Skip to Main Content

2018 HEDIS Measures That Matter For Behavioral Health Providers

Date: 04/16/18

The National Committee for Quality Assurance (NCQA) defines the Healthcare Effectiveness Data and Information Set (HEDIS) as a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of health plans.

This year, we are focusing on partnering with behavioral health providers to provide education and support in achieving the following 2018 HEDIS measures:

Children Prescribed ADHD Medications

This measure applies to children ages 6-12 with a newly prescribed ambulatory prescription dispensed for ADHD, who had at least three follow-up visits with a practitioner with prescribing authority within 10 months.

How To Meet The Measure:

  • Explain to the child’s parent/guardian how important it is that you monitor the child.
  • Ensure that the child receives a follow-up visit within 30 days of a new prescription.
  • Ensure that the child receives at least two more follow-up visits within nine months to make sure the treatment is working properly.

What To Know:

  • Initiation Phase: The first visit must be within 30 days of when the first ADHD medication was dispensed.
  • Continuation Phase: The second and third visits must occur within nine months of the end of the Initiation Phase. One of these visits can be telephonic.

Hospitalization For Mental Illness

This measure applies to patients ages 6+ who were hospitalized for treatment of select mental health disorders, and who had a follow-up visit with a mental health practitioner within 30 days of discharge.

How To Meet The Measure:

  • Talk to the patient, or the patient’s guardian, about the importance of follow-up care.
  • If you learn a patient has been hospitalized for a behavioral health diagnosis, confirm that follow-up care has been scheduled.
  • Explain to the patient or patient’s guardian the importance of receiving consistent care for a mental health diagnosis.

What To Know:

  • The measure records two rates: Follow-up care within 30 days of discharge and follow-up care within seven days of discharge.
  • Ensure that follow-up care is accurately documented to ensure compliance.

Antidepressant medications

This measure applies to patients ages 18+ who were treated with antidepressants, had a diagnosis of major depression, and remained on antidepressants for at least six months.

How To Meet The Measure:

  • Share your expectations with the patient regarding how long it will take for the medication to take effect.
  • Discuss possible side effects and how the patient can manage them.
  • Make sure the patient knows they must keep taking the medication, even if they “feel fine.”
  • Schedule a follow-up visit within 3-6 weeks to reassess symptoms.

What To Know:

  • Effective Acute Phase Treatment: These are patients who remained on the antidepressant for at least 12 weeks.
  • Effective Continuation Phase: These are patients who remained on antidepressants for at least six months.

Antipsychotic Medications – Patients With Schizophrenia

This measure applies to patients ages 19+ with schizophrenia who are prescribed an antipsychotic medication with adherence of at least 80 percent of the treatment period.

How To Meet The Measure:

  • Schedule regular follow-up visits to make sure the medication is taken as prescribed.
  • Document the reason the medication was prescribed and the patient’s response to it.

What To Know:

  • The treatment period is defined as a Proportion of Days Covered (PDC) of at least 80 percent of the measurement year, which is 12 months.
  • Refer patients to our Case Management services for personalized intervention and support to reduce or prevent non-compliance with medication adherence.

Diabetes Screening – Patients With Schizophrenia or Bipolar Disorder

This measure applies to patients ages 19-64 with schizophrenia or bipolar disorder, who were dispensed an antipsychotic medication and had a diabetes screening test annually.

How To Meet The Measure:

What To Know:

  • Behavioral health providers can order diabetic lab tests for patients who don’t have regular contact with their PCPs, but who regularly see the behavioral health provider.

Reminder To Behavioral Health Providers

We offer many programs and support services to assist you in improving outcomes, medication adherence and treatment compliance among your behavioral health patients. Learn more about some of these programs and support services below: