Quality Management Performance Measures For Acute-care Contractors and The Division of Developmental Disabilities Measurement Period Ending Sept. 30, 2009 Prepared by the Division of Health Care Management December 2010 AHCCCS Arizona Health Care Cost Containment System Thomas J. Betlach, Director TABLE OF CONTENTS INTRODUCTION Overview .................................................................................................................... Methodology .............................................................................................................. Data Sources …………............................................................................................... Data Validation ………….......................................................................................... Data Limitations …………......................................................................................... Deviations from Previous Methodology …………..................................................... 1 1 2 2 2 3 HIGHLIGHTS OF THE DATA Results for Acute-care Contractors ............................................................................. Results for DES/DDD ................................................................................................. Contractor Performance Standards and Improvement ................................................ 3 5 6 THE MEASURES Children’s and Adolescents’ Access to Primary Care Practitioners ........................... Adults’ Access to Preventive/Ambulatory Health Services ....................................... Well-Child Visits in the First 15 Months of Life ........................................................ Well-Child Visits in the Third, Fourth, Fifth and Sixth Months of Life ..................... Adolescent Well-Care Visits ……............................................................................... Annual Dental Visits ................................................................................................... Breast Cancer Screening ............................................................................................. Cervical Cancer Screening .......................................................................................... Chlamydia Screening .................................................................................................. Timeliness of Prenatal Care ........................................................................................ 9 13 16 19 22 25 28 31 33 36 ACUTE-CARE MEASURES FOR DES/DDD Overview ..................................................................................................................... Performance Standards ................................................................................................ Children’s and Adolescents’ Access to Primary Care Practitioners ........................... Well-Child Visits in the Third, Fourth, Fifth and Sixth Months of Life ..................... Adolescent Well-Care Visits ……............................................................................... Annual Dental Visits ................................................................................................... 39 39 40 40 41 41 CONCLUSION Overall Results …………………………................................................................... References .......................................……..………..................................................... 42 43 PERFORMANCE MEASURE TABLES INTRODUCTION Overview This is the annual report on Acute-care clinical quality performance measures by the Arizona Health Care Cost Containment System (AHCCCS). The report includes data on preventive health services provided to members enrolled with nine publicly and privately operated managed care organizations (MCOs) that contract with AHCCCS (referred to as Contractors) to provide services under the AHCCCS Acute-care program. In addition, performance measure results for services provided through the Department of Economic Security’s Division of Developmental Disabilities (DES/DDD) are included in an appendix. This report includes performance measurement data from nine publicly and privately operated managed care organizations These results should be viewed as indicators of utilization of services, rather than absolute rates. These data allow AHCCCS and its Contractors to identify areas for improvement and implement interventions to increase the use of preventive services. Methodology AHCCCS used Healthcare Effectiveness Data and Information Set (HEDIS®) 2010 specifications to collect and report 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 HEDIS requirements for selecting members to be included in the measures is that they are continuously enrolled for a minimum period of time with one Contractor. Thus, members included in the measures represent only a portion of the AHCCCS acute-care population. This report includes results for the contract year ending Sept. 30, 2009. Results are reported for Contractors overall and by individual health plan. The report also indicates whether changes in rates are statistically significant when compared with rates in the previous measurement. 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 a difference by chance is relatively low. National HEDIS averages for Medicaid and commercial managed care plans also are included in this report. However, it should be noted that some HEDIS measures may be calculated using data extracted from medical records, as well as claims for services (this is known as a hybrid data collection methodology). The use of medical records may reflect more complete data (and thus higher rates) than claims alone. Because national averages include data reported by health plans using the hybrid data collection methodology, they may not be directly comparable to rates reported by AHCCCS, which does not currently use a hybrid methodology to collect data for these measures. 1 In addition, some health plans in other states report HEDIS rates based on combined data for members eligible under Medicaid (Title XIX of the Social Security Act) and those eligible under the Children’s Health Insurance Program (CHIP, or Title XXI), known in Arizona as KidsCare. In Arizona, rates for these measures are typically higher among members covered under KidsCare. However, because the populations differ in terms of socioeconomic status, Arizona reports rates for these eligibility groups separately. The difference in reporting Medicaid rates separately from KidsCare rates also limits comparisons between Arizona and national HEDIS rates. The numerator data are based on encounters for professional services, primarily physician office and clinic visits 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, primarily physician office and clinic visits. 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. In addition, AHCCCS conducts a rigorous check of data quality for these measures each year. A random sample of denominator and numerator data are selected for each measure, and a multidisciplinary team checks recipient and service details to verify that AHCCCS members are correctly included or excluded from the denominator and numerator, based on HEDIS criteria. Data Limitations The data reported here are subject to a limitation because rates are based on encounter data, and may be negatively affected if Contractors have not submitted complete and accurate encounters to AHCCCS. In addition, members may receive health care services through other programs, such as Indian Health Service, Medicare, other medical coverage, or free/low-cost community providers. Thus, they may have received a service being measured, but it is not counted because it was not paid for under Medicaid or CHIP. 2 To minimize the impact of limited data available for Medicare beneficiaries who also are enrolled in AHCCCS, dual-eligible members who are enrolled in Medicare MCOs or who have fee-forservice Medicare coverage are excluded from the measurement. Consistent with HEDIS methodology, AHCCCS includes members who are enrolled in a Medicare plan that is aligned with their Medicaid plan (i.e., operated by or contracted with the same organization). Deviations from Previous Methodology The HEDIS methodology used for data collection in the current measurement differs from the methodology used for the previous measurement as follows: • Chlamydia Screening – AHCCCS added to its programming the HEDIS logic that excludes some members when identifying the denominator for this measure, women who are sexually active. Members who had a pregnancy test during the measurement year, followed within seven days (inclusive) by either a prescription for isotretinoin (Accutane) or an X-ray, were excluded. This exclusion does not apply to members who qualified for the denominator based on services other than the pregnancy test alone (e.g., they also received a prescription for oral contraceptives). • Timeliness of Prenatal Care – NCQA eliminated LOINC codes for lab panels because they indicate that tests were ordered, not necessarily that all tests in the panel were performed; however AHCCCS did not use these codes in the previous measurement. In addition to these changes, NCQA updates its methodology annually to add new codes to better identify the eligible population and/or services being measured or delete codes that have been retired from standardized coding sets used by providers, such as Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) coding. AHCCCS made these coding changes as well. HIGHLIGHTS OF THE DATA Results for Acute-care Contractors This report includes 22 measures of access to care and use of preventive services for which AHCCCS has set performance standards for Acutecare Contractors (age groups for Children’s and Adolescents’ Access to Primary Care Practitioners and Adults’ Access to Preventive/Ambulatory Health Services are considered separate measures, as are Medicaid and KidsCare populations, which are reported separately for child and adolescent measures). 3 Of the 22 measures, 17 (77.3 percent) showed statistically significant improvement. Results include the following: • Children’s Access to PCPs –Rates in all four age groups improved over the previous measurement (the overall rate also improved, but AHCCCS does not have a performance standard for the total rate because there is no comparable national benchmark reported). The rate for one age group exceeded the most recent HEDIS national mean for Medicaid health plans. For KidsCare members, rates for three age groups also improved, while another age group did not show a statistically significant change. KidsCare rates for two age groups exceeded the national means for both Medicaid and commercial health plans. • Well-Child Visits in the First 15 Months of Life – The rate for Medicaid-eligible children showed a statistically significant improvement, and continues to exceed the national HEDIS Medicaid mean. The rate for KidsCare members did not change significantly from the previous year, but also is well above the national mean for Medicaid health plans. • Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life – The overall rate for Medicaid members increased, while the rate for KidsCare members did not show a statistically significant change. AHCCCS rates for Medicaid and KidsCare members exceed the national means for both Medicaid and commercial health plans. • Adolescent Well-Care Visits – The overall rate for Medicaid members increased, and the rate for KidsCare members did not show a statistically significant change. AHCCCS rates for Medicaid and KidsCare members exceed the national means for both Medicaid and commercial health plans for this measure as well. • Annual Dental Visits – Overall rates for both Medicaid and KidsCare populations increased from the previous year and remain well above the national Medicaid mean, with rates for both populations in the 90th percentile of Medicaid plans nationally (because commercial medical plans generally do not include dental services, NCQA does not report commercial benchmarks for this measure) • Adults’ Access to Preventive/Ambulatory Health Services – Rates for both age groups increased from the previous measurement, and continue to exceed the national Medicaid means. • Breast Cancer Screening –The rate for women 52 to 69 years increased from the previous year and exceeds the national Medicaid mean for this age group. 