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As a Buckeye Health Plan provider you know that quality health care is a high priority for the Centers for Medicare & Medicaid Services (CMS). CMS considers statin use in patients with cardiovascular disease and statin therapy in members with diabetes very important quality measures that should be appropriately managed and monitored.
Buckeye has put in place the following initiatives to improve our measures and the success of Buckeye Health Plan quality efforts and the quality care of the members that we serve relies on each provider’s attention to these initiatives.
- Working with our data analytics team a monthly report is generated that identifies BHP members that fall into each of these measures.
- Our pharmacy team will make up to 2 fax attempts to each provider for each member identified.
- If no response from our fax outreach then a BHP clinical Pharmacist will attempt to contact the provider to review and resolve each opportunity.
Please consider the following for members that fall into these measures:
- Evaluate and consider if member would benefit from the use of statin therapy (either during annual wellness exam or by responding to BHP outreach)
- Consider prescribing the medication electronically to the patient’s pharmacy of choice.
- Make it easier for the patient to adhere to treatment by prescribing a 90-day supply, mail order or auto-refills – especially for patients stable on therapy.
- Assess health literacy to determine need for additional support in medication management.
- Educate the member on the role the medication plays in their disease process and what to do if they experience a side effect.
Measures For Your Reference:
SUPD Statin Use in Persons with Diabetes (Medicare)
Definition: Percentage of patients 40-75 years of age during the measurement year with at least 2 diabetes medications dispensed, and who also received a statin medication fill during the measurement year.
The SPC and SPD CMS Medicaid Quality measures can be found on the NCQA website.
PLEASE NOTE: For appropriate documentation of statin intolerance in clinical records/billing, please reference NCQA guidelines.