How are the scores used? Results from HEDIS data collection are used to measure quality improvement processes and preventive care programs.

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1 Healthcare Effectiveness Data and Information Set (HEDIS) 101 What is HEDIS? Nerk Health partners with providers to offer quality health care to our members, as measured through HEDIS quality measures. The National Committee of Quality Assurance (NCQA) defines HEDIS as a set of standardized performance measures designed to ensure that the public has the information it needs to compare organization performance. HEDIS 2017 examines care provided for a number of conditions across all body systems; addresses members access to and satisfaction with various health care services and measures utilization for specific procedures and care settings. How are the scores used? Results from HEDIS data collection are used to measure quality improvement processes and preventive care programs. How can I improve my HEDIS scores? Submit claims with proper ICD-10 or codes for all services rendered. Document services completely, to accurately reflect all services billed. ADULT HEALTH Adults Access to Preventive/Ambulatory Health Services (AAP) This measure evaluates the percentage of members age 20 years and older who had at least one ambulatory or preventive care visit per year. ICD , 92004, 92012, 92014, , , , , 99315, 99316, 99318, , , , , , , , 99411, 99412, Z00.00, Z00.01, Z00.121, Z00.129, Z00.5, Z00.8, Z02.0-Z02.6, Z02.71, Z02.79, Z02.81-Z02.83, Z02.89, Z02.9 G0402, G0438, G0439, G0463, T1015 Antidepressant Medication Management (AMM) This measure evaluates the percentage of members ages 18 and older who had a diagnosis of major depression, were treated with an antidepressant and remained on an antidepressant medication treatment. There are rates. Effective Acute Phase: Percentage who remained on an antidepressant medication for at least 84 days (12 weeks). Effective Continuation Phase: Percentage who remained on an antidepressant medication for at least 180 days (six months). ICD-10 F32.0-F32.4, F32.9-F33.3, F33.41, F33.9

2 Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis (ART) This measures the percentage of members 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). DESCRIPTION 5-Aminosalicylates Alkylating agents Aminoquinolines Anti-rheumatics Immunomodulators Immunosuppressive agents Janus kinase (JAK) inhibitor Tetracyclines MEDICATIONS Sulfasalazine Cyclophosphamide Hydroxychloroquine Auranofin, Leflunomide, Penicillamine, Gold sodium thiomalate, Methotrexate Abatacept, Adalimumab, Anakinra, Certolizumab, Certolizumab pegol, Etanercept, Golimumab, Infliximab, Rituximab, Tocilizumab Azathioprine, Cyclosporine, Mycophenolate Tofacitinib Minocycline Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET) This measure evaluates the percentage of adolescent and adult members with a new episode of alcohol or other drug abuse or dependence (AOD) who received: Initiation of AOD treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization, telehealth or medication assisted treatment (MAT) within 14 days of the diagnosis. Engagement of AOD Treatment with or more additional AOD or medication assisted treatment services within 34 days of the initiation visit. For follow up treatments, include an ICD-10 diagnosis for alcohol abuse and dependence, opioid abuse and dependence or other drug abuse and dependence. Treatment codes to be used with diagnosis codes , 99078, , G0155, G0176, G0177, G0396, G0397, G0409-G0411, 99215, , , G0443, G0463, H0001, H0002, H0004, H0005, H0007, 99345, , , H0015, H0016, H0022, H0031, H0034-H0037, H0039, 99397, , 99408, 99409, 99411, H0040, H0047, H2000, H2001, H2010-H2020, H2035, 99412, H2036, M0064, S0201, S9480, S9484, S9485, T1006, T1012, T1015 Treatment in office Use service codes below with the diagnosis code AND a place of service (POS) code. POS 90791, 90792, , , 03, 05, 07, 09, 11-20, 22, 33, 49, 50, 52, 53, 57, 90845, 90847, 90849, 90853, 90875, , 72 Treatment in community mental health center or psychiatric facility Use the service codes below with the diagnosis code and the place of service (POS) code. POS , , 99238, 99239, and 53

