January 26, 2022
Heart disease and stroke are among the leading causes of death in the U.S., according to the Centers for Disease Control and Prevention (CDC). We encourage you to talk with our members about reducing and managing risks. We’ve created resources that may help, including information on high blood pressure and cholesterol.
- The U.S. Preventive Services Task Force (USPSTF) recommends blood pressure checks for adults age 18 and older at every visit.
- The USPSTF recommends cholesterol screenings for adults ages 40 to 75. In addition, the American Heart Association recommends cholesterol screenings for adults ages 20 to 39 who have risk for coronary heart disease.
Closing Gaps in Care
We track data from quality measures to help assess and improve the quality of our members’ care. Controlling High Blood Pressure and Statin Therapy for Patients with Cardiovascular Disease are Healthcare Effectiveness Data and Information Set (HEDIS®) measures from the National Committee for Quality Assurance (NCQA).
For Controlling High Blood Pressure, we measure the percentage of members ages 18 to 85 who had a diagnosis of hypertension and whose blood pressure was adequately controlled. NCQA defines controlling blood pressure as:
- Systolic blood pressure < 140 mmHg
- Diastolic blood pressure < 90 mmHg
Statin Therapy for Patients with Cardiovascular Disease tracks the percentage of male members ages 21 to 75 and female members ages 40 to 75 who:
- Have atherosclerotic cardiovascular disease, and
- Were dispensed at least one high- or moderate-intensity statin medication and remained on the medication for at least 80% of the treatment period
For more information, see our preventive care and clinical practice guidelines.
Tips to Consider
- Talk with our members about taking medications as prescribed, smoking cessation, increasing physical activity and eating a low-sodium diet.
- Encourage members to return for follow-up visits. Reach out to those who cancel or miss appointments and help them reschedule as soon as possible.
- Build care gap alerts in your electronic medical records as reminders.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.
HEDIS is a registered trademark of NCQA. Use of this resource is subject to NCQA’s copyright, found here .