The Quality Performance Measure (QPM) score program was developed by AmeriHealth HMO, Inc. for participating primary care physicians (PCP). The QPM score program evaluates quality of care based on nationally accepted standards, such as those endorsed by the National Committee for Quality Assurance (NCQA). Annually, we evaluate participating primary care practices and score them relative to their peers based on their QPM results. Practices receive notification on their percent of completed measures compared to the percent of their peers.

New measures

As meaningful measures of quality continue to be developed and improved, the quality indicators included in the QPM score program are continuously refined. The following measures will be added to the QPM score program for measurement year 2014:

Measure Description Eligible members Avoidance of antibiotic treatment in adults with acute bronchitis Members 18 through 64 who were identified as having a diagnosis of acute bronchitis through claims for outpatient or emergency room (ER) visits between January 1 through December 24 of the measurement year (2014) and who were not dispensed an antibiotic prescription. Continuously enrolled members who were at least 18 as of January 1 of the measurement year (2014) through 64 as of December 31 of the measurement year (2014), who were identified through outpatient and ER visit claims as having a diagnosis of acute bronchitis, and who were continuously enrolled for one year prior to the diagnosis date through seven days after the diagnosis date, and who meet all of the following criteria: no active antibiotic prescription or any new antibiotic dispensed within 30 days prior to the diagnosis date; no other upper respiratory or other infectious disease that required antibiotics within 30 days prior to the diagnosis date through seven days after the diagnosis date; none of the following comorbid conditions in the 12 months prior to the diagnosis date: bronchiectasis chronic bronchitis COPD cystic fibrosis emphysema extrinsic allergic alveolitis HIV disease HIV, asymptomatic immunity disorders malignant neoplasms other respiratory system diseases pneumoconiosis and other lung disease due to external agent tuberculosis Appropriate treatment for children with URI Members 3 months through 18 who were identified through claims for outpatient or ER visits as having a diagnosis only of upper respiratory infection (URI), on or between July 1 of the year prior to the measurement year (2013) and June 30 of the measurement year (2014) and who were not dispensed an antibiotic prescription. Continuously enrolled members who were 3 months as of July 1 of the year prior to the measurement year (2013) through 18 as of June 30 of the measurement year (2014), who were identified through outpatient or ER visit claims as having a diagnosis of URI, and who were continuously enrolled from 30 days prior to the diagnosis date through three days after the diagnosis date, and who met the following criteria: no diagnosis other than URI on the diagnosis date; no active antibiotic prescription or any new antibiotic dispensed within 30 days prior to the diagnosis date; no claims/encounters with the following"competing diagnoses" either on the URI diagnosis date or the three days following: acne acute lymphadenitis acute pharyngitis acute sinusitis acute tonsillitis bacterial infection, unspecified cellulitis, mastoiditis, other bone infection chlamydia chronic sinusitis cystitis or UTI gonococcal infections and VD impetigo infection of the kidneys infection of the pharynx, larynx, tonsils, or adenoids inflammatory diseases (female reproductive organs) intestinal infection lyme disease or other arthropod-borne disease otitis media pertussis pneumonia prostatitis skin staph infection syphilis Appropriate testing for children with pharyngitis Members 2 through 18 who were identified as having a diagnosis of pharyngitis through claims for outpatient or ER visits on or between July 1 of the year prior to the measurement year (2013) and June 30 of the measurement year (2014), who were dispensed an antibiotic, and who received a group A streptococcus (strep) test for the episode within the seven day period from three days prior to the diagnosis date through three days after the diagnosis date. Continuously enrolled members who were 2 as of July 1 of the year prior to the measurement year (2013) through 18 as of June 30 of the measurement year (2014), who were identified through outpatient or ER visit claims as having a diagnosis of pharyngitis, and who were continuously enrolled from 30 days prior to the diagnosis date, through three days after the diagnosis date, and who met the following criteria: no diagnosis other than pharyngitis on the diagnosis date; prescribed an antibiotic for the pharyngitis episode on or within three days after the diagnosis date; no active antibiotic prescription or any new antibiotic dispensed within 30 days prior to the diagnosis date.

Updated measures

For measurement year 2014, the following measures are being updated: Breast Cancer Screening. The age range was changed from ages 42 through 69 to ages 50 through 74. Cervical Cancer Screening. The lower age limit was lowered from age 24 to age 21. In addition, a new requirement was added for cervical cytology/human papilomavirus co-testing. Cholesterol management (LDL-C) for patients with cardiovascular conditions. Credit will be given for this measure for members with LDL-C levels < 100 mg/dl. Diabetic care. Credit will be given for this measure for members with LDL-C levels < 100 mg/dl, as well as members with a HbA1c < 8.0%. If you have any questions about the measure changes or the QPM score program, please contact your Network Coordinator.