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:
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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)
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