Arizona Health Care Cost Containment System
Quality Management Performance Measures
for Acute-care Contractors
Measurement Period Ending September 30, 2005
Prepared by the Division of Health Care Management
December 2006
Anthony D. Rodgers
Director, AHCCCS

TABLE OF CONTENTS
INTRODUCTION
Overview ....................................................................................................................
Methodology ..............................................................................................................
Data Sources …………...............................................................................................
Data Validation …………..........................................................................................
Deviations from Previous Methodology ....................................................................
Data Limitations ………….........................................................................................
Rotation of Measures …………..................................................................................
Highlights of the Data .................................................................................................
Performance Standards and Improvement ..................................................................

1
1
2
2
2
2
3
3
4

THE MEASURES
Children’s Access to Primary Care Practitioners .......................................................
Adults’ Access to Preventive/Ambulatory Health Services .......................................
Breast Cancer Screening ……………………….........................................................
Cervical Cancer Screening …………………………………………..........................
Chlamydia Screening ……..........................................................................................
Timeliness of Prenatal Care ........................................................................................

6
17
22
26
30
34

CONCLUSION
Overall Results and Improvement Efforts ..................................................................
References …………….........…….............................................................................

38
39

APPENDICES

INTRODUCTION
Overview
This is the annual report on performance measures for preventive
health services provided to members enrolled with acute-care health
plans that contract with the Arizona Health Care Cost Containment
System (AHCCCS). The report includes data from nine publicly and
privately operated health plans (Contractors).
The results reported here should be viewed as indicators of utilization
of services, rather than absolute rates for how successfully AHCCCS
and/or its Contractors provide care. By analyzing trends over time,
AHCCCS and its Contractors have identified areas for improvement
and implemented interventions to increase access to, and use of,
services.
This report
includes
performance
measurement
data from nine
publicly and
privately
operated health
plans
(Contractors).

Methodology
AHCCCS used the Health Plan Employer Data and Information Set
(HEDIS®) as a guide for collecting and reporting results of these
measures. Developed and maintained by the National Committee for
Quality Assurance (NCQA), HEDIS is the most widely used set of
performance measures in the managed care industry.
One of the criteria for selecting members to be included in the analyses
is that they be continuously enrolled for a minimum period of time
with one Contractor. Thus, members included in the results of each
measure represent only a portion of AHCCCS members, rather than
the entire acute-care population.
This report includes results for the contract year ending September 30,
2005. Results are reported in aggregate, by individual Contractor and
by county. Data also are analyzed by race or ethnicity. The report also
indicates whether changes in rates overall or by Contractor are
statistically significant, when compared with rates for the previous
measurement period. Changes from the previous measurement are
described as increases or decreases only when analysis using the
Pearson chi-square test yields a statistically significant value (p<.05);
that is, the probability of obtaining such a difference by chance only is
relatively low.
Where available, national averages for managed care plans reported by
NCQA, as measured under HEDIS, are compared with AHCCCS
overall rates. It should be noted that the HEDIS measures of Breast
Cancer Screening, Cervical Cancer Screening and Timeliness of
Prenatal Care may be calculated using data extracted from medical
records, as well as claims for services. The use of medical records may
reflect more complete data (and thus higher rates) than claims alone.

1

Data Sources
AHCCCS uses an automated managed care data system known as the
Prepaid Medical Management Information System (PMMIS).
Members included in the denominator for each measure are selected
from the Recipient Subsystem of PMMIS. Numerators, and therefore
rates, for each measure are based on encounter data (records of
services provided and related claims paid by Contractors) in PMMIS.
The numerator data reported here are based on encounters for
professional services, such as physician visits and radiology services.

With this
measurement,
AHCCCS has
established new
baseline rates for
most acute-care
Performance
Measures.

Data Validation
AHCCCS conducts annual data validation studies of encounters.
Based on the most recent data validation study by AHCCCS,
approximately 90 percent of all encounters for acute-care professional
services are complete when compared with corresponding medical
records. Approximately 85 percent are fully accurate, compared with
services documented in members’ medical records.
Deviations from Previous Methodology
With the exception of the measure of Timeliness of Prenatal Care,
AHCCCS has changed the process by which data is collected for these
measures, utilizing a data warehouse, rather than collecting data on
services and recipients directly from PMMIS. In addition, AHCCCS is
mirroring the HEDIS 2005 methodology for this measurement, with the
exception of utilizing a contract year as the measurement period; HEDIS
uses a calendar-year measurement period. In previously reported
measurements, AHCCCS collected data directly from PMMIS, using
HEDIS specifications as a guide, but with additional deviations from that
methodology. Thus, with this measurement, AHCCCS has established
new baseline rates for most acute-care Performance Measures.
Timeliness of Prenatal Care has been collected directly from PMMIS
using the same process as in the previous two years, according to HEDIS
specifications.
In order to have valid comparisons with data collected through the new
process, AHCCCS utilized the data warehouse to calculate rates for the
previous year, CYE 2004, which also are reported in this document.
Except for Timeliness of Prenatal Care, the rates reported in this
publication cannot be directly compared with rates in the previous
AHCCCS report on Acute-care measures, published in November 2005.
Data Limitations
The data reported here are subject to at least three limitations. First,
because rates are based on encounter data, they may be negatively
affected if Contractors have not submitted complete and accurate
encounters to AHCCCS.

2

This may be especially true for the measure of prenatal care. Prenatal,
delivery and postpartum services provided through AHCCCS health
plans typically are paid for under a “global” fee. Providers may not
have reported all dates of prenatal visits when billing for obstetrical
services, which may have resulted in underreporting of rates for the
measure of Timeliness of Prenatal Care.
Second, data for both race and ethnicity (i.e., whether or not a person
is of Hispanic or Latino origin) is limited by the way these data are
stored by AHCCCS. Race and ethnicity data are collected according to
current U.S. Census Bureau classifications when members apply for
AHCCCS. However, the PMMIS system was designed long before the
current federal standards for collecting race and ethnicity were issued
in 1997, and does not accommodate both data fields at this time. After
applicants become eligible, data for race and ethnicity are merged into
one field when loaded into PMMIS. AHCCCS has developed a
hierarchy for merging race and ethnicity data (Appendix A), so they
are still useful in evaluating member demographics and possible trends
related to race or ethnicity. But, while people of Hispanic origin may
be of any race, the hierarchy does not allow AHCCCS to identify the
race of members who are classified as Hispanic. Thus, people of
Hispanic origin are reported separately, and are not included in any
race category.
Third, despite the limitations of storing race and ethnicity data, people
whose racial makeup includes more than one race may identify
themselves as “other”. In addition, members who do not identify their
race and/or ethnicity on the AHCCCS application are placed in the
“unknown/unspecified category.” Thus, race or ethnicity of some
members included in this measurement can only be described as
unknown, unspecified or other.
Rotation of Measures
NCQA reports measures on a rotating basis over a two-year period, and
AHCCCS has adopted a similar reporting schedule. Two measures are
reported annually: Children’s Access to Primary Care Practitioners
(PCPs) and Adults’ Access to Preventive/Ambulatory Health Services.
Four of six
measures
improved from
CYE 2004 to
CYE 2005.

Highlights of the Data
Four of six measures improved from CYE 2004 to CYE 2005, one did
not show a significant change, and the other, Timeliness of Prenatal Care,
showed a decline. Results by measure are as follows:
•
Children’s Access to PCPs – Total rates (including all age groups)
for both Medicaid and KidsCare members showed statistically
significant increases.
•
Adults’ Access to Preventive/Ambulatory Health Services – This
measure also showed a statistically significant increase overall.

3

•
•
•

•

Breast Cancer – The overall rate for this measure did not show a
significant change from the previous year.
Cervical Cancer Screening – The overall rate for this measure
showed a statistically significant increase.
Chlamydia Screening – This is the first year AHCCCS has reported
a rate for this measure. Compared with data for the previous year,
however, it showed a statistically significant increase.
Timeliness of Prenatal Care – The overall rate for this measure
declined by 3.3 percentage points.

