2013 HEDIS^® Initiation and Engagement of Alcohol and Other Drug Dependence Results

As noted on the NCQA website, the Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of health plans in the United States to measure performance on important areas of care and service. Collectively, HEDIS consists of 75 measures across eight categories of care.

HEDIS measurements that are specific to Behavioral Health services include, but are not limited to:

• Antidepressant medication management (AMM)
• Initiation and engagement in treatment following a substance abuse diagnosis (IET)
• Seven and 30-day follow up after a mental health hospitalization (FUH)
• Follow-up care for children prescribed ADHD medication (ADD)

The IET HEDIS metric includes the percentage of adolescent (13-plus years) and adult members with a new episode of alcohol or other drug dependence who received the following services:

• Initiation of Alcohol and Other Drug Dependence (AOD) Treatment – Treatment was initiated by members through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis.
• Engagement of Alcohol and Other Drug Dependence (AOD) Treatment – The percentage of members who initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of the initiation visit.

The goal of this measurement is to help ensure that members who receive an AOD diagnosis pursue and engage in treatment after the initial diagnosis.

On an annual basis, HEDIS measurements are calculated and compared to national averages. The 2013 national average for the IET Initiation was 40.15 and the 2013 national average for the IET Engagement was 14.06. In 2013, the average IET initiation for Blue Cross and Blue Shield of Texas (BCBSTX) members was 37.99 and the IET Engagement was 11.46.

What is BCBSTX Doing to Help Increase Member Participation?
BCBSTX has implemented a formal Quality Improvement Program (QIP) to help increase the number of members initiating and engaging in alcohol or other drug dependence treatment. Programs will be implemented to facilitate coordination with facilities and providers to identify members admitting with a diagnosis of alcohol or other drug dependence, as well as to assist members with setting up post discharge follow-up care.

What Can You Do to Help?
You may identify patients during the initiation of treatment for substance dependence and encourage them to seek ongoing treatment to prevent future relapse. You may assist your patients by discussing treatment options and facilitating follow-up care. If you feel that a patient may need counseling or psychiatric referrals, you also have the option to refer them to the BCBSTX Behavioral Health Case Management Program by calling the number on the back of the member’s ID card.

To share feedback or learn more, visit the Clinical Resources/Behavioral Health Care Management Program section of the BCBSTX provider website.

HEDIS is a registered trademark of the NCQA.