Download Annual Monitoring for Patients on Persistent Medications

Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
1
Proposed Changes to Existing Measure for HEDIS®1 2015:
Annual Monitoring for Patients on Persistent Medications (MPM)
NCQA seeks comments on proposed modifications to the Annual Monitoring for Patients on Persistent
Medications measure. This measure assesses the percentage of individuals on selected persistent medications
(angiotensin converting enzyme [ACE] inhibitors, angiotensin receptor blockers [ARB], digoxin, diuretics or
anticonvulsants) who received a therapeutic monitoring event in the measurement year. We propose the following
changes to the measure:
 Retire the anticonvulsant rate.
 Revise the numerator for ACE inhibitors or ARBs, digoxin and diuretics rates to no longer allow a blood
urea nitrogen therapeutic monitoring test to count as evidence of annual monitoring of kidney function.
 Revise the numerator for the digoxin rate to add monitoring of serum digoxin level.
The proposed changes would bring the measure in line with current evidence. In fall 2013, NCQA contracted with
a team of researchers at the Johns Hopkins Hospital Center for Medication Quality and Outcomes to review the
current evidence for annual monitoring of adults using these medications. The review supports the proposed
changes:
 Evidence demonstrates no benefit to routine drug concentration monitoring for patients on anticonvulsants
who are responding to therapy.
 For monitoring patients with persistent use of ACE inhibitors or ARBs, diuretics or digoxin, evidence
supports annual monitoring of serum creatinine and serum potassium to reduce potentially fatal risks
associated with the use of these medications. There is no evidence on the utility of using blood urea
nitrogen to monitor renal function.
 For monitoring patients with persistent use of digoxin, evidence from multiple clinical trials supports annual
monitoring of serum digoxin concentration level, to avoid potential digoxin toxicity.
Supporting documents for the proposed measure include the draft measure specification, recent performance
data, and the evidence work-up which contains a detailed description of the findings from the evidence review.
NCQA acknowledges the contributions of the Geriatric Measurement Advisory Panel.
1
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
©2014 National Committee for Quality Assurance
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
2
Annual Monitoring for Patients on Persistent Medications (MPM)
SUMMARY OF CHANGES TO HEDIS® 2015
 Revised the numerator for the ACE Inhibitors and ARB, digoxin and diuretics rates to no longer allow a
blood urea nitrogen therapeutic monitoring test to count as evidence of annual monitoring.
 Revised the numerator for the digoxin rate to add monitoring of serum digoxin level.
 Retired the indicator for anticonvulsants.
Description
The percentage of members 18 years of age and older who received at least 180 treatment days of
ambulatory medication therapy for a select 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 the four three rates separately and as a total rate.
 Annual monitoring for members on angiotensin converting enzyme (ACE) inhibitors or angiotensin
receptor blockers (ARB).
 Annual monitoring for members on digoxin.
 Annual monitoring for members on diuretics.
 Annual monitoring for members on anticonvulsants.
 Total rate (the sum of the four three numerators divided by the sum of the four three denominators).
Eligible Population
Product lines
Commercial, Medicaid, Medicare (report each product line separately).
Ages
18 years and older as of December 31 of the measurement year.
Continuous
enrollment
The measurement year.
Allowable gap
No more than one gap in enrollment of up to 45 days during the measurement year
each year of continuous enrollment. To determine continuous enrollment for a Medicaid
beneficiary for whom enrollment is verified monthly, the member may not have more
than a 1-month gap in coverage (i.e., a member whose coverage lapses for 2 months
[60 days] is not considered continuously enrolled).
Anchor date
December 31 of the measurement year.
Benefits
Medical and pharmacy.
Event/
diagnosis
Members on persistent medications (i.e., members who received at least 180 treatment
days of ambulatory medication in the measurement year). Refer to Additional Eligible
Population Criteria for each rate.
Treatment days are the actual number of calendar days covered with prescriptions
within the measurement year (i.e., a prescription of 90 days supply dispensed on
December 1 of the measurement year counts as 30 treatment days). Sum the days
supply for all medications and subtract any days supply that extends beyond December
31 of the measurement year.
Note: Medications dispensed in the year prior to the measurement year must be
counted toward the 180 treatment days.
©2014 National Committee for Quality Assurance
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
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Administrative Specification
For each product line, report each of the three four rates separately and as a combined rate. The total rate is
the sum of the three four numerators divided by the sum of the three four denominators.
Rate 1: Annual Monitoring for Members on ACE Inhibitors or ARBs
Additional
eligible
population
criteria
Members who received at least 180 treatment days of ACE inhibitors or ARBs, during
the measurement year. Refer to Table CDC-L to identify ACE inhibitors and ARBs.
Numerator
At least one serum potassium and either a serum creatinine or a blood urea nitrogen
therapeutic monitoring test in the measurement year. Any of the following during the
measurement year meet criteria:
Note: Members may switch therapy with any medication listed in Table CDC-L during
the measurement year and have the days supply for those medications count toward
the total 180 treatment days (i.e., a member who received 90 days of ACE inhibitors
and 90 days of ARBs meets the denominator definition for rate 1).
 A lab panel test (Lab Panel Value Set).
 A serum potassium test (Serum Potassium Value Set) and a serum creatinine
test (Serum Creatinine Value Set).
 A serum potassium test (Serum Potassium Value Set) and a blood urea nitrogen
test (Blood Urea Nitrogen Value Set).
Note: The tests do not need to occur on the same service date, only within the
measurement year.
Rate 2: Annual Monitoring for Members on Digoxin
Additional
eligible
population
criteria
Members who received at least 180 treatment days of digoxin (Table MPM-B) during
the measurement year.
Table MPM-B: Drugs to Identify Members on Digoxin
Description
Inotropic agents
Prescription
Digoxin
Note: NCQA will post a comprehensive list of medications and NDC codes to www.ncqa.org by November 1,
2013.
Numerator
At least one serum potassium, at least one and either a serum creatinine, and at least
one serum digoxin or a blood urea nitrogen therapeutic monitoring test in the
measurement year. Any of the following during the measurement year meet criteria:
 A lab panel test (Lab Panel Value Set) and serum digoxin test (Digoxin Level
Value Set).
 A serum potassium test (Serum Potassium Value Set) and a serum creatinine
test (Serum Creatinine Value Set) and serum digoxin test (Digoxin Level Value
Set).
