hedis® measures - what they mean for your practice · academy of child & adolescent...
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HEDIS® measures -What they mean for your practice
GARY M. HENSCHEN, MD, LFAPA
Agenda
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Review: What is HEDIS?
Follow-up Care for Children Prescribed ADHD Medication (ADD)
Metabolic Monitoring for Children & Adolescents on Antipsychotics (APM)
Diabetes and Cardiovascular Disease Screening and Monitoring for People with Schizophrenia or Bipolar Disorder (SSD, SMD, SMC)
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 Care for Children Prescribed ADHD Medication
(ADD)
Follow-up Care for Children Prescribed ADHD Medication (ADD) – two rates reported
Initiation phase:
Assesses children between 6-12 years old
Children must be diagnosed with attention-deficit/hyperactivity disorder (ADHD)
Measures presence of one follow-up visit with a prescriber within 30 days of their
first ADHD prescription
Continuity and maintenance phase:
Assesses children between 6-12 years old
Children must be diagnosed with ADHD, and receive a prescription for ADHD treatment
Measures continuation on the medication for at least 210 days
Measures whether the child had at least two follow-up visits with a practitioner in
the 9 months after the initiation phase
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Why it matters
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ADHD is one of the most common mental disorders affecting children
11% of children in the U.S. have been diagnosed with ADHD
Features of the illness: hyperactivity, impulsiveness and inability to sustain attention or concentration 1, 2
− 6.1% of children with ADHD are taking ADHD medication 1
Medications can control the above symptoms, but they also have side effects (e.g., psychosis, anxiety, compulsive behavior, cardiac problems) 3
Why it matters (continued)
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Children on these medications should be monitored by a child psychiatrist, psychiatrist or pediatrician
There may be psychiatric co-morbidity that must be addressed
ADD results – follow-up care after initiation of treatment
Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2017 41.6 39.9 44.6 ---- ----
2016 40.0 39.0 44.5 ---- ----
2015 39.4 38.6 42.2 ---- ----
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https://www.ncqa.org/hedis/measures/follow-up-care-for-children-prescribed-adhd-medication
ADD results – follow-up care during continuation of treatment
Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2017 48.2 46.5 55.0 ---- ----
2016 46.5 45.8 54.5 ---- ----
2015 47.7 46.0 54.5 ---- ----
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https://www.ncqa.org/hedis/measures/follow-up-care-for-children-prescribed-adhd-medication
References
1. Visser, S.N., M.L. Danielson, R.H. Bitsko, J.R. Holbrook, M.D. Kogan, R.M. Ghandour,…& S.J. Blumberg. 2014. “Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003—2011.” Journal of the American Academy of Child & Adolescent Psychiatry, 53(1), 34–46.
2. The American Psychiatric Association. 2012. Children’s Mental Health. http://www.psychiatry.org/mental-health/people/children
3. Moran, L.V., Ongur, D., et al. 2019. “Psychosis with Methylphenidate or Amphetamine in Patients with ADHD.” The New England Journal of Medicine, 380:1128-38.
4. www.ncqa.org_hedis_measures_follow-up-care-for-children.pdf
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Metabolic Monitoring for Children and Adolescents on Antipsychotics
(APM)
Assesses the percentage of children and adolescents with ongoing antipsychotic medication use who had metabolic testing during the year
Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
Why it matters
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Prescribing antipsychotic medication in children and adolescents has increased rapidly 1, 2
Metabolic complications can accompany the use of antipsychotics 3, 4
These can result in cardiac problems in adulthood 5
Metabolic monitoring is important to ensure appropriate management of potential side effects with this medication
Why it matters (continued)
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The American Psychiatric Association in concert with the American Diabetic Association established guidelines for metabolic monitoring for patients on antipsychotic medications 6
Magellan’s Antipsychotic Tip Sheet outlines recommended tests for metabolic monitoring
ADA-APA-AACE recommended monitoring for patients on second-generation antipsychotics
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Measure Baseline 4 weeks 8 weeks 12 weeks Annually
Personal/family
historyX X
Body mass index X X X X X
Waist circumference X X
Blood pressure X X X
Fasting blood
glucoseX X X
Fasting lipid profile X X X
American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004; 27 (2): 596-601.
