Closing the Gap: Preventative measures for better heart health

Heart disease is the leading cause of death in the United States, accounting for nearly 700,000 deaths each year. Its chief risk factor is high blood pressure or hypertension, which not only increases the risk of cardiovascular disease (CVD) including heart attack and stroke, but also kidney disease and other conditions. This February, encourage your members to take preventative care steps as we observe American Heart Month.

Known as the “silent killer,” CVD affects an estimated 121.5 million Americans, with a heart attack occurring approximately every 40 seconds according to the Centers for Disease Control and Prevention (CDC). Although men are more likely to suffer from CVD, other major risk factors include age, heredity, and stress. With proactive care and observance of a low-sodium diet, physical activity, and consistent medication adherence for those with CVD, these conditions can be managed and lower the risk of a heart attack.

Both the National Committee for Quality Assurance (NCQA) and the Centers for Medicare & Medicaid Services (CMS) have recognized that quality care standards are critical for plans to follow to support members’ cardiovascular health, which includes monitoring a number of related measures in both the HEDIS^® and Star Ratings programs. Here, as part of our monthly Closing the Gap series, we will explore the quality measures related to heart conditions and how they may be impacted by the implementation of the Tukey outlier deletion methodology.

Tukey outlier deletion impact

Beginning with the 2024 Star Ratings (to be released in October 2023), CMS is implementing the Tukey outlier deletion methodology to delete outlying rates from the data used to calculate Star Ratings cut points. Prior to clustering, this methodology is applied to increase the stability and predictability of the measure cut points. This may significantly impact a plan’s overall score by up to half of a star, according to reports from the Federal Register.

The Star Ratings measures related to heart conditions include Controlling High Blood Pressure (CBP), Statin Therapy for Patients with Cardiovascular Disease (SPC), Medication Adherence for Hypertension (ADH), and Medication Adherence for Cholesterol (MAC). With the exception of SPC, each of these measures will carry a weight of 3x in the 2024 Star Ratings, demonstrating CMS’s increased focus on measures related to cardiovascular health.

The simulated values in the table below, released by CMS in December 2022 based on the 2023 cut points, illustrate the impact the Tukey outlier deletion methodology would have on HEDIS measures related to heart health included in the Star Ratings program.

Measure with diligence

Monthly and year-over-year trending can help ensure you are meeting your benchmarks for the upcoming year. The ability to leverage predicted cut points that anticipate your plan’s rating in a given measure can provide valuable insight on the impact of the Tukey outlier deletion on your performance and help better prioritize projects, allocate resources, and understand the members to engage.

Here are some proactive steps to consider in order to reach your target Star Rating and reduce care gaps:

• Use one vendor to help with consistency and gap closure across all measures while reducing member abrasion. Bringing HEDIS outreach efforts together, rather than relying on a pharmacy benefits manager (PBM) or pharmacist team, can ensure a more seamless member experience.
• Review the previous years’ performance and compare it against the simulated cut points. Identify if any measures will fall short of the rating received from 2023 or are projected to miss your target for 2024. Even a one-point difference can reduce your measure rating from four to three stars.
• Gain a clear view of progress with trending and benchmarking dashboards by leveraging advanced analytics that offer measure predictions, trends, and opportunities for growth.
• Pay close attention to the CBP hybrid measure. Communicate with the HEDIS team to pay special attention to this measure during retrieval and abstraction to help ensure a 75% completion rate for a four-star projection. If the measure cut point increases by no more than the 5% guardrail, we recommend striving for at least 80% completion.
• Plan ahead for the 2025 Star Ratings by focusing on personalized messaging to deliver information to members at the right time and inspire action to reduce the effects of CVD. Early care gap closure is possible when effective member engagement interventions are in place.

Keep an eye out for our March Closing the Gap blog as we highlight quality measures related to Colorectal Cancer Awareness Month.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance.