Title: NCQA HEDIS Health Plan Measures

Transcription

1 Title: NCQA HEDIS Health Plan Measures Created by: Bob Rehm Organization: National Committee for Quality Assurance Created on: Jan 25, 2012 Report generated by the Quality Positioning System

2 Quality Positioning System Portfolio Report Table of Contents Portfolio Details...8 Measure Summary Table (NQF-endorsed )...9 Measure Summary Table (No Longer NQF-endorsed )...18 Measure Details (NQF-endorsed )...26 Measure Details (No Longer NQF-endorsed ) NQF Disclaimer: Measures may be used for non-commercial implementation and/or reporting of performance data. Contact the Measure Steward if you wish to use the measure for another purpose. The National Quality Forum (NQF) is not responsible for the application or outcomes of measures. NQF Portfolio Disclaimer: NQF The ability to create measure portfolios is intended to allow Quality Positioning System (QPS) users to share information regarding measure use. NQF does not endorse measure portfolios created in QPS. 2

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4 4. Use of the Quality Positioning System: a. QPS consists of software that is designed to allow you to access health care quality measures and related information. b. You agree that you will not engage in any activity that interferes with or disrupts QPS. c. You agree that you will not reproduce, duplicate, copy, sell, trade, or resell QPS, in whole or in part, for any purpose. You may not and you may not permit anyone else to copy, modify, create a derivative work of, reverse engineer, decompile or otherwise attempt to extract the source code of QPS or any part thereof. d. You agree not to access or attempt to access QPS by any means other than through the interface that is provided by NQF, unless you have been specifically allowed to do so in a separate agreement with NQF. You specifically agree not to access or attempt to access QPS through any automated means (including use of scripts or web crawlers) and shall ensure that you comply with the instructions set out in any robots.txt file present in QPS. 5. Use of Content: a. Information in QPS is compiled and published by the National Quality Forum ( NQF ) as a reference for information regarding health care quality measures endorsed by NQF. QPS users also have the ability to create content, such as measure portfolios (collectively, User-Generated Content ), which may be shared with other QPS users. b. Measures and related information (collectively, the Measures Content ) may only be used for non-commercial implementation and/or reporting of performance data. Measures Content regarding a specific measure may be protected by intellectual property rights which are owned by a Measure Steward that provides the Measures Content to NQF. You may not modify, rent, lease, loan, sell, distribute or create derivative works based on that specific Measures Content, in whole or in part, unless the Measure Steward associated with that Measures Content has specifically given you permission to do so. You should contact the appropriate Measure Steward if you wish to use the specific Measures Content for a purpose other than non-commercial implementation and/or reporting of performance data. Measures Content does not include User-Generated Content and User-Generated Content does not include 4

5 Measures Content. Measures Content and User-Generated Content constitute Content, collectively. c. Content may include hyperlinks to other web sites or resources. NQF has no control over, or responsibility for, third party websites or the information contained in those websites. d. Unless you have agreed otherwise in writing with NQF, nothing in the Terms of Use gives you the right to use any of NQF s trade names, trademarks, service marks, logos, domain names, and other distinctive brand features, with the exception of the term NQF-endorsed where applicable to measures. e. You agree that you shall not remove, obscure, or alter any proprietary rights notices (including copyright and trademark notices) which may be affixed to or contained within the Content. Such proprietary rights notices may be affixed to the Content by NQF or by the Measure Steward. f. Users may create User-Generated Content that references NQFendorsed measures, including but not limited to portfolios. Other users may have the ability to access, comment on and/or copy the User-Generated Content involving endorsed measures. The inclusion of or reference to an endorsed measure in User- Generated Content does not alter the Terms of Use related to the measure itself. g. Users retain copyright and any other rights already held in User- Generated Content which submitted, posted, or displayed on or through QPS. By submitting, posting or displaying User-Generated Content, you give NQF a perpetual, irrevocable, worldwide, royalty-free, and non-exclusive license to reproduce, adapt, modify, translate, publish, publicly display and distribute any User-Generated Content which you submit, post, or display on or through QPS. This license is for the sole purpose of enabling NQF to display, distribute and promote QPS. 6. Privacy: NQF reserves the right to monitor the use of QPS for: compliance with the Terms of Use; analysis of the traffic on our website; market research; and improvement of site utility. NQF reserves the right to monitor User-Generated Content submitted, posted, or displayed on or through QPS and to delete such User-Generated Content in its sole discretion. QPS users should note that the system allows users to publish information in a variety of ways that can be viewed by other QPS users. See the NQF Privacy Policy for further information at 5

