Product Lines:
EHP, Priority Partners and USFHP.

Eligible Population:
Members 5 - 64 years of age and older by December 31 of the measurement year. This includes Population Health Incentive Program (PHIP) and HealthChoice Performance Measure reporting for Priority Partners.

Definition:
The percentage of members 5-64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 50% or greater during the measurement year.

Report the following age stratifications and a total rate:

• 5–11 years.
• 12–18 years.
• 19–50 years.
• 51–64 years.
• Total. The total is the sum of the age stratifications for each product line.

Report stratification by race and ethnicity.

Continuous Enrollment:

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

Best Practice and Measure Tips

Schedule follow-up appointments:

• Ensure the patient is not using more rescue medications than preventive medication to control their asthma (i.e., rescue meds have 50 percent less usage than preventive meds)
• Report the appropriate diagnosis codes for the member’s condition. Include the appropriate codes for diagnosed conditions that may exclude the member from this measure.
• Ensure at least half of the medications dispensed to treat their asthma are controller medications throughout the treatment/measurement period. 

Patient is considered to have persistent asthma if they have any of the following during both the measurement year and the year prior to the measurement year. Criteria is not needed to be the same across both years.

• At least 1 ER visit or acute inpatient encounter with a principal diagnosis of asthma; 
• At least 1 acute inpatient discharge with a principal diagnosis of asthma on the discharge claim;
• At least 4 outpatient visits, telephone visits or e-visits or virtual check-ins, on different dates of service, with any diagnosis of asthma and at least 2 asthma medication dispensing events for any controller or reliever medication;
• At least 4 asthma medication dispensing events for any controller or reliever medications. 

Measure Exclusions

Required Exclusions:  

• Members who had a diagnosis that requires a different treatment approach than members with asthma any time during the member’s history through December 31 of the measurement year.
• Members who weren’t prescribed an asthma medication any time during the measurement year.
• Members in hospice or using hospice services anytime during the measurement year
• Members who died any time during the measurement year.   

Exclusion Codes:

•  Respiratory Diseases With Different Treatment Approaches Than Asthma
  • ICD-10-CM: E84.0, E84.11, E84.19, E84.8, E84.9, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.9, J68.4, J96.00, J96.01, J96.02, J96.20, J96.21, J96.22, J98.2, J98.3, 277.00, 277.01, 277.02, 277.03, 277.09, 492.0, 492.8, 493.20, 493.21, 493.22, 496, 506.4, 518.1, 518.2, 518.81. 

Measure Codes

Examples of persistent asthma codes:

• ICD-10-CM: J45.21, J45.22, J45.30 - J45.32, J45.40 - J45.42, J45.50 - J45.52, J45.901, J45.902, J45.909, J45.991, J45.998 

Measure Medications

Asthma Controller Medications

 

Asthma Reliever Medications