September 20, 2018
Almost a quarter of a million Americans – about 735,000 – have a heart attack each year. Guidelines recommend statins for adults with established clinical atherosclerotic cardiovascular disease (ASCVD) to reduce the risk of heart attack and stroke.
The Healthcare Effectiveness Data and Information Set (HEDIS) Statin Therapy for Patients with Cardiovascular Disease measure assesses patients with clinical atherosclerotic cardiovascular disease (ASCVD) who received statin therapy and their adherence rate to the medication. Premera tracks measures based on HEDIS, which is used by more than 90 percent of America's health plans to measure performance related to care and service.
What is HEDIS Statin Therapy measuring?
This measure examines the percentage of males 21–75 years of age and females 40–75 years of age who were identified as having clinical ASCVD and met the following criteria:
- Members who were dispensed at least one high-intensity or moderate-intensity statin medication during the measurement year
- Members who remained on a high-intensity or moderate-intensity statin medication for at least 80 percent of the treatment period
Patients who are unable to tolerate statins can be excluded from the measure by documenting the reason for intolerance and submitting the corresponding condition as an ICD-10 code on a claim.
You can refer to the HEDIS® statin therapy tip sheet for a list of the exclusionary ICD-10 codes, other exclusion criteria, and a statin formulary. For more information on this and other HEDIS measures email ProviderClinicalConsulting@premera.com