Transcript No Slide Title

Behavioral Health Quality:
HEDIS - Initiation & Engagement of Alcohol &
Other Drug Dependence Treatment - 2007
What Is “HEDIS”?
A set of standardized Performance measures
Evaluates health plans using quality
dimensions
Standard reporting allows results to be reliably
and fairly compared to each other
Reports available to purchasers and customers
Maintained by NCQA
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Behavioral Health HEDIS Measure:
Initiation and
Engagement of Alcohol & Other Drug Dependence Treatment
There are Three Components:
•
% of Total Health Plan Members Identified as
using Alcohol or Other Drug Services (IAD)
•
% of Identified Members that Initiate Treatment
(i.e., either they are discharged from an inpatient [non-detox] AOD
admission; or they have an ER or Outpatient AOD service and then
one additional AOD service (not an ER visit) within 14 days) [13 y/o
or older]
•
% of Initiated Patients that Engage in Treatment
(i.e., receive 2 more AOD services (not an ER visit) within 30 days
of Initiation) [13 y/o or older]
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Identification of Alcohol and Other Drug Dependence [IAD] Treatment
Any Services
HEDIS 2004-2007
10%
2004
2005
2006
2007
9%
8%
7%
6%
5%
4%
3%
2%
1%
0.82% 0.75% 0.82%
0%
Arizona Health Net
0.47% 0.60% 0.57% 0.72%
0.82% 0.93% 1.18% 1.22%
0.59% 0.64% 0.74% 0.74%
0.41% 0.51% 0.62% 0.59%
California Health Net
Connecticut Health Net
New Jersey Health Net
New York Health Net
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Initiation of Alcohol and other Drug Treatment [IET-Initiation]
HEDIS 2004-2007
2004
2005
2006
2007
100%
90%
80%
57.56%
61.20%
62.53%
50.48%
51.88%
57.79%
60.38%
44.94%
56.69%
62.67%
55.30%
49.99%
58.57%
44.68%
43.44%
40%
52.92%
50%
51.49%
60%
60.50%
70%
30%
20%
10%
0%
Arizona Health Net Plan
California Health Net Plan
Connecticut Health Net
Plan
New Jersey Health Net
Plan
New York Health Net Plan
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Engagement in Alcohol and other Drug Treatment [IET-Engagement]
HEDIS 2004-2007
2004
2005
2006
2007
100%
90%
80%
70%
60%
50%
40%
Arizona Health Net Plan
California Health Net Plan
Connecticut Health Net
Plan
New Jersey Health Net
Plan
23.29%
29.12%
19.75%
18.50%
22.36%
25.48%
18.48%
15.57%
28.28%
24.90%
16.76%
9.39%
15.29%
7.30%
8.74%
0%
14.33%
10%
13.53%
20%
21.05%
30%
New York Health Net Plan
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Behavioral Health HEDIS Measure: Initiation and Engagement of Alcohol & Other
Drug Dependence Treatment
What Medical Case Managers Can Do:
• Carefully ask about alcohol and other drugs and screen for
problem use
•
Encourage a follow-up session soon after the evaluation
session (within 14 days)
•
Encourage patients to follow through, especially after HLOC,
express interest in their progress
•
Encourage practitioners/facilities to document any AOD
diagnosis
•
Give advice, offer resources and consider referral to NA or AA
if needed
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Behavioral Health HEDIS Measure: Initiation and Engagement of
Alcohol & other Drug Dependence Treatment (IET)
•
What PCPs Can Do:
–
Carefully ask about AOD & screen for problem use
–
Make sure the diagnosis is listed (in chart, on claim)
–
Make sure a follow up session occurs soon after evaluation
session (within 14 days)
–
Encourage patients to follow through; express interest in
their progress
–
Make a clear statement about needing to cut down if use is
problematic. Give Advice.
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2-Question Screener
(from Brown et al, Journal of the American Board of Family Practice, 2001)
“Have you felt you wanted or needed to cut
down on your drinking or drug use in the last
year?”
“In the last year, have you ever drunk or used
drugs more than you meant to?”
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4-Question Screener- CAGE-AID
(Cage Adapted to Include Drugs)
Have you ever felt you should Cut down on your drinking or
drug use?
Yes_____
No_____
Have people Annoyed you by criticizing your drinking or drug
use?
Yes_____
No_____
Have you ever felt bad or Guilty about your drinking or drug
use?
Yes_____
No_____
Have you ever had a drink or used drugs first thing in the
morning to steady your nerves or get rid of a hangover or
residual drug effects (Eye opener)?
Yes_____
No_____
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Screening For Problem Alcohol Use
(from NIAAA’s Helping Patients Who Drink Too Much:Clinician’s Guide, 2005 Edition )
“How many times in the past year have you had
5 or more drinks in a day (for men)?”
4 or more drinks in a day (for women)?”
_______
If one or more, then ask the following:
On average, how many days a week do you have an alcoholic
drink?
_______
On a typical drinking day, how many drinks do you have?
_______
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What a Medical Care Manager (or Physician)
Might Say If a Member Screens Positive:
[based on Kainz, Professional Psychology, 2002]
"I have some concerns about what you have told me about
your alcohol/other drug use. I'd like you to consider seeing
a substance abuse specialist for an evaluation. This is not
necessarily a commitment to going for treatment, but I'd like
to see if there are any treatment interventions that could be
helpful for you. Here's the 800 number (found on the back of
the member’s Health Plan card) to call to get a referral from
your plan. Feel free to give me a call after the evaluation or
if you have any trouble setting it up and together we can
decide on the next logical step. How does that sound?
Would you be willing to give it a try?"
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Substance Abuse Resources
•
12 step programs can be found in the phone book or
online at www.aa.org, ttp://www.na.org/index.htm
•
Other info at www.niaa.nih.gov
•
Members Can Take a Free Emotional Health SelfAssessment or Access Self-Help Programs Online: Log on
to www.healthnet.com [>Wellsite>Condition
Centers>Depression>HN Resources>Learn More>SelfAssessments or Self-Help Programs>Alcohol & Substance
Abuse].
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Substance Abuse Resources
•
Members Can Listen to Free Mental Health and Substance Abuse
Info By Phone: Call 1-800-893-5597 (Push Option #2).
•
Members Can Learn Skills Online: Go to www.healthnet.com
[>Make an Informed Decision>It’s Your Life-Wellsite>Emotional
Health>Self-Assessments or Self-Help Programs] to see online
programs which teach skills for dealing with depression,
insomnia, stress and anxiety.
•
Members Can Find Out About Mental Health Specialists at MHN:
–
Go to Health Net’s web site at www.healthnet.com [>Doctor
Search>Behavioral Health] and find out which psychiatrists,
psychologists or other behavioral health practitioners are in-network
with MHN.
–
Call the 800 on member’s ID card and speak to an intake specialist
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Behavioral Health HEDIS Measure: Initiation and Engagement of
Alcohol & other Drug Dependence Treatment (IET)
What MHN Associates Can Do:
–
Encourage accurate listing of diagnoses even if CD is
secondary (in chart, on claim, on RFR, in authorization
screens)
–
Make sure treatment starts soon after evaluation (within 14
days)
–
Encourage patients to follow through after Higher Level of
Care discharges (CMA calls)
–
Carefully ask about CD issues, regardless of presenting
complaint, when speaking to members seeking treatment
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