New HEDIS Measures for 2006

Each year, Humana uses claims and encounter data and medical records documentation to gather information for the Health Plan Employer Data and Information Set (HEDIS®). HEDIS, the most widely used set of performance measures in the managed care industry, helps Humana assess its performance in meeting clinical guidelines and satisfying members’ needs.

The 2006 HEDIS review included some new measures. All of the new measures were assessed based on claims and encounter data; these new measures are not part of the medical record review process. The new measures are summarized below:

• Use of Spirometry Testing in the Assessment and Diagnosis of COPD
  This measure assesses the percentage of members 40 or older with a new diagnosis or newly active chronic obstructive pulmonary disease (COPD) who received appropriate spirometry testing to confirm the diagnosis.
• Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis
  This measure determines whether patients with rheumatoid arthritis (RA) have had at least one ambulatory prescription dispensed for a disease modifying anti-rheumatic drug (DMARD).
• Follow-Up Care for Children Prescribed Attention Deficit Hyperactivity Disorder (ADHD) Medication
  This measure evaluates two areas:
  - The percentage of members between ages 6 and 12 years with an ambulatory prescription for an ADHD medication who had one follow-up visit during the 30-day initiation phase.
  - The percentage of members between ages 6 and 12 years with an ambulatory prescription for an ADHD medication who remained on the medication for at least 210 days and had at least two additional follow-up visits within nine months.
• Drugs Generally to be Avoided in the Elderly
  This measure assesses two areas:
  - The percentage of Medicare members 65 or older who received at least one drug on the “Drugs to be Avoided in the Elderly” list compiled by the National Committee for Quality Assurance (NCQA) Committee on Performance Measurement.
  - The percentage of Medicare members 65 or older who received at least two different drugs on the “Drugs Generally to be Avoided in the Elderly” list.

NOTE: See the chart below for a complete list of drugs generally to be avoided in the elderly.

• Annual Monitoring for Patients on Persistent Medications
  This measure determines the percentage of members 18 or older who received at least 180 days’ supply of one or more of the following types of ambulatory medication and had at least one therapeutic monitoring event for the medication in the year: ACE inhibitors or angiotensins receptor blockers, digoxin, diuretics, anticonvulsants or statins.
• Inappropriate Antibiotic Treatment for Adults with Acute Bronchitis
  This measure quantifies the percentage of healthy adults between 18 and 64 years of age with a diagnosis of acute bronchitis who were dispensed an antibiotic prescription on or within three days after the episode.
• Antibiotic Utilization
  This measure evaluates many factors, including:
  - total number of antibiotic prescriptions
  - average number of antibiotic prescriptions per member per year
  - total days supplied for all antibiotic prescriptions
  - average number of days supplied per antibiotic prescription
  - total number of prescriptions per member per year for antibiotics of concern
  - average number of prescriptions per member per year reported by drug class for selected “antibiotics of concern” and for all other antibiotics
  - percentage of antibiotics of concern of total antibiotic prescriptions

List of Antibiotics of Concern by Therapeutic Class and Drugs
Antibiotics of Concern-Therapeutic	Drugs in the Therapeutic Class
Quinolones	Ciprofloxacin Enoxacin Flomefloxacin Gatifloxacin	Gemifloxacin Levofloxacin Lomefloxacin Moxifloxacin	Norfloxacin Ofloxacin Pefloxacin Sparfloxacin
Azithromycin and clarithromycin	Azithromycin	Clarithromycin
Cephalasporins (second generation)	Cefaclor Cefotetan	Cefprozil Cefuroxime	Cefoxitin Loracarbef
Cephalasporins (third and fourth generation)	Cefepime Cefdinir Cefoperzone Cefotaxime	Ceftibuten Cefpodoxime proxetil Ceftazidime	Ceftizoxime Ceftitoren Ceftriaxione
Amoxicillin/clavulanate	Amoxixillin/Clavulanate
Ketolides (Note: New drug class in 2004)	Telithromycin
Clindamycin	Clindamycin
Miscellaneous antibiotics of concern	Chloramphenical Teicoplanin	Vancomycin Quinupristin/Dalfopristin	Linezolid

NOTE: The “antibiotics of concern” list was developed by a panel of experts assembled by the NCQA. See the chart above for the complete list.

