Horizon Blue Cross Blue Shield of New Jersey 2015 Physician Quality Recognition Program (QRP)

Transcription

1 2015 Hrizn Blue Crss Blue Shield f New Jersey 2015 Physician Quality Recgnitin Prgram (QRP) Hrizn BCBSNJ's Physician Quality Recgnitin Prgram identifies and distinguishes ur highest perfrming participating practices in clinical quality. This prgram reaches acrss mst f ur prducts and invlves all practices within the designated specialties meeting activity levels that are statistically significant t measure. Gal: Encurage and recgnize imprvement in clinical quality in physician practices. Basis fr Prgram Develpment: Demands by emplyers and cnsumers fr valid infrmatin n physician perfrmance and a strng interest in value-based purchasing. Respnse t physicians wh seek perfrmance-based reimbursement advantages. New accreditatin rganizatin standards fr health plans. Prgram Gals: Develp standardized, bjective methd t measure physician perfrmance acrss multiple specialties. Use a "Balanced Screcard" apprach incrprating quality and clinical effectiveness. Prvide tangible evidence t illustrate physician perfrmance. Recgnize physician practices that prvide highest clinical quality. Prepare fr increased transparency in the marketplace fr clinical quality data. Principles f Physician Perfrmance Measurement: Balanced apprach quality and clinical effectiveness. Objective quantifiable, evidence based. Equitable risk adjustment, statistically significant, within physician respnsibility. Clinically relevant targeted prvider, disease state, ppulatin, etc. Measures shuld crrelate with utcmes. Scring/Weighting: The physician practice grup cmpliance rate is cmpared t the peer specialty cmpliance rate. The physician practice eligible member ppulatin fr clinical quality is weighted per measure based n the number f standard deviatins that the physician practice (grup) cmpliance rate is abve the peer cmpliance rate per measure. EXAMPLE: Measure Cmpliant Members Eligible Members Grup Cmpliance Rate Peer Cmpliance Rate Standard Deviatin Weight A B C Subttal Hrizn Blue Crss Blue Shield f New Jersey is an independent licensee f the Blue Crss and Blue Shield Assciatin. The Blue Crss and Blue Shield names and symbls are registered marks f the Blue Crss and Blue Shield Assciatin. The Hrizn name and symbls are registered marks f Hrizn Blue Crss Blue Shield f New Jersey.

2 Clinical Quality Subttal = Weight (140) / Eligible (120) = Grup cmpliance belw the peer cmpliance des nt yield a negative standard deviatin. The default is zer (0). The physician practice pharmacy dispensing behavir. Pharmacy Rx Prescribed Ttal Rx Prescribed Grup Cmpliance Rate Peer Cmpliance Rate Standard Deviatin Preferred Generic Grup cmpliance belw the peer cmpliance des nt yield a negative standard deviatin. The default is zer (0). The physician practice s final scre r ranking is equal t Clinical Quality 90% f final scre Pharmacy Dispensing Behavir 10% f final scre Fr the example abve the final scre is Categry Subttal Final Scre Final Scre Weight Calculatin Clinical Quality Pharmacy- Preferred Pharmacy- Generic Ttal 1.19 The ttal final scre fr this grup (1.19) is ranked against peers (1-100) t identify percentile. Categry Clinical Quality Pharmacy-.15 Ttal Percentile 75th 90th 86 th (verall ranking) In this example the physician practice receives nnfinancial and financial recgnitin because their final scre is 85% r higher. The exclusins fr financial recgnitin are listed belw. Recgnitin: Tp 25% f eligible practices (ttal final scre f 75% r better) within the fllwing specialties receive designatin n Hrizn BCBSNJ and BCBSA nline Prvider Directries: Cardilgy Endcrinlgy Family Practice Gastrenterlgy Internal Medicine Nephrlgy Ob/Gyn Orthpedic Surgery Otlarynglgy (ENT) Pediatrics. 2 P age

3 Tp 15% f eligible practices (ttal final scre f 85% r better) within the fllwing specialties receive enhanced reimbursement: Cardilgy. Endcrinlgy Family Practice. Internal Medicine. Ob/Gyn. Pediatrics. Nte: Physician practices that participate in ther Hrizn BCBSNJ nnstandard reimbursement and Hrizn BCBSNJ valued based prgrams are nt eligible fr financial recgnitin. This includes practices that participate in Hrizn BCBSNJ s patient-centered prgrams, such as Patient-Centered Medical Hme, Accuntable Care Organizatin, and Episde f Care prgrams. Enhanced reimbursement (15% abve Hrizn BCBSNJ s standard fee schedule) des nt apply t: Services including but nt limited t: HCPCS cdes, immunizatins, lab tests, durable medical equipment and radilgy cdes. Medicare primary r incme based (service benefits) member plicies Criteria: Member attributin: Members must be cntinuusly enrlled with Hrizn BCBSNJ. Members are attributed t the primary care physician they selected (panel cde ID) r the primary care physician seen mst ften by the member. Members are attributed t the specialist seen mst ften by the member. Nte: BlueCard (ut f state BCBS plan) members are excluded frm Hrizn BCBSNJ member attributin. Physician practice attributin: Physician practice must be affiliated with a participating tax identificatin number in the measurement year and the recgnitin year. If the physician practice terminates the tax identificatin number, then the physicians affiliated t the tax identificatin number will be ineligible t participate in the prgram Physician practice must have at least 30 Hrizn BCBSNJ members within their panel t be eligible fr prfiling. Physician practice must have at least 10 Hrizn BCBSNJ members in a minimum f 1 metric t cmpare t specialty peer. Metrics by Specialty Cardilgy Chlesterl Management fr Patient with Cardivascular Cnditins.(S) Persistence f Beta-Blcker Treatment after a Heart Attack. (H) Endcrinlgy Diabetic Chlesterl Management.(S) Diabetic Cntrl. (H,S) Diabetic Testing. (H,S) Family Practice All-Cause Readmissins (infrmatinal nly).(h,s) Antidepressant Medicatin Management. (H) Apprpriate Imaging fr Back Pain. (H) 3 P age