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8 NCQA HEDIS Health Plan Measures Portfolio Details Short Description The portfolio contains the NQF-endorsed NCQA HEDIS Health Plan Measures. The Healthcare Effectiveness Data and Information Set (HEDIS) is used by more than 90 percent of health plans to measure performance. Relevant Website(s) Number of NQF-endorsed measures included in portfolio: 31 Date portfolio was created: Jan 25, 2012 Date portfolio was last updated: Feb 13, 2012 Owner Name: Bob Rehm Owner Organization: National Committee for Quality Assurance Portfolio Collaborators: None Portfolio Notes Public: None Owner Keyword Search Terms: HEDIS, NCQA Portfolio Location: 8

9 NCQA HEDIS Health Plan Measures Measure Summary Table (NQF-endorsed ) The following is the list of the 31 NQF-endorsed measure(s) included within this portfolio. Row Measure Title NQF # Measure Description Steward 1 HEDIS: Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment 0004 The percentage of adolescent and adult patients with a new episode of alcohol or other drug (AOD) dependence who received the following. - Initiation of AOD Treatment. The percentage of patients who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis. National Committee for Quality Assurance 2 Controlling High Blood Pressure 3 Use of High-Risk Medications in the Elderly (DAE) - Engagement of AOD Treatment. The percentage of patients who initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of the initiation visit The percentage of patients 18 to 85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90) during the measurement year There are two rates for this measure: - The percentage of patients 65 National Committee for Quality Assurance National Committee for Quality Assurance 9

10 Row Measure Title NQF # Measure Description Steward years of age and older who received at least one high-risk medication. - The percentage of patients 65 years of age and older who received at least two prescriptions for the same high-risk medication. 4 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolesc ents (WCC) For both rates, a lower rate represents better performance Percentage of patients 3-17 years of age who had an outpatient visit with a primary care physician (PCP) or an OB/GYN and who had evidence of the following during the measurement year: - Body mass index (BMI) percentile documentation* - Counseling for nutrition - Counseling for physical activity National Committee for Quality Assurance 5 Medical Assistance With Smoking and Tobacco Use Cessation *Because BMI norms for youth vary with age and gender, this measure evaluates whether BMI percentile is assessed rather than an absolute BMI value The three components of this measure assess different facets of providing medical assistance with smoking and tobacco use cessation: National Committee for Quality Assurance Advising Smokers and Tobacco Users to Quit: A rolling average represents the percentage of 10

11 Row Measure Title NQF # Measure Description Steward patients 18 years of age and older who are current smokers or tobacco users and who received advice to quit during the measurement year. Discussing Cessation Medications: A rolling average represents the percentage of patients 18 years of age and older who are current smokers or tobacco users and who discussed or were recommended cessation medications during the measurement year. 6 Cervical Cancer Screening (CCS) 7 Chlamydia Screening in Discussing Cessation Strategies: A rolling average represents the percentage of patients 18 years of age and older who are current smokers or tobacco users and who discussed or were provided cessation methods or strategies during the measurement year Percentage of women years of age who were screened for cervical cancer using either of the following criteria: - Women age who had cervical cytology performed every 3 years. - Women age who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years The percentage of women years of age who were identified as sexually active and who had at National Committee for Quality Assurance National Committee for Quality 11

12 Row Measure Title NQF # Measure Description Steward Women (CHL) least one test for chlamydia during the measurement year. Assurance 8 Colorectal Cancer Screening (COL) 9 Osteoporosis Testing in Older Women (OTO) 10 Childhood Immunization Status (CIS) 11 Flu Vaccinations for Adults Ages 18 and Older 0034 The percentage of patients years of age who had appropriate screening for colorectal cancer The number of women years of age who report ever having received a bone density test to check for osteoporosis Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DtaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine The percentage of adults 18 years of age and older who self-report receiving an influenza vaccine within the measurement period. This measure is collected via the CAHPS 5.0H adults survey for Medicare, Medicaid, and commercial populations. It is reported as two separate rates stratified by age: and 65 years of age and older. National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance 12

