Understanding behavioral health quality measures.

Track key measures to strengthen behavioral health care

Martin’s Point has partnered with Dr. Dylan McKenney, Medical Director for the MaineHealth ACO Behavioral Health Care Program, to provide education regarding behavioral health quality measures for 2024. The Behavioral Health Care Program manages the behavioral health network and performs behavioral health utilization management for Martin’s Point Health Care.

Dylan McKenney, MD is certified with the American Board of Psychiatry and Neurology in both General Psychiatry and Child and Adolescent Psychiatry. Dr. McKenney has practiced in a hospital setting for nearly 10 years and has a wealth of experience in treating a broad range of acute mental health problems.

In 2024, Martin’s Point Health Care will monitor the five HEDIS^® measures below to determine the quality of care our beneficiaries receive from our network providers. If a measure falls below the benchmark of the 75th percentile of National Commercial Quality Compass² rates, an analysis will be performed to identify opportunities and steer possible outreach to providers or beneficiaries to determine barriers and provide education.

Psychosocial care before antipsychotics.

HEDIS Measure: The percentage of children and adolescents 1–17 years of age who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as first-line treatment.

Medications like risperidone, aripiprazole and lurasidone are commonly called antipsychotics despite their use for a variety of indications. They are more commonly used to stabilize mood and to augment the treatment of depression with SSRIs and SNRIs. In many cases, these compounds are prescribed to youths who may present with challenges in emotion regulation like oppositional behavior problems or self-injury. In such off-label uses, psychosocial interventions like individual therapy, parent training, or other family-based interventions are the established first line of treatment. They are the only types of medical interventions that bring long-term improvement. While the use of these medications in such conditions may be clinically appropriate, their use should always be paired with interventions that help youths learn strategies to self-regulate. This measure of behavioral health care quality tracks psychosocial interventions to ensure that we deliver effective, evidence-based treatment that addresses the causes of symptoms rather than simply suppressing symptoms with this powerful class of medication.

Metabolic monitoring for youth on antipsychotics.

HEDIS Measure: The percentage of children and adolescents 1–17 years of age who had two or more antipsychotic prescriptions and had metabolic testing.

This important quality measure is directed at preventing the onset of metabolic problems in youths being treated with this commonly prescribed class of medication. Best practices in the treatment of youths with atypical antipsychotic medications involve monitoring lipids and hemoglobin A1c along with tracking BMI closely during treatment. Monitoring of prolactin is also indicated in cases of gynecomastia or galactorrhea that emerge during treatment.

ADHD medication follow-up care.

HEDIS Measure: The percentage of children newly prescribed ADHD medication who had three follow-up visits in 300 days, including one within 30 days of the first prescription.

Stimulant treatment has become a first-line intervention in the management of ADHD in children and teenagers. This highly effective intervention has been shown to promote academic growth and to protect against adolescent development of antisocial behaviors as children progress into adolescence. A child with ADHD may improve significantly with regard to the core characteristics of ADHD. As a result, parents and caregivers may see less need to seek ongoing care and monitoring. Nonetheless, close follow-up is important to help identify potentially serious adverse reactions such as weight loss and growth restriction, as well as to monitor for comorbidities that may emerge during treatment. This measure encourages us to monitor children treated for ADHD during the initiation and maintenance phases of treatment.

Depression screening and follow-up.

HEDIS Measure: The percentage of members 12+ years screened for clinical depression with a standardized tool, and those who screened positive received follow-up care.

Rising rates of depressive illnesses among adolescents and adults have been seen yearly, since at least 2012 progressively. This measure tracks both detection of depression and follow-up. Diagnosing depression early is essential as is intervening early in the course of illness. This measure is reinforced by using a specific screening tool, the PHQ-9.

Using PHQ-9 to monitor depression.

HEDIS Measure: The percentage of members 12+ years with major depression or dysthymia who had a PHQ-9 score documented in the same assessment period as an outpatient visit.

The PHQ-9 is a screening instrument that measures subjective self-report of symptoms over a 2-week period. While the PHQ-9 is often used to screen for depression, it is also a validated instrument for monitoring symptomatic changes over time. This tool lends itself well to monitoring of treatment with medications, psychotherapy, and any other interventions. The use of the PHQ-9 has been identified as an important marker of behavioral health care quality as it highlights the presence of symptoms that may not otherwise be observed during medical encounters.

¹HEDIS® is one of healthcare’s most widely used performance improvement tools. ncqa.org/hedis

²Quality Compass® is developed and maintained by NCQA. ncqa.org/programs/data.