Michigan Quality Improvement Consortium

Measurement Committee Year-End Report

December 6, 2005

Accomplishments Year to Date• HEDIS 2005 data are the most complete they have ever been

• 6 Commercial Plans reporting

• 5 Medicaid Plans reporting

• Participation with Save Lives Save Dollars

• Creation and agreement re “lipid lowering agents” definition

Considerations for Data Analysis

• Results were calculated using the disease population within each reporting Plan (sum of all numerators for all Plans divided by the sum of the denominators for all Plans).

• If a Plan rotated a HEDIS measure, the previous year’s denominator was used and the numerator was imputed based on the mean of the previous year’s rate and the following year’s rate.

• At least two (2) Plans had to provide data in order for an indicator to be included.

Considerations for Data Analysis

• Comparison to “Best Practice” within MQIC• Where should we be?

HEDIS 2005 Results MQIC Best PracticeAppropriate Asthma Medications 5 - 9 Years Old 78.28% 92.5%Appropriate Asthma Medications 10 - 17 Years Old 69.80% 84.3%Appropriate Asthma Medications 18 - 56 Years Old 74.29% 80.9%Appropriate Asthma Medications Combined Ages 73.96% 83.3%

Measures

HEDIS Asthma IndicatorsCommercial Members

HEDIS 2000 - HEDIS 2005

65.5

1%

64.5

3%

68.6

9%

67.6

0%

64.4

9%

65.3

5%

67.0

9%

66.4

5%

69.4

9%

64.4

4%

69.8

4%

68.7

5%

63.4

5%

58.0

6% 65.5

5%

63.6

9%73.5

7%

66.8

0%

72.1

9%

71.3

1%

78.2

8%

69.8

0%

74.2

9%

73.9

6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

asthm med 5-9 yo asthma med 10-17 yo asthma med 18-56 yo asthma med all

Measures

%

2000

2001

2002

2003

2004

2005

75.33%73.58%

Appropriate Asthma Medications 18 - 56 Years OldAppropriate Asthma Medications Combined Ages

72.29%68.22%

HEDIS 2005 Results MQIC Best Practice65.44%63.59%

77.55%75.00%

MeasuresAppropriate Asthma Medications 5 - 9 Years OldAppropriate Asthma Medications 10 - 17 Years Old

HEDIS Asthma IndicatorsMedicaid Members

HEDIS 2000 - HEDIS 200565

.22%

56.0

4%

62.8

9%

61.9

7%

60.7

6%

63.6

1%

63.4

3%

62.9

0%

61.4

8%

64.4

2%

70.3

9%

66.9

0%

51.1

1%

58.9

8% 68.2

3%

62.0

9%

64.3

9%

63.8

2%

70.0

3%

67.0

7%65.4

4%

63.5

9%

72.2

9%

68.2

2%

0%10%20%30%40%50%60%70%80%90%

100%

asthm med 5-9 yo asthma med 10-17 yo asthma med 18-56 yo asthma med all

Measures

%

200020012002200320042005

HEDIS Asthma IndicatorsBCBS Members

HEDIS 2000 - HEDIS 2005

67.9

4%

62.3

6%

67.5

5%

66.6

2%

69.6

3%

64.5

1%

68.3

7%

67.7

4%

72.1

6%

66.4

0%

72.5

0%

71.4

2%

75.0

7%

69.5

0%

73.3

0%

72.8

1%

76.2

9%

70.2

6%

72.9

1%

72.7

7%

79.6

2%

72.5

5%

75.3

6%

75.3

1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

asthm med 5-9 yo asthma med 10-17 yo asthma med 18-56 yo asthma med all

Measures

%

2000

2001

2002

2003

2004

2005

Emergency Room Visits for Asthma/1000 Members with AsthmaPeriodic Assessment for Asthma

Non-HEDIS 2005 Results MQIC Best PracticeMeasures

151.55

86.59%

19.39

93.28%

Non-HEDIS Asthma IndicatorsCommercial Members

2001 - 2005

62.6

0

131.

78

88.1

0

76.0

9

73.6

1

115.

02

85.9

9

81.8

6

86.5

9

151.

