Behavioral mental health measures
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Transcript of Behavioral mental health measures
HEDIS 2017Behavioral HealthHEDIS MEASURES
What is HEDIS?The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of standardized performance measures designed to ensure that the public has the information it needs to compare organization performance.
HEDIS is one component of a larger accountability system and complements the NCQA Accreditation Program. When combined, the results of NCQA Accreditation and HEDIS provide the most complete view of organization quality available to purchasers and consumers.
HEDIS Measures Domain
HEDIS
Effectiveness of Care
Access / Availability of
Care
Experience of Care
Utilization and Risk Adjusted
Utilization
Relative Resource Use
Health Plan Descriptive Information
Measure Collected
using ECDS
Behavioral HealthADD
Follow-Up Care for Children Prescribed
ADHD Medication
AMM
Antidepressant Medication
Management
FUHFollow-Up
After Hospitalization
for Mental Illness
FUMFollow-Up After
Emergency Department Visit for Mental Illness (new measure)
FUA
Follow-Up After Emergency Department
Visit for Alcohol and Other Drug
Dependence(new measure)
SSDDiabetes
Screening for People With
Schizophrenia or Bipolar
Disorder Who Are Using
Antipsychotic Medications
SMDDiabetes
Monitoring for People With Diabetes and
Schizophrenia
SMCCardiovascular Monitoring for
People With Cardiovascular
Disease and Schizophrenia
SAAAdherence to Antipsychotic
Medications for Individuals With Schizophrenia
APMMetabolic
Monitoring for Children and
Adolescents on Antipsychotics
AMM
IPSD: Index Prescription star Date.
Exclusions: members in hospice are excluded
Ages: 18 years and older as of April 30 of the MY.
Event: Determine the IPSD. Identify the date of the earliest dispensing event for an antidepressant medication during the Intake Period.
ANTIDEPRESSANT Medication Management
Antidepressant MedicationDescription Prescription
Miscellaneous antidepressants
Bupropion Vilazodone Vortioxetine
Monoamine oxidase inhibitors
Isocarboxazid Phenelzine
Selegiline Tranylcypromine
Phenylpiperazine antidepressants
Nefazodone Trazodone
Psychotherapeutic combinations
Amitriptyline-chlordiazepoxide Amitriptyline-perphenazine
Fluoxetine-olanzapine
SNRI antidepressants Desvenlafaxine Duloxetine
Levomilnacipran Venlafaxine
SSRI antidepressants Citalopram Escitalopram
Fluoxetine Fluvoxamine
Paroxetine Sertraline
Tetracyclic antidepressants
Maprotiline Mirtazapine
Tricyclic antidepressants Amitriptyline Amoxapine Clomipramine
Desipramine Doxepin (>6 mg) Imipramine
Nortriptyline Protriptyline Trimipramine
ADDFollow- up Care for Children Prescribed ADHD Medication
Intake Period: The 12 month window starting March 1 of the year prior to the measurement year and ending February 28 of the MY.
IPSD: The earliest prescription dispensing date for an ADHD medication where the dates is the Intake Period and there is a Negative Medication History.
Ages: Six years as of March 1 of the year prior to the measurement year to 12 years as of February 28 of the MY.
Exclusions: members in hospice are excluded, members who had an acute impatient encounter for mental health or chemical dependency during 30 days after the IPSD.
ADHD medicationDescription Prescription
CNS stimulants Amphetamine-dextroamphetamine
Dexmethylphenidate
Dextroamphetamine Lisdexamfetamine
Alpha-2 receptor agonists
Clonidine Guanfacine
Miscellaneous ADHD medications
Atomoxetine
FUHFollow – up after Hospitalization for Mental Illness
Ages: 6 years and older as of the date of discharge.
Event: Acute Inpatient discharge with a principal diagnosis of mental illness on or between January 1 and December 1 of the MY.
Exclusions: Exclude discharge followed by readmission or direct transfer to an acute inpatient care setting with the 30 , regardless of principal diagnosis for the readmission.
