health Services
Inpatient Utilization - General Hospital/Acute Care
Ambulatory Care
Inpatient Utilization - Nonacute Care
Years in Business / Total Membership
57
60
64
Identification of Alcohol and Other Drug Services
Well Child Visits in the First 15 Months of Life
Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life
Adolescent Well-Care Visits
Frequency of Selected Procedures
HEDIS 2007 (Reporting Year 2006) Page 1
DISCLAIMERS
-1
0. Disclaimer Query located below1. In October 2009, it was discoverd that the formulas in the Inpatient Utilization: General
Hospital/Acute Care measure contained error. The formula was fixed and the data displayed now correctly reflects the rest of the data on the sheet.
HEDIS 2007 (Reporting Year 2006) Page 2
Effectiveness of Care Sanford Health PlanChildhood Immunization Status Data Last Refreshed:
Oct 7, 2009 1:21 PM
CommercialGeneral Measure
DataDTaP/DT IPV MMR HiB Hepatitis B VZV
Pneumo-coccal
ConjugateCombo 2 Combo 3
2006H
246
45 114 108 123 117 90 69 31 2018.29% 46.34% 43.90% 50.00% 47.56% 36.59% 28.05% 12.60% 8.13%
2460.00%246
45 114 108 123 117 90 69 31 2018.29% 46.34% 43.90% 50.00% 47.56% 36.59% 28.05% 12.60% 8.13%
3
0
0
2
0
24145 114 108 123 117 90 69 31 20165 120 125 111 116 123 58 162 89
87.14% 97.10% 96.68% 97.10% 96.68% 88.38% 52.70% 80.08% 45.23%82.70% 94.77% 94.21% 94.77% 94.21% 84.13% 46.19% 74.83% 38.74%91.57% 99.42% 99.15% 99.42% 99.15% 92.63% 59.21% 85.33% 51.72%Upper 95% Confidence Interval
Numerator Events by Medical RecordReported RateLower 95% Confidence Interval
Number of employee/dependent records excluded
Records Added from the Oversample List
DenominatorNumerator Events by Admin Data
Number of Records Excluded Because of Valid Data Errors
Number of Records Excluded because of Contraindications by Admin Data
Number of Records Excluded because of Contraindications by Medical Record Review
Oversampling RateFinal Sample Size (FSS)Numerator events by admin data in FSSAdmin rate on FSS
Numerator events by admin data in eligible populationCurrent Year's Administrative RateMinimum Required Sample Size
Data Elements
Measurement Year
Eligible Member PopulationData Collection Methodology
HEDIS 2007 (Reporting Year 2006) Page 3
Effectiveness of Care Sanford Health PlanChildhood Immunization Status Data Last Refreshed:
Oct 7, 2009 1:21 PM
MedicaidGeneral Measure
DataDTaP/DT IPV MMR HiB Hepatitis B VZV
Pneumo-coccal
ConjugateCombo 2 Combo 3
NR NR NR NR NR NR NR NR NR
NR NR NR NR NR NR NR NR NR
NR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NRUpper 95% Confidence Interval
Numerator Events by Medical RecordReported RateLower 95% Confidence Interval
Number of employee/dependent records excluded
Records Added from the Oversample List
DenominatorNumerator Events by Admin Data
Number of Records Excluded Because of Valid Data Errors
Number of Records Excluded because of Contraindications by Admin Data
Number of Records Excluded because of Contraindications by Medical Record Review
Oversampling RateFinal Sample Size (FSS)Numerator events by admin data in FSSAdmin rate on FSS
Numerator events by admin data in eligible populationCurrent Year's Administrative RateMinimum Required Sample Size
Data Elements
Data Collection MethodologyEligible Member Population
Measurement Year
HEDIS 2007 (Reporting Year 2006) Page 4
Effectiveness of Care Sanford Health PlanAdolescent Immunization Status Data Last Refreshed:
Oct 7, 2009 1:21 PM
CommercialGeneral Measure
DataMMR Hepatitis B VZV Combo 2
2006H
291
33 19 9 211.34% 6.53% 3.09% 0.69%
2910.00%
29133 19 9 2
11.34% 6.53% 3.09% 0.69%
0
0
0
0
0
29133 19 9 2199 125 63 46
79.73% 49.48% 24.74% 16.49%74.93% 43.57% 19.61% 12.06%84.52% 55.40% 29.87% 20.93%
Measurement Year
Numerator Events by Medical RecordReported RateLower 95% Confidence Interval
Records Added from the Oversample List
DenominatorNumerator Events by Admin Data
Upper 95% Confidence Interval
Number of Records Excluded Because of Valid Data Errors
Number of Records Excluded because of Contraindications by Admin Data
Number of Records Excluded because of Contraindications by Medical Record Review
Number of employee/dependent records excluded
Final Sample Size (FSS)Numerator events by admin data in FSSAdmin rate on FSS
Currect Year's Administrative RateMinimum Required Sample SizeOversampling Rate
Data Collection MethodologyEligible Member PopulationNumerator events by admin data in eligible population
Data Elements
HEDIS 2007 (Reporting Year 2006) Page 5
Effectiveness of Care Sanford Health PlanAdolescent Immunization Status Data Last Refreshed:
Oct 7, 2009 1:21 PM
MedicaidGeneral Measure
DataMMR Hepatitis B VZV Combo 2
NR NR NR NR
NR NR NR NR
NR NR NR NRNR NR NR NRNR NR NR NR
Measurement Year
Upper 95% Confidence IntervalLower 95% Confidence Interval
Number of Records Excluded Because of Valid Data Errors
Number of Records Excluded because of Contraindications by Admin Data
Number of Records Excluded because of Contraindications by Medical Record Review
Numerator Events by Medical RecordReported Rate
Number of employee/dependent records excluded
Records Added from the Oversample List
DenominatorNumerator Events by Admin Data
Final Sample Size (FSS)Numerator events by admin data in FSSAdmin rate on FSS
Numerator events by admin data in eligible populationCurrect Year's Administrative Rate
Oversampling RateMinimum Required Sample Size
Data Elements
Data Collection MethodologyEligible Member Population
HEDIS 2007 (Reporting Year 2006) Page 6
Effectiveness of Care Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
Appropriate Treatment for Children with Upper Respiratory Infection
CommercialGeneral Measure
Data
2006
A
546
43
92.12%
89.77%
94.48%
Data Elements
Data Collection Methodology
Eligible Member Population
Measurement Year
Numerator Events by Admin Data
Upper 95% Confidence Interval
Reported Rate
Lower 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006) Page 7
Effectiveness of Care Sanford Health PlanColorectal Cancer Screening Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial Medicare Advantage MSHO
2006
A
3737
NR NR NR
NR NR NR
1586
42.44% NR NR
40.84% NR NR
44.04% NR NR
Eligible population
Measurement Year
Data Elements
Data collection methodology (administrative or hybrid)
Oversampling rate
Final sample size (FSS)
Number of numerator events by administrative data in FSS
Number of numerator events by administrative data in eligible population (before exclusions)
Minimum required sample size (MRSS) or other sample size
Numerator events by administrative data
Number of original sample records excluded because of valid data errors
Number of administrative data records excluded
Number of medical record data records excluded
Reported rate
Administrative rate on FSS
Current year's administrative rate (before exclusions)
Data Elements with an Asterisk(*) are OPTIONAL and are not used in any calculation or total
Upper 95% confidence interval
Lower 95% confidence interval
Numerator events by medical records
Number of employee/dependent medical records excluded
Records added from the oversample list
Denominator
HEDIS 2007 (Reporting Year 2006) Page 8
Effectiveness of CareBreast Cancer Screening
Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
CommercialGeneral Measure
Data Ages 42-51 Ages 52-69
2006A
1664 1791 34551112 1353 2465
66.83% 75.54% 71.35%64.53% 73.53% 69.82%69.12% 77.56% 72.87%
TotalData Elements
Data Collection MethodologyEligible Member Population
Measurement Year
Reported RateLower 95% Confidence IntervalUpper 95% Confidence Interval
Numerator Events by Admin Data
HEDIS 2007 (Reporting Year 2006) Page 9
Effectiveness of CareBreast Cancer Screening
Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
Medicare AdvantageGeneral Measure
Data Ages 42-51 Ages 52-69
NRNR
NR NR NRNR NR NRNR NR NR
TotalData Elements
Measurement YearData Collection MethodologyEligible Member PopulationNumerator Events by Admin DataReported RateLower 95% Confidence IntervalUpper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006) Page 10
Effectiveness of CareBreast Cancer Screening
Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
MSHOGeneral Measure
Data Ages 42-51 Ages 52-69
NRNR
NR NR NRNR NR NRNR NR NR
TotalData Elements
Measurement YearData Collection MethodologyEligible Member PopulationNumerator Events by Admin DataReported RateLower 95% Confidence IntervalUpper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006) Page 11
Effectiveness of CareBreast Cancer Screening
Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
MedicaidGeneral Measure
Data Ages 42-51 Ages 52-69
NRNR
NR NR NRNR NR NRNR NR NR
Total
Numerator Events by Admin DataReported RateLower 95% Confidence IntervalUpper 95% Confidence Interval
Data Elements
Measurement YearData Collection MethodologyEligible Member Population
HEDIS 2007 (Reporting Year 2006) Page 12
Effectiveness of Care Sanford Health PlanCervical Cancer Screening Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial Medicaid2006
A3957
78.59% NR
NR NR
