Impacting HEDIS measures for COPD

Thursday, September 10, 2020 | By Theresa M. Lane, Pharm.D. BCMTMS

Impacting HEDIS measures for COPD

Chronic Obstructive Pulmonary Disease (COPD) is a serious disease that places a heavy burden on affected patients and the healthcare system. Consequently, there are two Pharmacotherapy management measures related to COPD exacerbation for HEDIS Measurement Year 2020 (MY 2020).1 COPD is a group of lung conditions that include emphysema, chronic bronchitis and sometimes asthma. Symptoms of COPD include shortness of breath, cough and sputum production. Exposure to tobacco smoke or air pollutants usually damages the lungs and leads to COPD. Often, COPD patients develop breathing difficulties that become severely worse, known as exacerbations. Serious exacerbations can lead to hospitalization, decreased lung function and possibly death.

COPD is the third leading cause of death in the US with more than 16.4 million people diagnosed with this disease.2 According to national estimates, another 12 million Americans are undiagnosed or misdiagnosed.3 Gender can also be a factor, with women being more susceptible than men to developing COPD.4 This is useful information when educating patients with early warning signs.

When looking specifically at Medicare, COPD is the third leading cause of hospital readmissions.5 Following discharge for a COPD exacerbation, hospitals readmit one in five patients within 30 days.6 The five-year hospital readmission rate is 55%. Because people often don’t understand the warning signs and may attribute shortness of breath to aging, a high incidence in the Medicare population seems to make sense. The issue is that when COPD goes undiagnosed and untreated, it can lead to serious long-term disability and early death, so it is important to identify and interact with patients that have early warning symptoms for this illness.

Although there is no cure, COPD is a preventable and manageable condition with appropriate diagnostic assessment, patient information, intervention and treatment. A Medication Therapy Management (MTM) Program can play a key role in managing COPD and reducing exacerbations. Specific MTM interventions that can decrease exacerbations and improve patient outcomes with COPD include7:

  • Checking immunization status Annual vaccination reduces serious exacerbations associated with influenza. Additionally, studies have shown that the pneumococcal vaccine reduces the incidence of community-acquired pneumonia in COPD patients.
  • Counseling for smoking cessation Pharmacists are able to counsel and engage patients on quitting smoking, reducing further lung damage.
  • Assessing medication inhaler technique – Proper use of the medication inhaler ensures effective delivery of drugs to the lungs. 
  • Educating patients on disease management – Pharmacists can train COPD patients to manage their disease through recognition of the signs and symptoms of an infection and when to contact their physician before symptoms worsen.
  • Measuring medication adherence Compared to single-inhalers, multiple-inhalers (more than 2 prescriptions) are associated with less adherence and higher discontinuation rates. SS&C Health has an RxAdherence solution for our customers to identify non-adherent members in common high-risk groups, including for asthma.
  • Evaluating the appropriateness and effectiveness of therapy – Appropriate therapy for COPD depends on disease classification as determined by spirometry results, patient symptoms and exacerbation history. This intervention supports the HEDIS MY2020 measures: Pharmacotherapy of management of COPD exacerbation, bronchodilator and corticosteroid use after hospitalization for acute COPD.

The MTM program flexibility allows the health plan to target those members vulnerable to COPD and intervene as appropriate. Our SS&C Health MTM program can easily accomplish the above interventions during the Comprehensive Medication Review (CMR) interview with the COPD patient. 

In summary

COPD interventions after hospitalization and throughout the plan year can lower healthcare costs and reduce the burden of this disease for members, while addressing the applicable HEDIS measures. If you are looking for HEDIS solutions under the pharmacy benefit, please reach out to see how we can help you make the most of the resources you have for the best possible outcomes with your COPD program.

You may also want to reference the previous blogs in this series: HEDIS® Measurement Year 2020 – continuing the pursuit of a core set of meaningful measures and NCQA timeline paves the way for proactive monitoring


  1. Required HEDIS and CAHPS Measures for HEDIS Reporting Year 2020. NCQA document.
  3. Mannino, David M. et al. Obstructive Lung Disease and Low Lung Function in Adults in the United States. Arch Intern Med 2000 160: 1683-1689.
  5. Jencks, Stephen F. et al Rehospitalizations Among Patients in the Medicare Fee-for-Service Program. NEJM (2009) 360: 1418-28.
  6. Shah, Tina et al. COPD Readmissions – Addressing COPD in the Era of Value-based Health Care. Chest (2016) 150(4): 916-926.
  7. Kochanek, Kenneth D. et al Deaths: Final Data for 2017. National Vital Statistics Reports 68(9): 1-77.




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