 A serum potassium test (Serum Potassium Value Set) and a blood urea
nitrogen test (Blood Urea Nitrogen Value Set).
©2014 National Committee for Quality Assurance
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
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Note: The tests do not need to occur on the same service date, only within the
measurement year.
Rate 3: Annual Monitoring for Members on Diuretics
Members who received at least 180 treatment days of a diuretic (Table MPM-C),
during the measurement year.
Additional
eligible
population
criteria
Note: Members may switch therapy with any medication listed in Table MPM-C during
the measurement year and have the days supply for those medications count toward
the total 180 treatment days.
Table MPM-C: Drugs to Identify Members on Diuretics
Description
Antihypertensive
combinations
Loop diuretics
Potassium-sparing
diuretics
Thiazide diuretics




















Prescription
Aliskiren-hydrochlorothiazide
 Fosinopril-hydrochlorothiazide
Aliskiren-hydrochlorothiazide-amlodipine
 Hydrochlorothiazide-irbesartan
Amiloride-hydrochlorothiazide
 Hydrochlorothiazide-lisinopril
Amlodipine-hydrochlorothiazide-olmesartan  Hydrochlorothiazide-losartan
Amlodipine-hydrochlorothiazide-valsartan
 Hydrochlorothiazide-methyldopa
Atenolol-chlorthalidone
 Hydrochlorothiazide-metoprolol
Benazepril-hydrochlorothiazide
 Hydrochlorothiazide-moexipril
Bendroflumethiazide-nadolol
 Hydrochlorothiazide-olmesartan
Bisoprolol-hydrochlorothiazide
 Hydrochlorothiazide-propranolol
Candesartan-hydrochlorothiazide
 Hydrochlorothiazide-quinapril
Captopril-hydrochlorothiazide
 Hydrochlorothiazide-spironolactone
Chlorthalidone-clonidine
 Hydrochlorothiazide-telmisartan
Enalapril-hydrochlorothiazide
 Hydrochlorothiazide-triamterene
Eprosartan-hydrochlorothiazide
 Hydrochlorothiazide-valsartan
Bumetanide
 Furosemide
Ethacrynic acid
 Torsemide
Amiloride
 Spironolactone
 Triamterene
Eplerenone
Chlorothiazide
 Hydrochlorothiazide
 Methyclothiazide
Chlorthalidone
 Indapamide
 Metolazone
Note: NCQA will post a comprehensive list of medications and NDC codes to www.ncqa.org by November 1,
2014.
Numerator
At least one serum potassium and either a serum creatinine or a blood urea nitrogen
therapeutic monitoring test in the measurement year. Any of the following during the
measurement year meet criteria:
 A lab panel test (Lab Panel Value Set).
 A serum potassium test (Serum Potassium Value Set) and a serum creatinine
test (Serum Creatinine Value Set).
 A serum potassium test (Serum Potassium Value Set) and a blood urea
nitrogen test (Blood Urea Nitrogen Value Set).
Note: The tests do not need to occur on the same service date, only within the
measurement year.
©2014 National Committee for Quality Assurance
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
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Rate 4: Annual Monitoring for Members on Anticonvulsants
Additional eligible
population
criteria
Members who received at least 180 treatment days for an anticonvulsant (Table
MPM-D) during the measurement year.
Note: Members who are on multiple anticonvulsant drugs count toward the
denominator multiple times if they meet the persistent medications criteria for each
drug taken during the measurement year (i.e., a member who received at least 180
days of phenytoin and 180 days of valproic acid is counted twice in the denominator
for Rate 4, once for each drug).
Table MPM-D: Drugs to Identify Members on Anticonvulsants
Description
Barbiturate anticonvulsants
Dibenzazepine anticonvulsants
Hydantoin anticonvulsants
Miscellaneous anticonvulsants




Drugs
Phenobarbital
Carbamazepine
Phenytoin
Divalproex sodium  Valproic acid
Note: NCQA will post a comprehensive list of medications and NDC codes
to www.ncqa.org by November 1, 2013.
Numerator
At least one drug serum concentration level monitoring test for the prescribed drug
during the measurement year as identified by the following value sets:
 Members prescribed phenobarbital must have at least one drug serum
concentration for phenobarbital (Phenobarbital Level Value Set).
 Members prescribed carbamazepine must have at least one drug serum
concentration for carbamazepine (Carbamazepine Level Value Set).
 Members prescribed phenytoin must have at least one drug serum
concentration for phenytoin (Phenytoin Level Value Set).
 Members prescribed valproic acid or divalproex sodium must have at least
one drug serum concentration for valproic acid (Valproic Acid Level Value
Set).
If a member received only one type of anticonvulsant, the drug serum concentration
level test must be for the specific drug taken as a persistent medication (i.e., a
member on phenytoin received a drug serum test for phenytoin).
If a member persistently received multiple types of anticonvulsants, each
anticonvulsant medication and drug monitoring test combination is counted as a
unique event (i.e., a member on both phenytoin and valproic acid with at least 180
treatment days for each drug in the measurement year must separately show
evidence of receiving drug serum concentration tests for each drug to be considered
numerator-compliant for each drug).
Exclusion (optional)
Exclude members from each eligible population rate who had an inpatient (acute or nonacute) claim/
encounter during the measurement year.
©2014 National Committee for Quality Assurance
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
Data Elements for Reporting
Organizations that submit HEDIS data to NCQA must provide the following data elements.
Table MPM-1/2/3: Data Elements for Annual Monitoring for Patients
on Persistent Medications
Administrative
Measurement year
Data collection methodology (Administrative)
Eligible population
Numerator events by administrative data
Reported rate
Lower 95% confidence interval
Upper 95% confidence interval


For each of the 3 rates and total
For each of the 3 rates and total
For each of the 3 rates and total
For each of the 3 rates and total
For each of the 3 rates and total
©2014 National Committee for Quality Assurance
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Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
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Annual Monitoring for Patients on Persistent Medications (MPM)
Measure Work-up
Measure Description
This measure assesses the percentage of members 18 years of age and older who received a least 180
treatment days of ambulatory medication therapy for a select 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 the four rates separately and as a total rate.
 Angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB): At least one
serum potassium and either a serum creatinine or a blood urea nitrogen therapeutic monitoring test in
the measurement year.
 Digoxin: At least one serum potassium and either a serum creatinine or a blood urea nitrogen
therapeutic monitoring test in the measurement year. Any of the following during the measurement year
meet criteria:
– Diuretics: At least one serum potassium and either a serum creatinine or a blood urea nitrogen
therapeutic monitoring test in the measurement year.
– Anticonvulsants: At least one drug serum concentration level monitoring test for the prescribed drug
during the measurement year.
 Total rate (the sum of the four numerators divided by the sum of the four denominators)
Topic Overview
Importance and Prevalence
Prevalence
In a given week, an average of 82 percent of adults in the U.S. take at least one
medication (prescription or nonprescription drug, vitamin/mineral, herbal/natural
supplement); 29 percent take five or more (Slone Survey, 2006). While the
prevalence of medication use has not increased dramatically since 2000,
polypharmacy has increased from 23 percent to 29 percent for use of five or more
medications, and from 6.3 percent to 12 percent for use of at least five prescription
drugs (Slone Survey, 2006). Prescription medication use is highest among older
adults. A 2005–2006 survey of adults aged 57–85 found that 81 percent of older
adults reported using at least one prescription medication and 29 percent of survey
respondents used at least five prescription medications concurrently. Use of at least
five prescription medications was highest among men (37.1 percent) and women
(36.0 percent) aged 75–85 years (Qato et al., 2008).
The same national survey of older adults found that the most commonly used
prescription or over-the-counter medications were cardiovascular agents. Aspirin was
the most commonly used medication (28 percent of respondents), followed by
hydrochlorothiazide (diuretic used by 15.6 percent of patients during the
measurement year.) The ACE-inhibitor lisinopril use was 12.2 percent of respondents
and the angiotensin receptor blockers amlodipine and valsartan were used by 8.3
percent and 4.6 percent of respondents, respectively (Qato et al., 2008).
Health importance
Approximately 1.5 million preventable adverse drug events occur in the United States
each year (Institute of Medicine, 2007). Some result from a lack of appropriate
monitoring. Appropriate monitoring is critical for detecting potentially harmful effects of
a medication and adjusting the dosage (Steinman et al., 2011). A cohort study of
30,397 Medicare enrollees that examined drug-related incidents in ambulatory clinical
settings found that 60.8 percent of identified preventable adverse drug events
occurred due to errors in monitoring, and inadequate laboratory monitoring of drug
therapies accounted for errors in 36.1 percent of these preventable adverse drug
©2014 National Committee for Quality Assurance
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
events. Diuretics as a drug class accounted for 22.1 percent of all preventable
adverse drug events, second only to cardiovascular agents, which accounted for 24.5
percent (Gurwitz et al., 2003).
Although the majority of research on adverse drug events has focused primarily on
older adults, adverse drug events are not exclusive to older adults. Younger adults
taking persistent medications are at risk for the same adverse drug events if
appropriate monitoring is not provided.
The most severe adverse drug events can result in hospitalization. From 2007–2009,
there were an estimated 99,628 emergency hospitalizations for adverse drug events
in adults 65 years of age or older. The medications in this measure were all listed
among the 13 most commonly implicated medications in emergency hospitalization
for adverse drug event:
Digoxin (3.5 percent).
Renin-angiotensin inhibitors (2.9 percent).
Anticonvulsants (1.7 percent).
Diuretics (1.1 percent).
Digoxin was also the medication most likely to result in hospitalization after an ED
visit (80 percent of ED visits for individuals on digoxin results in hospitalization). The
four most commonly implicated medications or medication classes were warfarin
(33.3 percent), insulin (13.9 percent), oral antiplatelet agents (13.3 percent) and oral
hypoglycemic agents (10.7 percent) (Budnitz et al., 2011).
Financial
importance and
cost effectiveness
The exact financial cost of not monitoring individuals on persistent medications is
unknown, but the resource use and cost associated with adverse drug events can
shed light on the financial impact. A recent estimation revealed that in the U.S., the
cost of problems linked to drug use in the ambulatory setting exceeded $177 billion in
2000 (Rodriguez et al., 2003). A retrospective cohort study of Medicare enrollees
found that for all adverse drug events, the increase in post-event costs over the preevent period was $1,310 greater for those experiencing an adverse drug event than a
comparison group, after controlling for age, sex, comorbidity, number of scheduled
medications and hospitalization during the pre-event period. For preventable adverse
drug events, the post-event health care costs were $1,983 greater. The national
annual costs were estimated to be $887 million in 2000 (Field et al., 2005).
Several studies have found that in both hospital and ambulatory settings, adverse
drug events that result in more serious patient outcomes (e.g., life threatening or fatal)
are more likely to be preventable than less serious adverse drug events (Gurwitz et
al., 2003; Bates et al., 1995; Gurwitz et al., 2000). Adverse drug events are generally
considered preventable when they are due to error that could have been avoided. For
individuals on persistent medications, appropriate monitoring will reduce the number
of preventable adverse drug events, thereby improving patient safety and outcomes
while decreasing health care costs.
©2014 National Committee for Quality Assurance
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Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
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Supporting Evidence for Annual Monitoring
To help re-evaluate this measure, NCQA contracted with a team of researchers at the Johns Hopkins Hospital
Center for Medication Quality and Outcomes to review the current evidence for annual monitoring for adults
using these medications. The initial search strategy included evidence- and consensus-based guidelines,
meta-analyses and systematic reviews. Upon review, the search strategy was broadened to include
randomized, controlled trials and cohort studies, in addition to relevant studies listed in the selected articles.
Two independent reviewers evaluated all selected articles to ensure quality. Where evidence included at least
one large, high-quality, randomized controlled trial, the researchers rated the evidence “sufficient.”
Their conclusions for each medication class included in this measure were as follows:
ACE Inhibitors or
ARBs
ACE inhibitors and ARBs are commonly used medications to treat hypertension.
There is sufficient evidence from several retrospective cohort studies (Miao 2011;
Hurley 2005; Coleman 2010; Raebel 2007), and the Reduction in Endpoints with the
Angiotensin Antagonist Losartan (RENAAL) trial that that ACE inhibitors or ARBs can
increase serum potassium concentrations (Brenner 2000).
