Behavioral Health Quality: HEDIS - Initiation & Engagement of Alcohol & Other Drug Dependence Treatment

2 What Is “HEDIS”? A set of standardized Performance measures Evaluates health plans using quality dimensions Standard reporting allows results to be reliably and fairly compared to each other Reports available to purchasers and customers Maintained by NCQA

3 There are Three Components: % of Total Health Plan Members Identified as using Alcohol or Other Drug Services (IAD) % of Identified Members that Initiate Treatment (i.e., either they are discharged from an inpatient [non-detox] AOD admission; or they have an ER or Outpatient AOD service and then one additional AOD service (not an ER visit) within 14 days) [13 y/o or older] % of Initiated Patients that Engage in Treatment (i.e., receive 2 more AOD services (not an ER visit) within 30 days of Initiation) [13 y/o or older] Behavioral Health HEDIS Measure: Initiation and Engagement of Alcohol & Other Drug Dependence Treatment

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7 What Medical Case Managers Can Do: Carefully ask about alcohol and other drugs and screen for problem use Encourage a follow-up session soon after the evaluation session (within 14 days) Encourage patients to follow through, especially after HLOC, express interest in their progress Encourage practitioners/facilities to document any AOD diagnosis Give advice, offer resources and consider referral to NA or AA if needed Behavioral Health HEDIS Measure: Initiation and Engagement of Alcohol & Other Drug Dependence Treatment

8 Behavioral Health HEDIS Measure: Initiation and Engagement of Alcohol & other Drug Dependence Treatment (IET) What PCPs Can Do: – Carefully ask about AOD & screen for problem use – Make sure the diagnosis is listed (in chart, on claim) – Make sure a follow up session occurs soon after evaluation session (within 14 days) – Encourage patients to follow through; express interest in their progress – Make a clear statement about needing to cut down if use is problematic. Give Advice.

9 2-Question Screener (from Brown et al, Journal of the American Board of Family Practice, 2001) “Have you felt you wanted or needed to cut down on your drinking or drug use in the last year?” “In the last year, have you ever drunk or used drugs more than you meant to?”

10 4-Question Screener - CAGE-AID (Cage Adapted to Include Drugs) Have you ever felt you should C ut down on your drinking or drug use? Yes_____No_____ Have people A nnoyed you by criticizing your drinking or drug use? Yes_____No_____ Have you ever felt bad or G uilty about your drinking or drug use? Yes_____No_____ Have you ever had a drink or used drugs first thing in the morning to steady your nerves or get rid of a hangover or residual drug effects ( E ye opener)? Yes_____No_____

11 Screening For Problem Alcohol Use ( from NIAAA’s Helping Patients Who Drink Too Much:Clinician’s Guide, 2005 Edition ) “How many times in the past year have you had 5 or more drinks in a day (for men)?” 4 or more drinks in a day (for women)?” _______ If one or more, then ask the following: On average, how many days a week do you have an alcoholic drink? _______ On a typical drinking day, how many drinks do you have? _______

12 What a Medical Care Manager (or Physician) Might Say If a Member Screens Positive: [based on Kainz, Professional Psychology, 2002] "I have some concerns about what you have told me about your alcohol/other drug use. I'd like you to consider seeing a substance abuse specialist for an evaluation. This is not necessarily a commitment to going for treatment, but I'd like to see if there are any treatment interventions that could be helpful for you. Here's the 800 number (found on the back of the member’s Health Plan card) to call to get a referral from your plan. Feel free to give me a call after the evaluation or if you have any trouble setting it up and together we can decide on the next logical step. How does that sound? Would you be willing to give it a try?"

13 Substance Abuse Resources 12 step programs can be found in the phone book or online at ttp:// Other info at Members Can Take a Free Emotional Health Self- Assessment or Access Self-Help Programs Online: Log on to [>Wellsite>Condition Centers>Depression>HN Resources>Learn More>Self- Assessments or Self-Help Programs>Alcohol & Substance Abuse].

14 Substance Abuse Resources Members Can Listen to Free Mental Health and Substance Abuse Info By Phone: Call (Push Option #2). Members Can Learn Skills Online: Go to [>Make an Informed Decision>It’s Your Life-Wellsite>Emotional Health>Self-Assessments or Self-Help Programs] to see online programs which teach skills for dealing with depression, insomnia, stress and anxiety. Members Can Find Out About Mental Health Specialists at MHN: – Go to Health Net’s web site at [>Doctor Search>Behavioral Health] and find out which psychiatrists, psychologists or other behavioral health practitioners are in-network with MHN. – Call the 800 on member’s ID card and speak to an intake specialist

15 Behavioral Health HEDIS Measure: Initiation and Engagement of Alcohol & other Drug Dependence Treatment (IET) What MHN Associates Can Do: – Encourage accurate listing of diagnoses even if CD is secondary (in chart, on claim, on RFR, in authorization screens) – Make sure treatment starts soon after evaluation (within 14 days) – Encourage patients to follow through after Higher Level of Care discharges (CMA calls) – Carefully ask about CD issues, regardless of presenting complaint, when speaking to members seeking treatment