HEDIS 2017Behavioral HealthHEDIS MEASURES

What is HEDIS?The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of standardized performance measures designed to ensure that the public has the information it needs to compare organization performance.

HEDIS is one component of a larger accountability system and complements the NCQA Accreditation Program. When combined, the results of NCQA Accreditation and HEDIS provide the most complete view of organization quality available to purchasers and consumers.

HEDIS Measures Domain

HEDIS

Effectiveness of Care

Access / Availability of

Care

Experience of Care

Utilization and Risk Adjusted

Utilization

Relative Resource Use

Health Plan Descriptive Information

Measure Collected

using ECDS

Behavioral HealthADD

Follow-Up Care for Children Prescribed

ADHD Medication

AMM

Antidepressant Medication

Management

FUHFollow-Up

After Hospitalization

for Mental Illness

FUMFollow-Up After

Emergency Department Visit for Mental Illness (new measure)

FUA

Follow-Up After Emergency Department

Visit for Alcohol and Other Drug

Dependence(new measure)

SSDDiabetes

Screening for People With

Schizophrenia or Bipolar

Disorder Who Are Using

Antipsychotic Medications

SMDDiabetes

Monitoring for People With Diabetes and

Schizophrenia

SMCCardiovascular Monitoring for

People With Cardiovascular

Disease and Schizophrenia

SAAAdherence to Antipsychotic

Medications for Individuals With Schizophrenia

APMMetabolic

Monitoring for Children and

Adolescents on Antipsychotics

AMM

IPSD: Index Prescription star Date.

Exclusions: members in hospice are excluded

Ages: 18 years and older as of April 30 of the MY.

Event: Determine the IPSD. Identify the date of the earliest dispensing event for an antidepressant medication during the Intake Period.

ANTIDEPRESSANT Medication Management

Antidepressant MedicationDescription Prescription

Miscellaneous antidepressants

Bupropion Vilazodone Vortioxetine

Monoamine oxidase inhibitors

Isocarboxazid Phenelzine

Selegiline Tranylcypromine

Phenylpiperazine antidepressants

Nefazodone Trazodone

Psychotherapeutic combinations

Amitriptyline-chlordiazepoxide Amitriptyline-perphenazine

Fluoxetine-olanzapine

SNRI antidepressants Desvenlafaxine Duloxetine

Levomilnacipran Venlafaxine

SSRI antidepressants Citalopram Escitalopram

Fluoxetine Fluvoxamine

Paroxetine Sertraline

Tetracyclic antidepressants

Maprotiline Mirtazapine

Tricyclic antidepressants Amitriptyline Amoxapine Clomipramine

Desipramine Doxepin (>6 mg) Imipramine

Nortriptyline Protriptyline Trimipramine

ADDFollow- up Care for Children Prescribed ADHD Medication

Intake Period: The 12 month window starting March 1 of the year prior to the measurement year and ending February 28 of the MY.

IPSD: The earliest prescription dispensing date for an ADHD medication where the dates is the Intake Period and there is a Negative Medication History.

Ages: Six years as of March 1 of the year prior to the measurement year to 12 years as of February 28 of the MY.

Exclusions: members in hospice are excluded, members who had an acute impatient encounter for mental health or chemical dependency during 30 days after the IPSD.

ADHD medicationDescription Prescription

CNS stimulants Amphetamine-dextroamphetamine

Dexmethylphenidate

Dextroamphetamine Lisdexamfetamine

Alpha-2 receptor agonists

Clonidine Guanfacine

Miscellaneous ADHD medications

Atomoxetine

FUHFollow – up after Hospitalization for Mental Illness

Ages: 6 years and older as of the date of discharge.

Event: Acute Inpatient discharge with a principal diagnosis of mental illness on or between January 1 and December 1 of the MY.

Exclusions: Exclude discharge followed by readmission or direct transfer to an acute inpatient care setting with the 30 , regardless of principal diagnosis for the readmission.