When analyzed by area, rates for these measures were highest in Pima
County, except for Breast Cancer Screening and Adults’ Access to
Preventive/Ambulatory Care. Rates for those two measures were highest
in the combined rural counties. Results by individual counties are
reported for each measure.
Data also were analyzed for members identified as Hispanic, Native
American or non-Hispanic Black relative to non-Hispanic White
members. Among members identified as Hispanic, rates for most
measures were approximately the same or higher than rates for nonHispanic Whites. For some measures, members identified as Black or
Native American had lower rates than non-Hispanic Whites.
Compared with the most recent national HEDIS means (averages)
reported by NCQA for Medicaid health plans, AHCCCS Medicaid rates
were lower than the national means, except for Adults’ Access to
Preventive and Ambulatory Health Services.
Performance Standards and Improvement
Contractor rates are compared to Minimum Performance Standards for
six measures, as specified in the AHCCCS CYE 2006 contracts with
health plans (Children’s Access to PCPs is counted as two measures,
since Medicaid and KidsCare rates are calculated separately). The
following table shows the number of measures for which each
Contractor met the minimum standard:
Contractor
University Family Care

Number of Measures for
Which Standard was Met
4

Arizona Physicians IPA

3

Mercy Care Plan

3

Health Choice Arizona

2

Pima Health System

2

st

Care 1 Healthplan of Arizona

1

Maricopa Health Plan

1

Phoenix Health Plan

1

4

In addition, the Comprehensive Medical and Dental Program operated
by the Arizona Department of Economic Security met the MPS for the
one measure in which it was included, Children’s Access to PCPs/
Medicaid members.
While rates for Chlamydia Screening are reported in this publication,
AHCCCS did not have a contractual requirement for this measure for
CYE 2006.
With the adoption of a new data collection system and technical
specifications that conform to HEDIS, AHCCCS has revised Contractor
performance standards for these measures (Appendix B). The new
AHCCCS Minimum Performance Standards and Goals were
established in June 2006, based on preliminary results from the data
warehouse. The new standards are included in the CYE 2007 contract,
which became effective October 1, 2006, and do not apply to the results
reported here. It should be noted, however, that some health plans
already are meeting the new minimum standards.
Contracted health plans will have at least nine months to improve or
maintain their rates in order to meet the CYE 2007 Minimum
Performance Standards. Contractors are required to internally monitor
their Performance Measure rates according to AHCCCS standardized
methodology. AHCCCS will monitor Contractor-reported rates for each
measure over the next several months and work with Contractors to
make improvements as necessary.
The data reported here also may be used in developing future
Performance Improvement Projects by AHCCCS or individual
Contractors.
For questions or comments about this report, please contact:
Rochelle Tigner, Quality Improvement Manager
Division of Health Care Management, MD 6700
701 E. Jefferson St.
Phoenix, AZ 85034
rochelle.tigner@azahcccs.gov

5

Children’s and Adolescent’s Access to
Primary Care Practitioners
Access to primary care services by children and adolescents is critical
to preventing the premature onset of disease and disability. Research
suggests that lack of access to primary care practitioners (PCPs) may
result in unnecessary hospitalizations.1,2 In addition, routine primary
and preventive care helps support healthy development and the ability
to learn. 3-5
PCPs can address physical, nutritional, developmental and behavioral
health needs, and make referrals to specialists or to services such as
nutritional support and developmental services. If members are
receiving general health care services through a PCP, they likely have
access to other levels of the health care system.
Description
AHCCCS measured the percentage of children and adolescents who:
•
were at least 12 months but not older than 19 years during the
measurement period (October 1, 2004, through September 30, 2005),
•
were continuously enrolled with one acute-care Contractor during
the measurement period (one break in enrollment was allowed if the
gap did not exceed one month), and
•
had one or more visits with PCPs (pediatricians, general or family
practitioners, internists, physician’s assistants, nurse practitioners or
obstetrician/gynecologists) during the measurement period.
Results for members who were eligible under Medicaid and the State
Children’s Health Insurance Program (SCHIP), known as KidsCare,
were calculated separately.
Performance Goals
AHCCCS has adopted the following Minimum Performance Standards
and Goals for both Medicaid and KidsCare members for the current
measurement. While rates are reported for each age group, the
AHCCCS standard applies to the Contractor’s overall rate. The
following table also includes the most recent HEDIS means for
Medicaid and commercial health plans, which are reported by age
group by the National Committee for Quality Assurance (NCQA):
NCQA 2005
Medicaid
Mean

NCQA 2005
Commercial
Mean

92.0%

96.7%

81.6%

88.1%

7 – 11 Years

82.5%

88.5%

12 – 19 Years

79.1%

85.5%

Age Group

AHCCCS
CYE 2006
MPS

AHCCCS
CYE 2007
Goal

12 – 24 Months
25 Mos – 6 Years

79%

6

82%

Results Overall and by Age Group
In the current period, total rates (all age groups combined) were 77.8
percent for Medicaid members and 84.7 percent for KidsCare
members. For both Medicaid and KidsCare populations, rates for all
age groups except one increased over the previous measurement
period.
Rates for
all age groups
except one
increased

Children 12 to 24 Months: The total rate for Medicaid-eligible children
(Table 1) did not show a significant change over the two measurement
periods. The current rate is 84.8 percent, compared with a rate of 84.3
percent for the previous period (p<.118). However, the total rate for
children eligible under KidsCare (Table 2) increased to 95.2 percent
from a rate of 93.3 percent for the previous period (p<.070).
Children 25 months to 6 Years: The total rate for Medicaid-eligible
children increased to 76.7 percent from 75.9 percent for the previous
measurement period (p<.001). The total rate for children eligible under
KidsCare also increased, to 83.0 percent from 80.6 percent for the
previous measurement period (p<.001).

Figure 1. Children’s and
Adolescents’ Access to
PCPs by County,
Medicaid Members

GREENLEE

2

< 70%
70 – 74.9%
75 – 79.9%
> 80%

Children 7 to 11 Years: The total rate for Medicaid-eligible children
increased to 76.2 percent from 75.0 percent for the previous
measurement period (p<.001). The total rate for children eligible under
KidsCare also increased, to 85.4 percent from 82.0 percent for the
previous measurement period (p<.001).
Children 12 to 19 Years: The total rate for Medicide-eligible children
increased to 78.1 percent from 76.1 percent for the previous
measurement period (p<.001). The total rate for children eligible under
KidsCare also increased, to 84.8 percent from 82.1 percent for the
previous measurement period (p<.001).
Results by Geographic Area
Overall rates (i.e., all ages combined) by individual counties for
Medicaid-eligible members ranged from 64.8 percent in La Paz
County to 83.7 percent in Santa Cruz County. Figure 1 shows relative
rates by county for Medicaid members.
For those covered under KidsCare, overall rates by individual county
ranged from 57.7 percent in La Paz County to 88.3 percent in Cochise
County (Greenlee County had a rate of 93.8 percent, but had only 16
members who qualified for inclusion in this measure).

7

Comparison with National Benchmarks
AHCCCS Medicaid rates were lower than the most recent national
HEDIS means for Medicaid health plans. Rates for KidsCare members
were lower than the commercial means.
Results by Race or Ethnicity
Compared with the overall rate for members identified as nonHispanic White (79.2 percent), Medicaid-eligible children and
adolescents who were Hispanic (78.2 percent), Black (73.3 percent) or
Native American (70.0 percent) were less likely to have a PCP visit.
By age group, there was no significant difference between Hispanic
and non-Hispanic White children in the three younger age groups (i.e.,
through 11 years of age). However, there was a significant difference
in the rate for Hispanic adolescents (78.3 percent), compared with nonHispanic White members (80.1 percent).
Discussion
Children 24 months and younger typically have a higher rate of
primary care visits because they are receiving immunizations that must
be given at specific intervals, and are screened for developmental
milestones during this period of rapid growth. After these “baby shots”
are completed and children’s growth and development begins to slow,
they are less likely to have PCP visits, unless they are ill or have other
specific needs. When analyzed by age group, rates for this measure are
highest for children 12 to 24 months.
Consistent with previous measurements, children enrolled with
AHCCCS Contractors through KidsCare have higher overall rates of
preventive services than those enrolled under Medicaid. Depending on
their incomes, parents of KidsCare members may pay a premium for
coverage and thus may be more likely to ensure that their children
receive covered benefits, including well-care visits. These parents also
may have a higher level of education and a better understanding of the
value of preventive health care services.
Data obtained through this measurement indicate that Native American
children and adolescents enrolled with AHCCCS health plans may
have the lowest rate of access to PCPs relative to members identified
as White. However, Native American members also may receive
primary care through Indian Health Service facilities on a fee-forservice basis. Data for services provided by IHS facilities is not
included in these data, unless a health plan paid for the service.