4 • Cervical Cancer Screening – This measure showed a small but significant decrease from the previous measurement, and falls below the national Medicaid mean. • Chlamydia Screening – The overall rate for this measure increased over the previous year, but falls below the national Medicaid mean. • Timeliness of Prenatal Care – This measure showed a significant increase from the previous measurement, but also falls below the national Medicaid mean. Results for DES/DDD AHCCCS has set performance standards for seven of the measures for children and adolescents enrolled with DES/DDD under Medicaid. It should be noted that eligibility for ALTCS members with developmental disabilities, differs from eligibility for Acute-care Contractors in that medical and functional criteria are considered along with financial criteria that are different than for non-DDD Medicaid members. Thus, many DDD members with AHCCCS coverage often have other medical coverage; recent data show that about 40 percent of DDD members also are covered by Medicare and/or private insurance. Because services can be provided through other insurers, AHCCCS may not have complete encounters for those services. The AHCCCSestablished performance standards reflect the data limitations for this population. Results include the following: • Children’s Access to PCPs –Rates in all four age groups improved over the previous measurement. Rates for two age groups – 12 to 24 months and 25 months to 6 years – exceeded HEDIS national means for Medicaid health plans, and the rate for children 12 to 24 months also exceeded the commercial health plan mean. • Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life – This rate also increased, but is below the national means for both Medicaid and commercial health plans. • Adolescent Well-Care Visits – The rate for this measure increased, and also is below the national means for Medicaid and commercial health plans. • Annual Dental Visits – The rate for this measure increased as well, and exceeded the national Medicaid mean. 5 Contractor Performance Standards and Improvement Contractor rates are compared to Minimum Performance Standards, as specified in the AHCCCS CYE 2010 contracts with health plans. The following table shows the Minimum Performance Standard (MPS) for Acute-care Contractors for each measure included in this report, as well as the AHCCCS Goal for the measure. Minimum standards are based on the most recent HEDIS national Medicaid means available from NCQA or, if the AHCCCS statewide average already is above the HEDIS mean, a rate slightly above the current rate. AHCCCS Goals are based on national “Healthy People 2010” objectives set by the U.S. Department of Health and Human Services several years ago. CYE 2010 Acute-care Performance Standards Performance Measure Children’s Dental Visits 2 to 21* Well-child Visits 15 Months* Well-child Visits 3 - 6 Years* Adolescent Well-care Visit* Children's Access to PCPs 12-24 Months* Children's Access to PCPs 25 months-6 Years* Children's Access to PCPs 7-11 Years* Children's Access to PCPs 12-19 Years* Cervical Cancer Screening Breast Cancer Screening Adult Preventive/Ambulatory Care 20-44 Years Adult Preventive/Ambulatory Care 45-64 Years Timeliness of Prenatal Care Chlamydia Screening Minimum Performance Standard 55% 65% 64% 41% Goal 57% 90% 80% 50% 93% 97% 83% 83% 81% 65% 54% 97% 97% 97% 90% 70% 78% 96% 85% 80% 51% 96% 90% 62% * Medicaid and KidsCare populations for these measures are evaluated separately against the AHCCCS contractual standards, and are thus counted as two separate measures. As noted, additional challenges in collecting complete data for DES/DDD members due to third-party insurance are reflected in the performance standards for this Contractor. These standards are as follows: 6 AHCCCS Performance Standards for the Division of Developmental Disabilities (DDD) Minimum Performance Standard (MPS) Goal Children’s Access to PCPs – 12 to 24 Months 78% 97% Children’s Access to PCPs – 25 Months to 6 Years 70% 97% Children’s Access to PCPs – 7 to 11 Years 70% 97% Children’s Access to PCPs – 12 to 19 Years 70% 97% Well-Child Visits 3 – 6 Yrs 44% 80% Adolescent Well-Care Visits 31% 50% Annual Dental Visits, 2 – 21 Yrs 41% 57% The following table shows the number of measures reported for each Contractor and the number for which the Contractor met the AHCCCS MPS in the current measurement. Contractor Performance Number of Measures in Which Contractor was Included Number of Measures for Which MPS was Met Mercy Care Plan 22 18 81.8% Phoenix Health Plan 22 18 81.8% Arizona Physicians IPA 22 15 68.2% Care 1st Healthplan of Arizona 22 15 68.2% Health Choice Arizona 22 13 59.1% Maricopa Health Plan 22 11 50.0% University Family Care (1) 21 12 57.1% Bridgeway Health Solutions (1) 15 7 46.7% DES/DDD 7 7 100.0% DES/CMDP (2) 7 6 85.7% Pima Health System (3) 4 2 50.0% Contractor Percent of Measures for Which MPS was Met Notes: 1. All Acute-care performance measures are included in contract for these two Contractors, but they did not have members who met the measure criteria for all measures. 2. The Department of Economic Security’s Comprehensive Medical and Dental Program (CMDP), a health plan for children and adolescents in foster care, has fewer performance standards than most other Acute-care Contractors. In addition, CMDP has too few KidsCare members to measure this population separately. 3. Pima Health System also has fewer performance measures because it serves primarily Medicare-Medicaid dual-eligible adults and any eligible family members who wish to enroll in the plan under its Acute-care contract with AHCCCS. 7 Overall rates for nearly all measures increased because of significant increases demonstrated by several Contractors. In July 2007, AHCCCS advised Contractors that it would levy financial sanctions if Contractors did not improve their performance, and followed up with ongoing monitoring, including requiring Contractors to evaluate the effectiveness of corrective actions and implement new interventions as necessary. This regulatory approach appears to have encouraged health plans to apply the resources necessary to increase rates. AHCCCS will request new corrective action plans (CAPs) from Contractors to bring their rates up to compliance with minimum standards when Minimum Performance Standards are not met. If Contractors already have CAPs in place as a result of the previous measurement, they will have to demonstrate that they have evaluated the effectiveness of interventions and are implementing new or revised actions to improve rates. 8 CHILDREN’S AND ADOLESCENTS’ 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 (Oct. 1, 2008, through Sept. 30, 2009), and • had one or more visits with PCPs (such as pediatricians, general or family practitioners, internists, physician’s assistants, nurse practitioners or obstetrician/gynecologists) during the measurement period. To be included in the denominator, members in the age groups of 12 to 24 months and 25 months to 6 years had to be continuously enrolled with the same Contractor during the measurement year (one break in enrollment was allowed if the gap did not exceed one member-month). To be counted in the numerator, these members would have had one or more PCP visits during the measurement year. Members 7 to 11 years and 12 to 19 years were included in the denominator if they were continuously enrolled with the same Contractor during the measurement year and the previous year (one break in enrollment was allowed per year if neither gap exceeded one member-month). These members were counted in the numerator if they had at least one PCP visit during the two-year period. Results for members who were eligible under Medicaid and the State Children’s Health Insurance Program (SCHIP), known as KidsCare, were calculated separately, by age group. Performance Goals AHCCCS has adopted Minimum Performance Standards by age group, which apply to both Medicaid and KidsCare members, for the current measurement, based on the most recent national Medicaid means reported by NCQA. AHCCCS also has set Goals based on national Healthy People 2010 objectives. These are shown in the following table: 9 AHCCCS Performance Standards for Children’s and Adolescents’ Access to PCPs Minimum Performance Standard (MPS) Goal 12 – 24 Months 93% 97% 25 Months – 6 Years 7 – 11 Years 12 – 19 Years 83% 83% 81% 97% 97% 97% Age Group Rates for Medicaid members in all four age groups increased, while rates for KidsCare members in three age groups increased Results Rates for all age groups in the Medicaid population increased from the previous measurement (Table 1). KidsCare rates for three age groups increased, while the rate for one age group did not significantly change (Table 2). In the current period, the total rate (all age groups combined) for Medicaid members was 84.0 percent, an increase from the previous rate of 80.8 percent in the previous year (p<.001). The total rate for KidsCare members was 89.4 percent, an increase from 87.2percent in the previous year (p<.001). AHCCCS does not set performance standards for the total rate for Children’s and Adolescents’ Access to PCPs because there is no comparable national benchmark available from NCQA; however, it analyzes the total rate for trending purposes. Comparison with National Benchmarks NCQA has reported 2009 national HEDIS means (averages) for Medicaid and commercial health plans. AHCCCS Medicaid and KidsCare rates compare to the national means as follows: AHCCCS Rates Compared with National HEDIS Means AHCCCS Medicaid Rate AHCCCS KidsCare Rate HEDIS Medicaid Mean HEDIS Commerci al Mean 12 – 24 Months 87.5% 93.0% 93.4% 96.9% 25 Months – 6 Years 7 – 11 Years 12 – 19 Years 84.0% 82.8% 83.5% 89.0% 89.8% 88.8% 84.3% 85.8% 82.6% 89.4% 89.5% 86.9% Measure/ Age Group 10 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. Thus, rates for Children’s and Adolescents’ Access to PCPs are highest for children 12 to 24 months. However, several AHCCCS health plans showed strong performance compared with national averages for adolescents’ access to PCPs, particularly among members enrolled under KidsCare. Consistent with previous measurements, children enrolled with AHCCCS Contractors through KidsCare have higher rates of preventive services than those enrolled under Medicaid. Parents of KidsCare members pay premiums for coverage and thus may be more likely to ensure that their children receive services such as well-care visits. These parents also may have a higher level of education and a better understanding of the need for preventive health care services. In the current measurement, three Contractors − DES/CMDP, Mercy Care Plan, and Phoenix Health Plan ─ met the Minimum Performance Standard (MPS) for three of four age groups for Medicaid-eligible members. Two Contractors ― Health Choice Arizona and Phoenix Health Plan ― each met the MPS for all four age groups among KidsCare members. While Contractors are evaluated on their rates by age group, Figures 1 and 2 show Contractor rates when all age groups are combined. 11 Figure 1. Rates by Contractor, Children’s Access to PCPs among Medicaid Members, All Age Groups Combined CYE 2009 compared with CYE 2008 100% 80% 60% 40% 20% 0% APIPA Bwy Care 1st CM DP HCA M HP CYE 2009 M CP PHP UFC CYE 2008 As shown above, the Comprehensive Medical and Dental Program (CMDP) had the highest rate of access to PCPs among Medicaideligible members for all age groups combined (88.0 percent). CMDP is a health plan operated by the state Department of Economic Security (DES) for children and adolescents in foster care. When these children and adolescents are taken into custody by the state, case managers work to ensure that they have a medical visit as soon as possible. Figure2. Rates by Contractor, Children’s Access to PCPs among KidsCare Members, All Age Groups Combined CYE 2009 compared with CYE 2008 100% 80% 60% APIPA BWY Care 1st HCA CYE 2009 M HP M CP PHP UFC CYE 2008 For KidsCare members, Mercy Care Plan recorded the highest total rate (91.0 percent). 12 ADULTS’ ACCESS TO PREVENTIVE AND AMBULATORY HEALTH SERVICES Behavioral risk factors such as smoking, poor diet, physical inactivity, and excessive drinking are linked to the leading causes of death in the United States. Controlling these behavioral risk factors and using preventive health services (e.g., smoking cessation services, influenza vaccinations and cholesterol screenings) can substantially reduce disease and premature death among U.S. adults.6,7 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 acute-care health plan members found that 44 percent of adults have smoked 100 or more cigarettes in their lifetimes and, of those, 62 percent still smoke either sometimes or every day (current smokers). 8 The most recent national data show an estimated 19.8 percent of Arizona adults are current cigarette smokers. 9 Rates of smoking increase as income falls below the federal poverty level. 8 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. Yet, a survey by the Centers for Disease Control and Prevention found that only 65.5 percent of Arizona adults had visited a doctor for a routine checkup in the preceding 12 months. 