Product Lines:
EHP, Priority Partners and USFHP.

Eligible Population:
Members 5 - 64 years of age and older by December 31 of the measurement year. This includes Value Based Purchasing (VBP) for Priority Partners.

Definition:
The percentage of members 5-64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 50% or greater during the measurement year.

Report stratification by race and ethnicity.

Continuous Enrollment:

• The measurement year and the year prior to the measurement year.
   

Best Practice and Measure Tips

Schedule follow-up appointments:

• Ensure the patient is not using more rescue medications than preventive medication to control their asthma (i.e., rescue meds have 50 percent less usage than preventive meds)
• Report the appropriate diagnosis codes for the member’s condition. Include the appropriate codes for diagnosed conditions that may exclude the member from this measure.
• Ensure at least half of the medications dispensed to treat their asthma are controller medications throughout the treatment/measurement period. 

Patient is considered to have persistent asthma if they have any of the following:

• At least 1 ER visit with a principal diagnosis of asthma; 
• At least 1 acute inpatient encounter with a principal diagnosis of asthma;
• At least 1 inpatient discharge with a principal diagnosis of asthma on the discharge claim;
• At least 4 outpatient visits, telephone visits or e-visits or virtual check-ins, on different dates of service, with any diagnosis of asthma and at least 2 asthma medication dispensing events for any controller or reliever medication;
• At least 4 asthma medication dispensing events for any controller or reliever medications. 

Measure Exclusions

Required Exclusions:  

• Members who had a diagnosis that requires a different treatment approach than members with asthma any time during the member’s history through December 31 of the measurement year.
• Members who weren’t prescribed an asthma medication any time during the measurement year.
• Members in hospice or using hospice services anytime during the measurement year
• Members who died any time during the measurement year.   

Exclusion Codes:

•  Respiratory Diseases With Different Treatment Approaches Than Asthma
  • ICD-10-CM: E84.0, E84.11, E84.19, E84.8, E84.9, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.9, J68.4, J96.00, J96.01, J96.02, J96.20, J96.21, J96.22, J98.2, J98.3, 277.00, 277.01, 277.02, 277.03, 277.09, 492.0, 492.8, 493.20, 493.21, 493.22, 496, 506.4, 518.1, 518.2, 518.81. 

Measure Codes

Examples of persistent asthma codes include:

• ICD-10-CM: J45.21, J45.22, J45.30 - J45.32, J45.40 - J45.42, J45.50 - J45.52, J45.901, J45.902, J45.909, J45.991, J45.998 

Measure Medications

Asthma Controller Medications Asthma Reliever Medications