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Johns Hopkins Health Plans

SMD - Diabetes Monitoring for People With Diabetes and Schizophrenia

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 diabetes who had both an LDL-C test and an HbA1c test during the measurement period.

Improvement Notation:
Increased score indicates improvement.

Data Collection:

  • Administrative.
  • Supplemental .

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.
  • 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 schizophrenia or schizoaffective disorder and diabetes.
Persons with schizophrenia or schizoaffective disorder are 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 diabetes. Either of the following meets criteria for 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:
An HbA1c and LDL-C test performed during the measurement period (on the same or different dates of service). The person must have both tests to be included in the numerator. The organization may use a calculated or direct LDL.

  • HbA1c Lab Test.
  • HbA1c Test Result or Finding.
  • LDL C Lab Test Value Set.
  • LDL C Test Result or Finding. 

Best Practice and Measure Tips

  • Order annual screening tests and establish care gap alerts within your electronic medical record system.
  • To ensure optimal visit outcomes, request that lab tests be completed prior to the member's scheduled appointment.
  • Follow up with patients to discuss and educate them about their lab results.
  • Coordinate care with patients' other providers.
  • Reach out to patients who cancel appointments and promptly reschedule them.
  • Discuss the importance of HbA1c and 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.
  • Educate members on the symptom’s indicative of new-onset diabetes.
  • Consider referring members to a dietitian or other healthcare professionals.
  • Promote shared decision-making by informing patients and caregivers about the increased risk of diabetes.

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

HbA1c Lab Test

  • CPT: 83036, 83037
  • LOINC: 4548-4, 4549-2, 17855-8, 17856-6, 96595-4

HbA1c Test Result or Finding

  • CPT-CAT-II: 3044F, 3046F, 3051F, 3052F
  • SNOMED CT US: 165679005, 451061000124104

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

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