3 Online assessment or telephone visit Use the service codes below with the diagnosis code , Medication Management for People with Asthma (MMA) This measure evaluates the percentage of members age five 64 who were identified as having persistent asthma and were dispensed appropriate medications which they remained on during the treatment period within the past year. RATES Medication Compliance 50 percent: Members who were covered by an asthma control medication at least 50 percent of the treatment period. Medication Compliance 75 percent: Members who were covered by an asthma control medication at least 75 percent of the treatment period. Adult BMI Assessment (ABA) This measure demonstrates the percentage of members ages 18 to 74 who had their Body Mass Index (BMI) documented during any outpatient visit in the past years. Recommendation is for adults to have BMI assessed at least every years. For patients 20 and over, code the BMI value on the date of service. For patients younger than 20, code the BMI percentile value set on the date of service. A distinct BMI value or percentile is required. ICD-10 BMI Z68.1, Z68.20-Z68.39, Z68.41-Z68.45; BMI Percentile Z68.51-Z68.54 Care for Older Adults (COA) This measure evaluates the following four components for adults 66 years and older. At least one functional status assessment per year. Can be a standard assessment tool or notation of either of the following: Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), or notation of cognitive status, ambulation status, hearing, vision and speech, and/or other functional independence. Evidence of advance care planning discussion or the presence of a plan. At least annually a review of the patient s medications by a prescribing practitioner. Includes the presence of a medication list and review of the medications. Transitional care management services also meet criteria. Pain assessment, either through a standardized pain assessment tool or documentation that pain was addressed. DESCRIPTION CATEGORY II Advance care planning F, 1124F, S F, 1158F Medication review 90863, 99605, F Medication list 1159F G8427 Transitional care management 99495, services Functional status assessment 1170F Pain assessment 1125F, 1126F

4 Colorectal Cancer Screening (COL) This measure evaluates the percentage of members ages who had at least one appropriate screening for colorectal cancer in the past year. Appropriate screening is FOBT in 2016, sigmoidoscopy in the last five years or colonoscopy in last 10 years. Patients who have a history of colon cancer (Z or Z85.048), who have had a total colectomy, and those 65 and older living long-term in institutional settings are exempt from this measure. FOBT Flexible sigmoidoscopy Colonoscopy FIT DNA 82270, G , , , G , 44397, , 45355, , G0105, G G0464 Controlling High Blood Pressure (CBP) The percentage of adults years of age who had a diagnosis of essential hypertension and whose blood pressure was adequately controlled based on the following criteria. Adults years of age whose blood pressure was <140/90 mm Hg Adults years of age, with a diagnosis of diabetes, whose blood pressure was <140/90 mm Hg Adults years of age, without a diagnosis of diabetes, whose blood pressure was <150/90 mm Hg Adults 65 and older living long-term in institutional settings are exempt from this measure. ICD-10 I10 COPD Exacerbation (Pharmacotherapy Management) (PCE) This measure evaluates the percentage of COPD exacerbations for members age 40 and older, had an acute inpatient stay or emergency department visit and who were dispensed appropriate medications. Intent is to measure compliance with recommended pharmacotherapy management for those with COPD exacerbations. RATES Systemic Corticosteroid: Dispensed prescription for systemic corticosteroid within 14 days after the episode. Bronchodilator: Dispensed prescription for a bronchodilator within 30 days after the episode date. APPROPRIATE MEDICATIONS Glucocorticoids Anticholinergic agents, Beta 2-agonists, Methylxanthines, Antiasthmatic combinations COPD (Spirometry Testing in the Assessment and Diagnosis) (SPR) This measure evaluates the percentage of members age 40 and older with a new diagnosis of Chronic Obstructive Pulmonary Disease (COPD) or newly active COPD, who received appropriate spirometry testing to confirm the diagnosis. Spirometry testing should be completed within 6 months of the new diagnosis or exacerbation , , 94060, 94070, 94375, 94620

5 Diabetes Care (Comprehensive) CDC This measure demonstrates the percentage of members ages with diabetes (types one and ) who were compliant in the following submeasures. HbA1c Test: Completed at least once per year (includes rapid A1c) , DESCRIPTION Poor Control: A1c > 9 percent 3046F Adequate Control: A1c <8 percent 3045F Good Control: A1c < 7 percent for specific 3044F populations under 65 years old* *Exclusions for HbA1c Control <7 percent: CABG, PCI, IVD, Thoracic aortic aneurysm, CHF, MI, ESRD, CKD stage 4, Dementia, Blindness, Amputation-LE Eye Exam: A retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) is completed every year OR a negative retinal exam (no evidence of retinopathy) by an eye care professional in the year prior. II code 3072F reflects a dilated retinal exam negative for retinopathy. II 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, , , F, 2024F, 2026F, 3072F S0620, S0621, S3000 Nephropathy Screening Test: Performed at least once per year. A member who is on ACE/ARBs or has nephropathy is compliant for this sub measure. II , 81005, , F-3062F, 3066F, 4010F FOLLOW-UP AFTER HOSPITALIZATION FOR MENTAL ILLNESS (FUH) This measure evaluates the percentage of discharges for members six 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. There are rates. 1.The percentage of discharges for which the member received follow-up within 30 days after discharge. 2.The percentage of discharges for which the member received follow-up within seven days after discharge. Meets both seven day and 30 day indicators , 99078, , , , , , , , , , 99411, 99412, G0155, G0176, G0177, G0409-G0411, G0463, H0002, H0004, H0031, H0034-H0037, H0039, H0040, H2000, H2001, H2010-H2020, M0064, S0201, S9480, S9484, S9485, T1015 AND POS 90791, 90792, , , 90845, 90847, 90849, 90853, , 90875, , 05, 07, 09, 11-20, 22, 24, 33, 49, 50, 52, 53, 71, 72 AND POS , , 99238, 99239, , , 53

6 Meets 30 day indicator Medication Reconciliation Post-Discharge (MRP) Measure evaluates the percentage of discharges for members age 18 and older for whom medications at discharge were reconciled against the outpatient medical record on or within 30 days of discharge. Submit codes to indicate the list of discharge medications were reconciled against the outpatient medications. CATEGORY II 99495, F Monitoring for Patients on Persistent Medications (Annual) (MPM) ACE Inhibitors or ARBs: Members who received at least 180 treatment days of ACE inhibitors or ARBs within the past year should have at least one of the following. A lab panel test OR A serum potassium test and a serum creatinine test Digoxin: Members who received at least 180 treatment days of digoxin within the past year should have at least one of the following. A lab panel test and a serum digoxin test OR A serum potassium test and a serum creatinine test and a serum digoxin test Diuretics: Members who have received at least 180 treatment days of a diuretic within the past year should have at least one therapeutic monitoring event annually. A lab panel test OR A serum potassium test and a serum creatinine test DESCRIPTION Lab panel (includes K+ and SCr) 80047, 80048, 80050, 80053, Serum potassium (K+) 80051, Serum creatinine (SCr) 82565, Digoxin level Persistence of Beta-Blocker Treatment After a Heart Attack (PBH) This measure evaluates the percentage of members age 18 and older who were hospitalized and discharged with a diagnosis of Acute myocardial infarction (AMI) and who received persistent betablocker treatment for six months after discharge. DESCRIPTION Non-cardioselective beta-blockers Cardioselective beta-blockers Antihypertensive combinations APPROPRIATE MEDICATIONS Carvedilol, Labetalol, Nadolol, Penbutolol, Pindolol, Propranolol, Timolol, Sotalol Acebutolol, Atenolol, Betaxolol, Bisoprolol, Metoprolol, Nebivolol Atenolol-chlorthalidone, Bendroflumethiazide-nadolol, Bisoprolol-hydrochlorothiazide, Hydrochlorothiazidemetoprolol, Hydrochlorothiazide-propranolol