FUM Follow – Up After Emergency Department Visit for Mental Illness

First – year measure

Description: The percentage of emergency department (ED) visits for members 6 years of age and older with a principal diagnosis of mental illness, who had a follow-up visit for mental illness. Two rates are reported: The percentage of ED visits for which the member received follow-up within 30 days

of the ED visit. The percentage of ED visits for which the member received follow-up within 7 days

of the ED visit.

Ages: 6 years and older as of the date of the ED visit.

Events: An ED visits with a principal diagnosis of mental illness on or between January 1 and December 1 of the MY.

FUAFollow – Up After Emergency Department Visits for Alcohol and other Drug

Dependence

Description: The percentage of emergency department (ED) visits for members 13 years of age and older with a principal diagnosis of alcohol or other drug (AOD) dependence, who had a follow up visit for AOD. Two rates are reported: The percentage of ED visits for which the member received follow-up within 30

days of the ED visit. The percentage of ED visits for which the member received follow-up within 7 days

of the ED visit.

Ages: 13 years and older as of the ED visits. Report 3 ages stratification and total rate13-17 years, 18 and older and total.

Event: An ED visit with a principal diagnosis of AOD on or between the January 1 of the MY

.

SSD Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who

are Using Antipsychotic Medications

Description: The percentage of members 18–64 years of age with schizophrenia or bipolar disorder, who were dispensed an antipsychotic medication and had a diabetes screening test during the measurement year.

Ages: 18-64 years as of December 31 of the MY.– Members with schizophrenia or bipolar disorder as those who met at least on the following criteria

during the MY.– At least one acute inpatient encounter, with diagnosis of schizophrenia or bipolar disorder.– At least two visits in an outpatient , intensive outpatient, partial hospitalization, ED or non acute

inpatient setting, on different dates of service with any diagnosis of schizophrenia. – At least two visits in an outpatient , intensive outpatient, partial hospitalization, ED or non acute

inpatient setting, on different dates of service with any diagnosis of bipolar disorder.

• Exclusions: Patients with Diabetes

Antipsychotic Medications

Description PrescriptionMiscellaneous antipsychotic agents

Aripiprazole Asenapine Brexpiprazole Cariprazine Clozapine Haloperidol Iloperidone

Loxapine Lurisadone Molindone Olanzapine Paliperidone Pimozide Quetiapine

Quetiapine fumarate

Risperidone Ziprasidone

Phenothiazine antipsychotics

Chlorpromazine Fluphenazine Perphenazine

Perphenazine-amitriptyline

Prochlorperazine

Thioridazine Trifluoperazine

Psychotherapeutic combinations

Fluoxetine-olanzapine

Thioxanthenes Thiothixene Long-acting injections Aripiprazole

Fluphenazine decanoate Haloperidol decanoate

Olanzapine Paliperidone

palmitate Risperidone

SMDDiabetes Monitoring for People with Diabetes and

Schizophrenia

Description: This measure assesses the percentage of members 18–64 years of age with schizophrenia and diabetes, who had both an LDL-C test and an HbA1c test during the measurement year.

Ages: 18 – 64 years of age as of December 31 of the MY

Event: Identify members with schizophrenia as those who met at least one of the following criteria during the MY.

– At least one acute inpatient encounter, with any diagnosis of schizophrenia– At least two visits in an outpatient, intensive outpatient, partial hospitalization , ED or no

acute inpatient setting, on different dates of service with any diagnosis of schizophrenia. – Identify patient who also have diabetes.

SMCCardiovascular Monitoring for People with Cardiovascular Disease and

Schizophrenia

Description: This measure assesses the percentage of members 18–64 years of age with schizophrenia and cardiovascular disease, who had an LDL-C test during the measurement year.

Ages: 18- 64 years as of December 31 of the MY

Enrollment : The MY and the year prior to the MY

Event: Identify members with schizophrenia as those who met at least one of the following criteria during the MY.

– At least one acute inpatient encounter, with any diagnosis of schizophrenia– At least two visits in an outpatient, intensive outpatient, partial hospitalization , ED or no

acute inpatient setting, on different dates of service with any diagnosis of schizophrenia. – Identify patient who also have cardiovascular disease.

Questions