550

20406080

100120140160180200220240

Asthma ER/1000 Asthma Px Exams

Measures

Rat

e

2001

2002

2003

2004

2005

Periodic Assessment for Asthma 88.39% 88.84%

Measures Non-HEDIS 2005 Results MQIC Best PracticeEmergency Room Visits for Asthma/1000 153.92 141.99

Non-HEDIS Asthma IndicatorsMedicaid Members

HEDIS 2005

88.39

153.92

0

50

100

150

200

250

Asthma ER/1000 Asthma Px Exams

Measures

Rat

e

2005

HEDIS Asthma IndicatorsBCBS Members

HEDIS 2000 - HEDIS 2005

67.9

4%

62.3

6%

67.5

5%

66.6

2%

69.6

3%

64.5

1%

68.3

7%

67.7

4%

72.1

6%

66.4

0%

72.5

0%

71.4

2%

75.0

7%

69.5

0%

73.3

0%

72.8

1%

76.2

9%

70.2

6%

72.9

1%

72.7

7%

79.6

2%

72.5

5%

75.3

6%

75.3

1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

asthm med 5-9 yo asthma med 10-17 yo asthma med 18-56 yo asthma med all

Measures

%

2000

2001

2002

2003

2004

2005

HEDIS 2005 Results MQIC Best PracticeAntidepressant Medications, Optimal Contacts 25.14% 32.26%Antidepressant Medications, Effective Acute 59.08% 72.55% Treatment PhaseAntidepressant Medication, Effective Continu- 40.48% 53.30% ation Treatment Phase

Measure

HEDIS Depression IndicatorsCommercial Members

HEDIS 2002 - HEDIS 2005

18.9

1%

54.9

2%

38.0

1%

25.0

0%

60.6

7%

41.5

8%

25.7

6%

56.1

0%

38.4

3%

25.1

4%

59.0

8%

40.4

8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Anti-Dep Med Opt Contact Anti-Dep Med Acute Tx Anti-Dep Med Cont Tx

Measures

Perc

ent 2002

2003

2004

2005

HEDIS 2005 Results MQIC Best PracticeRetinal Exams 54.90% 61.80%HbA1c Testing 88.02% 91.73%HbA1c Poor Control 27.14% 19.95%LDL-C Screening 93.32% 95.13%LDL-C Control < 130 mg/dL 71.24% 81.51%LDL-C Control < 100 mg/dL 43.08% 54.26%Nephropathy Monitoring 54.62% 67.15%

Measures

HEDIS Diabetes IndicatorsCommercial Members

HEDIS 2000 - HEDIS 2005

53.4

6%

80.3

3%

31.1

9%

65.8

2%

39.2

5%

42.6

5%52.3

3%

84.8

9%

39.0

2%

76.7

8%

48.2

4%

43.7

3%

56.4

5%

84.1

2%

28.8

2%

82.9

2%

56.9

4%

57.9

9%

52.5

4%

85.8

0%

31.6

4%

87.3

8%

57.5

8%

62.3

7%

50.8

6%

84.4

5%

29.9

7%

89.2

7%

65.4

1%

37.8

5%

51.7

7%

54.9

0%

88.0

2%

27.1

4%

93.3

2%

71.2

4%

43.0

8%

54.6

2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Retinal Exams HbA1c Testing HbA1c PoorControl

LDL-CScreening

LDL-C Control< 130

LDL-C Control< 100

NephropathyMonitoring

Measures

%

2000

2001

2002

2003

2004

2005

HEDIS 2005 Results MQIC Best PracticeRetinal Exams 49.90% 63.28%HbA1c Testing 81.43% 88.78%HbA1c Poor Control 42.70% 33.60%LDL-C Screening 83.54% 91.60%LDL-C Control < 130 mg/dL 61.88% 70.45%LDL-C Control < 100 mg/dL 44.90% 60.15%Nephropathy Monitoring 49.88% 64.78%

