2018 HEDIS 1 Measures Healthcare Effectiveness Data and Information Set

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1 2018 HEDIS 1 Measures Healthcare Effectiveness Data and Information Set *Measures collected with medicalrecord review. Red= new/addition to measures Blue= Medicare only Prevention and Screening Measure Pneumococcal Vaccination Coverage for Older Adults Adults 65 years and older Have received the recommended series of pneumococcalvaccines: 13-valent pneumococcal conjugate v accine(pcv13) and 23-valent pneumococcal p olysaccharide v accine ( PPSV23) *Immunizations for Adolescents NOTE: This measure includes the Human Papillomavirus Vaccine (HPV) for both males and females. Children who turn 13 years old during the measurement year (2017). CPT Codes: Meningococcal: Tdap: HPV: dose Meningococcal (between the 11 th and 13 th birthdays) and 1 tetanus, diphtheria toxoids and acelluar pertussis (Tdap) and 2-dose or 3-dose HPV vaccination series (between the9 th and 13 th birthdays). NOTE: All vaccines must be completed by the 13 th Birthday Documentation of immunizations are up-to-date is not acceptable. Exclusion: Contraindication for a specific vaccine (e.g., anaphylactic reaction to the vaccine or its components) *Childhood Immunization Children who turn 2 years old during the measurement year (2017). Vaccines must be completed on or before the 2 nd birthday 4 DTaP (do not count any before 42 days of age) 3 IPV (do not count any before 42 days of age) 1 MMR 3 HiB (do not count any before 42 days of age) 3 HepatitisB 1 VZV, positive serology, or documented chicken pox disease before 2 nd birthday 4 pneumococcal conjugate 1 HepatitisA 2 or 3 Rotavirus vaccine ( Dosage depends on the vaccine administered) (do not count any before 42 days of age) 2 Influenza with different dates of service (do not count any vaccine given prior to 6 months after birth) Documentation of immunizations are up-to-date is not acceptable. Documentation of an immunization received at delivery or in the hospital may be counted. Exclusion: Contraindication for a specific vaccine (e.g., anaphylactic reaction to the vaccine or its components) 1 HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA) Updated 8/2/2017

2 *Lead Screening in Children (Medicaid only) Children who turn 2 years old during the measurement year (2017). CPT Code: *Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Members 3-17 years of age, who had an outpatient visit with a PCP or OB/GYN and had evidence of the following documented: BMI percentile Counseling for Nutrition Counseling for Physical Activity ICD-9 Codes: BMI percentile: Z68.51-Z68.54 Counseling for nutrition : Z71.3 Counseling for physical activity: Z02.5 CPT Codes Counseling for nutrition: At least one capillary or venous lead test by their 2 nd birthday. Documentation in the record must include both of the following: Date the test was performed The result or finding BMI Percentile documentation must include date of the BMI and: BMI percentile (may be plotted on age-growth chart) Weight and height must be taken during the measurement year (2017). Counseling for Nutrition documentation must include a note indicating the date and evidence of at least one of the following: Engagement in discussion of current nutrition behaviors Checklist indicating nutrition was addressed Counseling or referral for nutrition education Member received educational materials on nutrition during a face-to-face visit Anticipatory guidance for nutrition Weight or obesity counseling Counseling for Physical Activity documentation includes a note indicating the date and evidence of at least one of the following: Engagement in discussion of current physical activity behaviors Checklist indicating physical activity was addressed Counseling or referral for physical activity education Member received educational materials on physical activity during a face-toface visit Anticipatory guidance for physical activity Weight or obesity counseling Documentation of meeting Developmental Milestones only does not meet HEDIS criteria for Physical Activity Counseling. Services specific to an acute or chronic condition do not count toward the counseling indicators for either nutrition or physical activity. Non-recommended PSA-Based Screening in Older Men Men age 70 and older Codes to identify PSA-based Screening CPT: Screened unnecessarily for prostate cancer Exclusions: Prostate cancer diagnosis Dysplasia of the prostate A PSA test during the year prior to the measurement year (2017)where laboratory data indicate an elevated result. Dispensed prescription for a 5-alpha reductase inhibitor during the measurement year.