4 Apprpriate Treatment fr Children with Upper Respiratry Infectin. (H) Apprpriate Use f First Line Antibitics fr Sre Thrat. (H) Avidance f Antibitic Treatment in Adults with Acute Brnchitis. (H) Breast Cancer Screening (infrmatinal nly). (H,S) Cervical Cancer Screening. (H) Childhd Immunizatins. (H) Chlamydia Screening. (H) Chlesterl Management fr Patient with Cardivascular Cnditins. (S) Clrectal Cancer Screening. (H,S) Diabetic Chlesterl Management. (S) Diabetic Cntrl. (H,S) Diabetic Testing. (H,S) Medicatin Adherence fr Chlesterl (Statins). (S) Medicatin Adherence fr Hypertensin (RAS antagnists). (S) Medicatin Adherence fr Oral Diabetes Medicatins. (S) Osteprsis Management in Wmen Wh Had a Fracture. (H,S) Persistence f Beta-Blcker Treatment after a Heart Attack. (H) Pharmacy Management fr COPD. (H) Prstate Cancer Screening (infrmatinal nly). (A) Rheumatid Arthritis Management. (H,S) Use f Apprpriate Medicatins fr Children with Asthma. (H) Gastrenterlgy Clrectal Cancer Screening. (H,S) Internal Medicine All-Cause Readmissins (infrmatinal nly). (H,S) Antidepressant Medicatin Management. (H) Apprpriate Imaging fr Back Pain. (H) Apprpriate Treatment fr Children with Upper Respiratry Infectin. (H) Apprpriate Use f First Line Antibitics fr Sre Thrat. (H) Avidance f Antibitic Treatment in Adults with Acute Brnchitis. (H) Breast Cancer Screening (infrmatinal nly). (H,S) Cervical Cancer Screening. (H) Chlamydia Screening. (H) Chlesterl Management fr Patient with Cardivascular Cnditins. (S) Clrectal Cancer Screening. (H,S) Diabetic Chlesterl Management. (S) Diabetic Cntrl. (H,S) Diabetic Testing. (H,S) Medicatin Adherence fr Chlesterl (statins). (S) Medicatin Adherence fr Hypertensin (RAS antagnists). (S) Medicatin Adherence fr Oral Diabetes Medicatins. (S) Osteprsis Management in Wmen Wh Had a Fracture. (H,S) Persistence f Beta-Blcker Treatment after a Heart Attack. (H) Pharmacy Management fr COPD. (H) Prstate Cancer Screening (infrmatinal nly). (A) Rheumatid Arthritis Management. (H,S) Nephrlgy Chrnic Kidney Disease Mnitring f Prteinuria. (A) Chrnic Kidney Disease Mnitring f Renal Functin. (A) Ob/Gyn Breast Cancer Screening (infrmatinal nly). (H,S) Cervical Cancer Screening. (H) Chlamydia Screening. (H) 4 P age

5 Osteprsis Management in Wmen Wh Had a Fracture. (H,S) Pstpartum Care. (H) Orthpedic Surgery Orthpedic Surgery - Trial f Cnservative Treatment Prir t Surgery. (A) Osteprsis Management in Wmen Wh Had a Fracture. (H,S) Otlarynglgy Otlarynglgy - Acute sinusitis. (A) Otlarynglgy - Otitis Media. (A) Otlarynglgy Tnsillectmy. (A) Pediatrics Apprpriate Treatment fr Children with Upper Respiratry Infectin. (H) Apprpriate Use f First Line Antibitics fr Sre Thrat. (H) Childhd Immunizatins. (H) Use f Apprpriate Medicatins fr Children with Asthma. (H) All Specialties Pharmacy Dispensing Behavir Ntes: H= Healthcare Effectiveness Data and Infrmatin Set (HEDIS) quality measure, Natinal Cmmittee fr Quality Assurance (NCQA), Website: NCQA.rg/HEDISQualityMeasurement.aspx S= Centers fr Medicare and Medicaid Services (CMS) Medicare Star quality measure, Website: CMS.gv/Medicare/Prescriptin-Drug-Cverage/PrescriptinDrugCvGenIn/PerfrmanceData.html A= U.S. Department f Health & Human Services, Agency fr Healthcare Research and Quality, Natinal Guideline Clearinghuse quality measure, Website: Guideline.gv/brwse/by-tpic.aspx Claim and Administrative Data T have the mst accurate and cmprehensive infrmatin abut the physicians practice and their patients, it is imprtant that they submit all claims fr their Hrizn BCBSNJ patients fr cnsideratin and refer their patients t ther in-netwrk r participating prviders. Every claim shuld include the mst apprpriate CPT and/r HCPC cdes, as well as all f the applicable diagnses fr their patients including their presenting and underlying diagnses. Neither the physician nr ther health care practitiner is at significant financial risk fr nt prviding services. This prgram is nt intended t replace the independent prfessinal clinical judgment f the physician r ther health care practitiner and des nt prvide incentives t withhld cvered services that are medically necessary. Physicians r ther health care practitiners are free t cmmunicate penly with a member abut all apprpriate diagnstic testing and treatment ptins, including alternative medicatins, regardless f benefit cverage limitatins. CPT is a registered mark f the American Medical Assciatin. 5 P age

6 All-Cause Readmissins (infrmatinal nly): Descriptin: Percentage f patients wh are readmitted (all cause) within 30 days f discharge (lwer is better). Patients wh had an acute inpatient discharge n r between January 1 and December 1 f the measurement year. Eligible Ppulatin: Cntinuusly enrlled ne year discharge date thrugh 30 days after the discharge date. Nnacute inpatient rehabilitatin services, including nnacute inpatient stays at rehabilitatin facilities. Hspital stays where the admissin date is the same as the discharge date. Inpatient stays with discharges fr death. Acute inpatient discharge with a principal diagnsis f pregnancy. Exclusins: Acute inpatient discharge with a principal diagnsis f a cnditin riginating in the perinatal perid. HEDIS NCQA.rg/HEDISQualityMeasurement.aspx. CMS Medicare Star Citatins: CMS.gv/Medicare/Prescriptin-Drug-Cverage/PrescriptinDrugCvGenIn/PerfrmanceData.html Surce: Claim data Descriptin: Antidepressant Medicatin Management Percentage f patients 18 years f age and lder wh were newly treated with antidepressant medicatin, and wh remained n an antidepressant medicatin treatment (at least tw prescriptins filled). Tw rates are reprted. Effective Acute Phase Treatment: percentage f newly diagnsed and treated members wh remained n an antidepressant medicatin fr at least 84 days (12 weeks). Effective Cntinuatin Phase Treatment: percentage f newly diagnsed and treated members wh remained n an antidepressant medicatin fr at least 180 days (six mnths). Patients 18 years f age and lder with a diagnsis f majr depressin. Cntinuusly enrlled 90 days (three mnths) prir t the Index Episde Start Date (IESD) thrugh 245 days after the IESD. Eligible Ppulatin: Exclusins: Nte: IESD is the earliest encunter during the intake perid with any diagnsis f majr depressin and a 90-day (three-mnth) negative medicatin histry. Negative medicatin histry is a perid f 90 days (three mnths) prir t the index prescriptin start date (IPSD) when the member had n pharmacy claims fr either new r refill prescriptins fr an antidepressant medicatin. IPSD is the earliest prescriptin dispensing date fr an antidepressant medicatin during the perid f 30 days prir t the IESD (inclusive) thrugh 14 days after the IESD (inclusive). Patients wh filled a prescriptin fr an antidepressant medicatin 90 days (three mnths) prir t the IPSD. HEDIS. NCQA.rg/HEDISQualityMeasurement.aspx. Citatins: Surce: Claim and administrative pharmacy data. Descriptin Prescriptin Miscellaneus Buprpin Vilazdne antidepressants Mnamine xidase Iscarbxazid Selegiline Tranylcyprmine inhibitrs Phenelzine Phenylpiperazine Nefazdne Trazdne antidepressants Psychtherapeutic Amitriptyline-chlrdiazepxide Amitriptyline-perphenazine Fluxetine-lanzapine cmbinatins SSNRI antidepressants Desvenlafaxine Dulxetine Venlafaxine SSRI antidepressants Citalpram Fluxetine Parxetine Escitalpram Fluvxamine Sertraline Tetracyclic antidepressants Maprtiline Mirtazapine Tricyclic antidepressants Amitriptyline Desipramine Nrtriptyline Amxapine Dxepin Prtriptyline Clmipramine Imipramine Trimipramine 6 P age

7 Apprpriate Imaging fr Back Pain Descriptin: Percentage f patients wh did nt have an imaging study (plain X-ray, MRI, CT scan) within 28 days f lw back pain diagnsis. Eligible Ppulatin: Patients with a primary diagnsis f lw back pain. Cntinuusly enrlled 180 days (6 mnths) prir t the Index Episde Start Date (IESD) thrugh 28 days after the IESD. Nte: IESD is the earliest date f service fr an utpatient, ffice r emergency department encunter during the intake perid with a principal diagnsis f lw back pain. Intake perid is used t identify the first utpatient, ffice r emergency department encunter with a primary diagnsis f lw back pain. Exclusins: Patients with a lw back pain diagnsis during the 180 days (six mnths) prir t the IESD. Patients with cancer, trauma, IV drug abuse and neurlgic impairment where lw back imaging is clinically indicated. Citatins: HEDIS. NCQA.rg/HEDISQualityMeasurement.aspx. Surce: Claim data- CPT cdes 72010, 72020, 72052, 72100, 72110, 72114, 72120, , 72141, 72142, , 72156, 72158, 72200, 72202, P age

8 Descriptin: Eligible Ppulatin: Apprpriate Treatment fr Children with Upper Respiratry Infectin Internal Medicine Pediatrics. Percentage f patients 3 mnths t 18 years f age nt dispensed an antibitic prescriptin n r three days after the episde start date. Patients 3 mnths t 18 years f age with a diagnsis f upper respiratry infectin (URI). Cntinuusly enrlled 30 days prir t the episde date thrugh three days after the episde date (inclusive). Nte: Episde date is the date f service fr any utpatient, ffice r emergency department visit during the intake perid with nly a diagnsis f URI. Intake perid is a 12-mnth windw that begins n July 1 f the year prir t the measurement year and ends n June 30 f the measurement year. The intake perid captures eligible episdes f treatment. Dates where a new r refill prescriptin fr an antibitic medicatin was filled 30 days prir t the episde date r was active n the episde date. Dates where the patient had a claim/encunter with a cmpeting diagnsis (n r three days after the episde date. Ntes: Cmpeting diagnsis is intestinal infectins, pertussis, bacterial infectin unspecified, Lyme disease and ther arthrpd-brne diseases, titis media, acute sinusitis, acute pharyngitis, acute tnsillitis, chrnic sinusitis, infectins f the pharynx, larynx, tnsils, adenids, prstatitis, cellulitis, mastiditis, ther bne infectins, acute lymphadenitis, impetig, skin staph infectins, pneumnia, gncccal infectins and venereal diseases, syphilis, chlamydia, inflammatry diseases (female reprductive rgans), infectins f Exclusins: the kidney, cystitis r UTI r acne. HEDIS. Citatins: NCQA.rg/HEDISQualityMeasurement.aspx. Surce: Claim and administrative pharmacy data. Descriptin Prescriptin Aminglycsides Amikacin Kanamycin Gentamicin Streptmycin Aminpenicillins Amxicillin Ampicillin Tbramycin Antipseudmnal Piperacillin penicillins Beta-lactamase inhibitrs Amxicillin-clavulanate Piperacillin-tazbactam Ticarcillin-clavulanate Ampicillin-sulbactam First-generatin Cefadrxil Cefazlin Cephalexin cephalsprins Furth-generatin Cefepime cephalsprins Ketlides Telithrmycin Lincmycin derivatives Clindamycin Lincmycin Macrlides Azithrmycin Erythrmycin Erythrmycin lactbinate Clarithrmycin Erythrmycin ethylsuccinate Erythrmycin stearate Miscellaneus antibitics Aztrenam Daptmycin Metrnidazle Chlramphenicl Erythrmycin-sulfisxazle Vancmycin Dalfpristin-quinupristin Linezlid Natural penicillins Penicillin G benzathine-prcaine Penicillin G prcaine Penicillin V ptassium Penicillin G ptassium Penicillin G sdium Penicillin G benzathine Penicillinase resistant Diclxacillin Nafcillin Oxacillin penicillins Quinlnes Ciprflxacin Levflxacin Nrflxacin Gemiflxacin Mxiflxacin Oflxacin Rifamycin derivatives Rifampin Secnd generatin Cefaclr Cefxitin Cefurxime cephalsprin Ceftetan Cefprzil Sulfnamides Sulfadiazine Sulfamethxazle-trimethprim Sulfisxazle Tetracyclines Dxycycline Mincycline Tetracycline Third generatin Cefdinir Ceftaxime Ceftibuten cephalsprins Cefditren Cefpdxime Ceftriaxne Cefixime Ceftazidime Urinary anti-infectives Fsfmycin Nitrfurantin macrcrystals Trimethprim Nitrfurantin Nitrfurantin macrcrystalsmnhydrate 8 P age

9 Apprpriate Use f First Line Antibitics fr Sre Thrat Pediatrics. Percentage f patients 1 t 17 years f age wh were treated with an antibitic during the measurement year where the apprpriate Descriptin: first line antibitic (penicillin, amxicillin, a first generatin cephalsprin r erythrmycin) was prescribed. Patients 1 t 17 years f age with a diagnsis f sre thrat. Eligible Ppulatin: Cntinuusly enrlled in measurement year and year prir t measurement year. Exclusins: Patients wh filled an antibitic prescriptin within the 30 days prir t the date f their ffice visit. HEDIS Citatins: NCQA.rg/HEDISQualityMeasurement.aspx Surce: Claim and administrative pharmacy data. Descriptin Prescriptin Aminglycsides Amikacin Gentamicin Kanamycin Streptmycin Aminpenicillins Amxicillin Ampicillin Tbramycin Antipseudmnal Piperacillin penicillins Beta-lactamase inhibitrs Amxicillin-clavulanate Piperacillin-tazbactam Ticarcillin-clavulanate Ampicillin-sulbactam First-generatin Cefadrxil Cefazlin Cephalexin cephalsprins Furth-generatin Cefepime cephalsprins Ketlides Telithrmycin Lincmycin derivatives Clindamycin Lincmycin Macrlides Azithrmycin Clarithrmycin Erythrmycin Erythrmycin ethylsuccinate Erythrmycin lactbinate Erythrmycin stearate Miscellaneus antibitics Aztrenam Chlramphenicl Daptmycin Erythrmycin-sulfisxazle Metrnidazle Vancmycin Dalfpristin-quinupristin Linezlid Natural penicillins Penicillin G benzathine-prcaine Penicillin G ptassium Penicillin G prcaine Penicillin G sdium Penicillin V ptassium Penicillin G benzathine Penicillinase resistant Diclxacillin Nafcillin Oxacillin penicillins Quinlnes Ciprflxacin Gemiflxacin Levflxacin Mxiflxacin Nrflxacin Oflxacin Rifamycin derivatives Rifampin Secnd generatin Cefaclr Cefxitin Cefurxime cephalsprin Ceftetan Cefprzil Sulfnamides Sulfadiazine Sulfamethxazle-trimethprim Sulfisxazle Tetracyclines Dxycycline Mincycline Tetracycline Third generatin cephalsprins Cefdinir Cefditren Cefixime Ceftaxime Cefpdxime Ceftazidime Ceftibuten Ceftriaxne Urinary anti-infectives Fsfmycin Nitrfurantin Nitrfurantin macrcrystals Nitrfurantin macrcrystalsmnhydrate Trimethprim 9 P age

