Blood pressure control, twelve members

**Examining Data Requirements**

I'm currently focusing on defining the eligible population for the QM-CBP measure, specifically identifying the age range for hypertension blood pressure control. This involves parsing through the criteria provided for the upcoming Measurement Year, 2026.

**Defining Patient Criteria**

I'm currently refining the inclusion and exclusion criteria for our QM-CBP measure. My focus is on the 2026 Measurement Year, specifically on identifying the eligible population by parsing encounter data and ensuring continuous enrollment. I'm also working through the exclusion criteria, such as ESRD and pregnancy.

**Validating Member Compliance**

I'm continuing to assess individual member cases against the defined criteria. My focus has shifted to evaluating the qualifying events and subsequent blood pressure readings for compliance, as demonstrated with Members 71012 and 71013.

**Evaluating Member Compliance**

I'm continuing to meticulously review member cases for compliance with the hypertension control measure. I've determined that Member 71017 is compliant, while Members 71015 and 71016 are not eligible due to age and enrollment issues, respectively. Member 71018's eligibility is still under review.

**Assessing Member Eligibility**

I'm continuing to process individual member data for the QM-CBP measure. I've determined Member 71019 to be non-compliant, with Members 71020 and 71021 also showing non-compliant and needing further review for encounter type.

**Analyzing Member Encounters**

I'm currently evaluating encounter data for Member 71021, specifically to determine if the emergency department visit qualifies as an outpatient encounter under the measure specifications. This is crucial for establishing a qualifying event for the hypertension diagnosis.

**Determining Eligibility Status**

I've completed the eligibility assessment for Members 71021 and 71022. Member 71021 is not eligible as the ED encounter doesn't qualify as an outpatient visit, and Member 71022 is ineligible because the diagnosis event occurred after the measurement period. I am now cross-referencing all 12 members.

**Finalizing Member Compliance**

I have now determined the compliance status for the remaining members, confirming Member 71014 as non-compliant due to a diastolic reading of 92 and Members 71013, 71015, 71016, and 71018 as not eligible based on enrollment or age criteria. The initial population has been fully assessed.

**Confirming Member Compliance**

I've now finalized the compliance status for all initial members. Members 71019 and 71020 were determined to be non-compliant due to elevated blood pressure readings, while Members 71021 and 71022 are ineligible as their qualifying events fell outside the measurement period or lacked the appropriate encounter type.

**My Thought Process for Evaluating QM-CBP Measure Compliance**

Alright, let's break down this QM-CBP measure evaluation for these 12 members. My primary goal here is to determine who meets the numerator criteria, who is in the denominator but doesn't meet the criteria, and who is excluded or not eligible for the measure entirely. This is a pretty standard HEDIS-style measure, so I'll walk through each member systematically, applying the rules as I go.

First, I need to get a solid grasp of the measure specifications.

*   **Measurement Period:** This is for the full year of 2026, from January 1st to December 31st.
*   **Eligible Population:**
    *   **Age:** They must be between 18 and 85 years old as of the end of the measurement year, so December 31, 2026. This is a straightforward age check.
    *   **Event:** This is crucial. They need at least one *outpatient* encounter with a hypertension diagnosis (I10 code) in the *first half* of the year, specifically between January 1, 2026, and June 30, 2026. This "outpatient" qualifier is important and I'll need to be mindful of what counts as outpatient versus, say, an ED visit or inpatient stay.
    *   **Enrollment:** They need to have been enrolled for the entire year, with a maximum of one gap in coverage, and that gap can't be longer than 45 days. This means I need to check their enrollment history carefully.
*   **Numerator:** For those who meet the eligibility criteria and have the qualifying event, their *most recent* outpatient blood pressure (BP) reading taken on or after their qualifying encounter date, but no later than December 31, 2026, must be *below* 140 systolic AND *below* 90 diastolic. Critically, BP readings from ED visits or inpatient admissions *do not count* for this numerator.
*   **Exclusions:** There are four exclusion categories:
    *   E1: End-Stage Renal Disease (ESRD) or dialysis on or before December 31, 2026.
    *   E2: Pregnancy during the measurement year (using O00-O9A codes).
    *   E3: Hospice or palliative care during the measurement year.
    *   E4: Died during the measurement year.

Now, let's go through each member one by one and apply these rules.

**MEMBER 71011:**
*   **Age:** 61 on 12/31/2026. That's within the 18-85 range. **Eligible.**
*   **Enrollment:** Continuous, no gaps. **Eligible.**
*   **Event:** Had an office visit with I10 on January 6, 2026. This falls within the Jan 1 - Jun 30 window and is an outpatient encounter. **Eligible.**
*   **Exclusions:** None of the E1-E4 apply.
*   **Numerator:** I need to look at BP readings on or after 01/06/2026.
    *   01/06/2026 Office I10: BP 122/76
    *   04/28/2026 Office J06.9: BP 132/70
    *   06/06/2026 Office I10: BP 133/87
    The most recent reading is from 06/06/2026: 133/87. Systolic (133) is <140, and Diastolic (87) is <90. Both conditions are met.
*   **Result:** This member is **compliant**.

