Performance Measures:

Diabetes: Eye Exam

The percentage of patients 18-75 years of age with diabetes (type 1 and type 2) who had an eye exam (retinal) performed.

Date Reviewed: November 4, 2018

Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.

Date Reviewed: May 9, 2024

Statin Therapy for Patients with Diabetes

The percentage of members 40–75 years of age during the measurement year with diabetes who do not have clinical atherosclerotic cardiovascular disease (ASCVD) who met the following criteria. Two rates are reported:

1. Received Statin Therapy. Members who were dispensed at least one statin medication of any intensity during the measurement year.
2. Statin Adherence 80%. Members who remained on a statin medication of any intensity for at least 80% of the treatment period

Date Reviewed: May 9, 2024

Osteoporosis Management in Women who had a Fracture

The percentage of women 50–85 years of age who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis in the six months after the fracture.

Date Reviewed: May 4, 2022

Screening for Osteoporosis for Men Aged 70 Years and Older

Percentage of male patients aged 70 years and older who had a central dual-energy X-ray absorptiometry (DXA) to screen for osteoporosis

Date Reviewed: May 4, 2022

Coronary Artery Disease: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%)

Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have diabetes OR a current or prior Left Ventricular Ejection Fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB therapy.

Date Reviewed: May 9, 2024

Vitamin D Level - Effective Control of Low Bone Mass/Osteopenia and Osteoporosis: Therapeutic Level Of 25 OH Vitamin D Level Achieved

Percentage of patients aged 65 years and older diagnosed with osteopenia or osteoporosis whose most recent serum 25 Hydroxy-Vitamin D results is greater than or equal to 30.0 ng/dL

Date Reviewed: May 4, 2022

Depression Remission at Twelve Months

The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission 12 months (+/- 60 days) after an index event date.

Date Reviewed: September 28, 2022

Kidney Health Evaluation

Percentage of patients aged 18-75 years with a diagnosis of diabetes who received a kidney health evaluation defined by an Estimated Glomerular Filtration Rate (eGFR) AND Urine Albumin-Creatinine Ratio (uACR) within the 12-month measurement period.

Date Reviewed: May 9, 2024

Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

Percentage of the following patients-all considered at high risk of cardiovascular events-who were prescribed or were on statin therapy during the measurement period:

Adults aged >= 21 years who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD); OR

Adults aged >=21 years who have ever had a fasting or direct low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia; OR

Adults aged 40-75 years with a diagnosis of diabetes with a fasting or direct LDL-C level of 70-189 mg/dL.

Date Reviewed: November 19, 2017

Emergency Department Visits for Hypoglycemia in Older Adults with Diabetes

For members 67 years of age and older with diabetes (types 1 and 2), the risk-adjusted ratio of observed to expected (O/E) emergency department (ED) visits for hypoglycemia during the measurement year. Two rates are reported:

• For all members 67 years of age and older with diabetes (types 1 and 2) the risk-adjusted ratio of O/E ED visits for hypoglycemia during the measurement year, stratified by dual eligibility.
• For a subset of members 67 years of age and older with diabetes (types 1 and 2) who had at least one dispensing event of insulin within each 180-day (6-month) treatment period from July 1 of the year prior to the measurement year through December 31 of the measurement year, the risk-adjusted ratio of O/E ED visits for hypoglycemia, stratified by dual eligibility.

Date Reviewed: May 9, 2024

Anti-Depressant Medication Management

"Percentage of patients 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. Two rates are reported.
a. Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks).
b. Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).

Date Reviewed: September 28, 2022

Ambulatory Palliative Care Patients’ Experience of Receiving Desired Help for Pain

The percentage of patients aged 18 years and older who had an ambulatory palliative care visit and report getting the help they wanted for their pain from their palliative care provider and team within 6 months of the ambulatory palliative care visit.

Date Reviewed: May 11, 2023