| 1 |
Medical Member Count |
Demographics |
Total member-years of medical enrollment during the measurement year. One member-year is equivalent to twelve months of insurance coverage. For example, if a member is enrolled for six months, they will have a value of 0.5 for this measure |
Total medical enrollment years for members during the measurement year |
NA |
| 2 |
Pharmacy Member Count |
Demographics |
Total member-years of pharmacy enrollment during the measurement year. One member-year is equivalent to twelve months of insurance coverage. For example, if a member is enrolled for six months, they will have a value of 0.5 for this measure |
Total pharmacy enrollment years for members during the measurement year |
NA |
| 3 |
Average Age |
Demographics |
The average age in years of members enrolled during the measurement year, based on age on the last day of the year |
Total age in years for members enrolled during the measurement year |
Count of members enrolled during the measurement year |
| 4 |
Commercial Enrollment Rate |
Demographics |
Percent of members with primary coverage in a commercial insurance plan during the measurement year |
Count of members with primary coverage in a commercial insurance plan during the measurement year |
Count of members enrolled during the measurement year |
| 5 |
Medi-Cal Enrollment Rate |
Demographics |
Percent of members with primary coverage in a Medi-Cal insurance plan during the measurement year |
Count of members with primary coverage in a Medi-Cal insurance plan during the measurement year |
Count of members enrolled during the measurement year |
| 6 |
Medicare Enrollment Rate |
Demographics |
Percent of members with primary coverage in a Medicare insurance plan during the measurement year |
Count of members with primary coverage in a Medicare insurance plan during the measurement year |
Count of members enrolled during the measurement year |
| 7 |
Atrial Fibrillation (A-Fib) Prevalence |
Health Conditions |
Percentage of members identified as having atrial fibrillation during the measurement year |
Count of members identified as having atrial fibrillation during the measurement year |
Count of members enrolled during the measurement year |
| 8 |
Alzheimer's Disease Prevalence |
Health Conditions |
Percentage of members identified as having Alzheimer's disease during the measurement year |
Count of members identified as having Alzheimer's disease during the measurement year |
Count of members enrolled during the measurement year |
| 9 |
Heart Attack (Acute Myocardial Infarction) Prevalence |
Health Conditions |
Percentage of members identified as having a heart attack (acute myocardial infarction) during the measurement year |
Count of members identified as having a heart attack (acute myocardial infarction) during the measurement year |
Count of members enrolled during the measurement year |
| 10 |
Anemia Prevalence |
Health Conditions |
Percentage of members identified as having anemia during the measurement year |
Count of members identified as having anemia during the measurement year |
Count of members enrolled during the measurement year |
| 11 |
Anxiety Prevalence |
Health Conditions |
Percentage of members identified as having anxiety during the measurement year |
Count of members identified as having anxiety during the measurement year |
Count of members enrolled during the measurement year |
| 12 |
Asthma Prevalence |
Health Conditions |
Percentage of members identified as having asthma during the measurement year |
Count of members identified as having asthma during the measurement year |
Count of members enrolled during the measurement year |
| 13 |
Breast Cancer Prevalence |
Health Conditions |
Percentage of members identified as having breast cancer during the measurement year |
Count of members identified as having breast cancer during the measurement year |
Count of members enrolled during the measurement year |
| 14 |
All Combined Cancer Prevalence |
Health Conditions |
Percentage of members identified as having bladder, cervical, colorectal, endometrial, breast, kidney/renal, lung, pancreatic, prostate, or thyroid cancer during the measurement year |
Count of members identified as having bladder, cervical, colorectal, endometrial, breast, kidney/renal, lung, pancreatic, prostate, or thyroid cancer during the measurement year |
Count of members enrolled during the measurement year |
| 15 |
Chronic Kidney Disease Prevalence |
Health Conditions |
Percentage of members identified as having chronic kidney disease during the measurement year |
Count of members identified as having chronic kidney disease during the measurement year |
Count of members enrolled during the measurement year |
| 16 |
Colorectal Cancer Prevalence |
Health Conditions |
Percentage of members identified as having colorectal cancer during the measurement year |
Count of members identified as having colorectal cancer during the measurement year |
Count of members enrolled during the measurement year |
| 17 |
COPD Prevalence |
Health Conditions |
Percentage of members identified as having COPD during the measurement year |
Count of members identified as having COPD during the measurement year |
Count of members enrolled during the measurement year |
| 18 |
Dementia (Non-Alzheimer's) Prevalence |
Health Conditions |
Percentage of members identified as having non-Alzheimer's dementia during the measurement year |
Count of members identified as having dementia during the measurement year |
Count of members enrolled during the measurement year |
| 19 |
Depression, Bipolar, or Other Depressive Mood Disorders Prevalence |
Health Conditions |