APM results
Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2017 37.0 32.8 34.6 ----- -----
2016 36.0 32.3 33.3 ----- -----
2015 33.9 30.7 29.8 ----- -----
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References
1. Patten, S.B., W. Waheed, L. Bresee. 2012. “A review of pharmacoepidemiologic studies of antipsychotic use in children and adolescents.” Canadian Journal of Psychiatry 57:71721.
2. Cooper, W.O., P.G. Arbogast, H. Ding, G.B. Hickson, D.C. Fuchs, and W.A. Ray. 2006.“Trends in prescribing of antipsychotic medications for US children.” Ambulatory Pediatrics 6(2):79–83.
3. Correll, C. U., P. Manu, V. Olshanskiy, B. Napolitano, J.M. Kane, and A.K. Malhotra. 2009. “Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents.” Journal of the American Medical Association
4. Andrade, S.E., J.C. Lo, D. Roblin, et al. December 2011. “Antipsychotic medication use among children and risk of diabetes mellitus.” Pediatrics128(6):1135–41.
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References (continued)
5. Srinivasan, S.R., L. Myers, G.S. Berenson. January 2002. “Predictability of childhood adiposity and insulin for developing insulin resistance syndrome (syndrome X) in young adulthood: the Bogalusa Heart Study.” Diabetes 51(1):204–9.
6. American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004; 27 (2): 596-601.
7. www.ncqa.org_hedis_measures_metabolic-monitoring-for-ch.pdf
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Diabetes and CardiovascularDisease Screening and Monitoring
for People with Schizophreniaor Bipolar Disorder (SSD, SMD, SMC)
Assesses adults ages 18-64 with schizophrenia or bipolar disorder
Who were dispensed an antipsychotic medication
Diabetes and Cardiovascular Disease Screening and Monitoring for People with Schizophrenia or Bipolar Disorder (SSD)
Who had a diabetes screening test during the measurement year
and
and
DIABETES SCREENING
Assesses adults ages 18-64 with schizophrenia and diabetes
Measures LCL-C testing and HBA1c testing during the measurement year
Diabetes and Cardiovascular Disease Screening and Monitoring for People with Schizophrenia or Bipolar Disorder (SMD)
DIABETES MONITORING
Assesses adults age 18-64 with schizophrenia and cardiovascular disease
Measures LDL-C testing during the measurement year
Diabetes and Cardiovascular Disease Screening and Monitoring for People with Schizophrenia or Bipolar Disorder (SMC)
CARDIOVASCULAR MONITORING
Why it matters
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Heart disease and diabetes - among the top 10 leading causes of death in the U.S.
Persons with serious mental illness on antipsychotic medications are at increased risk for diabetes and cardiovascular disease
Screening for these conditions is important
Lack of appropriate monitoring can lead to the emergence and worsening of diabetes
Why it matters (continued)
Lack of appropriate monitoring can lead to the emergence and worsening of cardiovascular disease
These conditions can lead to worsening health and death
Patients with these illnesses have a high incidence of non-compliance with diet and exercise regimens
Patients with schizophrenia have a high incidence of smoking
Why it matters (continued)
Addressing metabolic and cardiovascular issues can improve health and quality of life
SSD results
Commercial Medicaid Medicare
Year HMO PPO HMO PPO HMO
2017 ---- ---- 80.8 ---- ----
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SMD results
Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2017 ---- ---- 70.4 ---- ----
2016 ---- ---- 69.7 ---- ----
2015 ---- ---- 68.2 ---- ----
2014 ---- ---- 69.3 ---- ----
2013 ---- ---- 68.5 ---- ----
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SMC results
Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2017 ---- ---- 78.5 ---- ----
2016 ---- ---- 77.8 ---- ----
2015 ---- ---- 78.0 ---- ----
2014 ---- ---- 76.2 ---- ----
2013 ---- ---- 79.1 ---- ----
References
1. Murphy, S.L., J.Q. Xu, J.D. Kochanek. March 1, 2013. “Deaths: final data for 2010.”Morbidity and Mortality Weekly Report (MMWR). 62(08);155http://www.cdc.gov/nchs/data/dvs/deaths_2010_release.pdf
2. American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004; 27 (2): 596-601.
3. www.ncqa.org_hedis_measures_diabetes-and-cardiovascular.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
Questions?
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Confidentiality statement
By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc.
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.
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