Providers can play an important role in talking with our members about the signs of substance use disorder and encouraging them to seek help, if appropriate. We’ve created resources for members that may help.
We track two quality measures related to substance use disorders:
· Initiation and Engagement of Substance Use Disorder Treatment (IET)
· Follow-up after Emergency Department Visit for Substance Use (FUA)
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 substance use disorder. 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). See our tip sheet.
What FUA Measures
FUA applies to members ages 13 and older with a principal diagnosis of substance use disorder during an emergency department (ED) visit. The measure captures rates for follow-up visits for substance use disorder 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. See our tip sheet.
Tips to Consider
· Discuss the importance of timely follow-up visits with our members.
· Use the same diagnosis for substance use at each follow-up.
· Coordinate care between behavioral health and primary care providers. 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.