8

Figure 2. Rates by Contractor, Children’s Access to PCPs among Medicaid
Members, All Age Groups Combined
CYE 2004 and CYE 2005
100%

Benchmark Plan: CMDP
80%

60%

40%

20%

0%
APIPA

Care 1st

CMDP

HCA

MHP

MCP

PHP/CC

PHS

UFC

As shown in Figure 2, The Comprehensive Medical and Dental
Program (CMDP) had the highest rate of access to PCPs among
Medicaid-eligible members for all age groups combined, at 88.0
percent. CMDP is a special needs health plan operated by the state
Department of Economic Security for children and adolescents in
foster care. When these members are taken into custody, case
managers try to ensure that they are quickly seen by PCPs and other
providers to identify any physical, developmental or behavioral health
needs.

9

Table 1
Arizona Health Care Cost Containment System
CHILDREN'S ACCESS TO PRIMARY CARE PRACTITIONERS BY CONTRACTOR
MEMBERS ELIGIBLE UNDER MEDICAID
Measurement Period October 1, 2004, through September 30, 2005
* Indicates Contractor met the AHCCCS Minimum Performance Standard
Contractor

Number
of Members

Number with
1+ Visits

Percent with
1+ Visits

Statistical
Significance
p=.429
p=.649
p=.149
p<.001
p=.009

AZ Physicians IPA

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

6,463
28,636
15,977
18,431
69,507

5,441
21,834
12,339
14,592
54,206

84.2%
76.2%
77.2%
79.2%
78.0%

AZ Physicians IPA

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

6,932
25,765
13,869
15,472
62,038

5,801
19,602
10,613
11,991
48,007

83.7%
76.1%
76.5%
77.5%
77.4%

Care 1st

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

1,443
2,180
514
604
4,741

1,282
1,605
364
434
3,685

88.8%
73.6%
70.8%
71.9%
77.7%

p<.001
p=.001
N/A
N/A
p<.001

Care 1st

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total
12-24 mos.

223
892
N/A
N/A
1,115
489

166
604
N/A
N/A
770
452

74.4%
67.7%
N/A
N/A
69.1%
92.4%

p=.739

25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

1,654
399
898
3,440

1,393
346
836
3,027

84.2%
86.7%
93.1%
88.0%

p=.412
p=.274
p=.052
p=.160

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

404
1,151
302
847
2,704

371
956
253
767
2,347

91.8%
83.1%
83.8%
90.6%
86.8%

DES/CMDP *

DES/CMDP

Results of previous measurement period (Oct. 1, 2003, through Sept. 30, 2004) shown in shaded rows.

10

Table 1
Arizona Health Care Cost Containment System
CHILDREN'S ACCESS TO PRIMARY CARE PRACTITIONERS BY CONTRACTOR
MEMBERS ELIGIBLE UNDER MEDICAID
Measurement Period October 1, 2004, through September 30, 2005
* Indicates Contractor met the AHCCCS Minimum Performance Standard
Contractor

Number
of Members

Number with
1+ Visits

Percent with
1+ Visits

Statistical
Significance
p=.237
p=.487
p=.254
p.<001
p=.203

Health Choice AZ

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

2,879
11,956
4,614
4,775
24,224

2,415
9,114
3,420
3,684
18,633

83.9%
76.2%
74.1%
77.2%
76.9%

Health Choice AZ

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

2,784
9,060
3,121
2,938
17,903

2,367
6,869
2,277
2,163
13,676

85.0%
75.8%
73.0%
73.6%
76.4%

Maricopa Health
Plan

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

1,064
4,979
2,361
2,677
11,081

886
3,458
1,566
1,770
7,680

83.3%
69.5%
66.3%
66.1%
69.3%

Maricopa Health
Plan

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

1,424
4,538
2,248
2,375
10,585

1,149
3,049
1,424
1,516
7,138

80.7%
67.2%
63.3%
63.8%
67.4%

Mercy Care
Plan

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

6,367
25,147
10,521
11,297
53,332

5,438
19,595
8,143
8,824
42,000

85.4%
77.9%
77.4%
78.1%
78.8%

Mercy Care
Plan

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

6,174
19,591
8,576
8,729
43,070

5,260
15,184
6,529
6,689
33,662

85.2%
77.5%
76.1%
76.6%
78.2%

p=.099
p=.018
p=.034
p=.089
p=.003

p=.736
p=.293
p=.039
p=.013
p=.025

Results of previous measurement period (Oct. 1, 2003, through Sept. 30, 2004) shown in shaded rows.

11

Table 1
Arizona Health Care Cost Containment System
CHILDREN'S ACCESS TO PRIMARY CARE PRACTITIONERS BY CONTRACTOR
MEMBERS ELIGIBLE UNDER MEDICAID
Measurement Period October 1, 2004, through September 30, 2005
* Indicates Contractor met the AHCCCS Minimum Performance Standard
Contractor

Number
of Members

Number with
1+ Visits

Percent with
1+ Visits

Statistical
Significance
p=.678
p<.001
p=.005
p<.001
p<.001

Phoenix Health
Plan/Community
Connection

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

2,883
11,962
5,605
5,650
26,100

2,402
9,249
4,196
4,312
20,159

83.3%
77.3%
74.9%
76.3%
77.2%

Phoenix Health
Plan/Community
Connection

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

3,162
10,316
3,505
3,164
20,147

2,647
7,752
2,530
2,269
15,198

83.7%
75.1%
72.2%
71.7%
75.4%

Pima Health
System *

12-24 mos.
25 mos. - 6 yrs

821
2,469

680
1,978

82.8%
80.1%

p=.078
p=.431

7 - 11 yrs.
12 -19 yrs.
Total

1,065
1,435
5,790

872
1,201
4,731

81.9%
83.7%
81.7%

p=.243
p=.021
p=.122

Pima Health
System

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

550
1,661
713
829
3,753

475
1,314
568
662
3,019

86.4%
79.1%
79.7%
79.9%
80.4%

University Family
Care *

12-24 mos.
25 mos. - 6 yrs

284
1,483

247
1,157

87.0%
78.0%

p=.850
p=.869

7 - 11 yrs.
12 -19 yrs.
Total

1,002
1,474
4,243

807
1,234
3,445

80.5%
83.7%
81.2%

p=.541
p=.442
p=.810

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

429
1,606
1,022
1,330
4,387

371
1,249
834
1,099
3,553

86.5%
77.8%
81.6%
82.6%
81.0%

University Family
Care

Results of previous measurement period (Oct. 1, 2003, through Sept. 30, 2004) shown in shaded rows.

12

Table 1
Arizona Health Care Cost Containment System
CHILDREN'S ACCESS TO PRIMARY CARE PRACTITIONERS BY CONTRACTOR
MEMBERS ELIGIBLE UNDER MEDICAID
Measurement Period October 1, 2004, through September 30, 2005
* Indicates Contractor met the AHCCCS Minimum Performance Standard
Contractor

TOTAL

TOTAL

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total
12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

Number
of Members

Number with
1+ Visits

Percent with
1+ Visits

Statistical
Significance

22,693
90,466
42,058
47,241
202,458
22,082
74,580
33,356
35,684
165,702

19,243
69,383
32,053
36,887
157,566
18,607
56,579
25,028
27,156
127,370

84.8%
76.7%
76.2%
78.1%
77.8%
84.3%
75.9%
75.0%
76.1%
76.9%

p=.118
p<.001
p<.001
p<.001
p<.001

Results of previous measurement period (Oct. 1, 2003, through Sept. 30, 2004) shown in shaded rows.

13

Table 2
Arizona Health Care Cost Containment System
CHILDREN'S ACCESS TO PRIMARY CARE PRACTITIONERS BY CONTRACTOR
MEMBERS ELIGIBLE UNDER KIDSCARE
Measurement Period October 1, 2004, to September 30, 2005
* Indicates Contractor met the AHCCCS Minimum Performance Standard
Contractor

Age

Total Number
of Members

Number with
1+ Visits

Percent with
1+ Visits

Statistical
Significance

AZ Physicians IPA *

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total
12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

331
2,221
1,939
2,310
6,801
249
2,057
1,821
2,042
6,169

309
1,803
1,631
1,958
5,701
232
1,646
1,488
1,678
5,044

93.4%
81.2%
84.1%
84.8%
83.8%
93.2%
80.0%
81.7%
82.2%
81.8%

p=.931
p=.337
p=.050
p=.022
p=.002

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total
12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

119
126
49
67
361
7
45
N/A
N/A
52

119
108
43
56
326
7
39
N/A
N/A
46

100.0%
85.7%
87.8%
83.6%
90.3%
100.0%
86.7%
N/A
N/A
88.5%

N/A
p=.875
N/A
N/A
p=.678

Health Choice AZ *

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

162
1,001
540
604
2,307

155
844
447
519
1,965

95.7%
84.3%
82.8%
85.9%
85.2%

p=.348
p=.599
p=.440
p=.050
p=.042

Health Choice AZ

12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

84
789
380
390
1,643

78
658
307
317
1,360

92.9%
83.4%
80.8%
81.3%
82.8%

AZ Physicians IPA

Care 1st *

Care 1st

Results of previous measurement period (Oct. 1, 2003, through Sept. 30, 2004) shown in shaded rows.

14

Table 2
Arizona Health Care Cost Containment System
CHILDREN'S ACCESS TO PRIMARY CARE PRACTITIONERS BY CONTRACTOR
MEMBERS ELIGIBLE UNDER KIDSCARE
Measurement Period October 1, 2004, to September 30, 2005
* Indicates Contractor met the AHCCCS Minimum Performance Standard
Contractor
Maricopa Health
Plan *

Maricopa Health
Plan

Mercy Care
Plan *

Mercy Care
Plan

Phoenix Health
Plan/Community
Connection *

Phoenix Health
Plan/Community
Connection

Pima Health

Age
12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total
12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total
12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total
12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total
12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total
12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total
12-24 mos.

Total Number
of Members
55
446
321
249
1,071
46
442
284
240
1,012
418
2,305
1,495
1,498
5,716
242
1978
1255
1168
4,643
201
1,285
891
751
3,128
134
1,127
593
456
2,310
47

System *

Number with
1+ Visits
51
359
269
196
875
43
314
204
166
727
401
1,945
1,270
1,270
4,886
229
1620
1065
985
3,899
188
1,070
749
637
2,644
122
909
474
359
1,864
46

Percent with
1+ Visits
92.7%
80.5%
83.8%
78.7%
81.7%
93.5%
71.0%
71.8%
69.2%
71.8%
95.9%
84.4%
84.9%
84.8%
85.5%
94.6%
81.9%
84.9%
84.3%
84.0%
93.5%
83.3%
84.1%
84.8%
84.5%
91.0%
80.7%
79.9%
78.7%
80.7%
97.9%

Statistical
Significance
p=.0001
p=.001
p<.001
p=.016
p<.001

p=.438
p=.030
p=.948
p=.751
p=.034

p=.396
p=.095
p=.041
p=.007
p<.001

p=1.000

25 mos. - 6 yrs
148
127
85.8%
p=.569
7 - 11 yrs.
115
104
90.4%
p=.275
12 -19 yrs.
173
139
80.3%
p=.148
Total
483
416
86.1%
p=.968
Pima Health
12-24 mos.
20
20
100.0%
System
25 mos. - 6 yrs
101
84
83.2%
7 - 11 yrs.
67
57
85.1%
12 -19 yrs.
88
77
87.5%
Total
276
238
86.2%
Results of previous measurement period (Oct. 1, 2003, through Sept. 30, 2004) shown in shaded rows.

15

Table 2
Arizona Health Care Cost Containment System
CHILDREN'S ACCESS TO PRIMARY CARE PRACTITIONERS BY CONTRACTOR
MEMBERS ELIGIBLE UNDER KIDSCARE
Measurement Period October 1, 2004, to September 30, 2005
* Indicates Contractor met the AHCCCS Minimum Performance Standard
Contractor
University Family
Care *

University Family
Care

TOTAL

TOTAL

Age
12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total
12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total
12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total
12-24 mos.
25 mos. - 6 yrs
7 - 11 yrs.
12 -19 yrs.
Total

Total Number
of Members
8
68
114
224
414
8
108
160
256
532
1,341
7,600
5,464
5,876
20,281
790
6,647
4,560
4,640
16,637

Number with
1+ Visits
7
54
105
206
372
6
86
142
227
461
1,276
6,310
4,618
4,981
17,185
737
5,356
3,737
3,809
13,639

Percent with
1+ Visits
87.5%
79.4%
92.1%
92.0%
89.9%
75.0%
79.6%
88.8%
88.7%
86.7%
95.2%
83.0%
84.5%
84.8%
84.7%
93.3%
80.6%
82.0%
82.1%
82.0%

Statistical
Significance
p=1.000
p=.972
p=.358
p=.226
p=.132

p=.070
p<.001
p=.001
p<.001
p<.001

Results of previous measurement period (Oct. 1, 2003, through Sept. 30, 2004) shown in shaded rows.

16

Adults’ Access to Preventive and Ambulatory
Health Services
Three behaviors – tobacco use, poor nutrition and lack of physical
activity – are major contributors to some of this country’s leading
killers: cardiovascular disease, cancer, chronic lower respiratory
diseases and diabetes.6 Smoking and other unhealthy behaviors often
worsen the complications of chronic diseases, and increase the risk of
developing other serious illnesses. A recent survey of AHCCCS acutecare health plan members found that as many as 62 percent of adults
currently smoke cigarettes, either sometimes or every day. 7
Access to routine ambulatory medical services for adults is essential to
the early diagnosis and treatment of disease. Regular health care visits
also provide opportunities for clinicians to educate and counsel patients
on smoking cessation, diet, exercise and other healthy behaviors.
Description
AHCCCS measured the percentage of members who:
•
were ages 20 through 64 years at the end of the measurement
period (October 1, 2004, through September 30, 2005),
•
were continuously enrolled with one acute-care Contractor during
the measurement period (one break in enrollment was allowed if the
gap did not exceed one month), and
•
had one or more preventive/ambulatory visits during the
measurement period, including encounters with primary care physicians,
specialists, physician’s assistants, nurse practitioners, ophthalmologists
and optometrists.
Performance Goals
AHCCCS has adopted the following Minimum Performance Standards
and Goals for the current measurement. While rates are reported for
each age group, the AHCCCS standard applies to the Contractor’s
overall rate. The following table also includes the most recent HEDIS
means for Medicaid and commercial health plans, which are reported
by age group by the National Committee for Quality Assurance
(NCQA):

Age Group
20 – 44 Years

AHCCCS
CYE 2006
MPS

AHCCCS
CYE 2006
Goal

80%

82%

45 – 64 Years

17

NCQA 2005
Medicaid
Mean

NCQA 2005
Commercial
Mean

75.8%

92.7%

81.1%

94.6%

AHCCCS rates
for both age
groups are
higher than
the most
recent national
means.

Figure 3. Adults’ Access
to Preventive/Ambulatory
Health Services,
by County

GREENLEE

2

< 75%
75 – 79.9%
80 – 84.9%
> 85%

Results Overall and by Age Group
Compared with the previous measurement period, the total rate (i.e.,
both ages combined) increased (Table 3). The total rate was 79.2
percent, compared with 78.6 percent in the previous period (p=.004).
Adults 20 to 44 Years: This rate increased to 77.3 percent, from 76.7
percent in the previous measurement period (p=.007).
Adults 45 to 64 Years: This rate did not show a statistically significant
change. The current rate is 83.4 percent, compared with 83.0 percent in
the previous period (p=.181).
Results by Geographic Area
Total rates ranged from 72.9 percent in La Paz County to 85.8 percent
in Graham County. Figure 3 shows relative rates by county.
Comparison with National Benchmarks
AHCCCS rates for both age groups are higher than the most recent
national HEDIS means for Medicaid health plans. For adults 20 to 44
years, the AHCCCS rate was 1.5 percentage points higher and for adults
45 to 64 years, the AHCCCS rate was greater by 2.3 percentage points.
Results by Race or Ethnicity
Overall, there was no significant difference in rates of adults’ access to
preventive and abulatory care among members who were identified as
Hispanic (78.9 percent), non-Hispanic White (79.7 percent) and Native
American (79.9 percent). However, Blacks (76.2 percent) were less
likely than non-Hispanic Whites to have a preventive or ambulatory
care visit.
When analyzed by age group, the only significant difference was in
adults 20 to 44 years; non-Hispanic Blacks (74.7 percent) were less
likely than non-Hispanic Whites (78.2 percent) to have a preventive or
ambulatory visit.
Discussion
Ensuring that adult members use preventive services is challenging. This
may be due to lack of knowledge among members about when and what
types of routine preventive health services are recommended, skepticism
about the effectiveness of prevention or avoidance ─ especially if a
person is engaging in unhealthy behaviors like smoking. In addition,
medical professionals no longer recommend that adults have an annual
checkup. However, given the risks associated with smoking alone and
the substantial portion of members who use tobacco, yearly preventive
health care visits may be an important service for AHCCCS members.

