This measure is used to assess the relative resource use by members with persistent asthma by reporting total standard cost and service frequency for all services for which the organization has paid or expects to pay during the measurement year.

Note: Organizations must report the Use of Appropriate Medications for People with Asthma (ASM) quality measure when reporting Relative Resource Use for People with Asthma (RAS).

How much care costs is an important consideration when choosing a health plan. There is a great demand for information to help purchasers and consumers determine which organizations offer the highest quality services, along with effective management of those services and low premium or out-of-pocket costs.

HEDIS 2012 includes five relative resource use (RRU) measures for members with specific chronic and acute conditions: diabetes, cardiovascular conditions, hypertension, chronic obstructive pulmonary disorder (COPD), and asthma. These conditions account for over 50 percent of all health spending, and people with them do substantially better if they get effective treatments and avoid ineffective care.

The RRU measures are a standardized approach to measuring resource use. When evaluated with the corresponding Quality of Care measures, they provide more information about the efficiency or value of services rendered by an organization.

Persistent asthma; relative resource use; standard cost; service frequency

Members 5 to 64 years of age by December 31 of the measurement year with persistent asthma (see the related "Denominator Inclusions/Exclusions" field)

Total standard cost and service frequency counts for all services for which the organization has paid or expects to pay for the eligible population during the treatment period, reported by age, gender and risk group (see the related "Numerator Inclusions/Exclusions" field)

Almost every day, there are news reports about gaps in health care quality and unsustainable increases in health care spending. With health care reform legislation focused on expanding access to care, concerns about cost and quality will grow even more urgent. Moreover, the increasing prevalence of Americans with chronic conditions such as diabetes, heart disease, cancer, chronic obstructive pulmonary disease (COPD) and asthma account for the highest use of health care services and a growing percentage of the health care dollars spent in the United States.

The national bill for patients with chronic conditions accounts for 75 percent of health care spending, which is estimated to be at the $2 trillion mark. Simply put, of every dollar we spend, 75 cents goes toward treating patients with chronic diseases. In public programs such as Medicare and Medicaid, treating patients with chronic diseases constitutes an even higher portion of spending.

Asthma affects an estimated 23 million adults and children in the U.S., at an annual cost of $14.7 billion in direct health care costs. Indirect costs, such as lost productivity, add another $5 billion. Prescription drugs and hospital care account for the highest use of health care resources for people with asthma.

Unspecified

Age 5 to 64 years

The treatment period is the 12-month measurement year.

Inclusions
Members* 5 to 64 years of age by December 31 of the measurement year with persistent asthma**

*Members must have been continuously enrolled during the measurement year and the year prior to the measurement year.

Allowable Gap: No more than one gap in continuous enrollment of up to 45 days during each year of continuous enrollment (commercial). To determine continuous enrollment for a Medicaid beneficiary for whom enrollment is verified monthly, the member may not have more than a 1-month gap in coverage.

**Persistent asthma: Refer to the original measure documentation for steps to identify members with persistent asthma.

Refer to the original measure documentation for a description of the risk adjustment method and steps to assign members of the eligible population to a risk group.

Exclusions

• Active Cancer. Members who had at least one face-to-face encounter, in any setting, with any diagnosis of cancer in conjunction with any treatment code (refer to Table RRU-A in the original measure documentation), during the measurement year.
• End Stage Renal Disease (ESRD). Members who had at least one face-to-face encounter, in any setting, with any code to identify ESRD (refer to Table RRU-B in the original measure documentation), during the measurement year.
• Organ Transplant. Members who had at least one face-to-face encounter, in any setting, with any code to identify organ transplant (refer to Table RRU-C in the original measure documentation), during the measurement year.
• HIV/AIDS. Members who had at least two face-to-face encounters in an outpatient or nonacute inpatient setting, or at least one face-to-face encounter in an acute inpatient or ED setting, with any diagnosis of HIV (refer to Table RRU-D in the original measure documentation), with different dates of service during the measurement year. Refer to Table RRU-E in the original measure documentation for codes to identify visit type.
• Members diagnosed with emphysema, chronic obstructive pulmonary disorder (COPD), cystic fibrosis or acute respiratory failure (refer to Table ASM-E in the original measure documentation) any time on or prior to December 31 of the measurement year. Look as far back as possible in the member's history through December 31 of the measurement year. (Optional)

Inclusions
Total standard cost and service frequency counts for all services for which the organization has paid or expects to pay for the eligible population during the treatment period, reported by age, gender and risk group

Standard costs are calculated and reported for the following service categories:

• Inpatient Facility
• Evaluation & Management
  • Inpatient Services
  • Outpatient Services
• Laboratory Services
• Surgery and Procedure
  • Inpatient Services
  • Outpatient Services
• Imaging Services
• Pharmacy

Service frequency counts are reported for the following utilization categories:

• Acute Medicine: Discharges, Days
• Acute Surgery: Discharges, Days
• Nonacute: Discharges, Days
• Emergency Department (ED): Discharges
• Pharmacy Utilization
  • Name brand only (N1)
  • Name brand – Generic exists (N2)
  • Generic only (G1)
  • Generic name- Name brand exists (G2)

Note: Resource use is calculated for all services, whether or not they relate to the chronic condition.

Refer to the original measure documentation for additional information.

Exclusions
Unspecified

Unspecified

This measure requires that separate rates be reported for commercial and Medicaid product lines.

Service frequency and standard costs are reported by age, gender, and risk group, across all service categories.

Note: Refer to Guidelines for Relative Resource Use Measures in the original measure documentation for additional information.

Relative resource use for people with asthma (RAS).

Unspecified

National Committee for Quality Assurance's (NCQA's) Measurement Advisory Panels (MAPs) are composed of clinical and research experts with an understanding of quality performance measurement in the particular clinical content areas.

In order to fulfill National Committee for Quality Assurance's (NCQA's) mission and vision of improving health care quality through measurement, transparency and accountability, all participants in NCQA's expert panels are required to disclose potential conflicts of interest prior to their participation. The goal of this Conflict Policy is to ensure that decisions which impact development of NCQA's products and services are made as objectively as possible, without improper bias or influence.

2012 Apr 2

This measure was not adapted from another source.

Unspecified

Unspecified

Please note: This measure has been updated. The National Quality Measures Clearinghouse is working to update this summary.

The individual measure, "Relative Resource Use for People with Asthma (RAS)," is published in "HEDIS® 2012. Healthcare Effectiveness Data & Information Set. Vol. 2, Technical Specifications for Health Plans."

For more information, contact the National Committee for Quality Assurance (NCQA) at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Telephone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org .

The following is available:

• National Committee for Quality Assurance (NCQA). Insights for improvement. Measuring health care value: relative resource use. Washington (DC): National Committee for Quality Assurance (NCQA); 2010. 36 p. This document is available from the National Committee for Quality Assurance (NCQA) Web site .

This NQMC summary was completed by ECRI Institute on October 7, 2012.

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

For detailed specifications regarding the National Committee on Quality Assurance (NCQA) measures, refer to HEDIS Volume 2: Technical Specifications for Health Plans, available from the NCQA Web site at www.ncqa.org .