7 Statin Therapy for Patients with Cardiovascular Disease (SPC) This measures the percentage of males years of age and females years of age who were identified as having clinical atherosclerotic cardiovascular disease (ASCVD) and met the following criteria. Two rates are reported. 1. Received Statin Therapy. Dispensed at least one high-intensity of moderate-intensity statin medication. 2. Statin Adherence 80 percent. Remained on a high-intensity or moderate-intensity statin medication for at least 80 percent of the treatment period. High- and Moderate-Intensity Medications: DESCRIPTION MEDICATIONS High-intensity statin therapy Atorvastatin 40-80mg, Amlodipine-atorvastatin 40-80mg, Ezetimibe-atorvastatin 40-80mg, Rosuvastatin 20-40mg, Simvastatin 80mg, Ezetimibe-simvastatin 80mg Moderate-intensity statin therapy Atorvastatin 10-20mg, Amlodipine-atorvastatin 10-20mg, Ezetimibe-atorvastatin 10-20mg, Rosuvastatin 5-10mg, Simvastatin 20-40mg, Ezetimibe-simvastatin 20-40mg, Niacinsimvastatin 20-40mg, Sitagliptin-simvastatin 20-40mg, Pravastatin 40-80mg, Lovastatin 40mg, Niacin-lovastatin 40mg, Fluvastatin XL 80mg, Fluvastatin 40mg bid, Pitavastatin 2-4mg WOMEN S HEALTH Breast Cancer Screenings (BCS) This measure evaluates the percentage of women ages who had a mammogram at least once in the past 27 months. Women who have had a bilateral mastectomy and those 65 and older living longterm in institutional settings are exempt from this measure. Diagnostic screenings are not compliant. Mammography Screening , , G0202, G0204, G0206 History of Bilateral Mastectomy ICD-10 Z90.13 Cervical Cancer Screenings (CCS) Measure evaluates the percentage of women ages who were screened for cervical cancer using either of the following criteria. Cervical cytology performed every three years for women ages Cervical cytology/human papillomavirus (HPV) co-testing performed every five years (must occur within four days of each other) for women ages Women who have had a hysterectomy without a residual cervix are exempt from this measure. Cervical Cytology Codes (ages 21-64) , 88147, 88148, 88150, , , 88174, HCPS G0123, G0124, G0141, G0143-G0145, G0147, G0148, P3000, P3001, Q0091

8 Ages years old, Code from Cervical Cytology plus one HPV code , 87624, Absence of Cervix ICD-10 Q51.5, Z90.710, Z Chlamydia Screening (CHL) This measure evaluates the percentage of women ages 16 to 24 who are sexually active who had at least one test for chlamydia during the year. Chlamydia tests can be completed using any method, including a urine test. Sexually active is defined as a woman who has had a pregnancy test or testing for any other sexually transmitted disease or has been prescribed birth control , 87270, 87320, , Osteoporosis Management in Women Who Had a Fracture (OMW) This measure evaluates the percentage of women age years of age who suffered a fracture and had a bone mineral density (BMD) test or were prescribed medication to treat osteoporosis within 6 months following the fracture. Those who had a BMD during the 24 months prior to the fracture or were prescribed medication to treat osteoporosis during the 12 months prior to the fracture are excluded from this measure. Bone Density Tests ICD-10 APPROPRIATE MEDICATIONS 76977, 77078, , 77085, G0130 BP48ZZ1, BP49ZZ1, BP4GZZ1, BP4HZZ1, BP4LZZ1, BP4MZZ1, BP4NZZ1, BP4PZZ1, BQ00ZZ1, BQ01ZZ1, BQ03ZZ1, BQ04ZZ1, BR00ZZ1, BR07ZZ1, BR09ZZ1, BR0GZZ1 alendronate, alendronatecholecalciferol, ibandronate, risedronate, zoledronic acid, calcitonin, denosumab, raloxifene, teriparatide Prenatal Visits Timeliness of First Visit and Frequency of Visits Measure evaluates the percentage of pregnant women who had their first prenatal visit in the first trimester or within 42 days of enrollment with the plan. Also, the frequency of prenatal visits is assessed. *For OB or PCP provider types, choose to submit Stand Alone Prenatal Visit codes. *OB provider types may also submit any Prenatal Visit code in conjunction with any code for Other Prenatal Services. *PCP provider types can also submit and Stand Alone Prenatal Visit code and any code for Other Prenatal Services along with a pregnancy diagnosis. *Other Prenatal Services (any one listed): Obstetric Panel, Prenatal Ultrasound, Cytomegalovirus and Antibody Levels for Toxoplasma, Rubella, and Herpes Simplex, Rubella antibody and ABO, Rubella and Rh, Rubella and ABO/Rh Stand Alone Prenatal Visit Codes 99500, 0500F, 0501F, 0502F H1000-H1004 Prenatal Visit Codes (to use with pregnancy diagnosis or other prenatal services) , , G0463, T1015

