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

Our Quality Concierge Team (QCT) is also available to answer questions, provide updates, assist in the interpretation of monthly gaps 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.

Osteoporosis management in women who had a fracture (OMW)

Eligible population:

Women ages 67-85 who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis within six months of the fracture (does not include fractures to the finger, toe, face, or skull).

This measure applies to members enrolled in Medicare Advantage plans.

Measurement period:

Fractures between July 1, 2019 – June 30, 2020

This measure’s date range begins the year prior. Fractures that occur in July 2019 need to be closed by January 2020.

Measure process:

1. Patient identified as having a fracture
2. PCP is notified of fracture
3. PCP outreach to patient for follow-up:
   1. BMD test completed; or
   2. Prescribed osteoporosis medication*; or
   3. Contact MedXM to schedule in-home heel scan

Process must be completed within six months of fracture to close the HEDIS gap in care.

Best practices

• The treatment period to close this gap is only six months from the date of fracture.
• A referral for a BMD will not close this gap.
• Women at risk for osteoporosis should be prescribed a bone density screening every two years. At-risk women include those who are:
  • At increased risk for falls or have a history of falls
  • Being monitored to assess their response to, or efficacy of, an FDA-approved osteoporosis drug therapy regime
  • Diagnosed with primary hyperparathyroidism
  • Estrogen deficient
  • On long-term steroid therapy

BCBSRI partners with Quest HealthConnect on closing these gaps. To help patients schedule an in-home heel scan at no cost to them, call 1-884-943-8435.

Codes to use:

DESCRIPTION: Bone Mineral Density Test

CODES: 76977, 77078, 77080, 77081, 77082, 77085, 77086

This measure can only be closed through claims/administrative data.

Exclusions:

Exclusions apply to women who enrolled in a hospice program or are living in a long-term care facility. Women prescribed the following dementia medications are also excluded:

Cholinesterase inhibitors:

• Donepezil
• Galantamine
• Rivastigmine

Miscellaneous central nervous system agents:

• Memantine

Drug category medications

The member must be prescribed at least one of the following osteoporosis medications within 180 days of their fracture:

Bisphosphonates:

• Alendronate
• Alendronate-cholecalciferol
• Ibandronate
• Risedronate
• Zoledronic acid

Other agents:

• Abaloparatide
• Denosumab
• Raloxifene
• Teriparatide