PUBLIC Performance Profile Report FINAL -...

Healthy Families Program 2009 Plan Performance Profile Report

California Managed Risk Medical

Insurance Board Benefits & Quality Monitoring Division

Agenda Item 10.h. 05/12/11 Meeting

Managed Risk Medical Insurance Board Healthy Families Program (HFP)

MRMIB provides and promotes access to affordable coverage for comprehensive, high quality, cost effective health care services to

improve the health of Californians.

Janette Casillas Executive Director

Managed Risk Medical Insurance Board

Shelley Rouillard Deputy Director

Benefits & Quality Monitoring Division

Muhammad Nawaz Research Manager


Rachelle Weiss Research Program Specialist


TABLE OF CONTENTS

Executive Summary ………………………………………………………………………………………………...1 Reading the Report ………………………………………………………………………………………………...3

HEALTH PLANS

Alameda Alliance for Health ………………………………………………………………………………………..6 Anthem Blue Cross EPO ………………………………………………………………………………………..10 Anthem Blue Cross HMO ………………………………………………………………………………………..14 Blue Shield EPO ………………………………………………………………………………………………...18 Blue Shield HMO ………………………………………………………………………………………………...22 CalOptima …………………………………………………………………………………………………………26 Care 1st Health Plan ………………………………………………………………………………………………...30 CenCal Health ………………………………………………………………………………………………………....34 Central California Alliance for Health ……………………………………………………………………………….28 Community Health Group ………………………………………………………………………………………..42 Community Health Plan ………………………………………………………………………………………..46 Contra Costa Health Plan ………………………………………………………………………………………..50 Health Net ………………………………………………………………………………………………………....54 Health Plan of San Joaquin ………………………………………………………………………………………..62 Health Plan of San Mateo ………………………………………………………………………………………..66 Inland Empire Health Plan ………………………………………………………………………………………..70 Kaiser Foundation Health Plan ……………………………………………………………………………….72 Kern Family Health Plan ………………………………………………………………………………………..76 LA Care Health Plan ………………………………………………………………………………………………...80 Molina Healthcare ………………………………………………………………………………………………...84 San Francisco Health Plan ………………………………………………………………………………………..88 Santa Clara Family Health Plan ………………………………………………………...……………………….92 Ventura County Healthcare Plan …………………………………………………………………………………96

DENTAL PLANS

Access Dental ………………………………………………………………………………………....................100 Delta Dental ………………………………………………………………………………………………………..104 Health Net Dental ……………………………………………………………………………………………….108 Premier Access Dental ………………………………………………………………………………………112 SafeGuard Dental ……………………………………………………………………………………………….116 Western Dental …………………………………………………………………………………………….…120

VISION PLANS

EyeMed Vision Plan …………………………………………………………………………………………….…124 SafeGuard Vision Plan ………………………………………………………………………………………126 Vision Service Plan ……………………………………………………………………………………………….128 APPENDICES

Appendix A: 2009 Health Plan Performance Measures …………………………………………………...130 Appendix B: 2009 Dental Plan Performance Measures …………………………………………………...133

EXECUTIVE SUMMARY

2009 HFP PLAN PERFORMANCE PROFILES 1

Introduction

The 2009 Plan Performance Profile Report provides an assessment of individual plan performance on certain contractual requirements, including measures related to the quality of care provided to children in the Healthy Families Program (HFP). This report is a compilation of information previously released in the 2009 Healthcare Effectiveness Data and Information Set (HEDIS) and the 2009 Dental Quality Report. This report also includes coverage areas, and annual and monthly enrollment levels for each plan. These data provide the Managed Risk Medical Insurance Board (MRMIB) with detailed information related to how health, dental, and vision plans in the HFP met clinical and contractual performance standards. MRMIB uses these plan performance profiles to evaluate the quality of care provided in the HFP and to identify areas of focus to improve the quality of care for HFP children.

Performance Evaluation Criteria

The following data were used to evaluate plan performance for calendar year 2009:

• 2009 HEDIS results for health plans (12 measures/16 rates per plan)

• 2009 results of the HFP dental performance measures (8 measures/10 rates per plan)

• Enrollment trends

• Medical Loss Ratio Each plan profile contains a summary of the plan’s coverage areas, the plan’s enrollment trends, and summaries of the plan’s areas of achievement and areas for improvement. In addition, each profile includes tables and graphs of the plan’s performance over three years, from 2007 to 2009. Plan areas of achievement were determined by:

• Improvement in a HEDIS or dental quality measure rate of three percent or more from

2008 to 2009.

• HEDIS or dental quality measure rates three percent or more above the 2009 HFP weighted average for that measure.

Plan areas for improvement were determined by:

• Decrease in a HEDIS or dental quality measure rate of three percent or more from 2008 to 2009.

• HEDIS or dental quality measure rates three percent or more below the 2009 HFP weighted average for that measure.

Evaluation of plan performance also includes the plan reported Medical Loss Ratio for 2008-09.

Key Findings

Quality of Care: Health and Dental Plans Health Plans: 2009 HEDIS Rates Every health plan showed an increase in at least one HEDIS rate from the 2008 level. Six health plans had eight or more (out of 16) HEDIS scores that were three percentage points or more above the 2009 HFP weighted average:

• CalOptima – 9 rates

• Central California Alliance for Health – 9 rates

• Health Plan of San Mateo – 8 rates

• Kaiser Foundation Health Plan North – 9 rates

• Kaiser Foundation Health Plan South – 12 rates

• San Francisco Health Plan – 9 rates Six health plans had eight or more (out of 16) rates that `were three percentage points or more below the 2009 HFP weighted average:

• Anthem Blue Cross HMO - 12 rates

• Blue Shield EPO – 10 rates

• Blue Shield HMO – 10 rates

• Community Health Plan – 9 rates

• Molina Healthcare – 9 rates

• Ventura County Health Care Plan – 9 rates Although some health plans’ rates improved from 2008 to 2009, 2009 rates were actually lower than

EXECUTIVE SUMMARY


2007 rates for many plans, particularly in Well Child Visits, 1st 15 Months, 6 or More. Overall, Children’s Access to Primary Care is high, with many plans showing rates over 90 percent for each age cohort. Many plans showed declining rates in important preventive measures including Childhood Immunizations, Well Child Visits, 1st 15 Months, 6 or More and Adolescent Well Care Visits. Plans need to do more to ensure HFP children get all necessary preventive care visits and immunizations, especially for the youngest children in their first fifteen months of life. The declining rates in immunizations among HFP health plans may be related to concerns around whether an ingredient in measles, mumps, and rubella (MMR) vaccines causes autism. In February 2011, the US Supreme Court ruled there is no causative link between the MMR vaccine and autism, which is consistent with recent research on vaccine safety. The American Academy of Pediatrics (AAP) continues to advocate for preventive care, including immunizations, as “a major component of pediatric health care and disease prevention.” Plans still have a long way to go to improve performance rates on Appropriate Testing for Pharyngitis and Chlamydia Screening in Women. Nearly all plans’ rates for Appropriate Testing for Pharyngitis, Mental Health Utilization, and Identification of Alcohol and Other Drugs were at or below the national 10th percentile rate for commercial plans with the following exceptions.

• Both Kaiser Foundation Health Plans, North and South, were the only health plans to achieve the national 90th percentile rate for commercial plans for Appropriate Testing for Pharyngitis in 2009.

• Kaiser Foundation Health Plan - North was the only health plan that did not have a rate at or below the national 10th percentile rate for commercial plans for Mental Health Utilization in 2009.

• Ventura County Healthcare Plan was the only plan that did not have a rate at or below the

national 10th percentile rate for commercial plans in 2009 for Identification of Alcohol and Other Drugs.

MRMIB will work with the health plans and a contracted external quality review organization (EQRO) to use the information from this report to identify quality improvement projects (QIP) at both the statewide level and individual plan level. MRMIB will contract with the EQRO in 2011 and begin the QIPs in 2012. Dental Plans: 2009 Dental Performance Rates As noted in the 2009 Dental Quality Report, there are significant differences in performance in dental exclusive provider organizations (EPO) compared dental health maintenance organizations (HMO). That said, most of the dental plans realized increases of three percentage points or more from the 2008 level in their performance rates. Two dental plans, both dental EPOs, had five or more rates that were three percentage points or more above the 2009 HFP weighted average:

• Delta Dental – all 10 rates

• Premier Access Dental – all 10 rates Four dental plans, all of which are dental HMOs, had decreases in at least one dental quality rate from the 2008 level. Four dental plans had five or more dental rates three percentage points or more below the 2009 HFP weighted average:

• Access Dental – all 10 rates

• HealthNet Dental – all 10 rates

• SafeGuard Dental – all 10 rates

• Western Dental – 8 rates To address the low performance of dental plans, MRMIB has undertaken an oral health quality improvement project – Healthy Families - Healthy Smiles. The focus of the project is ensuring that young children, ages 0 to 7, enrolled in HFP, receive appropriate preventive services. The project will use a variety of strategies including identification and training of dentists willing to treat young children, incentives, and community partnerships to improve treatment and prevention

EXECUTIVE SUMMARY


of dental caries. The project is underway, and results will be reported in 2012. Enrollment Health Plans Overall, enrollment increased from 2008 to 2009. However, there were three health plans that had decreases in enrollment from 2008 to 2009: Anthem Blue Cross EPO, Anthem Blue Cross HMO, and Community Health Plan. Factors affecting health plan enrollment in 2009:

• The 2008-09 BY did not begin until February 2009 due to delays in the passage of the state budget.

• There were two open enrollment periods in 2008-09: November – December 2008 for the 2008-09 BY, and April - May 2009 for BY 09-10.

• In February 2009, HFP premiums increased for income categories B and C.

• In Orange, Riverside, and San Bernardino counties, Anthem Blue Cross (ABC) changed its plan from EPO to HMO, which required members to choose a new plan.

• Several large health plans - Blue Shield, Anthem Blue Cross, and Health Net – stopped covering two or more counties that they had covered in Benefit Year 2008-09. This impacted enrollment in several smaller, local health plans in those counties.

• There was a spike in enrollment in July 2009 due to implementation of the HFP wait list. People may have rushed to apply prior to implementation of the wait list, increasing enrollment levels in July 2009. The wait list ended in September 2009. Consequently, there were increases in enrollment from September 2009 through December 2009 as members who had been on the wait list were enrolled.

Dental Plans Delta Dental was the only dental plan and Vision Service Plan was the only vision plan to show decreased enrollment in 2009. A limitation on dental plan choice was implemented November 1, 2009, requiring newly enrolled HFP members to select a low-cost dental plan. Members must remain in a low-cost dental plan for at least two years before they can switch to higher-cost dental plan during the next open enrollment period.

READING THE REPORT


Reading the Plan Performance Profiles

Consider the following when reading this report:

• Reported coverage areas are plan coverage areas during the 2009-10 Benefit Year (BY).

• Enrollment levels by county represent the median monthly enrollment level for 2009 in each county for a given plan. Median was used because it is less sensitive to extreme values than the mean and provides a better estimate of annual enrollment given the fluctuations in enrollment levels from the 2008-09 BY to the 2009-10 BY. For plans with multiple counties in their coverage areas, the estimated enrollments were summed to obtain the estimated total annual enrollment for that plan for the 2009 calendar year. For plans with only one county in their coverage area, the median monthly enrollment for 2009 is the plan’s estimated total annual enrollment.

• Three percentage points or more was the criteria for significant change in quality measure scores. This was applied to changes from 2008 to 2009 as well as the distance above or below the 2009 HFP weighted average.

• Health and dental plan quality rates were evaluated against the 2009 HFP weighted average. Rates that were three percentage points or more above the 2009 HFP weighted average are significant. Comparisons of plan rates against state and national benchmarks for HEDIS are reported in the 2009 HEDIS Report for HFP.

• Three years of performance measure data are included in the plan profiles: 2007 – 2009. Where rates are shown as zero (0) in the plan HEDIS charts, this indicates the plan’s sample size was too small to report for that year.

• For Mental Health Utilization and Identification of Alcohol and Other Drugs, many plan scores are displayed as zero (0). This may occur for one of two reasons: the rate of service provision was less than one half of one percent, or these services were not utilized

during 2009.

• For dental performance measures, all rates except Annual Dental Visit are zero for 2007 because the remaining seven dental performance measures were not collected in 2007.

HEALTH PLAN PERFORMANCE PROFILES

ALAMEDA ALLIANCE FOR HEALTH


Alameda Alliance for Health has been a Healthy Families health plan since 1998 and is also a health plan in the Medi-Cal Managed Care program. Alameda Alliance was the Community Provider Plan in Alameda County in Benefit Year 2009-10 and provides services in Alameda County. Anthem Blue Cross HMO and Blue Shield HMO stopped covering Alameda County in 2009-10, which impacted Alameda Alliance for Health’s enrollment. The estimated annual enrollment (median monthly enrollment) for Alameda Alliance for Health in 2009 was 9,123. The following charts provide trends in enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of Alameda Alliance for Health.

Areas of Achievement

Ten HEDIS rates across each of the three care domains increased at least three percentage points from the 2008 level: Access & Availability of Care Domain

Children’s Access to Primary Care � Ages 12 – 24 months � Ages 7 - 11 years � Ages 12 – 18 years

Though these rates increased from 2008, the 2009 rates are lower than the 2007 rates.

Effectiveness of Care Domain

Childhood Immunizations � Combination 2 � Combination 3 Appropriate Medication for Asthma Appropriate Treatment for Upper Respiratory Infection Chlamydia Screening in Women

The plan improved their rates for five out of seven measures in this domain of care.

Use of Services Domain Well-Child Visits, 3rd – 6th Years Adolescent Well-Care Visits Though the rate for Well Child Visits, 3rd – 6th Years increased from 2008, the plan’s rate has decreased from 84 percent in 2007 to 78 percent in 2009. Five rates were at least three percentage points higher than the 2009 HFP weighted average:

• Childhood Immunizations, o Combination 2* o Combination 3*

• Chlamydia Screening in Women*

• Appropriate Treatment for Upper Respiratory Infection*

• Adolescent Well-Care Visits * *These rates are also at or above the national 90

th

percentile for commercial plans.

Areas for Improvement Three rates across two care domains decreased at least three percentage points from the 2008 level: Access & Availability of Care Domain

Children’s Access to Primary Care � Ages 25 months - 6 years (11%)*

*This measure shows a steady decline from 93 percent in 2007 to 72 percent in 2009. Effectiveness of Care Domain

Appropriate Testing for Pharyngitis (13%)* Lead Screening in Children (13%)

*This measure shows a steady decline from 52 percent in 2007 to only 34 percent in 2009.

Three rates fell three percentage points or more below the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 25 months – 6 years o Ages 12 – 18 years

• Lead Screening in Children The plan’s 2009 rate for Children’s Access to Primary Care, Ages 25 Months – 6 Years was at or below the national 10th percentile rate for commercial plans.

Enrollment

The median monthly enrollment for 2008 was 7,989, but increased to 9,123 members in 2009.



HEDIS: Access & Availability of Care

0%

20%

40%

60%

80%

100%

2007 Plan Rate 100% 93% 93% 88%

2008 Plan Rate 92% 83% 86% 82%

2009 Plan Rate 96% 72% 90% 85%

2009 HFP Weighted Average 98% 91% 91% 89%

Access to PCP: 12 -

24 Months

Access to PCP: 25

Months - 6 Years

Access to PCP: 7 - 11

Years

Access to PCP: 12 -

18 Years

HEDIS: Effectiveness of Care

0%

20%

40%

60%

80%

100%

2007 Plan Rate 96% 86% 98% 52% 95% 51% 0%

2008 Plan Rate 88% 88% 89% 47% 93% 16% 68%

2009 Plan Rate 91% 91% 96% 34% 96% 53% 55%

2009 HFP Weighted Average 79% 78% 94% 35% 87% 44% 62%

Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children

HEDIS: Use of Services

0%

20%

40%

60%

80%

100%

2007 Plan Rate 0% 84% 56% 1% 0%

2008 Plan Rate 61% 72% 59% 0% 0%

2009 Plan Rate 0% 78% 56% 2% 0%

2009 HFP Weighted Average 58% 77% 46% 2% 0%

Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of

Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services



2009-10 Coverage Areas Level of

Coverage

Median Monthly

Enrollment 2009

Alameda Full 9,123

Monthly Enrollment: 2008 and 2009

7,8

21

7,8

31

7,8

85

7,8

94

7,9

83

8,0

08

7,9

72

8,0

36

7,9

94

8,0

41

8,0

69

8,1

03

8,1

35

9,3

07

9,2

99

9,2

53

9,3

13

9,2

92

9,2

88

8,9

93

8,7

13

8,6

60

8,7

34

8,7

36

7,000

7,500

8,000

8,500

9,000

9,500

Jan-

08

Feb

-08

Mar

-08

Apr

-08

May

-08

Jun-

08

Jul-0

8Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec-

08Ja

n-09

Feb

-09

Mar

-09

Apr

-09

May

-09

Jun-

09

Jul-0

9Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec-

09

Months

Me

mb

ers

PAGE INTENTIONALLY LEFT BLANK

ANTHEM BLUE CROSS EPO


Anthem Blue Cross EPO has been a Healthy Families health plan since 1998 and provides coverage in 40, primarily rural, counties. Anthem EPO dropped eight counties from its coverage areas in 2009-10: Monterey, Orange, Riverside, San Bernardino, San Mateo, Santa Barbara, Solano, and Yolo. Coverage of Orange, Riverside, and San Bernardino counties was provided by Anthem HMO in 2009-10. Anthem EPO was the Community Provider Plan in 37 counties in 2009-10. The estimated annual enrollment for Anthem Blue Cross EPO for Calendar Year 2009 was 100,578. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of Anthem Blue Cross EPO.


