You may care for our members who have risk factors for heart disease and stroke. These conditions are among the leading causes of death in the U.S. We encourage you to talk with our members about reducing and managing their risks. This may include taking medications as prescribed, smoking cessation, increasing physical activity and eating a low-sodium diet. We’ve created resources for members, including information on high blood pressure and cholesterol.
Closing Gaps in Members’ Care
We track data from the quality measures Controlling High Blood Pressure and Statin Therapy for Patients with Cardiovascular Disease. These are Healthcare Effectiveness Data and Information Set (HEDIS®) measures from the National Committee for Quality Assurance.
For Controlling High Blood Pressure, we measure the percentage of members ages 18 to 85 who had a diagnosis of hypertension and whose blood pressure was adequately controlled. NCQA defines controlling blood pressure as:
- Systolic blood pressure < 140 mmHg
- Diastolic blood pressure < 90 mmHg
Statin Therapy for Patients with Cardiovascular Disease tracks the percentage of men ages 21 to 75 and women ages 40 to 75 who:
- Have atherosclerotic cardiovascular disease, and
- Were dispensed at least one high- or moderate-intensity statin medication and remained on the medication for at least 80% of the treatment period
Tips to Consider
- The U.S. Preventive Services Task Force recommends blood pressure checks for adults age 18 and older at every visit. Ensure that screenings and results are documented in our members’ electronic medical records.
- The American Heart Association recommends statin therapy to treat cardiovascular disease in adults with established clinical atherosclerotic cardiovascular disease. USPSTF recommends statin therapy to prevent cardiovascular disease in adults with certain risk factors. See our preventive care and clinical practice guidelines for more information.
- Heart disease, stroke and their risk factors disproportionately affect some populations, including Black adults. Social determinants of health can play a significant role in cardiovascular health, according to the Centers for Disease Control and Prevention. See our Health Equity and Social Determinants of Health webpage for information about addressing barriers to health.
- Offer telehealth services when available and appropriate for preventive care appointments.
- Encourage members to return for follow-up visits. Build care gap alerts in your electronic medical records as reminders. Reach out to those who cancel or miss appointments and help them reschedule as soon as possible.
- For members who need language assistance, let them know we offer help and information in their language at no cost. To speak to an interpreter, members may call the customer service number on their member ID card.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.
HEDIS is a registered trademark of NCQA.