The Centers for Medicare &
Medicaid Services (CMS) uses performance and quality measures to help Medicare
beneficiaries make informed decisions regarding medical and prescription drug
programs. As part of this effort, CMS calculates and publicizes several patient
safety measures, many of which are used to calculate ratings for health plans.
We are committed to working with our
providers to improve outcomes on these patient safety measures. As a first
step, we want to explain each measure as well as the role you can play to
ensure that our Medicare Advantage HMO and PPO members are receiving care that
is both safe and effective. The measures and their descriptions are listed
below.
High-Risk Medication (HRM)
The HRM rate analyzes the percentage of Medicare
Part D beneficiaries who are 65 and older and have filled prescriptions for
medications with a high risk of serious side effects in the elderly. The list of medications
that CMS defines as high-risk in the elderly was adapted from the National
Committee for Quality Assurance's (NCQA) Healthcare Effectiveness Data and
Information Set (HEDIS?) and adapted and
endorsed by the Pharmacy Quality Alliance (PQA). Providers should avoid
prescribing these medications, when possible, to patients who are 65 and
older.
Diabetes Treatment (DT)
The DT rate analyzes the percentage of Medicare
Part D beneficiaries who are 18 and older and have filled a prescription for
both diabetes and hypertension but did not
fill a prescription for an ACEI or ARB medication. Providers who have diabetic
patients who also need hypertension medications are encouraged to prescribe an
ACEI or ARB and educate their patients about the importance of taking an ACEI
or ARB in conjunction with treatment for diabetes and hypertension. CMS
provides a list of the
diabetes and hypertension medications included in this measure.
Drug-Drug Interaction (DDI)
The DDI rate analyzes the percentage of Medicare
Part D beneficiaries who have filled a prescription for a targeted medication
during the measurement period and who also filled a prescription for a
contraindicated medication, either at the same time or subsequent to the
initial prescription. Providers can view the list of targeted and contraindicated medications on
the CMS website and should avoid prescribing these medications together.
Diabetes Medication Dosage (DMD)
The DMD rate analyzes the percentage of Medicare
Part D beneficiaries who filled a prescription at a dose that was higher than
the daily recommended dose for biguanide, sulfonylurea, and thiazolidinedione
therapeutic classes of oral hypoglycemic drugs. Providers can view the list of
maximum recommended adult doses for these drugs on the CMS website and are
encouraged to prescribe them within the recommended dose range.
Part D Medication Adherence (ADH)
The ADH rates assess the extent to which Medicare
Part D beneficiaries adhered to their prescribed medications in the following
drug classes/therapeutic areas: antiretrovirals, cholesterol (statins),
hypertension (ACEI or ARB), and oral diabetes medications. Providers are
encouraged to educate their patients who have been prescribed these medications
about the importance of taking and refilling their prescriptions.
HEDIS® is a
registered trademark of the National Committee for Quality Assurance (NCQA).