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Public listing of 2014 Non-QPP measures  -  CUHSM.ORG - V2


 


Version 2b - nature of changes:
1) Measure number - name correction - change CUSHM to CUHSM
2) TBD - Future Changes anticipated in CG-CAPS measure definition  (~July 2014)
3) Type of information changes
       Yellow Background - information changed
       Blue Background = information moved
 

 
 

Note: The Public listing of CUHSM.ORG non-QPP measures using Input Tool  is located at bottom of this page

Public listing of CUHSM.ORG non-QPP measures -Narrative version
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ID: 
CUHSM #1
NQF#:
0569
eCQM#:
NA
Measure Title:
Adherence to Statins
Measure Description:
To ensure that members who are taking statins to treat hyperlipidemia filled sufficient medication to have at least 80% coverage during the measurement year.
NQS Domain:
Effective Communication and Care Coordination

Numerator:
The numerator consists of members in the denominator who filled a sufficient days supply of a statin to provide for at least 80% coverage (Medication Possession Ratio (MPR) >= 80%) during the measurement year. Of note, new users of a statin that started after the first 3 months of the measurement year will be excluded from the calculation.
Denominator:
Continuously enrolled members ages 19 years or older by the end of the measurement year who had a diagnosis of hyperlipidemia anytime prior to the end of the measurement year, cardiovascular disease or diabetes during the year prior to the measurement year, and filled at least a 60 days supply of statin during the measurement year.
Denominator Exclusions / Exceptions:
Members who were pregnant or diagnosed with myositis or rhabdomyolysis during the measurement year, members diagnosed with acute renal disease during the measurement year, members diagnosed with liver dysfunction (acute or chronic), alcoholism, or liver transplantation during the measurement year or members who were newly started on statin medication in the 4th through 12th month of the measurement year. Of note, MPR will not be calculated for these individuals, thus they will be dropped from the denominator.
Rationale:
Drug therapies can reduce hospitalizations, but nonadherence is high, ranging from 30% to 80%
Measure Type (Process/Outcome): 
Process
Steward:
Health Benchmarks - IMS-Health
Data Source:
Electronic Clinical Data: Pharmacy

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ID: CUHSM #2
NQF#
0541
eCQM# NA
Measure: 
5 Rates by Therapeutic Category - Proportion of Days Covered (PDC):
Title:
The percentage of patients 18 years and older who met the proportion of days covered (PDC) threshold of 80% during the measurement year.
Measure Description:
A performance rate is calculated separately for the following medication categories: Beta-Blockers (BB), Renin Angiotensin System (RAS) Antagonists, Calcium-Channel Blockers (CCB), Diabetes Medications, Statins.
NQS Domain:
Effective Communication and Care Coordination
Numerator:
The number of patients who met the PDC threshold during the measurement year for each therapeutic category separately. Follow the steps below for each patient to determine whether the patient meets the PDC threshold. 

Step 1: Determine the patient´s measurement period, defined as the index prescription date to the end of the calendar year, disenrollment, or death.
Step 2: Within the measurement period, count the days the patient was covered by at least one drug in the class based on the prescription fill date and days of supply. If prescriptions for the same drug (GCN) overlap, then adjust the prescription start date to be the day after the previous fill has ended.
Step 3: Divide the number of covered days found in Step 2 by the number of days found in Step 1. Multiply this number by 100 to obtain the PDC (as a percentage) for each patient.
Step 4: Count the number of patients who had a PDC greater than 80% and then divide by the total number of eligible patients.
Denominator:
Patients who were dispensed at least two prescriptions in a specific therapeutic category on two unique dates of service during the measurement year.
Denominator Exclusions / Exception:
Exclusion criteria for the PDC category of Diabetes medications: Patients who have one or more prescriptions for insulin in the measurement period.
Rationale: Drug therapies can reduce hospitalizations, but non-adherence is high, ranging from 30% to 80%.
There is an urgent need to identify cost-effective ways to improve adherence and reduce hospitalizations.
Measure Type (Process/Outcome):
Process
Steward:
Pharmacy Quality Alliance
Data Source:
Electronic Clinical Data:Pharmacy
 

ID: CUHSM #3
NQF#
0005
eCQM# NA
Measure Title:
CAHPS Clinician/Group Surveys -Adult Primary Care - Pediatric Care - Specialist Care Surveys
Measure Description:
-
Adult Primary Care Survey: 37 core and 64 supplemental question survey of adult outpatient primary care patients.
-Pediatric Care Survey: 36 core and 16 supplemental question survey of outpatient pediatric care patients.
-Specialist Care Survey: 37 core and 20 supplemental question survey of adult outpatients specialist care patients.
Level of analysis for each of the 3 surveys: group practices, sites of care, and/or individual clinicians
NQS Domain:
Patient/Caregiver Experience
Numerator:
TBD by CMS
Denominator: 
TBD by CMS
Denominator Exclusions / Exception:
TBD by CMS
Rationale:
Demonstrated ability of CG-CAHPS patient experience surveys to reveal gaps in system performance, to enhance loyalty to practices, increase member satisfaction, and to correlate with better performance on effective care processes, adherence and outcomes, creating a system to measure patient experience is foundational to the success of any new payment reform model.
Measure Type (Process/Outcome):
Process
Steward: QRHQ
Data Source:
Survey: Patient Reported Data/Survey

ID:
CUHSM #4
NQF#
0006
eCQM#
NA
Measure Title:
CAHPS Health Plan Survey v 4.0 - Adult questionnaire
Measure Description: 30-question core survey of adult health plan members that assesses the quality of care and services they receive. Level of analysis: health plan – HMO, PPO, Medicare, Medicaid, commercial
NQS Domain: Patient/Caregiver Experience
Numerator:
TBD by CMS
Denominator: 
TBD by CMS
Denominator Exclusions / Exception:
TBD by CMS
Rationale: Demonstrated ability of CG-CAHPS patient experience surveys to reveal gaps in system performance, to enhance loyalty to practices, increase member satisfaction, and to correlate with better performance on effective care processes, adherence and outcomes, creating a system to measure patient experience is foundational to the success of any new payment reform model.
Measure Type (Process/Outcome):
Process
Steward:
AHRQ
Data Source:
Survey: Patient Reported Data/Survey

ID:
CUHSM #5
NQF#
0553
eCQM# NA
Measure Title:
Care for Older Adults (COA) Medication Review
Measure Description:
Percentage of adults 65 years and older who had a medication review during the measurement year; a review of all a member’s medications, including prescription medications, over-the-counter (OTC) medications and herbal or supplemental therapies by a prescribing practitioner or clinical pharmacist.
NQS Domain:
Effective Communication and Care Coordination
Numerator:
At least one medication review conducted by a prescribing practitioner or clinical pharmacist during the measurement year and the presence of a medication list in the medical record 
Denominator: All patients 66 and older as of the end (e.g., December 31) of the measurement year.
none
Denominator Exclusions / Exception: n/a
Rationale:
This NQF measure is not driven by a hospital discharge (whereas QPP measure is driven by hospital discharge); this measure assesses annual outpatient medication review.
Measure Type (Process/Outcome):
Process
Steward:
NQF
Data Source:
Administrative claims, Electronic Clinical Data, Paper records
 

 

 

 

       
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