13 Row Measure Title NQF # Measure Description Steward 12 Osteoporosis Management in Women Who Had a Fracture 13 Disease- Modifying Anti- Rheumatic Drug Therapy for Rheumatoid Arthritis (ART) 14 Comprehensive Diabetes Care: Eye Exam (retinal) performed 15 Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing 16 Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis (AAB) 17 Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) 0053 The percentage of women age who suffered a fracture and who either had a bone mineral density test or received a prescription for a drug to treat osteoporosis in the six months after the fracture The percentage of patients 18 years of age 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) The percentage of patients years of age with diabetes (type 1 and type 2) who had an eye exam (retinal) performed The percentage of patients years of age with diabetes (type 1 and type 2) who received an HbA1c test during the measurement year The percentage of adults years of age with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription The percentage of patients years of age with diabetes (type 1 and type 2) whose most recent HbA1c level during the measurement year was greater than 9.0% (poor control) or was missing a result, or if an HbA1c test was not done during the measurement year. National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance 13

14 Row Measure Title NQF # Measure Description Steward 18 Comprehensive Diabetes Care: Blood Pressure Control (<140/90 mm Hg) 19 Comprehensive Diabetes Care: Medical Attention for Nephropathy 20 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet 21 Appropriate Treatment for Children With Upper Respiratory Infection (URI) 22 Persistence of Beta-Blocker 0061 The percentage of patients years of age with diabetes (type 1 and type 2) whose most recent blood pressure level taken during the measurement year is <140/90 mm Hg The percentage of patients years of age with diabetes (type 1 and type 2) who received a nephropathy screening or monitoring test or had evidence of nephropathy during the measurement year The percentage of patients 18 years of age and older who were discharged from an inpatient setting with an acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) during the 12 months prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and who had documentation of routine use of aspirin or another antiplatelet during the measurement year Percentage of children 3 months to 18 years of age with a diagnosis of upper respiratory infection (URI) who were not dispensed an antibiotic medication The percentage of patients 18 years of age and older during the National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance National Committee 14

15 Row Measure Title NQF # Measure Description Steward Treatment After a Heart Attack 23 Ischemic Vascular Disease (IVD): Blood Pressure Control measurement year who were hospitalized and discharged from July 1 of the year prior to the measurement year to June 30 of the measurement year with a diagnosis of acute myocardial infarction (AMI) and who received persistent beta-blocker treatment for six months after discharge The percentage of patients 18 to 75 years of age who were discharged alive with acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) during the 12 months prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and who had the following during the measurement year: for Quality Assurance National Committee for Quality Assurance 24 Antidepressant Medication Management (AMM) - Blood pressure control (BP): reported as under control <140/90 mm Hg The percentage of patients 18 years of age and older with a diagnosis of major depression and were treated with antidepressant medication, and who remained on an antidepressant medication treatment. Two rates are reported. National Committee for Quality Assurance a) Effective Acute Phase Treatment. The percentage of 15

16 Row Measure Title NQF # Measure Description Steward 25 Follow-Up Care for Children Prescribed ADHD Medication (ADD) 26 Care for Older Adults (COA) Medication Review 27 Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Control (<8.0%) patients who remained on an antidepressant medication for at least 84 days (12 weeks). b) Effective Continuation Phase Treatment. The percentage of patients who remained on an antidepressant medication for at least 180 days (6 months) Percentage of children newly prescribed attentiondeficit/hyperactivity disorder (ADHD) medication who had at least three follow-up care visits within a 10-month period, one of which is within 30 days of when the first ADHD medication was dispensed. An Initiation Phase Rate and Continuation and Maintenance Phase Rate are reported Percentage of adults 66 years and older who had a medication review during the measurement year; a review of all a patient s medications, including prescription medications, over-the-counter (OTC) medications and herbal or supplemental therapies by a prescribing practitioner or clinical pharmacist The percentage of patients years of age with diabetes (type 1 and type 2) whose most recent HbA1c level is <8.0% during the measurement year. National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance 16

17 Row Measure Title NQF # Measure Description Steward 28 Follow-Up After Hospitalization for Mental Illness (FUH) 0576 The percentage of discharges for patients 6 years of age and older who were hospitalized for treatment of selected mental illness diagnoses and who had a follow-up visit with a mental health practitioner. Two rates are reported: National Committee for Quality Assurance 29 Use of Spirometry Testing in the Assessment and Diagnosis of COPD 30 Well-Child Visits in the First 15 Months of Life 31 Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life - The percentage of discharges for which the patient received follow-up within 30 days of discharge - The percentage of discharges for which the patient received follow-up within 7 days of discharge The percentage of patients 40 years of age and older with a new diagnosis of COPD or newly active COPD, who received appropriate spirometry testing to confirm the diagnosis The percentage of children 15 months old who had the recommended number of well-child visits with a PCP during their first 15 months of life The percentage of children 3-6 years of age who had one or more well-child visits with a PCP during the measurement year. National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance 17

18 NCQA HEDIS Health Plan Measures Measure Summary Table (No Longer NQF-endorsed ) The following is the list of the 20 no longer NQF-endorsed measure(s) included within this portfolio. Row Measure Title NQF # Measure Description Steward 1 Appropriate Testing for Children with Pharyngitis(Endor sement Removed) 2 NCQA Supplemental items for CAHPS 4.0 Adult Questionnaire (CAHPS 4.0H)(Endorsemen t Removed) 0002 The percentage of children 2 18 years of age who were diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode. A higher rate represents better performance (i.e., appropriate testing) This supplemental set of items was developed jointly by NCQA and the AHRQ-sponsored CAHPS Consortium and is intended for use with the CAHPS 4.0 Health Plan survey. Some items are intended for Commercial health plan members only and are not included here. This measure provides information on the experiences of Medicaid health plan members with the organization. Results summarize member experiences through composites and question summary rates. National Committee for Quality Assurance National Committee for Quality Assurance In addition to the 4 core composites from the CAHPS 4.0 Health Plan survey and two composites for commercial populations only, the HEDIS supplemental set includes one composite score and two itemspecific summary rates. 18

19 Row Measure Title NQF # Measure Description Steward 3 Annual monitoring for patients on persistent medications(endo rsement Removed) 1. Shared Decision Making Composite 1. Health Promotion and Education item 2. Coordination of Care item 0021 The percentage of members 18 years of age and older who received at least 180 treatment days of ambulatory medication therapy for a select therapeutic agent during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year. For each product line, report each of the four rates separately and as a total rate. National Committee for Quality Assurance 4 Physical Activity in Older Adults (PAO)(Endorseme nt Removed) Annual monitoring for members on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) Annual monitoring for members on digoxin Annual monitoring for members on diuretics Annual monitoring for members on anticonvulsants Total rate (the sum of the four numerators divided by the sum of the four denominators) 0029 This measure has two rates that assess the promotion of physical activity in older adults: Discussing Physical Activity: National Committee for Quality Assurance 19

20 Row Measure Title NQF # Measure Description Steward Percentage patients 65 years of age and older who reported discussing their level of exercise or physical activity with a doctor or other health provider in the last 12 months 5 Management of Urinary Incontinence in Older Adults (MUI)(Endorsemen t Removed) Advising Physical Activity: Percentage patients 65 years of age and older who reported receiving advice to start, increase, or maintain their level of exercise or physical activity from a doctor or other health provider in the last 12 months 0030 The following components of this measure assess the management of urinary incontinence in older adults. - Discussing Urinary Incontinence. The percentage of Medicare members 65 years of age and older who reported having urine leakage in the past six months and who discussed their urinary leakage problem with a health care provider. National Committee for Quality Assurance - Treatment of Urinary Incontinence. The percentage of Medicare members 65 years of age and older who reported having urine leakage in the past six months and who treatment options for their current urine leakage problem. 20

21 Row Measure Title NQF # Measure Description Steward 6 Breast Cancer Screening(Endors ement Removed) 7 Fall Risk Management (FRM)(Endorseme nt Removed) - Impact of Urinary Incontinence. The percentage of Medicare members 65 years of age and older who reported having urine leakage in the past six months and who reported that urine leakage made them change their daily activities or interfered with their sleep a lot Percentage of women years of age who had a mammogram to screen for breast cancer 0035 Assesses different facets of fall risk management: Discussing Fall Risk. The percentage of adults 75 years of age and older, or years of age with balance or walking problems or a fall in the past 12 months, who were seen by a practitioner in the past 12 months and who discussed falls or problems with balance or walking with their current practitioner. National Committee for Quality Assurance National Committee for Quality Assurance Managing Fall Risk. The percentage of adults 65 years of age and older who had a fall or had problems with balance or walking in the past 12 months, who were seen by a practitioner in the past 12 months and who received fall risk intervention from their current practitioner. 21

22 Row Measure Title NQF # Measure Description Steward 8 Use of Appropriate Medications for People With Asthma (ASM)(Endorseme nt Removed) 9 Flu Shot for Older Adults(Endorseme nt Removed) 10 Pneumococcal Vaccination Status for Older Adults (PNU)(Endorseme nt Removed) 11 Use of Imaging Studies for Low Back Pain(Endorsement Removed) 12 Comprehensive Diabetes Care: LDL-C Screening(Endors ement Removed) 13 Comprehensive Diabetes Care: LDL-C Control <100 mg/dl(endorseme nt Removed) 14 Ischemic Vascular Disease (IVD): Complete Lipid Profile and 0036 The percentage of patients 5-64 years of age during the measurement year who were identified as having persistent asthma and who were appropriately prescribed medication during the measurement year Percentage of patients age 65 and over who received an influenza vaccination from September through December of the year 0043 Percentage of patients 65 years of age and older who ever received a pneumococcal vaccination The percentage of patients with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of diagnosis The percentage of members years of age with diabetes (type 1 and type 2) who received an LDL-C test during the measurement year The percentage of members years of age with diabetes (type 1 and type 2) whose most recent LDL-C test is <100 mg/dl during the measurement year The percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance 22

23 Row Measure Title NQF # Measure Description Steward LDL-C Control <100 mg/dl(endorseme nt Removed) coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) during the 12 months prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to measurement year, who had each of the following during the measurement year. 15 Pharmacotherapy Management of COPD Exacerbation (PCE)(Endorseme nt Removed) - Complete Lipid Profile - LDL-C control <100 mg/dl 0549 This measure assesses the percentage of COPD exacerbations for members 40 years of age and older who had an acute inpatient discharge or ED encounter on or between January 1 November 30 of the measurement year and who were dispensed appropriate medications. National Committee for Quality Assurance Two rates are reported. 1. Dispensed a systemic corticosteroid within 14 days of the event 2. Dispensed a bronchodilator within 30 days of the event Note: The eligible population for this measure is based on acute inpatient discharges and ED visits, not on members. It is possible for the denominator to include multiple events for the same individual. 23

24 Row Measure Title NQF # Measure Description Steward 16 Medication Reconciliation Post-Discharge (MRP)(Endorseme nt Removed) 17 Annual Dental Visit (ADV)(Endorseme nt Removed) 18 Frequency of Ongoing Prenatal Care (FPC)(Endorseme nt Removed) 0554 The percentage of discharges during the first 11 months of the measurement year (e.g., January 1 December 1) for patients 66 years of age and older for whom medications were reconciled on or within 30 days of discharge Percentage of patients 2-21 years of age who had at least one dental visit during the measurement year. This measure applies only if dental care is a covered benefit in the organization s Medicaid contract The percentage of Medicaid deliveries that had the following number of expected prenatal visits: less than 21 percent of expected visits. National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance 21 percent 40 percent of expected visits. 41 percent 60 percent of expected visits. 61 percent 80 percent of expected visits. 19 Immunizations by 18 years of age(endorsement Removed) greater than or equal to 81 percent of expected visits The percentage of adolescents who turned 18 years during the measurement year who had proper immunizations by the time they turn National Committee for Quality Assurance 24

25 Row Measure Title NQF # Measure Description Steward 18 years of age. 20 Prenatal & Postpartum Care (PPC)(Endorseme nt Removed) 1517 The percentage of deliveries of live births between November 6 of the year prior to the measurement year and November 5 of the measurement year. For these women, the measure assesses the following facets of prenatal and postpartum care: Rate 1: Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit as a member of the organization in the first trimester or within 42 days of enrollment in the organization. Rate 2: Postpartum Care. The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery. National Committee for Quality Assurance 25

26 Measure Details (NQF-endorsed ) NCQA HEDIS Health Plan Measures 0004 HEDIS: Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment Measure Status Endorsement Date: Aug 10, 2009 Endorsement Type: Endorsed Last Updated Date: Feb 08, 2016 Corresponding Measures: Measure Type: Process Measure Format: measure Measure Details Measure Steward: National Committee for Quality Assurance Measure Description: The percentage of adolescent and adult patients with a new episode of alcohol or other drug (AOD) dependence who received the following. - Initiation of AOD Treatment. The percentage of patients who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis. - Engagement of AOD Treatment. The percentage of patients who initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of the initiation visit. Numerator Statement: Initiation of AOD Dependence Treatment: 26

