HEDIS® Behavioral Health Measure Results Improve
Each year, Magellan provides data to our customer health plans for the Health Plan Employer Data and Information Set (HEDIS®)—a set of more than 60 measures of various evidence-based clinical guidelines for services rendered to commercial, Medicare and Medicaid HMO, POS and PPO plan members. Health plans supply HEDIS measure results to the National Committee for Quality Assurance (NCQA), which in turn aggregates and reports them publicly. These results also are used to produce U.S. News and World Report’s “America’s Best Health Plans.”
We are excited to announce that our partner plans that report to NCQA had an average 2.8 increase in the seven-day follow-up appointment after discharge rate.
However, we still have a long way to go from a behavioral health care perspective in terms of overall increases in HEDIS measures.
Again, here are some ways you can help improve performance for our specialty:
- Continue to have appointments available within seven days of member discharge after a hospital stay for a behavioral health disorder. If the patient is known to you prior to the hospital stay, please have them secure an appointment before they leave the hospital.
- As a prescriber of an antidepressant for a first-time user, encourage members to follow-up with you for medication re-fills as needed.
- As a prescriber of an ADHD medication for a first-time user, see the child at least once within the first month, and twice more during the next nine months.
- Identify teens and adults newly diagnosed with an Alcohol and Other Drug Dependence (AOD) disorder, and encourage them to attend visits or a program at least twice within the first 30 days of diagnosis.
Magellan may contact you to obtain information on these types of activities; be assured that its release is allowed under the Health Insurance Portability and Accountability Act (HIPAA).
Thank you for encouraging behavioral health treatment engagement and improving our members’ quality of life. Please feel free to provide any suggestions or ask questions about HEDIS by contacting NCQA or your Magellan network representative.