6 Description AHCCCS measured the percentage of Medicaid members who: • were ages 20 through 44 and 45 through 64 years at the end of the measurement period (Oct. 1, 2008, through Sept. 30, 2009), • 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 member-month), and • had one or more preventive/ambulatory visits, including encounters with primary care physicians, specialists, physician’s assistants, nurse practitioners, ophthalmologists and optometrists. Performance Goals AHCCCS has adopted Minimum Performance Standards by age group for Adults’ Access to Preventive/Ambulatory Health Services for the current measurement, based on the most recent national Medicaid means reported by NCQA. AHCCCS also has set Goals based on national Healthy People 2010 objectives. These are shown in the following table: 13 AHCCCS Performance Standards for Adults’ Access to Preventive/Ambulatory Health Services Minimum Performance Standard (MPS) Goal 20 – 44 Years 78% 96% 45 – 64 Years 85% 96% Age Group Rates for both age groups increased, and exceed the national Medicaid means Results Rates for both age groups showed statistically significant increases (Table 3). The total rate of both age groups combined also increased in the current measurement, to 84.6 percent from 83.0 percent in the previous year (p<.001). AHCCCS does not set performance standards for the total rate for Adults’ Access to Preventive/Ambulatory Health Services because there is no comparable national benchmark available from NCQA; however, it analyzes the total rate for trending purposes. Comparison with National Benchmarks NCQA has reported 2009 national HEDIS means for Medicaid and commercial health plans. The AHCCCS rates compare to the national means as follows: AHCCCS Rates Compared with National HEDIS Means AHCCCS Medicaid Rate HEDIS Medicaid Mean HEDIS Commercial Mean 20 – 44 Years 82.9% 76.8% 93.0% 45 – 64 Years 87.7% 82.4% 95.1% Measure/ Age Group Discussion Ensuring that adult members use preventive services is challenging. This may be due to lack of awareness among members about when and what types of routine preventive health services are recommended, or 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. 14 Seven of nine Contractors — Arizona Physicians IPA, Bridgeway Health Solutions, Care1st Healthplan, Health Choice Arizona, Mercy Care Plan, Phoenix Health Plan and University Family Care ― met the MPS for both age groups. While Contractors are evaluated on their rates by age group, Figure 3 shows Contractor performance when both age groups are combined. Figure 3. Rates by Contractor, Both Age Groups of Adults Combined, Medicaid Members CYE 2009 compared with CYE 2008 100% 80% 60% 40% 20% 0% APIPA Bwy Care 1st HCA CYE 2009 M HP M CP PHP PHS UFC CYE 2008 Phoenix Health Plan showed the highest rate (86.0 percent) for Adults’ Access to Preventive/Ambulatory Health Services when both age groups were combined. 15 WELL CHILD VISITS IN THE FIRST 15 MONTHS OF LIFE The most dramatic growth during childhood – physical, cognitive, social and emotional – occurs during infancy. In the first year of life, an infant’s birth weight triples, his length increases by almost 50 percent, and he achieves most of his brain growth.10 During this time, health care providers can help ensure that children are adequately protected against infectious diseases by vaccinating them and screening for physical illness or developmental delays, which can be minimized with early intervention. This also is an ideal time to counsel parents about infant care, nutrition, sleep position and injury prevention.10 Description AHCCCS measured the percentage of children who: • turned 15 months old during the measurement period (Oct. 1, 2008, through Sept. 30, 2009), • were continuously enrolled with one acute-care Contractor from 31 days of age through their 15-month birthdays (one break in enrollment, not exceeding one member-month, was allowed), and • had six or more well-child visits during the first 15 months of life. Performance Goals AHCCCS has adopted a Minimum Performance Standard that applies to both Medicaid and KidsCare members for the current measurement, based on the most recent national Medicaid mean reported by NCQA. AHCCCS also has set a Goal based on national Healthy People 2010 objectives. These are shown in the following table: AHCCCS Performance Standards for Well Child Visits in the First 15 Months of Life Age Group Well-Child Visits, 15 Months Minimum Performance Standard (MPS) Goal 65% 90% Results The overall rate for Medicaid members (Table 4) increased significantly in the current measurement to 64.2 percent, from 59.5 percent (p<.001). The overall rate for KidsCare members (Table 5) was effectively unchanged at 71.0 percent, compared with 71.3 percent in the previous measurement (p=.221). 16 Comparison with National Benchmarks NCQA has reported 2009 national HEDIS means for Medicaid and commercial health plans. AHCCCS Medicaid and KidsCare rates compare to the national means as follows: AHCCCS Rates Compared with National HEDIS Means Measure/ Age Group AHCCCS Medicaid Rate 64.2% Six Well Child Visits by 15 Months of Age The AHCCCS rates exceed the national Medicaid mean AHCCCS KidsCare Rate 71.0% HEDIS Medicaid Mean 53.0% HEDIS Commercia l Mean 72.8% Discussion While the AHCCCS overall rate for Well Child Visits in the First 15 Months of Life among Medicaid members is above the national mean, there is still room for improvement in this rate, given the goal that AHCCCS has established. Care1st Healthplan, Maricopa Health Plan, Mercy Care Plan and Phoenix Health Plan met the Minimum Performance Standard for Medicaid-eligible children, while all Contractors except Arizona Physicians IPA and Maricopa health Plan met the MPS for the KidsCare population. Figure 4. Rates by Contractor, Well-Child Visits in the First 15 Months of Life, Medicaid Members CYE 2009 compared with CYE 2008 10 0% 80 % 60 % 40 % 20 % 0% APIPA Care 1st HCA CYE 2009 M HP M CP PHP UFC CYE 2008 Care1st Healthplan had the highest rate for this measure in the current period (72.6 percent). 17 Figure 5. Rates by Contractor, Well-Child Visits in the First 15 Months of Life, KidsCare Members CYE 2009 compared with CYE 2008 100% 80% 60% 40% 20% 0% APIPA Care 1st HCA CYE 2009 M HP M CP PHP CYE 2008 Care 1st Healthplan had the highest rate for this measure in the current period (84.0 percent). 18 WELL CHILD VISITS IN THE THIRD, FOURTH, FIFTH AND SIXTH YEARS OF LIFE Children who are healthy are better able to learn and develop.11,12 Well-child visits during the preschool and early school years are important in helping children reach their full potential and become productive, healthy adults. These visits allow any medical, behavioral or developmental problems to be detected and addressed. Health care providers also can administer any needed vaccines and educate parents about adequate nutrition, oral health and injury prevention during well-child visits. Evidence shows that provider counseling can increase the use of seat belts, child safety seats and bicycle helmets, especially when directed at the parents. Description AHCCCS measured the percentage of members who: • were ages 3 through 6 years at the end of the measurement period (Oct. 1, 2008, through Sept. 30, 2009), • 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 member-month), and • had at least one well-child visit during the measurement period. Performance Goals AHCCCS has adopted a Minimum Performance Standard that applies to both Medicaid and KidsCare members for the current measurement, based on the most recent national Medicaid mean reported by NCQA. AHCCCS also has set a Goal based on national Healthy People 2010 objectives. These are shown in the following table: AHCCCS Performance Standards for Well Child Visits in the Third, Fourth, Fifth and Sixth Years of Life Age Group Well-Child Visits, 3 through 6 Years Minimum Performance Standard (MPS) Goal 64% 80% Results The overall rate for Medicaid members (Table 6) increased to 69.4 percent from 66.2 percent in the previous measurement (p<.001). The rate for KidsCare members (Table 7) was effectively unchanged at 73.7 percent, compared with 73.4 percent from in the previous measurement (p=.301). 19 Rates for both Medicaid and KidsCare members exceed the national means for Medicaid plans, and the KidsCare rate exceeds the commercial health plan mean Comparison with National Benchmarks NCQA has reported 2009 national HEDIS means for Medicaid and commercial health plans. AHCCCS Medicaid and KidsCare rates compare to the national means as follows: AHCCCS Rates Compared with National HEDIS Means Measure/ Age Group AHCCCS Medicaid Rate AHCCCS KidsCare Rate HEDIS Medicaid Mean HEDIS Commercial Mean Well-Child Visits, 3 through 6 Years 69.4% 73.7% 65.3% 67.8% Discussion In the first two years of life, children 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 primary care visits, unless they are ill or have other specific needs. Targeted efforts by AHCCCS health plans to educate parents about the value of preventive care visits for children in this age range appear to be effective based on the AHCCCS rates compared with national means. Arizona Physicians IPA, Care1st Healthplan, DES/CMDP, Maricopa Health Plan. Mercy Care Plan and Phoenix Health Plan met the Minimum Performance Standard for Medicaid-eligible children, while all Contractors except Bridgeway Health Solutions met the MPS for the KidsCare population. Figure 6. Rates by Contractor, Well-Child Visits in Third through Sixth Years of Life, Medicaid Members CYE 2009 compared with CYE 2008 100% 80% 60% 40% 20% 0% APIPA Bwy Care 1st CM DP CYE 2009 20 HCA M HP CYE 2008 M CP PHP UFC Mercy Care Health Plan had the highest rate of well-child visits for Medicaid members in this age group in the current period (74.4 percent). Six Contractors met the MPS for Medicaid-eligible children. Figure 7. Rates by Contractor, Well-Child Visits in the Third through Sixth Years of Life, KidsCare Members CYE 2009 compared with CYE 2008 100% 80% 60% 40% 20% 0% APIPA Bwy Care 1st HCA CYE 2009 M HP M CP PHP UFC CYE 2008 Care1st Healthplan had the highest rate for KidsCare members in the current period (80.7 percent. Seven Contractors met the AHCCCS MPS for this population. 21 ADOLESCENT WELL-CARE VISITS Adolescence generally is characterized by good health. However, data indicate that many teenagers are involved in unhealthy behaviors, including alcohol and drug use, tobacco use, unprotected sex, driving without seat belts and speeding, poor diet and inadequate physical activity. Nationally and in Arizona, the major causes of death in adolescents are motor vehicle accidents, homicide, suicide, malignant neoplasms (cancer) and disease of the heart.6,13 Many of these unhealthy behaviors and other medical problems can lead to chronic health conditions that last throughout life. In recent years, obesity has become a major cause of adolescent morbidity, contributing to a dramatic increase in the number of youth with type 2 diabetes mellitus.14 Several national studies show higher rates of overweight, low fitness, and diabetes among Hispanic and Black adolescents, compared with White adolescents.15 Since most of the factors that contribute to adolescent morbidity and mortality are preventable or may be minimized with medical treatment, it is crucial to identify early signs of unhealthy behaviors or physical problems. Regular well-care visits that address the psychological, behavioral and physical aspects of health are very important in helping adolescents become healthy adults. Description This indicator measured the percentage of members who: • were ages 12 to 21 years if eligible under Medicaid or 12 to 19 years if eligible under KidsCare at the end of the measurement period (Oct. 1, 2008, through Sept. 30, 2009), • were continuously enrolled with one acute-care Contractor during the measurement period (one break in enrollment, not exceeding one member-month, was allowed), and • had at least one well care visit during the measurement year. Performance Goals AHCCCS has adopted a Minimum Performance Standard that applies to both Medicaid and KidsCare members for the current measurement, based on the most recent national Medicaid mean reported by NCQA. AHCCCS also has set a Goal based on national Healthy People 2010 objectives. These are shown in the following table: AHCCCS Performance Standards for Adolescent Well Care Visits Age Group Minimum Performance Standard (MPS) Goal Adolescent Well-Care Visits 41% 50% 22 The rate for KidsCare members exceeds the national means for both Medicaid and commercial health plans Results The overall Medicaid rate for this measure (Table 8) improved to 43.0 percent from 41.6 percent in the previous period (p<.001). The rate for KidsCare members (Table 9) was unchanged at to 51.7 percent, compared with 51.6 percent in the previous period (p=.643). Comparison with National Benchmarks NCQA has reported 2009 national HEDIS means for Medicaid and commercial health plans. AHCCCS Medicaid and KidsCare rates compare to the national means as follows: AHCCCS Rates Compared with National HEDIS Means Measure/ Age Group Adolescent Well Care Visits AHCCCS Medicaid Rate AHCCCS KidsCare Rate HEDIS Medicaid Mean HEDIS Commercial Mean 43.0% 51.7% 42.0% 41.8% Discussion The relatively low rates for adolescent preventive care visits, both nationally and among AHCCCS health plans, demonstrates the difficulty in getting adolescents to do something they may not think is worthwhile, and the tendency of parents to not take them to the doctor unless they are sick. However, targeted outreach to parents and older adolescents by some Contractors appears to be having an impact on rates. Figure 8. Rates by Contractor, Adolescent Well-Care Visits, Medicaid Members CYE 2009 compared with CYE 2008 10 0% 80 % 60 % 40 % 20 % 0% APIPA Bwy Care 1st CM DP CYE 2009 HCA M HP M CP PHP UFC CYE 2008 CMDP had the highest rate of Adolescent Well Care visits among the Medicaid population (65.7 percent). 