HEDIS Non-HEDIS - MQIC

1 0430151 GuidelineGaps in CareMeasureCommCaidCareSNPM easureCommCaidCareComments1. Use of Appropriate Medications for People with Asthma (ASM)1. Preventive visit in year (5-64 years old) a. 5-11 years Natl HMO c. 12-18 years Natl HMO d. 19-50 years Natl HMO e. 51-64 years Natl HMO c. Total (sum of all the above) Natl HMO Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB) Natl HMO Percent members in HEDIS Diabetes or HTN populations who had a serum creatinine test (necessary for GFR) HEDIS measureConsider HEDIS diabetes and HTN populationsUneven availability of eGFR thru administrative dataGeneral Principles for the Diagnosis and Management of Asthma1. Improper use of spacers and inhaling devices2. Not using lung volume measurements to monitor3. Inattention to reversing asthma symptoms NHLBI EPR3: Classifying Asthma Severity and Initiating Therapy Assessing Asthma Control and Adjusting Therapy Stepwise Approach for Managing Asthma Long Term How to Use your Asthma Inhaler2.

2 ED visits with a Primary diagnosis of asthma/1000 asthma members (5-64 years old) : Asthma Action Plan (NIH pub 07-5251) Asthma Control Plan for Child Michigan Asthma Resource Kit (Mark) Inhaled Quick Relief and Control Medications (U of M) Asthma Guideline Implementation Steps & Tools (GIST)GFR calculationTools: noneDiagnosis and Management of Adults with Chronic Kidney DiseaseMost recent performance(2013 data)ASTHMABRONCHITISMQIC GUIDELINES, MEASURES and TOOLS SUMMARY - HEDIS 2014 (Reporting year 2013)Non-HEDISMost recent performance(2013 data) HEDIS Management of Uncomplicated Acute Bronchitis in Adults CDC Get Smart, Know When Antibiotics WorkTools:CHRONIC KIDNEY DISEASE0430152 GuidelineGaps in CareMeasureCommCaidCareSNPM easureCommCaidCareCommentsMost recent performance(2013 data)MQIC GUIDELINES, MEASURES and TOOLS SUMMARY - HEDIS 2014 (Reporting year 2013)Non-HEDISMost recent performance(2013 data) HEDIS No HEDIS measure1.

3 Antidepressant Medication Management (AMM) a. Effective Acute Phase Natl HMO b. Effective Continuation Natl HMO Comprehensive Diabetes Care (CDC) 1. Statin therapy for persons with Diabetes (one rx filled during the measurement year) a. HbA1c Natl HMO Disease Burden Measures b. HbA1c Poor Control (> ) a. Acute Natl HMO b. c. HbA1c Control (< ) c. Natl HMO d. d. HbA1c Good control (< ) Natl HMO e. Eye exam, retinal, Natl HMO f. LDL-C screening Natl HMO g. LDL-C control (<100 mg/dL) Natl HMO h. Med. Attention for Natl HMO i. Blood pressure control (<140/90mmHg) Natl HMO j. Blood pressure control (<140/80mmHg) Natl HMO American Diabetes Association Super Foods for Diabetics The Impact of Diabetes in Michigan: The Diabetes Burden Report and the MI Diabetes Action Plan 2011-2014 Tools:Management of Diabetes MellitusPrimary Care Diagnosis and Management of Adults with Depression1.

4 Pharmacological approaches to treatment Edinburgh Postnatal Depression Scale (EPDS) (UCSF)DIABETEST ools: noneDEPRESSIONDEEP VENOUS THROMBOSISC onsider dropping HEDIS practitioner contacts as proposed for HEDIS 2009, although addressed in guideline [D] (dropped) HEDIS measures for 84 and 180 days, not "9-12" months after acute symptoms resolve [A] Diabetes Checklist (PDF) Good Health Club Physician GLs: Prev. & Treatment of Ped Obesity & DiabetesDisease Burden measures retired 2011 Patient Health Questionnaire (PHQ-9) for Depression(2007 Performance)Tools:Outpatient Management of Uncomplicated Deep Venous Thrombosis1. Pharmacological approaches to outpatient treatmentDisease burden measuresRetired 20111. Acute Myocardial Infarction (AMI)2. Cerebrovascular Accident (CVA)3. Amputations4. DialysisStatin therapy: measurement per specs provided by BCBSMDo not measure ACE/ARB for diabetic members with HTN or albuminuriaDo not measure anti-platelet therapy (low-dose aspirin)Do not measure serum creatinine or calculated GFRM easure only LDL-C, not fasting lipid profile0430153 GuidelineGaps in CareMeasureCommCaidCareSNPM easureCommCaidCareCommentsMost recent performance(2013 data)MQIC GUIDELINES, MEASURES and TOOLS SUMMARY - HEDIS 2014 (Reporting year 2013)Non-HEDISMost recent performance(2013 data) HEDIS No HEDIS measureConsider specifications based on BCBSM PGIP1.