27 Initiation of AOD treatment through an inpatient admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the index episode start date. --- Engagement of AOD Treatment: Initiation of AOD treatment and two or more inpatient admissions, outpatient visits, intensive outpatient encounters or partial hospitalizations with any AOD diagnosis within 30 days after the date of the Initiation encounter (inclusive). Denominator Statement: Patients age 13 years of age and older who were diagnosed with a new episode of alcohol or other drug dependency (AOD) during the first 10 and ½ months of the measurement year (e.g., January 1-November 15). Exclusions: Exclude patients who had a claim/encounter with a diagnosis of AOD during the 60 days (2 months) before the Index Episode Start Date. (See corresponding Excel document for the AOD Dependence Value Set) Exclude from the denominator for both indicators (Initiation of AOD Treatment and Engagement of AOD Treatment) patients whose initiation of treatment event is an inpatient stay with a discharge date after December 1 of the measurement year. Risk Adjustment: No Harmonization Action: Harmonization Requested Measure(s) Considered in Harmonization Request: Classification Use in Federal Program: Medicaid, Medicare Physician Quality Reporting System (PQRS), Physician Feedback/Quality and Resource Use Reports (QRUR), Physician Value-Based Payment Modifier (VBM), Qualified Health Plan (QHP) Quality Rating System (QRS) Condition: Behavioral Health, Behavioral Health: Alcohol, Substance Use/Abuse 27

28 Cross-Cutting Area: Care Coordination, Safety Care Setting: Emergency Department and Services, Inpatient/Hospital, Outpatient Services National Quality Strategy Priorities: Effective Communication and Care Coordination Actual/Planned Use: Data Source: Claims, Electronic Health Records Level of Analysis: Health Plan, Integrated Delivery System Target Population: Children, Elderly, Populations at Risk Measure Steward Contact Information Measure Steward Organization: National Committee for Quality Assurance Measure Steward Address: Measure Steward URL: Information Unavailable Measure Disclaimer These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED AS IS WITHOUT WARRANTY OF ANY KIND. Measure Steward Copyright 2012 by the National Committee for Quality Assurance th Street, NW, Suite 1000 Washington, DC Found In Other Portfolio(s): 2016 Medicaid Adult Core Set Behavioral Health and Substance Use 28

29 CareLogic CQMS CCBHC Quality Measures and Other Reporting Requirements MAP Dual Eligible Beneficiaries Family of Measures Meaningful Use - Medicare and Medicaid EHR for Eligible Professionals MU Stage 2 CQMs NCQA HEDIS Physician Plan Measures NextGen Certified OKHCA QA/QI Pediatric NQFs Anderson Hills 29

30 0018 Controlling High Blood Pressure Measure Status Endorsement Date: Aug 10, 2009 Endorsement Type: Endorsed Last Updated Date: Apr 03, 2013 Corresponding Measures: Measure Type: Outcome Measure Format: measure Measure Details Measure Steward: National Committee for Quality Assurance Measure Description: The percentage of patients 18 to 85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90) during the measurement year. Numerator Statement: The number of patients in the denominator whose most recent BP is adequately controlled during the measurement year. For a patient s BP to be controlled, both the systolic and diastolic BP must be <140/90 (adequate control). To determine if a patient s BP is adequately controlled, the representative BP must be identified. Denominator Statement: Patients 18 to 85 years of age by the end of the measurement year who had at least one outpatient encounter with a diagnosis of hypertension (HTN) during the first six months of the measurement year. Exclusions: Exclude all patients with evidence of end-stage renal disease (ESRD) on or prior to the end of the measurement year. Documentation in the medical record must include a related note indicating evidence of ESRD. Documentation of dialysis or renal transplant also meets the criteria for evidence of ESRD. 30

31 Exclude all patients with a diagnosis of pregnancy during the measurement year. Exclude all patients who had an admission to a nonacute inpatient setting during the measurement year. Risk Adjustment: No Harmonization Action: Harmonization Requested Measure(s) Considered in Harmonization Request: Classification Use in Federal Program: Medicaid, Medicare Physician Quality Reporting System (PQRS), Medicare Shared Savings Program (MSSP), Million Hearts, Physician Feedback/Quality and Resource Use Reports (QRUR), Physician Value-Based Payment Modifier (VBM), Qualified Health Plan (QHP) Quality Rating System (QRS) Condition: Cardiovascular, Cardiovascular: Hypertension Cross-Cutting Area: Care Setting: Outpatient Services National Quality Strategy Priorities: Prevention and Treatment Actual/Planned Use: Payment Program, Public Reporting, Quality Improvement (Internal to the specific organization), Regulatory and Accreditation Programs Data Source: Claims, Electronic Health Records, Paper Medical Records Level of Analysis: Health Plan, Integrated Delivery System Target Population: Elderly, Populations at Risk Measure Steward Contact Information Measure Steward Organization: National Committee for Quality Assurance Measure Steward Address: nqf@ncqa.org 31

