Adult Behavioral Health HEDIS Measures

Hello, and thank you for attending this behavioral health quality programs presentation: An Overview of HEDIS Measures That Apply to Adults. My name is Kayla Bradshaw, and I am a Licensed Clinical Social Worker. I am one of the Behavioral Health, Clinical Quality Improvement Liaisons also known as a CQIL.

This presentation is provided in part by Horizon's, behavioral health department HEDIS Team. We thank you for joining and hope you will attend future presentations.

Please note that a copy of the slide deck will be sent out at the conclusion of today's Webex to those individuals who are present for the duration of the training. If you would like, more information, please reach out to your assigned behavioral health, clinical quality improvement liaison, or you can utilize the general behavioral health HEDIS Team email that will be provided at the conclusion of the Webex.

To begin, I am going to review the agenda for today's call. Our objectives are that at the conclusion of this training, you will have improved understanding of Horizon's goals, NCQA and HEDIS, review the measure requirements and criteria to meet the measures, be able to apply best practice recommendations and access the additional resources from Horizon to help you improve the quality of care provided to our members.

Horizon's goal for the quality programs is to improve clinical outcomes and performance on HEDIS measures and promote the care that our members receive.

The National Committee for quality assurance also known as NCQA is a private non-profit organization focused on quality of care. NCQA provides accreditation to a wide range of healthcare organizations and helps Horizon meet the goal of accreditation requirements in promoting supportive care that keeps members at optimum levels of health while controlling costs and meeting government and purchaser requirements.

When you see the NCQA seal on health plans materials that indicates that the plan has met the set guidelines for the standardized quality performance measures. NCQA is committed to providing consumers with the information needed to find high quality health care providers and plans.

If you are not already familiar with HEDIS, it is an acronym that stands for healthcare effectiveness, data and information set. HEDIS was developed by the National Committee for quality assurance, and is a set of standardized performance measures. It ensures the public has the information it needs to compare organization performance. HEDIS is not exclusive to Horizon. 90% of America's health plans use to measure performance and there are 95 HEDIS measures. However, today's presentation will focus specifically on our behavioral health HEDIS measures that apply to the treatment of mental health disorders for adults.

This slide lists the 11 measures and indicates which product line the data is collected Medicaid, Medicare or commercial. Even though every measure may not apply to every line of business plan we should still adhere to the best practice suggestions, regardless if we are monitoring these measures or not as we want to ensure we are providing the highest quality of care to our members. It is important to note that the 2 measures highlighted at the bottom in red are not current behavioral health owned HEDIS measures. While the behavioral health HEDIS team is not tasked with the performance rates for SMC or SMD they do relate to our members. So we monitor their performance.

Highlighted in green are the 5 HEDIS measures that are specific to the treatment of mental health disorders for adults, and will be the focus of today's presentation.

The first measure we will be reviewing is Antidepressant Medication Management, or AMM. For this measure, we are examining the percentage of members 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression and remained on an anti- depressant medication treatment.

Members who fall into the eligible population are 18 years of age, and older as of the index prescription start date who were treated with an antidepressant medication, had a diagnosis of major depression and remained on an antidepressant medication treatment. Starting on May 1st of the year prior to the measurement year ending on April 30th of the measurement year.

The lines of business reported are Medicaid, Medicare and commercial. In order to make compliance for this HEDIS measure, members must remain on their prescribed antidepressant medication treatment during the 2 rates reported.

The first rate is the Effective Acute Phase treatment, and this is a percentage of members who remained on anti-depressant medication for at least 84 days or 12 weeks. The second rate is Effective Continuation Phase treatment. This is the percentage of members who remained on an antidepressant medication for at least 180 days or 6 months.

Members who are excluded from this measure include members in hospice, or using hospice services at any time during the measurement year. Members who did not have a diagnosis of major depression. Members previously dispensed an antidepressant medication 105 days before the index prescription start date, and members who died during the measurement year.

This slide details some of the best practice recommendations for AMM. Discuss with patients the importance of taking medication as prescribed and remaining on the medication for a minimum of 6 months, even when the patient starts to feel better. Discuss with patients the risk of stopping medication before 6 months or abruptly and recommended follow up first for a consultation. Educate patients and caregivers on possible side effects, and the length of time for the medication to have the desired effect. Schedule a follow up appointment before the patient leaves the office and send appointment reminders. Develop a tracking method for patients prescribed antidepressants and require staff to follow up with patients that miss or cancel their appointment. When available use gap lists to help manage your total population. Consider the patient's work schedule as a barrier to the visit and offer extended evening or weekend hours or telemedicine.

The next measure for review is Follow-Up After Hospitalization for Mental Illness, Abbreviated FUH. For this measure, we are examining the percentage of discharges for members 6 years of age and older who were hospitalized for treatment of mental illness or intentional self-harm diagnosis who had a follow-up visit with a mental health provider.

Members who fall into the eligible population are age 6 years and older as of the date of the acute inpatient discharge with a principal diagnosis of mental illness or intentional self-harm on the discharge claim. On or between January 1st and December 1st of the measurement year. The line of business reported is Medicaid, Medicare a commercial.

