BCBSRI is committed to making it easier for your practice to be successful in all areas of quality improvement. Together, we can achieve our shared goal of improving health outcomes by identifying and addressing open care gaps.

Hints for HEDIS (and more) is a reference tool developed to explore various quality topics, including:

• Definitions, specifications, and exclusions of the many quality measures
• Billing codes used to report gap closure
• Collection and reporting methodologies
• Tips and best practices to maximize gap closure
   
  Controlling high blood pressure (CBP)
   
  Eligible population:
  Members 18-85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled (<130/90 mm Hg) during the measurement year.
   
  NOTE: The systolic blood pressure requirement has changed from 140/90 mm Hg to 130/90 mm Hg.
   
  The most recent BP reading in the medical record is used to report measure compliance.
   
  Measurement year:
  January 1, 2021 through December 31, 2021
   
  Codes to use:
  3074F - Most recent systolic blood pressure less than 130 mm Hg
  3075F - Most recent systolic blood pressure between 130-139 mm Hg
  3077F - Most recent systolic blood pressure greater than/equal to 140 mm Hg
  3078F - Most recent diastolic blood pressure less than 80 mm Hg
  3079F - Most recent diastolic blood pressure between 80-89 mm Hg
  3080F - Most recent diastolic blood pressure greater than/equal to 90 mm Hg
   
  Exclusions*:

• Members in hospice during the measurement year
• Members living in a long-term care facility
• Members with frailty and advanced illness
• Members diagnosed with ESRD
• Pregnancy
• Dispensed dementia medication (see table 1 below)
   
  *Exclusions via claims data only. Supplemental data cannot be used to exclude a member from a HEDIS measure.
   
  Table 1. Dementia medications        

Description

Prescription

Cholinesterase inhibitors

• Donepezil

• Galantamine

• Rivastigmine

Miscellaneous central nervous system agents

• Memantine

Dementia combinations

• Donepezil-memantine

Our Quality Concierge Team (QCT) is also available to answer questions, provide updates, assist in the interpretation of monthly gap-in-care reports, and provide overall HEDIS support to you and your practice. Reach our QCT nurses at QualityHEDIS@bcbsri.org or (401) 459-1005.