10 Avidance f Antibitic Treatment in Adults with Acute Brnchitis Percentage f patients 18 t 64 years f age nt dispensed an antibitic prescriptin n r seven days after the episde start date. Nte: Episde date is the date f service fr any utpatient, ffice r emergency department visit during the intake perid with a diagnsis f acute brnchitis. Intake perid is January 1 t December 24 f the measurement year. The Intake Perid captures Descriptin: eligible episdes f treatment. Adults 18 t 64 years f age with a diagnsis f acute brnchitis. Eligible Ppulatin: Cntinuusly enrlled ne year prir t the episde date thrugh seven days after the episde date (inclusive). Episde date when the member had a claim/encunter with a diagnsis fr a cmrbid cnditin during the 12 mnths prir t r n the episde date. Nte: Cmrbid cnditin is HIV disease, asymptmatic HIV, cystic fibrsis, disrders f the immune system, malignancy neplasms, chrnic brnchitis, emphysema, brnchiectasis, extrinsic allergic alvelitis, chrnic airway bstructin, chrnic bstructive asthma, pneumcnisis and ther lung disease due t external agents, ther diseases f the respiratry system, r Exclusins: tuberculsis. HEDIS. Citatins: NCQA.rg/HEDISQualityMeasurement.aspx. Surce: Claim and administrative pharmacy data. Descriptin Prescriptin Amikacin Kanamycin Tbramycin Aminglycsides Gentamicin Streptmycin Aminpenicillins Amxicillin Ampicillin Antipseudmnal penicillins Piperacillin Amxicillin-clavulanate Piperacillin-tazbactam Ticarcillin-clavulanate Beta-lactamase inhibitrs Ampicillin-sulbactam First-generatin Cefadrxil Cefazlin Cephalexin cephalsprins Furth-generatin Cefepime cephalsprins Ketlides Telithrmycin Lincmycin derivatives Clindamycin Lincmycin Azithrmycin Erythrmycin Erythrmycin lactbinate Macrlides Clarithrmycin Erythrmycin ethylsuccinate Erythrmycin stearate Aztrenam Daptmycin Metrnidazle Chlramphenicl Erythrmycin-sulfisxazle Vancmycin Miscellaneus antibitics Dalfpristin-quinupristin Linezlid Penicillin G benzathineprcaine Penicillin G prcaine Penicillin V ptassium Penicillin G sdium Penicillin G benzathine Natural penicillins Penicillin G ptassium Penicillinase resistant Diclxacillin Nafcillin Oxacillin penicillins Ciprflxacin Levflxacin Nrflxacin Quinlnes Gemiflxacin Mxiflxacin Oflxacin Rifamycin derivatives Rifampin Secnd generatin Cefaclr Cefxitin Cefurxime cephalsprin Ceftetan Cefprzil Sulfnamides Sulfadiazine Sulfamethxazle-trimethprim Sulfisxazle Tetracyclines Dxycycline Mincycline Tetracycline Cefdinir Ceftaxime Ceftibuten Third generatin Cefditren Cefpdxime Ceftriaxne cephalsprins Cefixime Ceftazidime Fsfmycin Nitrfurantin macrcrystals Trimethprim Urinary anti-infectives Nitrfurantin Nitrfurantin macrcrystalsmnhydrate 10 P age

11 Breast Cancer Screening (infrmatinal nly) Obstetrics and Gyneclgy. Descriptin: Percentage f female patients 50 t 74 years f age wh received a mammgram screening. Female patients 50 t 74 years f age. Eligible Ppulatin: Cntinuusly enrlled the measurement year and the year prir t the measurement year. Exclusins: Females wh had a bilateral mastectmy. HEDIS. NCQA.rg/HEDISQualityMeasurement.aspx. CMS Medicare Star Citatins: CMS.gv/Medicare/Prescriptin-Drug-Cverage/PrescriptinDrugCvGenIn/PerfrmanceData.html Surce: Claim data- CPT /HCPCs cdes , G0202, G0204, G0206. Descriptin: Eligible Ppulatin: Exclusins: Citatins: Surce: Descriptin: Eligible Ppulatin: Exclusins: Citatins: Surce: Cervical Cancer Screening Obstetrics and Gyneclgy. Percentage f patients 21 t 64 years f age wh received pap smear. Female patients 21 t 64 years f age. Cntinuusly enrlled the measurement year and the tw years prir t the measurement year. Females wh had a hysterectmy with n residual cervix. HEDIS. NCQA.rg/HEDISQualityMeasurement.aspx. Claim data- CPT/HCPCs cdes , 88147, 88148, 88150, , , 88174, 88175, G0123, G0124, G0141, G0143-G0145, G0147, G0148, P3000, P3001, Q0091. Childhd Immunizatins Pediatrics. Percentage f patients wh received the fllwing series f immunizatins prir t their secnd birthday. Cmb 3 (DTap, IPV, MMR, HIB, HepB, VZV, pneumcccal cnjugate). Cmb 2 (DTap, IPV, MMR, HIB, HepB, VZV). 4 DTaP. 3 IPV. 3 HIB. 3 Hepatitis B. 1 Varicella. 4 Pneumcccal cnjugate. 1 MMR. 1 Hepatitis A. 3 Rtavirus. 2 Influenza. Patients wh turn 2 years ld in the measurement year. Cntinuusly enrlled frm 12 mnths t the child s secnd birthday. Patients with cntraindicatins fr a specific vaccine/immunizatin. Immunizatin Descriptin Any particular vaccine Anaphylactic reactin t the vaccine r its cmpnents DTaP Encephalpathy IPV Anaphylactic reactin t streptmycin, plymyxin B r nemycin Immundeficiency, including genetic (cngenital) immundeficiency syndrmes HIV disease; asymptmatic HIV Cancer f lymphreticular r histicytic tissue Multiple myelma Leukemia MMR, VZV and influenza Anaphylactic reactin t nemycin Hepatitis B Anaphylactic reactin t cmmn baker s yeast HEDIS. NCQA.rg/HEDISQualityMeasurement.aspx. Claim data- CPT /HCPC cdes 90698, 90700, 90721, 90723, 90698, 90713, 90723, 90707, 90710, 90708, 90705, 90704, 90706, , 90698, 90721, 90748, 90723, 90740, 90744, 90747, 90748, 90710, 90716, 90669, 90670, 90633, 90681, 90680, 90655, 90657, 90661, 90662, G0008, G0009, G P age

12 Chlamydia Screening Obstetrics and Gyneclgy. Descriptin: Percentage f female patients 16 t 24 wh received annual chlamydia test. Female patients ages 16 t 24 identified as sexually active. Eligible Ppulatin: Cntinuusly enrlled the measurement year Patients wh had a pregnancy test during the measurement year fllwed within seven days by either a prescriptin fr istretinin Exclusins: (Accutane) r an X-ray. HEDIS. Citatins: NCQA.rg/HEDISQualityMeasurement.aspx. Surce: Claim data- CPT cdes 87110, 87270, 87320, , Chlesterl Management fr Patient with Cardivascular Cnditins Cardilgy. Descriptin: Percentage f patients 65 years and lder with a statin (r ther where apprpriate) class drug where at least tw prescriptins were filled. Eligible Ppulatin: Patients 65 years r lder with heart disease Cntinuusly enrlled in the measurement year Exclusins: Nne. Citatins: CMS Medicare Star. CMS.gv/Medicare/Prescriptin-Drug-Cverage/PrescriptinDrugCvGenIn/PerfrmanceData.html Surce: Administrative labratry data. Descriptin Brand Generic Antidiabetic Cmbinatins Juvisync Sitagliptin-Simvastatin Calcium Channel Blcker & Amld/Atrva Caduet Amldipine Besylate-Atrvastatin Calcium HMG CA Reductase Inhibit Cmb HMG CA Reductase Inhibitr Advicr Simcr Niacin-Lvastatin Cmbinatins Niacin-Simvastatin HMG CA Reductase Altprev Lipitr Lvastatin Inhibitrs Atrvastatin Lival Atrvastatin Calcium Crestr Mevacr Rsuvastatin Calcium Fluvastatin Pravachl Fluvastatin Sdium Lvastatin Pravastatin Pitavastatin Calcium Lescl Simvastatin Pravastatin Sdium Lescl XL Zcr Simvastatin Intest Chlest Absrp Inhib- HMG CA Reductase Inhib Cmb Vytrin Ezetimibe-Simvastatin 12 P age