High serum potassium, known as hyperkalemia, is a potentially fatal condition that
can alter heart function and cause arrhythmias. Additionally, ACE inhibitors and ARBs
can decrease renal function, for which serum creatinine is a commonly used clinical
marker (Gottlieb 1992; Packer 1987; Burnier 1989; Hurley 2005; Coleman 2010;
Raebel 2007). Therefore, serum potassium and serum creatinine are clinically useful
monitoring parameters for these potentially serious safety concerns associated with
the use of these drugs.
Typically, if hyperkalemia or decreased renal function are observed, more frequent
monitoring may be conducted or ACE inhibitor or ARB therapy may be withdrawn.
Frequency of monitoring depends on the amount of time an individual has been
taking the medication, but annual monitoring is the minimum appropriate frequency
(McDowell 2013).
There is less evidence of the utility of using blood urea nitrogen to monitor renal
function for patients taking ACE inhibitors or ARBs; however, serum creatinine will be
available in virtually all cases where a blood urea nitrogen is reported. There is
insufficient evidence to justify using serum sodium or serum urea as a monitoring
parameter for patients taking ACE inhibitors or ARBs.
Digoxin
Digoxin is used to treat heart failure and abnormal heart rhythms. Evidence from
multiple RCTs supports using an annual serum digoxin concentration measurement
as a monitoring parameter (Uretsky 1993; Packer 1993; Garg 1997; Young 1998;
Krum 1995; Hurley 2005). Digoxin toxicity is known to be a serious (potentially fatal)
safety concern and there are a number of factors (e.g., decreased renal function or
changes in serum electrolyte concentrations) that may precipitate toxicity, even in the
setting of a stable dose over time.
Although we recommend monitoring serum potassium and serum creatinine during
digoxin therapy, the clinical evidence to support this recommendation is less strong.
However, it is generally accepted and agreed on that hypokalemia poses a serious
and potentially fatal risk to patients taking digoxin and diuretics (Hurley 2005;
Pinkerman 2013; Hunt 2009). Additionally, digoxin is excreted renally; therefore,
monitoring serum creatinine is critical for determining if digoxin is affecting renal
function. The utility of blood urea nitrogen monitoring has been studied less.
Diuretics
Diuretics are used to treat a number of heart-related conditions, including high blood
pressure; heart failure; kidney and liver problems; and glaucoma. Evidence from the
Randomized Aldactone Evaluation Study (RALES) trial (Pitt 1999), the Eplerenome
Post-AHI Heart Failure Efficacy and Survival Study (EPHESUS) trial (Pitt 2003) and
other evidence and consensus based guidelines (Lindenfeld 2010; Hunt 2009;
McDowell 2013) supports using serum creatinine and serum potassium as annual
©2014 National Committee for Quality Assurance
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
monitoring parameters for patients taking diuretics.
Hypokalemia (decreased potassium level) is a common adverse effect of treatment
with diuretics and may cause fatal arrhythmias and increase the risk of digitalis
(digoxin) toxicity.
Hyperkalemia (increased potassium levels) may complicate therapy with ACE
inhibitors, ARBs, and potassium-sparing diuretics (aldosterone antagonists) (Hunt
2009; Juurlink 2003; Juurlink 2004; Scensson 2004). There is less evidence of the
utility of using blood urea nitrogen to monitor renal function for patients taking
diuretics.
Anticonvulsants
Gaps in care
Although monitoring the concentration of antiepileptic medications is common in
clinical practice, the best evidence demonstrates no advantage to annual drug
concentration monitoring, compared with using clinical response to therapy (Tomson
2007; Jannuzzi 2000). Some lower forms of evidence (reviews and FDA labels)
suggest that serum concentration monitoring may be useful in revealing drug
interactions and in patients taking multiple antiepileptic medications (Patsalos 2008;
Johannessen 2010; Eadie 2001).
Recent data from the HEDIS® Health Plan measure set show overall high rates of
annual monitoring for patients using ACE inhibitors or ARBs, digoxin or diuretics
(79 percent–93 percent across all product types). Rates of monitoring for patients
using anticonvulsants have remained relatively flat and low (56 percent–70 percent of
patients receiving annual monitoring) across all plans since 2007.
Medicare plans have consistently had higher rates of performance, compared with
commercial and Medicaid plans. The gap between the 10th and 90th percentile for
the total monitoring rate is approximately 10 percentage points for commercial plans
and approximately 6 percentage points for Medicaid and Medicare plans.
Health care
disparities
Several studies have examined racial and gender disparities in the use of
medications by older adults and have found differences in rates of medication-related
problems (Gaskin et al., 2006; Lewey et al., 2013; Qato et al., 2010; Roth et al.,
2011). Medication monitoring may therefore be particularly relevant to those
populations who experience higher rates of medication-related problems.
©2014 National Committee for Quality Assurance
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Selected Guidelines
Table 1: Monitoring for Patients on ACE Inhibitors or ARBs Reference
FDA Label (FDAa, 2012)
FDA Label (FDAb, 2013)
Joint National Committee on
Prevention, Detection,
Evaluation, and Treatment
of High Blood Pressure
(Chobanian 2003)
Medication
ACE Inhibitors—Lotensin®
(benazepril)
ARB—Cozaar®
(losartan potassium)
 ACE Inhibitor
 ARB
Monitoring Parameter
Renal function: serum
creatinine or blood urea
nitrogen
Population
Hypertensive patients with
impaired renal function
Monitoring Frequency
Within first few weeks of
therapy
Rationale
Treatment associated with
increases in blood urea
nitrogen and serum
creatinine.