3110
78.59% NR77.30% NR79.89% NRUpper 95% Confidence Interval
Minimum Required Sample SizeOversampling Rate
Denominator
Numerator Events by Medical Record
Records Excluded because of Valid Data Errors
Numerator events by admin data in FSS
Number of administrative data records excluded
Number of medical record data records excluded
Records Added from the Oversample List
Number of employee/dependent medical records excluded
Reported RateLower 95% Confidence Interval
Numerator Events by Admin Data
Admin Rate on FSS
Data Elements
Data Collection MethodologyEligible Member Population
Final Sample Size (FSS)
Numerator Events by Admin Data on Eligible Population (before exclusions)Current Year's Admin Rate
Measurement Year
HEDIS 2007 (Reporting Year 2006) Page 13
Effectiveness of CareChlamydia Screening in Women
Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
General Measure
DataAges 16-20 Ages 21-25
General Measure
DataAges 16-20 Ages 21-25
2006A
338 411 749 NR92 113 205 NR
27.22% 27.49% 27.37% NR NR NR22.33% 23.06% 24.11% NR NR NR32.11% 31.93% 30.63% NR NR NR
Total
Commercial Medicaid
Total
Upper 95% Confidence Interval
Reported RateNumerator Events by Admin Data
Lower 95% Confidence Interval
Data Elements
Data Collection MethodologyEligible Member Population
Measurement Year
HEDIS 2007 (Reporting Year 2006) Page 14
Effectiveness of Care Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
Osteoporosis Management in Women Who had a Fracture
Medicare Advantage MSHO
NR NRNR NRNR NRUpper 95% Confidence Interva
Data Elements
Data Collection MethodologyEligible Member PopulationNumerator Events by Admin DataReported RateLower 95% Confidence Interval
Measurement Year
HEDIS 2007 (Reporting Year 2006) Page 15
Effectiveness of CareControlling High Blood Pressure
Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
CommercialGeneral Measure
Data Ages 18-45 Ages 46-85
2006H
265 1008 1273
0 0 0
0.00% 0.00% 0.00%411
15.00%411
0 0 00.00% 0.00% 0.00%
10
0
1
0
1191 320 4110 0 040 199 239
43.96% 62.19% 58.15%33.21% 56.72% 53.26%54.70% 67.66% 63.04%
Total
Measurement Year
Current Year's Admin RateMinimum Required Sample SizeOversampling Rate
Lower 95% Confidence IntervalUpper 95% Confidence Interval
Number of medical record data records excluded
Denominator
Reported Rate
Numerator Events by Admin DataNumerator Events by Medical Record
Records Added from the OverSample List
Number of employee/dependent medical records excluded
Data Elements
Data Collection Methodology (Hybrid)Eligible Member Population
Number of administrative data records excluded
Final Sample Size (FSS)Numerator events by admin data in FSSAdmin rate on FSSRecords Excluded because of Valid Data Errors
Numerator Events by Admin Data on Eligible Population (before exclusions)
HEDIS 2007 (Reporting Year 2006) Page 16
Effectiveness of Care Sanford Health PlanBeta Blocker Treatment after Heart Attack Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial Medicare Advantage MSHO
2006H21
18
85.71% NR NR21
0.00%21
1885.71% NR NR
0
0
0
0
021182
NA NR NRNA NR NRNA NR NR
Final Sample Size (FSS)Numerator events by admin data in FSS
Data Elements
Data Collection MethodologyEligible Member PopulationNumerator Events by Admin Data on Eligible Population
Current Year's Admin Rate
Measurement Year
Number of administrative data records excluded
Number of medical record data records excluded
Records Added from the Oversample List
Number of employee/dependent medical records excluded
Admin rate on FSS
Minimum Required Sample SizeOversampling Rate
Upper 95% Confidence IntervalLower 95% Confidence IntervalReported Rate
Numerator Events by Admin DataNumerator Events by Medical Record
Denominator
Records Excluded because of Valid Data Errors
HEDIS 2007 (Reporting Year 2006) Page 17
Effectiveness of Care Sanford Health PlanPersistence of Beta Blocker Treatment After Hearth Attack Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial Medicare Advantage MSHO
2006A18
10
NA NR NRNA NR NRNA NR NRUpper 95% Confidence Interval
Lower 95% Confidence IntervalReported Rate
Measurement Year
Data Elements
Data Collection MethodologyEligible Member PopulationNumerator Events by Admin Data on Eligible Population
HEDIS 2007 (Reporting Year 2006) Page 18
Effectiveness of Care Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
Cholesterol Management for Patients with Cardiovascular Conditions
CommercialGeneral Measure
Data
LDL-C screening
LDL-C Level of <100 mg/dL
2006H
120
91 17
75.83% 14.17%120
0.00%120
91 1775.83% 14.17%
4
2
0
0
0114
91 178 52
86.84% 60.53%80.20% 51.11%93.49% 69.94%Upper 95% Confidence Interval
Lower 95% Confidence Interval
Data Elements
Data Collection MethodologyEligible Member Population
Measurement Year
Number of administrative data records excluded
Number of medical record data records excluded
Admin rate on FSS
Final Sample Size (FSS)
Numerator Events by Admin Data
Number of employee/dependent medical records excluded
Numerator Events by Admin Data on Eligible Population
Minimum Required Sample SizeOversampling Rate
Current Year's Admin Rate
Records Added from the Oversample ListDenominator
Numerator events by admin data in FSS
Records Excluded because of Valid Data Errors
Reported RateNumerator Events by Medical Record
HEDIS 2007 (Reporting Year 2006) Page 19
Effectiveness of Care Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
Cholesterol Management for Patients with Cardiovascular Conditions
Medicare AdvantageGeneral Measure
Data
LDL-C screening
LDL-C Level of <100 mg/dL
NR NR
NR NR
NR NRNR NRNR NR
Reported RateLower 95% Confidence IntervalUpper 95% Confidence Interval
Records Added from the Oversample ListDenominatorNumerator Events by Admin DataNumerator Events by Medical Record
Records Excluded because of Valid Data Errors
Number of administrative data records excluded
Number of medical record data records excluded
Number of employee/dependent medical records excluded
Oversampling RateFinal Sample Size (FSS)Numerator events by admin data in FSSAdmin rate on FSS
Eligible Member PopulationNumerator Events by Admin Data on Eligible PopulationCurrent Year's Admin RateMinimum Required Sample Size
Data Elements
Measurement YearData Collection Methodology
HEDIS 2007 (Reporting Year 2006) Page 20
Effectiveness of Care Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
Cholesterol Management for Patients with Cardiovascular Conditions
MSHOGeneral Measure
Data
LDL-C screening
LDL-C Level of <100 mg/dL
NR NR
NR NR
NR NRNR NRNR NR
Lower 95% Confidence IntervalUpper 95% Confidence Interval
Numerator Events by Admin DataNumerator Events by Medical RecordReported Rate
Number of medical record data records excluded
Number of employee/dependent medical records excludedRecords Added from the Oversample ListDenominator
Admin rate on FSS
Records Excluded because of Valid Data Errors
Number of administrative data records excluded
Minimum Required Sample SizeOversampling RateFinal Sample Size (FSS)Numerator events by admin data in FSS
Eligible Member PopulationNumerator Events by Admin Data on Eligible PopulationCurrent Year's Admin Rate
Data Elements
Measurement YearData Collection MethodologySampling Method Used
HEDIS 2007 (Reporting Year 2006) Page 21
Effectiveness of Care Sanford Health PlanComprehensive Diabetes Care Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
HbA1c Testing
Poor HbA1c Control
Good HbA1c Control Eye Exam LDL-C
ScreeningLDL-C Level <100 mg/dL
Monitoring for Diabetic
Nephropathy
Blood Pressure
<140/90 mm Hg
Blood Pressure
<130/80 mm Hg
2006 2006 2006 2006 2006 2006 2006 2006 2006H H H H H H H H H
730 730 730 730 730 730 730 730 730
341 730 21 202 294 47 4 0 046.71% 100.00% 2.88% 27.67% 40.27% 6.44% 0.55% 0.00% 0.00%
411 411 411 411 411 411 411 411 41115% 15% 15% 15% 15% 15% 15% 15% 15%411 411 411 411 411 411 411 411 411341 411 21 202 294 47 4 0 0
82.97% 100.00% 5.11% 49.15% 71.53% 11.44% 0.97% 0.00% 0.00%
17 17 17 17 17 17 17 17 17
0 0 0 0 0 0 0 0 0
11 11 11 11 11 11 11 11 11
0 0 0 0 0 0 0 0 0
28 28 28 28 28 28 28 28 28411 411 411 411 411 411 411 411 411341 1 21 202 294 47 4 0 032 87 169 34 29 115 334 266 144
90.75% 21.41% 46.23% 57.42% 78.59% 39.42% 82.24% 64.72% 35.04%87.83% 17.32% 41.29% 52.52% 74.50% 34.57% 78.42% 59.98% 30.30%93.68% 25.50% 51.17% 62.32% 82.68% 44.26% 86.06% 69.46% 39.77%
DenominatorNumerator Events by Admin DataNumerator Events by Medical RecordReported Rate
Numerator events by admin data in FSSAdmin rate on FSSNumber of Records Excluded Because of Valid Data Errors
Additional Records Added from the Oversample List
Number of administrative data records excluded
Number of medical record data records excluded
Number of employee/dependent medical records excluded
Minimum Required Sample SizeOversampling RateFinal Sample Size (FSS)
Data Elements
Measurement Year
Eligible Member PopulationData Collection Methodology
Numerator events by admin data in eligible populationCurrent Year's Administrative Rate
Lower 95% Confidence IntervalUpper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006) Page 22
