Follow-Up Care for Substance Abuse Disorders

04-21-22

Alcohol-related deaths in the U.S. increased more than 25 percent during the first year of the COVID-19 pandemic, according to a recent report in the Journal of the American Medical Association. At the same time, more than 40 million people ages 12 and older in the U.S. needed treatment for substance abuse disorder, but only about 2.6 million received it, according to the latest survey by the Substance Abuse and Mental Health Services Administration. We encourage providers to talk with our members about the signs of substance abuse disorder and urge them to seek help, if appropriate.

Closing Care Gaps

As part of monitoring and improving quality of care, we track two measures related to substance abuse:

Both are Healthcare Effectiveness Data and Information Set (HEDIS®) measures from the National Committee for Quality Assurance (NCQA).

What IET Measures

IET applies to members ages 13 and older with a new episode of alcohol or other drug abuse or dependence. The measure captures two stages of adequate and timely follow-up treatment:

  • Initiation of treatment, one treatment within 14 days of the diagnosis
  • Engagement of treatment, at least two additional treatment sessions within 34 days of the initiation appointment

Treatment may occur in an inpatient, residential, outpatient or telehealth setting or as medication-assisted treatment (MAT).

What FUA Measures

FUA applies to members ages 13 and older with a principal diagnosis of alcohol or other drug abuse or dependence during an emergency department (ED) visit. The measure captures rates for follow-up visits for alcohol or other drug abuse or dependence after an ED visit:

  • Within seven days of the ED visit (eight total days)
  • Within 30 days of the ED visit (31 total days)

If the first follow-up visit is within seven days after discharge, both rates are counted for this measure.

Tips to Consider

  • Discuss with members the importance of timely follow-up visits.
  • Use the same diagnosis for substance use at each follow-up.
  • Coordinate care between behavioral health and primary care physicians. Share progress notes and include the diagnosis for substance use.
  • Reach out to members who cancel appointments and help them reschedule as soon as possible.
  • For FUA, ED providers can help members schedule an in-person or telehealth follow-up visit within seven days. Send ED discharge paperwork to the appropriate outpatient provider within 24 hours of discharge.

 

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.