HEDIS^® Tip Sheet

Clinical ASCVD includes:

• Myocardial Infarction (MI)
• Coronary Artery Bypass Graft (CABG)
• Percutaneous Coronary Intervention (PCI)
• Other revascularization procedures.

Received Statin Therapy Compliance:

• Eligible population as determined by event/diagnosis, who have had at least one dispensing event for high or moderate intensity statin medication during the measurement year.

Statin Adherence 80% Compliance:

• Members who received a proportion of days covered of at least 80% during the treatment period.

Best Practices

• Educate patients on the importance of adherence to prescribed medication regimen.
• Include patient concerns/input in decision making processes for a treatment plan they can adhere to (i.e., once daily dosing, generic options, and medications to minimize side effects).
• Schedule and encourage routine follow-up and monitoring.

Exclusions

Members with any of the following during the measurement year or the year prior to the measurement year:

• Pregnancy diagnosis
• In vitro fertilization
• End stage renal disease or dialysis
• Cirrhosis
• Dispensed at least one prescription for clomiphene (estrogen agonist).

Members with the following during the measurement year:

• Myalgia, myositis, myopathy, rhabdomyolysis

Other Exclusions include:

• Members in hospice during the measurement year.
• Members who received palliative care during the measurement year.
• Members who died during the measurement year.
• Members 66+ years of age with frailty and advanced illness. Members must meet BOTH the frailty and advanced illness criteria to be excluded:
  • 1. At least two indicators of frailty with different dates of service during the measurement period.
  • 2. Any of the following during the measurement year or the year prior to the measurement year:
    • At least two outpatient visits, observation visits, ED visits, telephone visits, e-visits, or virtual check-ins, nonacute inpatient encounters, or nonacute inpatient discharges on different dates of service with an advanced illness diagnosis.
    • At least on acute inpatient encounter with an advanced illness diagnosis.
    • At least one acute inpatient discharge with an advanced illness diagnosis on the discharge claim.
• A dispensed dementia medication.