Serum potassium
Patients using an ACE
Inhibitor and potassium
supplements or potassiumsparing diuretics
Monitor frequently
Hyperkalemia occurred in
approximately 1% of
hypertensive patients
 Serum creatinine
 Serum potassium
Patients with type 2
diabetes with nephropathy
Endpoint: doubling of serum
creatinine
Based on the RENAAL
study, treatment associated
with reduction in the
occurrence of sustained
doubling of serum
creatinine3
Incidence of hyperkalemia
was higher in active
treatment group than
placebo but few patients
discontinued treatment
 Serum creatinine
 Blood urea nitrogen
Patients with unilateral or
bilateral renal artery
stenosis
Serum potassium
Patients with heart failure
and using an aldosterone
antagonist
Patients with renal disease
or renal transplantation
 Serum creatinine
 Serum potassium
©2014 National Committee for Quality Assurance
Treatment associated with
increases in serum
creatinine or blood urea
nitrogen
1–2 weeks following
initiation or escalation in
therapy
1–2 weeks following
initiation or escalation in
therapy
Risk of hyperkalemia
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
Reference
American College of
Cardiology and the
American Heart
Association (Hunt 2009)
Medication
 ACE Inhibitor
 ARB
Monitoring Parameter
Serum potassium
Population
Patients with heart failure
Monitoring Frequency
Serial monitoring
 Renal function
 Serum potassium
Patients using an ACE
Inhibitor and potassiumsparing diuretic (aldosterone
antagonist)
ACE Inhibitor
 Renal function
 Serum creatinine
Institute for Clinical Systems
Improvement (Pinkerman
2013)
 ACE Inhibitor
 ARB
 Serum creatinine
 Blood urea nitrogen
 Serum potassium
Patients with bilateral renal
artery stenosis or using an
nonsteroid anti-inflammatory
drug
Patients age 18 years or
older with heart failure
 Renal Function: monthly
for first 3 months and then
every 3 months
 Potassium: within 3 days
and again at 1 week
Renal function: monthly for
first 3 months and then
every 3 months
Best practice in primary
care pathology/ European
Task Force Guidelines
(Smellie 2007; Burden
2005; Swedberg 2005)
 ACE Inhibitor
 ARB
 Serum creatinine
 Serum electrolytes
Low-risk patients with heart
failure using ACE Inhibitors,
ARBs, and diuretics
High-risk patients with heart
failure using potassiumsparing diuretics or
combination therapy or with
existing renal dysfunction
©2014 National Committee for Quality Assurance
 1–4 weeks after
initiation/dose increase
then 1–2 times per year
 If elderly: 1–2 weeks after
initiation/dose increase,
then 1–2 times per year
1–2 weeks after each dose
increase/relevant drug
addition
5–7 days after each dose
increase/relevant drug
addition
12
Rationale
Hyperkalemia may
complicate therapy and
cause cardiac conduction
disturbances
Increases risk for
hyperkalemia
Increases serum creatinine
level
To assess deterioration in
kidney function associated
with use of ACEIs or ARBs
(patients with kidney
disease and/or heart failure)
Based on the European
Taskforce guideline
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
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Table 2: Monitoring for Patients on Digoxin Reference
Heart Failure Society
of America (Lindenfeld
2010)
Medication
Digoxin
Monitoring
Parameter
Serum digoxin (0.7–
0.9 ng/mL)
Population
Majority of patients except the
elderly or those with impaired
renal function
Frequency
Monitoring in specific
situations (see
rationale)
Rationale
Serum digoxin concentration <1.0 ng/mL were
associated with favorable outcomes whereas those
>1.2 ng/mL were associated with harm (B):
Monitoring considered when:
 A significant change in renal function occurs
 A potentially interacting drug is added or
discontinued
 Confirmation of suspected digoxin toxicity
FDA Label (FDAc,
2013)
Institute for Clinical
Systems Improvement
(Pinkerman 2013)
American College of
Cardiology and the
American Heart
Association (Hunt
2009)
Digoxin
(Lanoxin)
Digoxin
Digoxin
Serum digoxin
Adults with mild to moderate
heart failure and for the
control of resting ventricular
rate in patients with chronic
atrial fibrillation
Sample just before next
scheduled dose of drug
Blood tests will be necessary to ensure digoxin dose
is appropriate (therapeutic and toxic effect)
Serum digoxin
Elderly or renal-impaired
patient with heart failure
Monitor at 1–2 weeks
after initiation
Monitor to avoid digoxin toxicity: serum digoxin levels
do not always correlate to symptoms of toxicity
Serum digoxin
Patients age 18 years or older
with heart failure
5- to 7-days after
initiation/dose change
Monitoring also recommended for: suspected toxicity,
suspected non-adherence, new or existing renal
dysfunction, determination of therapeutic range
 Serum creatinine
 Electrolytes
Patients age 18 years or older
with heart failure
Baseline and
periodically thereafter
Serum potassium
Patients with heart failure and
using a diuretic
Serial monitoring
Dose of digoxin should be based on clinical grounds
but serum digoxin concentration can be helpful to the
clinician in determining the adequacy of digoxin
therapy and in assigning certain probabilities to the
likelihood of digoxin intoxication.
©2014 National Committee for Quality Assurance
Hypokalemia may cause fatal arrhythmias and
increase the risk of digoxin toxicity
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
14
Table 3: Monitoring for Patients on Diuretics Monitoring
Parameter
Serum potassium
Population
Patients with heart failure
Aldosterone Antagonist
(Potassium-Sparing
Diuretic)
Serum potassium
Patients with heart failure
Varied with RCT
RALES Trial: Serum potassium was monitored
every 4 weeks for 12 weeks, every 3 months up
to a year, and every 6 months after the first year
during Potassium-Sparing Diuretic therapy in
patients with diabetes or renal insufficiency or in
those taking ACE Inhibitors or ARBs.
EPHESUS Trial: Serum potassium was
monitored at 48 hours, at 4–5 weeks, and then
every 3 months during Potassium-Sparing
Diuretic therapy in patients taking a large
number of concomitant medications.
Spironolactone
Serum potassium
Serum creatinine
Patients with heart failure
Within first few weeks
of the treatment
See rationale above.
Eplerenone
Electrolytes,
especially serum
potassium
 Patients with heart
failure and with eGFR
<60 ml/min, baseline
serum potassium
 >4.3 mEq/L, diabetes
mellitus, and prior use of
antiarrhythmic drugs
Not specified
See rationale above.
Reference
Joint National Committee on
Prevention, Detection,
Evaluation, and Treatment
of High Blood Pressure.
