Behavioral Health HEDIS Measures

I remember many, many years ago when NCQA intended, and indeed tried, to create a robust set of behavioral health measures within HEDIS. For numerous reasons, a prominent one being the inconsistent availability of claims data by MBHOs, a major "target" of the behavioral health HEDIS measures, the effort never came to fruition.

In the current HEDIS public comment, NCQA is proposing a number of new measures related to behavioral health. I'm not sure what NCQA's long term plan is, but it wouldn't surprise me if the accreditation decision-making process for MBHOs were to morph in a manner that reserved the highest level of accreditation for those organizations that could submit audited results for the behavioral health subset of HEDIS measures.

In any case, you can find the public comment documents here. You have until close of business on March 14, 2012 to submit your comments to NCQA.

All the new behavioral-health related measures are being proposed for Medicaid only. Here's a brief run-down of the proposed new measures:

1. Continuity of Antipsychotic Medications for Treatment of Schizophrenia: The percentage of members 25–64 years of age with a diagnosis of schizophrenia who remained on an antipsychotic medication for at least 80 percent of their treatment period.
2. Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications: The percentage of members 25–64 years of age with a diagnosis of schizophrenia or a diagnosis of bipolar disorder, who were prescribed any antipsychotic medication and received a diabetes screening test during the measurement year.
3. Cardiovascular Health Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications: The percentage of members 25–64 years of age who were diagnosed with schizophrenia or bipolar disorder and prescribed any antipsychotic medication, and who received a cardiovascular health screening during the measurement year.
4. Diabetes Monitoring for People with Diabetes and Schizophrenia: The percentage of members 25–64 years of age who were diagnosed with schizophrenia and with diabetes, and received both an LDL-C test and an HbA1c test during the measurement year.
5. Cardiovascular Health Monitoring for People with Cardiovascular Disease and Schizophrenia: The percentage of members 25–64 years of age with a diagnosis of schizophrenia and a diagnosis of cardiovascular disease, who received a cardiovascular health monitoring test during the measurement year.
6. Cervical Cancer Screening for Women with Schizophrenia: The percentage of women 21–64 years of age with a diagnosis of schizophrenia who received one or more Pap tests to screen for cervical cancer.
7. Follow-Up after Hospitalization for Schizophrenia: The percentage of discharges for members 25–64 years of age and older who were hospitalized for treatment of schizophrenia and who had an outpatient visit, an intensive outpatient encounter or partial hospitalization with a mental health practitioner. Two rates are reported: the percentage of discharges for which the member received follow-up within 30 days of discharge and the percentage discharges for which the member received follow-up within 7 days of discharge