HEDIS 2018 (Health Effectiveness Data and Information Set includes two opioid measures.  According to the CDC (Center for Disease Control), Opioid-involved deaths continue to increase annually in the United States. Since 1999, the number of overdose deaths involving opioids (including prescription opioids) quadrupled.  From 2000 to 2015, more than half a million people died from drug overdoses involving opioids.

The 2016 CDC Guideline on opioid prescribing recommends the use of “additional precautions” when prescribing dosages greater than or equal to 50 morphine equivalent dose (MED) and generally recommend avoiding dosages greater than or equal to 90 mg MED suggesting that 120 MED be the maximum threshold dosage level prescribed (without special consideration).

Ninety – one Americans die every day from an overdose.  Prescription opioid pain relievers are responsible for nearly 3 out of 4 of these overdoses.

Use of Opioids at High Dosage (UOD) is a new measure that captures the rate per 1,000 of members 18 years and older who received prescription opioids for 15 days or more during the measurement year at a high dose (average morphine equivalent dose >120mg).  For this measure a lower number indicates better performance.  Medicaid, Medicare and Commercial insurance plans report this measure. 

Members in hospice at any time during the measurement year are excluded from the eligible population.

Required exclusions include any of the following during the measurement year:

• Members who had only a single opioid medication dispensing event.
• Cancer
• Sickle Cell Disease

One area of risk related to opioid use is the receipt of opioids prescriptions from multiple prescribers and pharmacies.  Evidence suggested that patients using four or more prescribers or pharmacies have a higher likelihood of opioid-related overdose death compared to patients who received opioids from one prescriber or pharmacy. 

Use of Opioids from Multiple Providers (UOP) is a new measure that captures the rate per 1,000 of members 18 years and older who received prescription opioids for 15 days or more during the measurement year from multiple providers.  Medicaid, Medicare and Commercial insurance plans report three rates: 

• Multiple Prescribers: The rate per 1,000 of members receiving prescriptions for opioids from four or more different prescribers during the measurement year.
• Multiple Pharmacies: The rate per 1,000 of members receiving prescriptions for opioids from four or more different pharmacies during the measurement year.
• Multiple Prescribers and Multiple Pharmacies: The rate per 1,000 of members receiving prescriptions for opioids from four or more different prescribers and four or more different pharmacies during the measurement year (i.e., the rate per 1,000 of members who are numerator compliant for both the Multiple Prescribers and Multiple Pharmacies rates).

A lower rate indicates better performance for all three rates.

Members in hospice at any time during the measurement year are excluded from the eligible population.

Exclude members who had only one single opioid medication dispensed during the measurement year.

Opioid Medications Include:

Buprenorphine, Butorphanol, Codeine, Dihydrocodeine, Fentanyl, Hydrocodone, Hydromorphone, Levorphanol, Meperidine, Methadone, Morphine, Nalbuphine, Opium, Oxycodone, Oxymorphone, Pentazocine, Tapentadol, Tramadol.

Opioid Medications List excludes:

• Injectables
• Opioid cough and cold products.

Single-agent and combination buprenorphine products used to treat opioid use disorder for medication-assisted treatment (i.e., buprenorphine sublingual tablets, buprenorphine subcutaneous implant and all buprenorphine/naloxone combination products).

Ionsys (fentanyl transdermal patch) is excluded because:

• It is only for inpatient use.
• It is only available through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS).

 As always, please refer to HEDIS 2018, Volume 2 published by NCQA for measure specifications for these new measures.

About The Author

Jane Jackson has more than  25 years experience in healthcare, including hospital-based care, home health, and managed care. She enjoys sharing her knowledge and can she be reached at Jane.Jackson@DailyDoseHQ.com. Also visit her blog, Daily Dose HQ.