(Chobanian 2003)
Medication
Potassium-Sparing
Diuretic
Heart Failure Society of
America (Lindenfeld 2010)
Frequency
©2014 National Committee for Quality Assurance
Rationale
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
Reference
American College of
Cardiology and the
American Heart
Association (Hunt 2009)
15
Medication
Diuretics
Monitoring Parameter
Serum potassium
Population
Patients with heart
failure
Frequency
Not specified
Rationale
Hypokalemia is a common adverse effect of
treatment with Diuretics and may cause fatal
arrhythmias and increase the risk of digitalis
(digoxin) toxicity, whereas hyperkalemia may
complicate therapy with ACE Inhibitors, ARBs,
and Potassium-Sparing Diuretics (Aldosterone
Antagonists)
Potassium-Sparing
Diuretic (Aldosterone
Antagonist)
Serum potassium
Renal function
Patients with heart
failure
3 days, 1 week, 3
months, and then 3
month intervals
Subsequent monitoring should be dictated by
the general clinical stability of renal function and
fluid status
The addition or an increase in dosage of ACE
Inhibitors or ARBs should trigger a new cycle of
monitoring
Potassium-Sparing
Diuretic (Aldosterone
Antagonists)
Serum potassium
Renal function
Patients with heart
failure
Not recommended
Under circumstances where monitoring for
hyperkalemia or renal dysfunction is not
anticipated to be feasible, the risks may
outweigh the benefits of the therapy in patients
with current or prior symptoms of heart failure
Institute for Clinical Systems
Improvement (ICSI)36




ACE Inhibitor
ARB
Diuretic
Potassium-Sparing
Diuretic
 (Aldosterone
Antagonist)
 Serum potassium
 Electrolytes
 Renal function
Patients with heart
failure and hypotension
Not specified
NA
FDA Label (FDAd, 2011)
LASIX® (furosemide)
 Serum electrolytes
(particularly
potassium)
 Serum creatinine
 Blood urea nitrogen
Patients taking Laxis
frequently during the
first few months of
therapy and
periodically thereafter
NA
FDA Label (FDAe, 2013)
Aldactone®
(spironolactone)
Serum electrolytes
Elderly patients and
those with significant
renal or hepatic
impairments
Not specified
NA
FDA Label (FDAf, 2011)
Hydrochlorothiazide
Serum electrolytes
Not specified
Not specified
NA
©2014 National Committee for Quality Assurance
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
16
Table 4: Monitoring for Patients on Anticonvulsants Reference
FDA Label (FDAg
2012)
Medication
Dilantin® (Phenytoin)
Monitor Parameter
Serum drug concentration (10 to
20 μg/mL)
Population
Not specified
FDA Label (FDAh,
2013)
Depakene® (Valproic
acid)
Serum drug concentration
Not specified
FDA Label (FDAi,
2013)
Tegretol®
(carbamazepine)
Serum drug concentration
Not specified
Frequency
When a change in the
dosage form or brand is
prescribed, careful
monitoring of phenytoin
serum levels should be
carried out
Rationale
NA
A good correlation has not been established
between daily dose, serum concentrations,
Not specified
©2014 National Committee for Quality Assurance
Since valproate may interact with
concurrently administered drugs which are
capable of enzyme induction, periodic
plasma concentration determinations of
valproate and concomitant drugs are
recommended during the early course of
therapy
Monitoring of blood levels has increased the
efficacy and safety of anticonvulsants and
aided in determining the cause of toxicity
when more than one medication is being
used
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
17
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Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
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©2014 National Committee for Quality Assurance
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
20
HEDIS® Health Plan Performance Rates: Annual Monitoring For Patients On Persistent Medications (MPM)
COMMERCIAL PRODUCT LINE
Table 1. HEDIS® MPM Measure Performance (ACE Inhibitors or ARBS)—Commercial HMO Plans
Year
2011
2012
2013
Total Number
of Plans
242
221
219
Plans Able to
Report (%)
231 (95.5)
211 (95.5)
212 (96.8)
Average
81.6
82.5
82.9
Standard
Deviation
4.8
5.0
4.3
10th
Percentile
77.0
78.1
78.1
25th
Percentile
79.3
80.6
80.7
50th
Percentile
82.0
82.9
83.2
75th
Percentile
84.5
85.4
85.5
90th
Percentile
86.5
87.4
87.5
50th
Percentile
78.9
79.4
79.6
75th
Percentile
81.2
81.7
81.6
90th
Percentile
83.0
83.2
83.6
50th
Percentile
60.1
60.2
58.4
75th
Percentile
65.5
65.1
63.7
90th
Percentile
70.0
69.6
69.7
50th
Percentile
58.6
57.0
56.4
75th
Percentile
61.6
61.0
59.7
90th
Percentile
64.5
63.7
62.7
Table 2. HEDIS MPM Measure Performance (ACE Inhibitors or ARBS)—Commercial PPO Plans
Year
2011
2012
2013
Total Number
of Plans
172
189
200
Plans Able to
Report (%)
171 (99.4)
188 (99.5)
198 (99.0)
Average
78.4
78.8
79.2
Standard
Deviation
4.2
4.3
3.7
10th
Percentile
73.0
73.7
74.1
25th
Percentile
76.5
