Pharmacotherapy management of COPD exacerbation HEDIS measure (Healthy Blue + Medicare (HMO D-SNP))

Please note, this communication applies to Healthy Blue + Medicare℠ (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina.

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

The Pharmacotherapy Management of COPD Exacerbation (PCE) measure assesses chronic obstructive pulmonary disease (COPD) exacerbations for adults 40 years of age and older who had appropriate medication therapy to manage an exacerbation. A COPD exacerbation is defined as an acute inpatient discharge or emergency department visit with a primary discharge diagnosis of COPD. Two rates are reported: 

Dispensed a systemic corticosteroid (or there is evidence of an active prescription) within 14 days of the event

Dispensed a bronchodilator (or there is evidence of an active prescription) within 30 days of the event. (1)

COPD is a debilitating lung condition that affects one in eight Americans age 45 and older. More than 16 million Americans have been diagnosed with COPD, and millions more have it without knowing. (2) 

COPD exacerbations make up a significant portion of the costs associated with the disease. 

Appropriate prescribing of medication following exacerbation can prevent future flare-ups, improve health outcomes, and reduce the healthcare burden of COPD.(3)

Who Has COPD?(4)

Prevalence By Ethnicity

• 12% American Indians and Alaska Natives
• 7% Non-Hispanic Blacks
• 7% Whites
• 4% Hispanics
• 3% Native Hawaiian/Pacific Islander
• 2% Asians

COPD Action Plan 
A COPD action plan is a personalized patient tool that includes the important steps to help manage COPD. It allows patients to track how they are doing and note any concerns to discuss with their provider. It addresses medications, exercise, diet, and avoidance of triggers, such as tobacco products and other inhaled irritants. The plan should be discussed at each visit and updated as needed. (5) 

HEDIS® Helpful Tips:

• Schedule a follow-up appointment after discharge and confirm that the patient has the appropriate medications. 
• Reconcile patients’ medications with those prescribed at discharge when you receive the discharge summary.
• Ask the patient if they have any barriers that prevent them from filling their prescriptions. 
• Assure patients with COPD are up to date on their vaccinations, including flu, pneumococcal, and COVID-19. 
• Provide a COPD action plan for the patient, including daily medications, trigger avoidance, and what to do when flare-ups do occur:
  • American Lung Association COPD Action Plan & Management Tools

Resources: 

1. NCQA. Pharmacotherapy Management of COPD Exacerbation. Pharmacotherapy Management of COPD Exacerbation - NCQA
2. National Heart, Lung and Blood Institute. COPD National Action Plan.
3. Pasquale, M.K., S.X. Sun, F. Song, H.J. Hartnett, and S.A. Stemkowski. Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population. International Journal of COPD 7:757-64. doi: 10.2147/COPD.S36997. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3496536/
4. Chronic Obstructive Pulmonary Disease and Smoking Status— United States, 2017, Morbidity and Mortality Weekly Report (MMWR),68(24), pp. 533-538 (June 21, 2019), Centers for Disease Control and Prevention (CDC). 
5. American Lung Association. COPD Action Plan & Management Tools. American Lung Association COPD Action Plan & Management Tools