Percentage of members identified as having depression, bipolar, or other depressive mood disorder during the measurement year |
Count of members identified as having depression during the measurement year |
Count of members enrolled during the measurement year |
| 20 |
Diabetes Prevalence |
Health Conditions |
Percentage of members identified as having diabetes during the measurement year |
Count of members identified as having diabetes during the measurement year |
Count of members enrolled during the measurement year |
| 21 |
Heart Failure Prevalence |
Health Conditions |
Percentage of members identified as having heart failure during the measurement year |
Count of members identified as having heart failure during the measurement year |
Count of members enrolled during the measurement year |
| 22 |
Hip/Pelvic Fracture Prevalence |
Health Conditions |
Percentage of members identified as having a hip or pelvic fracture during the measurement year |
Count of members identified as having a hip or pelvic fracture during the measurement year |
Count of members enrolled during the measurement year |
| 23 |
High Cholesterol (Hyperlipidemia) Prevalence |
Health Conditions |
Percentage of members identified as having high cholesterol (hyperlipidemia) during the measurement year |
Count of members identified as having high cholesterol (hyperlipidemia) during the measurement year |
Count of members enrolled during the measurement year |
| 24 |
High Blood Pressure (Hypertension) Prevalence |
Health Conditions |
Percentage of members identified as having high blood pressure (hypertension) during the measurement year |
Count of members identified as having high blood pressure (hypertension) during the measurement year |
Count of members enrolled during the measurement year |
| 25 |
Coronary Artery Disease (Ischemic Heart Disease) Prevalence |
Health Conditions |
Percentage of members identified as having coronary artery disease (ischemic heart disease) during the measurement year |
Count of members identified as having coronary artery disease (ischemic heart disease) during the measurement year |
Count of members enrolled during the measurement year |
| 26 |
Obesity Prevalence |
Health Conditions |
Percentage of members identified as having obesity during the measurement year |
Count of members identified as having obesity during the measurement year |
Count of members enrolled during the measurement year |
| 27 |
Osteoporosis Prevalence |
Health Conditions |
Percentage of members identified as having osteoporosis during the measurement year |
Count of members identified as having osteoporosis during the measurement year |
Count of members enrolled during the measurement year |
| 28 |
Rheumatoid Arthritis/Osteoarthritis Prevalence |
Health Conditions |
Percentage of members identified as having rheumatoid arthritis or osteoarthritis during the measurement year |
Count of members identified as having rheumatoid arthritis during the measurement year |
Count of members enrolled during the measurement year |
| 29 |
Stroke (Transient Ischemic Attack) Prevalence |
Health Conditions |
Percentage of members identified as having a stroke or ischemic attack during the measurement year |
Count of members identified as having a stroke or ischemic attack during the measurement year |
Count of members enrolled during the measurement year |
| 30 |
Potentially Avoidable ED Visit Rate |
Utilization |
The rate of potentially avoidable emergency department utilization calculated as the number of occurrences per 1,000 members per year |
Count of ED visits identified as potentially avoidable |
Total medical enrollment months per 1,000 members averaged over 12 months |
| 31 |
ED Visit Rate |
Utilization |
The rate of emergency department utilization calculated as the number of occurrences per 1,000 members per year |
Count of ED visits |
Total medical enrollment months per 1,000 members averaged over 12 months |
| 32 |
Total Inpatient Utilization Rate |
Utilization |
The rate of inpatient utilization calculated as the number of occurrences per 1,000 members per year |
Count of inpatient discharges |
Total medical enrollment months per 1,000 members averaged over 12 months |
| 33 |
Maternity Inpatient Utilization Rate |
Utilization |
The rate of maternity inpatient utilization calculated as the number of occurrences per 1,000 members per year |
Count of maternity inpatient discharges |
Total medical enrollment months per 1,000 members averaged over 12 months |
| 34 |
Surgical Inpatient Utilization Rate |
Utilization |
The rate of surgical inpatient utilization calculated as the number of occurrences per 1,000 members per year |
Count of surgical inpatient discharges |
Total medical enrollment months per 1,000 members averaged over 12 months |
| 35 |
Medical Inpatient Utilization Rate |
Utilization |
The rate of medical inpatient utilization calculated as the number of occurrences per 1,000 members per year |
Count of medical inpatient discharges |
Total medical enrollment months per 1,000 members averaged over 12 months |
| 36 |
Chronic Condition Prevalence |
Health Conditions |
Percentage of members identified as having any chronic condition during the measurement year |
Count of members identified as having any chronic condition during the measurement year |
Count of members enrolled during the measurement year |
| 37 |
Dual Enrollment Rate |
Demographics |
Percentage of members who were dually enrolled in a Medicare and Medicaid insurance plan during the measurement year |
Count of members who were dually enrolled in a Medicare and Medicaid insurance plan during the measurement year |
Count of members enrolled during the measurement year |