Product Lines:
Advantage MD, EHP, Priority Partners, and USFHP.

Eligible Population:
Members 18 years of age and older as of December 31 of the measurement year. This includes HealthChoice Performance Measure reporting for Priority Partners.

Definition:
The percentage of members 18 years of age and older during the measurement year who were hospitalized and discharged from July 1 of the year prior to the measurement year to June 30 of the measurement year with a diagnosis of AMI and who received persistent beta-blocker treatment for 180 days (6 months) after discharge.

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

Continuous Enrollment:

• Discharge date through 179 days after discharge.

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

Required Exclusion:

• Members in hospice or using hospice services anytime during the measurement year.
• Members who died any time during the measurement year.
• Members 67–80 years of age as of December 31 of the measurement year (all product lines) with frailty and advanced illness.
• Medicare members 66 years of age and older by the end of the measurement period who meet either of the following:
  • Enrolled in an Institutional SNP (I-SNP).
  • Living in Long Term Care.
• Exclude hospitalizations in which the member 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 year.
• Members with a medication dispensing event that indicates a contraindication to beta-blocker therapy (Asthma Exclusions Medications List) any time during the member’s history through the and of the continuous enrollment period.
• Members with a diagnosis that indicates a contraindication to beta-blocker therapy (Beta Blocker Contraindications) any time during the member’s history through the end of the continuous enrollment period meet criteria.

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

Exclusion Medications

Asthma Exclusions Medications

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