**MEMBER 71012:**
*   **Age:** 48. Within range. **Eligible.**
*   **Enrollment:** Continuous. **Eligible.**
*   **Event:** Had an office visit with I10 on March 27, 2026. This is an outpatient encounter in the first half of the year. **Eligible.**
*   **Exclusions:** None apply.
*   **Numerator:** Readings on or after 03/27/2026.
    *   03/27/2026 Office I10: BP 142/77
    *   06/14/2026 Office I10: BP 141/79
    *   07/03/2026 Office E78.5: BP 127/94 (Note: This diagnosis is E78.5, not I10, but it's still an outpatient BP reading after the event).
    *   08/06/2026 Office I10: BP 132/81
    The most recent reading is from 08/06/2026: 132/81. Systolic (132) is <140, and Diastolic (81) is <90. Both met.
*   **Result:** This member is **compliant**.

**MEMBER 71013:**
*   **Age:** 44. **Eligible.**
*   **Enrollment:** One gap of 36 days. This is within the allowed "max 1 gap up to 45 days". **Eligible.**
*   **Event:** I need to check for an outpatient I10 encounter between Jan 1 and Jun 30, 2026.
    *   05/20/2026 Inpatient S52.501A
    *   07/07/2026 Inpatient I10
    *   07/23/2026 Office I10
    There are no *outpatient* I10 encounters in the required Jan-Jun 2026 window. The inpatient encounters don't count as outpatient, and the office visit is too late.
*   **Result:** This member is **not_eligible** because they don't have the qualifying event.

**MEMBER 71014:**
*   **Age:** 70. **Eligible.**
*   **Enrollment:** One gap of 26 days. This is allowed. **Eligible.**
*   **Event:** Had an office visit with I10 on March 12, 2026. **Eligible.**
*   **Exclusions:** None apply.
*   **Numerator:** Readings on or after 03/12/2026.
    *   03/12/2026 Office I10: BP 127/89
    *   05/07/2026 Office I10: BP 125/102
    *   06/06/2026 Office I10: BP 119/92
    The most recent reading is from 06/06/2026: 119/92. Systolic (119) is <140, but Diastolic (92) is NOT <90.
*   **Result:** This member is **non_compliant**.

**MEMBER 71015:**
*   **Age:** 17 on 12/31/2026. This is below the minimum age of 18. **Not eligible.**
*   **Result:** **not_eligible.** (Even if they were older, I'd have to check enrollment if they had other issues, but age is the immediate disqualifier here).

**MEMBER 71016:**
*   **Age:** 70. **Eligible.**
*   **Enrollment:** I see a gap of 47 days listed. The rule states "max one gap up to 45 days". A 47-day gap exceeds this limit.
*   **Result:** This member is **not_eligible** due to enrollment.

**MEMBER 71017:**
*   **Age:** 48. **Eligible.**
*   **Enrollment:** One gap of 39 days. This is allowed. **Eligible.**
*   **Event:** Had an office visit with I10 on March 18, 2026. **Eligible.**
*   **Exclusions:** None apply.
*   **Numerator:** Readings on or after 03/18/2026.
    *   03/18/2026 Office I10: BP 143/80
    *   10/19/2026 Office I10: BP 134/85
    The most recent reading is from 10/19/2026: 134/85. Systolic (134) is <140, and Diastolic (85) is <90. Both met.
*   **Result:** This member is **compliant**.

**MEMBER 71018:**
*   **Age:** 70. **Eligible.**
*   **Enrollment:** A gap of 47 days is listed. This exceeds the "max one gap up to 45 days" rule.
*   **Result:** This member is **not_eligible** due to enrollment.

**MEMBER 71019:**
*   **Age:** 52. **Eligible.**
*   **Enrollment:** One gap of 42 days. This is allowed. **Eligible.**
*   **Event:** Had an office visit with I10 on June 14, 2026. **Eligible.**
*   **Exclusions:** None apply.
*   **Numerator:** Readings on or after 06/14/2026.
    *   06/14/2026 Office I10: BP 151/80
    The most recent reading is from 06/14/2026: 151/80. Systolic (151) is NOT <140.
*   **Result:** This member is **non_compliant**.

**MEMBER 71020:**
*   **Age:** 52. **Eligible.**
*   **Enrollment:** Continuous. **Eligible.**
*   **Event:** Had an office visit with I10 on January 20, 2026. **Eligible.**
*   **Exclusions:** None apply.
*   **Numerator:** Readings on or after 01/20/2026.
    *   01/20/2026 Office I10: BP 140/71
    *   06/02/2026 Office I10: BP 158/80
    The most recent reading is from 06/02/2026: 158/80. Systolic (158) is NOT <140.
*   **Result:** This member is **non_compliant**.

**MEMBER 71021:**
*   **Age:** 44. **Eligible.**
*   **Enrollment:** Continuous. **Eligible.**
*   **Event:** I need an outpatient encounter with I10 between Jan 1 and Jun 30, 2026.
    *   04/24/2026 Emergency department visit, diagnosis I10.
    *   07/15/2026 Office visit, diagnosis I10.
    *   09/09/2026 Emergency department visit, diagnosis R07.9.
    Here's where I need to be precise. The rule states "at least one *outpatient* encounter". The note on readings says, "A reading taken in an emergency department or on an inpatient admission does not count...". This strongly implies that ED visits are *not* considered "outpatient encounters" for the purpose of establishing the event, especially in contrast to office visits or other traditional outpatient settings. If the ED visit on 04/24/2026 doesn't count as the qualifying outpatient event, then there are no other qualifying events in the Jan-Jun window (the July office visit is too late).
*   **Result:** This member is **not_eligible** because they do not have a qualifying outpatient encounter in the specified period.