In order to meet compliance for this HEDIS measure, members who were hospitalized for treatment of mental illness, or intentional self-harm diagnosis, must have had a follow a visit with a mental health provider for either of the two rates shown below.

The first is a 7 day, follow up. This is a follow up visit with a mental health provider within 7 days after the discharge. We do not include visits that occur on the date of the discharge. Second is a 30 day follow up. This is a follow up visit with a mental health provider within 30 days after the discharge. We do not include visits at occur on the date of the discharge.

Members are excluded from this measure if they have hospice or are using hospice services at any time during the measurement year. Non acute inpatient stays. Discharges followed by readmission or direct transfer to a non-acute inpatient care setting within the 30 day follow up period. Regardless of the principal diagnosis for the readmission. Members who died during the measurement year.

Here are some recommended best practices for the FUH measure. Educate patients and caregivers on the importance of follow up to reduce the risk of impatient admission. Discuss the importance of seeking follow up with a mental health provider. Train staff on the “teach back method” to ensure patients and caregivers review and understand discharge instructions and the next step in their care for follow up. Develop outreach systems, or assign case managers to encourage recently released patients to keep follow up appointments or reschedule missed appointments. Outreach patients who do not keep initial follow-up appointments. Set flags, if available, in the electronic health record, or develop a tracking method for patients due or past due for follow up after discharge visits. Require staff to follow up with patients that cancel or miss their appointments. Coordinate care with behavioral health practitioners by sharing progress notes and updates.

The next measure in our presentation is Follow-Up After Emergency Department Visit for Mental Illness also known as FUM. For this measure, we are examining the percentage of emergency department visits for member 6 years of age, and older with a principal diagnosis of mental illness or intentional self-harm who had a follow up visit for mental illness. And for this one, there are 2 rates reported.

Members who fall into the eligible population are 6 years of age and older as of the date of the emergency department visit with a principal diagnosis of mental illness or intentional self-harm, on or between January 1st and December 1st of the measurement year.

The line of business reported is Medicaid, Medicare and commercial. In order to meet compliance for the HEDIS measure members, 6 years of age and older on the date of the ED visit, with a principal diagnosis of mental illness or intentional self-harm must have had follow up visit with a mental health practitioner for either of the two rates reported.

The First rate is a 7 day follow up. This is a follow up visit with any practitioner within 7 days after the emergency department visit. This is a total of 8 days. For this measure, you can include visits that occur on the date of the emergency department visit.

The second is a 30 day, follow up and this is a follow up visit with any practitioner within 30 days after the emergency department visit or 31 days total. And again, you can include visits that occur on the date of the ED visit.

Members are excluded if they are in hospice or using hospice services at any time during the measurement year. If the emergency department visit resulted in an inpatient stay and emergency department visits followed by an admission to an acute or non-acute inpatient care setting on the date of the ED visit or within 30 days after the visit. So, 31 days total regardless of the principal diagnosis for the admission. And members who died during the measurement year.

Once again, these are some of the recommended best practices for FUM. Schedule follow up appointments as soon as possible, particularly for those patients recently discharged from the emergency department. Train patients and staff on the “teach back method” to ensure patients and caregivers review and understand the discharge instructions and the next step in their follow up care. Encourage patients to bring their discharge paperwork to their first appointment. Educate the patient about the importance of follow up and adherence to treatment recommendations. Coordinate care with behavioral health practitioners by sharing progress notes and updates. Outreach patients who cancel appointments and assist them with rescheduling as soon as possible. Set flags available in the electronic health record, or develop a tracking method for patients due or past due for follow up after discharge visits. Use the same diagnosis for mental illness at each follow up visit. A non-mental illness diagnosis code will not fulfil this measure.

Moving on, we will now review Adherence to Antipsychotic Medications for Individuals with Schizophrenia or the SAA HEDIS measure. For this measure, we are examining the percentage of members, 18 years of age and older during the measurement year with schizophrenia or schizoaffective disorder who were dispensed and remained on an antipsychotic medication for at least 80% of their treatment period.

Members who fall into the eligible population are 18 years of age and older as of January 1st of the measurement year with schizophrenia or schizoaffective disorder who were dispensed and remain on an antipsychotic medication for at least 80% of their treatment period. The line of business reported is Medicaid, Medicare and commercial.

In order to meet compliance for this HEDIS measure members must achieve a proportion of days covered or PDC of at least 80% for their antipsychotic medications during the measurement year.

Members who are excluded from the measure include members in hospice or using hospice services at any time during the measurement year. Members with the diagnosis of dementia. Members who did not have at least 2 antipsychotic medication dispensing events. Medicare member 66 years of age and older as of December 31st of the measurement year enrolled institutional SNP or living in a long term institution at any time during the measurement year. Members 66 to 80 years of age as of December 1st of the measurement year. Members 81 years of age and older as of December 1st of the measurement year. And lastly, members who died during the measurement year.

