Helpful HEDIS Information

Posted on July 1, 2014

HEDIS Corner:  Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET)

This HEDIS measure looks at the percentage of adolescent and adult enrollees with a new episode of alcohol or other drug (AOD) dependence who receive the following:

• Initiation of Treatment: The percentage of enrollees who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient visit or partial hospitalization within 14 days of the diagnosis.
• Engagement of AOD Treatment: The percentage of enrollees who initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of the initiation visit.

Early identification of substance abuse issues can help enrollees avoid future drug-related illnesses and deaths as well as improve enrollee quality of life. It can also help curb the overuse of health care services related to substance dependence.

HNE recommends the following best practices for substance abuse:

• Screen for it! Make sure to incorporate substance use questions or tools upon intake and upon yearly treatment plan review, at a minimum. Many times substance abuse goes undetected simply due to not asking the question! You can be part of the solution by assessing substance use. Patients may want to minimize their substance abuse, so persistence is required in raising the topic and keeping it at the forefront of a patient’s treatment.
• Document it! If a substance abuse concern is identified, be sure to document it and code it on any claims submitted. Often, practitioners are reluctant to use a substance abuse diagnosis for fear of stigmatizing a patient who has discussed his or her struggles with substances. The lack of labeling a diagnosis, however, prevents other clinicians from working with a patient in a coordinated manner, ultimately resulting in less effective care for the patient.
• Follow-up! When a substance abuse concern is identified, it’s very important to schedule appropriate follow-up treatment. For newly diagnosed patients, in particular, we recommend making a point of scheduling 3 follow-up appointments within the first 30 days. Increased intensity of contact in early stages of treatment, will help to address the concerns as timely as possible and help to keep the patient connected and motivated for treatment.
• Educate! It’s important to educate patients on the effects of substance abuse and educate them on the treatment options that exist for them in their community. Additionally, substance abuse often co-occurs with other behavioral health problems, like: major depression, or anxiety disorders, which can make treating substance abuse or diagnosing a behavioral health disorder more difficult. In instances like these, you may want refer your patient to a behavioral health provider. If you need assistance, call our care management department at  1-800-842-4464. 

Categories: Hedis Help