18

Figure 4. Rates by Contractor, Both Age Groups of Adults Combined
CYE 2004 and CYE 2005
100%

Benchmark Plan: APIPA
80%

60%

40%

20%

0%
APIPA

Care 1st

HCA

MHP

MCP

PHP/CC

PHS

UFC

As shown in Figure 4, most Contractors’ total rates for Adults’ Access to
Preventive/Ambulatory Health Services are at or near 80 percent. APIPA
and Care 1st Healthplan showed statistically significant increases
between the two periods measured. APIPA also had the highest rate for
this measure in the current period, at 80.4 percent.

19

Table 3
Arizona Health Care Cost Containment System
ADULTS' ACCESS TO PREVENTIVE/AMBULATORY HEALTH SERVICES
BY CONTRACTOR
MEMBERS ELIGIBLE UNDER MEDICAID
Measurement Period October 1, 2004, through September 30, 2005
* Indicates Contractor met the AHCCCS Minimum Performance Standard
Number
Contractor
AZ Physicians IPA *

AZ Physicians IPA

Care 1st

Care 1st

Health Choice AZ

Health Choice AZ

Maricopa Health Plan

Maricopa Health Plan

Mercy Care Plan *

Mercy Care Plan

Percent with
>1 Visits

Statistical
Significance

Years

of Members

Number with
>1 Visits

21-44

24,241

18,980

78.3%

p=.026

45-64

10,748

9,142

85.1%

p=.519

Total

34,989

28,122

80.4%

p=.019

21-44

23,050

17,851

77.4%

45-64

10,011

8,483

84.7%

Total

33,061

26,334

79.7%

21-44

2,252

1,624

72.1%

p=.004

45-64

890

684

76.9%

p<.001

Total

3,142

2,308

73.5%

p<.001

21-44

903

604

66.9%

45-64

363

234

64.5%

Total

1,266

838

66.2%

21-44

8,717

6,708

77.0%

p=.341

45-64

3,628

2,912

80.3%

p=.667

Total

12,345

9,620

77.9%

p=.321

21-44

7,104

5,421

76.3%

45-64

3,061

2,444

79.8%

Total

10,165

7,865

77.4%

21-44

2,537

1,780

70.2%

p=.209

45-64

1,970

1,563

79.3%

p=.710
p=.336

Total

4,507

3,343

74.2%

21-44

2,723

1,867

68.6%

45-64

1,972

1,574

79.8%

Total

4,695

3,441

73.3%

21-44

19,028

14,859

78.1%

p=.804

45-64

8,182

6,971

85.2%

p=.021

Total

27,210

21,830

80.2%

p=.219

21-44

15,908

12,405

78.0%

45-64

7,093

5,947

83.8%

Total

23,001

18,352

79.8%

Results of previous measurement period (Oct. 1, 2003, through Sept. 30, 2004) shown in shaded rows.

20

Table 3
Arizona Health Care Cost Containment System
ADULTS' ACCESS TO PREVENTIVE/AMBULATORY HEALTH SERVICES
BY CONTRACTOR
MEMBERS ELIGIBLE UNDER MEDICAID
Measurement Period October 1, 2004, through September 30, 2005
* Indicates Contractor met the AHCCCS Minimum Performance Standard
Number

Percent with
>1 Visits

Statistical
Significance
p=.597
p=.513
p=.939

Contractor

Years

of Members

Number with
>1 Visits

Phoenix Health Plan/
Community Connection

21-44
45-64
Total

7,433
2,902
10,335

5,669
2,377
8,046

76.3%
81.9%
77.9%

Phoenix Health Plan/
Community Connection

21-44
45-64
Total

7,052
2,834
9,886

5,352
2,340
7,692

75.9%
82.6%
77.8%

Pima Health System

21-44
45-64
Total
21-44
45-64
Total

2,210
1,173
3,383
1,693
982
2,675

1,700
947
2,647
1,261
803
2,064

76.9%
80.7%
78.2%
74.5%
81.8%
77.2%

p=.077
p=.539
p=.313

21-44
45-64

1,580
952

1,240
787

78.5%
82.7%

p=.922
p=.610

Total

2,532

2,027

80.1%

p=.784

21-44
45-64

1,824
996

1,434
832

78.6%
83.5%

Total

2,820

2,266

80.4%

TOTAL

21-44
45-64
Total

67,998
30,445
98,443

52,560
25,383
77,943

77.3%
83.4%
79.2%

TOTAL

21-44
45-64
Total

60,257
27,312
87,569

46,195
22,657
68,852

76.7%
83.0%
78.6%

Pima Health System

University Family
Care *
University Family Care

p=.007
p=.181
p=.004

Results of previous measurement period (Oct. 1, 2003, through Sept. 30, 2004) shown in shaded rows.

21

Breast Cancer Screening
Breast cancer is the second most commonly diagnosed cancer among
women, after skin cancer.8 One out of 67 women will be diagnosed with
breast cancer by the age of 50.9 According to the Centers for Disease
Control and Prevention, more than 180,000 women were diagnosed with
breast cancer in 2003 (the latest year for which data are available), and
more than 41,000 women died of the disease.8 On average, nearly 700
Arizona women die of breast cancer each year.10
In the last decade, the overall death rate from female breast cancer has
declined. However, the rates of decline for Hispanic and black women
were lower than for white, non-Hispanic women, and the rates for
Asians, Pacific Islanders, American Indians and Alaska Natives were
virtually unchanged.11
Screening mammography is an important tool in the early detection of
breast cancer. Studies have demonstrated that screening mammography
may reduce mortality from the disease by up to 30 percent.12,13
Description
AHCCCS measured the percentage of members who:
•
were ages 52 through 69 years at the end of the measurement
period (October 1, 2004, through September 30, 2005),
•
were continuously enrolled with one acute-care Contractor during
the measurement period and the preceding year (one break in
enrollment per year was allowed if each gap did not exceed one
month), and
•
had a mammogram in the two-year period.
Performance Goals
AHCCCS has adopted the following Minimum Performance Standards
and Goals for the current measurement. The following table also
includes the most recent HEDIS means for Medicaid and commercial
health plans reported by the National Committee for Quality
Assurance (NCQA):

Breast
Cancer
Screening

AHCCCS
CYE 2006
MPS

AHCCCS
CYE 2006
Goal

NCQA 2005
Medicaid
Mean

NCQA 2005
Commercial
Mean

57%

60%

53.9%

72.0%

22

The overall rate
was unchanged
from the
previous year.

Figure 5. Breast Cancer
Screening with
Mammography,
by County

GREENLEE

2

< 35%
35 – 39.9%
45 – 49.9%
50 – 54.9%
60 – 64.9%
> 70%

Overall Results
Compared with the previous measurement period, the overall rate was
unchanged (p=.491). The rate of breast cancer screening for the current
measurement period was 48.8 percent, compared with 48.3 percent in
the previous period (Table 4).
Results by Geographic Area
Rates by individual counties ranged from 31.3 percent in Greenlee
County to 70.7 percent in Yuma County. Figure 5 shows relative rates
by county.
Comparison with National Benchmark
The AHCCCS overall rate is 5.1 percentage points lower than the most
recent national HEDIS mean reported by NCQA for Medicaid health
plans.
Results by Race or Ethnicity
There were significant differences in rates of breast cancer screening
among women who were identified as Hispanic and Native American,
compared with non-Hispanic White women. The rate for members of
Hispanic origin (55.8 percent) was greater than the rate for nonHispanic White women (46.3 percent).
The rate for members identified as Native American (34.2 percent)
was significantly lower than the rate for non-Hispanic Whites. NonHispanic Blacks (47.8 percent) did not show a significant difference
from non-Hispanic Whites.
Discussion
The identification of tumors while they are still localized and potentially
curable can significantly reduce breast cancer mortality.14 However,
many women do not obtain mammograms at the recommended one- to
two-year intervals. A significant percentage of women responding to a
recent National Cancer Institute survey said that they did not have a
mammogram because they did not know they needed one or their
doctor had not recommended one.15 Women of certain racial or ethnic
groups may be especially reluctant to obtain mammograms because of
embarrassment or the belief that one can do little to alter the future.16,17
Data obtained through this measurement indicate that Native American
women enrolled with AHCCCS health plans may be receiving
mammograms at a rate well below women of other races; however,
Native American women may receive these services through Indian
Health Service facilities on a fee-for-service basis even though they
are enrolled with AHCCCS health plans. In these cases, the services
may not be captured in AHCCCS encounter data unless a health plan
paid for them.
23

Possible underreporting of services for Native American women may
have contributed to lower rates in some counties, such as Coconino,
Apache and Navajo, where many of these women live.
Figure 6. Rates by Contractor, Breast Cancer Screening with Mammography
CYE 2004 and CYE 2005
100%

80%

Benchmark Plan: Pima HS
60%

40%

20%

0%
APIPA

Care 1st

HCA

MHP

MCP

PHP/CC

PHS

UFC

As shown in Figure 6, Pima Health System had the highest rate of breast
cancer screening in the current measurement period, at 54.6 percent.
Only one Contractor, APIPA, showed a significant change in its rate of
breast cancer screening between the two periods measured. Care 1st
Healthplan did not have any members who met the two-year enrollment
criteria for the measurement period of CYE 2004.

