Blue Cross measures and promotes clinical effectiveness for mental health treatment

Blue Cross Blue Shield of Michigan is committed to improving the quality of mental health treatment delivered to our members. To that end, we are taking the following actions:

• Encouraging doctors and other health care professionals to follow treatment standards developed by the Michigan Quality Improvement Consortium and Blue Cross
• Tracking certain aspects of care quality by using measures within the Healthcare Effectiveness Data and Information Set, also known as HEDIS

HEDIS measures
HEDIS provides four major measures related to behavioral health services, including:

• Follow-up after hospitalization for mental illness (FUH7): Proportion of patients discharged from a mental health facility who are seen by a mental health care provider within seven days of discharge
• Antidepressant medication management: Proportion of newly diagnosed depressed adults who receive an antidepressant:
  1. For 12 weeks (acute phase)
  2. For six additional months (continuation phase)
• Follow-up care for children prescribed attention deficit hyperactivity disorder medication: Proportion of children prescribed medication for ADHD who receive:
  1. At least one follow-up visit within 30 days of medication initiation
  2. At least two additional visits within the next seven months
• Initiation and engagement of alcohol and other drug dependence treatment: Proportion of patients diagnosed with alcohol and other drug dependencies who receive treatment within 14 days, followed by two additional services within 30 days

The Blue Cross Physician Group Incentive Program has endorsed two of the HEDIS-based behavioral health measures related to depression medication and follow-up for patients with ADHD in its tracking initiative (Evidence-Based Care Reports).

Michigan Quality Improvement Consortium standards
MQIC has two guidelines directed to mental health concerns, including:

• Primary care diagnosis and management of adults with depression: This guideline addresses key components of detection and diagnosis using validated screening tools (PHQ-2 and PHQ-9) and criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV). It includes recommendations for screening for suicidal risk and management of patients on antidepressant medication (including conditions and circumstances in which referral to a behavioral health specialist is advised).
• Screening, diagnosis and referral for substance use disorders: This guideline should be followed at every health maintenance exam or initial pregnancy visit. It also includes the HEDIS standards of treatment initiation and follow-up within 14 and 30 days, respectively.

You can find all of the MQIC guidelines at MQIC.org**.

Diagnosis and management of Attention Deficit Hyperactivity Disorder
Blue Cross Blue Shield of Michigan’s clinical practice guideline on diagnosing and managing ADHD summarizes:

• The core symptoms leading to detection and diagnosis
• Elements of nonpharmacological management and proper initiation of pharmacotherapy (beginning with stimulants as first-line therapy)
• Common comorbid conditions frequently seen with ADHD

This guideline may be found on web-DENIS in the online provider manuals in the “Best Practices” chapter.

**BCBSM does not control this website or endorse its general content.