Risk of Continued Opioid Use (COU)

HEDIS Measure

Risk of Continued Opioid Use (COU)

Line of business: Commercial Medicaid Medicare

Data Collection Method: Administrative

Measure Description

The percentage of members 18 years of age and older who have a new episode of opioid use that puts them at risk for continued opioid use. Two rates are reported:

• The percentage of members with at least 15 days of prescription opioids in a 30-day period.
• The percentage of members with at least 31 days of prescription opioids in a 62-day period.

*Inverted Measure

Numerator Compliance

≥15 Days Covered - Members who had 15 or more calendar days covered by an opioid medication during the 30-day period beginning on the IPSD through 29 days after the IPSD.

≥31 Days Covered - Members who had 31 or more calendar days covered by an opioid medication during the 62-day period beginning on the IPSD through 61 days after the IPSD.

IPSD - Index Prescription Start Date. The earliest prescription dispensing date for any statin medication of any intensity during the measurement year.

Best Practices

• Reference the CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

Opioid Medications