Measures

HEDIS Diabetes IndicatorsMedicaid Members

HEDIS 2000 - HEDIS 2005

43.1

1%

69.3

3%

37.4

1%

54.6

0%

27.0

7%

45.2

6%53.5

1%

73.5

9%

46.4

8%

63.5

3%

35.7

9%

47.6

2%

75.5

6%

43.1

6%

68.4

9%

41.3

4%

53.3

5%

41.3

1%

74.7

3%

57.4

7%

72.7

7%

41.1

8%

54.2

8%

43.6

1%

73.4

8%

52.2

4%

72.9

9%

50.7

9%

34.1

1% 41.0

2%

50.8

0% 49.9

0%

81.4

3%

42.7

0%

83.5

4%

61.8

8%

44.9

0%

49.8

8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

RetinalExams

HbA1cTesting

HbA1c PoorControl

LDL-CScreening

LDL-CControl <

130

LDL-CControl <

100

NephropathyMonitoring

Measures

%20002001

2002

20032004

2005

Based on administrative data only

HEDIS Diabetes IndicatorsBCBS Members

HEDIS 2000 - HEDIS 2005

44.4

2%

68.2

9%

71.7

0%

22.3

0%

43.5

4%

68.2

8%

75.5

4%

23.0

3%

44.8

0%

69.2

8% 79.6

9%

26.5

8%39.9

8%

77.8

3%

82.5

6%

32.2

9%

74.7

9%

83.5

6%

30.0

4%

78.3

0%

85.1

1%

40.3

6%

0%10%20%30%40%50%60%70%80%90%

100%

Retinal Exams HbA1c Testing LDL-C Screening Nephropathy Monitoring

Measures

%

2000

2001

2002

2003

2004

2005

Blood Pressure Controlled (< 140/90) 64.78% 74.00%

Measures Non-HEDIS 2005 Results MQIC Best PracticePrescription Filled for Lipid Lowering Drugs (50 yo+) 50.18% 60.83%

Non-HEDIS Diabetes IndicatorsCommercial Members

HEDIS 2005

51.1

2% 50.1

8% 64.7

8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Lipid Lowering Rx BP Control

Measures

%

2004

2005

Measures HEDIS 2005 Results MQIC Best PracticePrescription Filled for Lipid Lowering DrugsBP Control

59.22%70.53%

62.50%86.70%

Non-HEDIS Diabetic IndicatorsMedicaid Members

HEDIS 2005

59.22%

70.53%

0%

10%20%

30%40%

50%

60%70%

80%90%

100%

Lipid Lowering Rx BP Control

Measures

% 2005

Tobacco Control Considerations

• HEDIS reports a rolling average of two (2) years’ data (HEDIS 2004 and HEDIS 2005 comprise rolling average).

• This analysis shows separate levels for each year.

HEDIS 2005 Results MQIC Best Practice80.30%48.80%44.30%

MeasuresAdvising Smokers to QuitDiscussion of Smoking Cessation MedicationsDiscussion of Smoking Cessation Strategies

74.52%42.84%41.24%

HEDIS Tobacco Control IndicatorsCommercial Members

HEDIS 2003 - HEDIS 2005

74.9

0%

47.8

6%

41.9

6%

74.7

3%

46.3

3%

40.5

7%

74.5

2%

42.8

4%

41.2

4%

0%

10%20%

30%40%

50%

60%70%

80%90%

100%

Adv Smokers to Quit Disc Smok Cess Meds Disc Smok Cess Strat

Measures

2003

2004

2005

Discussion of Smoking Cessation Strategies 42.02% 48.20%

Advising Smokers to Quit 71.58% 74.34%Discussion of Smoking Cessation Medications 38.15% 45.00%

Measures HEDIS 2005 Results MQIC Best Practice

HEDIS Tobacco Control IndicatorsMedicaid Members

HEDIS 2004 - HEDIS 2005

67.6

4%

38.2

0%

32.7

0%

71.5

8%

38.1

5%

42.0

2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Adv Smokers to Quit Disc Smok Cess Meds Disc Smok Cess Strat

Measures

%

2004

2005

HEDIS Tobacco Control IndicatorsBCBS Members

HEDIS 2005

68.99%

43.12%38.94%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Adv Smokers to Quit Disc Smok Cess Meds Disc Smok Cess Strat

Measures

% 2005

Annual Quit Rate 9.85% 15.56%

Measures Non-HEDIS 2005 Results MQIC Best PracticeSmoking Prevalence 19.10% 14.14%

