Overview of ADD and ADHD

Hello, and welcome to this presentation on Follow-Up Care for Children Prescribed ADHD medication.

This presentation is designed to be informative and at the conclusion, our objective is that you will have an understanding of HEDIS and Horizon's goals for the Quality Program, understand ADHD medication follow up and best practices, learn about Horizon Healthy Journey and Horizon's Care Management department.

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

If you're familiar with Horizon's Quality Program, you may or may not know what HEDIS is.

HEDIS is an acronym that stands for health care effectiveness data and information set.

HEDIS was developed by the National Committee for Quality Assurance, known as NCQA, and is a set of standardized performance measures.

It ensures the public has the information it needs to compare organizations' performance. There are 96 HEDIS measures, and HEDIS is not exclusive to Horizon.

We'll now review the HEDIS measure, Follow-Up Care for Children Prescribed ADHD medication.

According to the American Psychiatric Association, Attention deficit hyperactivity disorder is a disorder that manifests in early childhood with symptoms of hyperactivity, impulsivity and/or inattention.

The symptoms affect cognitive, academic, behavioral, emotional and social functioning.

According to the National Institute of mental health also known as NIMH, the signs and symptoms of ADHD are inattention, including being easily distracted, having difficulty focusing and staying organized,

hyperactivity, including excessive fidgeting, tapping talking and extreme restlessness and or constant activity.

And then you have, impulsively, including acting without thinking, or having difficulty with self-control. The person desires immediate reward, or the inability to delayed gratification, also interrupting others or making important decisions without considering long term consequences.

For more information, the NIMH website will be referenced at the end of this presentation.

Let's review the risk factors.

NIMH found several contributing factors in their research that are both biological and environmental.

Genetics played a role. Their website also reports how ADHD is more common in males than females.

Environmental factors such as substance abuse, including cigarette smoking and alcohol use during pregnancy were common factors in their research.

Exposure to environmental toxins during pregnancy, or even at a young age. They also noted low birth weight and brain injuries as risk factors.

Treatment of ADHD includes, but is not limited to medications, including stimulants and non stimulants, therapies, including behavioral and cognitive behavioral therapies, and other interventions, such as parenting skills training, specific behavioral classroom management interventions and/or academic accommodations and support groups.

Although there's no cure for ADHD, the NIMH reports that treatment may help reduce symptoms and improve functioning, which is why interventions are so important.

NIMH notes conditions, such as learning disabilities, anxiety disorders,

disruptive behavior disorders, depression and substance abuse are more commonly associated with the diagnosis of ADHD.

Patients, parents or guardians should be encouraged to discuss options for treatment with individuals involved in the patient's care.

According to articles found in Pediatrics and Psychiatric Times, some barriers to medication adherence include parental beliefs and attitude towards ADHD diagnosis, perceptions regarding treatment, parental relationship with their health care provider was a strong factor.

Familial beliefs about ADHD diagnosis, influenced medication adherence.

Parents were more likely to accept their family's advice over their healthcare provider.

Misconceptions regarding medication, such as ADHD medications resulting in addiction.

The comfort level of the prescriber was also a barrier.

The child's reported aversion to take prescribed medication, predicted worse, long term adherence.

And also cancelled appointments and delays with new patient evaluations due to the impact of the Covid 19 pandemic.

According to Psychiatric Times and Current Psychiatry Reports, failure to effectively follow treatment and or monitor ADHD may result in an increased risk of comorbid conditions across the lifespan, poor academic performance, poor social skills, disciplinary problems, impulsiveness leading to higher incidences of harm, and for children, if left untreated into adulthood, may lead to frequent problems at work and/or failed relationships.

As you can see the health care team plays an important role as educators and gatekeepers in the process of identification and treatment of ADHD.

Prescribed medication and treatment plans need to be initiated in a way that encourages adherence.

Ongoing monitoring will encourage maximized benefit and minimal adverse effects, which will likely will promote adherence.

According to The Lancet Child & Adolescent Health Article, ADHD management and Covid has created unprecedented challenges.

Individuals with neurodevelopmental disorders, such as ADHD, are more vulnerable to increased behavioral problems.

The article recommends providers manage patients through telemedicine when face-to-face support is not possible.

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Parents should be encouraged to continue their course of prescribed medication and notify their prescribers or PCP, if experiencing concerning symptoms.

Now, let's review the HEDIS measure, Follow-Up Care for Children Prescribed ADHD medication.

This measure evaluates whether children 6 to 12 years of age, newly prescribed ADHD medication had at least 3 follow up care visits within a 10 month period, with the initial visit completed within 30 days of when the 1st ADHD medication was dispensed.

Before I go into a little bit more detail about the measure, let's take a closer look at some of the HEDIS terminology.

IPSD, or index prescription start date is the earliest prescription dispensing date for any ADHD medication during the measurement year.

IP, excuse me, known as the initiation phase, is the period of time the initial follow-up visit must be completed 30 days following the IPSD.

Then you have the C&M or the Continuance and Maintenance phase, and this is the period of time the follow up visit 2 & 3 must be completed, which is within 270 days or 9 months from the IPSD.

Eligibility for this measure includes the percentage of members newly prescribed ADHD medication ages 6 years as of March 1st of the year prior to the measurement year to 12 years, as of the last calendar day of February of the measurement year.

