Product Lines: Advantage MD, EHP, Priority Partners, and USFHP.

Measurement Period: January 1–December 31.

Description:
The percentage of persons 18 years of age and older during the measurement period, with schizophrenia or schizoaffective disorder, who were dispensed and remained on an antipsychotic medication for at least 80% of their treatment period.

Improvement Notation:
Increased score indicates improvement.

Data Collection:

• Administrative.
• Supplemental.

Initial Population:

• Measure Item Count: Person.
• Age: 18 years of age and older as of the start of the measurement period.
• Benefits: Medical and pharmacy.
• Continuous Enrollment: The measurement period.
• Allowable Gap: No more than one gap of ≤45 days during the measurement period. No gaps on the last day of the measurement period.

Definition:
IPSD - Index prescription start date: The earliest prescription dispensing date for any antipsychotic medication during the measurement year.

Long-acting injections dispensing event: Injections count as one dispensing event. Multiple codes (from the value sets and medication lists) for the same or different medication on the same day count as a single dispensing event.

Oral medication dispensing event: One prescription of an amount lasting 30 days or less.
Multiple prescriptions for different medications dispensed on the same day count as separate dispensing events. If multiple prescriptions for the same medication are dispensed on the same day, use the prescription with the longest days supply. Use the medication lists to determine if drugs are the same or different. Drugs in different lists are considered different drugs.

Treatment period: The period of time beginning on the IPSD through the last day of the measurement year.

PDC - Proportion of days covered: The number of days a member is covered by at least one antipsychotic medication prescription, divided by the number of days in the treatment period.

Treatment period: The period of time beginning on the IPSD through the last day of the measurement year.

Denominator:
Persons with a diagnosis of schizophrenia or schizoaffective disorder.
Persons with schizophrenia or schizoaffective disorder as those who met at least one of the following criteria during the measurement period:

• At least one acute inpatient encounter with any diagnosis of schizophrenia or schizoaffective disorder.
• At least two visits in an outpatient, intensive outpatient, partial hospitalization, ED or nonacute inpatient setting, on different dates of service, with any diagnosis of schizophrenia or schizoaffective disorder.

Numerator:

The number of members who achieved a PDC of at least 80% for their antipsychotic medications during the measurement year.

Best Practice and Measure Tips

• Ensure providers maintain appointment availability and schedule follow-up appointments before patients leave.
• Reach out to patients who miss follow-up appointments, set flags in the EHR, or develop a tracking system for those due or past due for follow-up visits, and require staff to follow up with patients who miss or cancel appointments.
• Coordinate care with patients' behavioral health specialists.
• Promptly reschedule appointments for patients who cancel or offer Telehealth visits.
• Ways to help patients find care they need:
  • Verify if the mental health provider is a good fit by considering location, transportation and time.
  • Identify and address any barriers that may prevent member from keeping the appointment.
  • Making sure member has a good support system by engaging parents/guardian or significant others in the treatment plan, stressing the importance of treatment, and attending to their appointment.
  • Share all transition of care with the member’s Primary Care Physician (PCP) to ensure members follows-up with the treatment plan.
  • Ensure member has a PCP.
• Member / Caregiver Education:
  • Consistently adhering to the medication regiment.
  • Discuss potential medication side effects with patients and inform them what to do if the side effect is severe and can potentially result in lack of adherence to the medication regiment and treatment plan and when to contact the provider.
  • Discuss potential medication side effects.
    • When to contact provider and what to do if the side effect is severe.
  • Crisis Intervention options.
• Submit all claims with correct service coding and principal diagnosis timely.
• Assess the need for Case Management and refer if necessary.
  • The Johns Hopkins Health Plans Care Management team offers a variety of services to help members who are living with substance abuse and mental health issues may receive confidential care management support and coordination of care from a Licensed Clinical Social Worker. These behavioral health clinicians help members navigate their treatment needs for conditions such as depression, anxiety disorders, addictions, and autism spectrum disorders. For Priority Partners members, we work with Carelon Behavioral Health of Maryland to manage mental health needs.
    • Please send us your member referrals by contacting us at:
      Phone: 800-557-6916
      Monday through Friday: 8 a.m. to 5 p.m.
      Voicemail messages received after normal business hours will be addressed the following business day.
      EHP Behavioral Health: 410-424-4891
      EHP Behavioral Health- Secured: 410-424-4765
      USFHP Mental Health: 410-424-4839
      Advantage MD Behavioral Health, Inpatient & Outpatient: 844-340-2217
      Email: [email protected]

Measure Exclusions

Denominator Exclusions:

• Persons in hospice or using hospice services anytime any time during the measurement period.
• Persons who died any time during the measurement period.
• Persons 66–80 years of age by the last day of the measurement period, with both frailty and advanced illness.
• Persons 81 years of age and older by the last day of the measurement period, with frailty.
• Medicare enrollees, 66 years of age and older by the last day of the measurement period, in an Institutional Special Needs Plan (I-SNP) or Living long-term in an institution (LTI).
• A diagnosis of dementia during the measurement period.
• Persons who did Did not have at least two antipsychotic medication dispensing events.