3 Non-Recommended Cervical Cancer Screening in Adolescent Females Adolescent females ages Screened unnecessarily for cervicalcancer Note: A lower rate indicates better performance Exclusion: History of cervical cancer, HIV or immunodeficiency *Cervical Cancer Screening Women ages CPT Codes to identify Cervical Cancer Screening Cervical cytology: ; ; 88150; ; ; HPV tests: ; A PAP test (cervical cytology) during the measurement year (2017) or prior two years (2015, 2016) for women ages Cervical cytology/human papillomavirus (HPV) co-testing during the measurement year (2017) or prior four years ( ) for women ages Exclusion: Hysterectomy with no residual cervix. Documentation of complete, total or radical abdominal or vaginal hysterectomy meets the criteria. Documentation of hysterectomy alone does not meet the criteria. Chlamydia Screening Females ages and identified as sexually active (by claims or pharmacy data) At least one test for Chlamydia during the measurement year (2017). CPT Codes to identify Chlamydia Screening: 87110; 87270; 87320; ; Breast Cancer Screening Women ages Codes to identify Breast Cancer Screening CPT: ; ; A screening mammogram or digital breast tomosynthesis on or between October 1, December 31,2017. Exclusion: Bilateral Mastectomy *Colorectal Cancer Screening Adults ages CPT Codes to identify Colorectal Cancer Screening FOBT: 82270; FIT-DNA: Flexible Sigmoidoscopy: ; ; ; CT Colonography: Colonoscopy: ; 44397; ; 45355; ; One or more of the following screenings: Colonoscopy in past 10 years( ) Flexible sigmoidoscopy in past 5 years( ) CT Colonography in the past 5 years( ) FIT-DNA test in the past 3 years( ) Fecal occult blood test (FOBT)annually(2017) Exclusion: Diagnosis of colorectal cancer or total colectomy.

4 * Adult BMI Assessment The percentage of members years of age who had an outpatient visit and whose body mass index (BMI) was documented during the measurement year (2017) or the year prior to the measurement year (2016). ICD-10 Codes for BMI Value: Z68.1; Z Z68.39; Z68.41-Z68.45 Percentile: Z68.51-Z68.54 Use of Services *Well-child Exams Ages 0-15 months (turned 15 months during 2017) Codes to Identify Well-Child Visits CPT: ; ; ICD-10: Z00.00-Z00.01; Z Z00.111; Z00.121; Z00.129; Z00.8; Z02.0; Z02.5 *Well-child Exams Ages 3-6 years Codes to Identify Well-Child Visits CPT: ; ; ICD-10: Z00.00-Z00.01; Z Z00.111; Z00.121; Z00.129; Z00.8; Z02.0; Z02.5 *Adolescent Well-Care Visit Ages years Codes to Identify Adolescent Well-Care Visits CPT: ; ; ICD-10: Z00.00-Z00.01; Z Z00.111; Z00.121; Z00.129; Z00.8; Z02.0; Z02.5 Respiratory Conditions Appropriate Testing of Children with Pharyngitis Children ages 3-18 years ICD-10 Codes to Identify Pharyngitis: J02.0; J02.8-J02.9; J03.00-J03.01; J03.80-J03.81; J03.90-J03.91 For members ages 20 and older, documentation in the medical record must include: Date of thebmi Weight BMI value For members ages 18-19yo, documentation of BMI percentile is required: BMI documented as a percentile(e.g.,75 th percentile) BMI percentile plotted on an age- growth chart. Documentation of height and weight only does not meet HEDIS criteria. Exclusion: Members with a diagnosis of pregnancy in 2016 or 2017 may be excluded from this measure. 6 well-care visits (at least 2 weeks apart) with apcp/pediatrician. Each visit must show evidence of all of the following: Health and developmental history (physical and mental) Physical exam Health education/anticipatory guidance At least one well-care visit with a PCP during the measurement year (2017). Must show evidence of all the following: Health and development history (physical and mental) Physical exam Health education/anticipatory guidance At least one comprehensive well-care visit with a PCP or OB/GYN during the measurement year(2017). Must show evidence of all the following: Health and development history (physical and mental) Physical exam Health education/anticipatory guidance Diagnosis of pharyngitis, Prescribed an antibiotic,and Received a group A streptococcus (strep) test in the 7 day period from 3 days prior to, through 3 days after, theprescription date.

