Alcohol and other drug dependence
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Measure
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Care, screening or test
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Initiation and engagement of alcohol and other drug (AOD) dependence treatment
Ages 13 and older:
13-17 years
18+ years
Total
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Patients diagnosed with alcohol and other drug dependence who:
- Initiate treatment within 14 days of diagnosis
- Receive two additional AOD services within 30 days of initiation
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Follow-up after emergency department visit for alcohol and other drug dependence
13 years of age and older with a principal diagnosis of alcohol or other drug dependence
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- The percentage of ED visits for which the member received follow-up within 30 days of the ED visit.
- The percentage of ED visits for which the member received follow-up within seven days of the ED visit.
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Risk of continued opioid use
18 years of age and older |
The percentage of members 18 years and older who have a new episode of opioid use that puts them at risk for continued opioid use. Two rates are reported:
- The percentage of members whose new episode of opioid use lasts at least 15 days in a 30-day period.
- The percentage of members whose new episode of opioid use lasts at least 31 days in a 62 day period.
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Pharmacotherapy for opioid use disorder
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The percentage of new opioid use disorder pharmacotherapy events with OUD pharmacotherapy for 180 or more days among members age 16 and older with a diagnosis of OUD.
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Follow-up after high-intensity care for substance use disorder
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The percentage of acute inpatient hospitalizations, residential treatment or detoxification visits for a diagnosis of substance use disorder among members 13 years of age and older that result in a follow-up visit or service for substance use disorder. Two rates are reported:
- The percentage of visits or discharges for which the member received follow-up for substance use disorder within the 30 days after the visit or discharge.
- The percentage of visits or discharges for which the member received follow-up for substance use disorder within the 7 days after the visit or discharge.
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Asthma
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Measure
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Care, screening or test
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Asthma medication ratio
Ages 5-85 years
Age stratifications:
5-11 years
12-18 years
19-50 years
51-64 years
65-85 years
Total rate
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The percentage of members 5–85 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year.
Exclusions: Emphysema, COPD, cystic fibrosis, acute respiratory failure or no dispensed medications.
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Cardiac
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Measure
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Care, screening or test
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Persistence of beta-blocker treatment after heart attack
Age 18 and older
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Patients who were hospitalized and discharged alive after an acute MI who:
- Received treatment with beta-blockers for six months after discharge
Exclusions:
- Patients identified as having a contraindication to beta-blocker therapy
- Patients with a history of adverse reaction to beta-blocker therapy
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Controlling high blood pressure
Age 18-85
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Patients 18-85 with a diagnosis of hypertension whose most recent blood pressure reading was controlled (<140/90 mm Hg) in the measurement year (taken by any digital device).
Exclusions:
- Patients with end stage renal disease (ESRD) or kidney transplant
- Pregnant during the measurement year
- Admission to a non-acute inpatient setting during the measurement year
- Members 81 and older with frailty or advanced illness
- Palliative care
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Chronic obstructive pulmonary disease (COPD)
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Measure
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Care, screening or test
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Use of spirometry testing in the assessment and diagnosis of COPD
Ages 40 and older
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Adults with a new (within the measurement year) diagnosis or newly active COPD who received spirometry testing to confirm the diagnosis.
- Spirometry testing must occur 730 days prior to or 180 days after the diagnosing event.
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Pharmacotherapy management of COPD exacerbation
Adults 40 and older
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Adults aged 40 or older who had an acute inpatient discharge or an ED encounter with a principal diagnosis of COPD who were dispensed both:
- A systemic corticosteroid within 14 days of discharge
- Bronchodilator within 30 days of discharge
NOTE: the eligible population for this measure is based on the discharges and visits, not the patient. It is possible for the denominator for this measure to include multiple events for the same patient.
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Depression
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Measure
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Care, screening or test
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Antidepressant medication management
Ages 18 years and older
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Adults newly diagnosed with depression and treated with an antidepressant who received the following:
- Effective acute phase: filled sufficient number of Rx to allow for 84 days of continuous therapy.
- Effective continuation phase: filled sufficient number of Rx to allow for 180 days of continuous therapy.
To qualify as a new diagnosis, two criteria must be met:
- A 120-day (four-month) negative diagnosis history on or before the start date
- A 90-day (three-month) negative medication history on or before the start date
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Diabetes
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Measure
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Care, screening or test
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*****Comprehensive diabetes care
Age 18-75
*****
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Yearly screening of the following:
- HbA1c testing
- HbA1c result > 9.0 = poor control
- HbA1c result < 8.0 = good control
- Retinal eye exam
- Monitoring for nephropathy
- Blood pressure reading < 140/90 (taken by any digital device)
Exclusions
- Members 81 and older with frailty or advanced illness
- Palliative care
- Polycystic ovarian syndrome (PCOS)
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Mental illness
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Measure
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Care, screening or test
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Follow-up after hospitalization for mental illness
Age 6 and over
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Patients discharged from an inpatient mental health admission and received:
- One follow-up encounter with a mental health provider within seven days after discharge.
- One follow-up encounter with a mental health provider within 30 days after discharge.
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Rheumatoid arthritis
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Measure
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Care, screening or test
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*****Anti-rheumatic drug therapy for rheumatoid arthritis
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Patients 18 years and older who were diagnosed with rheumatoid arthritis and who were dispensed at least one ambulatory prescription for a disease modifying anti-rheumatic drug (DMARD).
Exclusions
- Members 81 and older with frailty or advanced illness
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Tobacco users
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Measure
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Care, screening or test
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Medical assistance with smoking cessation
Tobacco users age 18 and older
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Current smokers who were seen by a practitioner during the measurement year and:
- Received advice to quit
- Cessation medications were recommended and discussed
- Cessation methods were recommended or discussed
Information is received via CAHPS®** survey methodology.
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Other
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Measure
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Care, screening or test
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Appropriate testing for pharyngitis
3 years of age and older
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Children who had an outpatient visit or ED encounter with only a diagnosis of pharyngitis who were dispensed an antibiotic and also received a Group A streptococcus test three days before or three days after the prescription.
Exclusions:
- Encounters with > 1 diagnosis
Children with a history of antibiotic Rx within 30 days of encounter
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Avoidance of antibiotic treatment for acute bronchitis
Ages 3 months of age and older
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Members diagnosed with acute bronchitis who did not receive an antibiotic Rx on or within seven days of diagnosis.
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