- 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.