**MEMBER 71022:**
*   **Age:** 19. **Eligible.**
*   **Enrollment:** Continuous. **Eligible.**
*   **Event:** I need an outpatient encounter with I10 between Jan 1 and Jun 30, 2026.
    *   10/08/2026 Office visit, diagnosis I10.
    This encounter occurs *after* the June 30th deadline. There are no qualifying events in the first half of the year.
*   **Result:** This member is **not_eligible** because they do not have the qualifying event.

**Consolidating the Results:**

Based on my analysis:

*   **Compliant Members:** 71011, 71012, 71017 (Total: 3)
*   **Non-Compliant Members:** 71014, 71019, 71020 (Total: 3)
*   **Excluded Members:** None met any of the E1-E4 criteria and were otherwise eligible. (Total: 0)
*   **Not Eligible Members:** 71013, 71015, 71016, 71018, 71021, 71022 (Total: 6)

**Population Breakdown:**

*   **Denominator:** This includes all members who are eligible for the measure and are either compliant or non-compliant. So, Compliant Members + Non-Compliant Members = 3 + 3 = 6.
*   **Numerator:** This is the count of compliant members. So, 3.
*   **Excluded:** 0.
*   **Not Eligible:** 6.

**Measure Performance:**

*   **Rate:** (Numerator / Denominator) * 100 = (3 / 6) * 100 = 50.0%.

So, in summary, out of the 12 members reviewed, 6 fall into the denominator, with 3 meeting the numerator criteria, resulting in a 50.0% performance rate for this QM-CBP measure. The remaining 6 were not eligible for various reasons, primarily related to not having the qualifying event or issues with their enrollment period.

**Evaluation of QM-CBP Measure for 12 Members**

Here's my thought process in evaluating these 12 members against the QM-CBP measure for the 2026 measurement year. The core of this task is to meticulously apply the eligibility criteria, numerator definition, and exclusion criteria to each individual, and then aggregate the results to report population metrics.

First, I familiarize myself with the **Measure details**:
*   **Measurement Year**: January 1, 2026, through December 31, 2026. This frames the entire evaluation period.
*   **Eligible Population**: This is the critical starting point for anyone to even be considered.
    *   **Age**: Between 18 and 85 as of December 31, 2026. Simple numerical check.
    *   **Event**: The qualifying hypertension encounter. It must be an *outpatient* encounter with an I10 diagnosis occurring between January 1, 2026, and June 30, 2026. This is a strict date and encounter type requirement.
    *   **Continuous Enrolment**: Full year coverage, with a maximum of one gap not exceeding 45 days. This ensures the member was present in the system for the majority of the year.
*   **Numerator**: The key performance indicator – a controlled blood pressure reading. The most recent *outpatient* BP reading taken on or after the qualifying hypertension encounter, but no later than December 31, 2026, must be less than 140 systolic AND less than 90 diastolic. I must remember that ED or inpatient readings are explicitly excluded here.
*   **Exclusions**: These are specific conditions that remove a member from the denominator, even if they meet the initial eligibility.
    *   E1: ESRD or dialysis dependence by the end of the year.
    *   E2: Pregnancy during the measurement year.
    *   E3: Hospice or palliative care during the year.
    *   E4: Died during the measurement year.

Now, I proceed to evaluate each member individually, systematically ticking off each criterion.

**MEMBER 71011**:
*   Age 61 – Eligible.
*   Enrolment – Continuous, no gaps – Eligible.
*   Event – January 6, 2026, office visit with I10 – Eligible.
*   Exclusions – None identified – Eligible.
*   Numerator – Most recent outpatient BP after Jan 6:
    *   Jan 6: 122/76
    *   Apr 28: 132/70
    *   Jun 6: 133/87
    *   The most recent is June 6 (133/87). 133 < 140 AND 87 < 90. Both met.
*   **Status: Compliant**.

**MEMBER 71012**:
*   Age 48 – Eligible.
*   Enrolment – Continuous – Eligible.
*   Event – March 27, 2026, office visit with I10 – Eligible.
*   Exclusions – None identified – Eligible.
*   Numerator – Most recent outpatient BP after Mar 27:
    *   Mar 27: 142/77
    *   Jun 14: 141/79
    *   Jul 3: 127/94
    *   Aug 6: 132/81
    *   The most recent is August 6 (132/81). 132 < 140 AND 81 < 90. Both met.
*   **Status: Compliant**.

**MEMBER 71013**:
*   Age 44 – Eligible.
*   Enrolment – One gap of 36 days – Eligible (since 36 <= 45).
*   Event – I need an outpatient encounter with I10 between Jan 1 and Jun 30, 2026.
    *   May 20: Inpatient admission with S52.501A (no I10). This doesn't count as an outpatient event for the numerator *or* as a qualifying event if I10 wasn't present.
    *   July 7: Inpatient admission with I10. This is *after* June 30, so it doesn't establish the event.
    *   July 23: Office visit with I10. This is also *after* June 30.
*   Outcome: No qualifying outpatient encounter with I10 on or between Jan 1 and Jun 30, 2026.
*   **Status: Not Eligible**.