5 Appropriate Treatment of Children with Upper Respiratory Infections Children ages 3 mos-18 yrs ICD-10 Codes to identify URI: J00; J06.0; J06.9 Diagnosis of Upper Respiratory Infection (URI),and Not prescribed an antibiotic within 3 days of URI diagnosis. Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis Adults ages ICD-10 Codes to identify Acute Bronchitis J20.3-J20.9; J40 Diagnosis of acute bronchitis, and Not dispensed an antibiotic prescription within 3 days of diagnosis. Exclusion: members with a diagnosis of any of the following comorbid conditions: Emphysema; COPD; Cystic Fibrosis; HIV; Malignant neoplasm Use of Spirometry Testing in the Assessment and Diagnosis of COPD Adults age 40 and older Codes for Spirometry Testing: New diagnosis of, (in 2017) or newly active, COPD and Spirometry testing to confirm diagnosis. CPT: 94010; ; 94060; 94070; 94375; Pharmacotherapy Management of COPD Exacerbation Adults age 40 and older ICD-10 Codes to identify COPD: J44.0-J44.1; J44.9 Members discharged from an acute inpatient admission or an ED encounter with a primary diagnosis of COPD who were dispensed both: A systemic corticosteroid within 14 days of theevent A bronchodilator within 30 days of theevent Medication Management for People with Asthma Members ages 5-64 ICD-10 Codes to identify Persistent Asthma: J45.20-J45.22; J45.30-J45.32; J45.40-J45.42; J45.50-J45.52; J J45.902; J45.909; J J45.991; J Identified as having persistent asthma and Dispensed appropriate medication that they remained on during the treatmentperiod. 1. Members remaining on asthma controller medication for at least 50% of their treatmentperiod. 2. Members remaining on asthma controller medication for at least 75% of their treatmentperiod.

6 Cardiovascular Measure Statin Therapy for Patients with Cardiovascular Disease Males ages and Females ages Identified as having clinical atherosclerotic cardiovascular disease (ASCVD) and met the following criteria: Codes to identify ASCVD: CABG: CPT: ; ; ; MI: ICD-10: I21.01-I21.02;I21.09; I21.11; I21.19; I21.21; I21.29;I21.3-I21.4; I22.0-I22.2; I22.8-I22.9; I23.0-I23.8; I25.2 PCI: CPT: 92920; 92924; 92928; 92933; 92937; 92941; 92943; 92980; 92982; *Controlling High Blood Pressure Adults ages ICD-10 Code to identify HTN: I10 1. Received Statin Therapy: Members who were dispensed at least one high or moderate-intensity statin medication during the measurement year(2017). 2. Statin Adherence 80%: Members who remained on a high or moderate-intensity statin medication for at least 80% of the treatment period (from prescription date through end of year). Diagnosis of hypertension prior to June 30,2017. Most recent blood pressure reading in the medical record for Adequate control is defined as: Ages 18-59: <140/90 Ages with a diagnosis of diabetes: <140/90 Ages without a diagnosis of diabetes: <150/90 If multiple readings are recorded on a single date, the lowest systolic and lowest diastolic BP on that date will be used as the representative BP. Member reported BP readings may not beused for HEDIS purposes. Exclusions: Evidence of any of the following during 2017: End Stage Renal Disease (ESRD), kidney transplant or dialysis -Pregnancy Non-acute inpatient admission Persistence of Beta-Blocker Treatment After Heart Attack Adults age 18 and older ICD-10 Codes to identify AMI: Hospitalized and discharged between July 1, 2016 and June 30, 2017 with a diagnosis ofami Persistent treatment with a beta-blocker for six months after discharge. A list of Beta-Blocker Medications included in the HEDIS criteria for this measure is available on request from the QI department at I21.01-I21.02; I21.09; I21.11; I21.11; I21.19; I21.21; I21.29; I21.3-I21.4 Exclusions: Asthma COPD Obstructive chronicbronchitis Chronic respiratory conditions due tofumes/vapors Hypotension, Heart Block > 1 degree, or SinusBradycardia Intolerance or allergy tobeta-blockers Intolerance or allergy to beta-blockertherapy

