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

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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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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.