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Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA)

What is the SAA — HEDIS® Measure?

Based on current NCQA HEDIS recommendations for best practices, members ages 18 years and older during the measurement year with schizophrenia or schizoaffective disorder who were dispensed and remained on an antipsychotic medication for at least 80 percent of their treatment period.

The following will meet compliance:

  • The number of members who achieved a proportion of days covered (PDC) of at least 80 percent for their antipsychotic medications during the measurement year. PDC is the number of days a member is covered by at least one antipsychotic medication prescription, divided by the number of days in the treatment period.

Best Practices

  • Educate patients and their caregivers on the importance of medication compliance.
  • Discuss with patients potential medication side effects and when to call you.
  • Ensure appointment availability in your practice for patients and a schedule follow-up appointment before the patient leaves the office.
  • Set flags, if available, in electronic health records or develop a tracking method for patients due or past due for follow-up visits. Also, require staff to follow up with patients who miss or cancel their appointment.

NCQA HEDIS Population Definition for This Measure:

Population

  • Members who are ages 18 to 64 as of January 1 of the measurement year with a diagnosis of either schizophrenia or schizoaffective disorder.
  • Members with either one acute inpatient encounter or two outpatient encounters with a diagnosis of either schizophrenia or schizoaffective disorder with at least two antipsychotic medication dispensing events.

Line of Business: Commercial, Medicaid, Medicare

SAA Oral Antipsychotic Medications

  • Amitriptyline-perphenazine
  • Aripiprazole
  • Asenapine
  • Brexpiprazole
  • Cariprazine
  • Chlorpromazine
  • Clozapine
  • Fluphenazine
  • Haloperidol
  • Iloperidone
  • Loxapine
  • Lurasidone
  • Molindone
  • Olanzapine
  • Paliperidone
  • Perphenazine
  • Prochlorperazine
  • Quetiapine
  • Risperidone
  • Thioridazine
  • Thiothixene
  • Trifluoperazine
  • Ziprasidone

To learn more about your practice’s current HEDIS performance, 2022 HEDIS Value sets for this or other measures, or for assistance in compliance with the HEDIS guidelines, please email BH_HEDISTeam@HorizonBlue.com or visit https://www.horizonblue.com/providers/resources/guidelines/hedis-measurement-year-my-2022-provider-tips-optimizing-hedis-results

Reference: Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA), NCQA HEDIS 2022 Tech Specifications