Hello and welcome to the 2021 Results and Recognition Programs presentation on Asthma Medication Ratio.
The objectives of this presentation is for you all to:
Have an understanding of HEDIS and Horizon’s Goals for the Quality Program,
Understand Asthma Medication Ratio and Best Practices,
Learn about Horizon Healthy Journey, as well as,
Horizon’s Care Management Department.
Horizon leverages the Results & Recognition Program, also known as the R&R Program, to improve clinical outcomes performance on HEDIS measures and promote the care received by our members. Horizon BCBSNJ has experienced improved HEDIS performance since the inception of the R&R Program in 2016.
What is HEDIS? For those of you who are not familiar with HEDIS, it stands for Healthcare Effectiveness Data and Information Set. HEDIS is a set of standardized performance measures that was developed by the National Committee for Quality Assurance, known as NCQA. HEDIS makes it possible for the public to compare health plans on an "apples-to-apples" basis by collecting data on the performance of health care providers. HEDIS is not exclusive to Horizon. 90% of our country’s health plans use HEDIS to measure performance on many different dimensions of care & service. HEDIS has 91 measures in total consisting of adult and pediatric measures. However, for our R&R Programs, we are only focusing on a selected few.
HEDIS monitors measures related to areas such as preventive care & screenings, chronic care, medication management and a few other areas. This presentation will focus on the HEDIS measure: Asthma Medication Ratio.
This slide is a brief overview of Asthma, and common triggers associated with it. According to the Asthma and Allergy Foundation of America, asthma causes swelling of the airways commonly triggered by exposures to certain irritants. The illustration of the lung on the top left is comparing a normal airway, which looks relaxed to asthmatic airway which looks inflamed. The bottom left illustration shows some examples of the most common triggers or causes of asthmatic episodes, such as pollution, pets, dust, chemicals…just to name a few.
Fortunately, the Asthma and Allergy Foundation of America notes asthmatic episodes can be controlled with managed care and preventative treatment.
So let’s take a look at Asthma Management and how we’re are doing in the State of NJ. According to the State of NJ Department of Health the most up to date asthma figures reported approximately 600,000 adults and 167,000 children currently with asthma, the highest asthma prevalence reported amongst African American and non-Hispanic adults. In 2020, an article in NJ.com shared results of The American Lung Association’s annual report for the State of the Air in NJ. The map displayed on the right illustrates the Ozone Grades or air quality of NJ; with a “B” grade representing the best air quality and a grade of “F” being the worst. Although the annual report noted some improvements with NJ’s air quality, it still ranks the worst in the nation especially with counties close to NYC and the Philadelphia areas. The annual report looked at 2 major air pollutants: Fine particle pollution such as soot and low-level ozone such as smog & emissions. The good news is the annual report also noted that compared to 2019, every county in NJ showed improvement for average level of particle pollution except Mercer County. For low-level Ozone grades, 9 NJ counties received a failing grade. However, the report notes Monmouth, Cumberland and Atlantic counties did show some improvement. The article notes, some of these improvements can be attributed to previous steps the state has taken to improve air quality, as well as the steps the State Government is considering to reduce vehicle emissions by offering incentives for purchasing electric cars and building more charging stations.
So let’s review some Asthma FACTs nationwide according to the CDC, which is the Centers for Disease Control & Prevention. According to the CDC’s Asthma facts website, 1 in 13 people have asthma, and 1 out of 12 school-aged children also have asthma. In the United States, African Americans have a higher rate of mortality from asthma than people of other races & ethnicities.
Asthma is more common in adult women versus men. Asthma also carries a higher risk of severe illness with Covid-19. Therefore, the CDC recommends asthmatics limit risk of exposure such as wearing masks, social distancing, hand washing, so on and so forth. Also, in consideration of COVID-19, the CDC recommends additional preparations by making sure asthmatics have at least a 30-day supply of their medications. The CDC also updated their website with information regarding the three COVID-19 vaccines authorized and recommended for use, which are Pfizer, Moderna, and Janssen. The website notes the CDC will continue share updates regarding vaccine effectiveness and recommendations. So for more information on this, you can visit the CDC website.
According to the CDC and Asthma and Allergy Foundation of America, asthma prevention and treatment should incorporate:
Avoiding some of the asthma triggers as noted previously such as dust, pet dander, mold, etc. - Review the asthma treatment plan with our members - Encourage members to consider using an Asthma Peak/flow diary; or consider utilizing an application on their smart phone to track their symptoms. Our network providers and members are encouraged to consider collaborating further with Horizon Healthy Journeys or Horizon’s Care Management Team as an additional resource - Finally, scheduling follow-up visits will enable providers to monitor treatment plans and track progress.
Horizon Healthy Journey is a program and it’s a great resource for providers and our members. This program focuses on all stages of life. We have a dedicated Population Health Management team whose focus is to reach out to members, through various methods, in helping to remind them of preventative care and services, which can also help in closing care gaps. The program also offers opportunities for education and chronic disease management, such as asthma. The team uses data collected from member enrollment and claims and implements targeted interventions appropriate for the member’s demographic, condition or care gaps. There are different ways in which the outreaches are done such as live calls and direct mailings. There are member reward programs as well and they also utilize vendors for care coordination and in-home screenings.