23 Figure 9. Rates by Contractor, Adolescent Well-Care Visits, KidsCare Members CYE 2009 compared with CYE 2008 100% 80% 60% 40% 20% 0% APIPA Bwy Care 1st HCA CYE 2009 M HP M CP PHP UFC CYE 2008 Phoenix Health Plan had the highest rate for the KidsCare population (53.0 percent), as shown in Figure 18. Five Contractors ─ APIPA, Care1st Healthplan, DES/CMDP, Mercy Care Plan and Phoenix Health Plan ─ met the Minimum Performance Standard for Medicaid members in the current measurement, and all Contractors met the MPS for the KidsCare population. 24 ANNUAL DENTAL VISITS Oral health is inseparable from overall health status. A child's ability to learn and function well can be affected by problems of the teeth and gums. Dental disease results in children’s failure to thrive, impaired speech development, absence from and inability to concentrate in school and reduced self-esteem. Even though most oral diseases are preventable, tooth decay is one of the most common health problems among children today. 16,17 Brushing, flossing and other oral health practices can reduce the risk of developing diseases of the teeth and gums. Regular professional dental care, in combination with these practices, is important. Preventive services, such as the application of topical fluorides, are known to reduce the rate of tooth decay and other oral diseases in children.17 Routine dental visits also serve to educate individuals about dental hygiene and preventive measures. The American Association of Pediatric Dentistry recommends that dental visits being by age 1. Description AHCCCS measured the percentage of children and adolescents who: • were ages 2 through 21 years if eligible under Medicaid, or 2 through 19 years if eligible under KidsCare, at the end of the measurement period (Oct. 1, 2008, through Sept. 30, 2009), • were continuously enrolled with one acute-care Contractor during the measurement period (one break in enrollment, not exceeding one member-month, was allowed), and • had at least one dental visit during the measurement year. Performance Goals AHCCCS has adopted a Minimum Performance Standard that applies to both Medicaid and KidsCare members for the current measurement, based on the most recent national Medicaid mean reported by NCQA. AHCCCS also has set a Goal based on national Healthy People 2010 objectives. These are shown in the following table: AHCCCS Performance Standards for Annual Dental Visits Age Group Annual Dental Visits, 2 through 21 Years 25 Minimum Performance Standard (MPS) Goal 51% 57% Rates for both Medicaid and KidsCare are well above the national mean for Medicaid health plans Results Among Medicaid members (Table 10), the overall rate increased to 64.0 percent from 60.9 percent in the previous year (p<.001). Among KidsCare members (Table 11), the rate also increased, to 74.3 percent from 71.8 percent in the previous year (p<.001). Comparison with National Benchmarks NCQA has reported 2009 national HEDIS means for Medicaid health plans. The HEDIS measure does not apply to commercial health plans because dental services are usually provided through a separate arrangement (dental managed care organization or fee-for-service). AHCCCS Medicaid and KidsCare rates compare favorably to the 90th percentile of Medicaid plans nationally, so that rate is also shown. AHCCCS Medicaid and KidsCare rates compare to national means as follows: AHCCCS Rates Compared with National HEDIS Means Measure/ Age Group Annual Dental Visits, 2 through 21 Years AHCCCS Medicaid Rate AHCCCS KidsCare Rate HEDIS Medicaid Mean Medicaid 90th Percentile 64.0% 74.3% 43.5% 61.3% Discussion Over the last several years, AHCCCS has focused much attention on improving rates of dental services among enrolled children and adolescents. In 2003, the Agency implemented a Performance Improvement Project (PIP), which required all Acute-care Contractors to show statistically significant improvement in rates of annual dental visits. This PIP and other initiatives appear to have had a very positive effect on improving the rate of annual dental visits. While this is a service area in which AHCCCS excels nationally, the rate of annual dental visits is lower than some other preventive services. More work needs to be done to ensure that children and adolescents have regular dental checkups. 26 Figure 10. Rates by Contractor, Annual Dental Visits, Medicaid Members CYE 2009 compared with CYE 2008 100% 80% 60% 40% 20% 0% APIPA Bwy Care 1st CM DP HCA M HP CYE 2009 M CP PHP UFC CYE 2008 CMDP had the highest rate of Annual Dental Visits for Medicaid members in the current measurement (69.8 percent). All Contractors met the Minimum Performance Standard. Figure 11. Rates by Contractor, Annual Dental Visits, KidsCare Members CYE 2009 compared with CYE 2008 100% 80% 60% 40% 20% 0% APIPA Bwy Care 1st HCA CYE 2009 M HP M CP PHP UFC CYE 2008 For the KidsCare population, Health Choice Arizona achieved the highest rate (75.0 percent). All Contractors achieved the AHCCCS MPS for this population as well. 27 BREAST CANCER SCREENING Breast cancer is the second leading cause of cancer death among North American women. Approximately 1 in 8 women will receive a diagnosis of breast cancer during her lifetime, and 1 in 30 will die of the disease. Breast cancer incidence increases with age, and although significant progress has been made in identifying risk factors, more than 50 percent of cases occur in women without known major predictors.18 According to the Centers for Disease Control and Prevention, more than 180,000 women are diagnosed with breast cancer each year, and more than 41,000 women die of the disease.19 On average, nearly 700 Arizona women die of breast cancer each year.20 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.21 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.18,22,23 However, results from a recent study of managed care plan members showed declining screening rates from 1999 to 2002.19 Description AHCCCS measured the percentage of members who: • were ages 52 through 69 years at the end of the two-year measurement period (Oct. 1, 2007, through Sept. 30, 2009), • were continuously enrolled with one acute-care Contractor during the measurement period (one break in enrollment per year was allowed if each gap did not exceed one member-month), and • had a mammogram in the two-year period. Performance Goals AHCCCS has adopted a Minimum Performance Standard for Breast Cancer Screening for the current measurement, based on the most recent national Medicaid mean reported by NCQA. AHCCCS also has set a Goal based on a comparable national Healthy People 2010 objective. These are shown in the following table: 28 AHCCCS Performance Standards for Breast Cancer Screening Minimum Performance Standard (MPS) Goal 65.7% 70% Breast Cancer Screening, 52 – 69 Years The AHCCCS rate increased, and exceeds the national mean for Medicaid health plans Results In the current period, the overall rate for breast cancer screening (Table 12) among women 52 to 69 years of age was 65.7 percent, an increase from the previous rate of 62.3 percent (p<.001). Comparison with National Benchmarks NCQA has reported 2009 national HEDIS means for Medicaid and commercial health plans. The AHCCCS rates compare to the national means as follows: AHCCCS Rates Compared with National HEDIS Means Measure/ Age Group AHCCCS Medicaid Rate HEDIS Medicaid Mean HEDIS Commercial Mean Breast Cancer Screening, 52 – 69 Years 65.7% 54.8% 71.6% Discussion Identification of tumors while they are still localized and potentially curable can significantly reduce breast cancer mortality.24 However many women do not obtain mammograms at the recommended one- to two-year intervals. A significant percentage of women responding to a National Cancer Institute survey said they did not have a mammogram because they did not know they needed one or their doctor had not recommended one.24 Women of some 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.25-27 However, several Contractors have reported targeted interventions that appear to have significantly improved the rate of breast cancer screening among women covered by AHCCCS. 29 Figure 12. Rates by Contractor, Breast Cancer Screening among Medicaid Members CYE 2009 compared with CYE 2008 100% 80% 60% 40% 20% 0% APIPA Care 1st HCA M HP CYE 2009 M CP PHP PHS UFC UFC CYE 2008 University Family Care had the highest rate of breast cancer screening (68.2 percent). All Contractors met the AHCCCS minimum standard for this measure. 30 CERVICAL CANCER SCREENING The American Cancer Society estimates that more than 11,000 new cases of invasive cervical cancer were diagnosed in the United States in 2009, and that more than 4,000 women died from the disease last year. Approximately half of deaths due to cervical cancer occur in women who were not screened at timely intervals.28 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.25 While a vaccine is now available to protect teens and young women against HPV, women should continue to be screened for cervical cancer at regular intervals. The American College of Obstetricians and Gynecologists, the American Cancer Society and the U.S. Preventive Services Task Force recommend that adolescents and other 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 (or 24 through 64 years at the end of the measurement period, Oct. 1, 2008, through Sept. 30, 2009), • 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 member-month), and • had a Pap test in the measurement period or in either of the two preceding years. Performance Goals AHCCCS has adopted a Minimum Performance Standard for Cervical Cancer Screening for the current measurement, based on the most recent national Medicaid mean reported by NCQA. AHCCCS also has set a Goal based on a comparable national Healthy People 2010 objective. These are shown in the following table: AHCCCS Performance Standards for Cervical Cancer Screening Cervical Cancer Screening 31 Minimum Performance Standard (MPS) Goal 65% 90% Results The overall rate of cervical cancer screening (Table 13) declined slightly, to a rate of 62.6 percent from 63.2 percent in the previous measurement period. (p=.001). The AHCCCS rate decreased slightly, and is lower than the national means for Medicaid and commercial health plans Comparison with National Benchmarks NCQA has reported 2009 national HEDIS means for Medicaid and commercial health plans. The AHCCCS rates compare to the national means as follows: AHCCCS Rates Compared with National HEDIS Means Measure/ Age Group AHCCCS Medicaid Rate HEDIS Medicaid Mean HEDIS Commercial Mean 62.6% 64.8% 81.7% Cervical Cancer Screening 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.26,27 Figure 13. Rates by Contractor, Cervical Cancer Screening among Medicaid Members CYE 2009 compared with CYE 2008 100% 80% 60% 40% 20% 0% APIPA Bwy Care 1st HCA CYE 2009 M HP M CP PHP PHS UFC CYE 2008 Arizona Physicians IPA (APIPA) had the highest rate (68.2 percent). APIPA and Mercy Care Plan were the only Contractors that met the AHCCS Minimum Performance Standard for this measure. 32 CHLAMYDIA SCREENING Chlamydia is one of the most commonly reported sexually transmitted diseases (STDs) in the United States, infecting an estimated 2.8 million people each year. Yet, it often is undetected because up to 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.29 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 24 years at the end of the measurement period (Oct. 1, 2008, through Sept. 30, 2009), • 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 member-month), and • were screened for Chlamydia infection during the measurement period. Performance Goals AHCCCS has adopted a Minimum Performance Standard for Chlamydia Screening for the current measurement, based on the most recent national Medicaid mean reported by NCQA. AHCCCS also has set a Goal based on the 90th percentile rate reported for Medicaid health plans nationally. These are shown in the following table: AHCCCS Performance Standards for Chlamydia Screening Age Group Chlamydia Screening, 16 – 24 Years 33 Minimum Performance Standard (MPS) Goal 51% 62% Results The overall rate for Medicaid members (Table 14) improved to 45.4 percent from 39.9 percent in the previous measurement (p<.001). The AHCCCS rate increased and exceeded the national mean for commercial health plans but was lower than the Medicaid health plan mean Comparison with National Benchmarks NCQA has reported 2009 national HEDIS means for Medicaid and commercial health plans. The AHCCCS rates compare to the national means as follows: AHCCCS Rates Compared with 2008 National HEDIS Means Measure/ Age Group Chlamydia Screening, 16 − 24 Years AHCCCS Medicaid Rate HEDIS Medicaid Mean HEDIS Commercial Mean 45.4% 50.8% 38.1% Discussion The current recommendation for chlamydia screening for all sexually active females ages 16 through 25 was made by the U.S. Preventive Services Task Force several years ago, but it appears that providers have not fully implemented this recommendation. Physicians are sometimes reluctant to discuss such screening with their patients because of the stigma associated with STDs.30 Many women probably do not seek testing because they are not aware of the seriousness of Chlamydia infection or are embarrassed about possibly having a sexually transmitted disease. The often asymptomatic nature of the infection also presents a major barrier to testing. 30 34 Figure 14. Rates by Contractor, Chlamydia Screening, Medicaid Members CYE 2009 compared with CYE 2008 100% 80% 60% 40% 20% 0% APIPA Bwy Care 1st HCA CYE 2009 M HP M CP PHP UFC CYE 2008 Maricopa Health Plan (MHP) had the highest rate for this measure in the current period (51.4 percent), exceeding both the HEDIS Medicaid and commercial means and was the only Contractor to meet the AHCCCS Minimum Performance Standard. 35 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.31-35 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.36 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. Birth certificate data reported by the Arizona Department of Health Services show that more than half of the 92,616 deliveries in the state in 2009 are paid for through AHCCCS. This number includes deliveries covered by health plans, as well as those paid for directly by AHCCCS a fee-for-service basis ─ the majority of which (more than 14,000) were to undocumented immigrants covered under the Federal emergency Services, or FES, program who did not qualify for coverage of prenatal care through AHCCCS). ADHS also reported that 72.5 percent of AHCCCS births were to mothers who began care in their first trimester of pregnancy, while 92.6 percent of all mothers covered by private insurance began care in the first trimester.37 Description AHCCCS measured the percentage of female members who: • had a live birth during the measurement period (Oct. 1, 2008, through Sept. 30, 2009). • 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 immediately preceding delivery. Performance Goals AHCCCS has adopted a Minimum Performance Standard for Timeliness of Prenatal Care for the current measurement, based on the most recent national Medicaid mean reported by NCQA. AHCCCS also has set a Goal based on a comparable national Healthy People 2010 objective. These are shown in the following table: 36 AHCCCS Performance Standards for Timeliness of Prenatal Care Age Group Timeliness of Prenatal Care The AHCCCS rate was lower than the national Medicaid and commercial means Minimum Performance Standard (MPS) Goal 80% 90% Results The overall rate for Medicaid members (Table 15) had a statistically significant increase to 71.0 percent from a rate of 67.1 percent in the previous measurement (p<.001). Comparison with National Benchmarks NCQA has reported 2009 national HEDIS means for Medicaid and commercial health plans. The AHCCCS rates compare to the national means as follows: AHCCCS Rates Compared with 2008 National HEDIS Means Measure/ Age Group AHCCCS Medicaid Rate HEDIS Medicaid Mean HEDIS Commercial Mean 71.0% 81.4% 91.9% Timeliness of Prenatal Care Discussion 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 likely has resulted in underreporting of rates for this measure. AHCCCS has been working with Contractors to ensure more complete reporting, and has convened a work group with health plans to address collection of more complete data for this measure, as well as any additional member outreach efforts needed in this area. 37 Figure 15. Rates by Contractor, Timeliness of Prenatal Care, Medicaid Members CYE 2009 compared with CYE 2008 100% 80% 60% 40% 20% 0% APIPA Bwy Care 1st CYE 2009 HCA M HP M CP PHP UFC CYE 2008 Bridgeway Health Solutions(Bwy) had the highest rate for Timeliness of Prenatal Care (85.0 percent). Two Contractors, Bridgeway and Health Choice Arizona, met the Minimum Performance Standard for this measure. 38 ACUTE-CARE MEASURES FOR DES/DDD Overview The Arizona Department of Economic Security’s Division of Developmental Disabilities (DDD) provides needed supports to Arizona residents who are at risk of having a developmental disability if younger than 6 years or, if older, have a diagnosis of epilepsy, cerebral palsy, cognitive disability (such as mental retardation) or autism that was made prior to the age of 18 years, and have substantial functional limitations in at least three major areas, such as self-care, learning and mobility. Many of DDD’s clients are dependent on ventilators to breathe. Many children and adolescents with developmental disabilities have comorbid physical conditions, such as asthma, cerebral palsy and diabetes. They also suffer from emotional and behavioral problems, and adolescents in particular are more likely to need mental health services than younger children with special health care needs.38 But, like all children, those with special health care needs require preventive health care services. In addition to early intervention services and therapies to help support optimal development, children with disabilities should have well-child checkups at regular intervals to monitor and improve their health. In general, people with developmental disabilities also have poorer oral health and oral hygiene than those without such disabilities. Data indicate that people who have mental retardation have more untreated caries and a higher prevalence of gingivitis and other periodontal diseases than the general population. Medications, malocclusion, multiple disabilities, and poor oral hygiene combine to increase the risk of dental disease in people with developmental disabilities.39 Thus, they also require regular dental visits. More than 60 percent of Arizonans served by DDD also are covered under Medicaid through the Arizona Long Term Care System (ALTCS), a program of the Arizona Health Cost Containment System (AHCCCS). DDD provides primary and acute medical services through subcontracts with health plans, most of which also serve AHCCCS Acute-care members. Performance Standards Under its contract with DDD, AHCCCS has established Performance Measures and Standards for primary and preventive health care provided to children and adolescents. 39 These Performance Standards are designed to drive improvement in DDD’s performance toward Goals that are based on Healthy People 2010 objectives. They also reflect the limitation in collecting complete data for these members, who qualify for DDD based on different criteria than Acute-care members and may have medical coverage through their parents’ insurance or Medicare. Performance Measures are collected according to HEDIS methodology in the same way as Performance Measures for Acute-care Contractors. This section reports DDD’s performance in the following measures: AHCCCS Performance Standards for the Division of Developmental Disabilities (DDD) Minimum Performance Standard (MPS) Goal Children’s Access to PCPs – 12 to 24 Months 78% 97% Children’s Access to PCPs – 25 Months to 6 Years 70% 97% Children’s Access to PCPs – 7 to 11 Years 70% 97% Children’s Access to PCPs – 12 to 19 Years 70% 97% Well-Child Visits 3 – 6 Yrs 44% 80% Adolescent Well-Care Visits 31% 50% Annual Dental Visits, 2 – 21 Yrs 41% 57% Children’s and Adolescents’ Access to PCPs In the current measurement, rates for all age groups and overall showed significant increases (Table 16). The rate for the 12-to-24month group increased to 100.0 from the previous rate of 84.3 percent in the previous measurement (p=.002). The rate for members 25 months to 6 years increased to 85.3 percent from the previous rate of 76.6 percent (p<.001). The rate for members 7 to 11 years increased to 80.6 percent from the previous rate of 72.2 percent (p<.001). The rate for members 12 to 19 years increased to 79.7 percent from 72.0 percent in the previous year (p<.001). The overall rate (all age groups combined) increased to 81.7 percent from73.5 percent in the current measurement (p<.001). Well-Child Visits in the Third through Sixth Years of Life In the current measurement, 51.8 percent of children had an annual well-care visit (Table 17), an increase from 46.9percent in the previous year (p<.001). 40 Adolescent Well-Care Visits In the current measurement, 39.3 percent of adolescents had a wellcare visit (Table 18), an increase from the previous year’s rate of 35.3 percent (p<.001). Annual Dental Visits The rate of annual dental visits (Table 19) increased in the current measurement, to 48.7 percent from 46.9 percent in the previous year (p=.005). Discussion In the current measurement, DDD showed statistically significant improvement in all its acute-care performance measures. The Division also met its Minimum Performance Standards for all of the measures reported here. Figure 16. DDD Performance Measure Rates CYE 2009 compared with CYE 2008 100% 80% 60% 40% 20% 0% CAP 12-24 CAP 25-6 CAP 7-11 CYE 2009 41 CAP 12-19 WC 3-6 CYE 2008 Adol WC Dental CONCLUSION Overall Results In the current measurement, Contractors significantly improved rates of primary and preventive care services, as measured under HEDIS. In July 2007, AHCCCS advised Acute-care Contractors that they would face significant financial sanctions in the next couple of years if they did not increase rates to meet Minimum Performance Standards. This was followed by ongoing monitoring over the next couple of years, including requiring Contractors to evaluate the effectiveness of corrective actions and implement new interventions as necessary. This regulatory approach has encouraged health plans to apply the resources necessary to significantly increase rates. Contractors will be required to continue improvement efforts, focusing on areas where they perform poorly. AHCCCS’ regulatory approach encouraged health plans to apply the resources necessary to significantly increase rates The data reported here indicate that, overall, children and adults enrolled with AHCCCS have a relatively high degree of access to the health care system, as evidenced by the use of several preventive care services. The AHCCCS rates for Adults’ Access to Preventive/Ambulatory Health Services, Well Child Visits in the First 15 Months of Life and Annual Dental Visits among Medicaid members are well above the national means for Medicaid managed care plans, with rates for several other measures also exceeding national Medicaid means. The rates for Annual Dental Visits among both the Medicaid and KidsCare populations also exceed the 90th percentile of Medicaid health plans nationally. KidsCare members, in particular, have higher rates of utilization than Medicaid and Children’s Health Insurance Program beneficiaries nationally. KidsCare rates for most measures are well above the most recent HEDIS national Medicaid means, which includes members in this beneficiary group, and some exceed comparable national means for commercial health plans. However, several Contractors’ rates for Children’s and Adolescents’ Access to PCPs still lag behind national means. AHCCCS-contracted health plans must focus resources on increasing rates for this measure. Data capture for Timeliness of Prenatal Care also is of concern, and AHCCCS has convened a work group to address this measure. 42 References 1 U.S. Department of Health and Human Services. Healthy People 2000 objectives. Washington, D.C.: U.S. Government Printing Office, November 1990. 2 Arizona Maternal and Child Health Committee. Maternal and Child Health Needs Assessment, Arizona 2000. Phoenix, Ariz.: Arizona Department of Health Services, April 2001. 3 American Academy of Pediatrics. Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents. Available at: http://brightfutures.aap.org/. Accessed Nov. 2, 2006. 4 Arizona School Readiness Task Force. Growing Arizona. Phoenix, Ariz.: Children’s Action Alliance. 2002. 5 Arizona School Readiness Board. Early Childhood Health Screening Fact Sheet. Available at: http://www.azgovernor.gov/cyf/school_readiness/index_school_readiness.html. Accessed Nov. 2, 2005. 6 Centers for Disease Control and Prevention. Surveillance of Certain Health Behaviors and Conditions Among States and Selected Local Areas -- Behavioral Risk Factor Surveillance System (BRFSS), United States, 2006. MMWR 2008. 57(SS07);1-188. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5707a1.htm. Accessed August 14, 2008. 7. Reducing Health Care Costs through Prevention. Health Care Reform Policy Brief. Prevention Institute and The California Endowment with The Urban Institute. August 2007. Available at http://www.preventioninstitute.org/index.php?option=com_jlibrary&view=article&i d=79&Itemid=127. Accessed July 8, 2010. 8 wba Market Research. 2006 Acute Care Health Plan Customer Satisfaction Survey. Presentation to AHCCCS health plan medical directors and chief executive officers. Oct. 20, 2006. 