HEDIS® measures - What they mean for your practice
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HEDIS® measures - What they mean for your practice GARY M. HENSCHEN, MD, LFAPA
Transcript of HEDIS® measures - What they mean for your practice
HEDIS® measures -What they mean for your practice
GARY M. HENSCHEN, MD, LFAPA
Agenda
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What is HEDIS?
Follow-up After Hospitalization for Mental Illness (FUH)• What’s included• Why it matters to your practice• Results
Agenda (continued)
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Follow-up After Emergency Department Visit for Mental Illness (FUM)• What’s included• Why it matters to your practice• Results
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA)• What’s included• Why it matters to your practice• Results
What is HEDIS?
Full name: Healthcare Effectiveness Data and Information Set (HEDIS®)
Includes more than 90 measures across six domains of care
• Effectiveness of Care
• Access/Availability of Care
• Experience of Care
• Utilization and Risk-Adjusted Utilization
• Health Plan Descriptive Information
• Measures Collected Using Electronic Clinical Data Systems
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NCQA collects HEDIS data from health plans and other healthcare organizations
Performance in these measures may be incorporated into pay-for-performance contracts
Of the 90 measures, 8 relate to behavioral health
HEDIS measures relating to behavioral health
Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA)
Antidepressant Medication Management (AMM)
Diabetes and Cardiovascular Disease Screening and Monitoring for People with Schizophrenia or Bipolar Disorder (SSD, SMD, SMC)
Follow-Up After Emergency Department Visit for Mental Illness (FUM)
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Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or for Alcohol and Other Drug Abuse or Dependence (FUA)
Follow-Up After Hospitalization for Mental Illness (FUH)
Follow-Up Care for Children Prescribed ADHD Medication (ADD)
Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
Follow-up After Hospitalization for Mental
Illness (FUH)
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Assesses both adults and children, six years of age or older
Follow-up After Hospitalization for Mental Illness
Measures an outpatient visit, intensive outpatient visit
or partial hospital visit
Visit must be with a mental health provider: psychiatrist, psychologist,
clinical social worker or other therapist
Follow-up After Hospitalization for Mental Illness
Visit cannot be on the day of discharge
Measures percentage of members who have visits 7 days and again
30 days of discharge
Why it matters
Patients who are hospitalized for mental illness are vulnerable after discharge
Follow-up care by a behavioral health provider is critical for their health and well-being
Over 2 million hospitalizations occur each year for mental illness in the U.S.
One in four adults suffer from mental illness in a given year
Nearly half of adults will develop at least one mental illness in their lifetime
Medical literature shows that aftercare reduces the rate of avoidable readmissions
Close follow-up reduces incidents of suicidal ideation, suicide attempts and completed suicide
Improving effectiveness in your practice
Communicate closely with the behavioral health provider regarding specific cases
Encourage patients after discharge to follow up with their behavioral health provider• Physical health appointments an opportunity to do this• Lab appointments
Use medications management as opportunity to encourage follow-up
Educate patients regarding the importance of • Follow-up• Medication side effects• Suicide risk assessment
Increase your awareness of patient groups who characteristically have low rates of follow-up
Improving effectiveness in your practice
Refer patients to your health plan’s case management program to improve care coordination
Arrange for notification of emergency department visits
Develop a referral relationship with behavioral health and substance use disorders providers
Educate patients regarding follow-up after emergency department visits
HEDIS FUH results2015-2017
FUH—effective follow-up within 7 days, post discharge
Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2017 48.2 44.9 37.0 32.2 32.4
2016 52.9 50.4 45.5 35.1 35.4
2015 52.2 48.6 43.6 33.8 33.4
FUH—effective follow-up within 30 days, post discharge
Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2017 69.7 67.3 58.0 52.7 55.1
2016 72.0 70.0 63.8 53.8 58.9
2015 70.7 68.7 61.2 52.1 53.6
References
1. National Alliance on Mental Illness. 2011. Mental Illness: What is Mental Illness: Mental Illness Facts. Retrieved from https://www.nami.org/Search?searchtext=about+mental+illness&searchmode
2. Centers for Disease Control and Prevention. Updated Sept. 1, 2011. CDC Mental Illness Surveillance. CDC Report: Mental Illness Surveillance Among Adults in the United States. Retrieved from http://www.cdc.gov/mentalhealthsurveillance/fact_sheet.html
3. Centers for Disease Control and Prevention. 2010. Health Data Interactive. Retrieved from http://www.cdc.gov/nchs/hdi.htm
4. Follow-up After Hospitalization for Mental Illness (FUH). Retrieved from www.ncqa.org_hedis_measures_follow-up-after-hospitalization.pdf
5. Brown, GK, Green, KL. 2014. A Review of Evidence-Based Follow-up Care for Suicide Prevention. American Journal of Preventive Medicine. 2014; 47(3S2):S209-S215.
6. Croake, S., Brown, JD, Miller, D., et al. Follow-up Care After Emergency Department Visits for Mental and Substance Use Disorders Among Medicaid Beneficiaries. Psychiatric Services. 2017; 68:566-572.
