Controlling High Blood Pressure – Exploratory Measure Tip Sheet

This is an exploratory measure; there is no payment for 2023 and 2024. For additional information, refer to the CBI Technical Specifications.

Identify members who had at least two outpatient visits, telephone visits, e-visits or virtual check-ins on different dates of service with a diagnosis of hypertension on or between January 1 of the year prior to the measurement year and June 30 of the measurement year. The visit type needs to be the same for the two visits. This includes outpatient visits (outpatient without UBREV codes) and telehealth visits (telephone, online assessments).

• Administrative members at end of the measurement period.
• Dual coverage members.
• Members in hospice, receiving hospice services or palliative care, or who died during the measurement year.
• Members with a procedure or diagnosis that indicates evidence of end-stage renal disease (ESRD), dialysis, nephrectomy or kidney transplant on or prior to December 31 of the measurement year.
• Members with a diagnosis of pregnancy during the measurement year.
• Members 66-80 years of age and older as of December 31 of the measurement year with frailty and advanced illness:
  • Frailty: At least two indications of frailty with different dates of service during the measurement year.
  • Advanced Illness: Any of the following during the measurement year or year prior to the measurement period (count services that occur over both years):
    • Advanced illness on at least two different dates of service.
    • A dispensed dementia medication.
• Members 81 years of age and older as of December 31 of the measurement year with at least two indications of frailty on different dates of service during the measurement year.

Note: Laboratory claims with POS 81 are not included to identify members with frailty or advanced illness diagnosis.

Blood Pressure CPT-II Codes:

Note: Category II codes with modifiers are not included.

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.

• Educate medical assistants to use proper technique when taking a patient's BP:
  • Recheck after five minutes if BP >140/90.
  • 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.
• Encourage members to make lifestyle changes:
  • Eat a well-balanced diet that’s low in salt.
  • Limit alcohol.
  • Enjoy regular physical activity.
  • Manage stress.
  • Maintain a healthy weight.
  • Quit smoking.
  • Take medications properly.
  • Get enough sleep.
• Educate members to use Ask Me 3^®: Good Questions for Your Good Health during visits to encourage them to ask three specific questions of their providers to better understand their health conditions, and what they need to do to stay healthy.

1. 1. What is my main problem?
   2. What do I need to do?
   3. Why is it important for me to do this?

• Alliance Cultural and Linguistic Services are available to network providers.
  • Language Assistance Services – request materials at 800-700-3874, ext. 5504.
  • Telephonic Interpreter Services – available to assist in scheduling members.
  • Face-to-Face Interpreter Services – can be requested for the appointment with the member.
  • For information about the Cultural and Linguistic Services Program, call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].
• Alliance Enhanced Care Management (ECM) and Community Supports.
  • Refer Alliance members through the Alliance Provider Portal, email [email protected], mail or fax, or by phone at 831-430-5512.
  • For Complex Care Management and Care Coordination, call the Care Management team at 800-700-3874 (TTY: Dial 711).
• Alliance Health Education and Disease Management Programs – Health Programs Referral Form. For any questions, please call the Alliance Health Education Line at (800) 700-3874, ext. 5580.
• Alliance Transportation Services for patients with transportation challenges.
  • Non-emergency medical transportation (NEMT), call 800-700-3874, ext. 5640 (TTY: Dial 711).
  • Non-medical transportation (NMT), call 800-700-3874m ext. 5577 (TTY: Dial 711).