13 Chlesterl Management fr Patient with Diabetes Endcrinlgy. Descriptin: Percentage f patients age 65 years and lder with a statin (r ther where apprpriate) class drug where at least tw prescriptins were filled. Eligible Ppulatin: Patients age 65 years and lder with diabetes. Cntinuusly enrlled in measurement year. Exclusins: Nne Citatins: CMS Medicare Star CMS.gv/Medicare/Prescriptin-Drug-Cverage/PrescriptinDrugCvGenIn/PerfrmanceData.html Surce: Administrative labratry data. Descriptin Brand Generic Antidiabetic Cmbinatins Juvisync Sitagliptin-Simvastatin Calcium Channel Blcker & Amld/Atrva Caduet Amldipine Besylate-Atrvastatin Calcium HMG CA Reductase Inhibit Cmb HMG CA Reductase Inhibitr Cmbinatins Advicr Simcr Niacin-Lvastatin Niacin-Simvastatin HMG CA Reductase Inhibitrs Intest Chlest Absrp Inhib- HMG CA Reductase Inhib Cmb Altprev Atrvastatin Crestr Fluvastatin Lvastatin Lescl Lescl XL Vytrin Lipitr Lival Mevacr Pravachl Pravastatin Simvastatin Zcr Lvastatin Atrvastatin Calcium Rsuvastatin Calcium Fluvastatin Sdium Pitavastatin Calcium Pravastatin Sdium Simvastatin Ezetimibe-Simvastatin Chrnic Kidney Disease- Mnitring f Prteinuria Nephrlgy Descriptin: Percentage f patients 18 t 75 years f age wh received annual testing f urine micralbumin r prtein test. Patients 18 t 75 years f age with chrnic kidney disease. Eligible Ppulatin: Cntinuusly enrlled in measurement year. Exclusins: Nne Michigan Quality Imprvement Cnsrtium. Diagnsis and management f adults with chrnic kidney disease. Suthfield (MI): Michigan Quality Imprvement Cnsrtium; 2013 May. KDIGO 2012 clinical practice guideline fr the evaluatin and management f chrnic kidney disease. Kidney Int Citatins: Suppl Jan;3(1): Surce: Claim data - CPT cdes 80061, 83700, 83701, 83704, 83721, 80048, 80053, Chrnic Kidney Disease- Mnitring f Renal Functin Nephrlgy Descriptin: Percentage f patients 18 t 75 years f age wh received egfr r serum creatinine test in last 12 reprted mnths. Patients 18 t 75 years f age with chrnic kidney disease. Eligible Ppulatin: Cntinuusly enrlled in measurement year and year prir t measurement year. Exclusins: Nne Michigan Quality Imprvement Cnsrtium. Diagnsis and management f adults with chrnic kidney disease. Suthfield (MI): Michigan Quality Imprvement Cnsrtium; 2013 May. KDIGO 2012 clinical practice guideline fr the evaluatin and management f chrnic kidney disease. Kidney Int Citatins: Suppl Jan;3(1): Surce: Claim data - CPT cdes 80061, 83700, 83701, 83704, 83721, 80048, 80053, P age

14 Clrectal Cancer Screening Gastrenterlgy. Descriptin: Percentage f patients 50 t 75 years f age wh received apprpriate screening fr cln cancer. Fecal ccult bld test (FOBT) during the measurement year regardless f FOBT type, guaiac (gfobt) r immunchemical (ifobt). Flexible sigmidscpy during the measurement year r the fur years prir t the measurement year. Clnscpy during the measurement year r the nine years prir t the measurement year. Eligible Ppulatin: Patients 50 t 75 years f age. Cntinuusly enrlled the measurement year and the year prir t the measurement year. Exclusins: Patients diagnsed with clrectal cancer r ttal clectmy. Citatins: HEDIS. NCQA.rg/HEDISQualityMeasurement.aspx. CMS Medicare Star. CMS.gv/Medicare/Prescriptin-Drug-Cverage/PrescriptinDrugCvGenIn/PerfrmanceData.html Surce: Claim data- CPT/HCPCs 82270, 82274, , , 45345, , 44397, 45355, , 45391, 45392, G0328, G0104, G0105, G0121. Diabetic Cntrl Endcrinlgy. Descriptin: Percentage f patients 18 t 75 years f age wh received annual test results fr HbA1c (< 8 percent). Eligible Ppulatin: Patients 18 t 75 years f age with diabetes (type 1 and 2). Cntinuusly enrlled in the measurement year. Exclusins: Nne Citatins: HEDIS. NCQA.rg/HEDISQualityMeasurement.aspx. CMS Medicare Star CMS.gv/Medicare/Prescriptin-Drug-Cverage/PrescriptinDrugCvGenIn/PerfrmanceData.html Surce: Administrative labratry data. Diabetic Testing Endcrinlgy. Descriptin: Percentage f patients 18 t 75 years f age wh received annual: HbA1c testing. LDL-C screening. Retinal eye exam. Nephrpathy mnitring. Eligible Ppulatin: Patients 18 t 75 years f age with diabetes (type 1 and 2). Cntinuusly enrlled in the measurement year. Exclusins: Nne Citatins: HEDIS. NCQA.rg/HEDISQualityMeasurement.aspx. CMS Medicare Star CMS.gv/Medicare/Prescriptin-Drug-Cverage/PrescriptinDrugCvGenIn/PerfrmanceData.html Surce: Claim data - CPT cdes 83036, 83037, 67028, 67030, 67031, 67036, , 67101, 67105, 67107, 67108, 67110, 67112, 67113, 67121, 67141, 67145, 67208, 67210, 67218, 67220, 67221, 67227, 67228, 92002, 92004, 92012, 92014, 92018, 92019, 92134, , 92230, 92235, 92240, 92250, 92260, , , , 80061, 83700, 83701, 83704, 83721, 82042, 82043, 82044, P age

15 Medicatin Adherence fr Chlesterl (Statins) Percentage f patients 18 years and lder wh adhere t their prescribed statin drug therapy. Descriptin: At least tw prescriptins filled. Patients 18 years and lder prescribed a statin. Eligible Ppulatin: Cntinuusly enrlled in the measurement year. Exclusins: Nne. CMS Medicare Star Citatins: CMS.gv/Medicare/Prescriptin-Drug-Cverage/PrescriptinDrugCvGenIn/PerfrmanceData.html Surce: Claim and administrative pharmacy data. Descriptin Brand Generic Antidiabetic Cmbinatins Juvisync Sitagliptin-Simvastatin Calcium Channel Blcker & HMG CA Reductase Inhibit Amld/Atrva Caduet Amldipine Besylate-Atrvastatin Calcium Cmb HMG CA Reductase Inhibitr Advicr Simcr Niacin-Lvastatin Niacin-Simvastatin Cmbinatins HMG CA Reductase Inhibitrs Intest Chlest Absrp Inhib- HMG CA Reductase Inhib Cmb Altprev Atrvastatin Crestr Fluvastatin Lvastatin Lescl Lescl XL Vytrin Lipitr Lival Mevacr Pravachl Pravastatin Simvastatin Zcr Lvastatin Atrvastatin Calcium Rsuvastatin Calcium Fluvastatin Sdium Ezetimibe-Simvastatin Pitavastatin Calcium Pravastatin Sdium Simvastatin 15 P age