**MEMBER 71014**:
*   Age 70 – Eligible.
*   Enrolment – One gap of 26 days – Eligible.
*   Event – March 12, 2026, office visit with I10 – Eligible.
*   Exclusions – None identified – Eligible.
*   Numerator – Most recent outpatient BP after Mar 12:
    *   Jun 6: 119/92.
    *   119 < 140, which is good. However, 92 is NOT < 90. The diastolic requirement is not met.
*   **Status: Non-Compliant**.

**MEMBER 71015**:
*   Age on Dec 31, 2026: Born May 26, 2009, so they are 17.
*   The age requirement is 18 to 85.
*   **Status: Not Eligible**. (Also, upon review, there are two gaps, which would also make them ineligible for enrolment criteria).

**MEMBER 71016**:
*   Age 70 – Eligible.
*   Enrolment – Checked dates: Jan 1 - May 24, then July 11 - Dec 31. This is a gap from May 25 to July 10. Calculating days: May (7 days) + June (30 days) + July (10 days) = 47 days.
*   The gap is 47 days, which is greater than the allowed 45 days.
*   **Status: Not Eligible**.

**MEMBER 71017**:
*   Age 48 – Eligible.
*   Enrolment – Checked dates: Jan 1 - Apr 23, then Jun 1 - Dec 31. This is a gap from Apr 24 to May 31. Calculating days: April (8 days) + May (31 days) = 39 days.
*   The gap is 39 days, which is within the allowed 45 days – Eligible.
*   Event – March 18, 2026, office visit with I10 – Eligible.
*   Exclusions – None identified – Eligible.
*   Numerator – Most recent outpatient BP on or after Mar 18:
    *   Oct 19: 134/85.
    *   134 < 140 AND 85 < 90. Both met.
*   **Status: Compliant**.

**MEMBER 71018**:
*   Age 70 – Eligible.
*   Enrolment – Checked dates: Jan 1 - Jun 1, then Jul 19 - Dec 31. This is a gap from Jun 2 to Jul 18. Calculating days: June (29 days) + July (18 days) = 47 days.
*   The gap is 47 days, which is greater than the allowed 45 days.
*   **Status: Not Eligible**.

**MEMBER 71019**:
*   Age 52 – Eligible.
*   Enrolment – Checked dates: Jan 1 - Mar 25, then May 6 - Dec 31. This is a gap from Mar 26 to May 5. Calculating days: Mar (7 days) + Apr (30 days) + May (5 days) = 42 days.
*   The gap is 42 days, which is within the allowed 45 days – Eligible.
*   Event – June 14, 2026, office visit with I10 – Eligible.
*   Exclusions – None identified – Eligible.
*   Numerator – Most recent outpatient BP on or after Jun 14:
    *   Jun 14: 151/80.
    *   151 is NOT < 140. The systolic requirement is not met.
*   **Status: Non-Compliant**.

**MEMBER 71020**:
*   Age 52 – Eligible.
*   Enrolment – Continuous – Eligible.
*   Event – January 20, 2026, office visit with I10 – Eligible.
*   Exclusions – None identified – Eligible.
*   Numerator – Most recent outpatient BP on or after Jan 20:
    *   Jun 2: 158/80.
    *   158 is NOT < 140. The systolic requirement is not met.
*   **Status: Non-Compliant**.

**MEMBER 71021**:
*   Age 44 – Eligible.
*   Enrolment – Continuous – Eligible.
*   Event – This is where I need to be careful. The event requires an *outpatient* encounter with I10 between Jan 1 and Jun 30.
    *   April 24: Emergency department visit, dx I10. In standard HEDIS definitions, ED visits are typically distinct from "outpatient encounters" when the measure specifies "outpatient". Furthermore, the numerator explicitly states, "A reading taken in an emergency department or on an inpatient admission does not count." This reinforces the distinction. So, I interpret "outpatient encounter" here to exclude ED.
    *   July 15: Office visit, dx I10. This is *after* June 30, so it doesn't establish the event.
*   Outcome: No qualifying outpatient encounter with I10 on or between Jan 1 and Jun 30, 2026.
*   **Status: Not Eligible**.

**MEMBER 71022**:
*   Age 19 – Eligible.
*   Enrolment – Continuous – Eligible.
*   Event – October 8, 2026, office visit, dx I10.
*   The qualifying hypertension encounter must be on or between Jan 1, 2026, and June 30, 2026. This encounter is after June 30.
*   Outcome: No qualifying event established within the required timeframe.
*   **Status: Not Eligible**.

**Population Metrics Summary**:

Based on this detailed evaluation:
*   **Compliant**: 3 members (71011, 71012, 71017)
*   **Non-Compliant**: 3 members (71014, 71019, 71020)
*   **Excluded**: 0 members
*   **Not Eligible**: 6 members (71013, 71015, 71016, 71018, 71021, 71022)

Total Members Evaluated: 12
Total in Denominator (Compliant + Non-Compliant): 3 + 3 = 6
Numerator (Compliant): 3

The **rate** for this cohort is therefore (3 / 6) * 100 = **50.0%**.

