Empire BlueCross BlueShield HealthPlus needs to report measurements according to the HEDIS® Quality Assurance Reporting Requirements (QARR) for measurement year 2018. Four new measures are specific to New York State, and two of them apply to pharmacotherapy:

  • Use of Pharmacotherapy for Alcohol Abuse or Dependence — This measure captures the percentage of members with an alcohol abuse or dependence diagnosis using at least one prescription medication for appropriate pharmacotherapy during the measurement year.
  • Initiation of Pharmacotherapy upon New Episode of Opioid Dependence — This measure captures the percentage of members who initiate pharmacotherapy with at least one prescription or visit for opioid treatment medication within 30 days following an index visit and opioid dependence diagnosis.
  • Continuity of Care from Inpatient Rehabilitation for Alcohol and Other Drug Abuse or Dependence Treatment to Lower Level of Care — This two-part measure pertains to members 13 and older who receive inpatient treatment for either alcohol or other substance dependence and who have had a follow-up lower-level visit for alcohol or substance dependence within 14 days of the discharge date.
  • Potentially Preventable Mental Health Related Readmission Rate 30 Days — This measure addresses the importance of outpatient continuity of care for both behavioral health and physical health concerns. This measure will be calculated by the New York State Office of Quality and Patient Safety.

 

In addition to those four measures, we continue to track the following measures:

  • Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) — This measure addresses patients newly diagnosed with a substance use disorder, recommending that they are seen within 14 days of their diagnosis for a follow-up visit. After this visit, it is recommended they are seen for two more visits within 30 days. Another requirement of this measure is that all members receiving mental health treatment are screened during intake for substance abuse. All visits must be documented.
  • Follow-Up After Emergency Department Visit for Mental Illness/Follow-Up After Emergency Department Visit for Alcohol and Other Drug Dependence (FUM/FUA) — These measures require that members with primary mental health or primary substance abuse diagnoses are seen by an outpatient provider within seven days following discharge from an emergency room visit. Commitment to these important measures will address preventive, acute and chronic behavioral health care issues for members.

 

Thank you for your collaboration on HEDIS QARR measures. Please remember to document your hard work.

 



Featured In:
August 2018 Empire Provider Newsletter