Five HEDIS rates, across all three care domains, increased at least three percentage points from the 2008 level: Access & Availability of Care Domain

Children’s Access to Primary Care � Ages 12 to 18*

*This rate was at or above the national 90th percentile

rate for commercial plans.

The plan’s rates for all four age cohorts for Children’s Access to Primary Care have remained constant from 2007 to 2009.


Childhood Immunizations � Combination 2* � Combination 3* Appropriate Testing for Pharyngitis

*The plan’s immunization rates dropped significantly in 2008, but the plan rebounded in 2009, with rates higher than the 2007 rates.

Use of Services Domain

Well-Child Visits, 1st 15 Months, 6 or More Three of the five measures in the Use of Services domain increased significantly from the 2007 level:

• Well-Child Visits, 1st 15 Months, 6 or More

• Well Child Visits, 3rd – 6th Years*

• Adolescent Well Care Visits* *The 2009 rate is below the HFP weighted average.

Areas for Improvement

Two HEDIS rates in the Effectiveness of Care domain decreased at least three percentage points from the 2008 level: Appropriate Medication for Asthma and Chlamydia Screening in Women Seven HEDIS rates were at least three percentage points below the HFP 2009 weighted average:

• Childhood Immunizations, o Combination 2* o Combination 3*

• Appropriate Treatment for Upper Respiratory Infection

• Chlamydia Screening in Women

• Lead Screening in Children*

• Well-Child Visits, 3rd – 6th Years

• Adolescent Well-Care Visits *These rates were at or below the national 10

th

percentile rate for commercial plans.

Enrollment

The median monthly enrollment for 2008 was 204,416. In 2009, the median monthly enrollment declined to 141,494 members due to the plan dropping coverage in eight counties.




0%

20%

40%

60%

80%

100%

2007 Plan Rate 99% 94% 92% 88%

2008 Plan Rate 98% 92% 91% 88%

2009 Plan Rate 99% 94% 93% 91%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 64% 59% 95% 30% 80% 29% 0%

2008 Plan Rate 46% 42% 96% 30% 82% 33% 36%

2009 Plan Rate 71% 64% 92% 34% 84% 30% 37%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 59% 69% 34% 2% 0%

2008 Plan Rate 61% 72% 40% 2% 0%

2009 Plan Rate 64% 72% 40% 3% 0%


Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of

Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services



Level of

Coverage

Median Monthly

Enrollment

2009

Full 2

Full 362

Full 3,126

Full 587

Full 1,405

Full 407

Full 2,148

Full 1,178

Full 3,390

Full 4,457

Full 306

Full 3,596

Full 1,423

Full 260

Full 3,254

Full 1,718

Full 210

Full 1,798

Full 7,648

Full 162

Full 447

Full 1,309

Full 1,929

Full 1,906

Full 269

Full 1,731

Full 4,046

Full 4,827

Full 3,943

Full 3,434

Full 43

Full 753

Full 6,316

Full 3,394

Full 1,257

Full 260

Full 11,208

Full 895

Full 13,545

Full 1,634Yuba

Tehama

Trinity

Tulare

Tuolumne

Ventura

Sonoma

Sutter

Santa Cruz

Shasta

Sierra

Siskiyou

Mendocino

San Luis Obispo

Plumas

San Benito

Napa

Nevada

Placer

San Joaquin

Lake

Lassen

Humboldt

Imperial

Inyo

Calaveras

Colusa

Kings

Marin

Mariposa

2009-10 Coverage Areas

Amador

Del Norte

Alpine

El Dorado

Glenn

Butte

Merced

Modoc

Mono

Madera




197,810

197,773

200,631

201,462

203,731

204,297

204,535

205,300

205,661

206,662

207,197

207,067

205,509

177,093

180,101

180,707

181,226

179,568

105,894

103,332

100,533

99,666

99,756

100,054

0

50,000

100,000

150,000

200,000

Jan-08

Feb-08

Mar-08

Apr-08

May-08

Jun-08

Jul-08

Aug-08

Sep-08

Oct-08

Nov-08

Dec-08

Jan-09

Feb-09

Mar-09

Apr-09

May-09

Jun-09

Jul-09

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Months

Members

ANTHEM BLUE CROSS HMO


Anthem Blue Cross HMO has been a Healthy Families health plan since 1998 and is also a Medi-Cal Managed Care health plan. Anthem HMO dropped four counties from its coverage areas in 2009-10: Alameda, Contra Costa, Fresno, and Stanislaus. Anthem HMO added three counties to its coverage areas in 2009-10: Orange, Riverside, and San Bernardino. Anthem HMO was the Community Provider Plan in Kern County in 2009-10. The estimated total annual enrollment for Anthem Blue Cross HMO for 2009 was 104,217. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of Anthem Blue Cross HMO.


Seven HEDIS rates, across all three care domains, increased at least three percentage points from the 2008 level: Access & Availability of Care Domain

Children’s Access to Primary Care � Ages 7 to 11 years � Ages 12 to 18 years


Childhood Immunizations � Combination 2 � Combination 3 Chlamydia Screening in Women Lead Screening in Children

Use of Services Domains Well Child Visits, 3rd – 6th Years The plan’s rates for Appropriate Treatment for Upper Respiratory are showing a slight upward trend from 2007 to 2009.


Two HEDIS rates, in two domains of care, decreased at least three percentage points from the 2008 level: Effectiveness of Care Domain Appropriate Medication for Asthma Use of Services Domain

Well-Child Visits, 1st 15 Months, 6 or More The plan’s rates for Appropriate Testing for Upper Respiratory Infection, Well Child Visits, 1st 15 Months, 6 or More, and Adolescent Well Care Visits are showing downward trends from 2007 to 2009, dropping at least three percentage points from 2007 to 2009.

All Anthem Blue Cross HMO 2009 HEDIS rates are at or below the HFP weighted average. Anthem Blue Cross HMO has rates among the lowest of all 24 health plans. Twelve of sixteen HEDIS rates were at least three percentage points below the 2009 HFP weighted average.

Enrollment

The median monthly enrollment for 2008 was 132,197. In 2009, the median monthly enrollment dropped to 112,475 members.




0%

20%

40%

60%

80%

100%

2007 Plan Rate 97% 89% 89% 85%

2008 Plan Rate 94% 83% 84% 80%

2009 Plan Rate 95% 85% 87% 84%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 79% 70% 94% 21% 80% 32% 0%

2008 Plan Rate 63% 58% 94% 19% 82% 32% 57%

2009 Plan Rate 73% 69% 89% 18% 84% 35% 63%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 59% 73% 49% 1% 0%

2008 Plan Rate 49% 61% 43% 1% 0%

2009 Plan Rate 43% 69% 45% 2% 0%


Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of

Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services



Level of

Coverage

Median

Monthly

Enrollment

2009Full 4,746

Full* 72,884

Full 4,158

Full 3,457

Full 3,145

Full 11,663

Full 4,166Santa Clara

San Bernardino

San Diego

*Coverage does not include Catalina Island


Riverside

Orange

Los Angeles

Kern


13

1,1

97

13

0,4

85

13

1,7

66

13

1,6

66

13

2,8

64

13

2,8

99

13

2,7

71

13

2,9

18

13

2,2

99

13

2,2

73

13

2,1

21

13

0,6

74

12

8,6

45

93

,85

5

94

,89

3

94

,83

0

95

,30

0

95

,07

0 11

5,0

41

11

4,7

78

11

2,7

04

11

2,2

45

11

3,6

31

11

4,5

65

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

BLUE SHIELD EPO


Blue Shield EPO has been a Healthy Families health plan since 2000 and is not a Medi-Cal Managed Care health plan. Blue Shield EPO stopped providing coverage in San Diego County and began providing coverage in Fresno in 2009-10. Blue Shield EPO provided coverage in 19 counties in 2009-10. The estimated total annual enrollment for Blue Shield EPO was 10,723 for 2009. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of Blue Shield EPO.


Four HEDIS rates, in two domains of care, increased at least three percentage points from the 2008 level: Effectiveness of Care Domain

Appropriate Medication for Asthma Appropriate Testing for Pharyngitis

Use of Services Domain Well Child Visits 1st 15 Months, 6 or More Adolescent Well Care Visits Although these rates increased by at least three percent, they are still among the lowest for these measures in the HFP and fall far below the 2009 HFP weighted average. All of the rates in the Access and Availability of Care Domain (Children’s Access to Primary Care, all four age cohorts) remained constant, with slight increases in rates from 2007 to 2009. One HEDIS rate was at least three percentage points above the HFP weighted average for 2009: Appropriate Testing for Pharyngitis.


Two HEDIS rates, in the Effectiveness of Care domain, decreased at least three percentage points from the 2008 level: Childhood Immunizations, Combination 3 and Chlamydia Screening in Women. The plan’s rates show significant decline in immunization rates and well child visits since 2007. The plan’s rate for Adolescent Well Care Visits is the lowest in the HFP in 2009. Ten HEDIS rates were three percentage points or more below the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 7 – 11 years o Ages 12 – 18 years

• Childhood Immunizations

o Combination 2* o Combination 3*




• Well Child Visits, 1st 15 Months, 6 or More*

• Well Child Visits, 3rd – 6th Years

• Adolescent Well Care Visits *These rates were at or below national 10

th percentile


None of the plan’s HEDIS rates were at or above the national 90th percentile for commercial plans and nearly all of their 2009 HEDIS rates were at or below the HFP weighted average.

Enrollment

The median monthly enrollment for 2008 was 8,693. In 2009, the median monthly enrollment was 10,834 members.

BLUE SHIELD EPO



0%

20%

40%

60%

80%

100%

2007 Plan Rate 98% 89% 86% 82%

2008 Plan Rate 100% 92% 89% 83%

2009 Plan Rate 99% 91% 88% 85%


Access to PCP: 12 -

24 Months

Access to PCP: 25

Months - 6 Years

Access to PCP: 7 -

11 Years

Access to PCP: 12 -

18 Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 74% 65% 90% 47% 83% 32% 0%

2008 Plan Rate 65% 60% 88% 45% 83% 34% 0%

2009 Plan Rate 65% 51% 92% 48% 83% 30% 24%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 44% 68% 25% 4% 0%

2008 Plan Rate 39% 60% 23% 3% 0%

2009 Plan Rate 42% 62% 28% 3% 0%


Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of

Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services

BLUE SHIELD EPO


Level of

Coverage

Median

Monthly

Enrollment

2009Full 653

Full 110

Full 137

Full 157

Full 204

Full 154

Full 689

Full 204

Full 234

Full 310

Full 584

Full 602

Full 143

Full 267

Full 778

Full 4,954

Full 255

Full 130

Full 161

Imperial

Lake

Kings

Yuba

Tehama

Tuolumne

Mendocino

San Benito

Shasta

Stanislaus

Madera

Merced

San Luis Obispo


Calaveras

Del Norte

Fresno

Butte

Glenn

Humboldt


7,9

53

7,9

70

8,1

77

8,2

54

8,4

03

8,6

46

8,7

40

8,8

69

9,0

79

9,2

96

9,4

93

9,6

23

9,7

13

9,2

15

9,9

25

10

,25

9

10

,55

0

10

,78

2

11

,39

4

11

,17

9

10

,88

6

11

,01

3

11

,37

7

11

,80

1

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

BLUE SHIELD HMO


Blue Shield HMO has been a Healthy Families health plan since 1998. Blue Shield HMO stopped providing coverage in El Dorado County in 2009-10. Blue Shield HMO provided coverage in 18 counties in 2009-10. The estimated annual enrollment for Blue Shield HMO was 46,915 for 2009. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of Blue Shield HMO.


Six HEDIS rates, across all three domains of care, increased at least three percentage points from the 2008 level: Access & Availability of Care Domain Children’s Access to Primary Care:

� Ages 25 months – 6 years � Ages 7 – 11 years � Ages 12 – 18 years

All four rates in this domain of care increased from the 2007 level. Effectiveness of Care Domain

Appropriate Testing for Pharyngitis* Appropriate Treatment for Upper Respiratory Infection*

*These rates are showing an upward trend from 2007.

Use of Services Domain Adolescent Well Care Visits* *The plan’s rates for this measure show an upward trend from 2007.


Three HEDIS rates, in two domains of care, decreased at least three percentage points from the 2008 level: Effectiveness of Care Domain

Childhood Immunizations � Combination 2 � Combination 3


Well Child Visits, 1st 15 Months, 6 or More The plan’s rates for immunizations and well child visits have decreased significantly from 2007 to 2009. Although Adolescent Well Care Visits increased from 2007, the plan’s 2009 rate is in the bottom three of all twenty-four health plans.

Ten HEDIS rates are at least three percentage points below the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 12 – 18 years

• Childhood Immunizations o Combination 2* o Combination 3*

• Appropriate Testing for Pharyngitis




• Well Child Visits, 1st 15 Months, 6 or More*


• Adolescent Well Care Visits *These rates were at or below the national 10

th


None of the plan’s HEDIS rates were three percentage points or more above the 2009 HFP weighted average. The plan did not have any rates at or above the national 90th percentile rate for commercial plans.

Enrollment

The median monthly enrollment for 2008 was 35,617. In 2009, the median monthly enrollment was 47,181 members.

BLUE SHIELD HMO



0%

20%

40%

60%

80%

100%

2007 Plan Rate 94% 84% 83% 79%

2008 Plan Rate 96% 86% 86% 82%

2009 Plan Rate 96% 89% 89% 85%


Access to PCP: 12 -

24 Months

Access to PCP: 25

Months - 6 Years


Years

Access to PCP: 12 -

18 Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 76% 68% 93% 23% 77% 34% 0%

2008 Plan Rate 77% 72% 94% 23% 80% 40% 0%

2009 Plan Rate 67% 62% 92% 29% 83% 34% 49%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 57% 70% 32% 3% 0%

2008 Plan Rate 48% 66% 33% 2% 0%

2009 Plan Rate 41% 67% 37% 3% 0%


Well Child Visits

1st 15 Months

of Life, 6 or

Well Child Visits

3rd-6th Years

of Life

Adolescent

Well Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services

BLUE SHIELD HMO


Level of

Coverage

Median

Monthly

Enrollment

2009Full 1,958

Full* 14,969

Full 113

Partial 430

Full 8,947

Partial 641

Partial 4,327

Partial 3,857

Full 599

Full 725

Full 3,507

Full 2,281

Full 433

Full 980

Full 438

Full 627

Full 1,040

Full 1,046

San Bernardino

San Francisco

San Joaquin

Santa Cruz

Santa Clara

Tulare

Santa Barbara

Solano

Sonoma

Ventura

Yolo



Riverside

Nevada

Orange

Los Angeles

Alameda

Marin

Placer


34

,40

6

34

,26

9

34

,74

4

34

,90

0

35

,33

1

35

,52

2

35

,71

1

35

,83

6

35

,81

9

36

,04

5

36

,25

2

36

,47

7

36

,80

0

39

,63

6

41

,22

3

42

,10

3

43

,55

5

44

,47

5

51

,82

5

51

,03

0

49

,92

3

49

,88

7

50

,81

0

51

,42

4

0

10,000

20,000

30,000

40,000

50,000

60,000

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

CALOPTIMA


CalOptima has been a Healthy Families health plan since 1998 and is a Medi-Cal Managed Care health plan. CalOptima has been the Community Provider Plan in Orange County for many years. CalOptima provided coverage in Orange County in 2009-10. The estimated total annual enrollment (median monthly enrollment) in 2009 for CalOptima was 37,122. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of CalOptima.


CalOptima received a Superior Performance Award from MRMIB for its performance in 2008 HEDIS measures. Two HEDIS rates, from the Effectiveness of Care domain, increased at least three percentage points from the 2008 level: Appropriate Treatment for Upper Respiratory Infection and Appropriate Testing for Pharyngitis. . The plan’s rates for the following show an upward trend from 2007 to 2009:

Children’s Access to Primary Care, � Ages 7 – 11 � Ages 12 – 18 Childhood Immunizations � Combination 3 Appropriate Treatment for Upper Respiratory Infection

Nine HEDIS rates were at least three percentage points above the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 25 months – 6 years o Ages 7 – 11 years o Ages 12 – 18 years

• Childhood Immunizations o Combination 2 o Combination 3


• Lead Screening in Children

• Well Child Visits,1st 15 Months, 6 or More

• Well Child Visits, 3rd – 6th Years Three HEDIS rates were at or above the national 90th percentile for commercial plans:

• Childhood Immunizations, Combination 2

• Well Child Visits in the 3rd – 6th Years

• Adolescent Well Care Visits* *CalOptima was one of the only two plans to achieve the benchmark rate for this measure in 2009.

With one exception, CalOptima’s 2009 HEDIS rates are consistently higher than the HFP weighted average.


Three HEDIS rates, in two domains of care decreased, three percentage points or more from the 2008 level: Effectiveness of Care Domain Lead Screening in Children Use of Services Domain Adolescent Well Care Visits Even though its rate for this measure decreased, CalOptima’s rate in 2009 was higher than nearly all other health plans. The plan’s rates for Well Child Visits, 1st 15 Months, 6 or More decreased eight percent from 2007 to 2009. One HEDIS rate was significantly lower than the 2009 HFP weighted average: Appropriate Testing for Pharyngitis (17% lower).