**HEDIS-like QM-CBP Measure Population Status Determination**

My objective is to meticulously assess the population status for 12 individuals against the criteria of the HEDIS-like QM-CBP measure for the year 2026. This involves determining if each member falls into the categories of compliant, non_compliant, excluded, or not_eligible.

Here's how I've approached the evaluation, following the specified measure details:

First, I've established the **eligible population** criteria:
*   **Age:** Between 18 and 85 years old as of December 31, 2026.
*   **Qualifying Event:** An outpatient encounter with an I10 (hypertension) diagnosis between January 1, 2026, and June 30, 2026, inclusive.
*   **Enrollment:** Full-year enrollment with a maximum of one gap not exceeding 45 days.

Next, I've defined the **numerator** requirements:
*   A most recent outpatient blood pressure reading must have been recorded on or after the qualifying I10 encounter and on or before December 31, 2026.
*   This reading must meet the criteria: Systolic < 140 mmHg AND Diastolic < 90 mmHg.
*   Crucially, blood pressure readings taken during an Emergency Department (ED) visit or an inpatient admission do not count towards the numerator.

Finally, I've considered the **exclusion criteria**:
*   **E1:** End-Stage Renal Disease (ESRD) or dialysis (N18.6/Z99.2) on or before December 31, 2026.
*   **E2:** Pregnancy during the measurement year.
*   **E3:** Hospice or palliative care during the measurement year.
*   **E4:** Death during the measurement year.

Now, let me walk through my assessment of each member:

*   **MEMBER 71011:** This member is 61 years old, had no enrollment gaps, and had an eligible outpatient I10 encounter on January 6, 2026. No exclusions apply. The most recent BP reading on June 6, 2026 (133/87) meets the numerator criteria (<140/90). Therefore, this member is **Compliant**.

*   **MEMBER 71012:** This member is 48 years old, fully enrolled, and had a qualifying I10 encounter on March 27, 2026. No exclusions. Their most recent BP reading on August 6, 2026 (132/81) satisfies the numerator requirements (<140/90). Thus, **Compliant**.

*   **MEMBER 71013:** This member, aged 44, had a single enrollment gap of 36 days, which is within the acceptable limit. However, they did not have an outpatient encounter with an I10 diagnosis between January 1 and June 30, 2026. Their I10 encounter on July 23, 2026, and inpatient encounters in July are outside the qualifying period or type. Consequently, this member is **Not Eligible**.

*   **MEMBER 71014:** At 70 years old with one 26-day enrollment gap, this member is eligible. They had a qualifying I10 encounter on March 12, 2026. No exclusions apply. However, the most recent BP reading on June 6, 2026 (119/92) fails the numerator criterion because the diastolic pressure (92) is not less than 90. This member is **Non-Compliant**.

*   **MEMBER 71015:** This member is 17 years old on December 31, 2026, making them younger than the minimum age of 18. They also had two enrollment gaps (18 and 27 days), violating the rule of a maximum of one gap. Therefore, this member is **Not Eligible**.

*   **MEMBER 71016:** This 70-year-old member had an enrollment gap from May 25 to July 10, 2026, totaling 47 days. This exceeds the maximum allowed gap of 45 days, making them **Not Eligible**.

*   **MEMBER 71017:** This 48-year-old member had a 39-day enrollment gap, which is acceptable. They had a qualifying I10 encounter on March 18, 2026, and no exclusions apply. Their most recent BP reading on October 19, 2026 (134/85) meets the numerator criteria (<140/90). Hence, **Compliant**.

*   **MEMBER 71018:** This 70-year-old member had an enrollment gap from June 2 to July 18, 2026, totaling 47 days. This exceeds the 45-day limit. Therefore, this member is **Not Eligible**.

*   **MEMBER 71019:** This 52-year-old member had a 42-day enrollment gap, which is permissible. They had a qualifying I10 encounter on June 14, 2026. No exclusions. However, their most recent BP reading on June 14, 2026 (151/80) fails the numerator criterion as the systolic pressure (151) is not less than 140. This member is **Non-Compliant**.

*   **MEMBER 71020:** This 52-year-old member was fully enrolled and had a qualifying I10 encounter on January 20, 2026. No exclusions. Their most recent BP reading on June 2, 2026 (158/80) fails the numerator criterion because the systolic pressure (158) is not less than 140. This member is **Non-Compliant**.

*   **MEMBER 71021:** This 44-year-old member had an ED visit with an I10 diagnosis on April 24, 2026. Given the measure's explicit exclusion of ED readings from counting and the typical distinction between ED and outpatient encounters in HEDIS measures, I determined this did not constitute a qualifying "outpatient encounter." Consequently, they are **Not Eligible**. (Even if considered eligible, their subsequent BP reading of 166/93 would have made them non-compliant).

*   **MEMBER 71022:** This 19-year-old member is within the age range. However, their only I10 encounter was on October 8, 2026, which falls outside the qualifying period of January 1 to June 30, 2026. Therefore, this member is **Not Eligible**.

