Antidepressant Medication Management Updates (CMS128)

Change Review Process MeetingNovember 19, 2015

Jenna Williams-BaderAnne Marie Smith

Stephanie Rodriguez

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Antidepressant Medication Management Measure Update

Revise measure to align with the HEDIS health plan measure• Patients 18 years of age and older who were treated with

antidepressant medication, had a diagnosis of major depression, and with a visit during the measurement period

• Exclude patients who do not have major depression diagnosis during the 121-day period from 60 days prior to the Index Prescription Start Date (IPSD) through the IPSD and the 60 days after the IPSD

• Exclude patients who filled a prescription for an antidepressant medication 105 days prior to the IPSD

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Current Denominator

Measure intent is to capture appropriate anti-depressant medication use in adults diagnosed with major depression

Denominator Statement• Patients 18 years of age and older with a diagnosis

of major depression, who were treated with antidepressant medication, and with a visit during the measurement period

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Updated Denominator

• Patients 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression, and with a visit during the measurement period

The updated measure looks for the use of antidepressant medication first, instead of the diagnosis, to better align with the measure intent.

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Current Denominator

Current Logic• AND: Age >= 18 year(s) at: "Measurement Period"• AND: $InitialMajDepressionDiagnosis• AND: $InitialDepMedication• AND: Union of:

– "Encounter, Performed: Office Visit"– "Encounter, Performed: Face-to-Face Interaction"– "Encounter, Performed: Preventive Care Services - Established Office Visit, 18

and Up"– "Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and

Up"– "Encounter, Performed: Home Healthcare Services"– "Encounter, Performed: Annual Wellness Visit"– "Encounter, Performed: Psych Visit - Diagnostic Evaluation"– "Encounter, Performed: Psych Visit - Psychotherapy"– during "Measurement Period"

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Current Denominator

Current Logic (cont.)Data Criteria (QDM Variables)• $InitialDepMedication =

– First: • "Medication, Dispensed: Antidepressant Medication" satisfies any

– <= 14 day(s) starts after start of $InitialMajDepressionDiagnosis

– <= 30 day(s) starts before start of $InitialMajDepressionDiagnosis

• $InitialMajDepressionDiagnosis = – First:

• "Diagnosis, Active: Major Depression" satisfies any – <= 90 day(s) starts after start of "Measurement Period" – <= 270 day(s) starts before or concurrent with start of

"Measurement Period"

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Denominator Update

Updated Logic Data Criteria (QDM Variables)• $InitialDepMedication =

– First: • "Medication, Dispensed: Antidepressant Medication" satisfies any

– <= 90 day(s) starts after start of "Measurement Period" – <= 270 day(s) starts before or concurrent with start of

"Measurement Period"

• $InitialMajDepressionDiagnosis = • "Diagnosis, Active: Major Depression" satisfies any

– <= 60 day(s) starts after start of $InitialDepMedication – <= 60 day(s) starts before start of $InitialDepMedication

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Current Exclusion

• Patients who were actively on an antidepressant medication in the 90 days prior to the Index Prescription Start Date

• Current Logic– OR: "Medication, Active: Antidepressant Medication" <= 90 day(s)

starts before start of $InitialDepMedication

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Updated Exclusion

• Exclude patients who filled a prescription for an antidepressant medication 105 days prior to the IPSD

• Updated Logic– OR: "Medication, Active: Antidepressant Medication" <= 105 day(s)

starts before start of $InitialDepMedication

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Denominator and Exclusion Questions

• Does the updated logic make sense? • Does it capture the intent of the measure?

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Question about the word “continuous”

• NCQA has received JIRA questions about the word “continuous” in the numerator – Numerator 1:

• Patients who have received antidepressant medication for at least 84 days (12 weeks) of continuous treatment during the 114-day period following the Index Prescription Start Date

– Current Definition: • The "continuous treatment" described in this measure allows for gaps in medication treatment up to a

total 30 days during the 114-day period (numerator 1) or 51 days during the 231-day period (numerator 2). Gaps can include either gaps used to change medication, or treatment gaps to refill the same medication.

• What additional guidance can we provide to make the definition more clear?

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Next Steps: Vote

Agree with proposed changes to Antidepressant Medication Management measure (CMS128)?1. Yes2. No

Measure updates will be implemented during 2016 Annual Update