Enrollment

The median monthly enrollment for 2008 was 33,954. In 2009, the median monthly enrollment was 37,122.

CALOPTIMA



0%

20%

40%

60%

80%

100%

2007 Plan Rate 99% 93% 91% 89%

2008 Plan Rate 98% 92% 93% 91%

2009 Plan Rate 99% 94% 95% 92%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 87% 78% 97% 11% 79% 59% 0%

2008 Plan Rate 91% 85% 96% 11% 85% 67% 80%

2009 Plan Rate 89% 85% 95% 18% 88% 66% 77%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 76% 87% 67% 1% 0%

2008 Plan Rate 68% 86% 71% 1% 0%

2009 Plan Rate 68% 86% 68% 2% 0%


Well Child Visits 1st

15 Months of Life, 6

or More Visits

Well Child Visits 3rd-

6th Years of Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other Drug

Services

CALOPTIMA



Coverage

Median Monthly

Enrollment 2009

Orange Full 37,122


32

,48

1

32

,55

7

33

,18

0

33

,27

9

33

,67

2

33

,95

4

34

,01

6

34

,15

9

34

,16

3

34

,32

7

34

,14

5

33

,95

3

33

,74

5

33

,45

3

33

,60

3

33

,27

8

33

,37

0

33

,44

1

46

,10

9

42

,91

4

41

,09

5

40

,49

8

40

,52

4

40

,52

5

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

CARE 1st HEALTH PLAN


Care 1st Health Plan has been a Healthy Families health plan since 2000 and is also a Medi-Cal Managed Care health

plan. Care 1st Health Plan covers Los Angeles County, with the exception of Catalina Island. The estimated total

annual enrollment (median monthly enrollment) in 2009 for Care 1st was 11,997. The following charts provide monthly

enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of Care 1

st Health Plan.


Five HEDIS rates, across all three domains of care, increased at least three percentage points from the 2008 level: Access and Availability of Care Domain Children’s Access to Primary Care

� Ages 7 – 11 years � Ages 12 – 18 years

All four rates in this domain of care show an upward trend from 2007 to 2009. Effectiveness of Care Domain

Appropriate Treatment for Upper Respiratory Infection Lead Screening in Children

Two of the plan’s rates in this domain of care show an upward trend from 2007 to 2009: Appropriate Treatment for Upper Respiratory Infection, and Chlamydia Screening in Women. Use of Services Domain Adolescent Well Care Visits Two of the plan’s rates in this domain of care show an upward trend from 2007 to 2009: Well Child Visits in the 3rd – 6th Years and Adolescent Well Care Visits. Five HEDIS rates were at least three percentage points above the 2009 HFP weighted average:


• Well Child Visits, 1st 15 Months, 6 or More


• Adolescent Well Care Visits

Care 1st Health Plan did not have any HEDIS rates that decreased three percentage points or more from the 2008 level.


The plan’s rate for Childhood Immunizations, Combination 2 shows a slight downward trend from 2007 to 2009. Care 1st had the lowest rate for Appropriate Testing for Pharyngitis. The rate has remained below ten percent from 2007 to 2009. Five HEDIS rates were at least three percentage points below the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 12 – 24 months o Ages 25 months – 6 years

• Appropriate Medication for Asthma *

• Appropriate Testing for Pharyngitis*


• Chlamydia Screening in Women *The rate for this measure was at or below the national 10

th percentile rate for commercial plans.

Enrollment

The median monthly enrollment for 2008 was 11,197 members. In 2009, the median monthly enrollment was 11,997.




0%

20%

40%

60%

80%

100%

2007 Plan Rate 88% 74% 78% 73%

2008 Plan Rate 93% 84% 83% 79%

2009 Plan Rate 94% 85% 86% 83%



Months

Access to PCP: 25 Months -

6 YearsAccess to PCP: 7 - 11 Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 87% 81% 87% 6% 69% 34% 0%

2008 Plan Rate 86% 80% 91% 5% 71% 38% 75%

2009 Plan Rate 84% 82% 89% 6% 78% 40% 79%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 0% 76% 48% 0% 0%

2008 Plan Rate 63% 79% 52% 0% 0%

2009 Plan Rate 61% 81% 57% 0% 0%




or More Visits


6th Years of Life

Adolescent Well Care

Visits

Mental Health

Utilization

Identification of


Services



Level of

Coverage

Median

Monthly

Enrollment

2009Full* 11,997Los Angeles




10

,03

3

10

,14

1

10

,40

9

10

,62

9

10

,86

5

11

,14

4

11

,24

9

11

,44

3

11

,61

9

11

,87

3

11

,97

0

12

,10

1

12

,07

2

11

,92

2

12

,16

2

12

,25

9

12

,24

8

12

,43

0

12

,18

7

11

,76

7

11

,39

3

11

,30

8

11

,54

9

11

,72

4

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

CENCAL HEALTH


CenCal Health has been a Healthy Families health plan since 1998 and is a health plan in the Medi-Cal Managed Care program. CenCal Health was the Community Provider Plan in San Luis Obispo and Santa Barbara counties in 2009-10. CenCal Health’s enrollment more than doubled when Health Net stopped covering San Luis Obispo in 2009-10, and both Health Net and Anthem Blue Cross stopped covering Santa Barbara in 2009-10. The estimated total annual enrollment in 2009 for CenCal Health was 7,365. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of CenCal Health.

Areas of Achievement Six HEDIS rates in two domains of care increased at least three percentage points from the 2008 level: Access and Availability of Care Domain Children’s Access to Primary Care

� Ages 12 – 18 years The plan’s rates for ages 12 – 24 months and ages 12 – 18 years show an upward trend from 2007 to 2009. The plan’s rates for three of the four age cohorts are among the highest in the HFP, and their rates for all four age cohorts are above the 2009 HFP weighted average. Effectiveness of Care Domain Childhood Immunizations

� Combination 2 � Combination 3

Appropriate Testing for Pharyngitis* Appropriate Treatment for Upper Respiratory Infection Lead Screening in Children

*The plan’s rates for this measure show an upward trend from 2007 to 2009, increasing fifteen percent or more each year.

Seven HEDIS rates were at least three percentage points above the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 25 months – 6 years o Ages 7 – 11 years o Ages 12 - 18



• Adolescent Well Care Visits The plan’s 2009 rate for Children’s Access to Primary Care, Ages 12 – 24 Months was at or

above the national 90th percentile rate for commercial plans.


Three HEDIS rates in two domains of care decreased at least three percentage points from the 2008 level: Effectiveness of Care Domain Chlamydia Screening in Women Use of Services Domain Well Child Visits, 3rd – 6th Years* Adolescent Well Care Visits *The plan’s rate for this measure shows a downward trend from 2007 to 2009, decreasing from 78 percent to 73 percent.

Three HEDIS rates were at least three percentage points below the 2009 HFP weighted average:




Enrollment

The median monthly enrollment for 2008 was 2,556. In 2009, the median monthly enrollment increased significantly to 7,359.

CENCAL HEALTH



0%

20%

40%

60%

80%

100%

2007 Plan Rate 93% 95% 94% 89%

2008 Plan Rate 99% 94% 94% 91%

2009 Plan Rate 100% 94% 94% 94%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 87% 85% 0% 5% 88% 0% 0%

2008 Plan Rate 82% 75% 0% 20% 84% 42% 40%

2009 Plan Rate 87% 82% 0% 39% 89% 37% 53%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead Screening

in Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 67% 78% 50% 0% 0%

2008 Plan Rate 74% 76% 56% 0% 0%

2009 Plan Rate 0% 73% 50% 0% 0%


Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of

Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services

CENCAL HEALTH


Level of

Coverage

Median

Annual

Enrollment

2009Full 213

Full 7,152


San Luis Obispo

Santa Barbara


2,3

58

2,3

88

2,4

58

2,4

87

2,5

24

2,5

33

2,5

79

2,6

17

2,6

17

2,6

32

2,6

55

2,6

81

2,7

28

7,3

98

7,2

86

7,3

05

7,3

62

7,3

55

7,6

39

7,4

97

7,3

45

7,2

88

7,3

90

7,5

46

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

CENTRAL CALIFORNIA ALLIANCE FOR HEALTH


Central California Alliance for Health (CCAH) has been a Healthy Families health plan since 2000 and is a health plan in the Medi-Cal Managed Care program. In 2009-10, CCAH was the Community Provider Plan in Monterey and Santa Cruz Counties. CCAH’s enrollment increased five-fold when Anthem Blue Cross EPO stopped providing coverage in Monterey County and Health Net HMO stopped providing coverage in Santa Cruz County in 2009-10. The estimated total annual enrollment in 2009 for CCAH was 20,136. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of CCAH.


Five HEDIS rates in two domains of care increased by at least three percentage points from the 2008 level: Effectiveness of Care Domain Childhood Immunizations

� Combination 2* � Combination 3*

Lead Screening in Children** *Rate decreased significantly in 2008, but surpassed the 2007 rate in 2009. **2009 rate was more than twice the 2008 rate, rising from 35 percent to 73 percent.

Use of Services Domain Well Child Visits, 3rd – 6th Years* Adolescent Well Care Visits* Nine HEDIS rates were at least three percentage points above the 2009 HFP weighted average:

• Children’s Access to Primary Care, o Ages 25 Months – 6 years

• Childhood Immunizations, o Combination 2 o Combination 3






• Adolescent Well Care Visits Both of the plan’s rates for Childhood Immunizations and the plan’s rate for Children’s Access to Primary Care, Ages 12 – 24 Months were at or above the national 90th percentile rate for commercial plans.


Five HEDIS rates in two domains of care decreased at least three percentage points from the 2008 level: Effectiveness of Care Domain Appropriate Medication for Asthma Appropriate Testing for Pharyngitis

Appropriate Treatment for Upper Respiratory Infection Chlamydia Screening in Women*

*Plan’s rates show a downward trend from 2007 to 2009, decreasing twenty percentage points.


Well Child Visits, 1st 15 Months, 6 or More* *Plan’s rate shows a significant downward trend, of almost twenty percentage points from 2007 to 2009.

Two HEDIS rates were at least three percentage points below the 2009 HFP weighted average:

• Appropriate Medication for Asthma


Enrollment

The median monthly enrollment for 2008 was 3,529. In 2009, median monthly enrollment increased significantly to 20,139.




0%

20%

40%

60%

80%

100%

2007 Plan Rate 100% 92% 92% 91%

2008 Plan Rate 99% 93% 91% 89%

2009 Plan Rate 99% 95% 93% 90%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 87% 80% 0% 46% 91% 50% 0%

2008 Plan Rate 77% 74% 97% 50% 95% 49% 35%

2009 Plan Rate 90% 87% 91% 43% 92% 30% 73%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 87% 82% 55% 0% 0%

2008 Plan Rate 69% 75% 49% 1% 0%

2009 Plan Rate 66% 82% 56% 1% 0%


Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of

Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services



Level of

Coverage

Median

Monthly

Enrollment

2009Full 18,191

Full 1,946


Monterey

Santa Cruz


3,2

43

3,2

37

3,2

98

3,3

41

3,4

25

3,5

00

3,5

58

3,5

78

3,6

19

3,6

38

3,7

30

3,9

30

4,0

92

20,6

33

20,1

73

20,1

64

20,2

51

20,2

30

20,5

32

20,1

14

19,6

32

19,5

08

19,6

69

19,8

98

0

5,000

10,000

15,000

20,000

25,000

Jan-

08

Feb

-08

Mar

-08

Apr

-08

May

-08

Jun-

08

Jul-0

8Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec-

08Ja

n-09

Feb

-09

Mar

-09

Apr

-09

May

-09

Jun-

09

Jul-0

9Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec-

09

Months

Mem

bers

COMMUNITY HEALTH GROUP


Community Health Group has been a Healthy Families health plan since 1998 and is a Medi-Cal Managed Care health plan. Community Health Group is the Community Provider Plan in San Diego County. The plan covered San Diego and Riverside counties in 2009-10. Community Health Group’s enrollment was impacted when Blue Shield stopped providing coverage in San Diego in 2009-10. The estimated annual enrollment in 2009 for Community Health Group was 26,867. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of Community Health Group.


Community Health Plan received the Most Improved Award for its 2008 HEDIS rates. Seven HEDIS rates, across all three domains of care increased at least three percentage points from the 2008 level: Access and Availability of Care Domain Children’s Access to Primary Care

� Ages 25 months – 6 years � Ages 7 – 11 years � Ages 12 – 18 years

The plan’s rates for all four age groups for this measure show upward trends from 2007 to 2009, increasing as much as twenty percent from 2007 to 2009. Effectiveness of Care Domain Appropriate Medication for Asthma Lead Screening in Children Both of the plan’s rates for Childhood Immunizations increased six percent or more from the 2007 level. Use of Services Domain

Well Child Visits, 1st 15 Months, 6 or More Well Child Visits, 3rd – 6th Years*

Five HEDIS rates were at least three percentage points above the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 7 – 11 years






Two HEDIS rates, in two domains of care decreased three percentage points from the 2008 level: Effectiveness of Care Domain Appropriate Testing for Pharyngitis Use of Services Domain Adolescent Well Care Visits Two HEDIS rates were at least three percentage points below the 2009 HFP weighted average:

• Childhood Immunizations, o Combination 3

• Well Child Visits, 1st 15 Months, 6 or More* *Although the plan’s rate for this measure increased significantly from 2008 to 2009, the 2009 rate is far below the HFP weighted average and is at or below the national 10

th percentile for commercial plans.

Enrollment

The median monthly enrollment for 2008 was 25,325. For 2009, the average monthly enrollment was 26,874.




0%

20%

40%

60%

80%

100%

2007 Plan Rate 85% 73% 74% 73%

2008 Plan Rate 98% 90% 85% 83%

2009 Plan Rate 99% 93% 94% 91%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 74% 69% 92% 56% 90% 41% 0%

2008 Plan Rate 83% 76% 87% 59% 90% 39% 62%

2009 Plan Rate 81% 75% 91% 56% 92% 37% 67%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 33% 71% 43% 2% 0%

2008 Plan Rate 37% 75% 48% 3% 0%

2009 Plan Rate 47% 81% 45% 3% 0%


Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of

Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services



Level of

Coverage

Median

Monthly

Enrollment

2009Partial 476

Full 26,391


Riverside

San Diego


25

,01

9

24

,94

9

25

,29

5

25

,22

2

25

,33

1

25

,31

9

25

,26

2

25

,35

4

25

,33

3

25

,45

4

25

,62

8

25

,69

4

25

,50

6

27

,11

0

27

,30

6

27

,28

7

27

,37

0

27

,46

2

27

,46

3

26

,63

7

25

,83

6

25

,57

6 26

,05

6

26

,25

6

23,500

24,000

24,500

25,000

25,500

26,000

26,500

27,000

27,500

28,000

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

COMMUNITY HEALTH PLAN


Community Health Plan has been a Healthy Families health plan since 1998. Community Health Plan is the Community Provider Plan in Los Angeles County. The plan covers Los Angeles County, including Catalina Island. The estimated total annual enrollment (median monthly enrollment) in 2009 for Community Health Plan was 17,223 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of Community Health Plan.


Community Health Plan received the Special Recognition Award in 2009 for their efforts to improve services to adolescents. Three HEDIS rates in two domains of care increased at least three percentage points from the 2008 level: Access and Availability of Care Domain

Children’s Access to Primary Care, � Ages 12 – 24 months

Effectiveness of Care Domain Childhood Immunizations


Both of the Childhood Immunization rates show a slight upward trend from 2007 to 2009: One HEDIS rate was at least three percentage points higher than the 2009 HFP weighted average: Lead Screening in Children.


In most measures, the plan’s rates are significantly below the HFP weighted average, and many are below the national 10th percentile rate for commercial plans. Two HEDIS rates in two domains of care decreased at least three percentage points from the 2008 level: Access and Availability of Care

Children’s Access to Primary Care � Ages 25 months – 6 years

Effectiveness of Care Domain Appropriate Medication for Asthma Nine HEDIS rates were at least three percentage points below the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 12 – 24 months*

o Ages 25 months – 6 years* o Ages 7 – 11 years* o Ages 12 – 18 years*

• Childhood Immunizations, Combination 3

• Appropriate Medication for Asthma*


• Well Child Visits 3rd – 6th Years *These rates are at or below the national 10

th


Community Health Plan is among the bottom three health plans for all four rates for the Children’s Access to Primary Care measure in 2009.

Enrollment

In 2008, the median monthly enrollment was 19,353. In 2009, the median monthly enrollment decreased to 17,235.