9 Postpartum Visits (PPC) Measure evaluates the percentage of women who delivered a baby and who had their postpartum visit on or between 21 and 56 days after delivery (three and eight weeks). Any Postpartum Visit ICD , 58300, 59430, 99501, 0503F Z01.411, Z01.419, Z01.42, Z30.430, Z39.1, Z39.2 G0101 Any Cervical Cytology Procedure , 88147, 88148, 88150, , , 88174, G0123, G0124, G0141, G0143-G0145, G0147, G0148, P3000, P3001, Q0091 PEDIATRIC HEALTH Access to Primary Care Practitioners (CAP) Measure evaluates the percent of members age 12 months-six years who had a visit with a Primary Care Physician during the measurement year, and those seven-19 years who had a visit with a Primary Care Physician during the measurement year or the year prior to the measurement year. ICD , , , , , , , , 99411, 99412, 99429, G0402, G0438, G0439, G0463, T1015 Z00.00, Z00.01, Z00.121, Z00.129, Z00.5, Z00.8, Z02.0-Z02.6, Z02.71, Z02.79, Z02.81 Z02.83, Z02.89, Z02.9 ADHD Medication Follow-Up Care (ADD) Measure demonstrates the percent of members ages six 12 newly prescribed an ADHD medication that had at least three follow-up care visits within a 10-month period, one of which was within 30 days of when the first ADHD medication was dispensed. There are rates. Initiation Phase: One face-to-face outpatient follow-up visit with a practitioner with prescribing authority within 30 days after the date the ADHD medication was first dispensed , , 99078, , , , , , , , , , 99411, 99412, G0155, G0176, G0177, G0409-G0411, G0463, H0002, H0004, H0031, H0034- H0037, H0039, H0040, H2000, H2001, H2010-H2020, M0064, S0201, S9480, S9484, S9485, T1015 AND POS 90791, 90792, , , 90845, 90847, 90849, 90853, 90875, , 5, 7, 9, 11-20, 22, 33, 49, 50, 52, 53, 71, 72 AND POS , , 99238, 99239, , 53 Continuation and Maintenance Phase: Two more follow-up visits from 31 to 270 days (nine months) after the date the ADHD medication was first dispensed. One of the visits may be a telephone visit or telehealth visit. CODES TO IDENTIFY VISITS CODES - TELEPHONE VISITS Any code noted above in the initiation phase ,