7 Diabetes Measure *Comprehensive Diabetes Care Adults ages with diabetes (type 1 or type 2). ICD-10 Codes to identify Diabetes: E10; E11; E13 1. HbA1c testing (most recent date and result from2017) HbA1c < 8.0 % =control HbA1c > 9.0 % = poorcontrol 2. Retinal eye exam (most recent date and result from 2016 or 2017) 3. Medical attention for nephropathy (one of the following during 2017): Nephropathy screening ormonitoringtest ACE/ARBtherapy Evidence of nephropathy (ESRD, CKD, kidneytransplant) 4. Blood pressure (most recent date and resultfrom2017) BP of < 140/90 =control Statin Therapy for Patients with Diabetes Adults ages Musculoskeletal Osteoporosis Management in Women who had a Fracture Women ages CPT Codes to identify BMD test: 76977; 77078; ; HCPCS codes for osteoporosis meds: J0630; J0897; J1740; J3110; J3487- J3489; Q2051 Disease Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis Adults age 18 and older ICD-10 Code to identify Rheumatoid Arthritis: M05.10-M06.9 Exclusions: Members without a diagnosis of diabetes, but with either: Gestational diabetes (during 2016 or 2017) or Steroid-induced diabetes (during 2016 or 2017) Identified as having diabetes and do not have clinical atherosclerotic cardiovascular disease (ASCVD) who met the following criteria: 1. Received Statin Therapy: Members who were dispensed at least one statin medication of any intensity during the measurement year (2017). 2. Statin Adherence 80%: Members who remained on a statin medication of any intensity for at least 80% of the treatment period (from prescription date through end of year). Suffered a fracture and had either: A bone mineral density (BMD) test or A prescription for a drug to treat osteoporosis in the six months after the fracture Diagnoses of rheumatoid arthritis and Received at least one ambulatory prescription for a disease-modifying anti-rheumatic drug (DMARD). Exclusions: Diagnosis during 2017 of: HIV or Pregnancy

