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

Eligible Population:
Members ages 40–75 during the measurement year.

Definition:
Percentage of members ages 40–75 during the measurement year with diabetes who do not have clinical atherosclerotic cardiovascular disease (ASCVD) who met the following criteria for the two rates.

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

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. Help patients with diabetes understand they are more likely to develop heart disease or stroke, and Statins can help reduce their chance of developing these conditions.
• Educate patients on the importance of statin medication adherence.
• Adherence for the SPD measure is determined by the member remaining on their prescribed high or low intensity statin medication for 80% of their treatment period.
• Adherence is determined by pharmacy claims data (the plan will capture data each time the member fills their prescription).

Continuous Enrollment:

• The measurement year and the year prior to the measurement year.

Measure Exclusions

Required Exclusions:

• Palliative Care
• Members in hospice or using hospice services anytime during the measurement year.
• Members who died any time during the measurement year.
• Frailty
• Frailty and Advanced Illness
• Living in Long Term Care
• Members without a diagnosis of diabetes in any setting and a diagnosis of polycystic ovarian syndrome, gestational diabetes or steroid-induced diabetes during the measurement year or the year prior.

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 year prior to the Measurement Year:

• Coronary artery bypass grafting (CABG)
• Myocardial infarction
• Old Myocardial Infraction
• Other revascularization procedure
• Percutaneous coronary intervention (PCI)

During the Measurement Year:

• Myalgia
• Myositis
• Myopathy
• Rhabdomyolysis

During both the Measurement Year and the year prior to the Measurement Year:

• A diagnosis of ischemic vascular disease IVD.

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, Moderate and Low-Intensity Statin Medications

Diabetes Medications