Product Lines:
Priority Partners.

Measurement Period: January 1 - December 31

Description: 
The percentage of persons 18–64 years of age with schizophrenia, schizoaffective disorder or bipolar disorder, who were dispensed an antipsychotic medication and had a diabetes screening 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 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.

Denominator:
Persons with schizophrenia or bipolar disorder.
Persons who met at least one of the following criteria during the measurement period.

• At least one acute inpatient encounter with any diagnosis of schizophrenia, schizoaffective disorder or bipolar disorder. 
• At least two of the following, on different dates of service, where both encounters have any diagnosis of schizophrenia or schizoaffective disorder or both encounters have any diagnosis of bipolar disorder:
  • An outpatient visit.
  • An intensive outpatient encounter or partial hospitalization.
  • A community mental health center visit.
  • Electroconvulsive therapy.
  • An ED visit.
  • A nonacute inpatient encounter.
  • A telehealth visit.
  • A telephone visit.
  • An e-visit or virtual check-in.

Numerator:
Persons with a glucose test or an HbA1c test.
Any of the following meet criteria:

• Glucose Lab Test
• Glucose Test Result or Finding
• HbA1c Lab Test
• HbA1c 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 diabetes screening with members.
• 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.
• 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.
• Persons with a diagnosis of diabetes. Either of the following meets criteria:
  • 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.
• Persons without at least one antipsychotic medication dispensing event. Either of the following meets criteria:
  • Claim/encounter data. An antipsychotic medication.
  • Pharmacy data. Dispensed an antipsychotic medication. 

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

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

Exclusion Codes

The Diabetes Value Set exclusion codes are too numerous to list here. To obtain the complete set of codes, please contact your Provider Engagement Liaison or email [email protected].

Long-Acting Injections HCPCS: J0401, J1631, J1943, J1944, J2358, J2426, J2680, J2794, J2798, J2801

Exclusion Medications

Antipsychotic Medications List

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

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 

Measure Codes

Glucose Lab Test

• CPT: 80047, 80048, 80050, 80053, 80069, 82947, 82950, 82951
• LOINC: 10450-5, 1492-8, 1494-4, 1496-9, 1499-3, 1501-6, 1504-0, 1507-3, 1514-9, 1518-0, 1530-5, 1533-9, 1554-5, 1557-8, 1558-6, 17865-7, 20436-2, 20437-0, 20438-8, 20440-4, 2345-7, 26554-6, 41024-1, 49134-0, 6749-6, 9375-7

Glucose Test Result or Finding

• SNOMED CT: 166890005, 166891009, 166892002, 166921001, 166922008, 442545002, 444780001, 1179458001, 1259140002

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