8 Use of Imaging Studies for Low Back Pain Adults ages ICD-10 Codes to identify Uncomplicated Low Back Pain: M47.26-M47.28; M M47.818; M M47.898; M48.06-M48.08; M51.16-M51.17; M51.26-M51.27; M51.36-M51.37; M51.86-M51.87 S33.xxx; S39.xxx Behavioral Health Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults Members ages 12 and older ICD-10 Codes to identify Major Depression and Dysthymia: F32.0-F32.5; F32.9; F33.0-F33.3; F43.40-F43.42; F33.9; F34.1 CPT Codes to identify Depression Encounters: 90791; 90792; 90832; 90834; 90837; ; 99078; ; ; ; ; ; ; ; ; ; ; LOINC Codes to identify PHQ administered: ; ; ; Depression Remission or Response for Adolescents and Adults Members ages 12 and older ICD-9 Codes to identify Major Depression and Dysthymia: F32.0-F32.5; F32.9; F33.0-F33.3; F43.40-F43.42; F33.9; F34.1 CPT Codes to identify Depression Encounters: 90791; 90792; 90832; 90834; 90837; ; 99078; ; ; ; ; ; ; ; ; ; ; Primary diagnosis of low back pain who did not have an imaging study (x-ray, MRI, CT) within 28 days of the diagnosis. A higher score indicates appropriate treatment of low back pain Exclusions: An imaging study in the presence of low back pain is considered clinically indicated in patients with a diagnosis of: -Cancer -Neurologic Impairment -Major Organ Transplant -Recent Trauma -HIV -Prolonged Use of Corticosteroids -IV Drug Abuse -Spinal Infection Diagnosis of major depression ordysthymia Have a PHQ-9 or PHQ-A tool administered during an outpatient encounter at least once during a four-month period 1. Inclusion in ECDS Rate: The percentage of members 12 and older with a diagnosis of major depression or dysthymia, who are included in an electronic clinical data system(ecds). 2. Utilization of PHQ-9 Rate: The percentage of PHQ utilization. Members with a diagnosis of major depression or dysthymia who are covered by an ECDS and, if they had an outpatient encounter, have a PHQ-9 score present in theirrecord. Exclusions: Bipolar disorder; Personality disorder; Psychotic disorder, Pervasive Developmental disorder Diagnosis ofdepression An elevated PHQ-9score Evidence of response or remission within 4-8 months of the elevated score Four rates are reported: 1. ECDS Coverage: Health plan can receive any electronic clinical quality data 2. Follow-Up PHQ-9 within 5-7 months of the elevated score 3. Depression Remission: PHQ-9 score of<5 4. Depression Response: a PHQ-9 score reduction of at least 50% Exclusions: Bipolar disorder; Personality disorder; Psychotic disorder, Pervasive Developmental disorder Use of Multiple Concurrent Antipsychotics in Children and Adolescents On 2 or more concurrent antipsychotic medications for 90 days or more during the measurement year(2017) Children/Adolescents ages 1-17 A lower rate indicates better performance for this measure.

9 Depression Screening and Follow-Up for Adolescents and Adults Ages 12 years and older Screened for depression using a standardized tool If screening was positive, received follow-up care within 30 days Unhealthy Alcohol Use Screening and Follow-Up Adults age 18 and older Screened for unhealthy alcohol use using a standardized tool If screening was positive, received brief counseling or other follow-up care within 2 months Metabolic Monitoring for Children and Adolescents on antipsychotics Children/Adolescents ages 1-17 CPT Codes to identify cholesterol tests other than LDL: 82465; 83718; Antidepressant Medication Management Adults age 18 and older ICD-10 Codes to identify Major Depression: F32.0-F32.4; F32.9; F33.0- F33.3; F33.41; F33.9 Follow-up Care for Children Prescribed ADHD Medication Ages 6-12 years At least 2 antipsychotic prescriptions (same or different medications) on different dates during the measurementyear (2017) Blood glucose or HbA1c test during the measurement year (2017) and LDL-C or cholesterol test during the measurement year (2017) Were treated with antidepressant medication Had a diagnosis of major depression and Remained on antidepressant medication treatment. 1. Effective acute phase: remained on an antidepressant medication for at least 84 days (12weeks) 2. Effective continuation phase: remained on anantidepressant medication for at least 180 days (6months) An initial prescription for ADHD medication (or first fill in >120 days) Remained on the medication Had appropriate follow up care visits 1. InitiationPhase: one follow-up visit with a prescribing practitioner within 30 days 2. Continuation and MaintenancePhase: remained on the medication for at least 210 days and had two additional visits with a practitioner within 270 days (9 months after the Initiation Phase ended). Adherence to Antipsychotic Medications for Individuals with Schizophrenia Adults ages Diagnosis ofschizophrenia Dispensed an antipsychotic medication and Remained on the medication for at least 80% of their treatment period (days between the earliest prescription fill in 2017 and the end of the year)