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Follow-up After Emergency Department Visit for Mental
Illness (FUM)
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Follow-Up After Emergency Department Visitfor Mental Illness (FUM)
Assesses emergency department visits for adults and children, six
years and older
Measures follow-up visits for mental illness
Can include practitioners of any specialty
Medical and substance co-morbidities are prominent in this population
High co-morbidity with physical illnesses
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Non-compliance for medical, SUD and BH issues is a prominent problem
Higher rates of emergency visits increases likelihood of mental illness, with severity linked to frequency
Good care coordination can reduce emergency visits
• MI• Diabetes• Cancer• Stroke
• HIV• Hepatitis C• Skin infections
Why it matters
Mental illness affects people of all ages
18% of adults and 13-20% of children under 18 experience mental illness
Follow-up care results in fewer repeat ED visits
It improves physical and mental function
It results in better compliance with both behavioral and physical issues
Medical literature shows that aftercare reduces the rate of avoidable readmissions
Close follow-up reduces the incidence of suicidal ideation, suicide attempts and completed suicide
Case management can direct the patient to outpatient services rather than use the emergency department
HEDIS FUM results2017
FUM—effective follow-up within 7 days of emergency visit
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Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2017 45.9 44.9 40 32 29
FUM—effective follow-up within 30 days of emergency visit
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Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2017 60.2 60.1 54.7 48 45.8
References1. Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health
indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52).Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
2. Perou, R. et al. (2013). Mental Health Surveillance Among Children — United States, 2005–2011. Centers for Disease Control and Prevention-Morbidity and Mortality Weekly Report, 62(02), 1-35. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/su6202a1.htm?s_cid=su6202a1_w
3. Bruffaerts, R.., Sabbe, M., Demyffenaere, K. (2005). Predicting Community Tenure in Patients with Recurrent Utilization of a Psychiatric Emergency Service. General Hospital Psychiatry, 27, 269-74.
4. Griswold, K.S., Zayas, L.E., Pastore, P.A., Smith, S.J., Wagner, C.M., Servoss, T.J. (2018) Primary Care After Psychiatric Crisis: A Qualitative Analysis. Annals of Family Medicine, 6(1), 38-43. doi:10.1370/afm.760.
5. Follow-Up After Emergency Department Visit for Mental Illness (FUM).Retrieved from www.ncqa.org_hedis_measures_follow-up-after-emergency-d.pdf
6. Brown, GK, Green, KL. 2014. A Review of Evidence-Based Follow-up Care for Suicide Prevention. American Journal of Preventive Medicine. 2014; 47(3S2):S209-S215.
7. Croake, S., Brown, JD, Miller, D., et al. Follow-up Care After Emergency Department Visits for Mental and Substance Use Disorders Among Medicaid Beneficiaries. Psychiatric Services 2017; 68:566-572.
8. Niedzwiecki, MJ, Pranav, JS, Kanzaria, HK, et al. Factors Associated with Emergency Department Use by Patients with and without Mental Health Diagnoses. JAMA Network Open. 2018; 1(6);e183528.
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Follow-up After Emergency Department Visit for Alcohol
and Other Drug Abuse or Dependence (FUA)
Assesses ED visits for patients 13 years and older
Involves principal diagnosis of alcohol or other drug abuse or
dependence
Follow-Up After Emergency Department Visitfor Alcohol and Other Drug Abuse orDependence (FUA)
Measures whether the patient had a follow-up visit for alcohol or
other drug abuse or dependence
Why it matters
20.1 M
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Americans over age 12 were classified as having SUD
of the population
THIS IS ABOUT
7.5%
High ED usage may indicate• Lack of access to care• Incomplete detox• Lack of continuity of care
Timely follow-up results in
Reduction in substance abuse
Reduction in further emergency department use
Reduction in hospital admissions
Reduction in lengths of stay
Improved entry into recovery
Better identification and treatment of mental and physical health issues
HEDIS FUA results2017
FUA—effective follow-up within 7 days
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2017 Commercial Medicaid Medicare
HMO PPO HMO HMO PPO
13-17years
9.4 5.9 8.1 ------- --------
18+ years
11.4 10.5 12.5 8.4 8.3
Total /All ages (13+)
10.9 10.1 12.2 8.4 8.3
FUA—effective follow-up within 30 days
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2017 Commercial Medicaid Medicare
HMO PPO HMO HMO PPO
13-17years
12.4 8.1 11.9 ----- -----
18+ years
15.6 13.8 ----- 12.2 11.8
Total /All ages (13+)
15.0 13.8 ----- 12.2 11.8
References
1. Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
2. New England Health Care Institute (NEHI). 2010. A Matter of Urgency: Reducing Emergency Department Overuse, A NEHI Research Brief. Retrieved from http://www.nehi.net/writable/publication_files/file/nehi_ed_overuse_issue_brief_032610finaledits.pdf
3. Kunz, F.M., French, M.T., Bazargan-Hejazi, S. (2004). Cost-effectiveness analysis of a brief intervention delivered to problem drinkers presenting at an inner-city hospital emergency department. Journal of Studies on Alcohol and Drugs, 65, 363-370.
4. Mancuso, D., Nordlund, D.J., Felver, B. (2004). Reducing emergency room visits through chemical dependency treatment: focus on frequent emergency room visitors. Olympia, Wash: Washington State Department of Social and Health Services, Research and Data Analysis Division.
5. Parthasarthy, S., Weisner, C., Hu, T.W., Moore, C. (2001) Association of outpatient alcohol and drug treatment with health care utilization and cost: revisiting the offset hypothesis. Journal of Studies on Alcohol and Drugs, 62, 89-97.
6. Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA). Retrieved from www.ncqa.org_hedis_measures_follow-up-after-emergency-SUD.pdf
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A helpful tool
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Includes:
Educational materials about behavioral health conditions
Tip sheets useful for assessments
Diagnostic tools such as the PHQ-9 and CAGE-AID
Patient education materials
Quality measures
Magellan primary care physician toolkit –MagellanPCPtoolkit.com
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The information contained in this presentation is intended for educational purposes only and is not intended to define a standard of care or exclusive course of treatment, nor be a substitute for treatment.
The information contained in this presentation should not be considered legal advice. Recipients are encouraged to obtain legal guidance from their own legal advisors.
