Controlling High Blood Pressure – Exploratory Measure Tip Sheet
The percentage of members 18–85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (< 140/90 mm Hg) in the last 12 months.
BP reading must occur on or after the date of the second HTN diagnosis.
This is an exploratory measure; there is no payment for 2022 and 2023. For additional information, refer to the CBI Technical Specifications.
Members in hospice or receiving hospice services or palliative care during the measurement year.
Members 66 years of age and older as of December 31 of the measurement year with frailty and advanced illness:
- At least one encounter for frailty during the measurement year.
- At least one of the following during the measurement year or year prior to the measurement period:
- At least two outpatient, observation, emergency department (ED) visits or non-acute inpatient encounter on a different date of service (DOS), with an advanced illness diagnosis. Visit types must be the same for the two visits.
- At least one acute inpatient encounter with an advanced illness diagnosis.
- Dispensed dementia medication.
Members 81 years of age and older are excluded with frailty.
Members with evidence of end-stage renal disease (ESRD), dialysis, nephrectomy or kidney transplant on or prior to December 31 of the measurement year.
Female members with a diagnosis of pregnancy during the measurement year.
All members who had a nonacute inpatient admission during the measurement year.
Blood Pressure CPT-II Codes:
|BP Value||CPT-CAT-II Code|
|Systolic Less Than 130||3074F|
|Systolic Greater Than or Equal To 140||3077F|
|Diastolic Less Than 80||3078F|
|Diastolic Greater Than or Equal To 90||3080F|
Data for this measure will be collected using claims, DHCS Fee-For-Service encounter claims, Santa Cruz Health Information Exchange (SCHIE) and provider data submissions via the Data Submission Tool on the Provider Portal. To find gaps in data:
- Run a report from your electronic health record (EHR) system; or.
- Manually compile patient data (Example: Download your Care-Based Incentives Measure Details report on the Provider Portal and compare to your EHR/paper charts).
This measure allows providers to submit blood pressure readings from the clinic EHR system or paper records to the Alliance by the DST contractual deadline. To submit, you may upload data files to the DST on the Provider Portal. To be accepted, data must be submitted as a CSV file. Step-by-step instructions are available in the Data Submission Tool Guide on the Provider Portal.
Measuring Blood Pressure:
Please remind your patients to utilize proper technique when taking their BP, such as:
- BP > 140/90 requires a recheck.
- Support back/feet; uncross legs.
- Put cuff on bare arm.
- Empty bladder first.
- Use correct cuff size.
- Don’t have a conversation.
- Support arm at heart level.
Educate Members To:
- Utilize the Alliance health education and chronic disease self-management programs to help members achieve healthier outcomes:
- Healthier Living Program (Chronic Health Conditions).
- Wellness that Works (Adult (ages 18 and older; Weight Management)
- Tobacco Cessation Support
You can refer members using the Health Education and Disease Management Programs Referral Form. For any questions, please call the Alliance Health Education Line at (800) 700-3874 ext. 5580.
- Make lifestyle changes that matter like:
- Eating a well-balanced diet that’s low in salt.
- Limiting alcohol.
- Enjoy regular physical activity.
- Manage stress.
- Maintain a healthy weight.
- Quit smoking.
- Take your medications properly (i.e. what medication is taken and how?).
- Getting enough sleep.
- Utilize Ask Me 3® during visits to encourage members to ask three specific questions of their providers to better understand their health conditions, and what they need to do to stay healthy.
- What is my main problem?
- What do I need to do?
- Why is it important for me to do this?
- Refer Alliance members to Care Management services, including Complex Case Management and Care Coordination, by calling Case Management at 800-700-3874, ext. 5512.
- Refer Alliance members to Enhanced Care Management (ECM) Services and Community Supports through the Alliance Provider Portal, email ([email protected]), mail or fax, or by phone at 831-430-5512.
- Alliance interpreting services are available to network providers:
- Telephonic interpreting services are available to assist in scheduling members.
- Face-to-face interpreters can be requested to be at the appointment with the member.
- Refer patients who have transportation challenges to the Alliance’s Transportation Coordinator at 800-700-3874, ext. 5577. This service is not covered for non-medical locations or for appointments that are not medically necessary.