Outpatient Services

The percentage of members 18 years of age and older who received at 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. For each product line, report each of the four rates separately and as a total rate.

• Annual monitoring for members on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB)
• Annual monitoring for members on digoxin
• Annual monitoring for members on diuretics

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:

The percentage of children 2–18 years of age who were diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode. A higher rate represents better performance (i.e., appropriate testing).

To ensure that all women have endometrial sampling performed before undergoing an endometrial ablation.

Percentage of patients aged 5 years and older with a diagnosis of persistent asthma who were prescribed long-term control medication

Three rates are reported for this measure:
1. Patients prescribed inhaled corticosteroids (ICS) as their long term control medication
2. Patients prescribed other alternative long term control medications (non-ICS)
3. Total patients prescribed long-term control medication

The percentage of patients aged 12 years and older with coronary artery disease, or 18 years and older with cerebrovascular disease or peripheral vascular disease that have been screened for dyslipidemia with a lipid profile

The percentage of patients aged 18 and older with a diagnosis of atherosclerotic disease whose most recent LDL-C value is greater than 100 mg/dL and who are taking a lipid lowering agent

Percentage of adult patients aged 25 and older with atrial fibrillation and major stroke risk factors who are on anticoagulation therapy.

Percentage of patients aged 18 years and older with a diagnosis of nonvalvular atrial fibrillation (AF) or atrial flutter whose assessment of the specified thromboembolic risk factors indicate one or more high-risk factors or more than one moderate risk factor, as determined by CHADS2 risk stratification, who are prescribed warfarin OR another oral anticoagulant drug that is FDA approved for the prevention of thromboembolism

Percentage of patients aged 18 years and older with a diagnosis of nonvalvular atrial fibrillation (AF) or atrial flutter in whom assessment of all the specified thromboembolic risk factors using the CHADS2 risk criteria is documented