0%

20%

40%

60%

80%

100%

2007 Plan Rate 95% 76% 80% 74%

2008 Plan Rate 87% 78% 76% 74%

2009 Plan Rate 92% 71% 76% 73%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 77% 71% 89% 13% 83% 19% 0%

2008 Plan Rate 78% 72% 93% 13% 84% 33% 74%

2009 Plan Rate 81% 75% 89% 12% 85% 32% 75%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 23% 68% 42% 0% 0%

2008 Plan Rate 42% 74% 47% 0% 0%

2009 Plan Rate 0% 72% 45% 1% 0%


Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of

Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services



Level of

Coverage

Median

Monthly

Enrollment

2009Full* 17,235

*Coverage includes Catalina Island

Los Angeles

Coverage Areas


19

,69

8

19

,58

1

19

,66

3

19

,64

8

19

,56

6

19

,42

0

19

,28

6

19

,20

2

19

,09

0

18

,98

6

18

,81

7

18

,72

7

18

,45

6

17

,70

7

17

,57

3

17

,54

4

17

,55

2

17

,42

8

17

,04

1

16

,33

1

15

,66

3

15

,23

0

15

,41

7

15

,65

3

0

5,000

10,000

15,000

20,000

25,000

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

CONTRA COSTA HEALTH PLAN


Contra Costa Health Plan (CCHP) has been a Healthy Families health plan since 1998 and is a health plan in the Medi-Cal Managed Care program. CCHP was the Community Provider Plan in Contra Costa County in 2009-10 and provided full coverage in the county. The estimated total annual enrollment (median monthly enrollment) for CCHP in 2009 was 4,093 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of CCHP.


Contra Costa Health Plan received the Superior Performance Award from MRMIB for the 2008 HEDIS rates. All four rates for Children’s Access to Primary Care remained fairly constant from 2007 – 2009. Two HEDIS rates in the Effectiveness of Care domain increased at least three percentage points from the 2008 level: Lead Screening in Children and Appropriate Testing for Pharyngitis. The plan’s rates for Childhood Immunizations, Combination 3 show a slight upward trend from 2007 to 2009. Five HEDIS rates were at least three percentage points above the 2009 HFP weighted average:




• Well Child Visits, 3rd – 6th Years *Rates were at or above the national 90

th percentile


Areas of Improvement

Two HEDIS rates in two domains of care decreased at least three percentage points from the 2008 level: Effectiveness of Care Domain Chlamydia Screening in Women Use of Services Domain Adolescent Well Care Visits. The plan’s rate for this measure decreased 13 percent from 2007 to 2009. Two HEDIS rates were at least three percentage points below the 2009 HFP weighted average:



Enrollment

The median monthly enrollment in 2008 was 3,599 and 4,093 in 2009.




0%

20%

40%

60%

80%

100%

2007 Plan Rate 95% 90% 88% 87%

2008 Plan Rate 97% 93% 89% 89%

2009 Plan Rate 96% 92% 90% 90%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 89% 89% 92% 25% 90% 0% 0%

2008 Plan Rate 95% 92% 97% 18% 94% 47% 62%

2009 Plan Rate 93% 93% 0% 24% 94% 42% 68%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 51% 80% 50% 2% 0%

2008 Plan Rate 74% 81% 50% 2% 0%

2009 Plan Rate 0% 82% 43% 2% 0%


Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of

Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services



Level of

Coverage

Median

Monthly

Enrollment

2009Full 4,093Contra Costa



3,4

99

3,5

28

3,5

47

3,5

42

3,5

74

3,5

90

3,6

08

3,6

24

3,6

29

3,6

46

3,6

36

3,6

09

3,6

21

4,3

85

4,3

31

4,2

99

4,2

82

4,2

12

4,1

68

4,0

17

3,8

71

3,8

17

3,8

65

3,9

45

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

HEALTH NET


Health Net HMO has been a Healthy Families health plan since 1998. Health Net HMO is also a health plan in the Medi-Cal Managed Care Program. Health Net HMO stopped providing coverage in eight counties in 2009-10: Madera, Marin, Merced, Nevada, Santa Barbara, Santa Clara, Santa Cruz, and Stanislaus. Health Net HMO was the Community Provider Plan in El Dorado, Sacramento, Solano, and Yolo counties in 2009-10. The estimated total annual enrollment for Health Net HMO in 2009 was 138,543 members. Health Net EPO has been a Healthy Families plan since 2002. In 2009-10 Health Net EPO stopped covering four counties: Butte, Glenn, Lake, and San Luis Obispo. Health Net EPO began covering Del Norte and El Dorado in 2009-10. The estimated total annual enrollment for Health Net in 2009 was 721 members. Health Net HMO and EPO cover 32 counties altogether, offering full coverage in 27 counties and partial coverage in 5 counties in 2009-10. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. HEDIS results are combined for Health Net EPO and HMO because enrollment in Health Net EPO is too small to report separate HEDIS rates. Below is a summary profile of Health Net.


Two HEDIS rates in two domains of care increased three percentage points or more from the 2008 level: Access and Availability of Care

Children’s Access to Primary Care, � Ages 12 – 24 months � Ages 7 – 11 years

All four of the plan’s rates for Children’s Access to Primary Care have increased from 2007 to 2009, with all but the rate for ages 12 – 18 showing an upward trend. Effectiveness of Care Domain Appropriate Testing for Pharyngitis The plan’s rate for Appropriate Treatment for Upper Respiratory Infection shows a slight upward trend from 2007 to 2009, increasing from 81 percent in 2007 to 86 percent in 2009. The plan’s rates for Well Child Visits, 1st 15 Months, 6 or More shows an upward trend from 2007 to 2009. The plan’s rates from 2007 to 2009 for Well Child Visits, 3rd – 6th Years have remained constant at 76 percent. Two HEDIS rates were at least three percentage points above the 2009 HFP weighted average:

• Childhood Immunizations o Combination 2


Areas of Improvement

Three measures, in two domains of care, show decreases over the past three years: Effectiveness of Care Domain Childhood Immunizations


Both of these rates show downward trends from 2007 to 2009. Use of Services Domain Adolescent Well Care Visits The plan’s rate for this measure dropped from 2007 to 2009. One HEDIS rate was more than ten percentage points below the HFP weighted average: Lead Screening in Children.

Enrollment

The median monthly enrollment for Health Net HMO was 121,150 in 2008 and 139,009 in 2009. The median monthly enrollment for Health Net EPO was 967 in 2008 and 725 in 2009.

HEALTH NET



0%

20%

40%

60%

80%

100%

2007 Plan Rate 94% 86% 88% 85%

2008 Plan Rate 95% 88% 87% 85%

2009 Plan Rate 98% 90% 90% 87%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 88% 82% 92% 28% 81% 41% 0%

2008 Plan Rate 84% 78% 94% 27% 85% 44% 48%

2009 Plan Rate 82% 77% 92% 30% 86% 42% 50%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 58% 76% 47% 2% 0%

2008 Plan Rate 61% 76% 44% 2% 0%

2009 Plan Rate 63% 76% 45% 2% 0%


Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services

HEALTH NET


Level of

Coverage

Health Net HMO

Median Monthly

Enrollment

2009

Health Net EPO

Median Monthly

Enrollment

2009

Full 1,545 0

Full 0 19

Full 0 99

Full 2,335 0

Partial 420 0

Full 17,726 0

Full 0 30

Full 0 117

Partial 4,563 0

Full 344 0

Full 54,964 0

Full 0 13

Full 0 33

Full 475 0

Full 11,355 0

Partial 692 0

Full 0 11

Partial 7,689 0

Full 10,524 0

Partial 5,801 0

Full 9,777 0

Full 1,263 0

Full 898 0

Full 0 1

Full 1,190 0

Full 799 0

Full 0 238

Full 0 38

Full 2,410 0

Full 1,551 0

Full 2,229 0

Full 0 124

Kern

Kings

Sierra

Plumas

Los Angeles

El Dorado

Fresno

Tehama

Yuba

Sutter

Ventura

Yolo

Tulare

San Joaquin

Solano

Sonoma

Sacramento

San Bernardino

San Diego

San Francisco

Orange

Placer

Riverside

Mariposa

Mendocino

Napa

Humboldt

Imperial


Amador

Colusa

Alameda

Contra Costa

HEALTH NET


Monthly Enrollment Health Net EPO: 2008 and 2009

855

852 891

889

915 957

976

982

1,0

05

1,0

19

1,0

43

1,0

39

1,0

24

720

735

729

738

740

736

710

677

680

701

715

0

200

400

600

800

1,000

1,200

Jan-

08

Feb-0

8

Mar

-08

Apr

-08

May

-08

Jun-

08

Jul-0

8

Aug

-08

Sep

-08

Oct-0

8

Nov-

08

Dec-

08

Jan-

09

Feb-0

9

Mar

-09

Apr

-09

May

-09

Jun-

09

Jul-0

9

Aug

-09

Sep

-09

Oct-0

9

Nov-

09

Dec-

09

Months

Me

mb

ers

Monthly Enrollment Health Net HMO: 2008 and 2009

11

5,7

95

11

6,0

87

11

7,8

99

11

8,6

76

12

0,2

62

12

1,0

09

12

1,2

90

12

1,5

71

12

1,9

78

12

2,9

37

12

3,5

29

12

3,7

32

12

3,8

14

13

5,3

13

13

7,3

72

13

8,2

26

13

9,8

01

14

0,4

57

14

6,0

57

14

2,5

45

13

8,8

67

13

7,9

63

13

9,1

50

14

0,0

41

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov-

08Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov-

09Dec

-09

Months

Me

mb

ers

HEALTH PLAN OF SAN JOAQUIN


Health Plan of San Joaquin (HPSJ) has been a Healthy Families health plan since 1998 and is also a Medi-Cal Managed Care Health Plan. HPSJ was the Community Provider Plan in San Joaquin and Stanislaus Counties in 2009-10. HPSJ covers four counties: Merced, Sacramento, San Joaquin, and Stanislaus. HPSJ’s enrollment was impacted when Anthem Blue Cross HMO and Health Net HMO stopped covering Stanislaus County in 2009-10. The estimated total annual enrollment for HPSJ in 2009 was 18,081 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of HPSJ.


Two HEDIS rates in two domains of care increased at least three percentage points from the 2008 level. Access and Availability of Care Domain Children’s Access to Primary Care:

• Ages 12 – 18 All four of the plan’s Children’s Access to Primary Care rates have increased significantly from 2007 to 2009. Effectiveness of Care Domain Appropriate Testing for Pharyngitis The plan’s rates show a significant upward trend for this measure from 2007 to 2009, increasing from 31 percent in 2007 to 59 percent in 2009. The plan’s rates for Appropriate Treatment for Upper Respiratory Infection also shows an upward trend, increasing significantly from 2007 to 2009. Three HEDIS rates were at least three percentage points above the 2009 HFP weighted average:

• Childhood Immunizations o Combination 2




Four HEDIS rates in two domains of care decreased three percentage points or more from the 2008 level: Effectiveness of Care Domain Appropriate Medication for Asthma Chlamydia Screening in Women* Both rates for Childhood Immunizations have decreased significantly from 2007 to 2009. Use of Services Domain Well Child Visits 3rd – 6th Years Adolescent Well Care Visits The plan’s rates for Adolescent Well Care Visits show a significant downward trend from 2007 – 2009, decreasing from 58 percent in 2007 to 47 percent in 2009. Three HEDIS rates were three percentage points or more below the 2009 HFP weighted average:




Enrollment

The median monthly enrollment in 2008 was 10,488 and 18,060 in 2009.




0%

20%

40%

60%

80%

100%

2007 Plan Rate 88% 80% 77% 78%

2008 Plan Rate 97% 89% 89% 83%

2009 Plan Rate 97% 91% 91% 87%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 91% 83% 96% 31% 68% 21% 0%

2008 Plan Rate 84% 78% 97% 42% 83% 44% 55%

2009 Plan Rate 83% 77% 93% 59% 84% 37% 57%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 75% 82% 58% 1% 0%

2008 Plan Rate 69% 82% 53% 1% 0%

2009 Plan Rate 67% 75% 47% 1% 0%




or More Visits


6th Years of Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services



Level of

Coverage

Median

Annual

Enrollment

2009Full 500

Partial 81

Full 8,951

Full 8,550


Stanislaus

San Joaquin

Sacramento

Merced


9,7

95

9,8

37

10

,05

9

10

,18

4

10

,43

3

10

,47

4

10

,50

2

10

,53

6

10

,65

4

10

,64

9

10

,84

1

11

,16

0

11

,33

0

18

,73

5

18

,59

0

18

,51

0

18

,50

3

18

,40

7

18

,30

6

17

,81

4

17

,28

6

17

,05

2

17

,13

4

17

,29

9

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

HEALTH PLAN OF SAN MATEO


Health Plan of San Mateo (HPSM) has been a Healthy Families health plan since 1998 and is a Medi-Cal Managed Care health plan. HPSM was the Community Provider Plan in San Mateo County in 2009-10. HPSM’s enrollment was impacted when Anthem Blue Cross EPO stopped covering San Mateo County in 2009-10. The estimated total annual enrollment (median monthly enrollment) for HPSM in 2009 was 6,128 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of HPSM.


HPSM received a Superior Performance Award from MRMIB for their 2008 HEDIS rates. Three HEDIS rates in three domains of care increased at least three percentage points from the 2008 level: Access and Availability of Care Domain

Children’s Access to Primary Care:

• Ages 12 – 18* *Plan was one of the top three health plans for this rate, which was at or above the national 90

th percentile

rate for commercial plans. The plan achieved the highest rate possible (100%) in this measure for the 12 – 24 month-old age group and has maintained this level of performance from 2007 to 2009. In addition, the plan’s rates for the 7 – 11 year-old and 12 – 18 year-old age groups show slight upward trends from 2007 – 2009. Effectiveness of Care Domain

Appropriate Treatment for Upper Respiratory Infection

Use of Services Domain Adolescent Well Care Visits The plan’s rates for this measure show a significant upward trend from 2007 to 2009. Additionally, the plan’s 2009 rate for this measure was one of the top three of all health plans. Eight HEDIS rates were at least three percentage points higher than the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 7 – 11 years o Ages 12 – 18 years

• Childhood Immunizations o Combination 2 o Combination 3*




• Adolescent Well Care Visits *Rate is at or above the national 90

th percentile rate for

commercial plans.


Three HEDIS rates in the Effectiveness of Care domain decreased at least three percentage points from the 2008 level:

• Childhood Immunizations, o Combination 2


• Lead Screening in Children *Plan’s rates show a significant downward trend from 2007 to 2009, although the 2009 rate is higher than the HFP weighted average.

The rate for Chlamydia Screening in Women dropped ten percent from 2007 to 2009 and Lead Screening in Children decreased fourteen percent from 2007 to 2009. One HEDIS measure was at least three percentage points below the 2009 HFP weighted average: Chlamydia Screening in Women

Enrollment

The median monthly enrollment for 2008 was 3,727 members. For 2009, the median monthly enrollment was 6,128 members.




0%

20%

40%

60%

80%

100%

2007 Plan Rate 100% 93% 91% 87%

2008 Plan Rate 100% 92% 93% 89%

2009 Plan Rate 100% 90% 94% 92%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 78% 78% 90% 49% 92% 45% 0%

2008 Plan Rate 91% 87% 95% 46% 87% 34% 92%

2009 Plan Rate 88% 87% 95% 42% 91% 35% 78%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 0% 79% 52% 2% 0%

2008 Plan Rate 0% 75% 56% 2% 0%

2009 Plan Rate 0% 76% 60% 2% 0%




or More Visits


6th Years of Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of


Services




Coverage

Median Monthly

Enrollment 2009

San Mateo Full 6,128


3,5

04

3,4

70

3,5

66

3,6

04

3,6

99

3,7

33

3,7

27

3,7

26

3,7

27

3,7

47

3,7

73

3,8

43

3,8

46

6,2

08

6,2

26

6,2

17

6,2

55

6,2

34

6,2

21

5,9

93

5,7

87

5,8

02

5,9

25

6,0

48

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

INLAND EMPIRE HEALTH PLAN


Inland Empire Health Plan (IEHP) has been a Healthy Families health plan since 1998 and participates in the Medi-Cal Managed Care program. IEHP was the Community Provider Plan in Riverside and San Bernardino Counties in 2009-10. The estimated total annual enrollment for IEHP in 2009 was 52,935 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of IEHP.


Four HEDIS rates in two domains of care increased at least three percentage points from the 2008 level: Effectiveness of Care Domain Appropriate Testing for Pharyngitis*

Appropriate Treatment for Upper Respiratory Infection* Lead Screening in Children

*Rates show an upward trend from 2007 to 2009. Use of Services Domain Adolescent Well Care Visits* *This is the only rate where the plan is trending upward. Two HEDIS rates were at least three percentage points above the 2009 HFP weighted average:


• Adolescent Well Care Visits The plan’s 2009 rate for Children’s Access to Primary Care for ages 12 – 24 months was at or above the national 90th percentile rate for commercial plans.


Both of the Childhood Immunizations rates have decreased significantly from 2007 to 2009. The plan’s rates for Appropriate Medication for Asthma show a downward trend from 2007 to 2009. Five HEDIS rates were at least three percentage points below the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 7 – 11 o Ages 12 – 18



• Well Child Visits 1st 15 Months, 6 or More* *Rate was at or below the national 10

th percentile rate

for commercial plans.

Enrollment

The median monthly enrollment in 2008 was 48,816 members and for 2009 it was 53,163 members.