5 Cholesterol Management for Patients with Cardiovascular Conditions (CMC)1. Statin therapy for persons with Cardiovascular Conditions (one rx filled during the measurement year) a. LDL-C Natl HMO b. LDL-C control (<100mg/dL) Natl HMO Controlling High Blood Pressure (CBP) (<140/90 mm Hg) Natl HMO Use of Imaging Studies for Low Back Pain (LBP) Natl HMO measure is for DMARD for RA1. Osteoporosis Management in Women Who Had a Fracture (OMW) Natl HMO ATP III Guidelines At-A-Glance Quick Desk ReferenceHEART LOW BACK PAINOSTEOPOROSIS1 Underuse ACE & ARBs2. Treatment for special populations ( African-Americans)3. Electrolyte monitoring4. Admission and re-admission includes post-event (1/1-11/1) and IVD members (measurement year or year prior) HEDIS is ages 18-75; guideline is 18+ HEDIS is screening for LDL-C onlylStatin therapy: measurement per specs provided by BCBSM DASH Diet Tools:Tools: noneScreening and Management of Hypercholesterolemia1.

6 Pharmacogical management with statin therapyTools: ATP III Cholesterol Mgt Implementation Tool for Palm OS NHLBI Assessment Tool - Estimating your 10-year risk of having a heart attackManagement and Prevention of OsteoporosisTools: none Hypertension Encounter Form (AAFP) Michigan Hypertension Core Curriculum Reference card from the 7th Report of the Joint Natl. Conf. on Prevention, Detection, Evaluation, and Treatment of HBP (JNC 7) FRAX (WHO Fracture Risk Assessment Tool)Medical Management of Adults with Osteoarthritis1. Pharmacological approaches to treatmentManagement of Acute Low Back PainOSTEOARTHRITISHEDIS measures not sufficient- Medicare and women only- Following fracture, not preventive- Osteoporosis testing - from Health Outcomes SurveyTools: noneAdults with Systolic Heart FailureMedical Management of Adults with Hypertension1. Pharmacological approaches to treatment1.

7 Percent members (adult) with any diagnosis of HTN Essential Guide to HTN: Accurate Blood Pressure Readings (AMA)Tools: HEDIS is 18-85; guideline is 18+ HEDIS denominator includes (only) members with dx of HTN during first 6 months of the measurement in CareMeasureCommCaidCareSNPM easureCommCaidCareCommentsMost recent performance(2013 data)MQIC GUIDELINES, MEASURES and TOOLS SUMMARY - HEDIS 2014 (Reporting year 2013)Non-HEDISMost recent performance(2013 data) HEDIS 1. Adult BMI Assessment (ABA) Natl HMO Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) a. BMI Assessment ages Natl HMO Avgn/an/a b. BMI Assessment ages Natl HMO Avgn/an/a c. BMI Assessment all ages Natl HMO d. Nutrition Counseling Natl HMO Avgn/an/a e. Nutrition Counseling Natl HMO Avgn/an/a f. Nutrition Counseling all ages Natl HMO g.

8 Counseling for Phys. Activity Natl HMO Avgn/an/a h. Counseling for Phys. Activity Natl HMO Avgn/an/a i. Couns. for Phys. Activity Total All Natl HMO NHLBI Obesity Education Initiative: Portion Distortion and Adult Clinical Guidelines Slide Sets1. Non-surgical interventions for weight loss and weight management Communication GLs to Promote Health Behavior Change (PDF) (Permanente Medical Group) MI Steps Up Healthy People (comprehensive patient and physician materials) CDC BMI for age and other clinical growth charts for Children & Adolescents Communication GLs to Promote Health Behavior Change (PDF) (Permanente Medical Group) AAP Rx for Healthy Active Living AAP White House Obesity InitiativeOVERWEIGHT/OBESITY47 Prevention and Identification of Childhood Overweight and ObesityTreatment of Childhood Overweight and ObesityTools: CDC BMI Calculator for Children and Teens 2-20 years Good Health Club Physician GLs: Prev.

9 & Treatment of Ped Obesity & Diabetes MI Steps Up Healthy People (comprehensive patient and physician materials)Management of Overweight and Obesity in the Adult NHLBI Adult BMI Online Calculator and downloadable apps and charts CDC Adult BMI Calculator ages 20 and upTools: NHLBI Obesity Education Initiative Slide Sets: Portion Distortion and Adult Clinical Practice Guidelines0430155 GuidelineGaps in CareMeasureCommCaidCareSNPM easureCommCaidCareCommentsMost recent performance(2013 data)MQIC GUIDELINES, MEASURES and TOOLS SUMMARY - HEDIS 2014 (Reporting year 2013)Non-HEDISMost recent performance(2013 data) HEDIS 1. Appropriate testing for children with pharyngitis (CWP) Natl HMO HEDIS measureNo meaningful measures from administrative data1. Prenatal and Postpartum Care (PPC) a. Prenatal: % deliveries that received a prenatal care visit in 1st trimester or within 42 days after Natl HMO b.

10 Postpartum: % deliveries that had postpartum visit on or between 21-56 days after Natl HMO AND POSTPARTUM CARET ools: Preconception Screening & Counseling Checklist (March of Dimes)PHARYNGITISPREGNANCY PREVENTION CDC Get Smart, Know When Antibiotics Work. Pharyngitis: Treat Only Proven Group A StrepAcute Pharyngitis in Children 2-18 years1. Inappropriate use of antibioticsPrevention of Pregnancy in Adolescents 12-17 years MDCH Teen Pregnancy Prevention InitiativeTools: Prevention of Unintended Pregnancy in Adults18 Years and Older1. Interventions to decrease risk of unintended pregnancy Preventing Unintended Pregnancy in Adults Provider Toolkit ( ) Patient Fact Sheets ( )Tools: Routine Prenatal and Postnatal Care1. Interventions to decrease risk of unintended pregnancy in adolescents Provider Tool for DialogueTools: HEDIS frequency of on-going prenatal care is Medicaid only.