10 Follow-up After Hospitalization for Mental Illness Ages 6 and over ICD-10 Codes to identify Mental Health Diagnosis: F20.0-F20.3; F20.5; F20.81; F20.89; F20.9; F21-F24; F25.0-F25.1; F25.8- F25.9; F28; F29; F30.10-F30.13; F30.2-F30.4; F30.8-F30.9; F31.0; F31.10-F31.13; F31.2; F31.30-F31.32; F31.4- F31.5; F31.60-F31.64; F F31.78; F31.81; F31.89; F31.9; F32.0- F32.5; F32.8-F32.81; F32.9; F33.0- F33.3; F33.40-F33.42; F33.8-F33.9; F34.0- F34.1; F34.8-F34.81; F34.89; F34.9; F39; F42; F42.2-F42.4; F42.8- F42.9; F43.0; F F43.12; F F43.25; F43.29; F43.8-F43.9; F44.89; F53; F60.0-F60.7; F60.81; F60.89; F60.9; F63.1-F63.3; F63.81; F63.89; F63.9; F68.10-F68.13; F68.8; F84.0; F84.2-F84.3; F84.5; F84.8-F84.9; F90.0- F90.2; F90.8-F90.9; F91.0-F91.3; F91.8- F91.9; F93.0; F93.8-F93.9; F94.0-F94.2; F94.8-F94.9 Follow-Up After Emergency Department visit for Mental Illness Ages 6 and over Discharged from an inpatient admission for select mental illness diagnoses and One follow-up outpatient visit, intensive outpatient encounter, or partial hospitalization with a mental health practitioner. 1. Follow-up visit within 7 days of discharge 2. Follow-up visit within 30 days of discharge ED visit with a principal diagnosis of Mental Illness Follow-Up visit for Mental Illness 1. Follow-up visit within 7 days of discharge 2. Follow-up visit within 30 days of discharge Follow-Up After Emergency Department Visit for Alcohol and Other Drug Dependence Ages 13 and older ED visit with principal diagnosis of Alcohol or Other Drug (AOD) Dependence Follow-Up visit for AOD 1. Follow-up visit within 7 days of discharge 2. Follow-up visit within 30 days of discharge Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who are Using Antipsychotic Medications Adults ages Diagnosis of Schizophrenia or Bipolar Disorder Dispensed an Antipsychotic medication Diabetes screening (glucose or HbA1c) test during the measurement year (2017) ICD-10 Codes to identify diagnosis: Bipolar: F30.10-F30.13; F30.2-F30.4; F30.8- F30.9; F31.0; F31.10-F31.13; F31.2; F31.30-F31.32; F31.4-F31.5; F31.60-F31.64; F31.70-F31.78 CPT Codes to Identify Diabetes Screening: Glucose tests: 80047, 80048, 80050, 80053, 80069, 82947, 82950, HbA1c tests: 83036,83037

11 Follow-up After Hospitalization for Mental Illness Ages 6 and over ICD-10 Codes to identify Mental Health Diagnosis: F20.0-F20.3; F20.5; F20.81; F20.89; F20.9; F21-F24; F25.0-F25.1; F25.8-F25.9; F28; F29; F30.10-F30.13; F ; F30.8-F30.9; F31.0; F31.10-F31.13; F31.2; F31.30-F31.32; F31.4- F31.5; F31.60-F31.64; F31.70-F31.78; F31.81; F31.89; F31.9; F32.0-F32.5; F32.8-F32.81; F32.9; F33.0- F33.3; F33.40-F33.42; F33.0- F33.3; F33.40-F33.42; F33.8-F33.9; F34.0- F34.1; F34.8-F34.81; F34.89; F34.9; F39; F42; F42.2-F42.4; F42.8-F42.9; F43.0; F F43.12; F43.20-F43.25; F43.29; F43.8-F43.9; F44.89; F53; F60.0-F60.7; F60.81; F60.89; F60.9; F63.1-F63.3; F63.81; F63.89; F63.9; F68.10-F68.13; F68.8; F84.0; F84.2-F84.3; F84.5; F84.8-F84.9; F90.0-F90.2; F90.8-F90.9; F91.0-F91.3; F91.8-F91.9; F93.0; F93.8-F93.9; F94.0-F94.2; F94.8-F94.9 Follow-Up After Emergency Department visit for Mental Illness Ages 6 and over Discharged from an inpatient admission for select mental illness diagnoses and One follow-up outpatient visit, intensive outpatient encounter, or partial hospitalization with a mentalhealthpractitioner. 3. Follow-up visit within 7 days of discharge 4. Follow-up visit within 30 days of discharge ED visit with a principal diagnosis of Mental Illness Follow-Up visit formental Illness 3. Follow-up visit within 7 days of discharge 4. Follow-up visit within 30 days of discharge Follow-Up After Emergency Department Visit for Alcohol and Other Drug Dependence Ages 13 and older ED visit with principal diagnosis of Alcohol or Other Drug (AOD) Dependence Follow-Up visit foraod 3. Follow-up visit within 7 days of discharge 4. Follow-up visit within 30 days of discharge Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who are Using Antipsychotic Medications Adults ages Diagnosis of Schizophrenia or Bipolar Disorder Dispensed an Antipsychotic medication Diabetes screening (glucose or HbA1c) test during the measurement year (2017) ICD-10 Codes to identify diagnosis: Bipolar: F30.10-F30.13; F30.2-F30.4; F30.8- F30.9; F31.0; F31.10-F31.13; F31.2; F31.30-F31.32; F31.4-F31.5; F31.60-F31.64; F31.70-F31.78 CPT Codes to Identify Diabetes Screening: Glucose tests: 80047, 80048, 80050, 80053, 80069, 82947, 82950, HbA1c tests: 83036,83037

