This HEDIS® measure looks at the percentage of members ages 18 to 85 years who have had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (< 140/90 mm Hg)

 

Record your efforts:

Document blood pressure and diagnosis of hypertension. Members whose BP is adequately controlled include:

  • Members 18 to 85 years of age who had a diagnosis of HTN and whose BP was adequately controlled
  • (< 140/90 mm Hg) during the measurement year.
  • The most recent BP reading during the measurement year on or after the second diagnosis of HTN.
  • If no BP is recorded during the measurement year, assume that the member is not controlled.

 

What does not count for this HEDIS measure?

  • If blood pressure is taken on the same day as a diagnostic test or procedure or for a change in diet or medication regimen
  • If blood pressure is taken on or one day before the day of any test or procedure
  • Blood pressure taken during an acute inpatient stay or an emergency department visit

 

Exclusions:

  • End stage renal disease
  • Nephrectomy or Kidney transplant
  • Pregnancy
  • Nonacute inpatient stay
  • Members aged 66 to 80 with frailty and advanced illness
  • Members 81 years old and above with frailty

 

Helpful tips:

  • Have your office staff recheck blood pressure for members with initial diagnosis of hypertension and record readings greater than 140 mm Hg systolic and 90 mm Hg diastolic during outpatient office visits. Educate your staff to record the recheck in member’s medical records.
  • Refer high-risk members to our hypertension programs and other programs for additional education and support.
  • Educate members and their spouses, caregivers or guardians about the elements of a healthy lifestyle such as:
    • Heart-healthy eating and a low-salt diet.
    • Smoking cessation and avoiding secondhand smoke.
    • Adding regular exercise to daily activities.
    • Home BP monitoring.
    • Ideal BMI.
    • The importance of taking all prescribed medications as directed.
  • Remember to include the applicable Category II reporting code on the claim form to help reduce the burden of HEDIS medical record review

 

How can we help?

We support you in helping members control high blood pressure by:

  • Providing online Clinical Practice Guidelines on our provider website.
  • Reaching out to our hypertensive members through our education and support programs.

 

Other available resources:



Featured In:
October 2020 Anthem Provider News - Indiana