2024 PCMH Core Quality Metrics

Core Metric Description Threshold
1. Antidepressant Medication Management (adults only) – Effective Continuation Phase The percentage of members 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression and who remained on an antidepressant medication for at least 180 days (6 months).  ≥ 40.00%
2. Blood Pressure Control for Patients with Diabetes The percentage of members 18–75 years of age with diabetes (types 1 and 2) whose blood pressure (BP) was adequately controlled (<140/90 mm Hg). ≥ 62.00%
3. Eye Exam for Patients with Diabetes The percentage of members 18–75 years of age with diabetes (types 1 and 2) who had a retinal eye exam.  ≥ 51.00%
4. Glycemic Status Assessment for Patients with Diabetes Glycemic Status <8.0% The percentage of members 18–75 years of age with diabetes (types 1 and 2) whose most recent glycemic status (hemoglobin A1c [HbA1c] or glucose management indicator [GMI] was at the following levels during the measurement year: Glycemic Status <8.0% ≥ 47.00%
5a. Child and Adolescent Well-Care Visits 12-21 years    
  • Child and Adolescent Well-Care Visits, Ages 12 – 17 years
 The percentage of members aged 12-17 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year. ≥ 57.00%
  • Child and Adolescent Well-Care Visits, Ages 18 – 21 years
 The percentage of members aged 18-21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year. ≥ 39.00%
Core Metric Description Threshold
1. Antidepressant Medication Management (adults only) – Effective Continuation Phase The percentage of members 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression and who remained on an antidepressant medication for at least 180 days (6 months). ≥ 40.00%
2. Breast Cancer Screening - Electronic The percentage of members 50-74 years of age who were recommended for routine breast cancer screening and had a mammogram to screen for breast cancer. ≥ 47.00%
3. Controlling High Blood Pressure The percentage of members 18–85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90 mm Hg) during the measurement year. ≥ 60.00%
4. Childhood Immunizations Status - Combination 10 The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday ≥ 42.00%
5. Blood Pressure Control for Patients with Diabetes The percentage of members 18–75 years of age with diabetes (types 1 and 2) whose blood pressure (BP) was adequately controlled (<140/90 mm Hg). ≥ 62.00%
6. Eye Exam for Patients with Diabetes The percentage of members 18–75 years of age with diabetes (types 1 and 2) who had a retinal eye exam. ≥ 51.00%

7. Glycemic Status Assessment for Patients with Diabetes Glycemic Status <8.0%

The percentage of members 18–75 years of age with diabetes (types 1 and 2) most recent glycemic status (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) was at the following levels during the measurement year:

  • Glycemic Status <8.0%.
 ≥ 47.00%
8. Child and Adolescent WellCare Visits    
  • Ages 3 – 11 Years
 The percentage of members 3–11 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year. ≥ 65.00%
  • Ages 12 -17 Years
 The percentage of members 12–17 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year. ≥ 57.00%
  • Ages 18 – 21 Years
 The percentage of members 18–21 years of age who had at least one comprehensive well-care visit with a PCP or OB/GYN practitioner during the measurement year. ≥ 39.00%
9. Well-Child Visits in the First 30 Months of Life    
  • Well-Child Visits in the First 15 Months

The percentage of members who had the following number of wellchild visits with a PCP during the last 15 months.

  • Children who turned 15 months old during the measurement year: Six or more well-child visits.
 ≥ 61.00%
  • Well-Child Visits for Age 15 Months - 30 Months

The percentage of members who had the following number of wellchild visits with a PCP during the last 15 months.

  • Children who turned 30 months old during the measurement year: Two or more well-child visits.
 ≥ 71.00%
10. Immunizations for Adolescents, Total Rate – Combination 2 The percentage of adolescents 13 years of age who had one dose of meningococcal vaccine, one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine, and have completed the human papillomavirus (HPV) vaccine series by their 13th birthday. ≥ 26.00%
Core Metrics Description Threshold
1. Upper Respiratory Infection • 3 months – 17 years The percentage of episodes for members 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event. ≥ 93.00%
2. Childhood Immunization Status - Combination 10

The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB), one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday.

≥ 42.00%
3. Child and Adolescent Well-Care Visits    
  • Ages 3 -11 Years

The percentage of members 3–11 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.

≥ 65.00%
  • Ages 12 – 17 Years

The percentage of members 12-17 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.

≥ 57.00%
  • Ages 18 – 21 Years

The percentage of members aged 18–21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.

≥ 39.00%
4. Well-Child Visits in the First 30 Months of Life    
  • Well-Child Visits in the First 15 Months

The percentage of members who had the following number of well-child visits with a PCP during the last 15 months.

  • Children who turned 15 months old during the measurement year: Six or more well-child visits.

≥ 61.00%
  • Well-Child Visits for Age 15 Months – 30 Months

The percentage of members who had the following number of well-child visits with a PCP during the last 15 months.

  • Children who turned 30 months old during the measurement year: Two or more well-child visits.
 ≥ 71.00%
5. Immunizations for Adolescents, Total Rate – Combination 2 The percentage of adolescents 13 years of age who had one dose of meningococcal vaccine, one tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine, and have completed the human papillomavirus (HPV) vaccine series by their 13th birthday. The measure calculates a rate for each vaccine and two combination rates.  ≥ 26.00%