Product Lines: Priority Partners.

Measurement Period: January 1 - December 31 

Description: 
The percentage of persons 18–64 years of age with schizophrenia or schizoaffective disorder and cardiovascular disease, who had an LDL-C test during the measurement period.

Improvement Notation:
Increased score indicates improvement.

Data Collection:

• Administrative.
• Supplemental.
  

Initial Population:

• Measure Item Count: Person.
• Age: 18–64 years of age as of the last day of the measurement period.
• Benefits: Medical.
• Continuous Enrollment: The measurement period and the year prior to 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.

Denominator:
Persons with cardiovascular disease and schizophrenia.
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.

Persons who also have cardiovascular disease as those who met at least one of the following:

• Event. Any of the following during the year prior to the measurement period meet criteria:
  
  • Discharged from an inpatient setting with an AMI diagnosis on the discharge claim. 
  • Persons who had CABG in any setting. 
  • Persons who had PCI in any setting.
• Diagnosis. Persons with IVD as those who met at least one of the following criteria during both the measurement period and the year prior to the measurement period. Criteria need not be the same across both years. 
  
  • An outpatient visit, telephone visit, e-visit, virtual check-in or acute inpatient encounter with an IVD diagnosis. 
  • At least one acute inpatient discharge with a diagnosis of IVD on the discharge claim.

Numerator
Persons who had at least one LDL-C test performed during the measurement period.

Either of the following meets criteria:

• LDL C Lab Test
• LDL C Test Result or Finding

Note: The organization may use a calculated or direct LDL.

Best Practice and Measure Tips

• Follow up with patients to discuss and educate them about their lab results.
• To ensure optimal visit outcomes, request that lab tests be completed prior to the member's scheduled appointment.
• Coordinate care with patients' other providers, such as their Primary Care Physician, Behavioral Health Specialists, and other relevant healthcare professionals.
• Reach out to patients who cancel appointments and promptly reschedule them.
• Order annual cholesterol (LDL-C) screening tests and set up care gap alerts in your electronic medical record system.
• Discuss the importance of LDL-C testing with members.
• Educate members about the increased risk of cardiovascular disease associated with antipsychotic medications and provide lifestyle counseling on nutrition and physical activity.
• Consider referring members to a dietitian or other healthcare professionals.

Measure Exclusions

Denominator Exclusions:

• Persons in hospice or using hospice services any time during the measurement period.
• Persons who died any time during the measurement period.

Numerator Exclusions:
For CPT Category II codes do not include:

• Laboratory claims (POS 81).
• CPT CAT II Modifier.

Measure Codes

LDL C Lab Test

• CPT: 80061, 83700, 83701, 83704, 83721
• LOINC: 12773-8,13457-7, 18261-8, 18262-6, 2089-1, 49132-4, 55440-2, 96259-7

LDL C Test Result or Finding

• CPT-CAT-II: 3048F, 3049F, 3050F