24

Table 4
Arizona Health Care Cost Containment System
BREAST CANCER SCREENING BY CONTRACTOR
Measurement Period October 1, 2003 through September 30, 2005
* Indicates Contractor met the AHCCCS Minimum Performance Standard

Contractor
AZ Physicians IPA

Care 1st

Health Choice AZ

Maricopa Health Plan

Mercy Care Plan

Phoenix Health Plan/CC

Pima Health System

University Family Care

TOTAL

Number

Number

Percent

of

Receiving

Receiving

Members

Mammograms

Mammograms

Statistical
Significance

4,292

2,208

51.4%

p=.001

3,527

1,683

47.7%

119

43

36.1%

N/A

N/A

N/A

1,212

512

42.2%

789

333

42.2%

799

401

50.2%

807

425

52.7%

3,263

1,542

47.3%

2,625

1,271

48.4%

1,193

559

46.9%

647

274

42.3%

456

249

54.6%

356

204

57.3%

464

240

51.7%

412

235

57.0%

11,798

5,754

48.8%

9,163

4,425

48.3%

N/A

p=.986

p=.321

p=.375

p=.064

p=.442

p=.115

p=.491

Results of previous measurement period (Oct. 1, 2002, through Sept. 30, 2004) shown in shaded rows.

25

Cervical Cancer Screening
Nearly 10,000 new cases of invasive cervical cancer are diagnosed and
about 3,700 women die of the disease each year.18 Approximately half
of these deaths occur in women who were not screened at timely
intervals.14
Cytologic screening through the use of the Papanicolaou (Pap) test has
led to an 80-percent reduction in the incidence of cervical cancer. The
Pap test can detect precancerous conditions and infection with the human
papilloma virus (HPV). Certain types of HPV are strongly associated
with cervical cancer.14
The American College of Obstetricians and Gynecologists, the American
Cancer Society and the U.S. Preventive Services Task Force recommend
that women have a Pap test and pelvic examination when they become
sexually active or at age 18, whichever occurs first. Annual Pap tests are
recommended until three consecutive Pap tests are interpreted as being
normal. Following this, Pap tests can be performed every three years, at
the discretion of a woman’s health care provider.
Description
AHCCCS measured the percentage of members who:
•
were ages 21 through 64 years at the end of the measurement
period (October 1, 2004, through September 30, 2005),
•
were continuously enrolled with one acute-care Contractor during
the measurement period (one break in enrollment was allowed if the
gap did not exceed one month), and
•
had a Pap test in the measurement period or in either of the two
preceding years.
Performance Goals
AHCCCS has adopted the following Minimum Performance Standards
and Goals for the current measurement. The following table also
includes the most recent HEDIS means for Medicaid and commercial
health plans reported by the National Committee for Quality
Assurance (NCQA):

Cervical Cancer
Screening

AHCCCS
CYE 2006
MPS

AHCCCS
CYE 2006
Goal

NCQA 2005
Medicaid
Mean

NCQA 2005
Commercial
Mean

61%

63%

65.0%

81.8%

26

The overall rate
improved,
compared with
the previous
period.

Overall Results
The overall rate improved, compared with the previous measurement
period (Table 5). The rate of cervical cancer screening increased to
54.4 percent in the current period from 52.5 percent (p<.001).

Results by Geographic Area
Rates by individual counties ranged from 30.5 percent in Gila County
to 64.6 percent in Yuma County. Figure 7 shows relative rates by
county.
Comparison with National Benchmark
The AHCCCS overall rate is 10.6 percentage points lower than the most
recent national HEDIS mean for Medicaid health plans.

Figure 7. Cervical Cancer
Screening with Pap tests,
by County

Results by Race or Ethnicity
Rates for women who were identified as Hispanic (61.3 percent) or
non-Hispanic Black (54.7 percent) were significantly higher than
women who were identified as non-Hispanic White (51.3 percent).
The rate for members identified as Native American (45.9 percent)
was significantly lower than non-Hispanic White women.

GREENLEE

2

< 35%
40 – 44.9%
45 – 49.9%
50 – 54.9%
55 – 59.9%
> 60%

Discussion
As with breast cancer screening, many women may not have Pap tests
at recommended intervals because they are not aware they are due for
such screening, embarrassment or cultural factors and beliefs.15-17
Results for this measure are calculated from laboratory data, as well as
from physician encounters. One Contractor has reported to AHCCCS
that a large laboratory provider accounted for a significant percentage
of omissions of encounter data for this health plan during both periods
measured (CYE 2004 and CYE 2005). This laboratory company,
which contracts with several AHCCCS health plans, experienced
significant issues in formatting its data to be compliant with federal
standards under the Health Insurance Portability and Accountability
Act (HIPAA). This problem may have affected other Contractor’s
rates and thus overall results for this measure.
Data obtained through this measurement indicate that Native American
women enrolled with AHCCCS health plans may Pap tests at a lower
rate than women of other races; however, as in the case of
mammograms, Native American women enrolled with health plans
may receive these services through Indian Health Service facilities on
a fee-for-service basis. Thus, data on these services may not be
captured in AHCCCS health plan encounter data.

27

Figure 8. Rates by Contractor, Cervical Cancer Screening with Pap Tests
CYE 2004 and CYE 2005
100%

80%

Benchmark Plan: UFC
60%

40%

20%

0%
APIPA

Care 1st

HCA

MHP

MCP

PHP/CC

PHS

UFC

University Family Care had the highest rate of cervical cancer screening
in the current period, at 59.1 percent. Five Contractors showed
significant increases between the two periods measured. One, Phoenix
Health Plan, showed a statistically significant decline, which may be
related to problems with capturing laboratory data for this service.

28

Table 5
Arizona Health Care Cost Containment System
CERVICAL CANCER SCREENING BY CONTRACTOR
Measurement Period October 1, 2004 through September 30, 2005
* Indicates Contractor met the AHCCCS Minimum Performance Standard

Contractor

AZ Physicians IPA

Care 1st

Health Choice Arizona

Maricopa Health Plan

Mercy Care Plan

Phoenix Health Plan/CC

Pima Health System

University Family Care

TOTAL

Number of
Members

Number
Receiving Pap
Tests

Percent
Receiving Pap
Tests

Statistical
Significance

24,077

14,115

58.6%

p<.001

22,488

12,536

55.7%

2,107

1,029

48.8%

847

257

30.3%

8,313

4,775

57.4%

6,821

3,687

54.1%

2,704

1,508

55.8%

2,820

1,406

49.9%

18,870

10,893

57.7%

15,781

8,950

56.7%

7,193

1,969

27.4%

6,731

2,215

32.9%

2,214

1,269

57.3%

1,723

851

49.4%

1,667

986

59.1%

1,824

1,089

59.7%

67,145

36,544

54.4%

59,035

30,991

52.5%

p<.001

P<.001

P<.001

p=.058

P<.001

P<.001

p=.738

p<.001

Results of previous measurement period (Oct. 1, 2003, through Sept. 30, 2004) shown in shaded rows.

