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Integrated Healthcare Association Align. Measure. Perform. (AMP) Programs Integrated Healthcare Association Align. Measure. Perform. (AMP) Programs Measurement Year 2019 Manual Released September 1, 2019 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording or any information storage and retrieval system, without the written permission of NCQA and IHA, except for the purposes of reporting quality data for the AMP programs or for internal quality improvement activities. © 2019 by the National Committee for Quality Assurance and Integrated Healthcare Association, all rights reserved. Table of Contents Table of Contents AMP Programs Overview Background .................................................................................................................................................... 1 AMP Commercial HMO Measurement and Reporting .................................................................................. 1 AMP Medicare Advantage Measurement and Reporting .............................................................................. 1 AMP Commercial ACO Measurement and Reporting ................................................................................... 2 AMP Medi-Cal Managed Care Measurement and Reporting ........................................................................ 2 Key Organizations Involved in Data Collection, Aggregation and Reporting ................................................ 3 Participation and Use of Results ................................................................................................................... 3 Domains and Reporting Entities .................................................................................................................... 5 Joining AMP as a new Health Plan or PO ............................................................................................................ 6 AMP Data Collection and Reporting Timeline ............................................................................................... 7 Key Dates for Review and Corrections of MY 2019 Results ....................................................................... 10 Manual Revisions ........................................................................................................................................ 11 If You Have Questions About the Specifications ......................................................................................... 11 What’s in AMP MY 2019? ............................................................................................................................ 12 Testing Measures ........................................................................................................................................ 13 General Guidelines for Data Collection and Reporting Reporting Options ........................................................................................................................................ 16 Encounter/Claims Submission ..................................................................................................................... 17 Reporting Policies ........................................................................................................................................ 18 Membership Changes ................................................................................................................................. 25 Required Enrollment Periods and Benefits ................................................................................................. 26 Data Collection ............................................................................................................................................ 30 Coding Conventions .................................................................................................................................... 38 Data Submission.......................................................................................................................................... 41 The Audit Review......................................................................................................................................... 43 Clinical Domain Technical Specifications Overview ...................................................................................................................................................... 48 Guidelines for Clinical Quality Measures ..................................................................................................... 49 Cardiovascular CBP Controlling High Blood Pressure ............................................................................................... 51 SPC Statin Therapy for Patients With Cardiovascular Disease ......................................................... 55 PDC Proportion of Days Covered by Medications ............................................................................. 62 Diabetes PDC Proportion of Days Covered by Medications ............................................................................. 62 CDC Diabetes Care ............................................................................................................................ 70 SPD Statin Therapy for Patients With Diabetes ................................................................................ 81 SUPD Statin Use in Persons With Diabetes ......................................................................................... 90 Musculoskeletal ART Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis ............................. 94 OMW Osteoporosis Management in Women Who Had a Fracture..................................................... 98 Prevention CIS Childhood Immunization Status ............................................................................................... 104 IMA Immunizations for Adolescents ................................................................................................ 109 CHL Chlamydia Screening in Women ............................................................................................. 111 CCS Cervical Cancer Screening ...................................................................................................... 114 CCO Cervical Cancer Overscreening ............................................................................................... 116 BCS Breast Cancer Screening ........................................................................................................ 119 COL Colorectal Cancer Screening ................................................................................................... 123 September 1, 2019 Measurement Year 2019 AMP Manual Table of Contents WCC Weight Assessment and Counseling for Nutrition and Physical Activity for Children/ Adolescents .............................................................................................................................. 126 ABA Adult BMI Assessment ............................................................................................................ 128 Respiratory AMR Asthma Medication Ratio ........................................................................................................ 130 CWP Appropriate Testing for Pharyngitis ......................................................................................... 135 AAB Avoidance of Antibiotic Treatment for Bronchitis/Bronchiolitis ................................................ 139 Behavioral Health & Substance Use HDO Use of Opioids at High Dosage ............................................................................................... 144 COB Concurrent Use of Opioids and Benzodiazepines .................................................................. 152 IET Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment .................................................................................................................................. 156 Data Quality ENRST Encounter Rate by Service Type ............................................................................................ 166 Encounter Format .................................................................................................................................. 171 Encounter Timeliness ........................................................................................................................... 172 Advancing Care Information Domain Overview ....................................................................................................................................................... 174 Description ................................................................................................................................................ 174 Who We Measure ..................................................................................................................................... 174 Data Collection .......................................................................................................................................... 174 ECBP Controlling High Blood Pressure (e-Measure) .......................................................................... 177 ESCD Screening for Depression and Follow-Up Plan (e-Measure) .................................................... 184 Patient Experience Domain Overview ......................................................................................................................................................
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