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AMR: Asthma Medication Ratio
Asthma Medication Ratio (AMR) is a HEDIS measure that focuses on patients with persistent asthma and looks at the number of their controller medication fills in relation to total asthma medication fills (rescue and controller).
Did you know?
- In 2023, current asthma rates in Ohio were 159,955 (6.8%) in children and 1,007,049 (11.0 %) in adults. ¹
- Up to 80% of patients cannot use their inhaler correctly!
- At least 50% of adults and children do NOT take controller medications as prescribed.
- Regular use of SABA (short acting beta agonist), even for 1-2 weeks, is associated with increased AHR (airway hyperresponsiveness), reduced bronchodilator effect, increased allergic response, and increased eosinophils. This can lead to a vicious cycle encouraging overuse. Overuse of SABA is associated with increased exacerbations and increased mortality. ²
- GINA (Global Initiative for Asthma) does not recommend treatment of asthma in adults, adolescents, or children 6-11 years with short-acting beta2 agonist (SABA) alone. Instead, they should receive inhaled corticosteroid (ICS)-containing treatment to reduce their risk of severe exacerbations and to control symptoms.²
Currently Buckeye Health Plan (BHP) has in place the following initiatives:
- In conjunction with our data analytics team, a daily report is generated that identifies BHP members who are non-adherent to their asthma controller medications as well as those filling multiple rescue inhalers.
- Our pharmacy team makes fax attempts as well as phone outreaches to providers, including topics such as non-adherence to controller medications, extended day supplies, those with no controller medications, and multiple rescue inhaler fills.
- Our pharmacy team also sends out text messages to members who are non-adherent to their asthma controller medications, reminding them that their medication is important in controlling their asthma.
- In addition, our pharmacy team also sends out educational text messages to our asthma members regarding topics such as asthma triggers, smoking cessation, children having inhalers at school, SMART, and vaccinations.
Please consider the following:
- During each visit with the member, review their medication list and ask if there are any issues with filling or taking medications as prescribed.
- Provide an asthma action plan if the member does not already have one.
- Discuss with members the difference between their rescue inhalers and controller inhalers/medications and make sure they understand how and when to use each.
- Consider prescribing a spacer with a mask to ensure the member is using their inhaler correctly and getting the full dose.
- Address medication therapy if a member is overutilizing their rescue inhaler.
- Determine if SMART (Single Maintenance and Reliever Therapy) may be appropriate for a member.
- Offer an extended day supply of medications to help improve adherence and lessen member trips to the pharmacy.
- Continue to monitor a member’s progress and follow up as needed.
References:
SPC: Statin Therapy for Patients with Cardiovascular Disease
Product Line: Medicaid, Medicare, Marketplace
Statin Therapy for Patients with Cardiovascular Disease (SPC) is a HEDIS measure that focuses on patients and their adherence to at least one high or moderate-intensity statin medication therapy during the measurement year.
Service Needed
Male patients 21-75 years of age and female patients 40-75 years of age, with a diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD) and being treated with and remain taking a high or moderate-intensity statin medication.
Two rates reported for this measure are:
- The percentage of patients who are dispensed at least one high or moderate-intensity statin medication during the measurement year.
- Percentage of patients who remain on a high or moderate-intensity statin medication for at least 80 percent of the treatment period.
Tips for Attainment:
- At each visit, review the medication list and ask if there are any issues with filling or taking medications as prescribed. If there are any problems/issues with the medication, open-ended questions will assist you with solutions and remove patient barriers to adherence.
- Educate members on the purpose of the medication, including how often to take the medication and possible side effects. Advise member to contact provider's office if side effects occur or are suspected.
- Assess health literacy to determine need for additional support in medication management.
- Offer a 100-day supply of medication to members, if stable.
- Encourage member to sign up with their retail or mail-order pharmacy.
- Reminder calls, emails, text messages or mailings can assist with ensuring members do not miss scheduled appointments.
- Schedule an annual visit or follow-up visit before the member leaves the office.
- Ensure member completes any required labs such as cholesterol, kidney values (both blood and urine) and/or A1c
Buckeye Initiatives:
Weekly Outreach
- Data analytics team generates weekly report identifying BHP members with diagnosis of ASCVD and no record of statin therapy
- Pharmacy team makes up to 2 fax attempts to each provider for each identified member to request provider to evaluate if statin therapy is appropriate for member
- No response from fax outreach, then Buckeye clinical pharmacist (when appropriate) attempts to contact provider to review and resolve the opportunity.
- For members currently taking statin therapy but fall below 80% adherence – fax outreach is made to provider to alert them that member is non-adherent to their statin therapy. Cardiovascular disease (CVD) is the leading cause of morbidity and death in the US, resulting in more than 1 of every 4 deaths.1 Coronary heart disease is the single leading cause of death and accounts for 43% of deaths attributable to CVD in the US.
In 2019, an estimated 558 000 deaths were caused by coronary heart disease and 109 000 deaths were caused by ischemic stroke. Men have a higher overall prevalence of and mortality from CVD, although women experience higher mortality from certain cardiovascular events, such as stroke. On average, men experience CVD events earlier in life compared with women. The prevalence of CVD also differs by race and ethnicity. Among both sexes, Black adults have the highest prevalence of CVD.
Statin Use for the Primary Prevention of Cardiovascular Disease in Adults
2024 Heart Disease and Stroke Statistics Update Fact Sheet (PDF)
For more information and improvement tips see the SPC page of our HEDIS Reference Guide (PDF).
SPD: Statin Therapy for Patients with Diabetes (SUPD below)
Product Line: Medicaid, Medicare, Marketplace
Statin Therapy for Patients with Diabetes is a HEDIS measure that focuses on patients and their adherence to at least one statin medication of any intensity during the measurement year.
Service Needed
Patients 40 to 75 years of age with diagnosis of diabetes who do not have diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD) and being treated with and remain taking at least one statin medication of any intensity.
Two rates reported for this measure are:
- The percentage of patients who are dispensed at least one statin medication of any intensity during the measurement year.
- Percentage of patients who remain on a statin medication of any intensity for at least 80 percent of the treatment period.
Tips for Attainment:
- At each visit, review the medication list and ask if there are any issues with filling or taking medications as prescribed. If there are any problems/issues with the medication, open-ended questions will assist you with solutions and remove patient barriers to adherence.
- Assess health literacy to determine need for additional support in medication management.
- Educate members on the purpose of taking a statin medication to prevent cardiovascular disease. Discuss how often to take the medication and possible side effects.
- Advise member to contact provider's office if side effects occur or are suspected. Consider an alternative dosing schedule to prevent or lessen side effects.
- Offer 100-day supply of medication to members, if stable.
- Encourage member to sign up for mail orders at their retail or mail-order pharmacy.
- Reminder calls, emails, text messages or mailings can assist with ensuring members do not miss scheduled appointments.
- Schedule an annual visit or follow-up visit before the member leaves the office.
- Ensure member completes any required labs such as cholesterol, kidney values (both blood and urine) and/or A1c.
SUPD: Statin Use in Persons with Diabetes
Product Line: Medicare
Statin Use in Persons with Diabetes is a Medicare measure that is defined as the percent of Medicare Part D beneficiaries ages 40 to 75 who were dispensed at least two diabetes medication fills on unique days of service and received a statin medication fill during the measurement period.
Service Needed
Patients 40 to 75 years of age with diagnosis of diabetes being treated with and remain taking at least one statin medication of any intensity.
The rate reported for this measure is:
The percentage of Medicare Part D beneficiaries ages 40 to 75 who were dispensed at least two diabetes medication fills on unique days of service and received a statin medication fill during the measurement period.
Tips for Attainment:
- At each visit, review the medication list and ask if there are any issues with filling or taking medications as prescribed. If there are any problems/issues with the medication, open-ended questions will assist you with solutions and remove patient barriers to adherence.
- Assess health literacy to determine need for additional support in medication management.
- Educate members on the purpose of taking a statin medication to prevent cardiovascular disease. Discuss how often to take the medication and possible side effects.
- Advise member to contact provider's office if side effects occur or are suspected. Consider an alternative dosing schedule to prevent or lessen side effects.
- Offer 100-day supply of medication to members, if stable.
- Encourage member to sign up for mail orders at their retail or mail-order pharmacy.
- Reminder calls, emails, text messages or mailings can assist with ensuring members do not miss scheduled appointments.
- Schedule an annual visit or follow-up visit before the member leaves the office.
- Ensure member completes any required labs such as cholesterol, kidney values (both blood and urine) and/or A1c.
- Diabetes is an epidemic in the United States. According to the Centers for Disease Control and Prevention (CDC), over 38 million Americans have diabetes and face its devastating consequences. What’s true nationwide is also true in Ohio. Obesity is linked to up to 53 percent of new cases of type 2 diabetes each year. Treating the chronic disease of obesity can help prevent, delay, and even result in diabetes remission. See the great information provided by the AMA below.
AMA - The Burden of Diabetes in OhioExternal Link
For more information, exclusions and improvement tips see our HEDIS Reference Guide (PDF).