29

Chlamydia Screening
Chlamydia is one of the most commonly reported sexually transmitted
diseases in the United States, infecting an estimated 2.8 million people
each year. Yet, it often is undetected because approximately 80 percent
of women and 50 percent of men infected with the chlamydia
trachomatis bacteria have no symptoms. It is estimated that, by age 30,
half of sexually active women have had chlamydia.19
If untreated, chlamydia infection can cause serious reproductive and
other health problems. The infection can result in pelvic inflammatory
disease, which in turn can lead to infertility, an ectopic or tubal
pregnancy, or chronic pelvic pain. In pregnant women, chlamydia
infections may lead to premature delivery and babies born to infected
mothers can have eye infections or pneumonia.
Because chlamydia is most prevalent among women in their late teens
and early 20s ― and is often without symptoms ― the U.S. Preventive
Services Task Force has recommended that all sexually active females
25 and younger be tested for the infection at least once a year. This can
be done as part of a routine gynecologic examination.
Description
AHCCCS measured the percentage of female members who:
•
were ages 16 through 25 years at the end of the measurement
period (October 1, 2004, through September 30, 2005),
•
were identified as sexually active, based on specific gynecological
services received during the measurement period,
•
were continuously enrolled with one acute-care Contractor during
the measurement period (one break in enrollment was allowed if the
gap did not exceed one month), and
•
were screened for chlamydia infection during the measurement
period.
Performance Goals
While rates for Chlamydia Screening are reported in this publication,
AHCCCS did not have a contractual requirement for this measure in its
CYE 2006 contract with health plans.

30

The overall rate
improved,
compared with
the previous
period.

Overall Results
The overall rate for this measure also improved, compared with the
previous period (Table 6). The rate of chlamydia screening increased
to 41.1 percent in the current period from 40.0 percent (p=.035).
Results by Geographic Area
Rates by individual counties ranged from 15.5 percent in Santa Cruz
County to 51.8 percent in Pima County. Figure 9 shows relative rates
by county.
Comparison with National Benchmark
The AHCCCS overall rate is 9.3 percentage points lower than the most
recent national mean for Medicaid health plans reported by NCQA.

Figure 9. Chlamydia
Screening, by County

Results by Race or Ethnicity
Rates for females identified as being of Hispanic origin (43.0 percent)
or non-Hispanic Black (45.6 percent) were significantly higher than
the rate for non-Hispanic White members (38.7 percent).
The rate for Native Americans (37.5 percent) was not significantly
different than the rate for non-Hispanic White members.

GREENLEE

2

< 20%
20 – 24.9%
25 – 29.9%
30 – 34.9%
35 – 39.9%
45 – 49.9%
> 50%

Discussion
The current recommendation for annual screening of all sexually
active females ages 16 through 25 was made by the U.S. Preventive
Services Task Force in 2001, but it appears that providers have not
fully implemented this recommendation. Many women probably do not
seek testing because they are not aware of the problem of chlamydia or
are embarrassed about possibly having a sexually transmitted disease.
The often asymptomatic nature of the infection further presents a barrier
to testing.
Results for this measure also may have been affected by significant
data issues experienced by one of the state’s largest laboratory
providers, as discussed in the previous section on Cervical Cancer
Screening. This appears to have affected data for Phoenix Health Plan,
which identified that this laboratory provider accounted for a significant
percentage of its encounter omissions during CYE 2004 and CYE 2005.
Other Contractors’ rates and thus overall rates also may have been
affected by this problem.

31

Figure 10. Rates by Contractor, Chlamydia Screening
CYE 2004 and CYE 2005
100%

80%

Benchmark Plan: Maricopa HP
60%

40%

20%

0%
APIPA

Care 1st

HCA

MHP

MCP

PHP/CC

PHS

UFC

Maricopa Health Plan had the highest rate of chlamydia screening in the
current period, at 59.5 percent. Maricopa Health Plan and Pima Health
System showed statistically significant increases between measurement
periods.

32

Table 6
Arizona Health Care Cost Containment System
CHLAMYDIA SCREENING BY CONTRACTOR
Measurement Period October 1, 2004 through September 30, 2005
Number
Contractor
AZ Physicians IPA

Care 1st Arizona

Health Choice AZ

Maricopa Health Plan

Mercy Care Plan

Phoenix Health Plan/CC

Pima Health System

University Family Care

TOTAL

Number

Percent

of
Members

Receiving
Screening

Receiving
Screening

Statistical
Significance

6,096

2,536

41.6%

p=.130

5,749

2,313

40.2%

602

248

41.2%

212

84

39.6%

2,306

1130

49.0%

1846

956

51.8%

627

373

59.5%

621

312

50.2%

5,214

2,432

46.6%

4,295

1,956

45.5%

2,069

124

6.0%

1917

195

10.2%

634

302

47.6%

386

142

36.8%

378

217

57.4%

439

228

51.9%

17,926

7,362

41.1%

15,465

6,186

40.0%

p=.689

p=.074

p=.001

p=.283

p<.001

p=.001

p=.117

p=.035

Results of previous measurement period (Oct. 1, 2003, through Sept. 30, 2004) shown in shaded rows.

33

Timeliness of Prenatal Care
Women who receive early and ongoing prenatal care are more likely to
have better pregnancy outcomes than women who receive little or no
prenatal care.20-24 Babies of mothers who do not get prenatal care are
three times more likely to have a low birth weight and five times more
likely to die than those born to mothers who do get care.25
Prenatal care affords physicians and other health care practitioners
opportunities to address risk factors such as smoking, alcohol use and
improper diet, as well as treat medical complications that can
negatively affect the health of mother and baby. In addition, prenatal
care provides opportunities to educate pregnant women, especially
first-time mothers, on childbirth and infant care.
According to the Arizona Department of Health Services, 68.4 percent
of all births covered by AHCCCS in 2005 (including those covered
through health plans, or on a fee-for-service basis) were to mothers
who began care in their first trimester of pregnancy.26
Description
AHCCCS measured the percentage of female members who:
• had a live birth during the measurement period (October 1, 2004,
through September 30, 2005).
• were continuously enrolled with the same acute-care Contractor for
43 days or more prior to delivery, and
• had a prenatal care visit during their first trimester of pregnancy or
within 42 days of enrollment, depending on the date of enrollment
with the Contractor.
Performance Goals
AHCCCS has adopted the following Minimum Performance Standards
and Goals for the current measurement. The following table also
includes the most recent HEDIS means for Medicaid and commercial
health plans reported by the National Committee for Quality
Assurance (NCQA):

Timeliness of
Prenatal Care

AHCCCS
CYE 2006
MPS

AHCCCS
CYE 2006
Goal

NCQA 2005
Medicaid
Mean

NCQA 2005
Commercial
Mean

62%

68%

79.1%

91.8%

34

The overall rate
was unchanged
from the
previous year.

Overall Results
Compared with the previous measurement period, the overall rate was
declined (p<.001). The rate of timely prenatal care for the current
measurement period was 64.1 percent, compared with 67.4 percent in
the previous period (Table 7).
Results by Geographic Area
Rates by individual counties ranged from 13.4 percent in Apache
County to 79.4 percent in Yavapai County. Figure 11 shows relative
rates by county.
Comparison with National Benchmark
The AHCCCS overall rate is 15 percentage points lower than the most
recent national HEDIS mean for Medicaid health plans.

Figure 11. Timeliness of
Prenatal Care,
by County

GREENLEE

2

< 50%
50 – 54.9%
55 – 59.9%
60 – 64.9%
65 – 69.9%
> 70%

Results by Race or Ethnicity
There were nor significant differences among rates for women who
were identified as being of Hispanic origin (64.3 percent), NonHispanic Blacks (62.6 percent) or Native American (64.1 percent),
compared with non-Hispanic White members (63.9 percent).
Discussion
As previously noted, prenatal, delivery and postpartum services
provided through AHCCCS health plans typically are paid for under a
“global” fee. Providers may not have reported all dates of prenatal
visits when billing for OB services, which may have resulted in
underreporting of rates for the measure of Timeliness of Prenatal Care.
In addition, laboratory tests for obstetrical patients are used to help
identify prenatal care under this measure. As previously discussed, one
of the state’s largest laboratory providers experienced significant
issues with data reporting during the two periods measured; these
issues may have affected rates for this measure.

35

Figure 12. Rates by Contractor, Timeliness of Prenatal Care
CYE 2004 and CYE 2005
100%

Benchmark Plan: Mercy Care
80%

60%

40%

20%

0%
APIPA

Care 1st

HCA

MHP

MCP

PHP/CC

PHS

UFC

As shown in Figure 12, Mercy Care Plan had the highest rate of
Timeliness of Prenatal Care in the current measurement period, at 70.3
percent. One Contractor, Care 1st Healthplan, showed a statistically
significant increase in its rate, while three other Contractors showed
significant decreases. One Contractor, Phoenix Health Plan, has
identified issues with incorrect coding for prenatal visits, as well as
underreporting of specific visit dates related to the total OB billing
process, and is working to correct these problems.