FUM Follow – Up After Emergency Department Visit for Mental Illness
First – year measure
Description: The percentage of emergency department (ED) visits for members 6 years of age and older with a principal diagnosis of mental illness, who had a follow-up visit for mental illness. Two rates are reported: The percentage of ED visits for which the member received follow-up within 30 days
of the ED visit. The percentage of ED visits for which the member received follow-up within 7 days
of the ED visit.
Ages: 6 years and older as of the date of the ED visit.
Events: An ED visits with a principal diagnosis of mental illness on or between January 1 and December 1 of the MY.
FUAFollow – Up After Emergency Department Visits for Alcohol and other Drug
Dependence
Description: The percentage of emergency department (ED) visits for members 13 years of age and older with a principal diagnosis of alcohol or other drug (AOD) dependence, who had a follow up visit for AOD. Two rates are reported: The percentage of ED visits for which the member received follow-up within 30
days of the ED visit. The percentage of ED visits for which the member received follow-up within 7 days
of the ED visit.
Ages: 13 years and older as of the ED visits. Report 3 ages stratification and total rate13-17 years, 18 and older and total.
Event: An ED visit with a principal diagnosis of AOD on or between the January 1 of the MY
.
SSD Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who
are Using Antipsychotic Medications
Description: The percentage of members 18–64 years of age with schizophrenia or bipolar disorder, who were dispensed an antipsychotic medication and had a diabetes screening test during the measurement year.
Ages: 18-64 years as of December 31 of the MY.– Members with schizophrenia or bipolar disorder as those who met at least on the following criteria
during the MY.– At least one acute inpatient encounter, with diagnosis of schizophrenia or bipolar disorder.– At least two visits in an outpatient , intensive outpatient, partial hospitalization, ED or non acute
inpatient setting, on different dates of service with any diagnosis of schizophrenia. – At least two visits in an outpatient , intensive outpatient, partial hospitalization, ED or non acute
inpatient setting, on different dates of service with any diagnosis of bipolar disorder.
• Exclusions: Patients with Diabetes
Antipsychotic Medications
Description PrescriptionMiscellaneous antipsychotic agents
Aripiprazole Asenapine Brexpiprazole Cariprazine Clozapine Haloperidol Iloperidone
Loxapine Lurisadone Molindone Olanzapine Paliperidone Pimozide Quetiapine
Quetiapine fumarate
Risperidone Ziprasidone
Phenothiazine antipsychotics
Chlorpromazine Fluphenazine Perphenazine
Perphenazine-amitriptyline
Prochlorperazine
Thioridazine Trifluoperazine
Psychotherapeutic combinations
Fluoxetine-olanzapine
Thioxanthenes Thiothixene Long-acting injections Aripiprazole
Fluphenazine decanoate Haloperidol decanoate
Olanzapine Paliperidone
palmitate Risperidone
SMDDiabetes Monitoring for People with Diabetes and
Schizophrenia
Description: This measure assesses the percentage of members 18–64 years of age with schizophrenia and diabetes, who had both an LDL-C test and an HbA1c test during the measurement year.
Ages: 18 – 64 years of age as of December 31 of the MY
Event: Identify members with schizophrenia as those who met at least one of the following criteria during the MY.
– At least one acute inpatient encounter, with any diagnosis of schizophrenia– At least two visits in an outpatient, intensive outpatient, partial hospitalization , ED or no
acute inpatient setting, on different dates of service with any diagnosis of schizophrenia. – Identify patient who also have diabetes.
SMCCardiovascular Monitoring for People with Cardiovascular Disease and
Schizophrenia
Description: This measure assesses the percentage of members 18–64 years of age with schizophrenia and cardiovascular disease, who had an LDL-C test during the measurement year.
Ages: 18- 64 years as of December 31 of the MY
Enrollment : The MY and the year prior to the MY
Event: Identify members with schizophrenia as those who met at least one of the following criteria during the MY.
– At least one acute inpatient encounter, with any diagnosis of schizophrenia– At least two visits in an outpatient, intensive outpatient, partial hospitalization , ED or no
acute inpatient setting, on different dates of service with any diagnosis of schizophrenia. – Identify patient who also have cardiovascular disease.
Questions