0%

20%

40%

60%

80%

100%

2007 Plan Rate 98% 92% 88% 84%

2008 Plan Rate 98% 89% 88% 84%

2009 Plan Rate 99% 90% 88% 85%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 86% 81% 95% 15% 80% 39% 0%

2008 Plan Rate 88% 82% 92% 16% 85% 44% 62%

2009 Plan Rate 79% 76% 90% 22% 88% 45% 65%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 55% 78% 50% 2% 0%

2008 Plan Rate 47% 80% 48% 2% 0%

2009 Plan Rate 49% 78% 58% 2% 0%




or More Visits


6th Years of Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of


Services



Level of

Coverage

Median

Monthly

Enrollment

2009Partial 28,401

Partial 24,535San Bernardino

Riverside



48

,33

5

48

,12

1

48

,81

7

48

,95

6

49

,41

0

49

,44

3

49

,21

3

49

,00

8

48

,81

0

48

,79

0

48

,81

5

48

,60

4

48

,23

8

47

,24

8

47

,65

9

47

,75

6

48

,34

0

48

,36

5

66

,91

4

61

,78

7

58

,85

6

57

,96

1

58

,48

0

58

,88

5

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

KAISER FOUNDATION HEALTH PLAN - NORTH


Kaiser Foundation Health Plan (Kaiser) has been a Healthy Families health plan since 1998 and is a Medi-Cal Managed Care health plan. Kaiser provided coverage in 25 counties in 2009-10. The estimated total annual enrollment for Kaiser in 2009 was 151,522 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile for Kaiser Foundation Health Plan South and North.

Areas of Achievement: Kaiser North

Kaiser North received a 2008 Superior Performance Award from MRMIB. Three HEDIS rates in the Effectiveness of Care domain increased at least three percentage points from the 2008 level: Childhood Immunizations

� Combination 2 � Combination 3*

Appropriate Testing for Pharyngitis Lead Screening in Children *Highest rate in HFP in 2009.

Although the plan’s rates for Adolescent Well Care Visits show an upward trend from 2007 to 2009, its rate is below the 2009 HFP weighted average. Nine HEDIS rates were at least three percentage points above the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 25 Months – 6 Years o Ages 7 – 11 o Ages 12 - 18


• Appropriate Testing for Pharyngitis**

• Appropriate Testing for Upper Respiratory Infection*


• Mental Health Utilization *Rates were at or above the national 90

th percentile

rate for commercial plans. **Kaiser North was one of two plans to achieve the benchmark rate for this measure.

Kaiser North was the only health plan that was not at or below the national 10th percentile rate for commercial plans for Mental Health Utilization. The plan’s rates for all four age groups reported for Children’s Access to Primary Care remained

constant from 2007 to 2009. The rate for ages 12 to 24 months was at or above the national 90th percentile rate for commercial plans.

Areas for Improvement: Kaiser North

Two HEDIS rates decreased at least three percentage points from the 2008 level: Chlamydia Screening in Women and Well Child Visits, 1st 15 Months, 6 or More. The rates for both of these measures dropped six percent or more from the 2007 level. All other rates remained the same or increased from the 2007 level. Three HEDIS rates were at least three percentage points below the 2009 HFP weighted average:


• Well Child Visits 3rd – 6th Years*

• Adolescent Well Care Visits* *Rates are showing an upward trend from 2007 to 2009.

KAISER FOUNDATION HEALTH PLAN - NORTH


HEDIS: Access & Availability of Care - Kaiser North

0%

20%

40%

60%

80%

100%

2007 Plan Rate 100% 94% 92% 91%

2008 Plan Rate 100% 94% 92% 91%

2009 Plan Rate 99% 94% 94% 92%



Months

Access to PCP: 25

Months - 6 Years


Years


Years

HEDIS: Effectiveness of Care – Kaiser North

0%

20%

40%

60%

80%

100%

2007 Plan Rate 88% 85% 98% 88% 96% 65% 0%

2008 Plan Rate 85% 83% 99% 87% 97% 68% 40%

2009 Plan Rate 88% 99% 98% 90% 97% 59% 48%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children

HEDIS: Use of Services – Kaiser North

0%

20%

40%

60%

80%

100%

2007 Plan Rate 70% 66% 33% 6% 0%

2008 Plan Rate 74% 68% 37% 6% 1%

2009 Plan Rate 60% 69% 39% 6% 1%


Well-Child Visits

1st 15 Months of

Life, 6 or More

Well-Child Visits

3rd-6th Years of

Life

Adolescent Well-

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services

KAISER FOUNDATION HEALTH PLAN - SOUTH


Areas of Achievement: Kaiser South

Kaiser South received three awards from MRMIB for its performance in HEDIS:

• Superior Performance – 2008 HEDIS

• Superior Performance – 2009 HEDIS

• Most Improved Health Plan – 2009 HEDIS

Kaiser South was the highest performing plan in 2009. Seven HEDIS rates across all three domains of care increased at least three percentage points from the 2008 level: Access and Availability of Care Domain

Children’s Access to Primary Care,

• Ages 25 Months - 6 Years The plan’s rates for all Children’s Access to Primary Care age cohorts have increased since 2007. The plan’s rate for the 25 months to 6 years age group was at 100 percent in 2009 and was also at or above the national 90th percentile rate for commercial plans. Effectiveness of Care Domain Childhood Immunizations,

• Combination 3* Appropriate Testing for Pharyngitis* Lead Screening in Children *Rates show a significant upward trend from 2007 to 2009. Kaiser South was one two plans to reach the benchmark rate for this measure.

Use of Services Domain Well Child Visits, 1st 15 Months, 6 or More* Well Child Visits 3rd – 6th Years* Adolescent Well Care Visits* *Kaiser South has made significant improvements in these measures from 2007 to 2009.

Twelve HEDIS rates were at least three percentage points above the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 25 months – 6 years* o Ages 7 – 11 years o Ages 12 – 18 years






• Lead Screening in Children Well Child Visits, 1st 15 Months, 6 or More

• Well Child Visits 3rd – 6th Years* *Rates were at or above the national 90

th percentile


Areas for Improvement: Kaiser South

One HEDIS rate in the Effectiveness of Care domain decreased at least three percentage points from the 2008 level: Chlamydia Screening in Women.

Enrollment

The median monthly enrollment for Kaiser Foundation Health Plan in 2008 was 123,808 members. In 2009, the median monthly enrollment was 152,150 members.

KAISER FOUNDATION HEALTH PLAN - SOUTH


HEDIS: Access & Availability to Care – Kaiser South

0%

20%

40%

60%

80%

100%

2007 Plan Rate 100% 92% 93% 91%

2008 Plan Rate 99% 92% 93% 92%

2009 Plan Rate 100% 96% 95% 94%



Months

Access to PCP: 25

Months - 6 Years


Years


Years

HEDIS: Effectiveness of Care – Kaiser South

0%

20%

40%

60%

80%

100%

2007 Plan Rate 86% 81% 93% 84% 96% 66% 0%

2008 Plan Rate 88% 84% 95% 87% 98% 71% 66%

2009 Plan Rate 87% 98% 97% 92% 98% 66% 76%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children

HEDIS: Use of Services – Kaiser South

0%

20%

40%

60%

80%

100%

2007 Plan Rate 26% 65% 37% 4% 0%

2008 Plan Rate 41% 75% 38% 4% 0%

2009 Plan Rate 64% 95% 42% 4% 0%


Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of

Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services

KAISER FOUNDATION HEALTH PLAN


L e v e l o f

C o v e ra g e

M e d ia n

M o n th ly

E n ro llm e n t

2 0 0 9F u ll 7 ,9 2 5

P a rt ia l 2 0

F u ll 6 ,1 4 2

P a rt ia l 3 9 7

P a rt ia l 4 ,1 6 8

P a rt ia l 3 ,0 5 1

P a rt ia l 3 1

F u ll* 4 2 ,4 2 0

P a rt ia l 4 4 7

F u ll 9 8 2

P a rt ia l 9 2 9

F u ll 8 ,4 0 6

P a rt ia l 1 ,5 0 2

P a rt ia l 1 2 ,1 0 0

F u ll 1 3 ,1 0 3

P a rt ia l 1 2 ,1 4 3

P a rt ia l 9 ,2 3 3

F u ll 1 ,5 1 2

F u ll 5 ,7 7 5

F u ll 4 ,1 0 3

P a rt ia l 8 ,2 5 1

F u ll 3 ,1 2 8

P a rt ia l 4 ,6 4 1

P a rt ia l 5 0 7

P a rt ia l 6 1 2

2 0 0 9 -1 0 C o v e ra g e A re a s

A la m e d a

A m a d o r

K e rn

E l D o ra d o

F re s n o

C o n tra C o s ta

M a d e ra

M a r in

K in g s

L o s A n g e le s

R iv e rs id e

S a c ra m e n to

N a p a

O ra n g e

P la c e r

S a n ta C la ra

S a n B e rn a rd in o

S a n D ie g o

S a n F ra n c is c o

S a n J o a q u in

S a n M a te o

*C o v e ra g e d o e s n o t in c lu d e C a ta lin a Is la n d

V e n tu ra

Y o lo

S o la n o

S o n o m a


11

6,8

06

11

6,8

08

11

8,8

89

11

9,8

93

12

2,0

45

12

3,4

00

12

4,2

16

12

5,1

27

12

5,7

14

12

7,1

62

12

8,5

29

13

0,0

14

13

0,6

12

14

1,0

17

14

4,5

82

14

6,9

53

15

0,0

94

15

1,8

52

16

0,0

83

15

6,6

03

15

2,5

94

15

2,4

47

15

5,0

36

15

7,2

66

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

KERN FAMILY HEALTH PLAN


Kern Family Health Plan has been a Healthy Families health plan since 1998 and is a Medi-Cal Managed Care health plan. Kern Family Health Plan provides coverage in Kern County. The estimated total annual enrollment (median monthly enrollment for 2009) for Kern Family Health Plan in 2009 was 13,290 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of Kern Family Health Plan.


Two HEDIS rates in two domains of care increased at least three percentage points from the 2008 level: Effectiveness of Care Domain Lead Screening in Children Use of Services Domain Well Child Visits 3rd – 6th Years The plan’s rates in all four Children’s Access to Primary Care age groups remained constant from 2007 to 2009. In 2008, the plan achieved the highest rate (100%) for the 12 to 24 month old age group, and remained at this level in 2009. Additionally, the plan’s rate for the 12 – 24 month age group was at or above the national 90th percentile rate for commercial plans. Five HEDIS rates were at least three percentage points above the 2009 HFP weighted average:

• Children’s Access to Primary Care, Ages 25 Months – 6 years



• Adolescent Well Care Visits *Rate was at or above the national 90

th percentile rate

for commercial plans. Kern Family Health Plan was the only plan to achieve this in 2009.


Three HEDIS rates, in two domains of care, the decreased at least three percentage points from the 2008 level: Effectiveness of Care Domain

Appropriate Medication for Asthma* Appropriate Testing for Pharyngitis.

*Rates show a downward trend from 2007 to 2009.

Use of Services Domain Well Child Visits, 1st 15 Months, 6 or More The plan’s rates for this measure show a significant downward trend with a 23 percent decrease from 2007 to 2009. Five HEDIS rates were at least three percentage points below the 2009 HFP weighted average:





• Well Child Visits, 1st 15 Months, 6 or More* *Rate below the national 10

th percentile for commercial

plans.

Enrollment

The median monthly enrollment for 2008 was 12,901 members. The 2009 median monthly enrollment was 13,290 members.




0%

20%

40%

60%

80%

100%

2007 Plan Rate 99% 94% 90% 87%

2008 Plan Rate 100% 92% 90% 87%

2009 Plan Rate 100% 94% 91% 88%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 91% 86% 93% 24% 80% 34% 0%

2008 Plan Rate 90% 85% 92% 24% 81% 39% 78%

2009 Plan Rate 89% 86% 88% 20% 81% 38% 98%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 72% 77% 43% 0% 0%

2008 Plan Rate 52% 72% 51% 0% 0%

2009 Plan Rate 49% 75% 49% 0% 0%


Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of

Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services



Level of

Coverage

Median

Annual

Enrollment

2009Partial 13,290Kern



12,0

23

12,0

54

12,4

35

12,4

93 12,7

90

12,8

71

12,9

31

13,0

31

13,1

40

13,2

52

13,2

77

13,2

83

13,2

68 1

3,6

36

13,6

55

13,5

67

13,5

59

13,4

47

13,3

11

12,7

85

12,3

52

12,2

08

12,2

14

12,2

13

11,000

11,500

12,000

12,500

13,000

13,500

14,000

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Mem

bers

LA CARE HEALTH PLAN


LA Care Health Plan was a Healthy Families health plan from 1998 to 2002. In 2005, LA Care again participated in the Healthy Families Program. LA Care also participates in the Medi-Cal Managed Care program. The estimated total annual enrollment (median monthly enrollment for 2009) for LA Care in 2009 was 6,925 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of LA Care.


Eight HEDIS rates across all three domains of care increased at least three percentage points from the 2008 level: Access and Availability of Care Domain

Children’s Access to Primary Care, � Ages 25 Months – 6 years


� Combination 2 � Combination 3 Appropriate Treatment for Upper Respiratory Infection* Chlamydia Screening in Women Lead Screening in Children

*Although this rate increased from 2008 to 2009, the 2009 rate is lower than the 2007 rate.

Use of Services Domain Well Child Visits 3rd – 6th Years Adolescent Well Care Visits The plan’s rates for Children’s Access to Primary Care, Ages 25 Months to 6 years and Adolescent Well Care Visits show a significant upward trends from 2007 to 2009. Four HEDIS rates were at least three percentage points higher than the 2009 HFP weighted average:





One HEDIS rate, in the Access and Availability of Care domain decreased five percentage points from the 2008 level: Children’s Access to Primary Care, Ages 12 – 24 Months. Six HEDIS rates were at least three percentage points below the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 12 – 24 months* o Ages 7 – 11 years* o Ages 12 – 18 years*



• Chlamydia Screening in Women *Rates at or below the national 10


commercial plans. The plan’s rates for Appropriate Testing for Pharyngitis have remained below ten percent for the past three years. Further, the plan’s rate for 2009 is among the lowest in HFP.

Enrollment

The median monthly enrollment for 2008 is 4,278 members and for 2009 the median monthly enrollment is 6,925 members.

LA CARE HEALTH PLAN



0%

20%

40%

60%

80%

100%

2007 Plan Rate 93% 75% 83% 77%

2008 Plan Rate 97% 86% 85% 82%

2009 Plan Rate 92% 91% 83% 80%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 0% 0% 0% 8% 88% 0% 0%

2008 Plan Rate 79% 74% 0% 8% 83% 33% 55%

2009 Plan Rate 88% 81% 91% 9% 86% 40% 80%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 0% 78% 42% 0% 0%

2008 Plan Rate 0% 74% 46% 0% 0%

2009 Plan Rate 0% 79% 49% 0% 0%


Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of

Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services

LA CARE HEALTH PLAN


Level of

Coverage

Median

Annual

Enrollment

2009Full* 6,925


Los Angeles



3,5

89

3,6

55

3,8

28

3,8

90

4,0

67

4,2

19

4,3

37

4,4

46

4,6

01

4,7

62

5,0

17

5,1

81

5,2

74 6

,027

6,2

63

6,5

09

6,7

94

6,9

62 7,4

41

7,2

40

6,9

38

6,9

11

7,2

38

7,4

44

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Mem

bers

MOLINA HEALTHCARE


Molina Healthcare has been a Healthy Families health plan since 1998 and is a Medi-Cal Managed Care health plan. Molina provided coverage in five counties in 2009-10: Los Angeles, Riverside, Sacramento, San Bernardino, and San Diego. The estimated total annual enrollment for Molina in 2009 was 43,241 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of Molina.


Two HEDIS rates in two domains of care increased at least three percentage points from the 2008 level: Access and Availability of Care Domain

Children’s Access to Primary Care � Ages 12 – 18

The rates for all four ages for this measure have either remained constant or increased slightly from 2007 to 2009. Effectiveness of Care Domain

Lead Screening in Children The plan’s rates for Chlamydia Screening in Women show a slight upward trend from 2007 to 2009. Two HEDIS rates were at least three percentage points higher than the 2009 HFP weighted average:




Seven HEDIS rates in two domains of care decreased at least three percentage points from the 2008 level: Effectiveness of Care Domain Childhood Immunizations


Appropriate Medication for Asthma Appropriate Treatment for Upper Respiratory Infection

Since 2007, rates for these measures have either decreased or remained about the same.

Use of Services Domain Well Child Visits, 1st 15 Months, 6 or More* Adolescent Well Care Visits *Rate was at or below the national 10

th percentile rate


There was an eighteen percent decrease in Well Child Visits, 1st 15 Months, 6 or More from 2007 to 2009. Nine HEDIS rates were at least three percentage points below the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 25 months – 6 years* o Ages 7 – 11 years o Ages 12 – 18 years



• Appropriate Treatment for Pharyngitis


• Lead Screening in Children *Rates were at or below the national 10

th percentile


Enrollment

The median monthly enrollment for 2008 was 36,907 members. In 2009 the median monthly enrollment was 43,294 members. The estimated total annual enrollment was 43,241 members. .