This slide lists some of the recommended best practices for the SAA measure. Educate patients and their caregivers on the importance of medication compliance. Discuss with members, potential medication, side effects and when to call their doctor. Ensure appointment availability in your practice for patients and schedule a follow up appointments before the patient leaves the appointment. Set flags, if available in the electronic health record, or develop a tracking method for patients due or past due for follow up visits. Require staff to follow up with patients that miss or cancel their appointment. Coordinate care with the primary care physician, patient's behavioral health specialists and other providers.

The final measure we will be looking at today is Diabetes Screening for People with Schizophrenia, or Bipolar Disorder Who are Using Antipsychotic Medications also known as the SSD HEDIS measure. For this measure, we are examining the percentage of members 18 to 64 years of age with schizophrenia, schizoaffective disorder, or bipolar disorder who were dispensed an antipsychotic medication and had a diabetes screening test during the measurement year.

Members who fall into the eligible population are 18 to 64 years of age as of December 31st of the measurement year with schizophrenia, Schizoaffective disorder, or bipolar disorder, who were dispensed an antipsychotic medication. The line of business reported is Medicaid.

In order to meet compliance for this, HEDIS measure, members who were dispensed an antipsychotic medication must have had a glucose test or HbA1c test performed during the measurement year.

Members who are excluded from this measure include: Members in hospice, or using hospice services at any time during the measurement year. Members with diabetes members, who did not have antipsychotic medications dispensed during the measurement year and members who died during the measurement year.

Some of the recommended best practices for the SSD measure include: Order a diabetes screening test every year and build care gap alerts in your electronic medical record. Follow up with patients to discuss and educate on lab results. Coordinate care with the primary care physician, patients' behavioral health specialists, or other providers. Outreach patients who cancel appointments and reschedule them as soon as possible. Encourage shared decision making by educating patients and caregivers about the increased risk of diabetes with antipsychotic medications, the importance of screening for diabetes, symptoms of new onset diabetes.

Now that we have reviewed the 5 adult specific behavioral health HEDIS measures and how to better support members who fall into these populations,we are going to discuss why HEDIS is important at Horizon. HEDIS helps horizon obtain and maintain accreditation requirements. HEDIS information improves health plan delivery and services. HEDIS quality measures reduces gaps in care. HEDIS evaluates clinical quality performance. HEDIS improves outcomes for members which reduces costs of care. HEDIS enables data to identify at risk populations. And information from the HEDIS reports helps create the annual State of Health Care Quality Report from NCQA.

Horizon understands that as a provider in our network, your role is crucial in improving patient outcomes. The next few slides will detail some of the resources available to our members and network providers to assist with closing gaps and care for all HEDIS measures.

The behavioral health quality team at Horizon includes several behavioral health, specific clinical quality improvement liaisons, or CQILS. As an in network behavioral health provider, you have access to a dedicated CQIL team who will help collaborate with your practice by supporting the goal of improving HEDIS quality performance and care provided to our members. CQILs assist providers with a comprehensive variety of tools, including resources, education, data, and practice transformation with the objective to enhance treatment delivery.

CQILs can help with meeting HEDIS measures by acting as a single point of contact within Horizon to assist with navigating NCQA HEDIS. Providing a variety of resources, tools and webinars to improve HEDIS knowledge. Assisting to analyze quality performance reports and address barriers to care and ongoing collaboration to promote best practices.

This slide contains the names of the 5 CQILs on the behavioral health HEDIS team along with their email and phone number. We also have an email set up for general, behavioral health HEDIS related inquiries that we check regularly, which is noted at the bottom of the slide. If you have not been assigned to work with a specific behavioral health CQIL we encourage you to use the general HEDIS email and someone from the team will respond timely to your outreach.

Horizon's online quality resource center contains various supports, designed to assist providers ongoing efforts in delivering quality services to their patients. The quality resource center web address is located at the top of this slide. Here you can find links to resources, including provider tips for optimizing HEDIS results booklet. The HEDIS and quality management programs manual. The HEDIS measurement guidelines interactive HEDIS guidelines, information regarding the results and recognition program as well as previously recorded provider educational webinars.

Our network providers have the ability to access Horizon's HEDIS measure guidelines for behavioral health via the horizonblue.com website. Each link provides summarized NCQA HEDIS best practice recommendations along with a link to access the Provider Tips for Optimizing HEDIS Results booklet.

Another resource available to our members is Horizon's care management teams. Care management is a unique opportunity for members to collaborate with our clinical team in efforts to educate and coordinate care. Members with an assigned care manager may receive updates on various programs and vendors. Members who qualify for care management and have agreed to engage in the program needs complete assessments based on the program criteria. The risk level scoring will indicate the level of care management interventions. If the member is enrolled, they will be assessed through additional outreach and receive assistance from our care management teams. If you think someone may benefit from one of our care management teams, please feel free to use the numbers located at the right side of the screen and let them know our member would like to be assessed.

This slide details some additional resources available to our members and network providers. Listed are important phone numbers, emails and Web sites for members and provider assistance. Additional resource resources for providers can be found on the HNJH website.

Once again, we thank you for attending today's webinar. This concludes our presentation. We thank you for your participation and look forward to you joining us in future HEDIS trainings.

If you have any additional questions, please contact us at BH_HEDISTeam@horizonblue.com. Thank you. And we hope you will attend additional behavioral health HEDIS trainings.