Behavioral health HEDIS® measures messages

Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)

 

More than 20 million Americans age 13 and older are classified as having a substance use disorder involving alcohol and other drug use (AOD). Treatment has been shown to reduce AOD-associated morbidity and mortality; improve health, productivity and social outcomes; and reduce health spending. Despite these benefits, less than 20% of individuals with substance use disorders receive treatment. To ensure these positive outcomes, it’s important to remember the following for your Anthem HealthKeepers Plus members 13 and older who are newly diagnosed with a substance use disorder in any level of care:

 

• Ensure that your patient is seen by a mental health practitioner within 14 days for initiation of AOD treatment. Treatment can be through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization, telehealth, or medication-assisted treatment (MAT).

 

• Following that visit, at least two additional visits are recommended within 34 days of the initial visit.

 

All visits must be documented with a substance use diagnosis.

 

Follow-up after Emergency Department visit for alcohol and other drug Abuse or dependence (FUA)

 

Millions of Americans age 13 and older are classified as having a substance use disorder involving alcohol and other drug use (AOD). High ED use for individuals with AOD may signal a lack of access to care or issues with continuity of care. Timely follow-up care for individuals with AOD who were seen in the ED is associated with a reduction in substance use, future ED use, hospital admissions and bed delays.

 

Do the following to ensure the best outcome for your members age 13 and older discharged from an emergency room visit with a primary diagnosis of alcohol or other drug use or dependence: Make sure they are seen by an outpatient provider (any practitioner) and have a principal diagnosis of AOD use. This follow-up visit may occur on the date of discharge.

 

Two rates are reported:

 

• ED visits for which the member received follow-up within 30 days of the ED visit (31 total days)

 

• ED visits for which the member received follow-up within seven days of the ED visit (eight total days)

Follow-up is key.  Make sure your members are seen within the seven- and 30-day window.

 

Follow-up after Emergency Department Visit for Mental Illness (FUM)

 

Mental illness can affect people of all ages. In the United States, 18% of adults and 13% to 20% of children under 18 years of age experience mental illness. Research suggests that follow-up care for people with mental illness is linked to fewer repeat ED visits, improved physical and mental function and increased compliance with follow-up instructions.

 

It’s important to remember that your patients ages 6 and older discharged from an emergency department visit with a primary mental health diagnosis must be seen by an outpatient provider. The visit may occur on the date of discharge.

 

Two rates are reported:

 

• ED visits for which the member received follow-up within 30 days of the ED visit (31 total days)

 

• ED visits for which the member received follow-up within seven days of the ED visit (eight total days)

Follow-up is key. Make sure your members are seen within the seven- and 30-day window.

If you have any questions about this communication, call Provider Services at 1‑800‑901‑0020 or Anthem CCC Plus Provider Services at 1‑855‑323‑4687.

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

 

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