9 Centers for Disease Control and Prevention. State-specific Prevalence and Trends in Adult Cigarette Smoking – United States, 1998 – 2007.. MMWR 2009. 58(09);221-226. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5809a1.htm. Accessed October 14, 2009. 10 American Academy of Pediatrics. Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents. Available at: http://brightfutures.aap.org/tool_and_resource_kit.html. Accessed Dec. 3, 2010. 11 Arizona School Readiness Task Force. Growing Arizona. Phoenix, Ariz.: Children’s Action Alliance. 2002. 12 Arizona School Readiness Board. Early Childhood Health Screening Fact Sheet. 13 Mrela CK, Torres C. Arizona Health Status and Vital Statistics 2006. Arizona Department of Health Services, Bureau of Public Health Services, Health Status and Vital Statistics Section. 14 Elster, A. Guidelines for adolescent preventive services [last updated Jan. 29, 2008]. American Medical Association. 15 Fox HB, McManus MA, Zarit M, et al. Racial and ethnic disparities in adolescent health and access to care [fact sheet]. Incenter Strategies, The National Alliance to Advance Adolescent Health. Washington, DC; January 2007. Available at: http://www.incenterstrategies.org/facts.html. Accessed July 16, 2008. 16 Office of the Surgeon General. Oral Health in America. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, September 2000. 17 Arizona Office of Oral Health. Arizona Oral Health Update. Phoenix, AZ: Arizona Department of Health Services. May 2000. 43 18 . Agency for Healthcare Research and Quality. Breast cancer screening: summary of the evidence. Available at: Accessed http://www.ahrq.gov/clinic/3rduspstf/breastcancer/bcscrnsum1.htm. November 14, 2008. 19 Centers for Disease Control and Prevention. Use of mammograms among women aged >40 years -- United States, 2000--2005. MMWR. 56(03);49-51. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5603a1.htm?s_cid=mm5603a1_e. Accessed November 14, 2008. 20 Arizona Department of Health Services. Office of Chronic Disease Prevention and Nutrition Services. The Arizona Comprehensive Cancer Control Plan. Available at: http://www.azdhs.gov/phs/oncdps/index.htm. Accessed Nov. 3, 2006. 21 Keppel KG, Pearcy JN, Wagener DK. Trends in racial and ethnic-specific rates for health status indicators: United States, 1990-1998. Healthy people statistical notes, no. 23. Hyattsville, Maryland: National Center for Health Statistics. January 2002. 22 National Cancer Institute. Summary of evidence: screening by mammography. Available at: http://www.cancer.gov/cancertopics/pdq/screening/breast/HealthProfessional/page5. .Accessed Nov. 3, 2006. 23 Annual Meeting of the 95th American Association for Cancer Research. Conference Report – Early cancer diagnosis: beating the odds. Available at: http://www.medscape.com/viewprogram/3254_pnt. Accessed Auig. 4, 2006. 24 National Cancer Institute. Breast cancer screening physician data query (PDQ®), 2001. Available at: http://www.cancer.gov/cancer_information/pdq. Accessed May 2, 2005. 25 Alarcon M. Breast and cervical cancer among Latino women. National Council of La Raza, Washington, D.C. 1998. 26 Transcultural Nursing. Basic concepts and case studies: Asian community. Available at: http://www.culturediversity.org/asia.htm#Pain. Accessed April 9, 2003. 27 National Cancer Institute. Annual report to the nation finds cancer death rate decline doubling: Special feature examines cancer in American Indians and Alaska Natives. U.S. National Institutes of Health. October 2007. 28 American Cancer Society. What are the key statistics about cervical cancer? 29 National Women’s Health Information Center. Chlamydia: Frequently asked questions. U.S. Department of Health and Human Services, Office of Women’s Health. May 2005. Available at: http://www.womenshealth.gov/faq/stdchlam.htm. Accessed Nov. 3, 2006. 30 National Committee for Quality Assurance. Improving chlamydia screening: Strategies from top performing health plans. Emory University. Atlanta, Ga. December 2007. 31 Greenberg RS: The impact of prenatal care in different social groups. Am J Obstet Gyn. April 1, 1983. 32 Leveno KJ, et al: Prenatal care and the low birth weight infant, Obstet Gyn. November 1985. 33 National Center for Health Statistics. 1996 final natality data, prepared by the March of Dimes Perinatal Data Center. 1998. 34 Kirkman-Liff B: Analysis of prenatal care in Arizona, Arizona State University School of Health Administration and Policy; December 1993. 35 Centers for Disease Control and Prevention. Surveillance Summaries, July 2, 2004. MMWR 2004:53(SS-4). 36 National Women’s Health Information Center. Prenatal Care: Frequently asked questions. U.S. Department of Health and Human Services, Office of Women’s Health. May 2005. Available at: http://www.womenshealth.gov/faq/prenatal.htm#b. Accessed Nov. 3, 2006. 44 37 Arizona Department of Health Services. Arizona Health Status and Vital Statistics 2009. Natality: maternal characteristics and newborns’ health. Table 1B-28. Available at: http://www.azdhs.gov/plan/report/ahs/ahs2009/xls/t1b28.xls. Accessed Dec. 21, 2010. 38 Health Resources and Services Administration. Oral Health for Children and Adolescents with Special Health Care Needs: Challenges and Opportunities. 2005. 39 U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. The National Survey of Children with Special Health Care Needs Chartbook 2001. Rockville, Maryland: U.S. Department of Health and Human Services, 2004. Available at: http://mchb.hrsa.gov/chscn/index.htm. Accessed Mar. 1, 2006. For questions or comments about this report, please contact: Rochelle Tigner, Quality Improvement Manager Clinical Quality Management Unit Division of Health Care Management, MD 6700 701 E. Jefferson St. Phoenix, AZ 85034 rochelle.tigner@azahcccs.gov 45 Table 1 Arizona Health Care Cost Containment System CHILDREN'S ACCESS TO PRIMARY CARE PRACTITIONERS BY CONTRACTOR, MEMBERS ELIGIBLE UNDER MEDICAID Measurement Period Oct. 1, 2008, through Sept. 30, 2009 Minimum Performance Standards: 12-24 Months 93 Rates in bold face denote the Contractor met 25 Months - 6 Years 83 the AHCCCS Minimum Performance Standard 7-11 Years 83 12-19 Years Contractor AZ Physicians IPA AZ Physicians IPA 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 Total Number of Members 4,431 22,695 14,088 16,523 Number with 1+ Visits 3,814 19,041 11,673 13,907 57,737 5,766 27,126 17,221 20,671 48,435 4,902 21,967 13,593 16,654 70,784 57,116 85.0% 81.0% 78.9% 80.6% 80.7% Percent with 1+ Visits Relative Percent Change From Previous Year Statistical Significance 86.1% 83.9% 82.9% 84.2% 83.9% 1.2% 3.6% 5.0% 4.5% 4.0% P=.132 P<.001 P<.001 P<.001 P<.001 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 1.8% 4.4% 9.0% 4.3% 4.7% P=.312 P<.001 P<.001 P=.029 P<.001 Bridgeway Health Solutions 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total 278 1,363 0 0 1,641 247 1,105 0 0 1,352 88.8% 81.1% 0.0% 0.0% 82.4% Bridgeway Health Solutions 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 N/A N/A N/A N/A N/A 884 4,001 1,180 1,307 N/A N/A N/A N/A N/A Care1st Healthplan N/A N/A N/A N/A N/A 1,006 4,696 1,480 1,633 8,815 899 3,622 1,211 1,327 7,372 776 2,956 886 1,018 7,059 5,636 Care1st Healthplan 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total 81 87.9% 85.2% 79.7% 80.0% 83.6% 86.3% 81.6% 73.2% 76.7% 79.8% Table 1 Arizona Health Care Cost Containment System CHILDREN'S ACCESS TO PRIMARY CARE PRACTITIONERS BY CONTRACTOR, MEMBERS ELIGIBLE UNDER MEDICAID Measurement Period Oct. 1, 2008, through Sept. 30, 2009 Minimum Performance Standards: 12-24 Months 93 Rates in bold face denote the Contractor met 25 Months - 6 Years 83 the AHCCCS Minimum Performance Standard 7-11 Years 83 12-19 Years Contractor DES/CMDP DES/CMDP Health Choice AZ Health Choice AZ Maricopa Health Plan Maricopa Health Plan 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 81 Total Number of Members Number with 1+ Visits Percent with 1+ Visits Relative Percent Change From Previous Year Statistical Significance 541 1,557 409 892 481 1,324 354 832 3,399 498 0.2% 1.3% 0.2% 0.7% 0.5% P=.937 P=.427 P=.946 P=.612 P=.556 1,417 382 941 2,991 442 1,190 330 872 88.9% 85.0% 86.6% 93.3% 88.0% 3,238 4,332 19,262 7,426 7,148 2,834 3,747 15,593 5,903 5,656 38,168 3,457 13,815 6,774 6,692 30,899 2,860 10,872 5,126 5,163 4.6% 2.9% 5.0% 2.6% 3.6% P<.001 P<.001 P<.001 P=.005 P<.001 30,738 940 4,798 2,761 2,767 24,021 808 3,796 2,169 2,091 11,266 1,029 4,098 2,391 2,410 8,864 845 3,088 1,724 1,628 4.7% 5.0% 9.0% 11.9% 7.2% P=.020 P<.001 P<.001 P<.001 P<.001 9,928 7,285 88.8% 84.0% 86.4% 92.7% 87.5% 86.5% 81.0% 79.5% 79.1% 81.0% 82.7% 78.7% 75.7% 77.2% 78.1% 86.0% 79.1% 78.6% 75.6% 78.7% 82.1% 75.4% 72.1% 67.6% 73.4% Table 1 Arizona Health Care Cost Containment System CHILDREN'S ACCESS TO PRIMARY CARE PRACTITIONERS BY CONTRACTOR, MEMBERS ELIGIBLE UNDER MEDICAID Measurement Period Oct. 1, 2008, through Sept. 30, 2009 Minimum Performance Standards: 12-24 Months 93 Rates in bold face denote the Contractor met 25 Months - 6 Years 83 the AHCCCS Minimum Performance Standard 7-11 Years 83 12-19 Years Contractor Mercy Care Plan Age 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total Mercy Care Plan 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total Phoenix Health Plan 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total Phoenix Health Plan 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total University Family Care University Family Care 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 7,200 33,502 17,011 17,052 Number with 1+ Visits 6,374 28,825 14,344 14,381 74,765 63,924 7,296 30,053 14,962 15,485 67,796 3,990 19,449 7,860 7,986 6,224 25,068 11,945 12,522 55,759 3,541 16,610 6,614 6,891 39,285 2,753 11,919 6,330 6,389 33,656 2,379 9,988 5,003 5,227 27,391 22,597 960 4,977 748 1,024 826 4,062 650 868 7,709 104 697 810 1,099 6,406 95 571 655 928 2,710 2,249 81 Percent with 1+ Visits Relative Percent Change From Previous Year Statistical Significance 88.5% 86.0% 84.3% 84.3% 85.5% 3.8% 3.1% 5.6% 4.3% 4.0% P<.001 P<.001 P<.001 P<.001 P<.001 2.7% 1.9% 6.5% 5.5% 3.8% P=.004 P<.001 P<.001 P<.001 P<.001 -5.8% -0.4% 7.5% 0.4% 0.1% P=.132 P=.844 P=.001 P=.836 P=.897 85.3% 83.4% 79.8% 80.9% 82.2% 88.7% 85.4% 84.1% 86.3% 85.7% 86.4% 83.8% 79.0% 81.8% 82.5% 86.0% 81.6% 86.9% 84.8% 83.1% 91.3% 81.9% 80.9% 84.4% 83.0% Table 1 Arizona Health Care Cost Containment System CHILDREN'S ACCESS TO PRIMARY CARE PRACTITIONERS BY CONTRACTOR, MEMBERS ELIGIBLE UNDER MEDICAID Measurement Period Oct. 1, 2008, through Sept. 30, 2009 Minimum Performance Standards: 12-24 Months 93 Rates in bold face denote the Contractor met 25 Months - 6 Years 83 the AHCCCS Minimum Performance Standard 7-11 Years 83 12-19 Years 81 Age Total Number of Members Number with 1+ Visits Percent with 1+ Visits Relative Percent Change From Previous Year Statistical Significance TOTAL 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total 23,678 112,299 51,783 55,025 242,785 20,722 94,357 42,887 45,933 203,899 87.5% 84.0% 82.8% 83.5% 84.0% 3.0% 2.9% 5.6% 4.3% 3.9% P<.001 P<.001 P<.001 P<.001 P<.001 TOTAL 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total 21,802 92,747 50,081 55,014 219,644 18,523 75,700 39,262 44,012 177,497 85.0% 81.6% 78.4% 80.0% 80.8% Contractor Notes: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P <.05. Bridgeway Health Solutions did not become an AHCCCS Contractor for the Acute-care program until Oct. 1, 2008, and did not have any members who met the two-year continuous enrollment criteria for the age groups 7 to 11 and 12 to 19. Table 2 Arizona Health Care Cost Containment System CHILDREN'S ACCESS TO PRIMARY CARE PRACTITIONERS BY CONTRACTOR MEMBERS ELIGIBLE UNDER KIDSCARE Measurement Period Oct. 1, 2008, to Sept. 30, 2009 93 83 83 81 Minimum Performance Standards: 12-24 Months Rates in bold face denote the Contractor met 25 Months - 6 Years the AHCCCS Minimum Performance Standard 7-11 Years 12-19 Years Total Number of Members Number with 1+ Visits 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total 206 1,328 1,397 1,666 191 1,184 1,262 1,472 4,597 4,109 AZ Physicians IPA 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total 422 2,696 2,312 2,930 386 2,302 1,970 2,540 8,360 7,198 91.5% 85.4% 85.2% 86.7% 86.1% Bridgeway Health Solutions 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total 17 102 0 0 119 15 89 0 0 104 88.2% 87.3% 0.0% 0.0% 87.4% Bridgeway Health Solutions 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Care1st Healthplan 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total 46 305 142 147 42 278 121 127 640 568 91.3% 91.1% 85.2% 86.4% 88.8% 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total 86 454 178 204 84 403 147 177 922 811 Contractor AZ Physicians IPA Care1st Healthplan Age Percent with 1+ Visits Relative Percent Change From Previous Year Statistical Significance 92.7% 89.2% 90.3% 88.4% 89.4% 1.4% 4.4% 6.0% 1.9% 3.8% P=.591 P=.001 P<.001 P=.103 P<.001 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A -6.5% 2.7% 3.2% -0.4% 0.9% P=.182 P=.290 P=.527 P=.920 P=.633 97.7% 88.8% 82.6% 86.8% 88.0% Table 2 Arizona Health Care Cost Containment System CHILDREN'S ACCESS TO PRIMARY CARE PRACTITIONERS BY CONTRACTOR MEMBERS ELIGIBLE UNDER KIDSCARE Measurement Period Oct. 1, 2008, to Sept. 30, 2009 Minimum Performance Standards: 12-24 Months Rates in bold face denote the Contractor met 25 Months - 6 Years the AHCCCS Minimum Performance Standard 7-11 Years 12-19 Years Contractor Age Total Number of Members Number with 1+ Visits Percent with 1+ Visits Relative Percent Change From Previous Year Statistical Significance 1.2% 2.4% 8.4% 5.3% 4.5% P=.618 P=.131 P<.001 P=.012 P<.001 -3.8% -0.1% 6.7% 1.4% 1.9% P=.688 P=.971 P=.032 P=.714 P=.318 -2.6% 2.1% 3.6% 4.4% 2.7% P=.158 P=.027 P=.001 P<.001 P<.001 Health Choice AZ 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total 216 1,152 696 690 203 1,010 617 609 2,754 2,439 94.0% 87.7% 88.6% 88.3% 88.6% Health Choice AZ 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. 