Data Workgroup

Responsibilities:

• Agree on a shared set of performance measures
• Use care delivery standards to establish a common, mutually agreed upon set of performance measures that will be collected across all health plans
• Set up reporting template
• Collect and analyze HEDIS data from health plans
• Present data to stakeholders

Members:

• Galina Priloutskaya, PhD, MBA, CHCA (Chair), New Mexico Medical Review Association (NMMRA)
• Blue Cross and Blue Shield of New Mexico
• Lovelace Health Plan
• Molina Healthcare 
• New Mexico Health Policy Commission
• Presbyterian Health Plan
• United Health Care
• University of New Mexico College of Pharmacy

Quality Indicators – Data Specifications:

This coalition will use HEDIS methodology established by the National Committee for Quality Assurance (NCQA) for selecting quality indicators:

For Medicare line of business

Drugs to Be Avoided in the Elderly:

1. The percentage of Medicare members 65 years and older who, during measurement year, received at least one drug to be avoided in the elderly
2. The percentage of Medicare members 65 years and older who, during measurement year, received at least two different drugs to be avoided by the elderly

Since plans have the option of reporting this measure based on therapeutic classification, the steering committee members will choose the therapeutic class applications from the Beer list and NCQA requirements.

All lines of business (commercial, Medicaid, Medicare)

Annual Monitoring for Patient on Persistent Medications:

This measure assesses whether persistent users of medications receive timely monitoring to prevent potential harms associated with persistent use of these drugs.

The percentage of members 18 years of age and older who received at least a 180-day supply of ambulatory medication therapy for the selected therapeutic agent during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year

For each product line, report each of five rates separately and as a combined rate:

1. Annual monitoring of members on ACE inhibitors or ARB
   
   Denominator:
   The percentage of members in the eligible population who received at least a 180-day supply of any ACE inhibitors or ARBs, including any combination products during the measurement year
   
   Numerator:
   The number of members with at least one serum potassium and either a serum creatinine or a blood urea nitrogen therapeutic monitoring test in the measurement year
   
   
2. Annual monitoring of members on digoxin
   
   Denominator:
   The percentage of members in the eligible population who received at least a 180-day supply of any drug in digoxin category, including any combination products during the measurement year
   
   Numerator:
   The number of members with at least one serum potassium and either a serum creatinine or a blood urea nitrogen therapeutic monitoring test in the measurement year
   
   
3. Annual monitoring of members on diuretics
   
   Denominator:
   The percentage of members in the eligible population who received at least a 180-day supply of any drug in diuretics category, including any combination products during the measurement year
   
   Numerator:
   The number of members with at least one serum potassium and either a serum creatinine or a blood urea nitrogen therapeutic monitoring test in the measurement year
   
   
4. Annual monitoring of members on anticonvulsants (phenytoin, phenobarbital, valproic acid, carbamazepine)
   
   Denominator:
   The percentage of members in the eligible population who received at least a 180-day supply of any drug in anticonvulsants category, including any combination products during the measurement year; each member-drug combination is considered a unique event
   
   Numerator:
   The number of members with at least one drug serum concentration level monitoring test for the prescribed drug in the measurement year
   
   
5. Annual monitoring for members on statins
   
   Denominator:
   The percentage of members in the eligible population who received at least a 180-day supply of any statin, including any combination products during the measurement year
   
   Numerator:
   The number of members with both an ALT and an AST liver enzyme test in the measurement year
   
   
6. Combined rate (the sum of the five numerators divided by the sum of the five denominators)
   
   For this indicator PDPs will collaborate with NMMRA for technical assistance in merging Part D and Parts A/B data and receiving patient profile reports.

1. Prevalence of lipid lowering agents (in diabetes mellitus or DM)
2. Prevalence of beta-blockers (in post-MI and CHF)
3. Prevalence of ACEI/ARB (in DM and CHF)
4. Prevalence of calcium channel blocker in DM
5. Prevalence of diuretics in HTN

Prescription Drug Plan Analytic Report: Additional Information
The following documents provide further detail to the Prescription Drug Plan (PDP) Analytic Report:

Technical Specifications - Drug Measures (Medispan)
(zipped .xls file size: 1,647 KB; may take several minutes to download, depending on connection speed)