10 Medication Management for People with Asthma (MMA) Measure evaluates the percentage of members ages five 85 who were identified as having persistent asthma and were dispensed appropriate medications which they remained on during the treatment period within the past year. RATES Medication Compliance 50 percent: Members who were covered by one asthma control medication at least 50 percent of the treatment period. Medication Compliance 75 percent: Members who were covered by one asthma control medication at least 75 percent of the treatment period Immunizations Childhood Immunizations (CIS): Percentage of year olds that have all of the required immunizations listed below by age. IMMUNIZATION DETAILS CVX DTaP IPV MMR Hib Hepatitis B VZV Pneumococcal Hepatitis A Rotavirus1 Influenza At least four doses <age At least three doses < age At least one dose < age At least three doses < age At least three doses < age At least one dose < age At least four doses < age At least one dose < age Before age : doses of -dose vaccine; one dose of the dose vaccine and doses of the three dose vaccine or three doses of the three dose vaccine At least doses < age 1 Record must document if Rotavirus is or three dose vaccine , 90700, 90721, , 50, 106, 107, 110, , 90713, , 89, 110, , , 94 Measles/ Rubella Mumps-90704, Measles-90705, Rubella Mumps-07, Measles-05, Rubella , 90698, , 46-51, 120, 90721, , 90740, 90744, G , 44, 45, 51, , , , , G , 133, , 83, 85 dose schedule three dose schedule , 90657, 90661, 90662, 90673, , 122 G , 135, 140, 141, 150, 153, 155, 158, 161

11 Adolescent Immunizations (IMA): Percentage of adolescents turning 13 who had all the required immunizations listed below. IMMUNIZATION DETAILS CVX Meningococcal one on or between birthdays , 136, 147 Tdap one on or between birthdays Tdap Human Papillomavirus (HPV) Three doses or doses at least 146 days apart between nine 13 birthdays , 118, 137, 165 Pharyngitis Appropriate Testing (CWP) Measure evaluates the percentage of children age three-18 diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus test for the episode. A higher rate represents better performance (i.e., appropriate testing). Ensure any secondary diagnoses indicating the need for an antibiotic are submitted on the claim. Rapid strep tests in the office are acceptable and should be billed , 87071, 87081, 87430, , Upper Respiratory Infection Appropriate Testing (URI) Measure evaluates the percentage of children age three months-18 years who were given a diagnosis of upper respiratory infection and were not dispensed an antibiotic prescription. Ensure any secondary diagnoses indicating the need for an antibiotic are submitted on the claim. ICD-10 J00, J06.0, J06.9 Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) This measure demonstrates the percentage of members ages three-17 who had an outpatient visit with a PCP or OB/GYN and who had evidence of the following completed at least annually. BMI percentile documentation counseling for nutrition counseling for physical activity DESCRIPTION ICD-10 BMI Percentile --- Z68.51-Z Counseling for Nutrition Z71.3 G0270, G0271, G0447, S9449, S9452, S9470 Counseling for Physical Activity --- Z02.5 G0447, S9451 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 percentile ranking is based on the Centers for Disease Control and Prevention s (CDC) BMI-for-age growth charts. Pregnant members excluded. Well Child and Adolescent Well Care Visits Components of a comprehensive well visit include the following. a health history a physical developmental history a mental developmental history a physical exam health education/anticipatory guidance

12 Visits must be with a primary care practitioner, even though the PCP does not have to be the practitioner assigned to the child. Assessment or treatment of an acute or chronic condition do not count toward the measure. Use age-appropriate codes when submitting well child visits. Well Child Visits in the First 15 Months of Life (W15) Measure evaluates the percentage of infants who had six comprehensive well care visits within the first 15 months of life Initial hospital care for evaluation and management of normal newborn infant counts towards the measure (99461). Well Child Visits, Ages Three-Six Years Old (W34) Measure evaluates the percentage of children ages three, four, five or six years old who had at least one comprehensive well care visit per year. Adolescent Well Care Visits (AWC) Measure evaluates the percentage of adolescents age years old who had at least one comprehensive well care visit per year. ICD , , Z00.00, Z00.01, Z00.110, Z00.111, Z00.121, Z00.129, Z00.8, Z02.0, Z02.2- Z02.6, Z02.71, Z02.79, Z Z02.83, Z02.89, Z02.9 G0438, G0439