Effectiveness of Care Sanford Health PlanComprehensive Diabetes Care Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage
HbA1c Testing
Poor HbA1c Control
Good HbA1c Control Eye Exam LDL-C
ScreeningLDL-C Level <100 mg/dL
Monitoring for Diabetic
Nephropathy
Blood Pressure
<140/90 mm Hg
Blood Pressure
<130/80 mm Hg
NR NR NR NR NR NR NR NR NR
NR NR NR NR NR NR NR NR NR
NR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NR
Data Elements
Measurement Year
Lower 95% Confidence IntervalReported Rate
Number of employee/dependent medical records excludedAdditional Records Added from the Oversample ListDenominatorNumerator Events by Admin DataNumerator Events by Medical Record
Number of administrative data records excluded
Number of Records Excluded Because of Valid Data Errors
Admin rate on FSS
Oversampling Rate
Current Year's Administrative RateMinimum Required Sample Size
Numerator events by admin data in FSSFinal Sample Size (FSS)
Data Collection Methodology
Number of medical record data records excluded
Eligible Member PopulationNumerator events by admin data in eligible population
Upper 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006) Page 23
Effectiveness of Care Sanford Health PlanComprehensive Diabetes Care Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
HbA1c Testing
Poor HbA1c Control
Good HbA1c Control Eye Exam LDL-C
ScreeningLDL-C Level <100 mg/dL
Monitoring for Diabetic
Nephropathy
Blood Pressure
<140/90 mm Hg
Blood Pressure
<130/80 mm Hg
NR NR NR NR NR NR NR NR NR
NR NR NR NR NR NR NR NR NR
NR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NR
Lower 95% Confidence IntervalUpper 95% Confidence Interval
DenominatorNumerator Events by Admin DataNumerator Events by Medical RecordReported Rate
Number of administrative data records excluded
Number of medical record data records excluded
Number of employee/dependent medical records excludedAdditional Records Added from the Oversample List
Final Sample Size (FSS)Numerator events by admin data in FSSAdmin rate on FSSNumber of Records Excluded Because of Valid Data Errors
Numerator events by admin data in eligible populationCurrent Year's Administrative RateMinimum Required Sample SizeOversampling Rate
Data Collection Methodology
Data Elements
Measurement Year
Eligible Member Population
HEDIS 2007 (Reporting Year 2006) Page 24
Effectiveness of Care Sanford Health PlanComprehensive Diabetes Care Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
HbA1c Testing
Poor HbA1c Control
Good HbA1c Control Eye Exam LDL-C
ScreeningLDL-C Level <100 mg/dL
Monitoring for Diabetic
Nephropathy
Blood Pressure
<140/90 mm Hg
Blood Pressure
<130/80 mm Hg
NR NR NR NR NR NR NR NR NR
NR NR NR NR NR NR NR NR NR
NR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NR
Numerator Events by Medical RecordReported Rate
Admin rate on FSSNumber of Records Excluded Because of Valid Data ErrorsNumber of administrative data records excluded
Number of medical record data records excluded
Minimum Required Sample SizeOversampling Rate
Lower 95% Confidence IntervalUpper 95% Confidence Interval
Number of employee/dependent medical records excludedAdditional Records Added from the Oversample ListDenominatorNumerator Events by Admin Data
Final Sample Size (FSS)Numerator events by admin data in FSS
Eligible Member PopulationNumerator events by admin data in eligible populationCurrent Year's Administrative Rate
Data Elements
Measurement YearData Collection Methodology
HEDIS 2007 (Reporting Year 2006) Page 25
Effectiveness of Care Sanford Health PlanUse of Appropriate Medications for People with Asthma Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
General Measure Data Ages 5-9 Ages 10-17 Ages 18-56
2006A
28 40 143 21128 37 120 185NA 92.50% 83.92% 87.68%NA 83.09% 77.54% 83.01%NA 100.00% 90.29% 92.35%
Measurement Year
Total
Upper 95% Confidence IntervalLower 95% Confidence IntervalReported Rate
Data Elements
Data Collection Methodology
Numerator Events by Admin DataEligible Member Population
HEDIS 2007 (Reporting Year 2006) Page 26
Effectiveness of Care Sanford Health PlanUse of Appropriate Medications for People with Asthma Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
General Measure Data Ages 5-9 Ages 10-17 Ages 18-56
NRNR
NR NR NR NRNR NR NR NRNR NR NR NRUpper 95% Confidence Interval
Measurement Year
Numerator Events by Admin DataReported RateLower 95% Confidence Interval
Data Elements Total
Data Collection MethodologyEligible Member Population
HEDIS 2007 (Reporting Year 2006) Page 27
Effectiveness of Care Sanford Health PlanAntidepressant Medication Management Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
General Measure
Data
Optimal Practitioner Contacts for Medication
Management
Effective Acute Phase
Treatment
Effective Continuation
Phase Treatment
2006A63
11 49 3817.46% 77.78% 60.32%7.29% 66.72% 47.44%
27.63% 88.84% 73.19%
Measurement Year
Reported Rate
Data Elements
Data Collection MethodologyEligible Member Population
Upper 95% Confidence IntervalLower 95% Confidence Interval
Numerator Events by Admin Data
HEDIS 2007 (Reporting Year 2006) Page 28
Effectiveness of Care Sanford Health PlanAntidepressant Medication Management Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage
General Measure
Data
Optimal Practitioner Contacts for Medication
Management
Effective Acute Phase
Treatment
Effective Continuation
Phase Treatment
NR NR NRNR NR NRNR NR NR
Measurement Year
Reported RateLower 95% Confidence IntervalUpper 95% Confidence Interval
Data Elements
Data Collection MethodologyEligible Member PopulationNumerator Events by Admin Data
HEDIS 2007 (Reporting Year 2006) Page 29
Effectiveness of Care Sanford Health PlanAntidepressant Medication Management Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
General Measure
Data
Optimal Practitioner Contacts for Medication
Management
Effective Acute Phase
Treatment
Effective Continuation
Phase Treatment
NR NR NRNR NR NRNR NR NR
Measurement Year
Lower 95% Confidence IntervalUpper 95% Confidence Interval
Data Elements
Data Collection MethodologyEligible Member PopulationNumerator Events by Admin DataReported Rate
HEDIS 2007 (Reporting Year 2006) Page 30
Effectiveness of Care Sanford Health PlanAntidepressant Medication Management Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
General Measure
Data
Optimal Practitioner Contacts for Medication
Management
Effective Acute Phase
Treatment
Effective Continuation
Phase Treatment
NR NR NRNR NR NRNR NR NR
Measurement Year
Upper 95% Confidence Interval
Reported RateLower 95% Confidence Interval
Data Elements
Data Collection MethodologyEligible Member PopulationNumerator Events by Admin Data
HEDIS 2007 (Reporting Year 2006) Page 31
Effectiveness of Care Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
Follow-Up Care for Children PrescribedAttention-Deficit/Hyperactivity Disorder (ADHD) Medication
General Measure
Data
Initiation Phase
Continuation and
Maintenance Phase
General Measure
Data
Initiation Phase
Continuation and
Maintenance Phase
2006A
35 51 0
10 328.57% NA NR NR12.18% NA NR NR44.97% NA NR NR
Medicaid
Upper 95% Confidence Interva
Data Elements
Data Collection MethodologyEligible Member Population
Numerator Events by Admin DataReported RateLower 95% Confidence Interval
Total Exclusions
Measurement Year
Commercial
HEDIS 2007 (Reporting Year 2006) Page 32
Effectiveness of Care Sanford Health PlanGlaucoma Screening in Older Adults Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage MSHO
NR NRNR NRNR NR
Measurement Year
Upper 95% Confidence Interva
Data Elements
Data Collection MethodologyEligible Member PopulationNumerator Events by Admin DataReported RateLower 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006) Page 33
Effectiveness of Care Sanford Health PlanData Last Refreshed:
Oct 7, 2009 1:21 PMAnnual Monitoring for Patients on PersistenMedications
Commercial
ACE Inhibitors or ARBs Digoxin Diuretics Anti-
convulsants Total
2006A
1211 23 823 56 21130 0 0 0 0
821 14 586 36 145767.80% NA 71.20% 64.29% 68.95%65.12% NA 68.05% 50.84% 66.96%70.47% NA 74.36% 77.73% 70.95%
Total Exclusions
Annual Monitoring for Members onGeneral Measure
DataData Elements
Measurement Year
Reported Rate
Data Collection MethodologyEligible Member Population
Upper 95% Confidence IntervalLower 95% Confidence Interval
Numerator Events by Admin Data
HEDIS 2007 (Reporting Year 2006) Page 34
Effectiveness of Care Sanford Health PlanData Last Refreshed:
Oct 7, 2009 1:21 PMAnnual Monitoring for Patients on PersistenMedications
Medicare Advantage
ACE Inhibitors or ARBs Digoxin Diuretics Anti-
convulsants Total
NR NR NR NR NRNR NR NR NR NRNR NR NR NR NR
Total Exclusions
General Measure
Data
Annual Monitoring for Members on
Measurement Year
Data Elements
Reported RateLower 95% Confidence IntervalUpper 95% Confidence Interval
Data Collection MethodologyEligible Member Population
Numerator Events by Admin Data
HEDIS 2007 (Reporting Year 2006) Page 35
Effectiveness of Care Sanford Health PlanData Last Refreshed:
Oct 7, 2009 1:21 PMAnnual Monitoring for Patients on PersistenMedications
MSHO
ACE Inhibitors or ARBs Digoxin Diuretics Anti-
convulsants Total
NR NR NR NR NRNR NR NR NR NRNR NR NR NR NR
Total Exclusions
Data ElementsGeneral Measure
Data
Annual Monitoring for Members on
Measurement Year
Eligible Member Population
Numerator Events by Admin Data
Lower 95% Confidence IntervalUpper 95% Confidence Interval
Reported Rate
Data Collection Methodology
HEDIS 2007 (Reporting Year 2006) Page 36
Effectiveness of Care Sanford Health PlanData Last Refreshed:
Oct 7, 2009 1:21 PMAnnual Monitoring for Patients on PersistenMedications
Medicaid
ACE Inhibitors or ARBs Digoxin Diuretics Anti-
convulsants Total
NR NR NR NR NRNR NR NR NR NRNR NR NR NR NR
Total Exclusions
General Measure
Data
Annual Monitoring for Members on
Measurement Year
Data Elements
Upper 95% Confidence Interval
Reported RateLower 95% Confidence Interval
Data Collection MethodologyEligible Member Population
Numerator Events by Admin Data
HEDIS 2007 (Reporting Year 2006) Page 37
Effectiveness of Care Sanford Health PlanDrugs to Be Avoided in the Elderly Data Last Refreshed:
Oct 7, 2009 1:21 PM
General Measure
Data
1 or More Prescriptions
2 or More Prescriptions
General Measure
Data
1 or More Prescriptions
2 or More Prescriptions
NR NR NR NRNR NR NR NRNR NR NR NR
MSHO
Data Elements
Numerator Events by Admin Data
Data Collection MethodologyEligible Member Population
Upper 95% Confidence IntervalLower 95% Confidence Interval
Measurement Year
Reported Rate
Medicare Advantage
HEDIS 2007 (Reporting Year 2006) Page 38
Effectiveness of Care Sanford Health PlanPotentially Harmful Drug-Disease Interactions in the Elderly Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage
History of Falls + Tricyclic
Antidepressants, Antipsychotics or
Sleep Agents
Dementia + Tricyclic
Antidepressants orAnticholinergic
Agents
Chronic Renal Failure +
Nonaspirin NSAIDsor Cox-2 Selective
NSAIDs
Total
NR NR NR NRNR NR NR NRNR NR NR NR
Drug-Disease Interactions
Eligible Member Population
Upper 95% Confidence Interval
Data Collection Methodology
Numerator Events by Admin Data
General Measure
Data
Reported RateLower 95% Confidence Interval
Data Elements
Measurement Year
HEDIS 2007 (Reporting Year 2006) Page 39
Effectiveness of Care Sanford Health PlanPotentially Harmful Drug-Disease Interactions in the Elderly Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
History of Falls + Tricyclic
Antidepressants, Antipsychotics or
Sleep Agents
Dementia + Tricyclic
Antidepressants orAnticholinergic
Agents
Chronic Renal Failure +
Nonaspirin NSAIDsor Cox-2 Selective
NSAIDs
Total
NR NR NR NRNR NR NR NRNR NR NR NR
Data ElementsGeneral Measure
Data
Drug-Disease Interactions
Numerator Events by Admin DataEligible Member Population
Upper 95% Confidence Interval
Measurement Year
Reported Rate
Data Collection Methodology
Lower 95% Confidence Interval
HEDIS 2007 (Reporting Year 2006) Page 40
Use of Services Sanford Health PlanWell Child Visits in the First 15 Months of Life Data Last Refreshed:
Oct 7, 2009 1:21 PM
CommercialGeneral Measure
DataZero Visits 1 visit 2 visits 3 visits 4 visits 5 visits 6 or more
visits
2006A
210
NR NR NR NR NR NR NR
NR NR NR NR NR NR NR
3 2 4 8 11 50 132
1.43% 0.95% 1.90% 3.81% 5.24% 23.81% 62.86%0.00% 0.00% 0.00% 0.98% 1.99% 17.81% 56.08%3.27% 2.50% 3.99% 6.64% 8.49% 29.81% 69.63%
Numerator Events by Admin DataNumerator Events by Medical Record
Lower 95% Confidence Interval
Number of Records Excluded Because of Valid Data Errors
Number of employee/dependent medical records excluded
Additional Records Added from the Oversample ListDenominator
Number of records excluded because of contraindications identified through medical record review
Number of records excluded because of contraindications identified through administrative data
Numerator events by admin data in eligible population
Minimum Required Sample SizeCurrect Year's Administrative Rate
Oversampling Rate
Data Elements
Data Collection MethodologyEligible Member Population
Measurement Year
Upper 95% Confidence Interval
Administrative rate on FSS
Reported Rate
Final sample size (FSS)Numerator events by admin data in FSS
HEDIS 2007 (Reporting Year 2006) Page 41
Use of Services Sanford Health PlanWell Child Visits in the First 15 Months of Life Data Last Refreshed:
Oct 7, 2009 1:21 PM
MedicaidGeneral Measure
DataZero Visits 1 visit 2 visits 3 visits 4 visits 5 visits 6 or more
visits
NR NR NR NR NR NR NR
NR NR NR NR NR NR NR
NR NR NR NR NR NR NRNR NR NR NR NR NR NRNR NR NR NR NR NR NR
Lower 95% Confidence IntervalUpper 95% Confidence Interval
DenominatorNumerator Events by Admin DataNumerator Events by Medical RecordReported Rate
Number of Records Excluded Because of Valid Data Errors
Number of employee/dependent medical records excluded
Additional Records Added from the Oversample List
Number of records excluded because of contraindications identified through administrative data
Number of records excluded because of contraindications identified through medical record review
Oversampling RateFinal sample size (FSS)Numerator events by admin data in FSSAdministrative rate on FSS
Numerator events by admin data in eligible populationCurrect Year's Administrative RateMinimum Required Sample Size
Data Elements
Data Collection MethodologyEligible Member Population
Measurement Year
HEDIS 2007 (Reporting Year 2006) Page 42
Use of Services Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
Well Child Visits in the 3rd, 4th, 5th and 6th Years of Life
Commercial Medicaid2006
A1157
NR NR
NR NR
541
46.76% NR43.84% NR49.68% NR
Oversampling Rate
Denominator
Upper 95% Confidence IntervalLower 95% Confidence IntervalReported Rate
Administrative rate on FSS
Numerator Events by Admin DataNumerator Events by Medical Record
Numerator events by admin data in eligible population
Records Excluded because of Valid Data Errors
Records Added from the Oversample List
Final sample size (FSS)Numerator events by admin data in FSS
Number of employee/dependent medical records excluded
Records Excluded - Contraindications/Medical Record Review
Records Excluded - Contraindications/Admin Data
Current Year's Admin RateMinimum Required Sample Size
Data Elements
Data Collection MethodologyEligible Member Population
Measurement Year
HEDIS 2007 (Reporting Year 2006) Page 43
Use of Services Sanford Health PlanAdolescent Well-Care Visits Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial Medicaid2006
A3280
NR NR
NR NR
870
26.52% NR25.00% NR28.05% NR
Numerator Events by Admin Data
Records Excluded - Contraindications/Medical Record Review
Oversampling Rate
Current Year's Admin Rate
Final sample size (FSS)Numerator events by admin data in FSS
Upper 95% Confidence IntervalLower 95% Confidence IntervalReported Rate
Administrative rate on FSS
Numerator Events by Medical Record
Number of employee/dependent medical records excludedRecords Added from the Oversample ListDenominator
Records Excluded - Contraindications/Admin Data
Records Excluded because of Valid Data Errors
Numerator events by admin data in eligible population
Minimum Required Sample Size
Data Elements
Data Collection MethodologyEligible Member Population
Measurement Year
HEDIS 2007 (Reporting Year 2006) Page 44
Use of Services Sanford Health PlanFrequency of Selected Procedures Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Age0-40-95-1910-19
Procedure AgeNumber of
Procedures0-4 154 6.905-19 23 0.320-9 38 0.8510-19 24 0.48
Age Male Female15-44 7609820-44 61686 6348030-64 8606245-64 47130 4958565+ 1828 1398
Procedure AgeNumber of
ProceduresNumber of
Procedures15-44 19 0.2545-64 14 0.2815-44 21 0.2845-64 23 0.4665+ 0 0.0015-44 19 0.2545-64 32 0.6565+ 0 0.0030-64 1 0.0115-44 1 0.0145-64 6 0.1265+ 0 0.00 0 0.0030-64 28 0.3315-44 54 0.7145-64 26 0.5265+ 0 0.00 0 0.0020-44 52 0.84 103 1.6245-64 109 2.31 131 2.6465+ 2 1.09 4 2.8645-64 41 0.87 7 0.1465+ 0 0.00 0 0.0045-64 50 1.06 37 0.7565+ 7 3.83 0 0.0045-64 12 0.25 0 0.0065+ 0 0.00 0 0.0045-64 13 0.2865+ 1 0.5515-44 2 0.0345-64 7 0.1465+ 2 1.4315-44 15 0.2045-64 24 0.4865+ 0 0.00
Member Months
Female
Member MonthsTotal22326447697262250179
Male
Procedures / 1,000 Member
Months
Procedures / 1,000 Member
Months
Total
Procedures / 1,000 Member
Months
Lumpectomy
Cholecystectomy, Open
Back Surgery
Mastectomy
Cardiac Catheterization
Prostatectomy
CABG
Myringotomy
Tonsillectomy
Dilation & Curettage
Angioplasty (PTCA)
Hysterectomy, Abdominal
Hysterectomy, Vaginal
Cholecystectomy, Closed
HEDIS 2007 (Reporting Year 2006) Page 45
Use of Services Sanford Health PlanFrequency of Selected Procedures Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage
Age Male Female< 6565-7475-8485+
Procedure AgeNumber of
ProceduresNumber of
ProceduresCABG <65 NR NR
65-74 NR NR75-84 NR NR85+ NR NR
Angioplasty <65 NR NR(PTCA) 65-74 NR NR
75-84 NR NR85+ NR NR
Cardiac <65 NR NRCatheterization 65-74 NR NR
75-84 NR NR85+ NR NR
Carotid <65 NR NREndarterectomy 65-74 NR NR
75-84 NR NR85+ NR NR
