Rating scale
Mean ratios (mean cost for zip code area divided by TX mean) are color-coded and represent variation from Texas mean for each 3-digit zip code. Red (>20% of TX mean) to Dark green (<20% of TX mean).
Total Cost
Total cost represent sum of medical and pharmacy cost incurred during the measurement year. Numbers represent average per member per year cost. The measure is derived from the NQF 1604 sponsored by Health Partners. It includes all costs associated with treating members including professional, facility inpatient and outpatient, pharmacy, lab, radiology, ancillary and behavioral health services
Medical cost
This is a subcomponent of Total Cost: Medical cost represent cost for all health care-related services incurred during the measurement year. Numbers represent average per member per year cost.
Pharmacy cost
This is a subcomponent of Total Cost: Pharmacy cost represent cost for all prescription medications incurred during the measurement year. Numbers represent average per member per year cost.
Rating scale
Mean ratios (utilization in zip code area divided by TX mean) are color-coded and represent variation from Texas mean for each 3-digit zip code. Red (>20% of TX mean) to Dark green (<20% of TX mean).
Emergency Room (ER) visits
ER visits represents total number of unique ER claims (by unique patient and date of service) during the measurement year displayed per 1000 member year, per member year, or by percentage.
Acute Inpatient visits
Acute inpatient visits (Bill type: 1-1-1 or 1-1-4) represent total number of unique acute inpatient claims (by unique patients and unique admission date) during the measurement year displayed per 1000 member year, per member year, or by percentage.
Observation stays
Observation stays (Revenue codes: 760-762; 769) represent total number of unique claims for observation stay (by unique patients and service date) during the measurement year displayed per 1000 member year, per member year, or by percentage.
Outpatient visits
Outpatient visits represents total number of unique outpatient facility claims (Facility code: 1 or classification code: 3 or bill type: 13X) during the measurement year displayed per 1000 member year, per member year, or by percentage.
Professional visits
Professional visits represents total number of unique professional visit claims (POS codes: 1-99) during the measurement year displayed per 1000 member year, per member year, or by percentage
Readmissions
Readmissions represent 30-day preventable readmissions after discharge from an inpatient stay identified using the 3M® proprietary software during the measurement year displayed as percentage.
Rating scale
Mean ratios (prevalence in zip code area divided by TX mean) are color-coded and represent variation from Texas mean for each 3-digit zip code. Red (>20% of TX mean) to Dark green (<20% of TX mean).
Asthma
Percentage of members with persistent asthma in the measurement year or any prior year. Persistent asthma was defined using NQF 1799 criteria.
Cancer
Percentage of members with cancer in the measurement year. Persistent asthma was defined using HEDIS Cancer Value Code Sets.
Congestive Heart Failure
Percentage of members with congestive heart failure in the measurement year or any prior year. Congestive Heart Failure was defined using HEDIS Congestive Heart Failure Value Code Sets.
Chronic Kidney Disease and End-stage Renal Disease
Percentage of members with chronic kidney disease in the measurement year or any prior year. Chronic Kidney Disease was defined using HEDIS Chronic Kidney Disease Value Code Sets.
Chronic Liver Disease
Percentage of members with chronic liver disease (including Cirrhosis and Chronic Hepatitis) in the measurement year or any prior year. Chronic liver disease was defined using HEDIS Chronic liver disease Value Code Sets.
Chronic Pain
Percentage of members with chronic pain in the measurement year. Chronic liver disease was defined using HEDIS Chronic liver disease Value Code Sets.
Chronic Obstructive Pulmonary Disease (COPD)
Percentage of members with chronic obstructive pulmonary disease in the measurement year or any prior year. Chronic obstructive pulmonary disease was defined using HEDIS criteria.
Dementia and Alzheimer’s disease
Percentage of members with Dementia or Alzheimer’s disease in the measurement year or any prior year. Dementia or Alzheimer’s disease were defined using HEDIS criteria.
Diabetes
Percentage of members with Diabetes in the measurement year or any prior year. Diabetes was defined using HEDIS criteria.
Hypertension
Percentage of members with Diabetes in the measurement year or any prior year. Diabetes was defined using Healthcare Cost Institute criteria.
Multiple Sclerosis
Percentage of members with multiple sclerosis in the measurement year or any prior year. Multiple sclerosis was defined using HEDIS criteria.
Rheumatoid Arthritis
Percentage of members with rheumatoid arthritis in the measurement year or any prior year. Multiple sclerosis was defined using HEDIS criteria.
With 2 comorbidities
Percentage of members with up to two comorbid conditions in the measurement year or any prior year.
With 2+ comorbidities
Percentage of members with more than two comorbid conditions in the measurement year or any prior year.
Rating scale
Mean ratios (quality of care in the zip code area divided by TX mean) are color-coded and represent variation from Texas mean for each 3-digit zip code. Red (<20% of TX mean) to Dark green (>20% of TX mean).
Asthma Control
The percentage of members 5–64 years of age during the measurement year who were identified as having persistent asthma, and were dispensed appropriate medications and remained on medications at least 75% of their treatment period.
Diabetes eye exam
The percentage of members 18-75 years of age with diabetes (type 1 and type 2) who had an eye exam (retinal) performed during the measurement year.
Diabetes HbA1c testing
The percentage of members 18-75 years of age with diabetes (type 1 and type 2) who had HbA1c testing performed during the measurement year.
Diabetes Nephropathy monitoring
The percentage of members 18–75 years of age with diabetes type 1 and type 2 who had underwent nephropathy screening test or received medical attention for nephropathy during the measurement year.
COPD Spirometry
The percentage of members 40 years of age and older with a new diagnosis of COPD or newly active COPD, who received appropriate spirometry testing to confirm the diagnosis during the measurement year.
Rating scale
Mean ratios (risk score for zip code area divided by TX risk score) are color-coded and represent variation from Texas mean for each 3-digit zip code. Red (>20% of TX mean) to Dark green (<20% of TX mean).
Population risk were estimated using 3M® software. The software estimates clinical risk for each individual patient using a combination of clinical diagnosis, procedural, and prescription drug codes identified from medical and pharmacy claims and history of resource utilization using a copyrighted formula. Population is segmented by level of health status (first digit 1-9) and disease severity (second digit 0-6) where a higher number represents poorer health status and increased disease severity, respectively.