HEDIS Spotlight: Antidepressant medication management

HEDIS stands for Healthcare Effectiveness Data and Information Set. It is a widely used set of performance measures utilized by the nation’s health plans, and an essential tool to ensure our members are getting the best healthcare possible. It is extremely important that our providers understand the HEDIS® specifications and guidelines. In this section of The Checkup, we will highlight different HEDIS metrics. We will provide a description of the measures, the correct billing codes to support services rendered, and tips to direct you to available resources and tools.

MEASURE: Antidepressant Medication Management

MEASURE DESCRIPTION: The percentage of members 18 years of age and older who were treated with antidepressant medication had a diagnosis of major depression and remained on an antidepressant medication treatment. This measure is strictly related to medication compliance.

Two rates are reported:

• Effective Acute Phase Treatment: The percentage of members who remained on an antidepressant medication for at least 84 days or 12 weeks.
• Effective Continuation Phase Treatment: The percentage of members who remained on an antidepressant medication for at least 180 days or six months. The clock starts at the earliest prescription dispensing date for an antidepressant medication during the intake period.

CODING:

ICD-10 CM codes for major depression: F32.0-F32.4, F32.9, F33.0-F33.3, F33.41, F33.9

TIPS:

• Talk to your patients about the new medications and encourage discussion about:
  • Expectations of how long to wait for a determination to be made about the effectiveness, since it can take three weeks or longer
  • Expectations about how long the patient may need to be on the medication based on severity and lifetime recurrence
  • Risks of discontinuing the medication prior to six months and that this is associated with a higher rate of recurrence of depression
  • Possible side effects and that they are generally not dangerous so much as bothersome
  • What the patient should do if they experience side effects
  • The importance of continuing medication, even if the patient is feeling better
  • How to get in touch with your office with questions or concerns
  • Additional factors that can contribute to improvement in symptoms along with the medication, such as aerobic exercise and counseling or therapy
  • The goal of full remission, which may involve increasing the dose even if some improvement is noted at the first follow-up visit
  • Auto-refill programs and barriers to refilling medications
• Provide written instructions to support educational messages.
• Schedule follow-up visits in three to six weeks to reassess symptoms and see if changes need to be made to type or dose of medication.
• Outreach to patients who cancel appointments and have not rescheduled.

MEASURE: Follow-up Care for Children Prescribed ADHD Medication

MEASURE DESCRIPTION: This HEDIS measure looks at the percentage of children ages 6-12 who were newly prescribed attention deficit/hyperactivity disorder (ADHD) medication and have had at least three follow-up care visits within a 10-month period; the first visit should be within 30 days of the first ADHD medication dispensed.

Two rates are reported:

• Initiation phase: Patients between 6 and 12 years of age who were diagnosed with ADHD and had one follow-up visit within 30 days of their first prescription of ADHD medication.
• Continuation and maintenance phase: Patient remained on ADHD medication and had two more visits within nine months.

CODING:

ADHD medications:

TIPS:

• When prescribing a new ADHD medication, consider starting members with a 21-day supply to ensure they return for follow up within the first 30 days.
• Schedule the return appointment to occur within 14-21 days after the initial prescription to assess effectiveness, address any side effects and adjust or refill initial prescription.
• Schedule follow-up visits while patients are still in the office.
• Have your office staff call patients at least three days before appointments.
• After the initial follow-up visits, schedule at least two more office visits in the next nine months to monitor patient’s progress.
• Be sure that follow-up visits include the diagnosis of ADHD.
• Educate your patients and their parents, guardians or caregivers about the use of and compliance with long-term ADHD medications and the disease process.
• Provide written instructions to support educational messages.
• Outreach to patients who cancel appointments and have not rescheduled.
• DO NOT continue these controlled substances without at least 2 visits per year to evaluate the child’s progress. If nothing else, you need to monitor the child’s growth to make sure he or she is on the correct dosage.