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Johns Hopkins Health Plans

BDP/BPD-E - Blood Pressure Control for Patients with Diabetes

Product Lines:

Advantage MD, EHP, Priority Partners, and USFHP.

Measurement Period: January 1 - December 31

Eligible Population:
Members 18-75 years old as of December 31 of the measurement year. This includes HealthChoice Performance Measure reporting for Priority Partners.

Description:
The percentage of persons 18–75 years of age with diabetes (type 1 and type 2) whose blood pressure (BP) was adequately controlled (< 140/90) during the measurement period. Note: Uses last BP of the year.

Measure Reporting:
HealthChoice Performance Measure reporting for Priority Partners.

Improvement Notation: Increased score indicates improvement.

Data Collection: 

  • Administrative
  • ECDS
  • Hybrid
  • Supplemental

Initial Population:

  • Measure Item Count: Person
  • Age: 18–75 years of age as of the last day of the measurement period.
  • Benefits: Medical
  • Continuous Enrollment: The measurement period
  • Allowable Gap: No more than one gap of ≤45 days during each year of continuous enrollment. No gaps on the last day of the measurement period.

Denominator:

Persons with a diagnosis of diabetes.

  • Claim/encounter data. At least two diagnoses of diabetes on different dates of service during the measurement period or the year prior to the measurement period.
  • Pharmacy data. At least one diagnosis of diabetes and at least one diabetes medication dispensing event of insulin or a hypoglycemic/antihyperglycemic medication during the measurement period or the year prior to the measurement period.

Numerator:

Both a systolic and diastolic reading <140/90 mm Hg.
The most recent BP reading taken during the measurement period.

  • Compliant: BP is <140/90 mm Hg.
  • Non-compliant: BP is ≥140/90 mm Hg; no BP reading during the measurement period; or if the reading is incomplete (e.g., the systolic or diastolic level is missing).

If there are multiple BPs on the same date of service, use the lowest systolic and lowest diastolic BP on that date as the representative BP.

Summary of changes: This is the first year this measure is reported using ECDS and the measure will be in first year status for measurement year 2026. 

Best Practice and Measure Tips

BP reading must be the last BP result performed within the measurement year. 

See CBP Measure for tips.

Measure Exclusions

Denominator Exclusions:

  • Persons receiving Palliative Care or had an encounter for Palliative Care any time during the intake period through the last day of the measurement period.
  • Persons in hospice or using hospice services any time during the measurement period.
  • Persons who died any time during the measurement period.
  • Members 66 years of age and older as of December 31 of the measurement year (all product lines) with frailty and advanced illness.
  • Persons 66-80 years of age by the last day of the measurement period, with both frailty and advanced illness.     
    • Frailty. At least two indications of frailty with different dates of service during the intake period through the last day of the measurement period.
    • Advanced Illness. Either of the following during the measurement period or the year prior to the measurement period:
      • Advanced illness on at least two different dates of service.
      • Dispensed dementia medication.
  • Medicare enrollees, 66 years of age and older by the last day of the measurement period, in an institutional SNP (I-SNP) or living long-term in an institution (LTI).
  • Diagnosis code on a laboratory claim (POS 81) for:
    • Diabetes
    • Frailty
    • Advanced illness
    • Palliative care

Numerator Exclusions:

  • Do not include CPT Category II modifier.
  • Do not include BPs taken in an acute inpatient setting or during an ED visit (POS code 23).

Measure Codes

Systolic Blood Pressure

  • Systolic Less Than 140 CPT-CAT-II: 3074F (<130 mm Hg), 3075F (130-139 mm Hg)
  • Systolic Greater Than or Equal to 140 CPT-CAT-II: 3077F
  • LOINC: 8459-0, 8480-6, 8508-4, 8546-4, 8547-2, 75997-7

Diastolic Blood Pressure

  • Diastolic Less Than 90 CPT-CAT-II:  3078F (<80 mm Hg), 3079F (80-89 mm Hg)
  • Diastolic Greater Than or Equal to 90 CPT-CAT-II:  3080F
  • LOINC: 8453-3, 8462-4, 8496-2, 8514-2, 8515-9, 75995-1
     

Measure Medications

Diabetes Medications List 
Alpha-glucosidase inhibitors

  • Acarbose
  • Miglitol

Amylin analogs

  • Pramlintide

Antidiabetic combinations

  • Alogliptin-metformin 
  • Alogliptin-pioglitazone
  • Canagliflozin-metformin
  • Dapagliflozin-metformin
  • Dapagliflozin-saxagliptin
  • Empagliflozin-linagliptin
  • Empagliflozin-metformin
  • Empagliflozin-linagliptin-metformin
  • Ertugliflozin-metformin
  • Ertugliflozin-sitagliptin
  • Glimepiride-pioglitazone
  • Glipizide-metformin
  • Glyburide-metformin
  • Linagliptin-metformin 
  • Metformin-pioglitazone
  • Metformin-rosiglitazone
  • Metformin-saxagliptin
  • Metformin-sitagliptin

Insulin

  • Insulin aspart 
  • Insulin aspart-insulin aspart protamine
  • Insulin degludec 
  • Insulin degludec-liraglutide
  • Insulin detemir
  • Insulin glargine
  • Insulin glargine-lixisenatide 
  • Insulin glulisine 
  • Insulin isophane human
  • Insulin isophane-insulin regular
  • Insulin lispro
  • Insulin lispro-insulin lispro protamine 
  • Insulin regular human
  • Insulin human inhaled

Meglitinides

  • Nateglinide
  • Repaglinide

Biguanides

  • Metformin

Glucagon-like peptide-1 (GLP1) agonists

  • Albiglutide
  • Dulaglutide
  • Exenatide
  • Liraglutide
  • Lixisenatide 
  • Semaglutide
  • Tirzepatide

Sodium glucose cotransporter 2 (SGLT2) inhibitor

  • Canagliflozin
  • Dapagliflozin
  • Empagliflozin
  • Ertugliflozin

Sulfonylureas

  • Chlorpropamide
  • Glimepiride
  • Glipizide
  • Glyburide
  • Tolazamide
  • Tolbutamide

Thiazolidinediones

  • Pioglitazone
  • Rosiglitazone

Dipeptidyl peptidase-4 (DDP-4) inhibitors

  • Alogliptin
  • Linagliptin
  • Saxagliptin
  • Sitagliptin