In addition, the following measures were added in 2005 and were included in the 2006 HEDIS administrative review:

• Persistence of Beta Blocker Therapy
  This measure gauges the percentage of enrolled members 35 or older who were hospitalized and discharged with a diagnosis of acute myocardial infarction and who received persistent beta blocker treatment (defined as treatment for 135 of 180 days).
• Glaucoma Screening in Older Adults
  This measure evaluates the percentage of Medicare members 65 or older without a prior diagnosis of glaucoma who received a glaucoma eye exam in the last two years by an eye-care professional.
• Use of Imaging Studies for Low Back Pain
  This measure assesses whether imaging studies such as X-ray, MRI and CT scan, are overused in evaluating patients with acute low back pain.

Clinical care staff should be made aware of these changes. These efforts will help improve quality of care and make future HEDIS reviews quick and positive experiences.

For more information about HEDIS performance measures, visit www.ncqa.org/Programs/HEDIS/.

Drugs Generally To Be Avoided in the Elderly
Therapeutic Class/Application	Drug Name
Antianxiety	Meprobamate (Equagesic, Equanil, Miltown)
Antiemetic	Trimethobenzamide (Tigan)
Analgesic	Ketorolac (Tordal)
Antihistamines	Cyproheptadine (Periactin) Dexchlorpheniramine (Polaramine) Diphenhydramine (Benadryl) Hydroxyzine (Vistaril, Atarax) Promethazine (Phenergan) Tripelennamine
Antipsychotics, typical	Thioridazine (Mellaril) Mesoridazine (Serentil)
Amphetamines	Dextroamphetamine (Dexedine) Benzphetamine (Didrex) Methamphetamine (Desoxyn) Diethylproprion (Tenuate) Amphetamine Mixtures (Adderall) Phendimetrazine (Prelu-2) Methylphenidate (Ritalin, Methylin, etc) Phenteramine (Ionamin, Adipex) Pemoline (Cyclert)
Barbiturates	Amobarbital/Secobarbital (Tuinal) Pentobarbital (Nembutal) Aprobarbital (Alurate) Phenobarbital Butabarbital (Butisol) Secobarbital (Seconal) Mephobarbital (Mebaral)
Long-acting Benzodiazepines	Chlordiazepoxide (Librium) Diazepam (Valium) Chlordiazepoxide/Amitriptyline (Limbitrol) Flurazepam (Dalmane)
Other long-acting benzodiazepines	Clidinium/Chlordiazepoxide (Librax)
Calcium Channel Blockers	Nifedipine (Procardia, Adalat) – short acting only
Gastrointestinal antispasmodics	Dicyclomine (Bentyl) Propantheline (Pro-Banthine)
Belladonna alkaloids (including combination drugs)	Atropine Sulfate Belladonna Hyoscyamine (Anaspaz, Cystopaz, Levsin, Levsinex) In combination (Barbidonna, Bellergal-S, Butibel, Donnatal) Scopolamine (Scopace, Transdem-Scope)
Skeletal muscle relaxants	Carisoprodol (Soma) Chlorzoxazone (paraflex) Cyclobenzaprine (Flexeril) Metaxalone (Skelaxin) Methocarbamol (Robaxin) Orphenadrine (Norflex)
Oral estrogen	Oral estrogen (Premarin, Ogen, Menest)
Oral hypoglycemics	Chlorpropamide (Diabinese)
Narcotics	Meperidine Pentazocine (Talacen, Talwin, Talwin Cpd, Talwin NX) Propoxyphene (Darvon) Propoxyphene combinations(Darvon CPD, Darvon N, Darvocet-N)
Vasodilators	Cyclandelate (Cyclospasmol) Ergot mesyloids (Hydergine) Dipyridamole (Persantine) short acting only Isoxsuprine (Vasodilan)
Others	Desiccated thyroid Nitrofurantoin (Macrodantin) Methyltestosterone (Android, Virilon, Testrad)

Back to top