OM: New HEDIS Measures Target Diabetes, Cardio, Cancer Treatment for People Diagnosed w SMIs

Seven New HEDIS Medicaid Measures Target Schizophrenia, Bipolar Disorder

Open Minds March 19, 2012

Seven new care management measures for schizophrenia and bipolar disorder have been proposed for addition to the 2013 Healthcare Effectiveness Data and Information Set (HEDIS) for Medicaid. The new measures are intended to address identification and quality care management for people with serious mental illness who are at greater risk for morbidity and mortality from adverse outcomes due to lack of medication adherence, lack of preventive care, and gaps in treatment. The federal Department of Health and Human Services (HHS) included these new measures among the initial set of 26 quality measures for Medicaid-eligible adults released on January 4, 2012. The HHS quality measures are intended for state Medicaid agencies; use of the measures is voluntary.

On February 14, 2012, National Committee for Quality Assurance (NCQA) released the proposed measures for a one-month comment period, which closed March 14, 2012. This new set of proposed measures for SMI were based on 2011 research conducted by NCQA and Mathematica Policy Research. They conducted a field test to determine a baseline for the proposed measures using a Medicaid Analytic Extract; the dataset included fee-for-service data for beneficiaries in 22 states. About 10% of the Medicaid population in the data set was identified as having schizophrenia (98,412 individuals) and another three percent as having bipolar disorder (130,529 individuals).

2012 Mental Health-Related HEDIS Quality Measures For Medicaid-Eligible Adults

Measure	Description	NCQA Field Test Baseline Result
Use of Antipsychotic Medications for Schizophrenia Treatment	The percentage of members 25-64 years of age with a diagnosis of schizophrenia who remained on an antipsychotic medication for at least 80% of their treatment period.	An average of 65.7% of the individuals maintained continuous treatment with an antipsychotic for at least 80% of the time. The range across the states was 48.3% to 84.6%.
Schizophrenia/bipolar disorder and antipsychotic use: Diabetes screening	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.	An average of 12.1% of individuals received diabetes screening test. The range across the states was 2.3% to 28.2%.
Schizophrenia/bipolar disorder and antipsychotic use: Cardiovascular screening	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.	An average of 43.9% of individuals received cardiovascular health screening. The range across the states was 6.9% to 63.3%.
Schizophrenia and diabetes: Diabetes monitoring	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.	An average of 57.3% of individuals received LDL-C test and an HbA1c test. The range across the states was 9.1% to 81.6%.
Schizophrenia and cardiovascular health: Cardiovascular monitoring	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.	An average of 54.5% of individuals received cardiovascular health monitoring test. The range across the states was 11.7% to 85.7%.
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.	An average of 24.4% of females in the sample received one or more Pap tests. The range across the states was 7.9% to 34.8%.
Follow-Up After Hospitalization for Schizophrenia at seven and 30 days	The percentage of members 25-64 years of age with a diagnosis of schizophrenia who had an outpatient visit, intensive outpatient encounter, or partial hospitalization following discharge from a hospitalization for schizophrenia.	An average of 36% of individuals received follow-up care at seven days and 69.7% received follow-up care at 30 days. The range across the states was 8.3% to 66.1% for seven days, and 25.6% to 88.5% for 30 days.

NCQA is a private, non-profit organization dedicated to improving health care quality; as part of its work, NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. The HEDIS measures are developed and maintained by NCQA as a tool to assess how often insurers provide recommended tests and treatments. The HEDIS measures are primarily used as a performance measurement tool. The final 2013 measures are slated to publish in July 2012.

A link to the full text of “Proposed Measures for HEDIS 1 2013: Schizophrenia Continuity of Antipsychotic Medications for Treatment of Schizophrenia” may be found in The OPEN MINDS Circle Library at www.openminds.com/library/030112mhcdhedis2013antipsychoticmeds.htm.

A link to the full text of “Proposed Measures for HEDIS 1 2013: Schizophrenia Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications” may be found in The OPEN MINDS Circle Library atwww.openminds.com/library/030112mhcdhedis2013diabetesscreening.htm.

A link to the full text of “Proposed Measures for HEDIS 1 2013: Schizophrenia Cardiovascular Health Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications” may be found in The OPEN MINDS Circle Library atwww.openminds.com/library/030112mhcdhedis2013cardiovascularscreening.htm.

A link to the full text of “Proposed Measures for HEDIS 1 2013: Schizophrenia Diabetes Monitoring for People With Diabetes and Schizophrenia” may be found in The OPEN MINDS Circle Library at www.openminds.com/library/030112mhcdhedis2013diabetesmonitoring.htm.

A link to the full text of “Proposed Measures for HEDIS 1 2013: Schizophrenia Cardiovascular Health Monitoring for People With Cardiovascular Disease and Schizophrenia” may be found in The OPEN MINDS Circle Library atwww.openminds.com/library/030112mhcdhedis2013cardiovasclrmonitoring.htm.

A link to the full text of “Proposed Measures for HEDIS 1 2013: Schizophrenia Cervical Cancer Screening for Women With Schizophrenia” may be found in The OPEN MINDS Circle Library at www.openminds.com/library/030112mhcdhedis2013cervclcancerscrning.htm.

A link to the full text of “Proposed Measures for HEDIS 1 2013: Schizophrenia Follow-Up After Hospitalization for Schizophrenia” may be found in The OPEN MINDS Circle Library at www.openminds.com/library/030112mhcdhedis2013hosptlznfollwup.htm.

OPEN MINDS also reported on this topic in “HHS Releases Adult Medicaid Health Care Quality Measures.” The article is available at www.openminds.com/market-intelligence/basic/omolfree/022012strat5.htm#axzz1orhtmLuQ.

For more information, contact: Andy Reynolds, Assistant Vice President, Marketing and Communications, 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:reynolds@ncqa.org; Web site: www.ncqa.org.

Seven New HEDIS Medicaid Measures Target Schizophrenia, Bipolar Disorder. (2012, March 19). OPEN MINDS Weekly News Wire.

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