In summary, after a thorough review of each member against the measure's detailed criteria, I have categorized them as follows:

*   **Compliant Members (3):** 71011, 71012, 71017
*   **Non-Compliant Members (3):** 71014, 71019, 71020
*   **Excluded Members (0):** None met exclusion criteria.
*   **Not Eligible Members (6):** 71013, 71015, 71016, 71018, 71021, 71022

This leads to a denominator of 6 (compliant + non-compliant members) and a numerator of 3 (compliant members), resulting in a measure rate of 50.0%.

**Understanding the QM-CBP Measure: Blood Pressure Control in Hypertension**

Okay, I've been diving deep into this QM-CBP measure, focusing on Blood Pressure Control in Hypertension, and I'm piecing together the logic for how each patient scenario gets classified. My goal is to accurately determine who is compliant, non-compliant, excluded, or not eligible for the measurement year 2026.

First, I need to establish the **eligibility criteria** for patients to even be considered for this measure. This breaks down into several key components:

*   **Age:** They must be between 18 and 85 years old as of December 31, 2026.
*   **Qualifying Event:** They need at least one outpatient encounter where they were diagnosed with hypertension (ICD-10 code I10) between January 1, 2026, and June 30, 2026. This is a critical window.
*   **Continuous Enrollment:** They must have been continuously enrolled for the full measurement year (January 1 to December 31, 2026), with a maximum allowance of one gap in coverage lasting no more than 45 days.

Once a patient meets these initial eligibility requirements, they fall into the **denominator**. Then, I have to determine if they meet the **numerator** criteria to be considered compliant. The numerator focuses on their blood pressure control:

*   **Numerator Condition:** They need to have a most recent outpatient blood pressure (BP) reading taken on or after the date of their qualifying hypertension encounter, and on or before December 31, 2026.
*   **BP Threshold:** This reading must be *below* 140 systolic AND *below* 90 diastolic. It's important to note the "below" – equal to 140 or 90 is not compliant.
*   **Reading Exclusions:** I must remember to skip any BP readings taken during an emergency department visit or an inpatient admission when identifying that most recent qualifying reading. These visits don't count for the numerator.

If a patient is in the denominator but doesn't meet the numerator criteria (i.e., their most recent BP reading isn't controlled), they are classified as **non-compliant**.

Then, there are specific **exclusions** that remove patients from the denominator *before* calculating the rate. If a patient meets an exclusion criterion, they are removed entirely, not counted in either the numerator or the denominator. These exclusions are for:

*   End-Stage Renal Disease (ESRD) or renal dialysis.
*   Pregnancy during the measurement year.
*   Hospice or palliative care during the measurement year.
*   Death during the measurement year.

Finally, if a patient *fails* any of the initial age, event, or enrollment criteria, they are classified as **not eligible**. This classification takes precedence, even if an exclusion also applies.

Now, let me walk through how I applied these rules to the provided patient data:

*   **Member 71011:** This individual is 61, had a qualifying hypertension encounter on January 6, 2026, and maintained continuous enrollment. Their most recent outpatient BP reading was 133/87 on June 6, 2026. Since 133 < 140 and 87 < 90, they are **Compliant**.

*   **Member 71012:** This person is 48, had a qualifying encounter on March 27, 2026, and was continuously enrolled. Their most recent BP reading was 132/81 on August 6, 2026. Both values are below the threshold (<140/<90), so they are **Compliant**.

*   **Member 71013:** This individual is 44, but their encounters within the Jan-June window were either inpatient admissions or occurred too late in July. They did not have an "outpatient encounter with hypertension" in the required timeframe. Therefore, they are **Not Eligible** due to failing the event criterion.

*   **Member 71014:** At 70 years old, they had a qualifying encounter on March 12, 2026, and met enrollment requirements (a 26-day gap is acceptable). However, their most recent outpatient BP reading on June 6 was 119/92. While 119 is below 140, 92 is not below 90. This makes them **Non-Compliant**.

*   **Member 71015:** This individual is only 17 years old. The age requirement is 18-85, so they are immediately **Not Eligible**. (Even if they were older, they also had two enrollment gaps, which would have disqualified them).

*   **Member 71016:** This patient is 70, but their enrollment had a gap of 47 days, which exceeds the 45-day maximum. Therefore, they are **Not Eligible** due to enrollment failure. (Even if their enrollment was continuous, their qualifying encounter was on June 12, but that visit occurred *during* their enrollment gap.)

*   **Member 71017:** This 48-year-old had a qualifying encounter on March 18, 2026, and their enrollment gap of 39 days is acceptable. Their most recent BP reading on October 19 was 134/85. Since 134 < 140 and 85 < 90, they are **Compliant**.

*   **Member 71018:** This individual is 70 years old, but their enrollment had a gap of 47 days, exceeding the allowed limit. They are **Not Eligible** due to enrollment failure.

*   **Member 71019:** At 52, they had a qualifying encounter on June 14, 2026, and their enrollment gap of 42 days is within the acceptable limit. However, their most recent BP reading on June 14 was 151/80. Since 151 is not below 140, they are **Non-Compliant**.

