March 11, 2022
More than half of Americans will be diagnosed with a mental illness or disorder at some point in their lives, according to the Centers for Disease Control and Prevention. We encourage providers to talk with our members about mental health and getting help if needed. A depression screening tool can help with this conversation.
To help assess and improve our members’ care, we track these Healthcare Effectiveness Data and Information Set (HEDIS®) measures from the National Committee for Quality Assurance (NCQA):
- Antidepressant Medication Management (AMM)
- Follow-up after Hospitalization for Mental Illness (FUH)
- Follow-up after Emergency Department (ED) Visit for Mental Illness (FUM)
What AMM Measures
AMM captures the percentage of members ages 18 and older with major depression who are newly treated with antidepressant medication and remain on it. As defined by NCQA, providers who prescribe antidepressants should support members in reaching these two phases:
- Effective acute treatment phase: Adults who remained on antidepressant medication for at least 84 days (12 weeks)
- Effective continuation treatment phase: Adults who remained on antidepressant medication for at least 180 days (six months)
Each phase starts when the prescription is first filled. To help close gaps in care related to AMM, consider these tips:
- Document the date of service, diagnosis of major depression and clear evidence that antidepressant medication was prescribed.
- Help our members understand that most antidepressants take four to six weeks to work. How long treatment lasts depends on the episode severity and number of recurrences.
- Assess members within 30 days from when the prescription is first filled for any side effects and their response to treatment.
What FUH and FUM Measure
As defined by NCQA, FUH applies to members ages 6 and older who had a follow-up visit with a mental health provider after they were hospitalized for the treatment of selected mental illness or intentional self-harm. FUH captures the percentage of discharges for which members had a follow-up visit:
- Within 30 days of discharge (31 total days)
- Within seven days of discharge (8 total days)
FUM focuses on follow-up visits for mental illness after an ED visit for members ages 6 and older with a diagnosis of mental illness, according to NCQA. FUM captures the percentage of ED visits for which members had a follow-up visit:
- Within 30 days of the ED visit (31 total days)
- Within seven days of the ED visit (eight total days)
To help close gaps in care, EDs and hospitals can help members schedule an in-person or telehealth follow-up visit with a mental health provider within seven days of discharge. The follow-up visit must be on a different date than the discharge date. Professional providers may want to consider:
- Encouraging members to bring their discharge paperwork to their first appointment.
- Using the same diagnosis for mental illness at each follow-up visit. A non-mental illness diagnosis code will not fulfill this measure.
- Coordinating care between behavioral health and primary care providers.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.
HEDIS is a registered trademark of NCQA.