Non-HEDIS Tobacco Control IndicatorsCommercial Members

HEDIS 2003 - HEDIS 2005

19.67%

10.09%

21.27%

10.56%

19.10%

9.85%

0%

5%

10%

15%

20%

25%

30%

35%

Smoking Prevalence Quit Rate

Measures

%

200320042005

Smoking Prevalence 37.71% 32.43%Annual Quit Rate 4.37% 5.88%

Measures Non-HEDIS 2005 Results MQIC Best Practice

Non-HEDIS Tobacco Control IndicatorsMedicaid Members

HEDIS 2004 - HEDIS 2005

42.28%

3.51% 4.37%

37.71%

0%

10%

20%

30%

40%

50%

60%

Smoking Prevalence Quit Rate

Measures

%

2004

2005

ProductCommercial 67.19%

HEDIS 2005 Results MQIC Best PracticePercent 2 - 18 Years Old Tested for Strept and Were Prescribed an Antibiotic

Medicaid 35.60% 74.80%74.08%

HEDIS AC Pharyngitis IndicatorsHEDIS 2004 - HEDIS 2005

69.81%

26.60%

67.19% 35.60%

0%10%20%30%40%50%60%70%80%90%

100%

Commercial Medicaid

Product

Perc

ent 2004

2005

HEDIS AC Pharyngitis IndicatorsBCBS Members

HEDIS 2004 - HEDIS 2005

54.58% 54.99%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2-18 Years Old Tested

2004

2005

Medicaid 56.60% 75.96%

Product HEDIS 2005 Results MQIC Best PracticeCommercial 70.41% 73.70%

HEDIS Hypertension Indicators - CBPHEDIS 2004 - HEDIS 2005

65.86%57.87%

56.60%70.41%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Comm Medicaid

Product

Perc

ent

2004

2005

Hyperlipidemia HEDIS IndicatorsCommercial Members

HEDIS 2004 - HEDIS 2005

89.2

7%

65.4

1%

37.8

5%

78.0

1%

63.2

9%

47.3

5%

54.6

8%70.7

0%80.9

8%

43.0

8%

71.2

4%

93.3

2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

CDC LDL test CDC LDL < 130 mg/dL

CDC LDL < 100 mg/dL

CHM test CHM < 130 mg/dL

CHM < 100 mg/dL

Measures

%

2004

2005

69.83%

81.51%54.26%85.83%77.59%

CHM < 100 mg/dL

93.32%71.24%43.08%80.98%70.70%54.68%

CDC LDL < 130 mg/dLCDC LDL < 100 mg/dLCHM testCHM < 130 mg/dL

Measures HEDIS 2005 Results MQIC Best PracticeCDC LDL test 95.13%

CHM < 100 mg/dL 34.83% 45.40%

CHM test 61.24% 70.83%CHM < 130 mg/dL 44.38% 51.06%

CDC LDL < 130 mg/dL 61.88% 70.45%CDC LDL < 100 mg/dL 44.90% 60.15%

Measures HEDIS 2005 Results MQIC Best PracticeCDC LDL test 83.54% 91.64%

Hyperlipidemia HEDIS IndicatorsMedicaid Members

HEDIS 2004 - HEDIS 2005

72.9

9%

50.7

9%

34.1

1%

57.7

1%

40.5

7%

26.8

6%

61.2

4%

44.9

0%

83.5

4%

61.8

8%

44.3

8%

34.8

3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

CDC LDL test CDC LDL < 130mg/dL

CDC LDL < 100mg/dL

CHM test CHM < 130 mg/dL

CHM < 100 mg/dL

Measures

Perc

ent

2004

2005

Hyperlipidemia HEDIS IndicatorsBCBS Members

HEDIS 2004 - HEDIS 2005

83.36%74.63%

85.11%75.83%

10%20%

30%40%

50%60%

70%80%

90%100%

CDC LDL-C Testing CHM LDL-C Testing

Measures

%

2004

2005

Engagement of Alcohol & Other Drug Dependence Treatment

52.24%

25.50%

58.83%

35.76%

Measures HEDIS 2005 Results MQIC Best PracticeInitiation of Alcohol & Other Drug Dependence Treatment

Substance Use Disorders HEDIS IndicatorsCommercial Members

HEDIS 2004 - HEDIS 2005

55.07%

25.10%

52.24%

25.50%

0%10%20%30%40%50%60%70%80%90%

100%

Initiation of AAOD Tx Engagement of AAOD Tx

Measures

Perc

ent

2004

2005

Questions?

? ? ? ??