77.0
77.2
Table 3. HEDIS MPM Measure Performance (Anticonvulsants)—Commercial HMO Plans
Year
2011
2012
2013
Total Number
of Plans
242
221
219
Plans Able to
Report (%)
204 (84.3)
178 (80.5)
179 (81.7)
Average
60.4
60.5
58.8
Standard
Deviation
8.1
7.6
8.8
10th
Percentile
52.4
51.3
48.5
25th
Percentile
55.8
56.1
52.8
Table 4. HEDIS MPM Measure Performance (Anticonvulsants)—Commercial PPO Plans
Year
2011
2012
2013
Total Number
of Plans
172
189
200
Plans Able to
Report (%)
158 (91.9)
172 (91.0)
179 (89.5)
Average
57.9
56.9
56.3
Standard
Deviation
5.9
6.3
5.4
10th
Percentile
50.8
50.0
48.9
25th
Percentile
54.8
53.0
53.0
©2014 National Committee for Quality Assurance
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
21
Table 5. HEDIS MPM Measure Performance (Digoxin)—Commercial HMO Plans
Year
2011
2012
2013
Total Number
of Plans
242
221
219
Plans Able to
Report (%)
161 (66.5)
129 (58.4)
129 (58.9)
Average
84.6
85.4
86.5
Standard
Deviation
7.5
7.1
6.4
10th
Percentile
75.0
75.9
78.7
25th
Percentile
82.0
82.8
82.8
50th
Percentile
85.4
86.2
86.8
75th
Percentile
89.5
89.8
91.5
90th
Percentile
92.9
93.5
94.3
25th
Percentile
74.7
75.9
77.8
50th
Percentile
79.7
79.9
81.0
75th
Percentile
83.8
84.2
84.5
90th
Percentile
85.9
87.3
87.8
25th
Percentile
78.6
79.7
79.9
50th
Percentile
81.4
82.4
82.9
75th
Percentile
84.1
84.9
85.2
90th
Percentile
86.1
87.0
87.2
25th
Percentile
75.8
76.4
76.7
50th
Percentile
78.5
79.0
79.1
75th
Percentile
81.0
81.3
81.1
90th
Percentile
83.1
82.9
83.3
Table 6. HEDIS MPM Measure Performance (Digoxin)—Commercial PPO Plans
Year
2011
2012
2013
Total Number
of Plans
172
189
200
Plans Able to
Report (%)
126 (73.3)
140 (74.1)
145 (72.5)
Average
79.1
79.2
80.6
Standard
Deviation
6.5
7.3
6.1
10th
Percentile
71.0
69.3
71.8
Table 7. HEDIS MPM Measure Performance (Diuretics)—Commercial HMO Plans
Year
2011
2012
2013
Total Number
of Plans
242
221
219
Plans Able to
Report (%)
231 (95.5)
211 (95.5)
212 (96.8)
Average
81.0
82.1
82.5
Standard
Deviation
4.9
5.0
4.5
10th
Percentile
76.0
77.7
77.8
Table 8. HEDIS MPM Measure Performance (Diuretics)—Commercial PPO Plans
Year
2011
2012
2013
Total Number
of Plans
172
189
200
Plans Able to
Report (%)
171 (99.4)
188 (99.5)
198 (99.0)
Average
78.1
78.4
78.8
Standard
Deviation
4.3
4.4
3.8
10th
Percentile
72.9
73.0
74.1
©2014 National Committee for Quality Assurance
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
22
Table 9. HEDIS MPM Measure Performance (Total)—Commercial HMO Plans
Year
2011
2012
2013
Total Number
of Plans
242
221
219
Plans Able to
Report (%)
231 (95.5)
212 (95.9)
212 (96.8)
Average
80.9
81.9
82.3
Standard
Deviation
4.8
4.9
4.4
10th
Percentile
76.0
77.5
77.3
25th
Percentile
78.5
80.1
79.8
50th
Percentile
81.3
82.1
82.7
75th
Percentile
83.8
84.5
85.0
90th
Percentile
85.9
86.9
87.0
25th
Percentile
75.9
76.2
76.6
50th
Percentile
78.3
78.7
78.9
75th
Percentile
80.7
80.9
80.8
90th
Percentile
82.6
82.5
82.9
50th
Percentile
91.8
92.1
92.6
75th
Percentile
93.6
93.9
94.5
90th
Percentile
94.9
95.2
96.1
50th
Percentile
91.0
91.6
91.9
75th
Percentile
92.4
92.8
93.2
90th
Percentile
93.6
93.7
94.5
Table 10. HEDIS MPM Measure Performance (Total)—Commercial PPO Plans
Year
2011
2012
2013
Total Number
of Plans
172
189
200
Plans Able to
Report (%)
171 (99.4)
188 (99.5)
199 (99.5)
Average
77.8
78.2
78.5
Standard
Deviation
4.2
4.3
3.9
10th
Percentile
72.5
72.8
73.6
MEDICARE PRODUCT LINE
Table 1. HEDIS MPM Measure Performance (ACE Inhibitors or ARBS)—Medicare HMO Plans
Year
2011
2012
2013
Total Number
of Plans
314
316
361
Plans Able to
Report (%)
308 (98.1)
313 (99.1)
349 (96.7)
Average
90.7
91.3
92.0
Standard
Deviation
5.6
5.0
4.9
10th
Percentile
86.1
87.4
88.5
25th
Percentile
89.7
90.2
90.8
Table 2. HEDIS MPM Measure Performance (ACE Inhibitors or ARBS)—Medicare PPO Plans
Year
2011
2012
2013
Total Number
of Plans
128
139
155
Plans Able to
Report (%)
127 (99.2)
139 (100.0)
152 (98.1)
Average
90.8
91.4
91.6
Standard
Deviation
2.9
3.0
3.4
10th
Percentile
87.6
87.9
88.0
25th
Percentile
89.2
89.8
90.0
©2014 National Committee for Quality Assurance
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
23
Table 3. HEDIS MPM Measure Performance (Anticonvulsants)—Medicare HMO Plans
Year
2011
2012
2013
Total Number
of Plans
314
316
361
Plans Able to
Report (%)
262 (83.4)
281 (88.9)
286 (79.2)
Average
68.2
67.4
66.7
Standard
Deviation
10.4
10.2
9.9
10th
Percentile
56.4
54.2
54.3
25th
Percentile
62.5
61.6
60.2
50th
Percentile
68.6
67.8
66.2
75th
Percentile
73.9
73.6
71.6
90th
Percentile
81.3
79.5
78.1
25th
Percentile
62.7
62.0
60.7
50th
Percentile
67.2
66.6
64.7
75th
Percentile
72.8
72.0
70.0
90th
Percentile
83.6
81.1
78.8
25th
Percentile
91.5
91.8
93.3
50th
Percentile
94.0
94.2
95.0
75th
Percentile
95.6
95.8
96.5
90th
Percentile
97.0
97.1
98.1
25th
Percentile
90.5
91.0
91.7
50th
Percentile
