HEDIS ® Measures & Tips: Behavioral Health

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Presentation transcript:

HEDIS ® Measures & Tips: Behavioral Health

Antidepressant Medication Management (AMM) Patients ages 18 years or older with a diagnosis of major depression who were newly treated with an antidepressant medication and remained on antidepressant medication treatment. Data Collection: Administratively Only Measurement details: Effective acute phase treatment: Patients newly diagnosed and treated who remained on an antidepressant medication for at least 84 days (12 weeks). Effective continuation phase treatment: Patients newly diagnosed and treated who remained on an antidepressant medication for at least 180 days (6 months).

AMM Improvement Tips Educate your patients and their spouses, caregivers and/or guardians about the importance of: Compliance with long-term medications. Not abruptly stopping medications without talking to their physician. Understanding the medication side effects and contacting your office immediately if they experience any unwanted/adverse reactions so that their treatment can be re-evaluated. Scheduling and attending follow-up appointments to review the effectiveness of their medications. Calling your office or the health plan if they cannot get their medications refilled. Ask your patients who have a behavioral health diagnosis to provide you access to their behavioral health records if you are their primary care provider.

Follow-Up Care for Children Prescribed ADHD Medication (ADD) Patients ages 6 ‒ 12 newly prescribed ADHD medication who had at least three follow-up care visits within a 10-month period, the first visit should be within 30 days of when the first ADHD medication was dispensed Data Collection: Administrative Only Two rates are reported: • Initiation phase: follow-up visit with prescriber within 30 days of prescription • Continuation and maintenance phase: remained on ADHD medication and had two more visits within nine months

ADHD Improvement Tips When prescribing a new ADHD medication: Be sure to schedule a follow-up visit right away; Schedule follow up for 15-21 days following the new ADHD prescription. That will allow time to meet the 30 day criteria should the appointment need to be reschedule. If a patient restarts ADHD medication after a 120-day break, that is considered a new start and they should receive a follow up visit within 30 days. Schedule follow-up visits while patients are still in the office and send patient reminders. Educate your patients and their parents, guardians or caregivers about the use of, side effects and compliance with long-term ADHD medications. After the initial follow-up visits, schedule at least two more office visits in the next nine months to monitor patient’s progress

Follow-Up After Hospitalization for Mental Illness (FUH) Patients ages 6 and older who were hospitalized for treatment of selected mental illness diagnoses and who had an outpatient visit, an intensive outpatient encounter or partial hospitalization with a mental health practitioner. Data Collection: Administrative Only Two timelines are required: • An outpatient visit, intensive outpatient encounter or partial hospitalization within seven days of discharge • An outpatient visit, intensive outpatient encounter or partial hospitalization within 30 days of discharge

FUH Improvement Tips Educate your patients and their spouses, caregivers or guardians about the importance of compliance with the long-term medications prescribed. Encourage high risk patients to participate in our behavioral health case management program for help getting follow-up discharge appointments and other support. • Teach patients’ families to review all discharge instructions for patients and ask for details of all follow-up discharge instructions, such as the dates and times of appointments. • Ask patients with a mental health diagnosis to allow you access to their mental health records if you are their primary care provider.

Metabolic Monitoring for Children and adolescents on Antipsychotics Patients ages 1-17 years of age who had two or more antipsychotic prescriptions and has metabolic testing (both glucose and HbA1c or LDL or Cholesterol) Tips: Metabolic testing needs to be completed at least once per year while on these medications. Refer patient to prescribing physician for testing.