MOLINA HEALTHCARE



0%

20%

40%

60%

80%

100%

2007 Plan Rate 96% 84% 86% 82%

2008 Plan Rate 97% 86% 86% 82%

2009 Plan Rate 96% 88% 88% 86%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 83% 77% 86% 35% 86% 34% 0%

2008 Plan Rate 77% 72% 90% 28% 93% 36% 51%

2009 Plan Rate 74% 67% 86% 29% 88% 37% 54%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 75% 81% 55% 0% 0%

2008 Plan Rate 68% 79% 62% 0% 0%

2009 Plan Rate 57% 84% 56% 0% 0%


Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of

Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services

MOLINA HEALTHCARE


Level of

Coverage

Median

Monthly

Enrollment

2009Full* 9,911

Partial 6,113

Full 2,915

Partial 5,783

Full 18,520

Los Angeles


San Bernardino

San Diego

Riverside

Sacramento



34,979

34,988

35,704

35,849

36,354

36,646

37,167

37,776

38,036

38,776

39,209

39,551

39,538 43,685

43,390

43,197

43,438

43,539

45,436

44,094

42,623

42,052

42,294

42,306

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

Jan-08

Feb-08

Mar-08

Apr-08

May-08

Jun-08

Jul-08

Aug-08

Sep-08

Oct-08

Nov-08

Dec-08

Jan-09

Feb-09

Mar-09

Apr-09

May-09

Jun-09

Jul-09

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Months

Members

SAN FRANCISCO HEALTH PLAN


San Francisco Health Plan (SFHP) has been a Healthy Families health plan since 1998 and also participates in the Medi-Cal Managed Care program. In 2009-10, SFHP was the Community Provider Plan in San Francisco County. SFHP’s enrollment was impacted when Anthem Blue Cross stopped covering San Francisco County in 2009-10. The estimated total annual enrollment (median monthly enrollment for 2009) for SFHP in 2009 was 8,177 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of SFHP.


San Francisco Health plan received a 2008 Superior Performance Award from MRMIB. Three HEDIS rates, in two domains of care, increased at least three percentage points from the 2008 level: Effectiveness of Care Domain

Appropriate Medication for Asthma Appropriate Testing for Pharyngitis Use of Services Domain Adolescent Well Care Visits The plan’s rates for all four age groups collected for Children’s Access to Primary Care remained fairly constant from 2007 to 2009. Their rate for ages 12 to 24 months was at or above the national 90th percentile rate for commercial plans. Nine HEDIS rates were at least three percentage points above the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 7 – 11 o Ages 12 - 18





• Well Child Visits, 3rd – 6th Years*

• Adolescent Well Care Visits* *Rates were at or above the national 90

th percentile


Even though the two Childhood Immunizations rates were above the weighted average, the plan’s rates decreased from 2007 to 2009.


Three rates, in the Effectiveness of Care domain, decreased at least three percentage points from 2008: Childhood Immunizations

� Combination 2 � Combination 3 Chlamydia Screening in Women

Two HEDIS rates were three percentage points or more lower than the 2009 HFP weighted average: Appropriate Testing for Pharyngitis and Chlamydia Screening in Women. Though the plan’s rate for Appropriate Testing for Pharyngitis was below the 2009 HFP weighted average, the rates show a significant upward trend from 2007 to 2009 The plan’s rates for Chlamydia Screening in Women show a significant downward trend. Its rate in 2009 was half of the 2007 rate. In addition, the plan’s 2009 rate for this measure was at or below the national 10th percentile rate for commercial plans.

Enrollment The median monthly enrollment for 2008 was 6,408 members. For 2009, the median monthly enrollment was 8,111 members.




0%

20%

40%

60%

80%

100%

2007 Plan Rate 98% 95% 95% 94%

2008 Plan Rate 99% 95% 95% 94%

2009 Plan Rate 100% 93% 95% 94%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 95% 94% 95% 14% 93% 24% 0%

2008 Plan Rate 96% 93% 94% 17% 95% 18% 79%

2009 Plan Rate 91% 89% 100% 23% 95% 12% 81%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 57% 88% 74% 2% 0%

2008 Plan Rate 87% 89% 70% 1% 0%

2009 Plan Rate 0% 90% 74% 1% 0%


Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of

Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services



Level of

Coverage

Median

Annual

Enrollment

2009Full 8,177San Francisco



6,177

6,169

6,224

6,230

6,312

6,384

6,432

6,466

6,459

6,474

6,507

6,497

6,509

8,261

8,252

8,245

8,274

8,236

8,265

8,118

7,944

7,925

7,908

7,935

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

Jan-08

Feb-08

Mar-08

Apr-08

May-08

Jun-08

Jul-08

Aug-08

Sep-08

Oct-08

Nov-08

Dec-08

Jan-09

Feb-09

Mar-09

Apr-09

May-09

Jun-09

Jul-09

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Months

Members

SANTA CLARA FAMILY HEALTH PLAN


Santa Clara Family Health Plan (SCFHP) has been a Healthy Families health plan since 1998 and is a Medi-Cal Managed Care health plan. In 2009-10, SCFHP was the Community Provider Plan in Santa Clara County. The estimated total annual enrollment (median monthly enrollment for 2009) for SCFHP in 2009 was 16,610 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of SCFHP.


Two HEDIS rates in the Effectiveness of Care domain increased at least three percentage points from the 2008 level: Appropriate Testing for Pharyngitis and Chlamydia Screening in Women. However, the plan’s rate for the latter is below the 2009 HFP weighted average. Five HEDIS rates were at least three percentage points above the 2009 HFP weighted average:




• Adolescent Well Care Visits *Rate was at or above the national 90

th percentile rate


The plan’s rate for Children’s Access to Primary Care, Ages 12 – 24 Months has remained constant from 2007 to 2009, at the highest rate (100%) possible. The plan’s rate for 12 to 24 month-olds for this measure was also at the 90th percentile rate for commercial plans.


Four HEDIS rates in two domains of care decreased three percentage points or more from the 2008 level: Access and Availability of Care Domain

Children’s Access to Primary Care, � Ages 7 – 11 Years



Appropriate Medication for Asthma The plan’s rates for Childhood Immunizations show significant downward trends from 2007 to 2009.

The plan’s rates for Well Child Visits, 1st 15 Months, 6 or More have decreased from 2007 to 2009. Seven HEDIS rates were at least three percent lower than the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 25 months – 6 years o Ages 7 – 11




• Well Child Visits, 1st 15 Months, 6 or More* *Rates at or below the national 10


commercial plans.

Enrollment The median monthly enrollment for 2008 was 15,690 members. For 2009, the median monthly enrollment was 16,610 members.




0%

20%

40%

60%

80%

100%

2007 Plan Rate 100% 90% 89% 83%

2008 Plan Rate 99% 89% 91% 87%

2009 Plan Rate 100% 88% 87% 85%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 85% 79% 90% 25% 88% 42% 0%

2008 Plan Rate 74% 71% 97% 24% 90% 51% 70%

2009 Plan Rate 65% 62% 90% 27% 92% 56% 69%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 57% 75% 49% 1% 0%

2008 Plan Rate 47% 76% 48% 1% 0%

2009 Plan Rate 45% 75% 50% 1% 0%


Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of

Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services



Level of

Coverage

Median

Annual

Enrollment

2009

Full 16,610


Santa Clara


15,058

15,033

15,259

15,348

15,562

15,693

15,686

15,783

15,747

15,843

15,932

16,005

16,055

16,701

16,884

16,957

17,107

17,127

17,044

16,518

16,054

16,067

16,267

16,469

13,500

14,000

14,500

15,000

15,500

16,000

16,500

17,000

17,500

Jan-08

Feb-08

Mar-08

Apr-08

May-08

Jun-08

Jul-08

Aug-08

Sep-08

Oct-08

Nov-08

Dec-08

Jan-09

Feb-09

Mar-09

Apr-09

May-09

Jun-09

Jul-09

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Months

Members

VENTURA COUNTY HEALTH CARE PLAN


Ventura County Health Care Plan has been a Healthy Families health plan since 1998. Ventura County Health Care Plan provided coverage in Ventura County in 2009-10. The estimated total annual enrollment (median monthly enrollment for 2009) for Ventura County Health Care Plan in 2009 was 3,903 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and HEDIS results for 2007 through 2009. Below is a summary profile of Ventura County Health Care Plan.


Two HEDIS rates in the Effectiveness of Care domain increased at least three percentage points from the 2008 level: Appropriate Testing for Pharyngitis and Chlamydia Screening in Women. Two HEDIS rates were at least three percentage points above the 2009 HFP weighted average:


• Adolescent Well Care Visits Ventura County Health Care Plan was the only health plan that was not in at the national 10th percentile rate for Identification of Alcohol and Other Drugs.


Nine HEDIS rates were at least three percentage points below the 2009 HFP weighted average:

• Children’s Access to Primary Care o Ages 7 - 11 o Ages 12 - 18






• Adolescent Well Care Visits *Rate at or below the national 10


commercial plans.

In addition to the rates indicated above, Ventura County Health Care Plan had two rates at or below the national 10th percentile rate for commercial plans in 2009: Appropriate Medication for Asthma and Chlamydia Screening in Women

Enrollment

The median monthly enrollment for 2008 was 3,533 members. For 2009, the median monthly enrollment was 3,903 members.




0%

20%

40%

60%

80%

100%

2007 Plan Rate 0% 90% 87% 83%

2008 Plan Rate 96% 89% 88% 82%

2009 Plan Rate 97% 89% 87% 84%



Months

Access to PCP: 25

Months - 6 Years


Years


Years


0%

20%

40%

60%

80%

100%

2007 Plan Rate 0% 0% 0% 39% 86% 0% 0%

2008 Plan Rate 0% 0% 0% 40% 84% 30% 0%

2009 Plan Rate 76% 70% 84% 50% 88% 29% 54%


Childhood

Immunizations,

Combo 2

Childhood

Immunizations,

Combo 3

Appropriate

Medication for

Asthma

Appropriate

Testing for

Pharyngitis

Appropriate Tx

for Upper

Respiratory

Chlamydia

Screening in

Women

Lead

Screening in

Children


0%

20%

40%

60%

80%

100%

2007 Plan Rate 0% 66% 28% 1% 0%

2008 Plan Rate 56% 63% 38% 2% 0%

2009 Plan Rate 0% 69% 36% 2% 1%


Well Child Visits

1st 15 Months of

Life, 6 or More

Well Child Visits

3rd-6th Years of

Life

Adolescent Well

Care Visits

Mental Health

Utilization

Identification of

Alcohol & Other

Drug Services



Level of

Coverage

Median

Annual

Enrollment

2009Full 3,903


Ventura


3,1

96

3,2

37

3,2

94

3,3

44

3,4

22

3,5

05

3,5

61

3,6

53

3,7

31

3,7

94

3,8

18

3,8

92

3,9

11

3,8

95

3,9

91

4,0

13

4,0

80

4,1

30

4,0

29

3,8

92

3,7

55

3,6

75

3,6

35

3,6

84

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

Jan-

08Fe

b-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Mem

bers

DENTAL PLAN PERFORMANCE PROFILES

ACCESS DENTAL


Access Dental has been a Healthy Families dental plan since 1998. Access Dental provided coverage in 23 counties in 2009-10. The estimated total annual enrollment for Access Dental in 2009 was 139,137 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and dental quality results for 2007 through 2009. Below is a summary profile of Access Dental.


Two dental quality rates improved at least three percentage points from the 2008 level:

• Oral Health Examinations

• Continuity of Care None of the dental quality rates were three percentage points or more above the 2009 HFP weighted average.


One dental quality measure decreased at least three percentage points from the 2008 level: Utilization of Dental Services, Continuously Enrolled 1 Year. Every dental quality measure was at least three percentage points below the 2009 HFP weighted average:

• Annual Dental Visit

• Utilization of Dental Services o Continuously Enrolled 1 Year o Continuously Enrolled 2 Years o Continuously Enrolled 3 Years

• Preventive Dental Services

• Use of Dental Treatment Services


• Treatment (Tx)/Prevention (Pv) of Carries

• Filling to Preventive Services Ratio

• Continuity of Care In 2009, more than half (52%) of children enrolled in Access Dental did not have a dental visit.

Enrollment

The median monthly enrollment for 2008 was 128,440 members. In 2009, the median monthly enrollment was 138,618 members.

ACCESS DENTAL


Dental Performance Measures

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2007 Plan Score 56% 0 0 0 0 0 0 0 0 0

2008 Plan Score 47% 44% 45% 50% 39% 23% 40% 34% 60% 62%

2009 Plan Score 48% 40% 46% 52% 40% 24% 43% 36% 62% 65%

2009 HFP Weighted Average 59% 48% 57% 68% 53% 32% 54% 50% 77% 77%

Annual Dental

Visit

Utilization:

Cnt. Enrld. 1

Yr.

Utilization:

Cnt. Enrld. 2

Yrs.

Utilization:

Cnt. Enrld. 3

Yrs.

Preventive

Dental

Services

Use of Dental

Treatment

Services

Oral Health

Examinations

Tx/Pv of

Caries

Filling to

Preventive

Services Ratio

Continuity of

Care

ACCESS DENTAL


Level of

Coverage

Median

Monthly

Enrollment

2009Full 2,157

Full 324

Full 1,290

Full 1,377

Full 1,145

Full* 59,739

Full 777

Full 1,009

Full 19,763

Full 13,688

Full 3,421

Full 11,969

Full 10,026

Full 812

Full 1,947

Full 1,139

Full 3,865

Full 469

Full 788

Full 1,861

Full 359

Full 979

Full 238

Butte


Alameda


Kern

Fresno

Merced

Monterey

Los Angeles

Riverside

Santa Clara

San Bernardino

San Diego

San Francisco

San Joaquin

Ventura

Yuba

Contra Costa

Solano

Stanislaus

Sutter

Shasta

San Mateo

Sacramento

Orange


12

5,3

80

12

4,9

57

12

6,5

51

12

6,8

12

12

8,0

17

12

8,3

46

12

8,5

34

12

9,0

27

12

8,8

64

12

9,5

63

13

0,0

90

13

1,0

52

13

1,5

37

13

0,7

69 1

35

,26

4

13

8,2

53

14

3,4

75

14

5,9

69

14

5,1

74

14

0,8

50

13

5,6

85

13

6,5

75

13

8,9

82

14

2,4

88

110,000

115,000

120,000

125,000

130,000

135,000

140,000

145,000

150,000

Jan-

08Feb

-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

DELTA DENTAL


Delta Dental has been a Healthy Families dental plan since 1998. Delta Dental provided full coverage in every county in 2009-10. The estimated total annual enrollment for Delta Dental in 2009 was 390,703 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and dental quality results for 2007 through 2009. Below is a summary profile of Delta Dental.


Three dental quality rates increased at least three percentage points from the 2008 level:



• Treatment (Tx)/ Prevention (PV) of Carries All of the dental quality rates were at least three percentage points above the 2009 HFP weighted average:





• Oral Health Examinations (5%)



• Continuity of Care Overall, Delta Dental has the highest rates in the HFP.


One dental quality measure decreased at least three percentage points from the 2008 level: Utilization of Dental Services, Continuously Enrolled 1 Year. In 2009, nearly 30 percent of children enrolled in Delta Dental did not have a dental visit.

Enrollment

The median monthly enrollment for 2008 was 428,012 members. In 2009, the median monthly enrollment decreased to 393,191 members.

DELTA DENTAL



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2007 Plan Score 70% 0 0 0 0 0 0 0 0 0

2008 Plan Score 70% 66% 67% 74% 66% 38% 66% 62% 82% 83%

2009 Plan Score 72% 63% 69% 74% 69% 39% 69% 66% 84% 85%


Annual Dental

Visit

Utilization:

Cnt. Enrld. 1

Yr.

Utilization:

Cnt. Enrld. 2

Yrs.

Utilization:

Cnt. Enrld. 3

Yrs.

Preventive

Dental

Services

Use of Dental

Treatment

Services

Oral Health

Examinations

Tx/Pv of

Caries

Filling to

Preventive

Services Ratio

Continuity of

Care

DELTA DENTAL


L e v e l o f

C o v e ra g e

M e d ia n

M o n th ly

E n ro llm e n t

2 0 0 9F u ll 1 4 ,4 7 0

F u ll 0

F u ll 2 8 3

F u ll 2 ,3 9 5

F u ll 4 6 2

F u ll 1 ,2 7 5

F u ll 8 ,4 4 5

F u ll 1 7 0

F u ll 1 ,5 2 4

F u ll 1 7 ,3 0 3

F u ll 1 ,0 7 7

F u ll 8 1 3

F u ll 4 ,2 2 7

F u ll 1 8 4

F u ll 2 0 ,6 5 8

F u ll 2 ,6 6 7

F u ll 1 ,0 2 3

F u ll 1 4 5

F u ll* 1 7 ,0 8 8

F u ll 3 ,8 5 7

F u ll 1 ,7 8 5

F u ll 1 7 6

F u ll 1 ,2 8 4

F u ll 7 ,8 9 4

F u ll 9 6

F u ll 4 4 7

F u ll 1 5 ,2 7 3

F u ll 3 ,1 5 1

F u ll 6 8 4

F u ll 7 ,2 8 5

F u ll 3 ,2 3 4

F u ll 1 8 9

F u ll 3 2 ,1 3 9

F u ll 1 8 ,8 1 2

F u ll 1 ,5 0 7

F u ll 2 6 ,3 2 6

F u ll 4 6 ,8 8 8

F u ll 9 ,6 1 9

F u ll 1 6 ,0 5 8

F u ll 4 ,9 4 5

F u ll 7 ,1 5 0

F u ll 2 ,6 2 1

F u ll 2 2 ,7 0 8

F u ll 5 ,3 9 7

F u ll 2 ,6 8 2

F u ll 2 1

F u ll 2 2 7

F u ll 4 ,1 2 7

F u ll 7 ,3 0 3

F u ll 9 ,7 6 1

F u ll 2 ,6 8 6

F u ll 8 3 1

F u ll 1 5 8

F u ll 9 ,7 2 1

F u ll 1 ,0 2 4

F u ll 1 4 ,2 3 3

F u ll 2 ,8 6 4

F u ll 1 ,3 4 4

2 0 0 9 -1 0 C o v e ra g e A re a s

A la m e d a

A lp in e

A m a d o r

B u tte

C a la v e ra s

C o lu s a

C o n tra C o s ta

D e l N o r te

E l D o ra d o

F re s n o

G le n n

H u m b o ld t

Im p e r ia l

In yo

K e rn

K in g s

L a k e

L a s s e n

L o s A n g e le s

M a d e ra

M a r in

M a r ip o s a

M e n d o c in o

M e rc e d

M o d o c

M o n o

M o n te re y

N a p a

N e v a d a

O ra n g e

P la c e r

P lu m a s

R iv e rs id e

S a c ra m e n to

S a n B e n ito


S a n D ie g o


S a n J o a q u in

S a n L u is O b is p o

S a n M a te o

S a n ta B a rb a ra

S a n ta C la ra

S a n ta C ru z

S h a s ta

S ie r ra

S is k iyo u

S o la n o

S o n o m a

S ta n is la u s

S u tte r

T e h a m a

T r in ity

T u la re

T u o lu m n e

*C o v e ra g e in c lu d e s C a ta lin a Is la n d

V e n tu ra

Y o lo

Y u b a

DELTA DENTAL



41

6,3

99

415

,78

6

42

1,2

28

42

2,2

28

42

6,5

94

428

,11

8

427

,90

6

42

9,3

76

42

9,7

56

431

,94

4

433

,28

9

43

1,4

12

426

,97

2

42

0,5

47

41

5,2

90

40

5,9

02

397

,38

5

391

,23

8

39

5,1

44

38

5,8

61

37

3,3

24

376

,23

3

371

,09

7

36

5,6

33

320,000

340,000

360,000

380,000

400,000

420,000

440,000Ja

n-08

Feb

-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Feb

-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Mem

bers

HEALTH NET DENTAL


Health Net Dental has been a Healthy Families dental plan since 2006. Health Net Dental provided coverage in 26 counties in 2009-10. The estimated total annual enrollment for Health Net Dental in 2009 was 84,772 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and dental quality results for 2007 through 2009. Below is a summary profile of Health Net Dental.


