December 5, 2022
Cardiovascular disease is the leading global cause of death, according to the World Health Organization. It accounts for 17.9 million deaths per year. Statin therapy is recommended:
- To prevent cardiovascular disease in diabetics, according to the American Diabetes Association
- To treat cardiovascular disease in adults with established clinical atherosclerotic cardiovascular disease (ASCVD), according to the American Heart Association
- To prevent cardiovascular disease in adults with certain risk factors, according to the U.S. Preventive Services Task Force
Statin Therapy Quality Measures
To help monitor and improve our members’ care, we track the Healthcare Effectiveness Data and Information Set (HEDIS®) measures from the National Committee for Quality Assurance (NCQA): Statin Therapy for Patients with Cardiovascular Disease (SPC) and Statin Therapy for Patients with Diabetes (SPD). You can help ensure quality care by following these guidelines from the NCQA:
- Men ages 21-75 and women 40-75 with clinical ASCVD should be dispensed at least one high-or moderate-intensity statin medication.
- Adults ages 40-75 with diabetes who don’t have clinical ASCVD should be dispensed at least one statin medication of any intensity.
- All patients prescribed statin therapy should remain on prescribed statin medications for at least 80% of their treatment period.
Tips To Close Gaps in Care
- Discuss lifestyle changes with our members to lower serum cholesterol. These can include exercise, adequate sleep and good nutrition, as well as stopping smoking and substance use. We’ve created resources that may help. When diet and exercise aren’t enough, statins may be needed to achieve lower cholesterol levels and reduce the risk of heart disease.
- Emphasize the importance of staying on statin medication to our members. Educate them on the proper dose and frequency. Consider converting their medication to a 90-day supply through mail order or a retail pharmacy to encourage adherence.
Discuss common side effects of statin use and what to do if our member has problems with the medication. Remind your patients to contact you if they think they’re experiencing side effects.
- Review our member’s medication profile to confirm statin use history at follow-ups. Clearly document any diagnosis indicating an intolerance to statin therapy and any drug interactions with current medications.
For coding tips related to statin therapy, refer to the Blue Cross and Blue Shield of Illinois (BCBSIL) branded Payer Spaces resources section in Availity® Essentials.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.
HEDIS is a registered trademark of NCQA.
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.