[
This article series is a monthly tool to help physicians maximize patient
health outcomes in accordance with
NCQA's* HEDIS®† measurements for high quality care on
important dimensions of services.
Go to our Highlighting HEDIS webpage to view previously published
Highlighting HEDIS® topics.
If you have feedback or would like to request a topic, email us.
HEDIS® definition
Pharmacotherapy management of COPD exacerbation: The percentage of
chronic obstructive pulmonary
disease (COPD) exacerbations for members ages 40 and older who had an acute
inpatient discharge or emergency
department visit on or between January 1 – November 30 of the measurement
year and who were dispensed
appropriate medications. Two rates are reported:
- Dispensed a bronchodilator (or there was evidence of an active
prescription) within 30 days of the event;
- Dispensed a systemic corticosteroid (or there was evidence of an active
prescription) within 14 days of the event.
Note: The eligible population for this measure is based on acute
inpatient discharges and emergency department
visits, not on members. It is possible for the denominator to include multiple
events for the same individual.
Plan Performance
For this measure, the HEDIS 2014 rates‡ for all AmeriHealth
New Jersey plans fall below the HEDIS 90th percentile benchmark, an industry
indicator of excellence and desired target for each plan. Performance compared
to the HEDIS 90th percentile is broken down by line of business and plan type
below.
| Bronchodilator dispense
rate | Systemic corticosteriod dispense
rate |
| Source |
Commercial |
Medicare |
| HMO |
PPO |
HMO |
| AmeriHealth New
Jersey | 69.4% | N/A | N/A |
| HEDIS 90th percentile | 88.0% | 89.0% |
|
| Source |
Commercial |
Medicare |
| HMO |
PPO |
HMO |
| AmeriHealth New
Jersey | 66.7% | N/A | N/A |
| HEDIS 90th percentile | 81.0% | 78.0% |
|
Why this measure is important
While other major causes of death have been decreasing, COPD mortality has
risen, making it the fourth leading cause of death in the U.S. The disease
results in both direct and indirect costs, and exacerbations of COPD account
for the greatest burden on the health care system, though studies have shown
that proper management of exacerbations may have the greatest potential to
reduce the clinical, social, and economic impact of the disease.
Pharmacotherapy is an essential component of proper management.
? NCQA, HEDIS 2015 V1
Did you know?
AmeriHealth New Jersey case managers can collaborate with you to support and
guide patients through an acute or chronic episode to help achieve the medical
treatment goals you establish.
Please provide the AmeriHealth New Jersey case management line phone number
to your patients. AmeriHealth New Jersey case managers can support your
patients as they make important decisions about their health. Ask them to call
1-888-YOUR-AH1 (1-888-968-7241) and say "Case Management" when
prompted.
* The National Committee for Quality Assurance (NCQA) is
the most widely recognized accreditation program in the U.S.
† The Healthcare Effectiveness Data and Information Set (HEDIS) is an
NCQA tool used by more than 90 percent of U.S. health plans to measure
performance on important dimensions of care.
‡HEDIS 2014 rates reflect data collected in 2013.
HEDIS is a registered trademark of the National Committee for Quality Assurance
(NCQA). Used with permission.
]