32 Measure Steward URL: Measure Disclaimer Measure Steward Copyright Found In Other Portfolio(s): 2012 MAP Diabetes Family of Measures 2016 ACO Quality Measures 2016 Medicaid Adult Core Set ACO - PCMH Measures ACO Measures AHP Measures (klc) Better Health Greater Cleveland Publicly Reported Measures Bridges to Excellence Care Recognition Programs CareLogic CQMS CCBHC Quality Measures and Other Reporting Requirements Chris ACO measures CPC+ ecqms 2017 HHS Million Hearts Initiative Howard Brown Health Center Quality Measures ID/DD Measures MAP Dual Eligible Beneficiaries Family of Measures Meaningful Use - Medicare and Medicaid EHR for Eligible Professionals MN Community Measurement's Publicly Reported Measures MU Stage 2 CQMs NCQA HEDIS Physician Plan Measures New Mexico Coalition for Healthcare Quality Publicly Reported Measures NextGen Certified NQF Measures On Diabetes & Hypertension OKHCA QA/QI 32

33 ONC Beacon Communities' Measures in Use Prevention and Treatment of Cardiovascular Disease SHC Ambulatory Care- PHASE I Total Cost of Care TransforMED Quality Metrics Wisconsin Collaborative for Healthcare Quality (WCHQ) Publicly Reported Measures 33

34 0022 Use of High-Risk Medications in the Elderly (DAE) Measure Status Endorsement Date: Aug 10, 2009 Endorsement Type: Endorsed Last Updated Date: Jan 26, 2017 Corresponding Measures: Measure Type: Process Measure Format: measure Measure Details Measure Steward: National Committee for Quality Assurance Measure Description: There are two rates for this measure: - The percentage of patients 65 years of age and older who received at least one highrisk medication. - The percentage of patients 65 years of age and older who received at least two prescriptions for the same high-risk medication. For both rates, a lower rate represents better performance. Numerator Statement: Numerator 1: Patients who received at least one high-risk medication during the measurement year. Numerator 2: Patients who received at least two prescriptions for the same high-risk medication during the measurement year. 34

35 For both numerators a lower rate indicates better performance. Denominator Statement: All patients 65 years of age and older. Exclusions: Patients who were enrolled in hospice care at any time during the measurement year. Risk Adjustment: No Harmonization Action: Harmonization Requested Measure(s) Considered in Harmonization Request: Classification Use in Federal Program: Medicare Physician Quality Reporting System (PQRS), Physician Feedback/Quality and Resource Use Reports (QRUR), Physician Value- Based Payment Modifier (VBM) Condition: Cross-Cutting Area: Safety: Medication Care Setting: Outpatient Services National Quality Strategy Priorities: Patient Safety Actual/Planned Use: Payment Program, Public Reporting, Quality Improvement (external benchmarking to organizations), Regulatory and Accreditation Programs Data Source: Claims, Electronic Health Data, Electronic Health Records Level of Analysis: Health Plan, Integrated Delivery System Target Population: Elderly, Populations at Risk, Populations at Risk: Dual eligible beneficiaries, Populations at Risk: Individuals with multiple chronic conditions Measure Steward Contact Information Measure Steward Organization: National Committee for Quality Assurance 35

36 Measure Steward Address: Measure Steward URL: Information Unavailable Measure Disclaimer These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED AS IS WITHOUT WARRANTY OF ANY KIND. Measure Steward Copyright 2006 by the National Committee for Quality Assurance th Street, NW, Suite 1000 Washington, DC Found In Other Portfolio(s): 2012 MAP Safety Family of Measures Communication & Care Coordination: Medication Management MAP Dual Eligible Beneficiaries Family of Measures MU Stage 2 CQMs NCQA HEDIS Physician Plan Measures Partnership for Patients: All Measures Partnership for Patients: Medication Safety Patient Safety Safety: Healthcare-associated Conditions 36

