NYAPRS Note: While post discharge follow up, improvements in diabetes and cardiovascular care and increased and informed use of desired medications are important measures, it is frankly galling that the NCQA’s approach to expanding BH care measures continues to focus only on medically related measures and leaves out the social determinants of health.
Here in New York, our emerging integrated behavioral health and medical managed care initiative will also be evaluating plan performance on measures like housing stability, employment and economic status, decreased criminal justice involvement and increased access to peer support. Improved outcomes in these areas are highly correlated to improved health and decreased use of avoidable inpatient and ER services.
It’s long past time for the NCQA to extend its focus well beyond symptom management measures, especially because these measures are what will drive care for most Americans with mental health conditions.
NCQA Reports Decline In Health Plan Performance On Two Behavioral Health Quality Measures
OPEN MINDS NEWS REPORT | DECEMBER 21, 2014
Newly released National Committee for Quality Assurance (NCQA) health plan data shows an overall performance decline on behavioral health quality measures between 2012 and 2013. Of the two measures for behavioral health quality measured by the NCQA Healthcare Effectiveness Data and Information Set (HEDIS), one showed a decline and the other showed no improvement from the prior year.
The HEDIS performance measures are reported by commercial and Medicare health maintenance organizations (HMO) and preferred provider organizations (PPO) and Medicaid HMOs. For 2012 and 2013, health plans reported on the following behavioral health HEDIS measures:
- The timeliness of community-based outpatient care post discharge from a psychiatric hospitalization for members age six and older. The measure identifies the percentage of members who received outpatient follow-up within 7 days of discharge and within 30 days of discharge. The measure includes an outpatient visit, an intensive outpatient encounter, or a partial hospitalization with a mental health practitioner.
- Provision of follow-up care for children between 6 and 12 years of age diagnosed with attention deficit/hyperactivity disorder (ADHD). The measure identifies the percentage who received a follow-up visit within 30 days of their first prescription of ADHD medication, and the percentage who remained on the medication for at least 210 days, and had at least two follow-up visits with a practitioner in the 9 months subsequent to the Initiation Phase
Of the two measures, health plan quality declined on the seven-day and 30-day timeliness measures for community-based outpatient care post-discharge from a psychiatric hospitalization. Health plan quality was the same for the ADHD follow-up care measures.
The findings were released “The State of Health Care Quality.” Data for the report was submitted by 814 HMOs and 353 PPOs, representing more than 171 million people. About 54% of Americans are enrolled in health plans that report HEDIS performance to NCQA. The HEDIS measures affect multiple aspects of health care quality. Nearly half of the 139 HEDIS measures showed significant, long-term improvement. Eleven measures (8%) reported a decline over the past three to five years. Sixty-four measures (46%) reported performance gains, and another 64 measures showed a mixed result over the past three to five years.
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2012 & 2013 Health Plan Performance On Timely Outpatient Care Within 7 Days & 30 Days Following Psychiatric Discharge By Payer & Plan Structure |
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2012 |
2013 |
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|
7-Day Follow-Up |
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|
Commercial HMO |
57.9% |
54.6% |
|
Commercial PPO |
53.0% |
49.8% |
|
Medicare HMO |
38.1% |
34.5% |
|
Medicare PPO |
37.7% |
33.5% |
|
Medicaid HMO |
43.7% |
42.0% |
|
30-Day Follow Up |
||
|
Commercial HMO |
76.0% |
72.8% |
|
Commercial PPO |
72.2% |
69.0% |
|
Medicare HMO |
56.4% |
53.5% |
|
Medicare PPO |
60.6% |
56.0% |
|
Medicaid HMO |
63.6% |
60.9% |
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2012 & 2013 Health Plan Performance On Follow-Up For Initiation & Continuing Care Appointments For Children Prescribed ADHD Medication, By Payer & Plan Structure |
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|
2012 |
2013 |
|
|
Initiation |
||
|
Commercial HMO |
57.9% |
54.6% |
|
Commercial PPO |
53.0% |
49.8% |
|
Medicaid HMO |
43.7% |
42.0% |
|
Continuing & Maintenance |
||
|
Commercial HMO |
76.0% |
72.8% |
|
Commercial PPO |
72.2% |
69.0% |
|
Medicaid HMO |
63.6% |
60.9% |
The NCQA reported that it expects behavioral health measure reporting to more than double from 2013 to 2015. In 2013, the following new behavioral health-focused performance measures were implemented for Medicaid, but no other plan types reported on the measures. The new behavioral health measures include the following:
- Diabetes monitoring for people on antipsychotics for schizophrenia or bipolar disorder
- Diabetes monitoring for people with both diabetes and schizophrenia
- Cardiovascular monitoring people with heart disease and schizophrenia
- Adherence to antipsychotic medications for people with schizophrenia
- Using multiple concurrent antipsychotics in children and adolescents
- Metabolic monitoring for children and adolescents prescribed antipsychotics
- Using first-line psychosocial care for both children and adolescents taking antipsychotics
The full text of the 2014 “State of Health Care Quality” report can be viewed online atwww.ncqa.org/ReportCards/HealthPlans/StateofHealthCareQuality/2014TableofContents.aspx(accessed December 1, 2014).
OPEN MINDS reported on a the new behavioral health measures in “Seven New HEDIS Medicaid Measures Target Schizophrenia, Bipolar Disorder,” which published June 5, 2012. The article is available at www.openminds.com/market-intelligence/news/031912mhcd7.htm.
OPEN MINDS most recently reported on the NCQA quality measures in “Tufts Tops NCQA List Of Top 20 Highest Quality Private Health Plans For 2014,” which published on December 7, 2014. The article is available at www.openminds.com/market-intelligence/news/ncqa-names-top-20-highest-quality-private-health-plans-2014.htm.
For more information, contact:
- Andy Reynolds, Media Contact, National Committee for Quality Assurance, 1100 13th Street, NW, Suite 1000, Washington, District of Columbia 20005; 202-955-3500; Fax: 202-955-3599; E-mail: reynolds@ncqa.org; Website: www.ncqa.org
- Apoorva Stull, Media Contact, National Committee for Quality Assurance, 1100 13th Street, NW, Suite 1000, Washington, District of Columbia 20005; 202-955-3518; Fax: 202-955-3599; E-mail: stull@ncqa.org; Website: www.ncqa.org