Quality group disappointed by plans’ behavioral health performance

The National Committee for Quality Assurance (NCQA) reports that quality within behavioral health care delivery still has a long way to go. The committee’s annual report, released today, encapsulates data on physical and behavioral health gathered from more than half of the health plans in the country.

Among the 139 measures that make up the 2014 report, over a three to five year measurement period, 64 measures (46 percent) had consistent and statistically significant performance gains, and 11 measures (8 percent) had performance declines. The report currently measures only eight behavioral health performance indicators, but more are in the works.

 “The glass is half full, and it’s also still half empty,” NCQA President Margaret E. O’Kane said in a conference announcing the “State of Health Care Quality 2014” today.

Performance on mental health and addiction treatment metrics is weakest among the categories. But four new measures that have just started tracking this year and three new measures that NCQA plans to introduce next year will help bring needed attention to behavioral health, according to O’Kane. She said behavioral health stands out as an opportunity to improve.

“We know, as we pore over healthcare data, that people with behavioral health issues are often high users of medical care as well,” she said. “There is an argument to be made about appropriate care for behavioral health.”

For example, the report notes there is a lack of follow-up care within 30 days for those who have experienced a mental health inpatient stay. Declines were highest among commercial health plans, with only 72.8 percent of HMOs and 69 percent of PPOs  following up with patients post-discharge in the 2013 plan year, compared to 76 percent and 72.2 percent, respectively, in the previous year.

 “I find this hard to believe—I don’t doubt it, but I’m just shocked that we’re not at a higher point,” O’Kane said. “The idea that a person would come out of the hospital and not have appropriate follow up is not right, and it’s not smart.”

New measures

O’Kane says NCQA has increased the number of quality measures that health plans track for behavioral health—from four in the 2013 report, to eight in 2014, to 11 upcoming in 2015. The increased attention to the measures is a reflection not just of the magnitude of  behavioral health, but also of the emerging trend of increasing numbers of Americans with health-plan coverage.

“Many with chronic serious mental illness are now being put into managed care plans, and we want to make sure they get state-of-the-art care,” she said.

Four new measures for behavioral healthcare added to the current NCQA roster include:

1.       Diabetes monitoring for those with schizophrenia or bipolar disorder who use antipsychotic medications;

2.       Diabetes monitoring for those with schizophrenia and diabetes;

3.       Cardiovascular monitoring for those with schizophrenia and cardiovascular disease; and

4.       Adherence to antipsychotic medications for those with schizophrenia.

Because the measures are new, no trends can be reported yet. However, as one example of the emerging data, Medicaid HMOs so far have reported 60.1% of their members on antipsychotic medications are adherent.

In 2015, additional measures will include:

1.       Use of multiple concurrent antipsychotics in children and adolescents;

2.       Metabolic monitoring of children and adolescents on antipsychotics; and

3.       Use of fist line psychosocial care for children and adolescents on antipsychotic medications.

Substance use program

NCQA tracks initiation and engagement of alcohol and other drug dependence treatment and found that numbers are slacking. For example, commercial HMOs reported 39.1 percent of those with a new episode of dependence received some type of treatment initiation in last year’s report, but the number slipped to 37.6 percent this year. The pattern was similar among PPOs, Medicare and Medicaid plans.

But  O’Kane says there are examples of bright spots for improvement in behavioral health issues.

With grant support from the Open Society Foundations, the Association for Community Affiliated Plans (ACAP) has launched a substance use disorder collaborative with 16 safety net plans participating. The goal is to drive practices that produce improved outcomes. For example, plans are finding pain management alternatives, such as chiropractic care, that avoid the use of opioids, which aims to prevent addiction and help those in recovery.

“We know no plans do very well in the [quality] scores for the initiation and engagement of those with substance use disorder after diagnosis,” said Meg Murray, CEO of ACAP, speaking at the NCQA presentation today.

On average, 38% of those diagnosed initiate treatment, and about 10% get engaged in treatment, she says.  Clearly there is room for improvement. In April 2015, ACAP will release a tool kit for health plans to help them do a better job of caring for members with substance abuse disorder.

 “Behavioral health is an area where we need to look hard at some new strategies,” O’Kane said. “They are often carved out, and there are failures to coordinate between major payers and the carve outs. And we also have HIPAA and privacy getting in the way. We need to figure out a way to ensure privacy but also to ensure people get the right care.”

The NCQA study can be accessed here.

The standard measures  known as HEDIS (Health Effectiveness Data Information Set) that NCQA uses to produce its annual quality reports can be accessed here.