280 1,391 894 845 3,410 260 1,191 731 708 2,890 92.9% 85.6% 81.8% 83.8% 84.8% 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total 29 280 251 250 26 238 229 206 810 699 89.7% 85.0% 91.2% 82.4% 86.3% 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total 88 510 387 357 82 434 331 290 1342 1137 Total Maricopa Health Plan Maricopa Health Plan Mercy Care Plan 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total 284 2,016 1,713 1,759 261 1,831 1,559 1,600 5,772 5,251 Mercy Care Plan 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total 639 3,481 2,415 2,369 603 3,096 2,122 2,064 8,904 7,885 93 83 83 81 93.2% 85.1% 85.5% 81.2% 84.7% 91.9% 90.8% 91.0% 91.0% 91.0% 94.4% 88.9% 87.9% 87.1% 88.6% Table 2 Arizona Health Care Cost Containment System CHILDREN'S ACCESS TO PRIMARY CARE PRACTITIONERS BY CONTRACTOR MEMBERS ELIGIBLE UNDER KIDSCARE Measurement Period Oct. 1, 2008, to Sept. 30, 2009 Minimum Performance Standards: 12-24 Months Rates in bold face denote the Contractor met 25 Months - 6 Years the AHCCCS Minimum Performance Standard 7-11 Years 12-19 Years Contractor Age Total Number of Members Number with 1+ Visits Phoenix Healh Plan 12-24 mos. 25 mos. - 6 yrs. 7 - 11 yrs. 12 -19 yrs. Total 197 1,320 988 926 188 1,166 867 811 3,431 3,032 Phoenix Health Plan 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 266 1,838 1,379 1,214 253 1,646 1,213 1,053 4,697 32 160 36 57 285 2 27 58 86 173 1,027 6,663 5,223 5,495 18,408 1,783 10,397 7,623 8,005 27,808 4,165 29 133 36 54 252 2 25 54 81 162 955 5,929 4,691 4,879 16,454 1,670 9,097 6,568 6,913 24,248 University Family Care University Family Care TOTAL TOTAL 93 83 83 81 Percent with 1+ Visits Relative Percent Change From Previous Year Statistical Significance 95.4% 88.3% 87.8% 87.6% 88.4% 0.3% -1.4% -0.2% 1.0% -0.3% P=.873 P=.279 P=.878 P=.564 P=.672 -9.4% -10.2% 7.4% 0.6% -5.6% P=1.000 P=.263 P=.294 P=1.000 P=.066 -0.7% 1.7% 4.2% 2.8% 2.5% P=.429 P=.005 P<.001 P<.001 P<.001 95.1% 89.6% 88.0% 86.7% 88.7% 90.6% 83.1% 100.0% 94.7% 88.4% 100.0% 92.6% 93.1% 94.2% 93.6% 93.0% 89.0% 89.8% 88.8% 89.4% 93.7% 87.5% 86.2% 86.4% 87.2% Notes: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P <.05. University Family Care did not have enough KidsCare members ages 12 to 24 months who met the criteria for the eligible population to be included in the measurement Bridgeway Health Solutions did not become an AHCCCS Contractor for the Acute-care program until Oct. 1, 2008, and did not have any members who met the two-year continuous enrollment criteria for the age groups 7 to 11 and 12 to 19. Table 3 Arizona Health Care Cost Containment System ADULTS' ACCESS TO PREVENTIVE/AMBULATORY HEALTH SERVICES BY CONTRACTOR MEMBERS ELIGIBLE UNDER MEDICAID Measurement Period: Oct. 1, 2008, through Sept. 30, 2009 20-44 Years 78 Minimum Performance Standards: 45-64 Years 85 Rates in bold face denote the Contractor met the AHCCCS Minimum Performance Standard Contractor AZ Physicians IPA Age 20-44 45-64 Total AZ Physicians IPA Bridgeway Health Solutions Bridgeway Health Solutions 20-44 45-64 Total 20-44 45-64 Total 20-44 45-64 Total Care 1st Healthplan 20-44 45-64 Total Care 1st Healthplan 20-44 45-64 Total Health Choice AZ 20-44 45-64 Total Health Choice AZ 20-44 45-64 Total Maricopa Health Plan 20-44 45-64 Total Maricopa Health Plan 20-44 45-64 Total Number of Members 30,178 16,003 Relative Percent Change From Previous Year Statistical Significance 2.3% 0.7% P<.001 P=.053 1.6% P<.001 79.6% 87.4% 82.7% N/A N/A N/A N/A N/A N/A N/A N/A N/A 81.2% 86.0% 82.7% 3.5% 1.0% 2.5% P=.002 P=.429 P=.003 3.0% 3.7% 3.2% P<.001 P<.001 P<.001 5.9% 0.3% 3.1% P<.001 P=.811 P=.003 Number with Percent with 1+ Visits 1+ Visits 25,176 83.4% 14,224 88.9% 46,181 37,567 21,306 39,400 30,632 18,800 58,873 49,432 1,964 1,255 3,219 N/A N/A N/A 4,751 2,315 1,564 1,097 2,661 N/A N/A N/A 3,856 1,990 7,066 3,694 1,879 5,846 2,898 1,599 5,573 23,034 11,530 4,497 18,605 9,883 34,564 15,861 7,889 28,488 12,439 6,520 23,750 3,416 2,543 18,959 2,590 2,101 5,959 2,817 2,250 4,691 2,017 1,853 5,067 3,870 85.3% 81.5% 88.2% 84.0% 78.5% 85.1% 80.7% 80.8% 85.7% 82.4% 78.4% 82.6% 79.8% 75.8% 82.6% 78.7% 71.6% 82.4% 76.4% Table 3 Arizona Health Care Cost Containment System ADULTS' ACCESS TO PREVENTIVE/AMBULATORY HEALTH SERVICES BY CONTRACTOR MEMBERS ELIGIBLE UNDER MEDICAID Measurement Period: Oct. 1, 2008, through Sept. 30, 2009 Minimum Performance Standards: 20-44 Years 78 45-64 Years 85 Rates in bold face denote the Contractor met the AHCCCS Minimum Performance Standard 38,573 19,606 32,382 17,522 20-44 45-64 58,179 35,267 18,500 49,904 28,989 16,279 Total 20-44 45-64 Total 20-44 45-64 Total 20-44 45-64 Total 20-44 45-64 Total 20-44 45-64 Total 20-44 45-64 Total 20-44 45-64 Total 20-44 45-64 Total 53,767 20,622 9,757 30,379 11,154 5,189 16,343 60 77 137 4,200 2,338 6,538 7,762 4,506 12,268 1,108 837 1,945 130,360 67,592 194,733 111,668 60,188 171,856 45,268 17,567 8,546 26,113 9,303 4,435 13,738 42 69 111 3,342 1,953 5,295 6,238 3,856 10,094 882 729 1,611 108,020 59,288 164,647 90,502 52,168 142,670 Mercy Care Plan 20-44 45-64 Total Mercy Care Plan Phoenix Health Plan Phoenix Health Plan Pima Health System Pima Health System University Family Care University Family Care TOTAL TOTAL 83.9% 89.4% 85.8% 2.1% 1.6% 1.9% P<.001 P<.001 P<.001 2.1% 2.5% 2.3% P<.001 P<.001 P<.001 -12.0% 7.3% 0.0% P=.069 P=.155 P=.992 1.0% -1.7% -0.7% P=.551 P=.246 P=.555 2.2% 1.2% 1.8% P<.001 P<.001 P<.001 82.2% 88.0% 84.2% 85.2% 87.6% 86.0% 83.4% 85.5% 84.1% 70.0% 89.6% 81.0% 79.6% 83.5% 81.0% 80.4% 85.6% 82.3% 79.6% 87.1% 82.8% 82.9% 87.7% 84.6% 81.0% 86.7% 83.0% Notes: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P <.05. Bridgeway Health Solutions did not become an AHCCCS Contractor for the Acute-care program until Oct. 1, 2008. Table 4 Arizona Health Care Cost Containment System WELL-CHILD VISITS IN THE FIRST 15 MONTHS OF LIFE BY CONTRACTOR MEMBERS ELIGIBLE UNDER MEDICAID Measurement Period: Oct. 1, 2008, to Sept. 30, 2009 65 Minimum Performance Standard: Rates in bold face denote the Contractor met the AHCCCS Minimum Performance Standard Contractor Total Number of Members Number with 6+ Visits Percent with 6+ Visits Relative Percent Change From Previous Year Statistical Significance 2.7% P=.163 10.2% P=.004 5.2% P=.020 9.1% P=.013 10.5% P<.001 6.7% P=.001 1.1% P=.932 7.8% P<.001 AZ Physicians IPA 3,421 2,003 58.6% AZ Physicians IPA 5,150 2,937 57.0% Care1st Healthplan 820 595 72.6% Care1st Healthplan 758 499 65.8% Health Choice AZ 2,877 1,756 61.0% Health Choice AZ 2,752 1,596 58.0% Maricopa Health Plan 829 570 68.8% Maricopa Health Plan 835 526 63.0% Mercy Care Plan 5,869 3,824 65.2% Mercy Care Plan 6,011 3,545 59.0% Phoenix Health Plan 2,498 1,739 69.6% Phoenix Health Plan 2,315 1,511 65.3% 140 95 73 49 52.1% TOTAL 16,454 10,560 64.2% TOTAL 17,916 10,663 59.5% University Family Care University Family Care 51.6% Notes: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P<.05. Bridgeway Health Solutions did not become an AHCCCS Contractor for the Acute-care program until Oct. 1, 2008, and did not have members who met the continuous enrollment criterion for this measure. Table 5 Arizona Health Care Cost Containment System WELL-CHILD VISITS IN THE FIRST 15 MONTHS OF LIFE BY CONTRACTOR MEMBERS ELIGIBLE UNDER KIDSCARE Measurement Period: Oct. 1, 2008, to Sept. 30, 2009 65 Minimum Performance Standard: Rates in bold face denote the Contractor met the AHCCCS Minimum Performance Standard Relative Percent Number of Number with Percent with Change From Statistical Members 6+ Visits 6+ Visitis Previous Year Significance AZ Physicians IPA 228 145 63.6% -7.8% p=.070 AZ Physicians IPA 467 322 69.0% Care1st Healthplan 50 42 84.0% 15.3% p=.516 Care1st Healthplan 81 59 72.8% Health Choice AZ 182 125 68.7% 5.3% p=.251 Health Choice AZ 282 184 65.2% Maricopa Health Plan 41 26 63.4% -14.4% p=.009 Maricopa Health Plan 85 63 74.1% Mercy Care Plan 372 274 73.7% 0.8% p=.858 Mercy Care Plan 620 453 73.1% Phoenix Health Plan 172 130 75.6% -1.4% p=.507 Phoenix Health Plan 244 187 76.6% TOTAL 1,045 742 71.0% -0.4% p=.221 TOTAL 1,779 1,268 71.3% Contractor Notes: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P<.05. University Family Care did not have enough KidsCare members who met the continuous enrollment criterion for this measure to report a rate. Bridgeway Health Solutions did not become an AHCCCS Contractor for the Acute-care program until Oct. 1, 2008, and did not have KidsCare members who met the continuous enrollment criterion for this measure. Table 6 Arizona Health Care Cost Containment System WELL-CHILD VISITS IN THE THIRD, FOURTH, FIFTH AND SIXTH YEARS OF LIFE BY CONTRACTOR MEMBERS ELIGIBLE UNDER MEDICAID Measurement Period: Oct. 1, 2008, through Sept. 30, 2009 64 Minimum Performance Standard: Rates in bold face denote the Contractor met the AHCCCS Minimum Performance Standard Contractor AZ Physicians IPA AZ Physicians IPA Bridgeway Health Solutions Bridgeway Health Solutions Care1st Healthplan Care1st Healthplan DES/CMDP DES/CMDP Health Choice AZ Health Choice AZ Maricopa Health Plan Maricopa Health Plan Mercy Care Plan Mercy Care Plan Phoenix Health Plan Phoenix Health Plan University Family Care University Family Care TOTAL TOTAL Number of Members Number with 6+ Visits Percent with 6+ Visitis 18,490 22,087 1,101 N/A 3,740 2,837 1,166 1,084 15,349 11,045 3,830 3,297 26,766 23,938 15,673 9,700 4,053 600 12,142 13,795 627 N/A 2,720 1,911 785 678 9,737 6,777 2,549 2,102 19,911 16,647 11,717 7,085 2,414 351 90,168 74,588 62,602 49,346 65.7% 62.5% 56.9% N/A 72.7% 67.4% 67.3% 62.5% 63.4% 61.4% 66.6% 63.8% 74.4% 69.5% 74.8% 73.0% 59.6% 58.5% 69.4% 66.2% Relative Percent Change From Previous Year Statistical Significance 5.1% P<.001 N/A N/A 8.0% P<.001 7.6% P=.018 3.4% P=.001 4.4% P=.013 7.0% P<.001 2.4% P=.002 1.8% P=.621 4.9% P<.001 Notes: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P <.05. Bridgeway Health Solutions did not become an AHCCCS Contractor for the Acute-care program until Oct. 1, 2008. Table 7 Arizona Health Care Cost Containment System WELL-CHILD VISITS IN THE THIRD, FOURTH, FIFTH AND SIXTH YEARS OF LIFE BY CONTRACTOR MEMBERS ELIGIBLE UNDER KIDSCARE Measurement Period Oct. 1, 2008, to Sept. 30, 2009 64 Minimum Performance Standard: Rates in bold face denote the Contractor met the AHCCCS Minimum Performance Standard Relative Percent Contractor AZ Physicians IPA AZ Physicians IPA Bridgeway Health Solutions Bridgeway Health Solutions Care1st Healthplan Care1st Healthplan Health Choice AZ Health Choice AZ Maricopa Health Plan Maricopa Health Plan Mercy Care Plan Mercy Care Plan Phoenix Health Plan Phoenix Health Plan University Family Care University Family Care TOTAL TOTAL Number of Members Number with 1+ Visits Percent with 1+ Visits Change From Previous Year Statistical Significance 1,100 2,200 87 N/A 249 375 922 1,123 224 423 1,642 2,840 1,090 1,537 133 26 755 1,475 49 N/A 201 294 663 764 166 323 1,316 2,204 775 1,176 91 17 2.4% P=.330 N/A N/A 3.0% P=.409 5.7% P=.034 -2.9% P=.526 3.3% P=.028 -7.1% P=.008 4.6% P=.704 5,447 8,524 4,016 6,253 68.6% 67.0% 56.3% N/A 80.7% 78.4% 71.9% 68.0% 74.1% 76.4% 80.1% 77.6% 71.1% 76.5% 68.4% 65.4% 73.7% 73.4% 0.5% P=.301 Note: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant w Bridgeway Health Solutions did not become an AHCCCS Contractor for the Acute-care program until Oct. 1, 2008. Table 8 Arizona Health Care Cost Containment System ADOLESCENT WELL-CARE VISITS BY CONTRACTOR MEMBERS ELIGIBLE UNDER MEDICAID Measurement Period: Oct. 1, 2008, through Sept. 30, 2009 Minimum Performance Standard: 41 Rates in bold face denote the Contractor met the AHCCCS Minimum Performance Standard Contractor AZ Physicians IPA AZ Physicians IPA Bridgeway Health Solutions Bridgeway Health Solutions Care1st Healthplan Care1st Healthplan DES/CMDP DES/CMDP Health Choice AZ Health Choice AZ Maricopa Health Plan Maricopa Health Plan Mercy Care Plan Mercy Care Plan Phoenix Health Plan Phoenix Health Plan University Family Care University Family Care TOTAL TOTAL Total Number of Members 26,985 31,969 Number with 1+ Visits 11,603 12,732 1,336 N/A 3,390 2,419 1,719 1,700 