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

Eligible Population:
Males 21-75 years of age and females 40-75 years of age as of December 31 of the measurement year.

Definition:
The percentage of males 21-75 years of age and females 40-75 years of age as of December 31 of the measurement year, diagnosed with clinical atherosclerotic cardiovascular disease (ASCVD) and were dispensed at least one high or moderate-intensity statin medication during the measurement year.

The following rates are reported:

1. Received Statin Therapy. Dispensed at least one medication during the measurement year.
2. Statin Adherence 80%. Remained on medication for at least 80% of the treatment period.

Total Rate:  Report two age/gender stratifications and a total rate. 

*NOTE: All numerator compliant for Rate 1 must be used as the eligible population for Rate 2 (regardless of the data source used to capture the Rate 1 numerator).

Continuous Enrollment:

• 180 days prior to the IPSD through 61 days after the IPSD.

Best Practice and Measure Tips

The treatment period is defined as the earliest prescription dispensing date in the measurement year for any statin medication of at least moderate intensity through the last day of the measurement year.

• Consider prescribing a high or moderate intensity statin, as appropriate.
• Member must use their insurance card to fill one of the statins or statin combination medications through the last day of the measurement year.
• Educate members: Statin use should always be accompanied by lifestyle modifications focused on diet and weight loss to improve a patient's lipid panel.
• Members are identified by event or diagnosis.
  • Event: Discharged from an inpatient setting with a myocardial infarction (MI Value Set) and/or old myocardial infraction (Old Myocardial Infarction Value Set) on the discharge claim. CABG, PCI or any other revascularization in any setting the year prior to the measurement year.
  • Diagnosis: Identify members as having ischemic vascular disease (IVD) who met at least one of the following criteria during both the measurement year and the year prior to the measurement year:
    • At least one outpatient visit, telephone visit, e-visit or virtual check-in with an IVD diagnosis.
    • At least one acute inpatient encounter with an IVD diagnosis without telehealth.
    • At least one acute inpatient discharge with an IVD diagnosis on the discharge claim.

Measure Exclusions

Required Exclusions:

• Frailty and Advanced Illness

Any time during the measurement year or the prior year:

• Members with a diagnosis of pregnancy
• In vitro fertilization
• Dispensed at least one prescription for clomiphene
• ESRD or dialysis
• Cirrhosis

During the Measurement Year:

• Myalgia
• Myositis
• Myopathy
• Rhabdomyolysis 
• Palliative Care
• Living in Long Term Care
• Members in hospice or using hospice services.
• Members who died.

Exclusion Codes

Common diagnosis codes for exclusion:

• Muscular Pain 
  • Myopathy ICD-10-CM: G72.0, G72.2, G72.9
  • Myositis ICD-10-CM: M60.80, M60.811, M60.812, M60.819, M60.821, M60.822, M60.829, M60.831, M60.832, M60.839, M60.841, M60.842, M60.849, M60.851, M60.852, M60.859, M60.861, M60.862, M60.869, M60.871, M60.872, M60.879, M60.88, M60.89, M60.9
  • Rhabdomyolysis ICD-10-CM: M62.82
  • Myalgia ICD-10-CM: M79.10, M79.11, M79.12, M79.18
• Cirrhosis 
  • ICD-10-CM: K70.30, K70.31, K71.7, K74.3, K74.4, K74.5, K74.60, K74.69, P78.81
• ESRD 
  • ICD-10-CM: N18.5, N18.6, Z99.2

Measure Medications

To comply with this measure, one of the following medications must have been dispensed:

High and Moderate-Intensity Statin Medications