Assessing opportunities to improve performance measures focused on major depressive disorder Sarah Sampsel, MPH Research Scientist June 2008

2 Academy Health June 2008 NCQA: Committed to Measurement, Transparency, Accountability Quality measurement means: Use of objective measures based on evidence Results that are comparable across organizations Impartial third-party evaluation and audit Public Reporting NCQA’s quality programs include: Accreditation of health plans using performance data HEDIS clinical measures CAHPS consumer survey Measurement of quality in provider groups Physician Recognition

3 Academy Health June 2008 Study Purpose Assess effects of proposed changes to HEDIS Antidepressant Medication Management measure – In HEDIS since 1999 – Eligible population identification concerns Length of negative diagnosis history Length of negative medication history – Opportunities to improve optimal practitioner contacts rate Inclusion of care management National monitoring of quality has not resulted in improvements in care…can revisions in a nationally standardized performance measure result in improvement?

4 Academy Health June 2008 Measurement Leads to Improvement Denotes measure specification change in 2006 Measurement at plan level makes a difference

5 Academy Health June 2008 State of Health Care Quality 2007 Antidepressant Medication Management – Commercial Rates

6 Academy Health June 2008 HEDIS ® Antidepressant Medication Management Measure Eligible population: health plan members, 18 years and older, with a new diagnosis of major depressive disorder and a new prescription for an antidepressant. Three rates: – Optimal practitioner contacts: members who had three visits within 12 weeks (84 days) – Effective acute phase treatment: members who remain on an antidepressant for 84 days – Effective continuation phase treatment: members who remain on an antidepressant for at least 180 days

7 Academy Health June 2008 Study Design Three health plans Membership: 244,794 – 492, total members in eligible population Diagnosis of major depression Prescription for anti-depressant 18 – 85 years Patient level data Current and past diagnoses and visit dates Current and past prescriptions Care management utilization

8 Academy Health June 2008 Population Characteristics

9 Academy Health June 2008 Prior Diagnosis and Prescription within Past Year n% Population with prior Dx n% Population with Prior Rx A (N=418)409.57% % B (N=733) % % C (N=2829) % % Commercial (N=3738) % % Medicaid (N=240) % % Total (N=3980) % %

10 Academy Health June 2008 What happens if negative history criteria are lengthened? Eligible Population Effect Sizes Negative History Criteria Total Eligible Population N% Difference Current Spec Neg Dx = 120 Neg Rx = Neg Dx = 120 Neg Rx = % Neg Dx = 150 Neg Rx = % Neg Dx = 180 Neg Rx = %

11 Academy Health June 2008 Effects on Measure Rates (Aggregated) Negative History Criteria Optimal Contacts Acute Phase Continuation Phase Current Spec Neg Dx = 120 Neg Rx = %61.43%45.38% Neg Dx = 120 Neg Rx = %57.16%41.62% Neg Dx = 150 Neg Rx = %57.01%41.37% Neg Dx = 180 Neg Rx = %57.06%41.39%

12 Academy Health June 2008 How does allowing care management contribute to the OPC?

13 Academy Health June 2008 Conclusions While revisions to the eligible population specifications would increase the specificity of identification; they do not meaningfully impact measure rates Adding care management did not meaningfully impact improvements in optimal practitioner contacts rate – Optimal practitioner contacts rate will be retired for HEDIS 2009 There are opportunities to refocus efforts to improve measurement in this area – Assessment and monitoring – Use of standardized assessment tool – Expand to broader population

14 Academy Health June 2008 Acknowledgements NCQA Staff – Zakiya Pierre – Sarah Hudson Scholle – Phil Renner – Greg Pawlson – Lisa Nern NCQA Behavioral Health Measurement Advisory Panel (BHMAP) Field-test sites