*   **Member 71020:** This 52-year-old had a qualifying encounter on January 20, 2026, with continuous enrollment. Their most recent BP reading on June 2 was 158/80. Since 158 is not below 140, they are **Non-Compliant**.

*   **Member 71021:** This individual is 44, but their only encounter within the Jan-June window was an Emergency Department visit on April 24. Based on the measure's definition and common quality measure standards, an ED visit is not considered an "outpatient encounter" for the denominator event. Therefore, they did not meet the qualifying event criterion and are **Not Eligible**.

*   **Member 71022:** This person is 19 years old (which is within the eligible age range of 18-85), and they had continuous enrollment. However, their qualifying hypertension encounter with an I10 diagnosis occurred on October 8, 2026, which falls *outside* the required Jan 1 to June 30 window for the event. Thus, they are **Not Eligible** due to failing the event criterion.

Based on this review:

*   There are **3 Compliant members**: 71011, 71012, 71017.
*   There are **3 Non-Compliant members**: 71014, 71019, 71020.
*   There are **0 Excluded members**.
*   There are **6 Not Eligible members**: 71013, 71015, 71016, 71018, 71021, 71022.

This leads to a total denominator of 6 (3 Compliant + 3 Non-Compliant).
The numerator is 3 (the number of Compliant members).
The calculated rate is therefore **50.0%**.

**My Thought Process for Analyzing QM-CBP: Blood Pressure Control in Hypertension**

My objective was to determine the performance measure rate for QM-CBP (Blood Pressure Control in Hypertension) for the 2026 measurement year, based on the provided criteria and member data. This involved meticulously applying the rules for eligibility, exclusions, and numerator compliance.

Here's how I approached it, step-by-step:

**1. Understanding the Core Measure:**

First, I familiarized myself with the fundamental requirements of the QM-CBP measure:
*   **Target Population:** Patients aged 18-85 by the end of 2026.
*   **Qualifying Event:** At least one outpatient encounter with a diagnosis of Hypertension (ICD-10 code I10) between January 1, 2026, and June 30, 2026. This period defines the "index period" for identifying the patient's hypertension diagnosis within the measurement year.
*   **Continuous Enrollment:** Members must have been continuously enrolled for the entire measurement year (January 1, 2026, to December 31, 2026), with a maximum of one enrollment gap not exceeding 45 days.
*   **Numerator Goal:** The patient's most recent outpatient blood pressure (BP) reading on or after their qualifying hypertension encounter and on or before December 31, 2026, must be *below 140 mmHg systolic AND below 90 mmHg diastolic*.
*   **Exclusions:** Specific conditions that remove a member from the denominator, even if they meet other criteria. These include ESRD/dialysis, pregnancy, hospice/palliative care, or death within the measurement year.
*   **Important Nuance:** Blood pressure readings from Emergency Department (ED) or inpatient settings *do not count* towards the numerator, and this also implies that ED visits might not qualify as "outpatient encounters" for the initial event, a critical distinction I had to carefully consider.

**2. Initial Screening for Eligibility (Age and Enrollment):**

I began by processing each member individually, starting with the broadest criteria:

*   **Member 71015:** Immediately flagged as not eligible due to age. At 17 years old on December 31, 2026, they fall outside the 18-85 age range.
*   **Members 71016 and 71018:** I examined their enrollment gaps.
    *   Member 71016 had a gap of 47 days (May 25, 2026, to July 10, 2026). This exceeds the 45-day limit, so they were marked as not eligible.
    *   Member 71018 also had a gap of 47 days (June 2, 2026, to July 18, 2026), also exceeding the limit, marking them as not eligible.
*   **Member 71013:** Checked their enrollment gap: June 3, 2026, to July 8, 2026, which is 36 days. This is within the acceptable limit. So, enrollment is okay for now, but I'd proceed to check for the qualifying event.
*   **Member 71019:** Checked their enrollment gap: March 25, 2026, to May 5, 2026, which is 42 days. This is within the acceptable limit. Enrollment is okay.
*   **All other members (71011, 71012, 71014, 71017, 71020, 71021, 71022):** Confirmed they met the age range and had continuous enrollment or acceptable gaps.

**3. Identifying the Qualifying Event (Hypertension Diagnosis - I10):**

Next, I focused on identifying if members had an "outpatient encounter with diagnosis I10" between January 1, 2026, and June 30, 2026. This is a crucial step for placing members into the denominator.