This measure focuses on the Medicaid and Commercial lines of business.

To meet measure compliance there are 2 phases reported.

The initiation phase again known as the IP and continuation and maintenance phase known as C&M.

The IP is evaluating members 6 to 12 as of the index prescription start date, or IPSD, with a prescription dispensed for ADHD medication and had one follow up visit with a practitioner with prescribing authority during the 30 day IP.

Per HEDIS, do not count a visit completed on the IPSD, as the initiation phase visit.

Also per HEDIS, a telehealth visit will meet criteria for this phase.

The C&M phase is evaluating members ages 6 to 12 as of the IPSD with a dispensed ADHD medication who remained on that medication for at least 210 days and who, in addition to the visit in the IP had at least 2 follow up visits with a practitioner within 270 days or 9 months after the IP ended.

Per HEDIS, telehealth visits will meet criteria for this phase as well, but only 1 of the 2 visits during days, 31 to 300, may be an e-visit or virtual check in.

Exclusions for this measure, include members with an acute inpatient encounter for a mental behavioral or neurodevelopmental disorder during the 30 days after the IPSD, members with a diagnosis of narcolepsy, anytime during their history, and also members in hospice, or using hospice services, any time during the measurement year.

So, now that we've reviewed the terminology, let's see an example that breaks down the calculations for meeting HEDIS compliance. In this example, Dylan was dispensed medication on February 14th, 2022.

The treatment period now begins from February 14^th through December 31st of the measurement year, which is a total of 320 days.

The initiation phase is when the first follow up visit must be completed before March 16th, 2022, or 30 days of when the first ADHD medication was dispensed, which is the IPSD.

So, an example is Dylan must complete a follow up visit with either a prescribing provider or his PCP within 30 days of the initial dispensing event. Per HEDIS specifications, we cannot count a visit completed on the IPSD as the IP visit.

After Dylan has completed the IP visit, he must now complete the C&M phase whereby he must complete a 2nd and 3rd follow up visit prior to December 31st, 2022.

Again, telehealth visits will meet criteria for the IP and C&M phase, but only 1 of the 2 visits may be an e-visit or virtual check in.

This slide details some HEDIS best practices for the ADHD measure.

First, is discuss with patients the importance of taking medication as prescribed and remaining on them, educate patients on possible side effects and length of time for the medication to have the desired effect.

Schedule at least 3 follow up appointments within a 10 month period.

An example is 2 weeks, 6 weeks, 3 or 6 month appointments.

Before the patient leaves the office, you want to do this.

First visit, again, must be completed within 30 days of the IPSD.

Send appointment reminders to patients and require staff to follow up with patients that miss or cancel their appointment.

Develop a tracking method for patients prescribed or restarted ADHD medication.

When available use gap lists to help manage your total population.

Consider telemedicine appointments when in-person visits are not feasible.

And then, lastly, consider the parents' work schedules as a barrier to visits and offer extended evening or weekend hours, if possible.

Horizon's online Quality Resource Center contains various tools and resources designed to assist providers and their ongoing efforts in delivering quality services to their patients. You can find links to resources, including the provider tips for optimizing HEDIS results booklet, HEDIS and quality management program materials, HEDIS measure guidelines and other resources. The web address is located at the top of this slide.

New for 2022 our network providers now 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 billing tips booklet for optimizing HEDIS results.

Our Behavioral Health HEDIS Team also has a variety of HEDIS specific provider tools designed to empower our providers with HEDIS best practice guidelines for improving HEDIS quality performance. Your assigned behavioral health CQIL can collaborate with your team to share and review resources that promote improved quality of care and HEDIS performance.

Horizon Healthy Journey program is a great resource for providers and for members.

The department consists of a dedicated population health management team whose focus is to reach out to members through various methods and helping to remind them of preventive care services. Hence, also helping in closing care gaps.

The program also offers opportunities for education and chronic disease management.

The number for our Healthy Journey team is listed here if you have any questions for them, and it can also be shared with your patients.

Outreaches include live calls, direct mailings, and member reward programs to name a few.

They also use vendors for care coordination and in-home screenings.

This slide shows primary care provider and prescriber notification letters from Horizon Healthy Journey. The intent of the letters are to be a friendly reminder of the NCQA HEDIS best practice guidelines, recommending completion of one follow up visit within 30 days of the initial IPSD.

Included with this letter will be a member gap list.

The objective of the member gap list is to coordinate continuity of care for follow up visits.

During the IP, and the gap list is sent to the PCP and to the prescribing provider.

Another resource available to our members is Horizon's Care Management team.

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, and members who qualify for Care Management have agreed to engage in the program, need to 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 team.

If you think someone may benefit from Care Management services, please feel free to call the number shown on the screen and let them know your patient would like to be assessed.

Horizon remains committed to offer support for our members and network providers.

Here are additional resources available to our members and network providers to assist with closing gaps for all HEDIS measures, including the one discussed during this presentation.

And here are yet additional resources for providers that can be found on the HNJH website.

And this slide contains the references used for this presentation.

Thank you for listening to this presentation, on Follow-Up Care for Children Prescribed ADHD medication.

If you have any questions, please send them to the email noted here.

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