This article series is a monthly tool to help physicians maximize patient health outcomes in accordance with NCQA?s¹ HEDIS^®2 measurements for high quality care on important dimensions of services.

Go to Highlighting HEDIS^® web page to view previously published topics. If you have feedback or would like to request a topic, email us.

HEDIS^® definition

Disease-modifying anti-rheumatic drug therapy for rheumatoid arthritis: The percentage of members who were diagnosed with rheumatoid arthritis and were dispensed at least one ambulatory prescription for a disease-modifying anti-rheumatic drug (DMARD).

Why this measure is important

Rheumatoid arthritis (RA) is a chronic autoimmune disorder often characterized by progressive joint destruction and multisystem involvement. It affects approximately 2.5 million Americans and affects women disproportionately. Because there is currently no cure for this disorder, the goal of treatment is to slow the progression of the disease, thereby delaying or preventing joint destruction, relieving pain, and maintaining functional capacity.

This measure assesses whether patients diagnosed with RA have been prescribed a DMARD. DMARDs modify the disease course of RA through attenuation of the progression of bony erosions, reduction of inflammation, and long-term structural damage. The utilization of DMARDs is also expected to provide improvement in functional status. ? NCQA, HEDIS 2013 V1

DMARD prescriptions

The following medications are reviewed by HEDIS^® for ambulatory prescriptions for DMARDs:

Medication class Prescription 5-Aminosalicylates sulfasalazine Alkylating agents cyclophosphamide Aminoquinolines hydroxychloroquine Anti-rheumatics auranofin, gold sodium thiomalate, leflunomide, methotrexate, penicillamine Immunomodulators abatacept, adalimumab, anakinra, certolizumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, tocilizumab Immunosuppressive agents azathioprine, cyclosporine, mycophenolate Janus kinase (JAK) inhibitor tofacitinib Tetracyclines minocycline

QIPS³ alert

DMARD therapy for RA is a performance measure in the Quality Incentive Payment System (QIPS) program for measurement year 2014 for participating providers.

Stars⁴ alert

This is also a Medicare Stars measure.

Medicare plan performance

Although our Medicare Advantage HMO and PPO plans performed below the national 25th percentile, focused intervention on a measure-eligible population of less than 1,000 members could result in rapid performance improvement.

¹The National Committee for Quality Assurance (NCQA) is the most widely recognized accreditation program in the United States.

²The Healthcare Effectiveness Data and Information Set (HEDIS^®) is an NCQA tool used by more than 90 percent of America?s health plans to measure performance on important dimensions of care.

³QIPS is a reimbursement system developed by Keystone Health Plan East for participating Pennsylvania primary care physicians that offers incentives for high-quality, accessible, and cost-effective care.

⁴Stars is a program developed by the Centers for Medicare & Medicaid Services to measure quality health care. Ratings are published annually to help educate consumers prior to enrollment decisions.

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