92.7
93.4
93.6
75th
Percentile
94.0
95.0
95.0
90th
Percentile
96.8
97.2
96.9
Table 4. HEDIS MPM Measure Performance (Anticonvulsants)—Medicare PPO Plans
Year
2011
2012
2013
Total Number
of Plans
128
139
155
Plans Able to
Report (%)
102 (79.7)
118 (84.9)
127 (81.9)
Average
69.1
68.5
66.3
Standard
Deviation
10.8
11.0
11.9
10th
Percentile
57.6
57.4
54.0
Table 5. HEDIS MPM Measure Performance (Digoxin)—Medicare HMO Plans
Year
2011
2012
2013
Total Number
of Plans
314
316
361
Plans Able to
Report (%)
261 (83.1)
271 (85.8)
271 (75.1)
Average
93.1
93.4
94.5
Standard
Deviation
4.3
3.6
3.5
10th
Percentile
88.4
88.9
90.6
Table 6. HEDIS MPM Measure Performance (Digoxin)—Medicare PPO Plans
Year
2011
2012
2013
Total Number
of Plans
128
139
155
Plans Able to
Report (%)
108 (84.4)
124 (89.2)
134 (86.5)
Average
92.7
93.2
93.2
Standard
Deviation
3.1
3.4
3.3
10th
Percentile
89.3
89.3
89.9
©2014 National Committee for Quality Assurance
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
24
Table 7. HEDIS MPM Measure Performance (Diuretics)—Medicare HMO Plans
Year
2011
2012
2013
Total Number
of Plans
314
316
361
Plans Able to
Report (%)
308 (98.1)
313 (99.1)
348 (96.4)
Average
90.9
91.6
92.2
Standard
Deviation
5.7
5.0
5.0
10th
Percentile
86.2
87.9
88.4
25th
Percentile
89.9
90.5
91.1
50th
Percentile
92.1
92.6
93.0
75th
Percentile
93.8
94.1
94.8
90th
Percentile
95.1
95.5
96.1
25th
Percentile
89.9
90.6
90.4
50th
Percentile
91.2
92.0
92.2
75th
Percentile
92.8
93.3
93.4
90th
Percentile
94.0
94.3
94.4
25th
Percentile
89.1
89.8
90.0
50th
Percentile
91.2
91.6
92.0
75th
Percentile
93.2
93.5
94.0
90th
Percentile
94.5
94.9
95.5
25th
Percentile
89.1
89.6
89.5
50th
Percentile
90.7
91.3
91.5
75th
Percentile
92.3
92.5
92.8
90th
Percentile
93.3
93.5
94.2
Table 8. HEDIS MPM Measure Performance (Diuretics)—Medicare PPO Plans
Year
2011
2012
2013
Total Number
of Plans
128
139
155
Plans Able to
Report (%)
127 (99.2)
139 (100.0)
151 (97.4)
Average
91.2
91.8
91.9
Standard
Deviation
2.8
2.9
3.2
10th
Percentile
87.9
88.5
88.7
Table 9. HEDIS MPM Measure Performance (Total)—Medicare HMO Plans
Year
2011
2012
2013
Total Number
of Plans
314
316
361
Plans Able to
Report (%)
309 (98.4)
313 (99.1)
350 (97.0)
Average
90.2
90.9
91.4
Standard
Deviation
5.7
5.0
5.0
10th
Percentile
85.9
86.8
87.2
Table 10. HEDIS MPM Measure Performance (Total)—Medicare PPO Plans
Year
2011
2012
2013
Total Number
of Plans
128
139
155
Plans Able to
Report (%)
127 (99.2)
139 (100.0)
152 (98.1)
Average
90.6
91.2
91.3
Standard
Deviation
2.9
3.0
3.4
10th
Percentile
87.4
87.6
88.0
©2014 National Committee for Quality Assurance
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
25
MEDICAID PRODUCT LINE
Table 1. HEDIS MPM Measure Performance (ACE Inhibitors or ARBS)—Medicaid HMO Plans
Year
2011
2012
2013
Total Number
of Plans
184
191
213
Plans Able to
Report (%)
130 (70.7)
157 (82.2)
176 (82.6)
Average
86.0
85.9
86.3
Standard
Deviation
4.1
5.4
4.6
10th
Percentile
79.9
80.2
80.8
25th
Percentile
83.6
83.7
84.6
50th
Percentile
86.5
86.9
87.1
75th
Percentile
88.6
89.2
89.2
90th
Percentile
90.6
91.3
91.2
25th
Percentile
63.2
61.7
61.8
50th
Percentile
68.6
65.3
66.0
75th
Percentile
72.6
70.3
70.7
90th
Percentile
76.6
74.7
73.7
25th
Percentile
87.5
87.9
87.5
50th
Percentile
90.3
91.0
90.8
75th
Percentile
93.3
93.4
93.2
90th
Percentile
95.5
95.6
95.0
25th
Percentile
82.8
83.2
83.8
50th
Percentile
85.8
86.4
86.7
75th
Percentile
88.6
88.9
89.1
90th
Percentile
90.7
91.3
91.3
Table 2. HEDIS MPM Measure Performance (Anticonvulsants)—Medicaid HMO Plans
Year
2011
2012
2013
Total Number
of Plans
184
191
213
Plans Able to
Report (%)
113 (61.4)
130 (68.1)
136 (63.9)
Average
67.7
65.2
65.8
Standard
Deviation
7.2
7.9
6.8
10th
Percentile
57.6
53.7
55.6
Table 3. HEDIS MPM Measure Performance (Digoxin)—Medicaid HMO Plans
Year
2011
2012
2013
Total Number
of Plans
184
191
213
Plans Able to
Report (%)
59 (32.1)
75 (39.3)
94 (44.1)
Average
89.7
90.3
90.2
Standard
Deviation
5.3
4.9
4.3
10th
Percentile
80.4
83.3
83.7
Table 4. HEDIS MPM Measure Performance (Diuretics)—Medicaid HMO Plans
Year
2011
2012
2013
Total Number
of Plans
184
191
213
Plans Able to
Report (%)
130 (70.7)
156 (81.7)
174 (81.7)
Average
85.5
85.4
86.0
Standard
Deviation
4.5
5.4
5.0
10th
Percentile
79.3
78.5
80.0
©2014 National Committee for Quality Assurance
Draft Document for HEDIS 2015 Public Comment—Obsolete After March 19, 2014
26
Table 5. HEDIS MPM Measure Performance (Total)—Medicaid HMO Plans
Year
2011
2012
2013
Total Number
of Plans
184
191
176
Plans Able to
Report (%)
132 (71.7)
157 (82.2)
176 (82.6)
Average
83.9
83.9
84.5
Standard
Deviation
4.1
5.0
4.5
10th
Percentile
78.3
78.5
79.3
25th
Percentile
81.8
81.2
82.4
©2014 National Committee for Quality Assurance
50th
Percentile
84.2
84.8
85.4
75th
Percentile
86.7
87.0
87.3
90th
Percentile
88.2
88.6
89.0