16 Medicatin Adherence fr Hypertensin (RAS antagnists) Percentage f patients 18 years and lder wh adhere t their prescribed drug therapy fr RAS antagnists. Descriptin: At least tw prescriptins filled. Patients 18 years and lder prescribed RAS antagnists. Eligible Ppulatin: Cntinuusly enrlled in the measurement year. Exclusins: Nne CMS Medicare Star. Citatins: CMS.gv/Medicare/Prescriptin-Drug-Cverage/PrescriptinDrugCvGenIn/PerfrmanceData.html Surce: Claim and administrative pharmacy data. Descriptin Brand Generic ACE Inhibitr & Calcium Channel Blcker Cmbinatins Amld/Benazp Amldipine Ltrel Tarka ACE Inhibitrs & Thiazide/Thiazide-Like ACE Inhibitrs Angitensin II Receptr Antag & Ca Channel Blcker Cmb Angitensin II Receptr Antagnists & Thiazides Angitensin II Receptr Antagnists Angitensin II Receptr Ant- Ca Channel Blcker-Thiazides Antihypertensive Cmbinatins Direct Renin Inhibitrs & Angitensin II Receptr Antag Direct Renin Inhibitrs & Thiazide/Thiazide-Like Cmb Accuretic Benazep/Hctz Captpr/Hctz Enalapr/Hctz Fsinp/Hctz Lisinp/Hctz Ltensin Hct Accupril Acen Altace Benazepril Captpril Enalapril Fsinpril Lisinpril Ltensin Mavik Azr Exfrge Atacand Hct Avalide Benicar Hct Candesa/Hctz Divan Hct Edarbyclr Atacand Avapr Benicar Czaar Divan Edarbi Exfrge Hct Exfrge H Mexipr/Hctz Prinzide Qnapril/Hctz Quinaretic Uniretic Vaseretic Zestretic Mexipril HCl Mnpril Perindpril Prinivil Quinapril Ramipril Trandlapril Univasc Vastec Zestril Twynsta Hyzaar Irbesar/Hctz Lsartan/Hct Micardis Hct Teveten Hct Valsart/Hctz Eprsart Mes Irbesartan Lsartan Pt Micardis Teveten Amldipine Besylate-Benazepril HCl Quinapril-Hydrchlrthiazide Benazepril & Hydrchlrthiazide Captpril & Hydrchlrthiazide Enalapril Maleate & Hydrchlrthiazide Quinapril Perindpril Erbumine Ramipril Benazepril HCl Captpril Enalapril Maleate Fsinpril Sdium Amldipine Besylate-Olmesartan Medxmil Amldipine Besylate-Valsartan Candesartan Cilexetil- Hydrchlrthiazide Irbesartan-Hydrchlrthiazide Olmesartan Medxmil- Hydrchlrthiazide Valsartan-Hydrchlrthiazide Candesartan Cilexetil Irbesartan Olmesartan Medxmil Lsartan Ptassium Valsartan Azilsartan Medxmil Amldipine-Valsartan- Hydrchlrthiazide Trandlapril-Verapamil Fsinpril Sdium & Hydrchlrthiazide Lisinpril & Hydrchlrthiazide Mexipril-Hydrchlrthiazide Lisinpril Trandlapril Mexipril HCl Quinapril HCl Ramipril Trandlapril Telmisartan-Amldipine Azilsartan Medxmil- Chlrthalidne Lsartan Ptassium & Hydrchlrthiazide Telmisartan-Hydrchlrthiazide Eprsartan Mesylate- Hydrchlrthiazide Eprsartan Mesylate Irbesartan Lsartan Ptassium Telmisartan Eprsartan Mesylate Tribenzr Olmesartan-Amldipine- Hydrchlrthiazide Amturnide Tekaml Aliskiren-Amldipine- Aliskiren-Amldipine Hydrchlrthiazide Valturna Aliskiren-Valsartan Tekturna Hct Aliskiren-Hydrchlrthiazide Aliskiren Fumarate 16 P age

17 Medicatin Adherence fr Oral Diabetes Medicatins Percentage f patients 18 years and lder wh adhere t their prescribed drug therapy fr acrss fur classes f ral diabetes medicatins (at least tw prescriptins filled): Biguanides. Sulfnylureas. Thiazlidinedines. Descriptin: Dipeptidyl peptidase (DPP)-IV inhibitrs. Patients 18 years and lder with diabetes. Eligible Ppulatin: Cntinuusly enrlled in the measurement year. Exclusins: Patients whse drug therapy is insulin. CMS Medicare Star. Citatins: CMS.gv/Medicare/Prescriptin-Drug-Cverage/PrescriptinDrugCvGenIn/PerfrmanceData.html Surce: Claim and administrative pharmacy data. Descriptin Brand Generic Biguanide and Biguanide Cmbinatins Actplus Met Avandamet Frtamet Glip/Metfrm Glucphage Glucvance Glumetza Glyb/Metfrm Janumet Dipeptidyl Peptidase-4 (DPP- 4) Januvia Onglyza Sulfnylureas and Amaryl Sulfnylureas cmbinatins Avandaryl Chlrprpam Diabeta Diabinese Duetact Glimepiride Glip/Metfrm Glipizide Glipizide ER Glipizide XL Thiazlidinedines Acts Avandia Janumet XR Jentaduet Kmbiglyze Metaglip Metfrmin Metfrmin ER Piglita/Met Prandimet Rimet Tradjenta Gluctrl Gluctrl XL Glucvance Glyb/Metfrm Glyburid Glyburide Glynase Metaglip Tlazamide Tlbutamide Piglitazne HCl- Metfrmin HCl Rsiglitazne Maleate- Metfrmin HCl Metfrmin HCl Glipizide-Metfrmin HCl Glyburide-Metfrmin Sitagliptin-Metfrmin Sitagliptin Phsphate Saxagliptin HCl Glimepiride Rsiglitazne Maleate- Glimepiride Chlrprpamide Glyburide Chlrprpamide Piglitazne HCl- Glimepiride Glipizide-Metfrmin HCl Linagliptin-Metfrmin HCl Saxagliptin-Metfrmin HCl Glipizide-Metfrmin HCl Repaglinide-Metfrmin HCl Linagliptin Glipizide Glyburide-Metfrmin Glyburide Micrnized Glyburide Tlbutamide Piglitazne Piglitazne HCl Rsiglitazne Maleate Trial f Cnservative Treatment Prir t Surgery Orthpedic Surgery. Percentage f patients wh received trial f cnservative treatment prir t surgery when apprpriate. Cnservative treatment may Descriptin: include any ne f the fllwing: physical, ccupatinal, chirpractic therapy and/r lcal crticsterid, if applicable. Patients wh have had a surgical prcedure in the measurement year r the year prir t measurement year. Eligible Ppulatin: Cntinuusly enrlled in measurement year and year prir t measurement year. Exclusins: Nne Citatins: Wrk Lss Data Institute. Wrk Lss Data Institute; Varius. Claim data and administrative pharmacy data - CPT cdes 97001, 97002, 97010, 97012, 97016, 97018, 97022, 97024, 97028, , 97110, 97112, 97113, 97116, 97124, 97140, 97150, 97530, 97750, 97760, 97761, Surce: 97762, G0151, S9131, Descriptin Prescriptin Gluccrticids Betamethasne Dexamethasne Hydrcrtisne Methylprednislne Prednislne Prednisne Triamcinlne 17 P age

