Antidepressant Medication Management Updates (CMS128) Change Review Process Meeting November 19, 2015 Jenna Williams-Bader Anne Marie Smith Stephanie Rodriguez

2 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

3 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

4 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.

5 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"

6 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"

7 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

8 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

9 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

10 Denominator and Exclusion Questions Does the updated logic make sense? Does it capture the intent of the measure?

11 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?

12 Next Steps: Vote Agree with proposed changes to Antidepressant Medication Management measure (CMS128)? 1.Yes 2.No Measure updates will be implemented during 2016 Annual Update