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August 2015

Blue Cross 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. As a result, we’re taking the following actions:

  • Encouraging all health care professionals to follow treatment guidelines developed by the Michigan Quality Improvement Consortium in connection with Blue Cross
  • Tracking certain aspects of quality using measures in the Healthcare Effectiveness Data and Information Set, also known as HEDIS®

MQIC guidelines
MQIC now has three guidelines focused on common conditions in mental health. These conditions include attention deficit hyperactivity disorder, depression and substance abuse.

  1. Diagnosis and management of ADHD (new)
    • Symptom assessment leading to detection and diagnosis
    • Elements of non-pharmacological management and proper initiation of pharmacotherapy
    • Common co-morbid conditions frequently seen with ADHD
    • Follow-up during the 30 days following initiation of pharmacotherapy and twice during the following nine months, the continuation and maintenance phase
  2. 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 of Mental Disorders, 4th edition, or DSM-IV.
    • The guideline includes recommendations for screening for suicidal risk and management of patients on antidepressant medication. This includes conditions and circumstances in which referral to a behavioral health specialist is advised.
    • Guideline for titration of medications and routine follow-up, typically at least monthly.
    • Guideline advises that patients should remain on medication at least nine to 12 months until symptoms completely resolve. May require longer treatment, particularly for recurrent major depression, which often requires lifelong treatment.
  3. Screening, diagnosis and referral for substance use disorders
    • This guideline should be followed at every health maintenance exam or first pregnancy visit.
    • The guideline includes the HEDIS standard of treatment initiation and follow-up within 14 and 30 days, respectively.

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

HEDIS measures
Four HEDIS measures are related to behavioral health services, including:

  • Antidepressant medication management
  • Follow-up care for children prescribed ADHD medication
  • Follow-up after hospitalization for mental illness
  • Initiation and engagement of alcohol and other drug dependence treatment

Blue Cross’ Physician Group Incentive Program endorses all of the behavioral health measures in its tracking initiative (evidence-based care reporting).

**Blue Cross Blue Shield of Michigan does not own or control this website.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.