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Qualified Health Plan (QHP) Quality Rating System (QRS)

Annual Monitoring for Patients on Persistent Medications (MPM)

  • This measure assesses the percentage of patients 18 years of age and older who received a least 180 treatment days of ambulatory medication therapy for a select therapeutic agent during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year. Report the following three rates and a total rate:

    CBE ID
    2371

Antidepressant Medication Management (AMM)

  • The percentage of members 18 years of age and older who were treated antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. Two rates are reported.

    a) Effective Acute Phase Treatment. The percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks).
    b) Effective Continuation Phase Treatment. The percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).

    CBE ID
    0105

Appropriate Treatment for Children With Upper Respiratory Infection (URI)

  • The Appropriate Treatment for Upper Respiratory Infection (URI) measure assesses whether members 3 months of age and older with a diagnosis of upper respiratory infection were not dispensed an antibiotic prescription. The measure includes patients enrolled in commercial, Medicaid, and Medicare health plans.

    CBE ID
    0069

Breast Cancer Screening

  • Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer

    CBE ID
    2372

Cervical Cancer Screening

  • The percentage of women 21–64 years of age who were screened for cervical cancer using either of the following criteria:
    -Women 21–64 years of age who had cervical cytology performed within the last 3 years.
    -Women 30–64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last 5 years.
    -Women 30–64 years of age who had cervical cytology/high-risk human papillomavirus (hrHPV) cotesting within the last 5 years.

    CBE ID
    0032

Childhood Immunization Status (CIS)

  • Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DtaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine.

    CBE ID
    0038

Chlamydia Screening in Women (CHL)

  • The percentage of women 16–24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year.

    CBE ID
    0033