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 who were hospitalized and discharged from July 1 of the year prior to the measurement period to June 30 of the measurement period with a diagnosis of AMI and who received persistent beta-blocker treatment for 180 days (6 months) after discharge.

Measure Reporting:
HealthChoice Performance Measure reporting for Priority Partners. 

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 last day of the measurement period.
• Benefits: Medical and pharmacy.
• Continuous Enrollment: The Discharge date through 179 days after discharge.
• Allowable Gap: No more than one gap of ≤45 days within the 180 days of the event. No gaps on the discharge date.

Definition: 
180-day measurement interval: The 180-day period that includes the discharge date and the 179 days after discharge. 

Direct transfer: When the discharge date from the first inpatient setting precedes the admission date to a second inpatient setting by 1 calendar day or less. 

Treatment days (covered days): The actual number of calendar days covered with prescriptions within the specified 180-day measurement interval (e.g., a prescription of a 90-day supply dispensed on the 100th day will have 81 days counted in the 180-day interval).

Denominator:
Hospitalization for AMI.
An acute inpatient discharge from July 1 of the year prior to the measurement period through June 30 of the measurement period with any diagnosis of AMI (AMI Value Set) on the discharge claim.

Numerator:
Persistent beta-blocker treatment.
Persons with at least 135 days of treatment with beta-blockers (Beta Blocker Medications List) during the 180-day measurement interval. This allows gaps in medication treatment of up to a total of 45 days during the 180-day measurement interval.
Assess for active prescriptions and include days supply that fall within the 180-day measurement interval.

Best Practice and Measure Tips

• This measure addresses the appropriate clinical management of a person who has experienced an acute myocardial infarction (AMI). Persistent beta-blocker treatment after a heart attack reduces the risk of mortality, reduces the risk and severity of re-infarction, and improves the preservation of the left ventricular function.
• This measure consist on any diagnosis of AMI on an acute inpatient discharge claim from July 1 of the year prior through June 30 of the measurement.
• Only the first discharge with AMI during the timeframe will be included.
• This measure allows a gap in medication treatment of up to a total of 45 days during the 180-day measurement interval.
• Any prescription for beta-blockers prior to admission and those dispensed during their inpatient stay are factored into adherence rate if the actual treatment days falls within the 180-days measurement interval.
• All active prescriptions including days supply that fall within the 180-days measurement interval are assessed.
  • An active prescription is one that is noted as having available medication left in the “days supply” through the episode date or further.
• Member must use their insurance card to fill their medications.
  • Gap closure is depended on pharmacy claims.
  • Consider adding directives to prescriptions instructing the pharmacy to run it through the patient’s pharmacy benefit. The use of discount programs, paying cash for medication and medication samples will not count toward gap closure.
• Experiencing adverse effects:
  • Instruct patients to contact their practitioner if they are experiencing adverse effects. Discuss potential side effects and ways to treat the side effects of medication.
  • Document any adverse effects in the medical record.
  • Determine if the signs/symptoms qualify as an exclusion.
  • Try reducing the dose or frequency or consider trying a different medication.
• Educate the Member on the importance of adhering to the medication regiment.
  • Sudden stop of medication can lead to complications such as heart attacks, increased hypertension or increased anxiety.
  • Consider other medication that member is taking that may require them to be taken at different times.
  • Developing a routine medication plan.
    • Utilizing pillbox.
    • Set up reminders and alarms.

Measure Exclusions

Denominator Exclusion:

• Persons in hospice or using hospice services 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 as of 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 SNP (I-SNP) or living long-term in an institution (LTI).
• Exclude hospitalizations in which the person had a direct transfer to a nonacute inpatient care setting for any diagnosis.
• Exclude both the initial discharge and the direct transfer discharge if the transfer discharge occurs after June 30 of the measurement period.
• Persons with a medication dispensing event (Asthma Exclusions Medications List) or a diagnosis (Beta Blocker Contraindications Value Set*) that indicates a contraindication to beta-blocker therapy any time during the person’s history through the last day of the continuous enrollment period.

Exclusion Codes

Beta Blocker Contraindications

• ICD-10-CM: I44.1, I44.2, I44.4, I44.5, I44.60, I44.69, I44.7, I45.0, I45.10, I45.19, I45.2, I45.3, I45.6, I49.5, I95.0, I95.1, I95.2, I95.3, I95.81, I95.89, I95.9, J44.0, J44.1, J44.81, J44.89, J44.9, J45.21, J45.22, J45.30, J45.31, J45.32, J45.40, J45.41, J45.42, J45.50, J45.51, J45.52, J45.901, J45.902, J45.909, J45.991, J45.998, J68.4, R00.1, T44.7X5A, T44.7X5D, T44.7X5S
• SNOMED CT US Edition: 2374000, 4973001, 6180003, 6374002, 11641008, 12428000, 13645005, 14718009, 15908004, 18041002, 19849005, 20143001, 27885002, 28189009, 28651003, 30667004, 31803008, 32425009, 32544004, 32758004*

*Please note that not all ICD-10-CM and SNOMED CT US Edition codes are listed here. For access to the complete set of codes related to PBH measure, contact your Provider Engagement Liaison or email [email protected].

Exclusion Medications

Asthma Exclusions Medications

• Beclomethasone
• Budesonide
• Budesonide-formoterol
• Ciclesonide
• Flunisolide
• Fluticasone
• Fluticasone-salmeterol
• Fluticasone-vilanterol
• Formoterol-mometasone
• Mometasone 

Measure Codes

Diagnosis of AMI

• ICD-10-CM: I21.01, I21.02, I21.09, I21.11, I21.19, I21.21, I21.29, I21.3, I21.4, I21.B

Measure Medications

Beta Blocker Medications

• Acebutolol
• Atenolol
• Atenolol-chlorthalidone
• Betaxolol
• Bisoprolol
• Bisoprolol-hydrochlorothiazide
• Carvedilol
• Hydrochlorothiazide-metoprolol
• Hydrochlorothiazide-propranolol
• Labetalol
• Metoprolol
• Nadolol
• Nebivolol
• Pindolol
• Propranolol
• Sotalol
• Timololc