In the bottom right corner, you will see the number of outreaches done last year. This is very busy and focused team. The number for our Horizon Healthy Journey team is listed here if you have any questions for them. This number can also be shared with your patients.
So this image shows an example of the Asthma Resources by Horizon Healthy Journeys. This comprehensive member booklet contains detailed information regarding asthma diagnosis, prevention and treatments. If you would like to receive a digital copy of this booklet, please reach out to your assigned CQIL who will be able to assist you. The image located on the right is an example of an Asthma Diary from kidshealth.org. As you may know, an asthma diary helps our members keep track of how well they are managing their asthma by recording their triggers, their symptoms and what medications helped relieve those symptoms. Providers are able to monitor how well their patients are doing and make any adjustments to their treatment plan.
Another resource available to our members is Horizon’s Care Management Department. We have a Care Management program that is comprised of a team of nurses and the terms Care Management & Case Management are often used interchangeably. Care Management is not part of Horizon Healthy Journey but does it does offer an additional layer of support for our members. If a member is being care managed by Horizon, you will see this on your member gap report with the risk level they are being managed at. That risk level is determined when the Care Manager assesses the member by way of a health needs survey, which is usually done by phone. Depending on the score of the health needs survey, this will determine if the member is at a risk level 1, 2 or 3. The higher the score, the more complexed the member’s needs are. The program is available for both adults and children. Also, all FIDE-SNP members have a dedicated Care Manager.
The contact information is noted on the bottom right if you feel a member would benefit from being case managed and this number can also be shared with your patients as well. Care Management is a unique opportunity for members to collaborate with our clinical team in efforts to educate and coordinate care to ensure quality of care is delivered to our members. Members with an assigned Care Manager may receive updates of grant programs or community based programs to aid in further managing asthma. Members interested in Care Management assessment needs, again, to complete at Health Needs Survey. If you think, again, that a member may benefit from this service, please feel free to reach out to that department.
Asthma Medication Ratio
The Asthma Medication Ratio is an incentivized HEDIS measure in Horizon’s R&R Program. Asthma Medication Ratio evaluates the percentage of members 5-64 years of age who’ve been identified as having persistent asthma and had a medication ratio of 0.50 or greater during the measurement year.
This slide summarizes the detailed HEDIS specifications for this Asthma Medication Ratio measure. The eligible population for this measure, again, is between the ages of 5 to 64. The member must have a true diagnosis of persistent asthma, not seasonal or exercise-induced asthma, but a true diagnosis, and they must have met at least one of the following criteria during both the measurement year and the year prior. So that is:
At least one Emergency Room visit with a principal diagnosis of asthma
At least one acute inpatient encounter, with a principal diagnosis of asthma without telehealth
At least one acute inpatient discharge with a principal diagnosis of asthma on the discharge claim
At least four outpatient, telephone e-visits or virtual check-ins, on different dates of service, with any diagnosis of asthma and at least two asthma medication dispensing events for any controller or reliever medications, and lastly,
At least four asthma medication dispensing events for any controller or reliever medications
We are focusing on the Medicaid line of business for this HEDIS measure.
Members who are compliant must have had a medication ratio of 0.50 or greater during the measurement year. This measure is captured via pharmacy claims and is based on specific calculations detailed on the next slide.
The exclusions for this measure are also noted at the bottom.
So in this example, we will calculate AMR as follows: units of controller medications divided by the units of total asthma medications. When identifying medication units for the numerator, you’re going to count each individual medication, defined as an amount lasting 30 days or less, as one medication unit. One medication unit equals one inhaler canister, one injection, one infusion, or a 30-day or less supply of an oral medication. For example, two inhaler canisters of the same medication dispensed on the same day count as two medication units and only one dispensing event. So let’s put this into play. The member filled a one-month supply of asthma medications and this consists of both the controller and the rescue meds, and has additional prescriptions for three refills of controller medications and three refills of rescue medications. The claims data shows within the measurement year, the controller meds were filled twice and rescue meds filled four times. So the AMR equation would be 2, which represents the units of controller meds, divided by the refills, 2+4, 2 for the controller, 4 for the rescue. That gives us .33. Therefore, this member would be Non-Compliant for this measure because the AMR is under the 0.50 compliant ratio.
Let’s look at some of the recommended suggested best practices for meeting the Asthma Medication Ratio compliance: develop an Asthma Action Plan, educate members on the importance of sticking to those medications and reducing the asthma triggers, advise members to incorporate inhalers in to their daily routine, and reach out to members to schedule follow-up visits for this condition. Also, this measure is captured by pharmacy claims for medication dispensing events.
Here are some resources for our Network Providers and these can also be found on the Horizon NJ Health’s website.
Here are some additional references for the Asthma Medication Ratio Webinar.
So this concludes the presentation on Asthma Medication Ratio. I hope you found this information useful. If you have any questions, your CQIL is always your first line of support. However, you are welcome to send questions to the email noted which is Quality_RR@HorizonBlue.com. You may also reach out to your CQIL to request a copy of this slide deck. Thank you again.
Discuss Asthma signs, symptoms, risks, treatments, suggested best practices, and resources.