COU: Risk of Continued Opioid Use
Percentage with extended opioid use (>15+ days in first 30, OR >31+ days in first 62). Lower is better.
Measure description
Percentage with extended opioid use (>15+ days in first 30, OR >31+ days in first 62). Lower is better.
Eligible population
Opioid-naive members starting opioids
Performance drivers
CDC opioid prescribing guidelines + 2022 update.
Documentation & PA strategy
Avoid extended supply prescriptions; consider tapering plan; document chronic pain dx + alternatives tried.
Why HEDIS matters for prior authorization
Health plans align prior authorization criteria with HEDIS measures: documenting your patient meets the HEDIS definition often streamlines or eliminates PA hurdles. For Medicare Advantage in particular, plans are heavily incentivized via Star Ratings to push members and providers toward measure compliance, which translates into faster approvals for measure-aligned services.
Frequently asked questions
What does HEDIS measure COU measure?
Percentage with extended opioid use (>15+ days in first 30, OR >31+ days in first 62). Lower is better.
What drives performance on this measure?
CDC opioid prescribing guidelines + 2022 update.
How should clinicians document for this measure?
Avoid extended supply prescriptions; consider tapering plan; document chronic pain dx + alternatives tried.
What is the eligible population?
Opioid-naive members starting opioids
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