Reduction of <65 NR NRFracture of Femur 65-74 NR NR
75-84 NR NR85+ NR NR
Total Hip <65 NR NRReplacement 65-74 NR NR
75-84 NR NR85+ NR NR
Total Knee <65 NR NRReplacement 65-74 NR NR
75-84 NR NR85+ NR NR
Partial Excision of <65 NR NRLarge Inestine 65-74 NR NR
75-84 NR NR85+ NR NR
Cholecystectomy, <65 NR NROpen 65-74 NR NR
75-84 NR NR85+ NR NR
Cholecystectomy, <65 NR NRClosed 65-74 NR NR(laparoscopic) 75-84 NR NR
85+ NR NRBack Surgery <65 NR NR
65-74 NR NR75-84 NR NR85+ NR NR
Hysterectomy <65 NRAbdominal 65-74 NR
75-84 NR85+ NR
Hysterectomy, <65 NRVaginal 65-74 NR
75-84 NR85+ NR
Mastectomy <65 NR65-74 NR75-84 NR85+ NR
Lumpectomy <65 NR65-74 NR75-84 NR85+ NR
Male Female
Procedures / 1,000 Member
Months
Procedures / 1,000 Member
Months
Member Months
HEDIS 2007 (Reporting Year 2006) Page 46
Use of Services Sanford Health PlanFrequency of Selected Procedures Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
Age Male Female< 6565-7475-8485+
Procedure AgeNumber of
ProceduresNumber of
ProceduresCABG <65 NR NR
65-74 NR NR75-84 NR NR85+ NR NR
Angioplasty <65 NR NR(PTCA) 65-74 NR NR
75-84 NR NR85+ NR NR
Cardiac <65 NR NRCatheterization 65-74 NR NR
75-84 NR NR85+ NR NR
Carotid <65 NR NREndarterectomy 65-74 NR NR
75-84 NR NR85+ NR NR
Reduction of <65 NR NRFracture of Femur 65-74 NR NR
75-84 NR NR85+ NR NR
Total Hip <65 NR NRReplacement 65-74 NR NR
75-84 NR NR85+ NR NR
Total Knee <65 NR NRReplacement 65-74 NR NR
75-84 NR NR85+ NR NR
Partial Excision of <65 NR NRLarge Inestine 65-74 NR NR
75-84 NR NR85+ NR NR
Cholecystectomy, <65 NR NROpen 65-74 NR NR
75-84 NR NR85+ NR NR
Cholecystectomy, <65 NR NRClosed 65-74 NR NR(laparoscopic) 75-84 NR NR
85+ NR NRBack Surgery <65 NR NR
65-74 NR NR75-84 NR NR85+ NR NR
Hysterectomy <65 NRAbdominal 65-74 NR
75-84 NR85+ NR
Hysterectomy, <65 NRVaginal 65-74 NR
75-84 NR85+ NR
Mastectomy <65 NR65-74 NR75-84 NR85+ NR
Lumpectomy <65 NR65-74 NR75-84 NR85+ NR
Member Months
Male Female
Procedures / 1,000 Member
Months
Procedures / 1,000 Member
Months
HEDIS 2007 (Reporting Year 2006) Page 47
Use of ServicesInpatient Utilization - General Hospital/Acute Care
nford Health PlanData Last Refreshed:
Oct 7, 2009 1:21 PM
CommercialAge Member Months<1 43071-9 4046210-19 5017920-44 12516645-64 9671565-74 309575-84 11985+ 12Unknown 0
320055
Age Discharges Days
Total Inpatient<1 53 12.31 195 45.28 3.681-9 86 2.13 255 6.30 2.9710-19 70 1.40 211 4.20 3.0120-44 756 6.04 2097 16.75 2.7745-64 627 6.48 2264 23.41 3.6165-74 21 6.79 60 19.39 2.8675-84 3 25.21 8 67.23 2.6785+ 0 0.00 0 0.00 NAUnknown 0 0 NA
1616 5.05 5090 15.90 3.15Medicine<1 47 10.91 156 36.22 3.321-9 70 1.73 185 4.57 2.6410-19 29 0.58 85 1.69 2.9320-44 134 1.07 381 3.04 2.8445-64 274 2.83 971 10.04 3.5465-74 12 3.88 34 10.99 2.8375-84 3 25.21 8 67.23 2.6785+ 0 0.00 0 0.00 NAUnknown 0 0 NA
569 1.78 1820 5.69 3.20Surgery<1 6 1.39 39 9.06 6.501-9 16 0.40 70 1.73 4.3810-19 25 0.50 88 1.75 3.5220-44 151 1.21 526 4.20 3.4845-64 353 3.65 1293 13.37 3.6665-74 9 2.91 26 8.40 2.8975-84 0 0.00 0 0.00 NA85+ 0 0.00 0 0.00 NAUnknown 0 0 NA
560 1.75 2042 6.38 3.65Maternity10-19 16 0.32 38 0.76 2.3820-44 471 3.76 1190 9.51 2.5345-64 0 0.00 0 0.00 NAUnknown 0 0 NA
487 1.79 1228 4.51 2.52
Days / 1,000 Member Months
Average Length of Stay
Total
Total
Total
Total
Total
Discharges / 1,000 Member
Months
HEDIS 2007 (Reporting Year 2006) Page 48
Use of ServicesInpatient Utilization - General Hospital/Acute Care
nford Health PlanData Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare AdvantageAge Member Months<11-910-1920-4445-6465-7475-8485+Unknown
NR
Age Discharges Days
Total Inpatient<1 NR NR NR1-9 NR NR NR10-19 NR NR NR20-44 NR NR NR45-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NRUnknown NR
NR NR NR NR NRMedicine<1 NR NR NR1-9 NR NR NR10-19 NR NR NR20-44 NR NR NR45-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NRUnknown NR
NR NR NR NR NRSurgery<1 NR NR NR1-9 NR NR NR10-19 NR NR NR20-44 NR NR NR45-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NRUnknown NR
NR NR NR NR NRMaternity10-19 NR NR NR20-44 NR NR NR45-64 NR NR NRUnknown NR
NR NR NR NR NR
Average Length of Stay
Discharges / 1,000 Member
Months
Days / 1,000 Member Months
Total
Total
Total
Total
Total
HEDIS 2007 (Reporting Year 2006) Page 49
Use of ServicesInpatient Utilization - General Hospital/Acute Care
nford Health PlanData Last Refreshed:
Oct 7, 2009 1:21 PM
MSHOAge Member Months<11-910-1920-4445-6465-7475-8485+Unknown
NR
Age Discharges Days
Total Inpatient<1 NR NR NR1-9 NR NR NR10-19 NR NR NR20-44 NR NR NR45-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NRUnknown NR
NR NR NR NR NRMedicine<1 NR NR NR1-9 NR NR NR10-19 NR NR NR20-44 NR NR NR45-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NRUnknown NR
NR NR NR NR NRSurgery<1 NR NR NR1-9 NR NR NR10-19 NR NR NR20-44 NR NR NR45-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NRUnknown NR
NR NR NR NR NRMaternity10-19 NR NR NR20-44 NR NR NR45-64 NR NR NRUnknown NR
NR NR NR NR NR
Days / 1,000 Member Months
Average Length of Stay
Total
Discharges / 1,000 Member
Months
Total
Total
Total
Total
HEDIS 2007 (Reporting Year 2006) Page 50
Use of ServicesAmbulatory Care
nford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
Commercial
AgeMember Months
<1 43071-9 4046210-19 5017920-44 12516645-64 9671565-74 309575-84 11985+ 12Unknown 0
320055
Outpatient Visits (Excludes MH/CD)
Emergency Room Visits
Age Visits Visits Procedures Stays<1 3969 921.52 112 26.00 38 8.82 22 5.111-9 11475 283.60 569 14.06 166 4.10 34 0.8410-19 9636 192.03 565 11.26 190 3.79 42 0.8420-44 27044 216.07 1261 10.07 826 6.60 140 1.1245-64 28432 293.98 769 7.95 1680 17.37 125 1.2965-74 1181 381.58 34 10.99 68 21.97 9 2.9175-84 82 689.08 2 16.81 3 25.21 0 0.0085+ 0 0.00 0 0.00 0 0.00 0 0.00Unknown 0 0 0 0
81819 255.64 3312 10.35 2971 9.28 372 1.16
Ambulatory Surgery/Procedures
Total
Total
Stays/ 1,000 Member Months
Observation Room Stays Resulting in Discharge
Visits/ 1,000 Member Months
Visits/ 1,000 Member Months
Procedures/ 1,000 Member
Months
HEDIS 2007 (Reporting Year 2006) Page 51
Use of ServicesAmbulatory Care
nford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
Medicare Advantage
AgeMember Months
<11-910-1920-4445-6465-7475-8485+Unknown
NR
Outpatient Visits (Excludes MH/CD)
Emergency Room Visits
Age Visits Visits Procedures Stays<1 NR NR NR NR1-9 NR NR NR NR10-19 NR NR NR NR20-44 NR NR NR NR45-64 NR NR NR NR65-74 NR NR NR NR75-84 NR NR NR NR85+ NR NR NR NRUnknown
NR NR NR NR NR NR NR NR
Visits/ 1,000 Member Months
Visits/ 1,000 Member Months
Procedures/ 1,000 Member
Months
Total
Ambulatory Surgery/Procedures
Observation Room Stays Resulting in Discharge
Stays/ 1,000 Member Months
Total
HEDIS 2007 (Reporting Year 2006) Page 52
Use of ServicesAmbulatory Care
nford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
MSHO
AgeMember Months
<11-910-1920-4445-6465-7475-8485+Unknown
NR
Outpatient Visits (Excludes MH/CD)
Emergency Room Visits
Age Visits Visits Procedures Stays<1 NR NR NR NR1-9 NR NR NR NR10-19 NR NR NR NR20-44 NR NR NR NR45-64 NR NR NR NR65-74 NR NR NR NR75-84 NR NR NR NR85+ NR NR NR NRUnknown
NR NR NR NR NR NR NR NRTotal
Total
Ambulatory Surgery/Procedures
Observation Room Stays Resulting in Discharge
Visits/ 1,000 Member Months
Visits/ 1,000 Member Months
Procedures/ 1,000 Member
Months
Stays/ 1,000 Member Months
HEDIS 2007 (Reporting Year 2006) Page 53
Use of Services Sanford Health PlanInpatient Utilization - Nonacute Care Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
AgeMember Months
<1 43071-9 4046210-19 5017920-44 12516645-64 9671565-74 309575-84 11985+ 12Unknown 0
320055
<1 0 0.00 0 0.00 NA1-9 0 0.00 0 0.00 NA10-19 0 0.00 0 0.00 NA20-44 8 0.06 46 0.37 5.7545-64 33 0.34 432 4.47 13.0965-74 0 0.00 0 0.00 NA75-84 0 0.00 0 0.00 NA85+ 0 0.00 0 0.00 NAUnknown 0 0 NA
41 0.13 478 1.49 11.66
Total
Total
Age
Discharges / 1,000 Member
MonthsDischarges DaysAverage Length
of Stay
Days / 1,000 Member Months
HEDIS 2007 (Reporting Year 2006) Page 54
Use of Services Sanford Health PlanInpatient Utilization - Nonacute Care Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage
AgeMember Months
<11-910-1920-4445-6465-7475-8485+Unknown
NR
<1 NR NR NR1-9 NR NR NR10-19 NR NR NR20-44 NR NR NR45-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NRUnknown NR
NR NR NR NR NR
Total
Total
DaysDischarges
Discharges / 1,000 Member
MonthsAge
Days / 1,000 Member Months
Average Lengthof Stay
HEDIS 2007 (Reporting Year 2006) Page 55
Use of Services Sanford Health PlanInpatient Utilization - Nonacute Care Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
AgeMember Months
<11-910-1920-4445-6465-7475-8485+Unknown
NR
<1 NR NR NR1-9 NR NR NR10-19 NR NR NR20-44 NR NR NR45-64 NR NR NR65-74 NR NR NR75-84 NR NR NR85+ NR NR NRUnknown NR
NR NR NR NR NR
Days
Days / 1,000 Member Months
Average Lengthof Stay
Total
Total
Age Discharges
Discharges / 1,000 Member
Months
HEDIS 2007 (Reporting Year 2006) Page 56
Use of Services Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
