| Public listing of 2016 Non-QPP measures -
CUHSM.ORG - V2 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%
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: 5 Rates by Therapeutic Category - Proportion of
Days Covered (PDC):
Title: The percentage of patients 18 years and older who met the
proportion of days covered (PDC) threshold of 80% during the
measurement year.
Measure Description: 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:
A random sample of the following:
o Adult Primary Care Questionnaire: Adult patients (≥18 years) who
received outpatient primary care from
any of the doctors who are the subject of the survey, OR
o Adult Specialty Care Questionnaire: Adult patients (≥18 years) who
received care from any of the
specialist doctors who are the subject of the survey OR
o Child Primary Care Questionnaire: Parents or guardians of children
who received care from any of the
doctors who are the subject of the survey.
• Survey size determined based on the number of performance levels
at which physicians are to be
distinguished, desired level of confidence about these distinctions,
expected amounts and types of
variability in survey scores, and expected response rates. Reports
of survey data should make public
statistical confidence levels and other aspects of survey and
analysis methods.
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
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: A random sample of the following:
o Adult Primary Care Questionnaire: Adult patients (≥18 years) who
received outpatient primary care from
any of the doctors who are the subject of the survey, OR
o Adult Specialty Care Questionnaire: Adult patients (≥18 years) who
received care from any of the
specialist doctors who are the subject of the survey OR
o Child Primary Care Questionnaire: Parents or guardians of children
who received care from any of the
doctors who are the subject of the survey.
• Survey size determined based on the number of performance levels
at which physicians are to be
distinguished, desired level of confidence about these distinctions,
expected amounts and types of
variability in survey scores, and expected response rates. Reports
of survey data should make public
statistical confidence levels and other aspects of survey and
analysis methods.
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.
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
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
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.
none
Denominator Exclusions / Exception: n/a
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.
Measure Type (Process/Outcome):
Process
Steward:
NQF
Data Source:
Administrative claims, Electronic Clinical Data, Paper records
ID: CUHSM #6
NQF# 1880
eCQM# NA
Measure Title: Adherence to Mood Stabilizers for Individuals with
Bipolar I Disorder
Measure Description: Percentage of individuals at least 18 years
of age as of the beginning of the
measurement period with schizophrenia or schizoaffective disorder who
had at least two prescription drug
claims for antipsychotic medications and had a Proportion of Days
Covered (PDC) of at least 0.8 for
antipsychotic medications during the measurement period (12 consecutive
months).
Numerator: Individuals with schizophrenia or schizoaffective
disorder who had at least two prescription
drug claims for antipsychotic medications and have a PDC of at least 0.8
for antipsychotic medications.
Denominator: Individuals at least 18 years of age as of the
beginning of the measurement period with
schizophrenia or schizoaffective disorder and at least two prescription
drug claims for antipsychotic
medications during the measurement period (12 consecutive months).
Exclusions: Individuals with any diagnosis of dementia during 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 #1880 assesses chronic adherence using the
Proportion of Days Covered
(PDC) method for assessing medication adherence with a threshold of an
80 percent rate. This measure
describes the degree to which providers utilize mood stabilizer
medications in treating this disorder and
subsequent patient adherence.
Randomized, placebo-controlled trials have demonstrated the
effectiveness of mood stabilizers in
reducing the symptoms and probability of relapse for patients diagnosed
with bipolar I disorder (Smith,
Cornelius, Warnock, Bell, & Young, 2007; Tohen et al., 2005; Bowden et
al., 2005). This body of evidence
has spawned numerous clinical guidelines. The American Psychiatric
Association recommends with
“substantial clinical confidence” that the first-line of pharmacological
treatment for bipolar episodes, both
manic and depressive, includes the use of mood stabilizers (Hirshfeld,
2006). The Expert Consensus
Guideline Series states that “mood stabilizing medications are the
cornerstone of preventive maintenance
treatment” for patients with bipolar disorder (Keck et al., 2004). By
describing the degree of compliance
with these recommendations, this measure has the potential to reduce the
symptoms and probability of
relapse for patients diagnosed with bipolar I disorder.
Measure Type (Process/Outcome): Process
NQS Domain: Patient Safety
ID: CUHSM #7
NQF# 1934
eCQM# NA
Measure Title: Diabetes Monitoring for People with Diabetes and
Schizophrenia (SMD)
Measure Description: The percentage of patients 18 – 64 years of
age with schizophrenia and diabetes
who had both an LDL-C test and an HbA1c test during the measurement
year.
Numerator: One or more HbA1c tests and one or more LDL-C tests
performed during the measurement
year.
Denominator: Patients age 18-64 years of age as of the end of the
measurement year (e.g. December
31) with a schizophrenia and diabetes diagnosis.
Exclusions: Exclude patients with a diagnosis of polycystic
ovaries who did not have a face-to-face
encounter, in any setting, with a diagnosis of diabetes during the
measurement year or the year prior to
the measurement year. Diagnosis may occur in any setting, any time in
the patient’s history, but must
have occurred by the end of the measurement year.
Exclude patients with gestational or steroid-induced diabetes who did
not have a face-to-face
encounter, in any setting, with a diagnosis of diabetes during the
measurement year or the year prior to
the measurement year. Diagnosis may occur in any setting, during the
measurement year or the year
prior to the measurement year, but must have occurred by the end of the
measurement year.
Rationale:
Measure #1934 addresses a high impact area as individuals with
schizophrenia or bipolar disorder have
nearly two times the risk for diabetes due to use of antipsychotic
medications.
- Measure #1934 focus is due to the particular risk of the target
population, who tend to use the
medication for a long time period. On average individuals with
schizophrenia and bipolar disease die 25
years earlier than the general population.
-A gap in performance was shown at the state level where the mean value
per state was 12.1 percent,
and the maximum was 28 percent - individuals with schizophrenia or
bipolar are not screened for
diabetes as often as they should be.
Measure Type (Process/Outcome): Process
NQS Domain: Patient Safety
ID: CUHSM #8
NQF# 1927
eCQM# NA
Measure Title: Cardiovascular Health Screening for People With
Schizophrenia or Bipolar Disorder Who
Are Prescribed Antipsychotic Medications
Measure Description: The percentage of individuals 25 to 64 years
of age with schizophrenia or bipolar
disorder who were prescribed any antipsychotic medication and who
received a cardiovascular health
screening during the measurement year.
Numerator: Individuals who had one or more LDL-C screenings
performed during the measurement
year.
Denominator: Individuals ages 25 to 64 years of age by the end of
the measurement year with a
diagnosis of schizophrenia or bipolar disorder who were prescribed any
antipsychotic medication during
the measurement year.
Exclusions: Individuals are excluded from the denominator if they
were discharged alive for a coronary
artery bypass graft (CABG) or percutaneous coronary intervention (PCI)
(these events may occur in the
measurement year or year prior to the measurement year), or diagnosed
with ischemic vascular disease
(IVD) (this diagnosis must appear in both the measurement year and the
year prior to the measurement
year), chronic heart failure, or had a prior myocardial infarction
(identified in the measurement year or as
far back as possible).
Rationale:
Measure #1927 addresses a high impact area, as individuals with
schizophrenia or bipolar disorder are at
a greater risk for cardiovascular disease due to lifestyle risk factors,
and high non-treatment rates for
hyperlipidemia among people with schizophrenia.
- Research submitted shows that patients in this population receive
cholesterol screening 25 percent less
often than the general population, which demonstrates a significant
performance gap.
- Screening is a necessary step along the way to improving the health of
this population.
Measure Type (Process/Outcome): Process
NQS Domain: Patient Safety |