17,865 11,762 4,507 3,579 29,811 26,628 18,560 10,238 6,663 1,296 441 N/A 1,402 1,050 1,130 1,093 6,624 4,264 1,718 1,242 12,842 11,072 9,244 5,275 2,686 539 110,836 89,591 47,690 37,267 Percent with 1+ Visits 43.0% 39.8% 33.0% N/A 41.4% 43.4% 65.7% 64.3% 37.1% 36.3% 38.1% 34.7% 43.1% 41.6% 49.8% 51.5% 40.3% 41.6% 43.0% 41.6% Relative Percent Change From Previous Year 8.0% Statistical Significance P<.001 N/A N/A -4.7% P=.119 2.2% P=.377 2.3% P=.149 9.8% P=.002 3.6% P<.001 -3.3% P=.005 -3.1% P=.391 3.4% P<.001 Note: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P <.05. Bridgeway Health Solutions did not become an AHCCCS Contractor for the Acute-care program until Oct. 1, 2008. Table 9 Arizona Health Care Cost Containment System ADOLESCENT WELL-CARE VISITS BY CONTRACTOR MEMBERS ELIGIBLE UNDER KIDSCARE Measurement Period: Oct. 1, 2008, through Sept. 30, 2009 41 Minimum Performance Standard: Rates in bold face denote the Contractor met the AHCCCS Minimum Performance Standard Total Number of Number with Percent with Relative Percent Change From Members 1+ Visits 1+ Visits Previous Year Statistical Significance AZ Physicians IPA 2,643 1,338 50.6% 6.1% P=.018 AZ Physicians IPA N/A N/A -13.4% P=.060 12.7% P=.001 3.5% P=.602 2.9% P=.225 -19.5% P<.001 8.6% P=.450 0.2% P=.643 Contractor 4,330 2,066 47.7% Bridgeway Health Solutions 208 94 45.2% Bridgeway Health Solutions N/A N/A N/A Care1st Healthplan 275 135 49.1% Care1st Healthplan 344 195 56.7% Health Choice AZ 1,700 850 50.0% Health Choice AZ 1,488 660 44.4% Maricopa Health Plan 353 186 52.7% Maricopa Health Plan 548 279 50.9% Mercy Care Plan 2,800 1,488 53.1% Mercy Care Plan 3,669 1,894 51.6% Phoenix Health Plan 1,924 1,019 53.0% Phoenix Health Plan 1,868 1,229 65.8% 444 94 241 47 54.3% TOTAL 10,347 5,351 51.7% TOTAL 12,341 6,370 51.6% University Family Care University Family Care 50.0% Note: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P <.05. Bridgeway Health Solutions did not become an AHCCCS Contractor for the Acute-care program until Oct. 1, 200 Table 10 Arizona Health Care Cost Containment System ANNUAL DENTAL VISITS AGE 2-21 BY CONTRACTOR MEMBERS ELIGIBLE UNDER MEDICAID Measurement Period: Oct. 1, 2008, through Sept. 30, 2009 55 Minimum Performance Standard: Rates in bold face denote the Contractor met the AHCCCS Minimum Performance Standard Contractor Total Number of Members Number Receiving Dental Services Percent Receiving Dental Services Relative Percent Change from Previous Year Statistical Significance AZ Physicians IPA AZ Physicians IPA Bridgeway Health Solutions Bridgeway Health Solutions Care1st Healthplan 70,885 83,757 3,804 N/A 10,710 45,726 52,050 2,480 N/A 6,812 64.5% 62.1% 65.2% N/A 63.6% 3.8% P<.001 N/A N/A 2.2% P=.055 Care1st Healthplan DES/CMDP DES/CMDP Health Choice AZ Health Choice AZ Maricopa Health Plan Maricopa Health Plan Mercy Care Plan Mercy Care Plan Phoenix Health Plan Phoenix Health Plan University Family Care University Family Care TOTAL TOTAL 8,040 4,370 4,118 52,522 36,075 13,239 10,945 89,595 79,538 53,967 31,572 16,298 2,876 5,004 3,051 3,083 34,980 21,829 8,438 6,113 57,123 47,851 33,901 18,821 9,310 1,763 -6.7% P<.001 10.1% P<.001 14.1% P<.001 6.0% P<.001 5.4% P<.001 -6.8% P<.001 315,390 256,921 201,821 156,514 62.2% 69.8% 74.9% 66.6% 60.5% 63.7% 55.9% 63.8% 60.2% 62.8% 59.6% 57.1% 61.3% 64.0% 60.9% 5.0% P<.001 Notes: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P <.05. Bridgeway Health Solutions did not become an AHCCCS Contractor for the Acute-care program until Oct. 1, 2008. Table 11 Arizona Health Care Cost Containment System ANNUAL DENTAL VISITS AGE 2-19 BY CONTRACTOR MEMBERS ELIGIBLE UNDER KIDSCARE Measurement Period: Oct. 1, 2008, through Sept. 30, 2009 Minimum Performance Standard: 55 Rates in bold face denote the Contractor met the AHCCCS Minimum Performance Standard Contractor Total Number of Members Number Percent Receiving Dental Receiving Dental Services Services Relative Percent Change from Previous Year Statistical Significance 2.8% P=.006 N/A N/A 1.5% P=.579 6.4% P<.001 9.0% P=.001 3.4% P<.001 3.0% P=.007 AZ Physicians IPA 6,295 4,612 73.3% AZ Physicians IPA 10,760 7,672 71.3% Bridgeway Health Solutions 456 325 71.3% Bridgeway Health Solutions N/A N/A N/A Care1st Healthplan 853 640 75.0% Care1st Healthplan 1,120 828 73.9% Health Choice AZ 4,433 3,345 75.5% Health Choice AZ 4,497 3,188 70.9% Maricopa Health Plan 1,016 742 73.0% Maricopa Health Plan 1,709 1,145 67.0% Mercy Care Plan 7,607 5,698 74.9% Mercy Care Plan 10,998 7,965 72.4% Phoenix Health Plan 5,266 3,970 75.4% Phoenix Health Plan 5,937 4,344 73.2% 888 183 600 141 67.6% 77.0% -12.3% P=.011 TOTAL 26,814 19,932 74.3% 3.5% P<.001 TOTAL 35,204 25,283 71.8% University Family Care University Family Care Notes: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P <.05. Bridgeway Health Solutions did not become an AHCCCS Contractor for the Acute-care program until Oct. 1, 2008. Table 12 Arizona Health Care Cost Containment System BREAST CANCER SCREENING, AGES 52-69 YEARS, BY CONTRACTOR Measurement Period: Oct. 1, 2007, through Sept. 30, 2009 Minimum Performance Standard: 54 Rates in bold face denote the Contractor met the AHCCCS Minimum Performance Standard Contractor AZ Physicians IPA AZ Physicians IPA Care1st Healthplan Care1st Healthplan Health Choice AZ Health Choice AZ Maricopa Health Plan Maricopa Health Plan Mercy Care Plan Mercy Care Plan Phoenix Health Plan Phoenix Health Plan Pima Health System Pima Health System University Family Care University Family Care TOTAL TOTAL Total Number Percent Relative Percent Number of Receiving Receiving Change from Statistical Previous Year Significance 10.7% P<.001 5.8% P=.313 8.3% P=.006 6.6% P=.135 -1.2% P=.325 13.3% P<.001 5.5% P=.673 -2.0% P=.675 5.6% P<.001 Members Mammograms Mammograms 4,948 6,663 575 503 1,940 2,024 618 612 6,143 5,862 1,635 1,584 43 635 415 339 3,371 4,101 324 268 1,102 1,062 409 380 4,175 4,033 1,036 886 27 378 283 236 16,317 18,222 10,727 11,344 68.1% 61.5% 56.3% 53.3% 56.8% 52.5% 66.2% 62.1% 68.0% 68.8% 63.4% 55.9% 62.8% 59.5% 68.2% 69.6% 65.7% 62.3% Notes: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P <.05. Bridgeway Health Solutions did not become an AHCCCS Contractor for the Acute-care program until Oct. 1, 2008. Table 13 Arizona Health Care Cost Containment System CERVICAL CANCER SCREENING BY CONTRACTOR Measurement Period: Oct. 1, 2008, through Sept. 30, 2009 65 Minimum Performance Standard: Rates in bold face denote the Contractor met the AHCCCS Minimum Performance Standard Total Number Contractor of Members 28,038 AZ Physicians IPA AZ Physicians IPA 31,631 1,826 Bridgeway Health Solutions Bridgeway Health Solutions N/A 3,850 Care1st Healthplan Care1st Healthplan 2,861 20,027 Health Choice AZ Health Choice AZ 12,424 3,112 Maricopa Health Plan Maricopa Health Plan 2,521 34,574 Mercy Care Plan Mercy Care Plan 29,041 17,455 Phoenix Health Plan Phoenix Health Plan 8,793 85 Pima Health System Pima Health System 3,428 7,096 University Family Care University Family Care 1,117 Number Receiving Pap Tests 19,121 20,186 686 N/A 2,455 1,720 11,278 7,437 1,904 1,437 23,508 18,992 10,760 5,427 47 2,181 2,844 690 Percent Receiving Pap Tests 68.2% 63.8% 37.6% N/A 63.8% 60.1% 56.3% 59.9% 61.2% 57.0% 68.0% 65.4% 61.6% 61.7% 55.3% 63.6% 40.1% 61.8% Relative Percent Change From Previous Year 6.9% Statistical Significance P<.001 N/A N/A 6.1% P=.002 -5.9% P<.001 7.3% P=.001 4.0% P<.001 -0.1% P=.906 -13.1% P=.115 -35.1% P<.001 -1.1% P=.001 TOTAL 116,063 72,603 62.6% TOTAL 91,816 58,070 63.2% Notes: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P <.05. Bridgeway Health Solutions did not become an AHCCCS Contractor for the Acute-care program until Oct. 1, 2008. Table 14 Arizona Health Care Cost Containment System CHLAMYDIA SCREENING, AGES 16-24, BY CONTRACTOR Measurement Period: Oct. 1, 2008, through Sept. 30, 2009 Minimum Performance Standard: 51 Rates in bold face denote the Contractor met the AHCCCS Minimum Performance Standard Contractor AZ Physicians IPA AZ Physicians IPA Bridgeway Health Solutions Bridgeway Health Solutions Care1st Healthplan Care1st Healthplan Health Choice AZ Health Choice AZ Maricopa Health Plan Maricopa Health Plan Mercy Care Plan Mercy Care Plan Phoenix Health Plan Phoenix Health Plan University Family Care University Family Care TOTAL TOTAL Number Number Percent Relative Percent of Receiving Receiving Change From Members 4,347 7,395 277 N/A 806 833 3,468 3,268 698 648 5,789 7,470 3,289 2,563 1,187 234 19,861 22,411 Screening 2,088 2,706 73 N/A 386 359 1,495 1,333 359 366 2,503 2,961 1,593 1,076 529 135 9,026 8,936 Screening 48.0% 36.6% 26.4% N/A Previous Year 31.3% Statistical Significance P<.001 N/A N/A 47.9% 43.1% 43.1% 40.8% 51.4% 56.5% 43.2% 39.6% 48.4% 42.0% 44.6% 57.7% 45.4% 39.9% 11.1% P=.051 5.7% P=.054 -8.9% P=.063 9.1% P<.001 15.4% P<.001 -22.8% P<.001 14.0% P<.001 Notes: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P <.05. Bridgeway Health Solutions did not become an AHCCCS Contractor for the Acute-care program until Oct. 1, 2008. Table 15 Arizona Health Care Cost Containment System TIMELINESS OF PRENATAL CARE BY CONTRACTOR Measurement Period: October 1, 2008, through September 30, 2009 CYE 2009 MPS = 80 Relative Percent Number Percent Number of Change from Members With Visits With visits Contractor Previous Year AZ Physicians IPA 5,480 3,884 70.9% AZ Physicians IPA 7,713 5,052 65.5% Bridgeway Health Solutions 367 312 85.0% Bridgeway Health Solutions N/A N/A N/A 1,458 1,087 74.6% Care1st HealthPlan 987 753 76.3% Health Choice AZ 4,815 3,968 82.4% Health Choice AZ 3,956 2,968 75.0% Maricopa Health Plan 925 528 57.1% Maricopa Health Plan 583 283 48.5% 7,852 5,742 73.1% Care1st Health Plan Mercy Care Plan Mercy Care Plan 9,731 6,237 64.1% Phoenix Health Plan 4,846 2,950 60.9% Phoenix Health Plan 2,930 2,092 71.4% University Family Care 782 87 56.5% University Family Care 1,383 148 TOTAL 27,126 19,253 71.0% TOTAL 26,048 17,472 67.1% Statistical Significance 8.2% P<.001 N/A N/A -2.3% P=.329 9.8% P<.001 17.6% P=.001 14.1% P<.001 -14.7% P<.001 -3.8% P=.601 5.8% P<.001 58.8% Notes: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P <.05. Bridgeway Health Solutions did not become an AHCCCS Contractor for the Acute-care program until Oct. 1, 2008. Table 16 Arizona Health Care Cost Containment System CHILDREN'S ACCESS TO PRIMARY CARE PRACTITIONERS MEMBERS ELIGIBLE UNDER DES/DDD Measurement Period Oct. 1, 2008, to Sept. 30, 2009 Minimum Performance Standards: 12-24 Months 78 Rates in bold face denote the Contractor met 25 Months - 6 Ye 70 the AHCCCS Minimum Performance Standard 7-11 Years 70 12-19 Years 70 Age Total Number of Members Number with 1+ Visits Percent with 1+ Visits Relative Percent Change From Previous Year Statistical Significance DES/DDD 12-24 mos. 25 mos. - 6 yrs 7 - 11 yrs. 12 -19 yrs. Total 59 3,162 3,559 4,044 10,824 59 2,697 2,868 3,222 8,846 100.0% 85.3% 80.6% 79.7% 81.7% 18.6% 11.3% 11.7% 10.6% 11.2% P=.002 P<.001 P<.001 P<.001 P<.001 DES/DDD 12-24 mos. 25 mos. - 6 yrs 7 - 11 yrs. 12 -19 yrs. Total 51 3,055 3,284 3,785 10,175 43 2,341 2,370 2,727 7,481 84.3% 76.6% 72.2% 72.0% 73.5% Contractor Notes: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P <.05. Table 17 Arizona Health Care Cost Containment System WELL-CHILD VISITS IN THE THIRD, FOURTH, FIFTH AND SIXTH YEARS OF LIFE MEMBERS ELIGIBLE UNDER DES/DDD Measurement Period: Oct. 1, 2008, through Sept. 30, 2009 Minimum Performance Standard: 44 Rates in bold face denote the Contractor met the AHCCCS Minimum Performance Standard Number with 1+ Visits 1,554 Percent with 1+ Visits Relative Percent Change From Previous Year Statistical Significance DES/DDD Total Number of Members 3,001 51.8% 10.5% P<.001 DES/DDD 2,854 1,338 46.9% Contractor Notes: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P <.05. Table 18 Arizona Health Care Cost Containment System ADOLESCENT WELL-CARE VISITS MEMBERS ELIGIBLE UNDER DES/DDD Measurement Period: Oct. 1, 2008, through Sept. 30, 2009 31 Minimum Performance Standard: Rates in bold face denote the Contractor met the AHCCCS Minimum Performance Standard Total Number of Members Number with 1+ Visits Percent with 1+ Visits Relative Percent Change From Previous Year Statistical Significance DES/DDD 5,016 1,969 39.3% 11.1% P<.001 DES/DDD 4,708 1,664 35.3% Contractor Notes: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P<.05. Table 19 Arizona Health Care Cost Containment System ANNUAL DENTAL VISITS - Ages 2-21 MEMBERS ELIGIBLE UNDER DES/DDD Measurement Period: Oct. 1, 2008, through Sept. 30, 2009 Minimum Performance Standard: 41 Rates in bold face denote the Contractor met the AHCCCS Minimum Performance Standard Total Number of Members Total Dental Services Percent Dental Services Relative Percent Change from Previous Year Statistical Significance DES/DDD 12,078 5,884 48.7% 3.9% P=.005 DES/DDD 11,343 5,320 46.9% Contractor Notes: Results of previous measurement period (Oct. 1, 2007, through Sept. 30, 2008) shown in shaded rows. Changes from the previous measurement are considered statistically significant when P<.05.