BCBSM measures, promotes clinical effectiveness for mental health

Blue Cross Blue Shield of Michigan is committed to improving the quality of mental health treatment delivered to our customers. For that reason, we encourage physicians to follow treatment standards developed by the Michigan Quality Improvement Consortium and one additional standard developed by BCBSM. We are also tracking some aspects of care quality by using measures within the Healthcare Effectiveness Data and Information Set, or HEDIS.

MQIC has two guidelines directed to mental health concerns, including:

•  The Primary Care Diagnosis and Management of Adults with Depression Guideline addresses key components of detection and diagnosis using validated screening tools (PHQ-2 and PHQ-9) and DSM-IV (Diagnostic and Statistical Manual, 4th edition, American Psychiatric Association) criteria. It includes recommendations in screening for suicidal risk and management of patients on antidepressant medication. (The latter includes conditions in which referral to a behavioral health specialist is advised.) 
• The Screening, Diagnosis, and Referral for Substance Use Disorders Guideline should be followed at every health maintenance exam or initial pregnancy visit, and also includes the HEDIS standards of treatment initiation and follow-up within 14 and 30 days, respectively. The MQIC guidelines may be viewed at MQIC.org.

Blue Cross Blue Shield of Michigan’s clinical practice guideline on Diagnosis and Management of Attention Deficit Hyperactivity Disorder is a useful summary of the core symptoms leading to detection and diagnosis, elements of nonpharmacological management and proper initiation of pharmacotherapy (beginning with stimulants as first line therapy), as well as common comorbid conditions frequently seen with adult ADHD. This guideline may be found on web-DENIS in the online provider manuals, “Best Practices” chapter.

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

• Follow-up after hospitalization for mental illness — 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 are treated with an antidepressant through 12 weeks (acute phase) of prescription therapy, and six additional months of (continuous phase) prescription therapy
• Follow-up care for children prescribed attention deficit hyperactivity disorder medication — Proportion of children prescribed medication for ADHD who receive at least one follow-up visit within 30 days of medication initiation, followed by 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 dependence who receive treatment within 14 days, followed by two additional services within 30 days

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