Public listing of CUHSM.ORG non-QPP
measures - Narrative version
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ID: CUHSM #1
NQF#: 0569
eCQM#: NA
Measure Title: Adherence to Statins
Measure Description: To ensure that members who are taking
statins to treat hyperlipidemia filled sufficient medication to have
at least 80% coverage during the measurement year.
NQS Domain: Effective Communication and
Care Coordination
Numerator: The numerator consists of
members in the denominator who filled a sufficient days supply of a
statin to provide for at least 80% coverage (Medication Possession
Ratio (MPR) >= 80%) during the measurement year. Of note, new users
of a statin that started after the first 3 months of the measurement
year will be excluded from the calculation.
Denominator: Continuously enrolled members
ages 19 years or older by the end of the measurement year who had a
diagnosis of hyperlipidemia anytime prior to the end of the
measurement year, cardiovascular disease or diabetes during the year
prior to the measurement year, and filled at least a 60 days supply
of statin during the measurement year.
Denominator Exclusions / Exceptions:
Members who were pregnant or diagnosed with myositis or
rhabdomyolysis during the measurement year, members diagnosed with
acute renal disease during the measurement year, members diagnosed
with liver dysfunction (acute or chronic), alcoholism, or liver
transplantation during the measurement year or members who were
newly started on statin medication in the 4th through 12th month of
the measurement year. Of note, MPR will not be calculated for these
individuals, thus they will be dropped from the denominator.
Rationale: Drug therapies can reduce
hospitalizations, but nonadherence is high, ranging from 30% to 80.
There is an urgent need to identify cost-effective ways to improve
adherence and reduce hospitalizations.
Measure Type (Process/Outcome):
Process
Steward: Health Benchmarks - IMS-Health
Data Source: Electronic Clinical
Data: Pharmacy
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ID: CUHSM #2
NQF#0541
eCQM# NA
Measure
Title: 5 Rates by Therapeutic Category - Proportion of
Days Covered (PDC):
Measure Description: The percentage of patients 18 years and older who met the
proportion of days covered (PDC) threshold of 80% during the
measurement year. A performance rate is calculated separately
for the following medication categories: Beta-Blockers (BB), Renin
Angiotensin System (RAS) Antagonists, Calcium-Channel Blockers (CCB),
Diabetes Medications, Statins.
NQS Domain: Effective Communication and Care Coordination
Numerator: The number of patients who met the PDC threshold
during the measurement year for each therapeutic category
separately. Follow the steps below for each patient to determine
whether the patient meets the PDC threshold.
Step 1: Determine the
patient´s measurement period, defined as the index prescription
date to the end of the calendar year, disenrollment, or death.
Step 2: Within the measurement period, count the days the
patient was covered by at least one drug in the class based on
the prescription fill date and days of supply. If prescriptions
for the same drug (GCN) overlap, then adjust the prescription
start date to be the day after the previous fill has ended.
Step 3: Divide the number of covered days found in Step 2 by the
number of days found in Step 1. Multiply this number by 100 to
obtain the PDC (as a percentage) for each patient.
Step 4: Count the number of patients who had a PDC greater than
80% and then divide by the total number of eligible patients.
Denominator: Patients who were dispensed at least two
prescriptions in a specific therapeutic category on two unique
dates of service during the measurement year.
Denominator Exclusions / Exception:
Exclusion criteria for
the PDC category of Diabetes medications: Patients who have one
or more prescriptions for insulin in the measurement period.
Rationale: Drug therapies can reduce hospitalizations,
but non-adherence is high, ranging from 30% to 80%. There is an urgent need to identify cost-effective ways to
improve adherence and reduce hospitalizations.
Measure Type (Process/Outcome):
Process
Steward: Pharmacy Quality
Alliance
Data Source:
Electronic Clinical Data: Pharmacy
ID: CUHSM #3
NQF# 0005
eCQM# NA
Measure
Title: CAHPS Clinician/Group Surveys -Adult Primary Care -
Pediatric Care - Specialist Care Surveys
Measure Description:
-Adult Primary Care Survey: 37 core and 64 supplemental question
survey of adult outpatient primary care patients.
-Pediatric Care Survey: 36 core and 16 supplemental question survey
of outpatient pediatric care patients.
-Specialist Care Survey: 37 core and 20 supplemental question survey
of adult outpatients specialist care patients.
