Medicare AdvantageNovember 1, 2023
Statin therapy end of year best practices
You may have patients who cannot tolerate moderate or high-dose statin therapy but appear in your HEDIS® denominator for Statin Use in Persons With Cardiovascular Disease (SPC). By properly submitting the required exclusion criteria for this measure, you can improve your quality scores before the end of the year. The Statin Therapy Exclusion Guide is a great resource to learn more on what qualifies as an exclusion and how to submit the proper criteria.
Tips for implementing best practices and improving your quality scores before the end of the year:
- Properly code and submit exclusion criteria for members who cannot tolerate moderate or high-dose statin therapy. Reference the Statin Therapy Exclusion Guide.
- Educate members on the importance of adhering to their statin therapy regime and educate them on potential side effects. If they start to experience muscle pain or weakness, have them contact you to discuss their options.
- Statin therapy should be accompanied by lifestyle modifications, such as a healthy diet and exercise. Work with your patients to proactively identify and overcome any barriers that may prevent lifestyle modifications:
- If they cannot make it to the gym, talk with them about exercising at home.
- Encourage a healthy diet based on the patient’s culture and local availability:
- Reference this conversation guide for more information on how to discuss lifestyle modifications if your patient is of a different culture than your own.
- For those patients who can tolerate moderate or high-dose statin therapy, encourage them to do 90-day prescriptions or mail order to eliminate barriers that may prevent them from getting their prescription on-time. As the SPC measure is reliant on pharmacy claims to close the care gap, try to prescribe the lowest cost medication that will work for them to eliminate any undue financial burdens on the patient and discourage the use of pharmacy discount cards.
Patient care opportunities
You can find patient care opportunities within the Patient360 application located on Availity Essentials* Payer Spaces. To access the Patient360 application, you must have the Patient360 role assignment. From Availity’s home page, select Payer Spaces, then choose the health plan from the menu. Select the Patient360 tile from the Payer Space Applications menu and complete the required information on the screen. Gaps in care are located in the Active Alerts section of the Member Summary.
* Availity, LLC is an independent company providing administrative support services on behalf of the health plan.
MULTI-BCBS-CR-037897-23-CPN37097
PUBLICATIONS: November 2023 Provider Newsletter
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