12 Diabetes Monitoring for People with Diabetes and Schizophrenia Adults ages Diagnoses of Schizophrenia and Diabetes HbA1c test during the measurement year (2017) and LDL-C test (direct or calculated) during the measurement year (2017) Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia Diagnoses of Cardiovascular Disease and Schizophrenia LDL-C test (direct or calculated) during the measurement year (2017) Adults ages CPT Codes to Identify LDL-C Screening: 80061; 83700; 83701; 83704; Medication Management/Care Coordination Measure Transitions of Care Adults ages 18 and older Documentation in the PCP record of the following in 2017: Follow-Up After ED Visit for People with High-Risk Multiple Chronic Conditions Notification of Inpatient Admission on the day of admission or the day after Receipt of Discharge Information on the day of discharge or the day after Patient Engagement After Inpatient Discharge (e.g., office visits, home visits, telehealth) provided within 30 days after discharge Medication Reconciliation on the date of discharge through 30 days after discharge Adults ages 18 and older (Medicare) ED Visit High-risk multiple chronic conditions Follow-Up service within 7 days of the ED visit Use of Opioids at High Dosage Adults ages 18 and older Receiving prescription opioids for 15 days during 2017 at a high dosage (average morphine equivalent dose [MED] > 120mg) NOTE: Reported as the rate per 1,000. A lower rate indicates better performance. Use of Opioids From Multiple Providers Adults ages 18 and older Receiving prescription opioids for 15 days during 2017 who received opioids from: Multiple Prescribers (four or more prescribersduring2017) Multiple Pharmacies (four or more pharmacies during2017) Multiple Prescribers and Multiple Pharmacies(both four or more prescribers and four or more pharmacies in2017)

13 Potentially Harmful Drug- Disease Interactions in the Elderly Adults age 65 and older Three rates are reported: 1. A history of falls and a prescription for anticonvulsants, SSRI s, antipsychotics, benzodiazepines, nonbenzodiazepine hypnotics, ortricyclicantidepressants 2. Dementia and a prescription for antipsychotics, benzodiazepines, nonbenzodiazepine hypnotics, tricyclic antidepressants, H2 receptor antagonists, oranticholinergicagents. 3. Chronic kidney disease and a prescription for Cox-2 Selective NSAIDs or nonaspirin NSAIDs Use of High-Risk Medications in the Elderly Adults age 66 and older 1. Members who received at least one dispensing event for a high-risk medication 2. Members who received at least two dispensing events for the same high-risk medication For both rates, a lower rate represents better performance. Annual Monitoring for Patients on Persistent Medications Adults age 18 and older At least 180 days of ambulatory medication therapy during the measurement year (2017)who Received the following lab test monitoring during 2017: Medications Annual monitoring lab tests CPT Codes to identify ACE / ARBs Diuretics A serum potassium test and a serum creatinine test (or a panel containing them) 80051, , , 80048, 80050, 80053, Dioxin A Digoxin level test and a lab panel test O R A Digoxin level test and both a serum potassium test and a serum creatinine , 80048, 80050, 80053, , , 82575