18 Osteprsis Management in Wmen Wh Had a Fracture Obstetrics and Gyneclgy. Orthpedic Surgery. Descriptin: Percentage f female patients 67 years f age and wh received a bne mineral density (BMD) test r 180 day curse f treatment with a drug t treat r prevent steprsis in the six mnths after the fracture. Eligible Ppulatin: Female patients 67 years f age and lder. Cntinuusly enrlled the 12 mnths (1 year) befre the Index Episde Start Date (IESD) thrugh 180 days (6 mnths) after the IESD. IESD: The earliest date f service fr any encunter during the intake perid with a diagnsis f fracture. Intake perid: A 12-mnth (1 year) windw that begins n July 1 f the year prir t the measurement year and ends n June 30 f the measurement year. The intake perid is used t capture the first fracture. Exclusins: Nne Citatins: HEDIS. NCQA.rg/HEDISQualityMeasurement.aspx. CMS Medicare Star. CMS.gv/Medicare/Prescriptin-Drug-Cverage/PrescriptinDrugCvGenIn/PerfrmanceData.html Surce: Claim data - CPT/HCPCs cdes 76977, , 78350, 78351, G0130 and administrative pharmacy data. Descriptin Prescriptin J Cdes Biphsphnates Alendrnate Alendrnate-chlecalciferl Calcium carbnate-risedrnate Ibandrnate Risedrnate Zledrnic acid J1740, J3488, J3487 Estrgens Other agents Sex hrmne cmbinatins Cnjugated estrgens Cnjugated estrgens synthetic Esterified estrgens Estradil Calcitnin Densumab Cnjugated estrgens medrxy-prgesterne Estradil-levnrgestrel Estradil-nrethindrne Estradil acetate Estradil cypinate Estradil valerate Estrpipate Ralxifene Teriparatide Estradil-nrgestimate Ethinyl estradil-nrethindrne J1000 J0630, J3110, J P age

19 Otlarynglgy- Acute sinusitis Otlarynglgy (ENT). Percentage f patients with acute sinusitis episde where a first line antibitic was dispensed (amxicillin, amxicillin clavulanate, Descriptin: sulfamethxazle/trimethprim) date f ffice visit r within five days f ffice visit. Patients with acute sinusitis. Eligible Ppulatin: Cntinuusly enrlled measurement year. Exclusins: Patients wh had antibitic filled prir t the date f service by an tlarynglgist fr acute sinusitis. University f Michigan Health System. Acute rhinsinusitis in adults. Ann Arbr (MI): University f Michigan Health System; 2011 Aug. Snellman L, Adams W, Andersn G, Gdfrey A, Gravley A, Jhnsn K, Marshall P, Myers C, Nesse R, Shrt S. Diagnsis and treatment f respiratry illness in children and adults. Blmingtn (MN): Institute fr Clinical Systems Citatins: Imprvement (ICSI); 2013 Jan. Surce: Claim and administrative pharmacy data. Descriptin Prescriptin Aminglycsides Amikacin Kanamycin Tbramycin Gentamicin Streptmycin Aminpenicillins Amxicillin Ampicillin Antipseudmnal Piperacillin penicillins Beta-lactamase inhibitrs Amxicillin-clavulanate Piperacillin-tazbactam Ticarcillin-clavulanate Ampicillin-sulbactam First-generatin Cefadrxil Cefazlin Cephalexin cephalsprins Furth-generatin Cefepime cephalsprins Ketlides Telithrmycin Lincmycin derivatives Clindamycin Lincmycin Macrlides Azithrmycin Clarithrmycin Erythrmycin Erythrmycin ethylsuccinate Erythrmycin lactbinate Erythrmycin stearate Miscellaneus antibitics Aztrenam Chlramphenicl Daptmycin Erythrmycin-sulfisxazle Metrnidazle Vancmycin Dalfpristin-quinupristin Linezlid Natural penicillins Penicillin G benzathine-prcaine Penicillin G ptassium Penicillin G prcaine Penicillin G sdium Penicillin V ptassium Penicillin G benzathine Penicillinase resistant Diclxacillin Nafcillin Oxacillin penicillins Quinlnes Ciprflxacin Gemiflxacin Levflxacin Mxiflxacin Nrflxacin Oflxacin Rifamycin derivatives Rifampin Secnd generatin Cefaclr Cefxitin Cefurxime cephalsprin Ceftetan Cefprzil Sulfnamides Sulfadiazine Sulfamethxazletrimethprim Sulfisxazle Tetracyclines Dxycycline Mincycline Tetracycline Third generatin cephalsprins Urinary anti-infectives Cefdinir Cefditren Cefixime Fsfmycin Nitrfurantin Ceftaxime Cefpdxime Ceftazidime Nitrfurantin macrcrystals Nitrfurantin macrcrystalsmnhydrate Ceftibuten Ceftriaxne Trimethprim 19 P age

20 Otlarynglgy- Otitis Media Otlarynglgy (ENT). Percentage f patients 2 mnths t 13 years f age n antibitic therapy with acute titis media that received either a first line r Descriptin: secnd line antibitic within 3 days f diagnsis f titis media. Patients 2 mnths t 13 years f age with titis media. Eligible Ppulatin: Cntinuusly enrlled measurement year and the year prir t measurement year. Exclusins: Histry f penicillin allergy. Patients wh had pharmacy claims fr either new r refill prescriptins fr a listed antibitic drug during a perid f 30 days prir t the diagnsis. Patients fr whm prescriptins were filled mre than 30 days prir t the diagnsis that were active at the time f the diagnsis was made. Patients with a cmpeting diagnsis during the three days after the episde start date. Ntes: Cmpeting diagnsis is intestinal infectins, pertussis, bacterial infectin unspecified, Lyme disease and ther arthrpdbrne diseases, titis media, acute sinusitis, acute pharyngitis, acute tnsillitis, chrnic sinusitis, infectins f the pharynx, larynx, tnsils, adenids, prstatitis, cellulitis, mastiditis, ther bne infectins, acute lymphadenitis, impetig, skin staph infectins, pneumnia, gncccal infectins and venereal diseases, syphilis, chlamydia, inflammatry diseases (female reprductive rgans), infectins f the kidney, cystitis/uti r acne. Citatins: Amer Acad Pediatrics subcmmittee n management f titis media; Pediatrics 2013 Mar;131(3):e University f Michigan Health System. Otitis media. Ann Arbr (MI): University f Michigan Health System; 2013 Apr. 12. Surce: Claim and administrative pharmacy data. Descriptin Prescriptin Aminglycsides Amikacin Kanamycin Tbramycin Gentamicin Streptmycin Aminpenicillins Amxicillin Ampicillin Antipseudmnal Piperacillin penicillins Beta-lactamase inhibitrs Amxicillin-clavulanate Piperacillin-tazbactam Ticarcillin-clavulanate Ampicillin-sulbactam First-generatin Cefadrxil Cefazlin Cephalexin cephalsprins Furth-generatin Cefepime cephalsprins Ketlides Telithrmycin Lincmycin derivatives Clindamycin Lincmycin Macrlides Azithrmycin Erythrmycin Erythrmycin lactbinate Clarithrmycin Erythrmycin ethylsuccinate Erythrmycin stearate Miscellaneus antibitics Aztrenam Daptmycin Metrnidazle Chlramphenicl Erythrmycin-sulfisxazle Vancmycin Dalfpristin-quinupristin Linezlid Natural penicillins Penicillin G benzathine-prcaine Penicillin G prcaine Penicillin V ptassium Penicillin G ptassium Penicillin G sdium Penicillin G benzathine Penicillinase resistant Diclxacillin Nafcillin Oxacillin penicillins Quinlnes Ciprflxacin Levflxacin Nrflxacin Gemiflxacin Mxiflxacin Oflxacin Rifamycin derivatives Rifampin Secnd generatin Cefaclr Cefxitin Cefurxime cephalsprin Ceftetan Cefprzil Sulfnamides Sulfadiazine Sulfamethxazle-trimethprim Sulfisxazle Tetracyclines Dxycycline Mincycline Tetracycline Third generatin Cefdinir Ceftaxime Ceftibuten cephalsprins Cefditren Cefpdxime Ceftriaxne Cefixime Ceftazidime Urinary anti-infectives Fsfmycin Nitrfurantin macrcrystals Trimethprim Nitrfurantin Nitrfurantin macrcrystalsmnhydrate 20 P age