Every dental quality measure increased significantly from the 2008 level. Yet, none of the dental quality rates were at least three percentage points above the 2009 HFP weighted average. The highest rates of improvement (>10%) were in the following measures:


• Utilization of Dental Services o Continuously Enrolled 1 Year




• Continuity of Care


Every dental measure was at least three percentage points below the 2009 HFP weighted average. Sixty percent of children enrolled in the plan did not visits the dentist in 2009.

Enrollment

The median monthly enrollment for 2008 was 67,557 members. In 2009, the median monthly enrollment increased substantially to 84,716 members.

HEALTH NET DENTAL



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2007 Plan Score 21% 0 0 0 0 0 0 0 0 0

2008 Plan Score 24% 18% 39% 41% 18% 14% 18% 18% 55% 36%

2009 Plan Score 40% 37% 47% 55% 31% 20% 33% 28% 60% 54%


Annual Dental

Visit

Utilization:

Cnt. Enrld. 1

Yr.

Utilization:

Cnt. Enrld. 2

Yrs.

Utilization:

Cnt. Enrld. 3

Yrs.

Preventive

Dental

Services

Use of Dental

Treatment

Services

Oral Health

Examinations

Tx/Pv of

Caries

Filling to

Preventive

Services Ratio

Continuity of

Care

HEALTH NET DENTAL


L e v e l o f

C o v e ra g e

M e d ia n

M o n th ly

E n ro llm e n t

2 0 0 9F u ll 4 4

F u ll 0

F u ll 1 ,4 2 4

F u ll 1 4 5

F u ll 1 ,0 9 8

F u ll 2

F u ll* 4 3 ,6 8 7

F u ll 2

F u ll 2

F u ll 9

F u ll 6

F u ll 1

F u ll 1 3 ,6 3 3

P a r tia l 7 ,8 0 9

F u ll 1 ,0 1 8

F u ll 0

P a r tia l 6 ,6 0 6

F u ll 6 ,0 8 5

F u ll 1 3

F u ll 4 9 0

F u ll 1 9

F u ll 2

F u ll 3

F u ll 6 0 1

F u ll 9 2 8

F u ll 1 ,1 5 2

S ta n is la u s

V e n tu ra

T u la re


S a n J o a q u in

S a n ta C la ra

S a n ta C ru z

S o n o m a

S a n B e n ito


S a n D ie g o


N a p a

O ra n g e

R iv e rs id e

S a c ra m e n to

M a d e ra

M a r in

M e rc e d

M o n te re y

Im p e r ia l

K e rn

K in g s

L o s A n g e le s

2 0 0 9 -1 0 C o v e ra g e A re a s

A la m e d a

E l D o ra d o

F re s n o


60

,41

1

60

,86

4

62

,88

2

63

,87

7

65

,78

0

66

,96

0

68

,15

3

69

,36

6

70

,14

8

71

,49

7

72

,58

4

73

,58

7

74

,20

5

75

,73

4

79

,01

6

81

,92

2

85

,66

8

87

,92

1

89

,28

6

86

,34

9

83

,76

4

83

,55

1

87

,91

8

92

,58

9

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

Jan-

08Feb

-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Feb

-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

PREMIER ACCESS DENTAL


Premier Access Dental has been a Healthy Families dental plan since 1998. Premier Access provided coverage in 37 counties in 2009-10. The estimated total annual enrollment for Premier Access in 2009 was 35,229 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and dental quality results for 2007 through 2009. Below is a summary profile of Premier Access.


Nine dental quality rates were at least three percentage points above the 2009 HFP weighted average.









None of the dental quality rates increased at least three percentage points from the 2008 level. The plan’s rates remained relatively constant from 2008 to 2009. One dental quality measure decreased at least three percentage points from the 2008 level: Utilization of Dental Services, Continuously Enrolled 1 Year. About one third (32%) of HFP children enrolled in the plan did not have a dental visit in 2009.

Enrollment

The median monthly enrollment for 2008 was 27,080 members. In 2009, the median monthly enrollment was 35,299 members.




0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2007 Plan Score 69% 0 0 0 0 0 0 0 0 0

2008 Plan Score 68% 64% 67% 72% 63% 32% 61% 58% 79% 83%

2009 Plan Score 68% 58% 69% 73% 64% 31% 62% 59% 81% 83%


Annual Dental

Visit

Utilization:

Cnt. Enrld. 1

Yr.

Utilization:

Cnt. Enrld. 2

Yrs.

Utilization:

Cnt. Enrld. 3

Yrs.

Preventive

Dental

Services

Use of Dental

Treatment

Services

Oral Health

Examinations

Tx/Pv of

Caries

Filling to

Preventive

Services Ratio

Continuity of

Care



L e v e l o f

C o v erag e

M ed ian

M o n th ly

E n ro llm e n t

200 9F u ll 2

F u ll 12 0

F u ll 88 0

F u ll 23 7

F u ll 23 7

F u ll 37 1

F u ll 1 ,4 32

F u ll 32 5

F u ll 2 ,7 37

F u ll 40 7

F u ll 12 8

F u ll 1 ,1 08

F u ll 64 0

F u ll 12 3

F u ll 39 7

F u ll 1 ,1 86

F u ll 4 8

F u ll 1 ,1 52

F u ll 6 8

F u ll 2 ,4 40

F u ll 63 0

F u ll 1 ,6 81

F u ll 1 ,3 45

F u ll 8 4

F u ll 26 1

F u ll 6 ,0 79

F u ll 58 7

F u ll 72 3

F u ll 2 3

F u ll 50 1

F u ll 4 ,3 48

F u ll 39 7

F u ll 69 8

F u ll 10 3

F u ll 2 ,3 13

F u ll 1 ,0 85

F u ll 33 4

S u tte r

Y o lo

Y u ba

T eh am a

T rin ity

T u la re

S h as ta

S ie rra

S isk iyou

S o nom a

P lum a s

S a n B e n ito

S a n ta B arb a ra

S a n ta C ru z

M on te rey

N apa

N evad a

P lace r

M arin

M arip osa

M end oc ino

M odo c

K ing s

La k e

La ssen

M ade ra

G len n

H um bo ld t

Im pe ria l

In yo

C a lave ra s

C o lusa

D e l N orte

E l D orad o

2 009 -1 0 C o v erag e Are as

A m ad or

B u tte

A lp ine




25

,27

2

25

,42

3

25

,96

1

26

,19

2

26

,69

5

26

,99

0

27

,16

9

27

,24

0

27

,43

1

27

,56

2

27

,75

3

28

,17

9

28

,56

0

31

,13

2

34

,09

6

36

,75

1

38

,85

4

39

,69

8

37

,25

4

36

,32

7

35

,14

4

35

,38

3

35

,21

4

34

,95

5

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000Ja

n-08

Feb-

08M

ar-0

8Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Fe

b-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

SAFEGUARD DENTAL


SafeGuard Dental has been a Healthy Families dental plan since 2004. SafeGuard provided coverage in fifteen counties in 2009-10. The estimated total annual enrollment for SafeGuard in 2009 was 143,355 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and dental quality results for 2007 through 2009. Below is a summary profile of SafeGuard.


Three dental quality rates increased at least three percentage points from the 2008 level:

• Utilization of Dental Services, o Continuously Enrolled 3 Years




One dental quality measure decreased at least three percentage points from the 2008 level: Utilization of Dental Services, Continuously Enrolled 2 Years. None of the dental quality rates were at least three percentage points above the 2009 HFP weighted average. All dental rates, except Use of Dental Treatment Services were three percentage points or more below the 2009 HFP weighted average. In 2009, more than half (53%) of children enrolled in SafeGuard did not have a dental visit.

Enrollment

The median monthly enrollment for 2008 was 138,670 members. In 2009, the median monthly enrollment increased to 141,578 members.

SAFEGUARD DENTAL



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2007 Plan Score 51% 0 0 0 0 0 0 0 0 0

2008 Plan Score 46% 30% 45% 60% 39% 28% 40% 34% 60% 57%

2009 Plan Score 47% 28% 38% 65% 40% 30% 41% 36% 69% 61%


Annual Dental

Visit

Utilization:

Cnt. Enrld. 1

Yr.

Utilization:

Cnt. Enrld. 2

Yrs.

Utilization:

Cnt. Enrld. 3

Yrs.

Preventive

Dental

Services

Use of Dental

Treatment

Services

Oral Health

ExaminationsTx/Pv of Caries

Filling to

Preventive

Services Ratio

Continuity of

Care

SAFEGUARD DENTAL


Level of

Coverage

Median

Monthly

Enrollment

2009Full 1,623

Full 1,109

Partial 583

Partial 1,399

Full* 71,577

Full 30,342

Partial 11,598

Full 959

Partial 11,189

Partial 6,545

Full 478

Full 742

Partial 904

Partial 2,658

Full 1,651

Contra Costa


Alameda


Orange

Los Angeles

Kern

Fresno

San Bernardino

San Diego

San Francisco

Riverside

Sacramento

Ventura

San Mateo

Santa Barbara

Santa Clara


13

8,6

73

13

7,9

51

13

8,7

58

13

8,6

66

13

9,3

62

13

9,4

07

13

9,0

86

13

8,8

73

13

8,3

19

13

8,2

10

13

7,9

81

13

7,8

83

13

7,5

65

13

8,5

02

14

1,4

52

14

4,2

64

14

7,6

91

14

8,2

12

14

7,4

33

14

3,3

05

13

8,2

79

13

9,3

54

13

9,9

52 14

1,7

04

132,000

134,000

136,000

138,000

140,000

142,000

144,000

146,000

148,000

150,000

Jan-

08Feb

-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Feb

-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

WESTERN DENTAL


Western Dental has been a Healthy Families dental plan since 2005. Western Dental provided full coverage in 33 counties in 2009-10. The estimated total annual enrollment for Western Dental in 2009 was 102,943 members. The following charts provide monthly enrollment for calendar years 2008 and 2009 and dental quality results for 2007 through 2009. Below is a summary profile of Western Dental.


Nine dental quality rates increased at least three percentage points from the 2008 level:


• Utilization of Dental Services, o Continuously Enrolled 1 Year o Continuously Enrolled 2 Years o Continuously Enrolled 3 Years




• Treatment (Tx) / Prevention (Pv) of Carries

• Continuity of Care Two dental quality rates were at least three percentage points above the 2009 HFP weighted average:

• Utilization of Dental Services, o Continuously Enrolled 2 Years o Continuously Enrolled 3 Years


Eight rates were three percentage points or more below the 2009 HFP weighted average:


• Utilization of Dental Services o Continuously Enrolled 1 Year






• Continuity of Care In 2009, over 40 percent of children enrolled in the plan did not visit a dentist.

Enrollment

The median monthly enrollment for 2008 was 87,908 members. In 2009, the median monthly enrollment increased to 102,335 members.

WESTERN DENTAL



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2007 Plan Score 23% 0 0 0 0 0 0 0 0 0

2008 Plan Score 41% 41% 57% 56% 36% 21% 37% 32% 68% 55%

2009 Plan Score 47% 45% 61% 73% 41% 25% 43% 38% 68% 61%


Annual Dental

Visit

Utilization: Cnt.

Enrld. 1 Yr.

Utilization: Cnt.

Enrld. 2 Yrs.

Utilization: Cnt.

Enrld. 3 Yrs.

Preventive

Dental

Services

Use of Dental

Treatment

Services

Oral Health

ExaminationsTx/Pv of Caries

Filling to

Preventive

Services Ratio

Continuity of

Care

WESTERN DENTAL


L e v e l o f

C o v e ra g e

M e d ia n

M o n th ly

E n ro llm e n t

2 0 0 9F u ll 2 ,1 0 6

P a r t ia l 2 1 5

F u ll 1 ,7 5 6

F u ll 1 ,6 0 0

F u ll 5 5 8

F u ll 1 ,2 7 8

F u ll 3 5 4

F u ll* 3 7 ,7 2 1

F u ll 3 7 9

P a r t ia l 8 8

F u ll 4 7 9

P a r t ia l 7 6 1

F u ll 1 4 ,0 8 0

P a r t ia l 2 2 9

F u ll 1 0 ,0 2 2

P a r t ia l 2 ,8 9 4

P a r t ia l 1 4 2

F u ll 9 ,2 1 2

P a r t ia l 6 ,5 3 6

F u ll 5 4 7

F u ll 1 ,8 0 9

P a r t ia l 2 8 0

F u ll 1 ,0 5 2

F u ll 1 ,1 7 9

F u ll 2 ,2 1 1

F u ll 3 0 3

F u ll 2 8 0

F u ll 4 4 7

P a r t ia l 5 0 0

F u ll 1 ,2 4 9

F u ll 1 5 7

F u ll 1 ,2 4 6

F u ll 1 ,2 7 9V e n tu ra

T u la re

S o la n o

S o n o m a

S ta n is la u s

S u tte r

S h a s ta

S a n L u is O b is p o

S a n M a te o


S a n ta C la ra

S a n D ie g o


S a n J o a q u in

S a n ta C ru z

S a n B e n ito

O ra n g e

P la c e r


2 0 0 9 -1 0 C o v e ra g e A re a s

A la m e d a

K in g s

L o s A n g e le s

Im p e r ia l

K e rn


F re s n o

B u tte

C o n tra C o s ta

M e rc e d

M o n te re y

M a d e ra

M a r in

R iv e rs id e

S a c ra m e n to


79,4

95

80,0

39

82,5

35

83,9

05

86,0

87

87,3

41

88,4

75

89,1

59

90,0

02

91,3

02

92,2

95

93,3

26

93,6

02

96,4

76

100,3

53

103,0

73

106,4

67

108,1

98

108,1

33

103,9

95

99,2

43

100,2

31

101,5

97

105,0

63

0

20,000

40,000

60,000

80,000

100,000

120,000

Jan-

08Feb

-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Feb

-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

VISION PLAN PROFILES

EYEMED VISION CARE


EyeMed Vision Care has been a Healthy Families vision plan since 2005. EyeMed provides coverage in all 58 counties. The estimated total annual enrollment in 2009 for EyeMed is 99,485 members. MRMIB does not collect performance data for vision plans. The following charts provide monthly enrollment for calendar years 2008 and 2009. Below is a summary profile of EyeMed Vision Care.

Enrollment The median monthly enrollment in 2008 was 83,782 members. In 2009, the median monthly enrollment was 102,276 members.


70

,51

8

71

,92

0

75

,12

4

77

,27

5

80

,48

9

82

,85

0

84

,71

3

86

,90

4

88

,71

6

91

,25

7

93

,27

8

95

,01

9

95

,82

8

98

,44

6

10

1,3

66

10

3,0

66

10

5,3

82

10

6,6

08

96

,25

5

10

4,9

62

10

1,4

85

10

0,9

98

10

3,4

80

10

5,9

55

0

20,000

40,000

60,000

80,000

100,000

120,000

Jan-

08Feb

-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Feb

-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

EYEMED VISION CARE


Level of

Coverage

Median

Monthly

Enrollment

2009Full 2,813

Full 0

Full 42

Full 518

Full 90

Full 130

Full 1,868

Full 24

Full 297

Full 3,232

Partial 133

Full 343

Full 794

Partial 10

Full 2,171

Full 460

Full 139

Full 15

Full* 26,474

Full 481

Full 361

Full 39

Partial 144

Full 900

Partial 7

Partial 52

Full 1,250

Full 410

Full 252

Full 8,885

Full 718

Partial 55

Full 9,840

Full 3,653

Full 140

Full 8,472

Full 8,587

Full 975

Full 2,262

Full 735

Full 1,104

Full 1,503

Full 2,732

Full 556

Full 488

Partial 12

Partial 41

Full 638

Full 1,772

Full 273

Partial 17

Full 2,385

Full 203

Modoc

Alpine

* Coverage includes Catalina Island.

