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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