Mental Health Utilization - Inpatient Discharges and Average Length of Stay, by Age and Sex
Commercial
Age Male Female0-12 30602 28336 5893813-17 13328 12896 2622418-64 113723 117944 23166765+ 1828 1398 3226Unknown 0 0 0
159481 160574 320055
Age GenderDischarges Days*
M 6 0.20 48 8.00F 1 0.04 16 16.00
7 0.12 64 9.14M 4 0.30 19 4.75F 14 1.09 189 13.50
18 0.69 208 11.56M 36 0.32 147 4.08F 46 0.39 243 5.28
82 0.35 390 4.76M 0 0.00 0 NAF 0 0.00 0 NA
0 0.00 0 NAM 0 0 NAF 0 0 NA
0 0 NA46 0.29 214 4.6561 0.38 448 7.34107 0.33 662 6.19
Unknown
Total
65+
Average Lengthof Stay
Total
Total
Total
Total
Total
TotalMFTOTAL
Member Months
0-12
13-17
18-64
Total
Discharges / 1,000 Member
Months
HEDIS 2007 (Reporting Year 2006) Page 57
Use of Services Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
Mental Health Utilization - Inpatient Discharges and Average Length of Stay, by Age and Sex
Medicare Advantage
Age Male Female0-12 NR13-17 NR18-64 NR65+ NRUnknown NR
NR NR NR
Age GenderDischarges Days*
M NR NRF NR NR
NR NR NR NRM NR NRF NR NR
NR NR NR NRM NR NRF NR NR
NR NR NR NRM NR NRF NR NR
NR NR NR NRM NRF NR
NR NR NRNR NR NR NRNR NR NR NRNR NR NR NR
Average Lengthof Stay
18-64
Total
0-12
Total13-17
Total
Total MFTOTAL
Unknown
Total
65+
Total
Discharges / 1,000 Member
Months
Member Months
Total
Total
HEDIS 2007 (Reporting Year 2006) Page 58
Use of Services Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
Mental Health Utilization - Inpatient Discharges and Average Length of Stay, by Age and Sex
MSHO
Age Male Female0-12 NR13-17 NR18-64 NR65+ NRUnknown NR
NR NR NR
Age GenderDischarges Days*
M NR NRF NR NR
NR NR NR NRM NR NRF NR NR
NR NR NR NRM NR NRF NR NR
NR NR NR NRM NR NRF NR NR
NR NR NR NRM NRF NR
NR NR NRNR NR NR NRNR NR NR NRNR NR NR NR
Unknown
Total
18-64
Total65+
Total
0-12
Total
Total MFTOTAL
13-17
Total
Total
Total
Discharges / 1,000 Member
Months
Average Lengthof Stay
Member Months
HEDIS 2007 (Reporting Year 2006) Page 59
Use of Services Sanford Health PlanData Last Refreshed:
Oct 7, 2009 1:21 PMMental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory
Commercial
Age Male Female Male Female Male Female Male Female0-12 30602 28336 58938 30602 28336 58938 30602 28336 58938 30602 28336 5893813-17 13328 12896 26224 13328 12896 26224 13328 12896 26224 13328 12896 2622418-64 113723 117944 231667 113723 117944 231667 113723 117944 231667 113723 117944 23166765+ 1828 1398 3226 1828 1398 3226 1828 1398 3226 1828 1398 3226Unknown 0 0 0 0 0 0 0 0 0 0 0 0
159481 160574 320055 159481 160574 320055 159481 160574 320055 159481 160574 320055
Age Sex Number Number Number NumberM 94 3.69% 5 0.20% 0 0.00% 94 3.69%F 65 2.75% 1 0.04% 0 0.00% 65 2.75%
159 3.24% 6 0.12% 0 0.00% 159 3.24%M 74 6.66% 4 0.36% 1 0.09% 72 6.48%F 98 9.12% 11 1.02% 1 0.09% 97 9.03%
172 7.87% 15 0.69% 2 0.09% 169 7.73%M 341 3.60% 27 0.28% 7 0.07% 329 3.47%F 584 5.94% 34 0.35% 7 0.07% 573 5.83%
925 4.79% 61 0.32% 14 0.07% 902 4.67%M 1 0.66% 0 0.00% 0 0.00% 1 0.66%F 2 1.72% 0 0.00% 0 0.00% 2 1.72%
3 1.12% 0 0.00% 0 0.00% 3 1.12%M 0 NA 0 NA 0 NA 0 NAF 0 NA 0 NA 0 NA 0 NA
0 NA 0 NA 0 NA 0 NA510 3.84% 36 0.27% 8 0.06% 496 3.73%749 5.60% 46 0.34% 8 0.06% 737 5.51%1259 4.72% 82 0.31% 16 0.06% 1233 4.62%
Member Months (Day/Night) Member Months (Ambulatory)
Any Mental Health Services Inpatient Mental Health Services
TotalTotal
Unknown
Total
0-12
13-17
18-64
65+
Percent Percent PercentDay/Night Mental Health Services Ambulatory Mental Health Services
Total
Total
Total
Total
Total
Total
Member Months (Any)
MFTotal
Total Total
Percent
Member Months (Inpatient)
HEDIS 2007 (Reporting Year 2006) Page 60
Use of Services Sanford Health PlanData Last Refreshed:
Oct 7, 2009 1:21 PMMental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory
Medicare Advantage
Age Male Female Male Female Male Female Male Female0-12 NR NR NR NR13-17 NR NR NR NR18-64 NR NR NR NR65+ NR NR NR NRUnknown NR NR NR NR
NR NR NR NR NR NR NR NR NR NR NR NR
Age Sex Number Number Number NumberM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR
Ambulatory Mental Health ServicesPercent Percent Percent
Member Months (Inpatient)
Percent
Total
Total
Total
Member Months (Day/Night) Member Months (Ambulatory)
Any Mental Health Services Inpatient Mental Health Services Day/Night Mental Health Services
TotalTotalTotal TotalMember Months (Any)
65+
TotalUnknown
TotalF
Total
Total
M
18-64
0-12
13-17
Total
HEDIS 2007 (Reporting Year 2006) Page 61
Use of Services Sanford Health PlanData Last Refreshed:
Oct 7, 2009 1:21 PMMental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory
MSHO
Age Male Female Male Female Male Female Male Female0-12 NR NR NR NR13-17 NR NR NR NR18-64 NR NR NR NR65+ NR NR NR NRUnknown NR NR NR NR
NR NR NR NR NR NR NR NR NR NR NR NR
Age Sex Number Number Number NumberM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR
Unknown
TotalTotal M
FTotal
18-64
Total65+
Total
0-12
Total13-17
Total
Ambulatory Mental Health ServicesPercent Percent Percent Percent
Total
Any Mental Health Services Inpatient Mental Health Services Day/Night Mental Health Services
Total Total Total TotalMember Months (Any) Member Months (Inpatient) Member Months (Day/Night) Member Months (Ambulatory)
HEDIS 2007 (Reporting Year 2006) Page 62
Use of Services Sanford Health PlanData Last Refreshed:
Oct 7, 2009 1:21 PMMental Health Utilization - % of Members Receiving Inpatient, Day/Night and Ambulatory
Medicaid
Age Male Female Male Female Male Female Male Female0-12 NR NR NR NR13-17 NR NR NR NR18-64 NR NR NR NR65+ NR NR NR NRUnknown NR NR NR NR
NR NR NR NR NR NR NR NR NR NR NR NR
Age Sex Number Number Number NumberM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR
13-17
Total
Day/Night Mental Health Services Ambulatory Mental Health ServicesPercent Percent
Unknown
Total
18-64
Total65+
Total
Total MFTotal
Percent PercentAny Mental Health Services Inpatient Mental Health Services
0-12
Total
Total Total
Total
Total TotalMember Months (Any) Member Months (Inpatient) Member Months (Day/Night) Member Months (Ambulatory)
HEDIS 2007 (Reporting Year 2006) Page 63
Use of Services Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
Chemical Dependency Utilization - Inpatient Discharges and Average Length of
Commercial
Age Male Female0-12 30602 28336 5893813-17 13328 12896 2622418-64 113723 117944 23166765+ 1828 1398 3226Unknown 0 0 0
159481 160574 320055
AgeDischarges Days
M 0 0.00 0 NAF 0 0.00 0 NA
0 0.00 0 NAM 3 0.23 56 18.67F 9 0.70 93 10.33
12 0.46 149 12.42M 29 0.26 422 14.55F 12 0.10 104 8.67
41 0.18 526 12.83M 0 0.00 0 NAF 0 0.00 0 NA
0 0.00 0 NAM 0 0 NAF 0 0 NA
0 0 NA32 0.20 478 14.9421 0.13 197 9.3853 0.17 675 12.74
Total
TotalMember Months
65+
18-64
TotalMTotalF
Unknown
TOTAL
0-12
Total
Total
13-17
Discharges / 1,000 Member
Months
Average Lengthof Stay
Total
Total
HEDIS 2007 (Reporting Year 2006) Page 64
Use of Services Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
Chemical Dependency Utilization - Inpatient Discharges and Average Length of
Medicare Advantage
Age Male Female0-12 NR13-17 NR18-64 NR65+ NRUnknown NR
NR NR NR
AgeDischarges Days
M NR NRF NR NR
NR NR NR NRM NR NRF NR NR
NR NR NR NRM NR NRF NR NR
NR NR NR NRM NR NRF NR NR
NR NR NR NRM NRF NR
NR NR NRNR NR NR NRNR NR NR NRNR NR NR NR
Average Lengthof Stay
0-12
Total
Member MonthsTotal
Total
Total18-64
Total
Discharges / 1,000 Member
Months
Total MFTOTAL
65+
TotalUnknown
Total
13-17
HEDIS 2007 (Reporting Year 2006) Page 65
Use of Services Sanford Health PlanData Last Refreshed:Oct 7, 2009 1:21 PM
Chemical Dependency Utilization - Inpatient Discharges and Average Length of
MSHO
Age Male Female0-12 NR13-17 NR18-64 NR65+ NRUnknown NR
NR NR NR
AgeDischarges Days
M NR NRF NR NR
NR NR NR NRM NR NRF NR NR
NR NR NR NRM NR NRF NR NR
NR NR NR NRM NR NRF NR NR
NR NR NR NRM NRF NR
NR NR NRNR NR NR NRNR NR NR NRNR NR NR NR
Unknown
TotalTotal M
FTOTAL
18-64
Total65+
Total
Average Lengthof Stay
0-12
Total13-17
Total
Member MonthsTotal
Total
Discharges / 1,000 Member
Months
HEDIS 2007 (Reporting Year 2006) Page 66
Use of ServicesIdentification of Alcohol and Other Drug Services
Sanford Health PlanData Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Age Male Female Male Female Male Female Male Female0-12 30602 28336 58938 30602 28336 58938 30602 28336 58938 30602 28336 5893813-17 13328 12896 26224 13328 12896 26224 13328 12896 26224 13328 12896 2622418-24 15702 15725 31427 15702 15725 31427 15702 15725 31427 15702 15725 3142725-34 23715 24495 48210 23715 24495 48210 23715 24495 48210 23715 24495 4821035-64 74306 77724 152030 74306 77724 152030 74306 77724 152030 74306 77724 15203065+ 1828 1398 3226 1828 1398 3226 1828 1398 3226 1828 1398 3226Unknown 0 0 0 0 0 0 0 0 0 0 0 0
159481 160574 320055 159481 160574 320055 159481 160574 320055 159481 160574 320055
Age Sex Number Number Number NumberM 0 0.00% 0 0.00% 0 0.00% 0 0.00%F 0 0.00% 0 0.00% 0 0.00% 0 0.00%
0 0.00% 0 0.00% 0 0.00% 0 0.00%M 5 0.45% 3 0.27% 1 0.09% 4 0.36%F 10 0.93% 4 0.37% 1 0.09% 6 0.56%
15 0.69% 7 0.32% 2 0.09% 10 0.46%M 16 NR 5 NR 5 NR 9 NRF 7 NR 2 NR 3 NR 4 NR