14 Access/Availability of Care Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics Ages 1-17 years Codes to identify psychosocial care: A new prescription (4 month negative medication history) for an antipsychotic medication Documentation of psychosocial care as a first-line treatment Exclusions: CPT: ; ; ; 90849; 90853; ; Adult Access to Preventive/Ambulatory Care At least one acute inpatient encounter, or at least 2 visits in an outpatient, intensive outpatient or partial hospitalization setting with A diagnosis of schizophrenia, bipolar disorder or other psychotic disorder during the measurement year (2017) Adults age 20 and over An ambulatory or preventive carevisit in the measurement year (2017) for Medicaid and M edicare members in the measurement year or the two years prior ( ) for Commercialmembers Children and Adolescents Access to PCPs Age 12 months to 19 years *Prenatal/Postpartum Care Pregnant Women who delivered a live infant between November 6, 2016 and November 5, 2017 Initiation and Engagement of Alcohol and Other Drug Dependence (AOD) Treatment Age 13 and older An ambulatory or preventive carevisit with a PCP in the measurement year (2017) for ages 12 months to6years in the measurement year or the year prior( ) for ages 7 to 19 years Prenatal visit within first trimester (or within 42 days of enrollment) Postpartum visit between 21 and 56 days after delivery A new episode (60 days negative diagnosis history) of alcohol or other drug (AOD) abuse ordependence Codes to identify AOD visits: ; 99078; ; ; ; ; ; ; ; ; ; ; ; Measures Collected through CAHPS Health Plan Survey Medical Assistance with Smoking Cessation Current Smoker/Tobacco user age 18 and older Initiate treatment within 14 days of the diagnosis through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization, telehealth, ormedication-assisted treatment (MAT) Receive at least 2 additional AOD services or MAT within 30 days of treatment initiation Received advice to quit during the measurement year(2017). Discussed or were recommended cessation medications during the measurement year. Discussed or were provided cessation methods or strategies during the measurement year.

15 Flu Vaccinations for Adults (ages 18-65) Flu Vaccinations for Older Adults (ages 65+) Received an influenza vaccination after July 1, Pneumococcal Vaccination Status for Older Adults Adults ages 65 and older Have ever received a pneumococcal vaccine. Measures Collected through Medicare Health Outcomes Survey (HOS) Fall Risk Management Adults ages 65 and older 1. Discussing Fall Risk Seen by a practitioner in the past 12months Discussed falls or problems with balance or walking with current practitioner 2. Managing Fall Risk Had a fall or problems with balance or walking in the past 12months Seen by a practitioner in the past 12months Received a recommendation for how to prevent falls or treat problems with balance or walking from their current practitioner Management of Urinary Incontinence in Older Adults Adults ages 65 and older 1. Discussing Urinary Incontinence Reported having urine leakage in the past6months Discussed their urinary leakage problem with a health care provider 2. Discussing Treatment of Urinary Incontinence Reported having urine leakage in the past6months Discussed treatment options for their current urine leakage problem 3. Impact of Urinary Incontinence Reported having urine leakage in the past6months Reported that urine leakage made them change their daily activities or interfered with their sleep a lot. Osteoporosis Testing in Older Women Women ages Reported ever having received a bone density test to check for osteoporosis Physical Activity in Older Adults Adults ages 65 and older 1. Discussing Physical Activity Had a doctor s visit in the past 12 months Spoke with a doctor or other health provider about their level of exercise or physical activity 2. Advising Physical Activity Had a doctor s visit in the past 12 months Received advice to start, increase or maintain their level of exercise or physical activity For more information regarding HEDIS 2018, please contact Quality Improvement Dept. at or toll-free at

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