The Centers for Medicare & Medicaid Services (CMS) uses performance and quality measures to help Medicare beneficiaries make informed decisions regarding medical and prescription drug programs. As part of this effort, CMS calculates and publicizes several patient safety measures, many of which are used to calculate ratings for health plans.

We are committed to working with our providers to improve outcomes on these patient safety measures. As a first step, we want to explain each measure as well as the role you can play to ensure that our Medicare Advantage HMO and PPO members are receiving care that is both safe and effective. The measures and their descriptions are listed below.

High-Risk Medication (HRM)

The HRM rate analyzes the percentage of Medicare Part D beneficiaries who are 65 and older and have filled prescriptions for medications with a high risk of serious side effects in the elderly. The list of medications that CMS defines as high-risk in the elderly was adapted from the National Committee for Quality Assurance's (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS?) and adapted and endorsed by the Pharmacy Quality Alliance (PQA). Providers should avoid prescribing these medications, when possible, to patients who are 65 and older.

Diabetes Treatment (DT)

The DT rate analyzes the percentage of Medicare Part D beneficiaries who are 18 and older and have filled a prescription for both diabetes and hypertension but did not fill a prescription for an ACEI or ARB medication. Providers who have diabetic patients who also need hypertension medications are encouraged to prescribe an ACEI or ARB and educate their patients about the importance of taking an ACEI or ARB in conjunction with treatment for diabetes and hypertension. CMS provides a list of the diabetes and hypertension medications included in this measure.

Drug-Drug Interaction (DDI)

The DDI rate analyzes the percentage of Medicare Part D beneficiaries who have filled a prescription for a targeted medication during the measurement period and who also filled a prescription for a contraindicated medication, either at the same time or subsequent to the initial prescription. Providers can view the list of targeted and contraindicated medications on the CMS website and should avoid prescribing these medications together.

Diabetes Medication Dosage (DMD)

The DMD rate analyzes the percentage of Medicare Part D beneficiaries who filled a prescription at a dose that was higher than the daily recommended dose for biguanide, sulfonylurea, and thiazolidinedione therapeutic classes of oral hypoglycemic drugs. Providers can view the list of maximum recommended adult doses for these drugs on the CMS website and are encouraged to prescribe them within the recommended dose range.

Part D Medication Adherence (ADH)

The ADH rates assess the extent to which Medicare Part D beneficiaries adhered to their prescribed medications in the following drug classes/therapeutic areas: antiretrovirals, cholesterol (statins), hypertension (ACEI or ARB), and oral diabetes medications. Providers are encouraged to educate their patients who have been prescribed these medications about the importance of taking and refilling their prescriptions.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).