*   **Member 71011:** Had an outpatient encounter on January 6, 2026, with diagnosis I10. This qualifies them.
*   **Member 71012:** Had an outpatient encounter on March 27, 2026, with diagnosis I10. This qualifies them.
*   **Member 71013:** Reviewed their encounters:
    *   May 20, 2026: Inpatient admission (diagnosis S52.501A, *not* I10).
    *   July 7, 2026: Inpatient admission (I10 present, but *after* June 30 and inpatient).
    *   July 23, 2026: Office visit (I10 present, but *after* June 30).
    *   Conclusion: No qualifying *outpatient* encounter with I10 occurred between Jan 1 and June 30, 2026. Member 71013 is not eligible for the measure.
*   **Member 71014:** Had an outpatient encounter on March 12, 2026, with diagnosis I10. This qualifies them.
*   **Member 71017:** Had an outpatient encounter on March 18, 2026, with diagnosis I10. This qualifies them.
*   **Member 71019:** Had an outpatient encounter on June 14, 2026, with diagnosis I10. This qualifies them.
*   **Member 71020:** Had an outpatient encounter on January 20, 2026, with diagnosis I10. This qualifies them.
*   **Member 71021:** Reviewed their encounters:
    *   April 24, 2026: Emergency department visit, diagnosis I10. BP 129/79.
    *   July 15, 2026: Office visit, diagnosis I10. (After June 30).
    *   **Critical Decision Point:** The measure specifies "outpatient encounter". The subsequent instruction clarifies that ED readings "do *not* count" for the numerator. In the context of quality measures like this, an ED visit is typically *not* considered an "outpatient encounter" that establishes the qualifying event, as distinct from office visits. Therefore, Member 71021 has no qualifying *outpatient* encounter before June 30. They are not eligible.
*   **Member 71022:** Had an outpatient encounter on October 8, 2026, with diagnosis I10. This is *after* the June 30 deadline. They are not eligible.

At this stage, Members 71013, 71015, 71016, 71018, 71021, and 71022 were identified as "Not Eligible" based on age, enrollment, or lack of a qualifying event.

**4. Checking for Exclusions:**

For the remaining members (those in the potential denominator), I checked for exclusion criteria:

*   I scanned the provided details for E1 (ESRD/dialysis), E2 (pregnancy during the measurement year), E3 (hospice/palliative care), and E4 (death).
*   Member 71016 had a mention of a pregnancy-related condition in *2025*, but the exclusion E2 specifies "during the measurement year" (2026). Thus, this prior diagnosis does not trigger exclusion for 2026.
*   No other members met any of the exclusion criteria.

**5. Determining Numerator Compliance (Blood Pressure Control):**

For members who qualified for the denominator and were not excluded, I evaluated their most recent outpatient BP reading on or after their qualifying encounter and by the end of the measurement year (December 31, 2026).

*   **Member 71011:**
    *   Qualifying Encounter: January 6, 2026 (I10, Outpatient).
    *   BP Readings (outpatient): 2026-01-06 (122/76), 2026-04-28 (132/70), 2026-06-06 (133/87).
    *   Most Recent: 133/87.
    *   Check: 133 < 140 (True) AND 87 < 90 (True).
    *   Result: Compliant.

*   **Member 71012:**
    *   Qualifying Encounter: March 27, 2026 (I10, Outpatient).
    *   BP Readings (outpatient): 2026-03-27 (142/77), 2026-06-14 (141/79), 2026-07-03 (127/94), 2026-08-06 (132/81).
    *   Most Recent: 132/81.
    *   Check: 132 < 140 (True) AND 81 < 90 (True).
    *   Result: Compliant.

*   **Member 71014:**
    *   Qualifying Encounter: March 12, 2026 (I10, Outpatient).
    *   BP Readings (outpatient): 2026-03-12 (127/89), 2026-05-07 (125/102), 2026-06-06 (119/92).
    *   Most Recent: 119/92.
    *   Check: 119 < 140 (True) BUT 92 < 90 (False).
    *   Result: Non-compliant.

*   **Member 71017:**
    *   Qualifying Encounter: March 18, 2026 (I10, Outpatient).
    *   BP Readings (outpatient): 2026-03-18 (143/80), 2026-10-19 (134/85).
    *   Most Recent: 134/85.
    *   Check: 134 < 140 (True) AND 85 < 90 (True).
    *   Result: Compliant.

*   **Member 71019:**
    *   Qualifying Encounter: June 14, 2026 (I10, Outpatient).
    *   BP Readings (outpatient): 2026-06-14 (151/80).
    *   Most Recent: 151/80.
    *   Check: 151 < 140 (False).
    *   Result: Non-compliant.

*   **Member 71020:**
    *   Qualifying Encounter: January 20, 2026 (I10, Outpatient).
    *   BP Readings (outpatient): 2026-01-20 (140/71), 2026-06-02 (158/80).
    *   Most Recent: 158/80.
    *   Check: 158 < 140 (False). (Note: The threshold is strictly *below* 140, so 140 itself is not compliant).
    *   Result: Non-compliant.

**6. Calculating the Performance Rate:**

Finally, I aggregated the results:

*   **Denominator:** This includes all members who were eligible and not excluded.
    *   Eligible members (after initial screening): 71011, 71012, 71013, 71014, 71017, 71019, 71020, 71021, 71022.
    *   Members identified as Not Eligible (excluding the initial screening): 71013, 71021, 71022.
    *   Total members in the denominator = 12 (initial total) - 6 (not eligible) = 6.
    *   These are: 71011, 71012, 71014, 71017, 71019, 71020.

*   **Numerator:** This is the count of compliant members within the denominator.
    *   Compliant members: 71011, 71012, 71017.
    *   Numerator count = 3.

*   **Excluded Members:** 0.

*   **Not Eligible Members:** 6 (71013, 71015, 71016, 71018, 71021, 71022).

*   **Performance Rate:** (Numerator / Denominator) * 100
    *   (3 / 6) * 100 = 50.0%

Therefore, my calculated performance rate for QM-CBP is 50.0%.