HEDIS 2024 documentation for Controlling High Blood Pressure (CBP) and Statin Therapy for Patients with Cardiovascular Disease (SPC)

HEDIS^® (Healthcare Effectiveness Data Information Set) is a widely used set of performance measures developed and maintained by NCQA. These are used to drive improvement efforts surrounding best practices.

HEDIS 2024 documentation for Controlling High Blood Pressure (CBP)

Measure description: The percentage of members 18 to 85 years of age who had a diagnosis of hypertension (HTN) and whose BP (blood pressure) was adequately controlled (< 140/90 mm Hg) during the measurement year.

What we are looking for in provider records:

• Last BP documented in 2024 regardless of reading

Documentation below could be used to exclude the patient:

• Evidence of hospice or palliative services in 2024
• Evidence patient expired in 2024
• Documentation of pregnancy any time during 2024
• Documentation of end stage renal disease, dialysis, nephrectomy, or kidney transplant any time in the member’s history on or prior to December 31, 2024

Helpful hints:

• Take BP at every visit.
• Take a second BP before the end of the office visit if the BP was ≥ 140/90.
• Counsel on healthy habits for managing high blood pressure.
• BPs cannot be taken:
  • On the same day as a diagnostic test or diagnostic or therapeutic procedure that requires a change in diet or change in medication on or one day before the day of the test or procedure, with the exception of fasting blood tests.
  • From member-reported BPs if taken with a non-digital device such as with a manual blood pressure cuff and a stethoscope.

HEDIS 2024 documentation for Statin Therapy for Patients with Cardiovascular Disease (SPC)

Measure description: The percentage of males 21 to 75 years of age and females 40 to 75 years of age during the measurement year who were identified as having clinical atherosclerotic cardiovascular disease (ASCVD) and received statin therapy and remained on the statin for at least 80% of the treatment period.

What we are looking for in provider records

Documentation in the medical record indicating the date the patient was dispensed at least one high-intensity or moderate-intensity statin medication during the measurement year.

All of the following must be present with a dispensed medication:

• Name of the drug (generic or brand name)
• Strength/dose
• Route
• Date when the medication was dispensed, filled, or shipped to the patient

Documentation below could be used to exclude the patient:

• Evidence of hospice services in 2024
• Evidence patient expired in 2024
• Evidence patient received palliative care in 2024
• Evidence patient was pregnant or underwent IVF treatment in 2023 or 2024
• Evidence of ESRD or dialysis in 2023 or 2024
• Evidence of cirrhosis in 2023 or 2024
• Evidence of a dispensed prescription for Clomiphene in 2023 or 2024
• History of myalgia, myositis, myopathy, muscle pain or rhabdomyolysis documented in 2024

Helpful hints:

• Recommended that if the patient has a reaction to statins, record the specific reaction (myalgia, myositis, myopathy, muscle pain or rhabdomyolysis) in the patient’s chart annually.
• Recommended to also include drug quantity and directions with the dispensed medication so that days’ supply can be calculated for the measure.