Description:   The percentage of members 5–85 years of age who were identified as having persistent asthma and had a ratio of controller

medications to total asthma medications of 0.50 or greater during the measurement year.


Note: For Medicaid, report only members 5–64 years of age. For Medicare, report only members 18–85 years of age.


Denominator:  


Product lines
Commercial, Medicaid, Medicare (report each product line separately).
Ages
For commercial, ages 5-85 as of December 31 of the measurement year. Report the following age stratifications and total rate:

  • 5–11 years.
  • 12–18 years.
  • 19–50 years.
  • 51–64 years.
  • 65–85 years.
  • Total.

For Medicaid, ages 5–64 as of December 31 of the measurement year. Report the following age stratifications and total rate:

  • 5–11 years.
  • 12–18 years.
  • 19–50 years.
  • 51–64 years.
  • Total.

For Medicare, ages 18–85 as of December 31 of the measurement year. Report the following age stratifications and total rate:
  • 18-50 years.
  • 51–64 years.
  • 65–85 years.
  • Total.
The total is the sum of the age stratification's for each product line.
Continuous enrollment
The measurement year and the year prior to the measurement year.
Allowable gap
No more than one gap in enrollment of up to 45 days during each year of continuous enrollment. To determine continuous enrollment for a Medicaid beneficiary for whom enrollment is verified monthly, the member may not have more than a 1-month gap in coverage during each year of continuous enrollment year.
Anchor date
December 31 of the measurement year.
Benefits
Medical. Pharmacy during the measurement year.




Event/ diagnosis
Follow the steps below to identify the eligible population.

Step 1









Step 2






Step 3

Required

Exclusions

Identify members as having persistent asthma who met at least one of the following criteria during both the measurement year and the year prior to the measurement year. Criteria need not be the same across both years.
At least one ED visit (ED Value Set), with a principal diagnosis of asthma (Asthma Value Set).
At least one acute inpatient encounter (Acute Inpatient Value Set), with a principal diagnosis of asthma (Asthma Value Set).
At least four outpatient visits (Outpatient Value Set) or observation visits (Observation Value Set), on different dates of service, with any diagnosis of asthma (Asthma Value Set) and at least two asthma medication dispensing events (Table MMA-A). Visit type need not be the same for the four visits.
At least four asthma medication dispensing events (Table MMA-A).

A member identified as having persistent asthma because of at least four asthma medication dispensing events, where leukotriene modifiers or antibody inhibitors were the sole asthma medication dispensed in that year, must also have at least one diagnosis of asthma (Asthma Value Set), in any setting, in the same year as the leukotriene modifier or antibody inhibitor (i.e., the measurement year or the year prior to the measurement year).
Exclude members who met any of the following criteria:


  • Members who had any diagnosis from any of the following value sets, any time during the member’s history through December 31 of the measurement year:
    • Emphysema Value Set.
    • Other Emphysema Value Set.
    • COPD Value Set.
    • Obstructive Chronic Bronchitis Value Set.
    • Chronic Respiratory Conditions Due to Fumes/Vapors Value Set.
    • Cystic Fibrosis Value Set.
    • Acute Respiratory Failure Value Set.
  • Members who had no asthma medications (controller or reliever) dispensed (Table AMR-A) during the measurement year.



Numerator:


Step 1

For each member, count the units of controller medications (Table AMR-A) dispensed during the measurement year. Refer to the definition of Units of medications.

Step 2

For each member, count the units of reliever medications (Table AMR-A) dispensed during the measurement year. Refer to the definition of Units of medications.

Step 3

For each member, sum the units calculated in step 1 and step 2 to determine units of total asthma medications. 

Step 4

For each member, calculate the ratio of controller medications to total asthma medications using the following formula.


                                                    Units of Controller Medications (step 1)

                                                  Units of total Asthma Medications (step 3)



Step 5

Sum the total number of members who have a ratio of 0.50 or greater in step 4.