23 NA 7 NA 8 NA 13 NAM 20 0.78% 7 0.27% 4 0.16% 13 0.51%F 3 0.13% 0 0.00% 0 0.00% 3 0.13%
23 0.47% 7 0.14% 4 0.08% 16 0.33%M 42 0.68% 15 0.24% 11 0.18% 27 0.44%F 14 0.22% 8 0.12% 1 0.02% 8 0.12%
56 0.44% 23 0.18% 12 0.09% 35 0.28%M 0 0.00% 0 0.00% 0 0.00% 0 0.00%F 0 0.00% 0 0.00% 0 0.00% 0 0.00%
0 0.00% 0 0.00% 0 0.00% 0 0.00%M 0 NA 0 NA 0 NA 0 NAF 0 NA 0 NA 0 NA 0 NA
0 NA 0 NA 0 NA 0 NA83 0.62% 30 0.23% 21 0.16% 53 0.40%34 0.25% 14 0.10% 5 0.04% 21 0.16%
117 0.44% 44 0.16% 26 0.10% 74 0.28%
13-17
Total
Total25-34
Total
Any Chemical Dependency Services Inpatient Chemical Dependency Services
Day/Night Chemical Dependency Services
Member Months (Any) Member Months (Inpatient)Total Total
Member Months (Day/Night) Member Months (Ambulatory)
Ambulatory Chemical Dependency Services
35-64
65+
F
18-24
Total
Total
0-12Percent Percent Percent Percent
Unknown
Total
Total
Total
Total
Total
Total
TotalM
HEDIS 2007 (Reporting Year 2006) Page 67
Use of ServicesIdentification of Alcohol and Other Drug Services
Sanford Health PlanData Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage
Age Male Female Male Female Male Female Male Female0-12 NR NR NR NR13-17 NR NR NR NR18-24 NR NR NR NR25-34 NR NR NR NR35-64 NR NR NR NR65+ NR NR NR NRUnknown NR NR NR NR
NR NR NR NR NR NR NR NR NR NR NR NR
Age Sex Number Number Number NumberM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR
0-12
Total
Total
Ambulatory Chemical Dependency Services
TotalTotalMember Months (Any) Member Months (Inpatient) Member Months (Day/Night) Member Months (Ambulatory)
Total
Percent
Total
Percent
Day/Night Chemical Dependency ServicesAny Chemical Dependency Services Inpatient Chemical Dependency
ServicesPercent Percent
13-17
Total
65+
Total
18-24
Total25-34
Total35-64
Total
Unknown
TotalTotal M
FTotal
HEDIS 2007 (Reporting Year 2006) Page 68
Use of ServicesIdentification of Alcohol and Other Drug Services
Sanford Health PlanData Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
Age Male Female Male Female Male Female Male Female0-12 NR NR NR NR13-17 NR NR NR NR18-24 NR NR NR NR25-34 NR NR NR NR35-64 NR NR NR NR65+ NR NR NR NRUnknown NR NR NR NR
NR NR NR NR NR NR NR NR NR NR NR NR
Age Sex Number Number Number NumberM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR
Total
65+
Total
Inpatient Chemical Dependency Services
Day/Night Chemical Dependency Services
Ambulatory Chemical Dependency Services
Percent Percent Percent Percent
Member Months (Inpatient) Member Months (Day/Night) Member Months (Ambulatory)Total Total Total Total
25-34
Total
Member Months (Any)
Total
Any Chemical Dependency Services
0-12
Total13-17
18-24
Total
35-64
Total
Unknown
TotalTotal M
FTotal
HEDIS 2007 (Reporting Year 2006) Page 69
Use of ServicesIdentification of Alcohol and Other Drug Services
Sanford Health PlanData Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
Age Male Female Male Female Male Female Male Female0-12 NR NR NR NR13-17 NR NR NR NR18-24 NR NR NR NR25-34 NR NR NR NR35-64 NR NR NR NR65+ NR NR NR NRUnknown NR NR NR NR
NR NR NR NR NR NR NR NR NR NR NR NR
Age Sex Number Number Number NumberM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRM NR NR NR NRF NR NR NR NR
NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR
Total MFTotal
65+
TotalUnknown
Total
0-12
Total13-17
Total
Ambulatory Chemical Dependency Services
Percent Percent Percent Percent
Total
Any Chemical Dependency Services Inpatient Chemical Dependency Services
Day/Night Chemical Dependency Services
Total Total Total TotalMember Months (Any) Member Months (Inpatient) Member Months (Day/Night) Member Months (Ambulatory)
18-24
Total25-34
Total35-64
Total
HEDIS 2007 (Reporting Year 2006) Page 70
Use of Services Sanford Health PlanOutpatient Drug Utilization Data Last Refreshed:
Oct 7, 2009 1:21 PM
CommercialAge Member Months0-9 4476910-19 5017920-44 12516645-64 9671565-74 309575-84 11985+ 12Unknown 0
320055Age
Total Cost of Prescriptions
Total Number of Prescriptions
0-9 $678,531.11 $15.16 14476 3.8810-19 $1,064,167.27 $21.21 16356 3.9120-44 $3,817,318.29 $30.50 70860 6.7945-64 $7,067,341.17 $73.07 123011 15.2665-74 $326,369.54 $105.45 6021 23.3475-84 $18,921.29 $159.00 320 32.2785+ $392.45 $32.70 8 8.00Unknown $0.00 0
$12,973,041.12 $40.53 231052 8.66
Avg. Cost of Prescriptions /
Per Member Per Month
Avg. Num. Of Prescriptions /
Per Member Per Year
Total
Total
HEDIS 2007 (Reporting Year 2006) Page 71
Use of Services Sanford Health PlanOutpatient Drug Utilization Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare AdvantageAge Member Months0-910-1920-4445-6465-7475-8485+Unknown
NRAge
Total Cost of Prescriptions
Total Number of Prescriptions
0-9 NR NR10-19 NR NR20-44 NR NR45-64 NR NR65-74 NR NR75-84 NR NR85+ NR NRUnknown
NR NR NR NR
Avg. Cost of Prescriptions /
Per Member Per Month
Avg. Num. Of Prescriptions /
Per Member Per Year
Total
Total
HEDIS 2007 (Reporting Year 2006) Page 72
Use of Services Sanford Health PlanOutpatient Drug Utilization Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHOAge Member Months0-910-1920-4445-6465-7475-8485+Unknown
NRAge
Total Cost of Prescriptions
Total Number of Prescriptions
0-9 NR NR10-19 NR NR20-44 NR NR45-64 NR NR65-74 NR NR75-84 NR NR85+ NR NRUnknown
NR NR NR NR
Total
Avg. Cost of Prescriptions /
Per Member Per Month
Avg. Num. Of Prescriptions /
Per Member Per Year
Total
HEDIS 2007 (Reporting Year 2006) Page 73
Use of Services Sanford Health PlanOutpatient Drug Utilization Data Last Refreshed:
Oct 7, 2009 1:21 PM
MedicaidAge Member Months0-910-1920-4445-6465-7475-8485+Unknown
NRAge
Total Cost of Prescriptions
Total Number of Prescriptions
0-9 NR NR10-19 NR NR20-44 NR NR45-64 NR NR65-74 NR NR75-84 NR NR85+ NR NRUnknown
NR NR NR NR
Total
Avg. Cost of Prescriptions /
Per Member Per Month
Avg. Num. Of Prescriptions /
Per Member Per Year
Total
HEDIS 2007 (Reporting Year 2006) Page 74
Access/Availability of Care Sanford Health PlanAdult's Access to Preventive/Ambulatory Health Services Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Data Elements General Measure Data Ages 20-44 Ages 45-64 Ages 65+
Measurement Year 2006
Data collection methodology (Administrativonly) A
Eligible member population (i.e. members who meet all denominator criteria) 3447 4251 196
Numerator events by administrative data 3253 4032 19294.37% 94.85% 97.96%93.59% 94.17% 95.72%95.16% 95.52% 100.00%
Reported rateLower 95% confidence intervalUpper 95% confidence interval
HEDIS 2007 (Reporting Year 2006) Page 75
Access/Availability of Care Sanford Health PlanAdult's Access to Preventive/Ambulatory Health Services Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage
Data Elements General Measure Data Ages 20-44 Ages 45-64 Ages 65+
Measurement Year
Data collection methodology (Administrativonly)Eligible member population (i.e. members who meet all denominator criteria)Numerator events by administrative data
NR NR NRNR NR NRNR NR NR
Lower 95% confidence intervalUpper 95% confidence interval
Reported rate
HEDIS 2007 (Reporting Year 2006) Page 76
Access/Availability of Care Sanford Health PlanAdult's Access to Preventive/Ambulatory Health Services Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
Data Elements General Measure Data Ages 20-44 Ages 45-64 Ages 65+
Measurement Year
Data collection methodology (Administrativonly)Eligible member population (i.e. members who meet all denominator criteria)Numerator events by administrative data
NR NR NRNR NR NRNR NR NR
Reported rateLower 95% confidence intervalUpper 95% confidence interval
HEDIS 2007 (Reporting Year 2006) Page 77
Access/Availability of Care Sanford Health PlanAdult's Access to Preventive/Ambulatory Health Services Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
Data Elements General Measure Data Ages 20-44 Ages 45-64 Ages 65+
Measurement Year
Data collection methodology (Administrativonly)Eligible member population (i.e. members who meet all denominator criteria)Numerator events by administrative data
NR NR NRNR NR NRNR NR NRUpper 95% confidence interval
Reported rateLower 95% confidence interval
HEDIS 2007 (Reporting Year 2006) Page 78
Access/Availability of Care Sanford Health PlanChildren's and Adolescents' Access to Primary Care Practitioners Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Data Elements General Measure Data 12-24 months
25 months - 6 yrs. 7-11 yrs. 12-19 yrs.
Measurement Year 2006
Data collection methodology (Administrativonly) A
Eligible member population (i.e. members who meet all denominator criteria) 306 1444 1093 2004
Numerator events by administrative data 303 1275 944 176299.02% 88.30% 86.37% 87.92%97.75% 86.60% 84.29% 86.47%
100.00% 89.99% 88.45% 89.38%
Reported rateLower 95% confidence intervalUpper 95% confidence interval
HEDIS 2007 (Reporting Year 2006) Page 79
Access/Availability of Care Sanford Health PlanChildren's and Adolescents' Access to Primary Care Practitioners Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
Data Elements General Measure Data 12-24 months
25 months - 6 yrs. 7-11 yrs. 12-19 yrs.
Measurement Year
Data collection methodology (Administrativonly)Eligible member population (i.e. members who meet all denominator criteria)Numerator events by administrative data
NR NR NR NRNR NR NR NRNR NR NR NRUpper 95% confidence interval
Reported rateLower 95% confidence interval
HEDIS 2007 (Reporting Year 2006) Page 80
Access/Availability of Care Sanford Health PlanPrenatal and Postpartum Care Data Last Refreshed:
Oct 7, 2009 1:21 PM
CommercialGeneral
Measure DataTimeliness of Prenatal Care
Postpartum Care
Data collection methodology (Administrative or Hybrid) HEligible member population (i.e. members who meet all denominator criteria) 380
Number of numerator events by administrative data in eligible population (before exclusions) 39 190
10.26% 50.00%
Minimum required sample size (MRSS) or other sample size 260
Oversampling rate 5%Final sample size (FSS) 260
Number of numerator events by administrative data in FSS 39 190
15.00% 73.08%Number of original sample records excluded because of valid data errors 1
Number of administrative data records excluded 0
Number of medical records data records excluded 1
Number of employee/dependent medical records excluded 0
Records added from the oversample list 2Denominator 260Numerator events by administrative data 39 190Numerator events by medical record 206 26
94.23% 83.08%91.20% 78.33%97.26% 87.83%Upper 95% confidence interval
Reported rateLower 95% confidence interval
Current year's administrative rate (before exclusions)
Administrative rate on FSS
HEDIS 2007 (Reporting Year 2006) Page 81
Access/Availability of Care Sanford Health PlanPrenatal and Postpartum Care Data Last Refreshed:
Oct 7, 2009 1:21 PM
MedicaidGeneral
Measure DataTimeliness of Prenatal Care
Postpartum Care
Data collection methodology (Administrative or Hybrid)Eligible member population (i.e. members who meet all denominator criteria)Number of numerator events by administrative data in eligible population (before exclusions)
NR NR
Minimum required sample size (MRSS) or other sample size
Oversampling rateFinal sample size (FSS)
Number of numerator events by administrative data in FSS
NR NRNumber of original sample records excluded because of valid data errors
Number of administrative data records excluded
Number of medical records data records excluded
Number of employee/dependent medical records excluded
Records added from the oversample listDenominatorNumerator events by administrative dataNumerator events by medical record
NR NRNR NRNR NRUpper 95% confidence interval
Current year's administrative rate (before exclusions)
Administrative rate on FSS
Reported rateLower 95% confidence interval
HEDIS 2007 (Reporting Year 2006) Page 82
Access/Availability of Care Sanford Health PlanInitiation/Engagement of Alcohol & Other Drug Dependence Treatment Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Data Elements General Measure
Data
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Measurement Year 2006
Data collection methodology (Administrative only) A
22 1
NA NA NA NA NA NA 31.43% 2.86% NA NA 36.07% 1.64%NA NA NA NA NA NA 14.62% 0.00% NA NA 23.20% 0.00%NA NA NA NA NA NA 48.24% 9.81% NA NA 48.94% 5.65%
0Reported rateLower 95% confidence intervalUpper 95% confidence interval
18-25 Year Olds 26-34 Year Olds 35-64 Year Olds 65+ Year Olds Overall Rate
Eligible member population (i.e. members who meet all denominator criteria) 6 12 35 0 61
13-17 Year Olds
0Numerator events by administrative data 3 0 3 0 11 1
8
5 0
HEDIS 2007 (Reporting Year 2006) Page 83
Access/Availability of Care Sanford Health PlanInitiation/Engagement of Alcohol & Other Drug Dependence Treatment Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage
Data Elements General Measure
Data
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Measurement YearData collection methodology (Administrative only)
NR NR
NR NR NR NR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NR NR NR NR
Reported rateLower 95% confidence intervalUpper 95% confidence interval
Eligible member population (i.e. members who meet all denominator criteria)Numerator events by administrative data
65+ Year Olds Overall Rate
NR
18-25 Year Olds 26-34 Year Olds 35-64 Year Olds13-17 Year Olds
HEDIS 2007 (Reporting Year 2006) Page 84
Access/Availability of Care Sanford Health PlanInitiation/Engagement of Alcohol & Other Drug Dependence Treatment Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
Data Elements General Measure
Data
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Measurement YearData collection methodology (Administrative only)
NR NR
NR NR NR NR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NR NR NR NR
Lower 95% confidence intervalUpper 95% confidence interval
Reported rateNumerator events by administrative data
NREligible member population (i.e. members who meet all denominator criteria)
Overall Rate18-25 Year Olds 26-34 Year Olds 35-64 Year Olds 65+ Year Olds13-17 Year Olds
HEDIS 2007 (Reporting Year 2006) Page 85
Access/Availability of Care Sanford Health PlanInitiation/Engagement of Alcohol & Other Drug Dependence Treatment Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
Data Elements General Measure
Data
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Initiation of AOD
Treatment
Engagement of AOD
Treatment
Measurement YearData collection methodology (Administrative only)
NR NR
NR NR NR NR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NR NR NR NRNR NR NR NR NR NR NR NR NR NR NR NR
Lower 95% confidence intervalUpper 95% confidence interval
Reported rate
NR
Numerator events by administrative data
Eligible member population (i.e. members who meet all denominator criteria)
65+ Year Olds Overall Rate13-17 Year Olds 18-25 Year Olds 26-34 Year Olds 35-64 Year Olds
HEDIS 2007 (Reporting Year 2006) Page 86
Health Plan Stability Sanford Health PlanYears in Business / Total Membership Data Last Refreshed:
Oct 7, 2009 1:21 PM
CommercialProduct/Product Line Years in Business Members*
Medicaid 0.00 0Commercial 8.00 27086Medicare (cost or risk) 0.00 0Self-insured 8.00 14309Other 8.00 2436
8.00 43831
Commercial 0.00 0Medicare (cost or risk) 0.00 0Self-insured 0.00 0Other 0.00 0
0.00 0
Commercial 0.00 0Medicare (cost or risk) 0.00 0Self-insured 0.00 0Other 0.00 0
0.00 043831
* Total number of members in each category as of December 31, 2006
Total HMO:
Total PPO:
Total POS: Total:
HMO
PPO
POS
HEDIS 2007 (Reporting Year 2006) Page 87
Health Plan Stability Sanford Health PlanYears in Business / Total Membership Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare AdvantageProduct/Product Line Years in Business Members*
MedicaidCommercialMedicare (cost or risk)Self-insuredOther
NR NR
CommercialMedicare (cost or risk)Self-insuredOther
NR NR
CommercialMedicare (cost or risk)Self-insuredOther
NR NRNR
* Total number of members in each category as of December 31, 2006
Total HMO:
Total POS: Total:
Total PPO:
HMO
PPO
POS
HEDIS 2007 (Reporting Year 2006) Page 88
Health Plan Stability Sanford Health PlanYears in Business / Total Membership Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHOProduct/Product Line Years in Business Members*
MedicaidCommercialMedicare (cost or risk)Self-insuredOther
NR NR
CommercialMedicare (cost or risk)Self-insuredOther
NR NR
CommercialMedicare (cost or risk)Self-insuredOther
NR NRNR
* Total number of members in each category as of December 31, 2006
Total HMO:
Total PPO:
Total POS: Total:
POS
HMO
PPO
HEDIS 2007 (Reporting Year 2006) Page 89
Health Plan Stability Sanford Health PlanYears in Business / Total Membership Data Last Refreshed:
Oct 7, 2009 1:21 PM
MedicaidProduct/Product Line Years in Business Members*
MedicaidCommercialMedicare (cost or risk)Self-insuredOther
NR NR
CommercialMedicare (cost or risk)Self-insuredOther
NR NR
CommercialMedicare (cost or risk)Self-insuredOther
NR NRNR
* Total number of members in each category as of December 31, 2006
Total HMO:
Total PPO:
Total POS:
HMO
PPO
POS
Total:
HEDIS 2007 (Reporting Year 2006) Page 90
Health Plan Descriptive Information Sanford Health PlanEnrollment by Product Line (Age & Sex) Data Last Refreshed:
Oct 7, 2009 1:21 PM
Commercial
Male Female<1 2100 2208 43081-4 9684 8340 180245-9 11484 10968 2245210-14 12744 11988 2473215-17 7932 7740 1567218-19 4908 4884 9792
48852 46128 9498030.63% 28.73% 29.67%
20-24 10800 10848 2164825-29 11964 12288 2425230-34 11760 12204 2396435-39 12912 13452 2636440-44 14268 14688 28956
61704 63480 12518438.68% 39.53% 39.11%
45-49 15528 15852 3138050-54 14196 14256 2845255-59 10644 12036 2268060-64 6756 7440 14196
47124 49584 9670829.54% 30.88% 30.21%
65-69 1428 1068 249670-74 336 264 60075-79 36 60 9680-84 24 0 2485-89 12 0 12>=90 0 0 0
1836 1392 32281.15% 0.87% 1.01%
Age Unknown 0 0 0159516 160584 320100
Member Months
20-44 Subtotal20-44 Subtotal: %
Total
Total
0-19 Subtotal0-19 Subtotal: %
45-64 Subtotal45-64 Subtotal: %
>=65 Subtotal>=65 Subtotal: %
HEDIS 2007 (Reporting Year 2006) Page 91
Health Plan Descriptive Information Sanford Health PlanEnrollment by Product Line (Age & Sex) Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicare Advantage
Male Female<1 NR1-4 NR5-9 NR10-14 NR15-17 NR18-19 NR
NR NR NRNR NR NR
20-24 NR25-29 NR30-34 NR35-39 NR40-44 NR
NR NR NRNR NR NR
45-49 NR50-54 NR55-59 NR60-64 NR
NR NR NRNR NR NR
65-69 NR70-74 NR75-79 NR80-84 NR85-89 NR>=90 NR
NR NR NRNR NR NR
Age Unknown NRNR NR NR
Member MonthsTotal
0-19 Subtotal0-19 Subtotal: %
20-44 Subtotal20-44 Subtotal: %
45-64 Subtotal45-64 Subtotal: %
>=65 Subtotal>=65 Subtotal: %
Total
HEDIS 2007 (Reporting Year 2006) Page 92
Health Plan Descriptive Information Sanford Health PlanEnrollment by Product Line (Age & Sex) Data Last Refreshed:
Oct 7, 2009 1:21 PM
MSHO
Male Female<1 NR1-4 NR5-9 NR10-14 NR15-17 NR18-19 NR
NR NR NRNR NR NR
20-24 NR25-29 NR30-34 NR35-39 NR40-44 NR
NR NR NRNR NR NR
45-49 NR50-54 NR55-59 NR60-64 NR
NR NR NRNR NR NR
65-69 NR70-74 NR75-79 NR80-84 NR85-89 NR>=90 NR
NR NR NRNR NR NR
Age Unknown NRNR NR NR
>=65 Subtotal>=65 Subtotal: %
Total
20-44 Subtotal20-44 Subtotal: %
45-64 Subtotal45-64 Subtotal: %
Member MonthsTotal
0-19 Subtotal0-19 Subtotal: %
HEDIS 2007 (Reporting Year 2006) Page 93
Health Plan Descriptive Information Sanford Health PlanEnrollment by Product Line (Age & Sex) Data Last Refreshed:
Oct 7, 2009 1:21 PM
Medicaid
Male Female<1 NR1-4 NR5-9 NR10-14 NR15-17 NR18-19 NR
NR NR NRNR NR NR
20-24 NR25-29 NR30-34 NR35-39 NR40-44 NR
NR NR NRNR NR NR
45-49 NR50-54 NR55-59 NR60-64 NR
NR NR NRNR NR NR
65-69 NR70-74 NR75-79 NR80-84 NR85-89 NR>=90 NR
NR NR NRNR NR NR
Age Unknown NRNR NR NR
>=65 Subtotal: %
Total
20-44 Subtotal: %
45-64 Subtotal45-64 Subtotal: %
>=65 Subtotal
Total
0-19 Subtotal0-19 Subtotal: %
20-44 Subtotal
Member Months
HEDIS 2007 (Reporting Year 2006) Page 94