National Committee for Quality Assurance
- Adolescent well-care visits: percentage of enrolled members 12 to 21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.
- Ambulatory care: summary of utilization of ambulatory care in the following categories: outpatient visits and ED visits.
- Antibiotic utilization: summary of outpatient utilization of antibiotic prescriptions during the measurement year, stratified by age and gender.
- Emergency department utilization: risk-adjusted ratio of observed to expected ED visits during the measurement year, for members 18 years of age and older.
- Frequency of ongoing prenatal care: percentage of Medicaid deliveries between November 6 of the year prior to the measurement year and November 5 of the measurement year that received less than 21%, 21% to 40%, 41% to 60%, 61% to 80%, or greater than or equal to 81% of the expected number of prenatal care visits.
- Frequency of selected procedures: summary of utilization of fourteen frequently performed procedures.
- Hospitalization for potentially preventable complications: rate of discharges for ambulatory care sensitive conditions (ACSC) per 1,000 members and the risk-adjusted ratio of observed to expected discharges for ACSC by chronic and acute conditions, for members 67 years of age and older.
- Identification of alcohol and other drug services: summary of the number and percentage of members with an alcohol and other drug (AOD) claim who received the following chemical dependency services during the measurement year: any service, inpatient, intensive outpatient or partial hospitalization, and outpatient or ED.
- Inpatient hospital utilization: risk-adjusted ratio of observed to expected acute inpatient discharges during the measurement year reported by Surgery, Medicine and Total Inpatient, for members 18 years of age and older.
- Inpatient utilization—general hospital/acute care: summary of utilization of acute inpatient care and services in the following categories: Total Inpatient, Maternity, Surgery, and Medicine.
- Mental health utilization: number and percentage of members receiving the following mental health services during the measurement year: any service, inpatient, intensive outpatient or partial hospitalization, and outpatient or ED.
- Plan all-cause readmissions: the number of acute inpatient stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days and the predicted probability of an acute readmission, for members 18 years of age and older.
- Well-child visits in the first 15 months of life: percentage of members who turned 15 months old during the measurement year and who had the following number of well-child visits with a PCP during their first 15 months of life: zero, one, two, three, four, five, six or more.