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Learn more: Complex care

Complex care: Helping you manage a long-lasting or chronic condition

If you have a chronic health condition such as diabetes, heart disease, or asthma, complex care is especially important to you. The scores for complex care tell you how well each health insurer works with its providers to help members manage health conditions and stay out of the hospital. It includes whether people with diabetes and mental illness are getting certain types of recommended care and whether people with asthma are taking medications appropriately. It also includes how often members have to return to the hospital for problems that may have been prevented with better coordination of care.

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What is included in the scores for complex care?

Diabetes blood sugar screening
This score looks at how well an insurance carrier and its providers help people with diabetes manage their condition. Specifically, this score looks at the percentage of patients ages 18 to 75 with diabetes who received annual blood sugar screenings.

Appropriate asthma medications
This score looks at how well an insurance carrier and its providers help people with asthma manage their condition with the appropriate medications. Specifically, this score looks at the percentage of patients (ages 5 to 18) with chronic asthma who received and filled a prescription for daily control medicine.

Hospital readmissions
This score shows how well an insurance carrier and its providers are able to prevent problems that occur soon after a member has been discharged from the hospital to keep the member from needing to be admitted again. Specifically, this score looks at the percentage of adult patients (ages 18 and older) who had a hospital stay and had to go back into the hospital again for any reason within 30 days of discharge.

Antidepressant medication management - acute and continuation
This score indicates how well an an insurance carrier and its providers help people with depression manage their condition with the appropriate medications. Specifically, this score looks at the percentage of patients (ages 18 and older) diagnosed with a new episode of major depression who were prescribed an antidepressant medication and who remained on the medication for the following time intervals: SHORT TERM (at least 12 weeks after diagnosis)LONG TERM (at least six months after the diagnosis).

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