HEDIS/STARS Measure LDL-C Control

MEASURE: Diabetes Care – Cholesterol Controlled
NUMERATOR: % of denominator whose most recent LDL-C level during the measurement year was 100 or less
DENOMINATOR: Diabetic enrollees


LDL-C Control <100 mg/dL
Identify the most recent LDL-C test during the measurement year. The member is numerator compliant if the most recent LDL-C level is <100 mg/dL. If the result for the most recent LDL-C test during the measurement year is ≥100 mg/dL or is missing, or if an LDL-C test was not performed during the measurement year, the member is not numerator compliant.

LDL-C Control <100 mg/dL
The most recent LDL-C level performed during the measurement year is <100 mg/dL, as documented through automated laboratory data or medical record review.
Administrative
Date of most recent LDL Screening
Results of the LDL Screening
The member is compliant if the most recent LDL-C level is <100 mg/dL.
If the results are missing or the results are ≥100 mg/dL then they are not compliant

Medical record
Documentation in medical record must include, at a minimum, a note indicating the date when the LDL-C test was performed and the result.

This is a pretty straight forward measure.  Get the screening and report the results. Either you passed or you didn't. items

Things that can impact the score.

• Not getting the lab results sent to the plans when the plan pays for them(Pretty rare in most cases since the plans usually get the results with the billing info)
• Not getting the results because the tests were done by a third party not connected to the plan. Supplemental Insurance, VA, Community Health Organizations.
• Bad Data sent to the health plans.

How can you improve upon these scores?

Outreach, Care Coordination and  patient education plain and simple.

If a practice or a health plan doesn't not have a serious outreach program to re-engage their patients once they leave the exam room they will miss the out on closing gaps. The practice will need help to reach these members and that's where care coordination comes into play. It maybe be the practice staff or another organization that works with the practice or plan to reach out and engage these members. The final piece is education.  You need to make the members understand that these preventative measure help them live longer, happier lives. Once they make these gaps closures part of their yearly routine the plans and the practices will save money and increase their reimbursement rates.  This is very hard to do. You will need a mature education program in place.