Condition

Measure Description

Weighting

Childhood Immunizations

The percentage of children who turned two years old during the measurement year, who were continuously enrolled for 12 months immediately preceding their second birthday, who received each of the following:

·         four DTaP/DT or

·         three IPV/OPV or

·         one MMR or

·         three H influenza type B or

·         three hepatitis B or

• one chicken pox vaccine

50%

Breast Cancer Screening

The percentage of women age 50 through 69 years who were continuously enrolled for two years, and who had a mammogram.

Cervical Cancer Screening

The percentage of women age 18 through 64 years who were continuously enrolled for 3 years, and who received one or more Pap tests.

Asthma

The percentage of patients with persistent asthma continuously enrolled for two years and who received at least one dispensed prescription for inhaled corticosteroids. The measure should be reported for each of three age stratifications:

·         5–9 year-olds

·         10–17 year-olds and

·         18 – 56 year-olds[JO1] 

Coronary Artery Disease

The percentage of patients age 18 through 75 years old as of December 31 and who were discharged alive by Dec. 31 for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) and had evidence of LDL-C screening.

Diabetes

The percentage of members with diabetes (Type 1 and Type 2) age 18 through 75 years old continuously enrolled for one year, and who had evidence of Hemoglobin A1c (HbA1c) screening.

Patient Satisfaction

1. Specialty care

2. Timely access to care

3. Doctor-Patient Communication

4. Overall ratings of care

40%

IT Investment

1. Integrate clinical electronic data sets at group level

2. Support clinical decision making at point of care

10%