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Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)

What is the APM — HEDIS® Measure?

Based on current NCQA HEDIS recommendations for best practices, children and adolescents ages 1 to 17 years of age who had two or more antipsychotic prescriptions should have metabolic testing completed.

The following three rates will meet numerator compliance:

  • Glucose or HbA1c Lab Test: Members who received at least one test for blood glucose orHbA1c during the measurement year
    • Documentation in the medical record must include a note indicating the date when the Glucose or HbA1c Lab test was performed
  • LDL-C or Cholesterol Lab Test: Members who received at least one test for LDL-C or cholesterol testing during the measurement year
    • Documentation in the medical record must include a note indicating the date when the LDL-C or Cholesterol Lab test was performed
  • All-of-the-Above Lab Testing: Members who received both of the following during the measurement year on the same or different dates of service
    • At least one test for blood glucose or HbA1c
    • At least one test for LDL-C or cholesterol
      • Documentation in the medical record must include a note indicating the date when all lab tests listed above were performed

Best Practices

  • The American Academy of Child and Adolescent Psychiatry (AACAP) recommends metabolic monitoring for children and adolescents on antipsychotic medications.
  • Monitor children on antipsychotic medications to avoid metabolic health complications such as weight gain and diabetes.
  • Inform parents/guardians of metabolic problems in childhood and adolescence that are associated with poor cardio-metabolic outcomes in adulthood.
  • Inform parents/guardians of the long-term consequences of pediatric obesity and other metabolic disturbances, including higher risk of heart disease in adulthood.
  • Establish a baseline and continuously monitor metabolic indices to ensure appropriate management of side effects of antipsychotic medication therapy.
  • Arrange for lab tests to be done in the office during a patient’s visit or schedule lab testing before the patient and parent/guardian leaves the office.
  • Determine whether the electronic medical record can flag lab tests based on diagnosis or when antipsychotic medications are prescribed.
  • Educate the parent/guardian about appropriate health screenings for certain medication therapies.
  • Coordinate care between Primary Care Physicians and Behavioral Health specialists.

NCQA HEDIS Population Definition for This Measure:

Population: Members who are 1 to 17 years of age as of December 31 of the measurement year who had two or more antipsychotic prescriptions dispensed of the same or different medications, on different dates of service, and had metabolic testing during the measurement year

Line of Business: Commercial, Medicaid

To learn more about your practice’s current HEDIS performance, 2022 HEDIS Value sets for this or other measures, or for assistance in compliance with the HEDIS guidelines, please email BH_HEDISTeam@HorizonBlue.com or visit https://www.horizonblue.com/providers/resources/guidelines/hedis-measurement-year-my-2022-provider-tips-optimizing-hedis-results

Reference: Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM), NCQA HEDIS 2022 Tech Specifications