Yuba

Ventura

Solano

Stanislaus

Sutter

Santa Barbara

Santa Clara

Santa Cruz

Shasta

San Francisco

San Joaquin

San Luis Obispo

San Mateo

Sacramento

San Benito

San Bernardino

San Diego

Orange

Placer

Plumas

Riverside

Mono

Monterey

Napa

Nevada

Madera

Marin

Mendocino

Merced

Mariposa

Kings

Lake

Los Angeles

Lassen

Humboldt

Imperial

Inyo

Kern

El Dorado

Fresno

Calaveras

Glenn

Sierra

Siskiyou

Trinity


Alameda

Butte

Contra Costa

Amador

Colusa

Del Norte

SAFEGUARD VISION CARE


SafeGuard Vision has been a Healthy Families vision plan since 2005. The plan provides coverage in 56 counties. The estimated total annual enrollment in 2009 for Safeguard is 91,559 members. MRMIB does not collect performance data for vision plans. The following charts provide monthly enrollment for calendar years 2008 and 2009. Below is a summary profile of SafeGuard Vision.



64

,98

3

66

,09

4

68

,84

1

70

,58

7

73

,19

2

74

,97

2

76

,40

1

77

,96

4

79

,30

0

80

,76

4

82

,46

5

83

,75

7

84

,34

5

85

,06

7

87

,99

7

90

,32

8

93

,15

1

94

,51

7

96

,25

5

93

,17

3

89

,97

1

89

,86

6

92

,63

1

95

,22

6

0

20,000

40,000

60,000

80,000

100,000

120,000

Jan-

08Feb

-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Feb

-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

SAFEGUARD VISION


Level of

Coverage

Median

Monthly

Enrollment

2009Full 1,942

Full 0

Full 20

Full 298

Full 43

Partial 64

Full 1,483

Full 21

Full 283

Full 2,125

Partial 71

Partial 175

Partial 425

Partial 2,449

Full 460

Full 116

Full* 25,209

Full 282

Full 145

Partial 3

Partial 42

Full 613

Partial 743

Full 216

Partial 115

Full 9,568

Full 397

Partial 9,874

Full 2,722

Full 97

Partial 10,650

Full 7,675

Full 461

Full 1,686

Full 446

Full 745

Full 1,066

Full 2,112

Full 324

Partial 471

Partial 0

Full 482

Full 808

Full 1,149

Full 239

Partial 119

Partial 34

Full 772

Partial 131

Full 1,812

Full 285

Full 101

Sutter

Tehama

Trinity

Yuba

Tulare

Tuolumne

Ventura

Yolo

Sierra

Solano

Sonoma

Stanislaus

Santa Barbara

Santa Clara

Santa Cruz

Shasta

San Francisco

San Joaquin

San Luis Obispo

San Mateo

Sacramento

San Benito

San Bernardino

San Diego

Nevada

Orange

Placer

Riverside

Mendocino

Merced

Monterey

Napa

Los Angeles

Madera

Marin

Mariposa

Imperial

Kern

Kings

Lake

El Dorado

Fresno

Glenn

Humboldt



Alameda

Alpine

Amador

Butte

Calaveras

Colusa

Contra Costa

Del Norte

VISION SERVICE PLAN


Vision Service Plan (VSP) has been a Healthy Families vision plan since 1998. The plan provides coverage in all 58 counties. The estimated total annual enrollment in 2009 for VSP is 711,215 members. MRMIB does not collect performance data for vision plans. The following charts provide monthly enrollment for calendar years 2008 and 2009. Below is a summary profile of VSP.



71

0,1

27

70

7,0

06

71

3,9

50

71

3,8

18

71

8,8

54

71

9,3

40

71

8,2

09

71

8,1

69

71

6,5

04

71

8,0

57

71

8,2

50

71

6,6

63

71

2,2

68

70

9,6

47

71

6,1

08

71

6,7

71

72

1,0

07

72

0,1

16

71

7,6

16

69

8,5

53

67

9,8

71

67

4,5

75

67

8,6

50

68

1,2

51

650,000

660,000

670,000

680,000

690,000

700,000

710,000

720,000

730,000

Jan-

08Feb

-08

Mar

-08

Apr

-08

May

-08

Jun-

08Ju

l-08

Aug

-08

Sep

-08

Oct

-08

Nov

-08

Dec

-08

Jan-

09Feb

-09

Mar

-09

Apr

-09

May

-09

Jun-

09Ju

l-09

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Months

Me

mb

ers

VISION SERVICE PLAN


L e v e l o f

C o v e ra g e

M e d ian

M o n th ly

E n ro llm e n t

2 0 09F u ll 1 5 ,7 72

F u ll 2

F u ll 3 4 0

F u ll 3 ,0 16

F u ll 5 6 7

F u ll 1 ,3 17

F u ll 9 ,3 27

F u ll 5 0 1

F u ll 2 ,4 48

F u ll 1 6 ,9 98

F u ll 1 ,2 09

F u ll 3 ,0 78

F u ll 4 ,0 96

F u ll 2 9 6

F u ll 2 1 ,2 25

F u ll 3 ,5 47

F u ll 1 ,4 28

F u ll 2 4 1

F u ll* 1 8 0 ,62 4

F u ll 3 ,8 90

F u ll 2 ,4 72

F u ll 1 8 4

F u ll 2 ,2 01

F u ll 7 ,7 24

F u ll 1 5 5

F u ll 3 9 9

F u ll 1 7 ,6 28

F u ll 3 ,1 62

F u ll 1 ,9 91

F u ll 6 7 ,7 93

F u ll 3 ,6 16

F u ll 2 2 4

F u ll 5 7 ,3 17

F u ll 2 1 ,0 10

F u ll 1 ,6 45

F u ll 4 7 ,9 19

F u ll 5 9 ,6 72

F u ll 1 0 ,2 40

F u ll 1 6 ,3 98

F u ll 4 ,0 84

F u ll 8 ,4 34

F u ll 8 ,2 06

F u ll 2 6 ,4 16

F u ll 5 ,4 28

F u ll 3 ,2 37

F u ll 3 2

F u ll 6 8 5

F u ll 4 ,2 76

F u ll 9 ,8 98

F u ll 1 0 ,5 73

F u ll 3 ,1 21

F u ll 1 ,1 58

F u ll 2 0 8

F u ll 1 2 ,0 04

F u ll 7 5 9

F u ll 1 6 ,3 85

F u ll 3 ,0 46

F u ll 1 ,6 08

T e h a m a

T rin ity

S o la n o

S o n o m a

S ta n is la us

S a n B e n ito

S a n B e rn a rd ino

S a n D ie go

S a n F ra n c isc o

P la ce r

P lu m a s

V e n tu ra

Y o lo

T u la re


S a n ta C la ra

S a n ta C ru z

S h a s ta

S ie rra

S isk iyo u

S u tte r

M erce d

M od o c

M on o

M on te rey

N a p a

N e va d a

O ran g e

T u o lu m n e

R ive rs id e

S a c ra m e n to

S a n J o aq u in

S a n L u is O b isp o

S a n M a te o

K e rn

K in g s

L ak e

Y u b a

L as s en

L os A n ge le s

M ad e ra

M arin

M arip o s a

M en d o c in o

Im p er ia l

In yo

D e l N o rte

E l D o ra d o

F re s n o

G le nn

*C o ve ra g e in c lu d e s C a ta lin a Is la n d

C o v e rag e Are a s

A la m e d a

A lp in e

A m a d o r

B u tte

C a la ve ra s

C o lu s a

C o n tra C o s ta

H u m b o ld t

APPENDIX A: 2009 HEALTH PLAN PERFORMANCE MESAURES


1. CHILDHOOD IMMUNIZATION STATUS (CIS) The percentage of HFP enrolled children who turned two years old during the measurement year, were continuously enrolled for 12 months immediately preceding their second birthday with no more than one gap in enrollment of up to 45 days, and received the following immunizations on or before their second birthday:

• Four DTaP, DT or individual diphtheria and tetanus (DTaP) vaccinations.

• Three polio (IPV) vaccinations.

• One measles, mumps, and rubella (MMR) vaccination.

• Three H influenza type B (HiB) vaccinations.

• Three hepatitis B vaccinations.

• One chicken pox (VZV) vaccination.

• Four pneumococcal conjugate vaccinations.

• Two hepatitis A vaccinations.

• Three rotavirus vaccinations.

• Two influenza vaccinations.

• A combined rate including children who have received all of the above immunizations. 2. IMMUNIZATIONS IN ADOLESCENTS (IMA)

The percentage of HFP adolescents who turned thirteen years old during the measurement year, were continuously enrolled for 12 months immediately preceding their thirteenth birthday with no more than one gap in enrollment of up to 45 days, and received the following immunizations on or before their thirteenth birthday:

• One meningococcal conjugage or meningovcoccal polysaccharide vaccine.

• One tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) or one tetanus, diphtheria toxoids vaccine (Td).

• A combined rate including adolescents who received all of the above immunizations.

3. LEAD SCREENING IN CHILDREN (LSC)

The percentage of HFP enrolled children who received at least one capillary or venous lead screening test on or before their second birthday.



4. CHILDREN AND ADOLESCENTS’ ACCESS TO PRIMARY CARE PRACTITIONERS (CAP)

The percentage of HFP enrolled children who had at least one visit to a pediatrician, family physician, or other health care provider during the measurement year. Four separate cohorts are reported:

• Cohort 1: Children age 12 through 24 months who were continuously enrolled during the measurement year.

• Cohort 2: Children age 25 months through 6 years who were continuously enrolled during the measurement year.

• Cohort 3: Children age 7 through 11 years who were continuously enrolled during the measurement year and the prior year.

• Cohort 4: Adolescents age 12 through 18 years who were continuously enrolled during the measurement year and the prior year.

5. WELL-CHILD VISITS IN THE FIRST 15 MONTHS OF LIFE (W15)

The percentage of HFP enrolled children who turned 15 months old during the measurement year and received zero, one, two, three, four, five, or six or more well-child visits with a primary care practitioner during their first 15 months of life. Each eligible child is included in only one numerator (e.g., a child receiving six well-child visits would not be included in the rate for five or fewer visits.)

6. WELL- CHILD VISIT IN THE THIRD, FOURTH, FIFTH, AND SIXTH YEARS OF LIFE (W34)

The percentage of HFP enrolled children age 3 through 6 years who were continuously enrolled during the measurement year with no more than one gap in enrollment of up to 45 days and received one or more well-child visits with a primary care provider during the measurement year.

7. ADOLESCENT WELL-CARE VISITS (AWC)

The percentage of HFP enrolled adolescents age 12 through 18 years who were continuously enrolled during the measurement year with no more than one gap in enrollment of up to 45 days and received at least one comprehensive well-care visit with a primary care provider during the measurement year.

8. USE OF APPROPRIATE MEDICATIONS FOR ASTHMA (ASM)

The percentage of HFP enrolled children age 5 through 18 years who were identified as having persistent asthma and were appropriately prescribed medication during the measurement year.



9. APPROPRIATE TREATMENT FOR CHILDREN WITH UPPER RESPIRATORY INFECTION (URI)

The percentage of HFP enrolled children age 3 months through 18 years during the measurement year who were given a diagnosis of upper respiratory infection and were not dispensed an antibiotic prescription on or three days after the episode date.

10. APPROPRIATE TESTING FOR CHILDREN WITH PHARYNGITIS (CWP)

The percentage of HFP enrolled children age 2 through 18 years during the measurement year who were diagnosed with pharyngitis, prescribed an antibiotic and received a group A streptococcus (strep) test for the episode.

11. CHLAMYDIA SCREENING IN WOMEN (CHL)

The percentage of HFP enrolled women age 16 through 18 years who were identified as sexually active, were continuously enrolled during the measurement year with no more than one gap in enrollment of up to 45 days, and had at least one test for chlamydia during the measurement year.

12. IDENTIFICATION OF ALCOHOL AND OTHER DRUG SERVICES (IAD)

The number and percentage of HFP enrolled members, by age and sex, who received alcohol and other drug services during the measurement year in four categories:

• Any chemical dependency services (inpatient, intermediate or ambulatory).

• Inpatient chemical dependency services.

• Intermediate chemical dependency services.

• Ambulatory chemical dependency services.

13. MENTAL HEALTH UTILIZATION (MPT)

The number and percentage of HFP enrolled members, by age and sex, who received mental health services during the measurement year in four categories of service:

• Any mental health services (inpatient, intermediate or ambulatory).

• Inpatient mental health services.

• Intermediate mental health services.

• Ambulatory mental health services.

APPENDIX B: 2009 DENTAL PLAN PERFORMANCE MESAURES


1. HEDIS MEASURE – ANNUAL DENTAL VISIT

The percentage of enrolled members 2-18 years of age who had at least one dental visit during the measurement year. Members who have had no more than one gap in enrollment of up to 45 days during the measurement year should be included in this measure.

Includes members ages 2-18 years as of December 31st of the measurement year. The measure is reported for each of the following age stratifications and as a combined rate.

• 2-3 years

• 4-6 years

• 7-10 years

• 11-14 years

• 15-18 years

• Total

Note: Visits for many 1-year olds will be counted because the specification includes children whose second birthday occurs any time during the measurement year.

Numerator: One or more dental visits with a dental practitioner during the measurement year. A member had a dental visit if a submitted claim/encounter contains any of the codes in Table ADV-A of the 2010 HEDIS® Technical Specifications.

Denominator: The eligible population for each age group and the combined total.

Data collection methodology: Administrative

2. OVERALL UTILIZATION OF DENTAL SERVICES

Percentage of members continuously enrolled in the same plan for 1, 2, and 3 years who received any dental service, including preventive services, over those periods.

Numerator (1): Number of members continuously enrolled in the same plan for 1 year who received any dental service (D0100-D9999), including preventive services, during that year.

Denominator (1): Number of members continuously enrolled in the same plan for 1 year. Numerator (2): Number of members continuously enrolled in the same plan for 2 years who received any dental service (D0100-D9999), including preventive services, during those two years.

Denominator (2): Number of members continuously enrolled in the same plan for 2 years.



Numerator (3): Number of members continuously enrolled in the same plan for 3 years who received any dental service (D0100-D9999), including preventive services, during those three years. Denominator (3): Number of members continuously enrolled in the same plan for 3 years. For children enrolled for multiple years, calculation is based on the longest period the child was enrolled in the plan. Each child is counted only once for the longest period they have been enrolled.

3. PREVENTIVE DENTAL SERVICES

Percentage of members enrolled for at least 11 of the past 12 months who received any preventive dental service in the past year.

Numerator: Number of members enrolled for at least 11 of the past 12 months who received any preventive dental service (D1000-D1999) in the past year.

Denominator: Number of members enrolled for at least 11 of the past 12 months.

4. USE OF DENTAL TREATMENT SERVICES (Excludes diagnostic and preventive services)

Percentage of members enrolled for at least 11 of the past 12 months who received any dental treatment, other than diagnostic or preventive services, in the past year.

Numerator: Number of members enrolled for at least 11 of the past 12 months who received any dental treatment (D2000-D9999) in the past year. Denominator: Number of members enrolled for at least 11 of the past 12 months.

5. EXAMINATIONS/ORAL HEALTH EVALUATIONS

Percentage of members enrolled for at least 11 of the past 12 months who received a comprehensive or periodic oral evaluation or, for members under three years of age, those who received an oral evaluation and counseling with the primary caregiver in the past year.

Numerator: Number of members enrolled for at least 11 of the past 12 months who received a comprehensive or periodic exam (D0120 or D0150) or, for members under three years of age, who received an oral evaluation and counseling with the primary caregiver (D0145) in the past year.




6. TREATMENT/PREVENTION OF CARIES

Percentage of members, enrolled for at least 11 of the past 12 months, who received a treatment for caries or a caries-preventive procedure.

Numerator: Number of members enrolled for at least 11 of the past 12 months who received a treatment for caries (D2000-D2999) or a caries-preventive procedure (D1203, D1204, D1206, D1310, D1330, D1351) in the past year.


7. FILLING TO PREVENTIVE SERVICES RATIO

Percentage of members, enrolled for at least 11 of the past 12 months, with 1 or more fillings in the past year who received a topical fluoride or sealant application. Numerator: Number of members enrolled for at least 11 of the past 12 months with 1 or more fillings (D2000-D2999) who received a topical fluoride (D1203, D1204 or D1206) or sealant application (D1351) in the past year.

Denominator: Number of members enrolled for at least 11 of the past 12 months with one or more fillings.

8. CONTINUITY OF CARE

Percentage of members continuously enrolled in the same plan for 2 years with no gap in coverage who received a comprehensive oral evaluation or a prophylaxis in the year prior to the measurement year and who also received a comprehensive or periodic oral evaluation or a prophylaxis in the measurement year. Numerator: Number of members in the denominator who also received a comprehensive or periodic oral evaluation (D0120, D0150) or a prophylaxis (D1110, D1120) in the measurement year. Denominator: Number of members continuously enrolled in the same plan for 2 years with no gap in coverage who received a comprehensive oral evaluation (D0150) or a prophylaxis (D1110, D1120) in the year prior to the measurement year.

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