Mount Carmel Health Partners HEDIS Tip Sheets - Page 22

HEDIS Tip Sheet Diabetes – Statin Therapy Definition: Percentage of members ages 40-75, who have been diagnosed with diabetes but DO NOT have a diagnosis of ASCVD (atherosclerotic cardiovascular disease) who fill their statin/cholesterol medication prescription 80% of the time they have been prescribed the medication. Service Needed: Filling prescriptions for statin/cholesterol medications. Exclusions: Hospice care in the measurement year. Chart Review Tips: • Cholesterol medications include statins. • Cholesterol medications can be found in the “Medications” section of the chart or noted in an office visit/progress note. Member Outreach Tips: • Ask patients if they are taking (or have been prescribed) a statin medication for cholesterol. • Encourage patients to take medications as prescribed. If patients do not take medication as prescribed, ask why: Lack of funds? A problem with side effects? Supplemental Data Tips • This measure must be met through either pharmacy data or claims, meaning supplemental data cannot be used. • Patients may be taking medication as prescribed and not using their insurance benefits (for example: $4 prescriptions) which would cause them to appear not meet the metric falsely. Statin medications include: • • • • • • • • • • • • • • • Advicor (niacin extended-release/lovastatin) Altoprev (lovastatin extended-release) Caduet (amlodipine and atorvastatin) Crestor (rosuvastatin) Juvisync (sitagliptin/simvastatin) Lescol (fluvastatin) Lescol XL (fluvastatin extended-release) Lipitor (atorvastatin) Liptruzet (atorvastatin-ezetimibe) Livalo (pitavastatin) Mevacor (lovastatin) Pravachol (pravastatin) Simcor (niacin extended-release/simvastatin) Vytorin (ezetimibe/simvastatin) Zocor (simvastatin) 22