37 0024 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) Measure Status Endorsement Date: Aug 10, 2009 Endorsement Type: Endorsed Last Updated Date: Dec 23, 2014 Corresponding Measures: Measure Type: Process Measure Format: measure Measure Details Measure Steward: National Committee for Quality Assurance Measure Description: Percentage of patients 3-17 years of age who had an outpatient visit with a primary care physician (PCP) or an OB/GYN and who had evidence of the following during the measurement year: - Body mass index (BMI) percentile documentation* - Counseling for nutrition - Counseling for physical activity *Because BMI norms for youth vary with age and gender, this measure evaluates whether BMI percentile is assessed rather than an absolute BMI value. Numerator Statement: The percentage of patients who had evidence of a Body mass index (BMI) percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year. 37

38 Denominator Statement: Patients 3-17 years of age with at least one outpatient visit with a primary care physician (PCP) or OB-GYN during the measurement year. Exclusions: Exclude patients who have a diagnosis of pregnancy during the measurement year. Risk Adjustment: No Harmonization Action: Harmonization Requested Measure(s) Considered in Harmonization Request: Classification Use in Federal Program: Medicaid, Medicare Physician Quality Reporting System (PQRS), Physician Feedback/Quality and Resource Use Reports (QRUR), Physician Value-Based Payment Modifier (VBM), Qualified Health Plan (QHP) Quality Rating System (QRS) Condition: Cross-Cutting Area: Primary Prevention Care Setting: Outpatient Services National Quality Strategy Priorities: Health and Well-Being Actual/Planned Use: Data Source: Claims, Electronic Health Records, Paper Medical Records Level of Analysis: Health Plan, Integrated Delivery System Target Population: Children Measure Steward Contact Information Measure Steward Organization: National Committee for Quality Assurance Measure Steward Address: nqf@ncqa.org Measure Steward URL: Information Unavailable 38

39 Measure Disclaimer Measure Steward Copyright by the National Committee for Quality Assurance th Street, NW, Suite 1000 Washington, DC Found In Other Portfolio(s): 2012 MAP Diabetes Family of Measures 2016 Medicaid Child Core Set AHP Measures (klc) Ambulatory - Pediatric CCBHC Quality Measures and Other Reporting Requirements Health and Well-Being ID/DD Measures Meaningful Use - Medicare and Medicaid EHR for Eligible Professionals MU Stage 2 CQMs NCQA HEDIS Physician Plan Measures NextGen Certified NQF-endorsed Population Health Measures ONC Beacon Communities' Measures in Use Pediatric Pediatric NQFs Anderson Hills Pediatric Quality Measures_v2 Pediatrics Quality Department (QPID) Reported Measures SHC Ambulatory Care- PHASE I TransforMED Quality Metrics 39

40 0027 Medical Assistance With Smoking and Tobacco Use Cessation Measure Status Endorsement Date: Aug 10, 2009 Endorsement Type: Endorsed Last Updated Date: Jun 28, 2017 Corresponding Measures: Measure Type: Process Measure Format: measure Measure Details Measure Steward: National Committee for Quality Assurance Measure Description: The three components of this measure assess different facets of providing medical assistance with smoking and tobacco use cessation: Advising Smokers and Tobacco Users to Quit: A rolling average represents the percentage of patients 18 years of age and older who are current smokers or tobacco users and who received advice to quit during the measurement year. Discussing Cessation Medications: A rolling average represents the percentage of patients 18 years of age and older who are current smokers or tobacco users and who discussed or were recommended cessation medications during the measurement year. Discussing Cessation Strategies: A rolling average represents the percentage of patients 18 years of age and older who are current smokers or tobacco users and who 40

41 discussed or were provided cessation methods or strategies during the measurement year. Numerator Statement: Advising Smokers and Tobacco Users to Quit: Patients who indicated that they received advice to quit smoking or using tobacco from their doctor or health provider Discussing Cessation Medications: Patients who indicated that their doctor or health provider recommended or discussed smoking or tobacco cessation medications Discussing Cessation Strategies: Patients who indicated their doctor or health provider discussed or provided smoking or tobacco cessation methods and strategies other than medication Denominator Statement: Patients 18 years and older who responded to the CAHPS survey and indicated that they were current smokers or tobacco users during the measurement year or in the last 6 months for Medicaid and Medicare. Exclusions: None Risk Adjustment: No Harmonization Action: Harmonization Requested Measure(s) Considered in Harmonization Request: Classification Use in Federal Program: Medicaid, Qualified Health Plan (QHP) Quality Rating System (QRS) Condition: Cross-Cutting Area: Primary Prevention Care Setting: Other, Outpatient Services 41