- Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are
Using Antipsychotic Medications.Diabetes - Monitoring for People With Diabetes and Schizophrenia.
- Cardiovascular Monitoring for People With Cardiovascular Disease and
Schizophrenia. - Adherence to Anti-psychotic Medications for Individuals With Schizophrenia.
I think there may be some serious discussion this year with mental health treatment and this may be one of the few areas that will get significant support.
I'll start breaking these down
Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Anti psychotic Medications (SSD)
The percentage of members 18–64 years of age with schizophrenia or bipolar disorder, who were dispensed an antipsychotic medication and had a diabetes screening test during the measurement year
Product lines Medicaid.
Ages 18–64 years as of December 31 of the measurement year.
Continuous enrollment The measurement year.
Allowable gap No more than one gap in enrollment of up to 45 days during the measurement year. To
determine continuous enrollment for a Medicaid beneficiary for whom enrollment is
verified monthly, the member may not have more than a 1-month gap in coverage (i.e.,
a member whose coverage lapses for 2 months [60 days] is not considered
continuously enrolled).
Anchor date December 31 of the measurement year.
Benefits Medical and pharmacy.
Event/diagnosis
Follow the steps below to identify the eligible population.
Step 1 Identify members with schizophrenia or bipolar disorder as those who met at least one
of the following criteria during the measurement year.
- At least one acute inpatient claim/encounter (Table SSD-A) with any diagnosis
of schizophrenia (Table SSD-B) or bipolar disorder (Table SSD-C). - At least two visits in an outpatient, intensive outpatient, partial hospitalization,
ED or nonacute inpatient setting (Table SSD-A), on different dates of service,
with any diagnosis of schizophrenia (Table SSD-B). - At least two visits in an outpatient, intensive outpatient, partial hospitalization,
ED or nonacute inpatient setting (Table SSD-A), on different dates of service,
with any diagnosis of bipolar disorder (Table SSD-C)
Required exclusions
- Members with diabetes. There are two ways to identify members with diabetes: by
pharmacy data and by claim/encounter data. The organization must use both
methods to identify members with diabetes, but a member need only be identified by
one method to be excluded from the measure. Members may be identified as having
diabetes during the measurement year or the year prior to the measurement year.
Pharmacy data. Members who were dispensed insulin or oral hypoglycemics/
antihyperglycemics during the measurement year or year prior to the measurement
year on an ambulatory basis (Table CDC-A).
Claim/encounter data. Members who had two face-to-face encounters in an
outpatient setting or nonacute inpatient setting, on different dates of service, with a
diagnosis of diabetes (Table CDC-B), or one face-to-face encounter in an acute
inpatient or ED setting, during the measurement year or the year prior to the
measurement year. The organization may count services that occur over both years.
Refer to Table CDC-C for codes to identify visit type. - Members who had no antipsychotic medications (Table SSD-D) dispensed during the
measurement year.
Denominator The eligible population.
Numerator
Diabetes Screening
A glucose test (Table SSD-E) or an HbA1c test (Table CDC-D) performed during the
measurement year, as identified by claim/encounter or automated laboratory data.
I'll be honest this may be a hard measure to get good results for. The Medicaid Population can be tricky when trying to fill gaps. Plus trying to accurate identify members with correct diagnosis codes for physch disorder could be tough. Various support service may or may not bill in a way that will be accessible by a plan.
