Author: MM_ADMIN

Disease management programs are increasingly being utilized by state Medicaid programs to provide better care while reducing costs, particularly for individuals with chronic conditions. Early research has shown that while disease management programs are relatively new, there can be substantial reductions in health care service use and expenditures. Disease management programs have been developed and implemented largely by managed care plans. Programs for diabetes, asthma, hypertension, depression and congestive heart failure are the most common. Health plans and Medicaid agencies generally contract with disease management organizations to provide services, although some choose to operate the program themselves.

Further reading –

http://www.aafp.org/dam/AAFP/documents/advocacy/coverage/medicaid/ES-MedicaidDiseaseManagementPrograms-121305.pdf

Potentially Harmful Drug-Disease Interactions in the Elderly – Potentially Harmful Drug-Disease Interactions in the Elderly: Assesses adults 65 and older who have a specific disease or condition (i.e., chronic renal failure, dementia, history of falls) and were dispensed a prescription for a medication that could exacerbate that condition.

Use of High-Risk Medications in the Elderly: Assesses adults 65 and older who received at least one high-risk medication or who received at least two different high-risk medications.

Prescription drug use by the elderly can often result in adverse drug events that contribute to hospitalization, increased duration of illness, nursing home placement, falls and fractures. Despite widely accepted medical consensus that certain drugs increase the risk of harm to the elderly, 1 these drugs continue to be prescribed. Because older adults are more likely to take multiple medications for multiple conditions, they are also at higher risk of potentially harmful drug-disease interactions. Avoiding the use of high-risk drugs is an important, simple and effective strategy in reducing medication-related problems and adverse drug events in older adults.2

Further reading –

http://passporthealthplan.com/wp-content/uploads/2017/01/Potentially-Harmful-Drug-Disease-Interactions-in-the-Elderly.pdf

Appropriate Treatment for Children with Pharyngitis – The percentage of children 2–18 years of age who were diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode. A higher rate represents better performance (i.e., appropriate testing).

Further reading –

http://www.ncqa.org/portals/0/Appropriate%20Testing%20for%20Children%20With%20Pharyngitis.pdf

NCQA’s Credentials Verification Organization (CVO) Certification Program evaluates credentials verification operations and the processes that the CVO uses to continuously improve the services it provides to its managed care clients. CVO certification is available to organizations that conduct credentials verification, report the credentialing information to clients and have systems in place to protect the confidentiality and integrity of the information.

The NCQA Certification Survey includes rigorous onsite and offsite evaluations conducted by a survey team that includes at least one CR surveyor and one administrative surveyor. A Review Oversight Committee (ROC) of physicians analyzes the team’s findings and assigns a certification status based on the CVO’s performance against core standards and the requirements within applicable certification options.

Further reading –

http://www.ncqa.org/programs/certification/credentials-verification-organization-cvo

Childhood Immunization Status . The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and nine separate combination rates.

Further reading –

http://www.ncqa.org/portals/0/Childhood%20Immunization%20Status.pdf

Qualified Clinical Data Registry – QCDRs are one of the reporting mechanisms physicians and group practices can use to report MIPS performance measures. Under MACRA, QCDRs must meet certain criteria in order to be eligible to submit data on behalf of providers.

Further reading –

https://qpp.cms.gov/docs/QPP_2017_CMS_Approved_QCDRs.pdf

Physician Quality Reporting System – PQRS is a quality reporting program that encourages individual eligible professionals and group practices to report information on the quality of care to Medicare. PQRS gives participating providers and group practices the opportunity to assess the quality of care they provide to their patients, helping to ensure that patients get the right care at the right time. It is one of the Medicare reporting programs that is being moved into MIPS.

Further reading –

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/PQRI/15_MeasureCodes.asp