Level of analysis for each of the 3 surveys: group practices, sites
of care, and/or individual clinicians
NQS Domain: Person and Caregiver-
Centered Experience and Outcome
Numerator:
Completed questionnaires. A questionnaire is considered complete if
responses are available for half of the key survey items.
Denominator: -Refusals. The individual (or parent or guardian of the sampled
child) refused in writing or by phone to participate.
-Nonresponse. The individual (or parent or guardian of the sampled
child) is presumed to be eligible but did not complete the survey
for some reason (never responded, was unavailable at the time of the
survey, was ill or incapable, had a language barrier, and so on).
-Bad addresses/phone numbers. In either case, the sampled individual
(or parent or guardian) is presumed to be eligible but was never
located
Denominator Exclusions / Exception:
-Deceased. In some cases, a household or family member may inform you
of the death of the sampled individual or child;
-Ineligible. The sampled individual or child did not receive care
from the participating medical group or health system in the last 12
months.
Rationale: Demonstrated ability of CG-CAHPS patient experience surveys to
reveal gaps in system performance, to enhance loyalty to practices,
increase member satisfaction, and to correlate with better
performance on effective care processes, adherence and outcomes,
creating a system to measure patient experience is foundational to
the success of any new payment reform model.
Measure Type (Process/Outcome): Process
Steward: ARHQ
Data Source: Survey: Patient Reported Data/Survey
Note: CG-CAHPS online Survey tool and instructions have been
updated by ARHQ. The above text for CG-CAHPS survey measures reflect
an earlier revision level.
ID: CUHSM #4
NQF# 0006
eCQM# NA
Measure
Title: CAHPS Health Plan Survey v 4.0 - Adult questionnaire
Measure Description: 30-question core survey of adult health plan members that assesses
the quality of care and services they receive. Level of analysis:
health plan – HMO, PPO, Medicare, Medicaid, commercial
NQS Domain: Person and
Caregiver- Centered Experience and Outcome
Numerator: Completed questionnaires. A questionnaire is considered complete if
responses are available for half of the key survey items.
Denominator: Refusals. The individual (or parent or guardian of the sampled
child) refused in writing or by phone to participate.
Nonresponse. The individual (or parent or guardian of the sampled
child) is presumed to be eligible but did not complete the survey
for some reason (never responded, was unavailable at the time of the
survey, was ill or incapable, had a language barrier, and so on).
Bad addresses/phone numbers. In either case, the sampled individual
(or parent or guardian) is presumed to be eligible but was never
located
Denominator Exclusions / Exception: Deceased. In some cases, a household or family member may
inform you
of the death of the sampled individual or child;
Ineligible. The sampled individual or child did not receive care
from the participating medical group or health system in the last 12
months.
Rationale: Demonstrated ability of CG-CAHPS patient experience surveys to
reveal gaps in system performance, to enhance loyalty to practices,
increase member satisfaction, and to correlate with better
performance on effective care processes, adherence and outcomes,
creating a system to measure patient experience is foundational to
the success of any new payment reform model.
Measure Type (Process/Outcome): Process
Steward: AHRQ
Data Source: Survey: Patient Reported Data/Survey
Note: CG-CAHPS online Survey
tool and instructions have been updated by ARHQ. The above text for
CG-CAHPS survey measures reflect an earlier revision level.
ID: CUHSM #5
NQF#
0553
eCQM# NA
Measure
Title:
Care for Older Adults (COA)
Medication Review
Measure Description:
Percentage of adults 65 years and older who had a medication review
during the measurement year; a review of all a member’s medications,
including prescription medications, over-the-counter (OTC)
medications and herbal or supplemental therapies by a prescribing
practitioner or clinical pharmacist.
NQS Domain:
Effective Communication and Care Coordination
Numerator:
At least one medication review conducted by a prescribing
practitioner or clinical pharmacist during the measurement year and
the presence of a medication list in the medical record
Denominator:
All patients 66 and older as of the end (e.g., December 31) of the
measurement year.
Denominator Exclusions / Exception:
None
Rationale:
This NQF measure is not driven by a hospital discharge (whereas
QPP measure is driven by hospital discharge); this measure assesses
annual outpatient medication review;
this measure assesses annual outpatient medication review.
Reference: NQF online document 0553_NCQA_OlderAdultsMedReview.pdf
Measure Type (Process/Outcome):
Process
Steward:
NQF
Data Source:
Administrative claims, Electronic Clinical Data, Paper records