36

Table 7
Arizona Health Care Cost Containment System
TIMELINESS OF PRENATAL CARE BY CONTRACTOR
Measurement Period October 1, 2004, through September 30, 2005
* Indicates Contractor met the AHCCCS Minimum Performance Standard

Contractor
AZ Physicians IPA *
Care 1st
Health Choice AZ *
Maricopa Health Plan
Mercy Care Plan *
Phoenix Health Plan/CC
Pima Health System
University Family Care *
TOTAL

Visit within
First Trimester
Enrollment With Visits Percent

Visit within 42 days
of enrollment
Enrollment With Visits Percent Enrollment

Total
Statistical
With Visits Percent Significance
6,401
63.3%
p<.001
7,121
66.4%
697
59.3%
p<.001
250
44.1%

2,521
2,702
241
53

2,086
2,267
170
30

82.7%
83.9%
70.5%
56.6%

7,592
8,028
934
514

4,315
4,854
527
220

56.8%
60.5%
56.4%
42.8%

10,113
10,730
1,175
567

891
915
137
173

701
779
87
110

78.7%
85.1%
63.5%
63.6%

3,084
2,744
454
530

1,774
1,545
276
294

57.5%
56.3%
60.8%
55.5%

3,975
3,659
591
703

2,475
2,324
363
404

62.3%
63.5%
61.4%
57.5%

2,120
2,506
775
814
176
144

1,726
2,237
557
689
121
106

81.4%
89.3%
71.9%
84.6%
68.8%
73.6%

6,673
6,277
2,877
2,708
768
615

4,459
4,417
1,500
1,472
439
371

66.8%
70.4%
52.1%
54.4%
57.2%
60.3%

8,793
8,783
3,652
3,522
944
759

6,185
6,654
2,057
2,161
560
477

70.3%
75.8%
56.3%
61.4%
59.3%
62.8%

72
172

57
139

79.2%
80.8%

149
304

94
163

63.1%
53.6%

221
476

151
302

68.3%
63.4%

p=.209

6,933
7,479

5,505
6,357

79.4%
85.0%

22,531
21,720

13,384
13,336

59.4%
61.4%

29,464
29,199

18,889
19,693

64.1%
67.4%

p<.001

Results of previous measurement period (Oct. 1, 2003, through Sept. 30, 2004) shown in shaded rows.

37

p=.259
p=.149
p<.001
p<.001
p=.139

CONCLUSION
Overall Results and Improvement Efforts
The data reported here indicate that children and adults enrolled with
AHCCCS have a high degree of access to the health care system, as
evidenced by rates of primary care visits. However, many women
enrolled with AHCCCS may not be taking advantage of preventive
services such as mammograms, screening for cervical cancer and
chlamydia, and prenatal care.
AHCCCS and/or its contracted health plans have begun addressing
this problem by:
•

Identifying evidence-based methods for increasing member
knowledge of the importance and use of these services. This outreach
to members must go beyond the usual reminders mailed to members
due for services or pre-recorded telephone contact. A proven strategy
to increase breast cancer screening among women enrolled with health
plans who are overdue for mammograms is targeted telephone
counseling, in which a nurse or other professional, trained to address
barriers or objections, calls members, discusses their specific issues
and assists with scheduling mammograms.27-30
Similar approaches providing education and assistance in smallgroup neighborhood settings also have proven effective in increasing
cervical cancer screening among low-income and minority women
enrolled with health plans. These initiatives include culturally relevant
messages and education. 31,32
•

Analyzing and reporting performance measure data by individual
county and race or ethnicity. This marks the first report of these
measures by individual counties. Detailed data will be provided to
Contractors, and may guide interventions, such as increasing network
capacity where possible or more intensive outreach, targeted to
specific areas.
This report also includes an initial evaluation of performance
measure data by race or ethnicity. Based on these data, members
identified as Native American or Black both had lower rates of
Children’s Access to PCPs. Native Americans also showed lower rates
of breast and cervical cancer screening, as well as chlamydia testing.
Members identified as Black had lower rates of Adults’ Access to
Preventive and Ambulatory Health Services. These data also may
provide guidance to Contractors for improved outreach that is
culturally relevant to specific populations.

38

Improving data collection processes. The data used to calculate
these measures ― particularly Cervical Cancer Screening, Chlamydia
Screening and Timeliness of Prenatal Care ― may be underreported.
Problems with reporting of laboratory data appear to have been
corrected in CYE 2006. For the measure of Timeliness of Prenatal
Care, Contractors must ensure that obstetrical providers report the first
and last dates of prenatal visits for each member with the global
billing, and that visits are coded correctly. Several Contractors have
begun looking at the completeness of their prenatal claims data, and
ways to improve this information. AHCCCS will continue to work
with them to help ensure they collect all data necessary to accurately
reflect health plan performance.
•

In addition, some Contractors have developed “pay-for-performance”
programs to reward providers that achieve specific levels of
performance, including measures of preventive health. These
approaches also have shown some success in other programs.33,34
AHCCCS was recently chosen to participate in a Pay-for-Performance
Purchasing Institute designed to help states implement innovative,
provider-level incentive programs. The 18-month program ― which is
coordinated by the Center for Health Care Strategies and funded by the
Commonwealth Fund ― will offer states intensive training and
technical assistance in developing incentive structures, selecting
performance measures, engaging providers, and disseminating data
and outcomes. AHCCCS will partner with its contracted health plans
and others, such as medical associations, on this initiative.
Performance measures, such as those reported here, may be selected
for this program.
AHCCCS will further increase Minimum Performance Standards and
Goals for these measures in the CYE 2008 contract. The agency is
considering other contractual measures to ensure that Contractors
dedicate appropriate resources to meet AHCCCS Performance
Measure requirements.

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1

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Arizona Maternal and Child Health Committee. Maternal and Child Health Needs
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April 2001.
3
American Academy of Pediatrics. Bright Futures: Guidelines for Health
Supervision
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Arizona School Readiness Task Force. Growing Arizona. Phoenix, Ariz.:
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Arizona School Readiness Board. Early Childhood Health Screening Fact Sheet.
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.wba Market Research. 2006 Acute Care Health Plan Customer Satisfaction Survey.
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Arizona Department of Health Services. Office of Chronic Disease Prevention and
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Greenberg RS: The impact of prenatal care in different social groups. Am J Obstet
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Lantz PM, Stencil D, et al. Breast and cervical cancer screening in a low-income
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2005.
Available
at:
http://www.ihealthbeat.org/index.cfm?Action=dspItem&itemID=112598. Accessed
July 15, 2005.
34
Improving Preventive Care Services for Children. Best Clinical and
Administrative Practices for Medicaid Health Plans Toolkit. Center for Health Care
Strategies Inc. Lawrenceville, NJ. March 2002.

41

Appendix A
PMMIS Race/Ethnicity Hierarchy
AI
HI
BL
AS
NH
WH
UD
RA

DES Field Coded with “Y”
American Indian (Native American)
Hispanic or Latino
Black
Asian
Native Hawaiian/Pacific Islander
White (Caucasian)
Unable to Determine (Other)
Refused to Answer

NA
HS
BL
AS
AS
CW
UN
UN

i

AHCCCS Conversion
Native American
Hispanic
Black
Asian/Pacific Islander
Asian/Pacific Islander
Caucasian/White
Unknown/Unspecified
Unknown/Unspecified

Appendix B
For the next measurement period (October 1, 2005, through September 30, 2006), AHCCCS has
adopted the following Minimum Performance Standard (MPS) and Goal for each of the
measures reported in this publication. If Contractors are already meeting the MPS for a particular
measure, they should strive to meet the Goal.
AHCCCS CYE 2007
MPS*

AHCCCS CYE 2007
Goal*

Children’s Access to PCPs, 12 − 24 Months

85%

86%

Children’s Access to PCPs, 25 Months – 6 Years

78%

80%

Children’s Access to PCPs, 7 – 11 Years

77%

79%

Children’s Access to PCPs, 12 – 19 Years
Adults’ Access to Preventive/Ambulatory Health Services,
20-44 Years
Adults’ Access to Preventive/Ambulatory Health Services,
45-64 Years

79%

81%

78%

80%

83%

84%

Breast Cancer Screening

50%

52%

Cervical Cancer Screening

57%

60%

Chlamydia Screening

43%

45%

Timeliness of Prenatal Care

70%

72%

Measure/Age Group

* AHCCCS Performance Standards will be compared to rates for the measurement period of CYE 2006, as specified
in CYE 2007 contracts with health plans.

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ii