HEDIS measures: Follow-up after ED visits for mental illness and alcohol and drug dependency

Please note, this communication applies to Anthem HealthKeepers Plus, Medallion and Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) offered by HealthKeepers, Inc.

 

The following HEDIS^® measures assess the percentage of emergency department (ED) visits for which the member received a follow-up appointment within seven days and 30 days of being seen in the ED for mental illness or for alcohol and other drug dependence.

 

Follow-up after ED visit for mental illness (FUM)

 

Evaluates the percentage of ED visits for members 6 years of age and older with a principal diagnosis of mental illness or intentional self-harm, who had a follow-up visit with any practitioner for mental illness. Two rates are reported. The percentage of ED visits for which the member received:

1. Follow-up within seven days of the ED visit.
2. Follow-up within 30 days of the ED visit.

 

Timely follow-up care for people with mental illness can lead to fewer repeat visits to the ED and improved physical and mental health function.

 

Follow-up after ED visit for alcohol and other drug abuse or dependence (FUA)

 

Evaluates the percentage of ED visits for members 13 years of age and older with a principal diagnosis of alcohol or other drug (AOD) abuse or dependence, who had a follow up visit with any practitioner for AOD. Two rates are reported. The percentage of ED visits for which the member received:

1. Follow-up within seven days of the ED visit.
2. Follow-up within 30 days of the ED visit.

 

According to studies, follow-up care for individuals with AOD who were seen in the ED is associated with reduced substance use, repeat ED visits, and hospital admissions.

 

Helpful tips:

 

• Maintain appointment availability for patients with recent ED visits.
• Assist in scheduling in-person or telehealth follow-up appointments as soon as possible after the ED visit.
• Use appropriate documentation and correct coding. Use the same diagnosis for mental illness or substance use for follow-up visits (a non-mental health/non-substance diagnosis code will not fulfill the measure).
• Reference the plan’s Quality Measures Desktop Reference for Medicaid Providers and the HEDIS® Benchmarks and Coding Guidelines for Quality that is provided for coding information.
• Educate patients on the importance of compliance with their discharge plan and their follow-up appointments.
• Reach out to patients who cancel their appointments and assist with rescheduling as soon as possible.
• Facilitate referrals to behavioral healthcare specialists when appropriate.

 

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

 

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

 

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