21 Tnsillectmy Otlarynglgy (ENT). Descriptin: Percentage f patients less than 21 years f age wh had a tnsillectmy and met clinical criteria fr this prcedure. Patients less than 21 years f age with diagnsis was hypertrphy f tnsils and adenids, bstructive r unspecified sleep apnea, dysphagia r peritnsillar abscess. Eligible Ppulatin: Cntinuusly enrlled measurement year and year prir t measurement year Exclusins: Nne Baugh RF, Archer SM, Mitchell RB, Rsenfeld RM, Amin R, Burns JJ, Darrw DH, Girdan T, Litman RS, Li KK, Mannix ME, Schwartz RH, Setzen G, Wald ER, Wall E, Sandberg G, Patel MM, American Academy f Otlarynglgy-Head and Neck Surgery Citatins: Fundatin. Clinical practice guideline: tnsillectmy in children. Otlaryngl Head Neck Surg Jan;144(1 Suppl):S1-30. Surce: Claim data- CPT cdes , 42970, 92971, Persistence f Beta-Blcker Treatment After a Heart Attack Cardilgy. Descriptin: Percentage f patients 18 years f age and lder wh received 180 day curse f treatment with beta-blckers Eligible Ppulatin: Patients 18 years f age and lder during the measurement year wh were hspitalized and discharged alive frm July 1 f the year prir t the measurement year t June 30 f the measurement year with a diagnsis f AMI and wh received persistent beta-blcker treatment fr six mnths after discharge. Cntinuusly enrlled frm the discharge date thrugh 180 days after discharge. Exclusins: Nne Citatins: HEDIS. NCQA.rg/HEDISQualityMeasurement.aspx. Surce: Administrative pharmacy data. Descriptin: Nncardiselective betablckers Cardiselective betablckers Antihypertensive cmbinatins Prescriptin: Cartell Carvedill Labetall Acebutll Atenll Atenll-chlrthalidne Bendrflumethiazide-nadll Bisprll-hydrchlrthiazide Nadll Penbutll Pindll Betaxll Bisprll Hydrchlrthiazide-metprll Hydrchlrthiazide-prpranll Prpranll Timll Stall Metprll Nebivll Pharmacy Dispensing Behavir Cardilgy. Orthpedic Surgery. Endcrinlgy. Nephrlgy. Otlarynglgy (ENT). Ob/Gyn. Pediatrics. Gastrenterlgy. Descriptin: Percentage f grup practice's generic and frmulary cmpliance versus brand prescriptins cmpared t peers during the measurement year. Eligible Ppulatin: Cntinuusly enrlled in measurement year. Exclusins: The medicatins that d nt have a generic alternative r have a narrw therapeutic index are excluded. Citatins: Hrizn BCBSNJ Surce: Administrative pharmacy data. 21 P age

22 Pharmacy Management fr Chrnic Obstructive Pulmnary Disease (COPD) Descriptin: Percentage f patients 40 years f age and lder wh received apprpriate medicatins fr COPD Tw rates are reprted: Dispensed a systemic crticsterid within 14 days f the event. Dispensed a brnchdilatr within 30 days f the event. Eligible Ppulatin: Patients 40 years f age and lder wh had an acute inpatient discharge r an emergency department encunter n r between January 1 and Nvember 30 f the measurement year. Cntinuusly enrlled episde date thrugh 30 days after the episde date. Nte: Episde date is the date f service fr any acute inpatient discharge r emergency department claim/encunter during the intake perid with a principal diagnsis f COPD. Exclusins: Nne Citatins: HEDIS. NCQA.rg/HEDISQualityMeasurement.aspx. Surce: Administrative pharmacy data. Descriptin Prescriptin Gluccrticids Betamethasne Dexamethasne Hydrcrtisne Antichlinergic agents Aclidinium brmide Albuterl-ipratrpium Beta 2-agnists Albuterl Arfrmterl Budesnide-frmterl Fluticasne-salmeterl Methylxanthines Aminphylline Dyphylline-guaifenesin Methylprednislne Prednisne Prednislne Triamcinlne Ipratrpium Titrpium Frmterl Metaprterenl Indacaterl Pirbuterl Levalbuterl Salmeterl Mmetasne-frmterl Guaifenesin-thephylline Thephylline Dyphylline Pstpartum Care Obstetrics and Gyneclgy. Descriptin: Percentage f patients wh received pstpartum visit n r between 21 and 56 days after delivery. Patients wh have delivered a live birth Nvember 6 prir t measurement year and Nvember 5 f measurement year. Eligible Ppulatin: Cntinuusly enrlled in measurement year and year prir t measurement year Exclusins: Nne HEDIS. Citatins: NCQA.rg/HEDISQualityMeasurement.aspx. Surce: Claim data- CPT cdes 57170, 58300, 59400, 59410, 59430, 59510, 59515, 59610, 59614, 59618, 59622, , 88147, 88148, 88150, , , 88174, 88175, 99501, G0101, G0123, G0124, G0141, G0143-G0145, G0147, G0148, P3000, P3001, Q0091. Prstate Cancer Screening (infrmatinal nly) Descriptin: Percentage f patients 50 years and lder that had a prstate specific antigen test in last 12 reprted mnths Males age 50 years ld and lder. Eligible Ppulatin: Cntinuusly enrlled in the measurement year and prir t the measurement year Exclusins: Males with prstate cancer, prstatitis and benign prstatic hyperplasia Wlf AM, Wender RC, Etzini RB, Thmpsn IM, D'Amic AV, Vlk RJ, Brks DD, Dash C, Guessus I, Andrews K, DeSantis C, Smith RA, American Cancer Sciety Prstate Cancer Advisry Cmmittee. American Cancer Sciety guideline fr the early Citatins: detectin f prstate cancer: update CA Cancer J Clin Mar-Apr;60(2): Surce: Claim data- CPT cdes , G0102, G P age