Exclusion Codes

Dementia

• ICD-10-CM: F01.50, F01.51, F01.511, F01.518, F01.52, F01.53, F01.54, F01.A0, F01.A11, F01.A18, F01.A2, F01.A3, F01.A4, F01.B0, F01.B11, F01.B18, F01.B2, F01.B3, F01.B4, F01.C0, F01.C11, F01.C18, F01.C2, F01.C3, F01.C4, F02.80, F02.81, F02.811, F02.818, F02.82, F02.83, F02.84, F02.A0, F02.A11, F02.A18, F02.A2, F02.A3, F02.A4, F02.B0, F02.B11, F02.B18, F02.B2, F02.B3, F02.B4, F02.C0, F02.C11, F02.C18, F02.C2, F02.C3, F02.C4, F03.90, F03.91, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A0, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B0, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C0, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, F04, F10.27, F10.97, F13.27, F13.97, F18.17, F18.27, F18.97, F19.17, F19.27, F19.97, G30.0, G30.1, G30.8, G30.9, G31.83
• SNOMED CT US Edition: 281004, 4817008, 6475002, 9345005, 10349009, 10532003, 12348006, 14070001, 15662003, 25772007, 26852004, 26929004, 32875003, 51928006, 52448006, 54502004, 55009008, 56267009, 59651006, 62239001, 65096006, 66108005, 70936005, 82959004, 90099008, 111480006*

* Please note that not all SNOMED CT US Edition codes are listed here. For access to the complete set of codes, contact your Provider Engagement Liaison or email [email protected].

Measure Codes

• Long Acting Injections 28 Days Supply HCPCS:
  • J0401 Injection, aripiprazole (abilify maintena), 1 mg
  • J1631 Injection, haloperidol decanoate, per 50 mg
  • J1943 Injection, aripiprazole lauroxil, (aristada initio), 1 mg
  • J1944 Injection, aripiprazole lauroxil, (aristada), 1 mg
  • J2358 Injection, olanzapine, long-acting, 1 mg
  • J2426 Injection, paliperidone palmitate extended release (invega sustenna), 1 mg
  • J2680 Injection, fluphenazine decanoate, up to 25 mg
• Long Acting Injections 14 Days Supply HCPCS:
  • J2794 Injection, risperidone (risperdal consta), 0.5 mg
  • J2801 Injection, risperidone (rykindo), 0.5 mg
• Injection, risperidone, (perseris), 0.5 mg HCPCS: J2798

Measure Medications

Oral Antipsychotic Medications

• Amitriptyline Perphenazine Oral Medications
• Aripiprazole Oral Medications
• Asenapine Oral Medications
• Brexpiprazole Oral Medications
• Cariprazine Oral Medications
• Chlorpromazine Oral Medications
• Clozapine Oral Medications
• Fluphenazine Oral Medications
• Haloperidol Oral Medications
• Iloperidone Oral Medications
• Loxapine Oral Medications
• Lumateperone Oral Medications
• Lurasidone Oral Medications
• Molindone Oral Medications
• Olanzapine Oral Medications
• Paliperidone Oral Medications
• Perphenazine Oral Medications
• Prochlorperazine Oral Medications
• Quetiapine Oral Medications
• Risperidone Oral Medications
• Thioridazine Oral Medications
• Thiothixene Oral Medications
• Trifluoperazine Oral Medications
• Ziprasidone Oral Medications

Long-Acting Injections

Long Acting Injections 14 Days Supply Medications

• Risperidone (excluding Perseris®)

Long Acting Injections 28 Days Supply Medications

• Aripiprazole
• Aripiprazole lauroxil
• Fluphenazine decanoate
• Haloperidol decanoate
• Olanzapine

Long Acting Injections 30 Days Supply Medications

• Risperidone(Perseris®)

Long Acting Injections 35 Days Supply Medications: risperidone

• Amitriptyline-perphenazine (Erzofri, Invega)

Long Acting Injections 104 Days Supply Medications

• Amitriptyline-perphenazine (Invega)

Long Acting Injections 201 Days Supply Medications

• Amitriptyline-perphenazine (Invega)