Osteoporosis management in women who had a fracture (OMW) Weight = 1 Percentage of females 67 to 85 years old who suffered a fracture and had either a bone mineral density (BMD) test or prescription to treat or prevent osteoporosis in the six months after the fracture To exclude: Either a BMD within 24 months or drug treatment for osteoporosis within 12 months prior to the fracture date Perform bone mineral density testing within 180 days of fracture date. and/or Prescribe a medication to treat or prevent osteoporosis within 180 days (six months) after the fracture. Physician codes Osteoporosis therapy – medication injections HCPCS: J0630, J0897, J1740, J3110, J3487, J3488, J3489 Radiology codes Bone mineral density test CPT: 76977, 77078, 77080, 77081, 77082, 77085, 77086 HCPCS: G0130 ICD-10-CM procedure: BP48ZZ1, BP49ZZ1, BP4GZZ1, BP4HZZ1, BP4LZZ1, BP4MZZ1, BP4NZZ1, BP4PZZ1, BQ00ZZ1, BQ01ZZ1, BQ03ZZ1, BQ04ZZ1, BR00ZZ1, BR07ZZ1, BR09ZZ1, BR0GZZ1 NDC codes are several NDC codes for prescriptions to treat osteoporosis based on pharmacy claims received by Humana. NCQA posts a comprehensive list of these NDC codes on its website each year. Description: Bisphosphonates ▪ Alendronate ▪ Ibandronate ▪ Alendronate-cholecalciferol ▪ Risedronate ▪ Calcium carbonate-risedronate ▪ Zoledronic acid Description: Other agents Calcitonin ▪ Raloxifene Denosumab ▪ Teriparatide Additional information The following codes identify fractures (eligible members) S2360
Disease-modifying antirheumatic drug (DMARD) therapy for rheumatoid arthritis (ART) Continued Description: Immunomodulators ▪ Certolizumab pegol ▪ Tocilizumab Description: Immunosuppressive agents ▪ Azathioprine ▪ Cyclosporine ▪ Mycophenolate Description: kinase (JAK) inhibitor ▪ Tofacitinib Description: Tetracyclines ▪ Minocycline Adult body mass index (BMI) assessment (ABA) Weight = 1 Percentage of members 18 to 74 years old who had an outpatient visit and who had a BMI documented during the measurement year or the year prior to the measurement year Note: The weight and BMI must be from the same data source. Documented BMI for outpatient visits in 2016 or 2017 Physician codes Codes to identify BMI assessment ICD-10-CM diagnosis: Z68.1, Z68.20-39, Z68.41-45, Z68.51 – Z68.54
Care for adults advanced care planning (COA‒ACP) Weight = N/A (Medicare SNP only) Percentage of adults 66 years old and older who had advance care planning (advance directive, living will, power of attorney, health care proxy, actionable medical decision-maker or surrogate decision-maker) during the measurement year Advance care planning Documentation of advance care planning in 2017 Evidence of advance care planning must include: An advance care plan in the medical record or Advance care planning discussion with the provider documented and in the medical record or Notation that the member has previously executed an advance care plan that meets criteria Physician codes CPT: 99497 CPT Category II: 1158F HCPCS: S0257
Influenza vaccination status (Weight = 1) Percentage of plan members who reported having received an influenza vaccination between July 2017 and the date when the Medicare CAHPS survey was completed (March through June 2018) Order influenza vaccine for your office in advance of flu season. Identify options for purchasing additional vaccines and/or referring patients to alternative administration sites should demand exceed your supply of vaccines. Make sure all eligible members are encouraged to receive an influenza vaccination between September and December each year. Make efforts to confirm the member understands services rendered. Note: Make sure that is submitted and that it includes the appropriate CPT code for the flu shot administration date of service. Did you get a flu shot last year?
Taking pressure medication as directed (Weight = 3) Medicare Part D beneficiaries 18 years old or older with a prescription for a blood pressure medication who fill their prescription often enough to cover 80 percent or more of the time they are supposed to be taking the medication. Note: In this measure, pressure medication” means an ACE (angiotensin-converting enzyme) inhibitor or an ARB (angiotensin receptor blocker) drug, or a direct renin inhibitor drug. Assess proactively whether patient is taking medication as prescribed. Discuss adherence barriers with your patients to identify and resolve them. Encourage adherence by providing 90-day prescriptions for maintenance drugs. Provide an updated prescription to the pharmacy if your patient’s medication dose has changed since his/her original prescription. Refer patients to http://humana.com/takemymedicine for adherence tips and tools. No reporting required from health care providers. The health plan evaluates prescription claims data for this measure. Taking cholesterol medication as directed (Weight = 3) Percentage of Medicare Part D beneficiaries 18 or older with a prescription for a cholesterol medication who fill their prescription often enough to cover 80 percent or more of the time they are supposed to be taking the medication Note: In this measure, “cholesterol medication” means a statin drug. Assess proactively whether patient is taking medication as prescribed. Discuss adherence barriers with your patients to identify and resolve them. Encourage adherence by providing 90-day prescriptions for maintenance drugs. Provide an updated prescription to the pharmacy if your patient’s medication dose has changed since his/her original prescription. patients to http://humana.com/takemymedicine for adherence tips and tools. No reporting required from health care providers. The health plan evaluates prescription claims data for this measure.