One hundred and nineteen million Americans are enrolled in healthcare plans that report HEDIS results, making it one of the most widely used performance tools in US healthcare.
HEDIS measures are used to create a standardized measurement for healthcare provision across different systems. HEDIS measures for behavioral health are impacting how care is provided and what determines ‘success’ in the field. But how much does this impact the work of clinicians on the ground?
The Healthcare Effectiveness Data and Information Set (HEDIS) was created to allow purchasers and consumers with the information they need to make a reliable comparison of a health plan’s performance. As well as enabling a comparison between plans, the data generated via HEDIS measures allow for the identification of areas to be improved, and monitoring those improvements.
Although HEDIS measures were initially specified for health plan reporting, the National Committee for Quality Assurance (NCQA) which administers the HEDIS program, developed the Rules for Allowable Adjustment to enable HEDIS measures to apply to various levels of the wider health care system for quality improvement initiatives. This allowed for flexibility in evaluating differing populations without changing the measures’ clinical intent.
Understanding HEDIS measures
HEDIS measures largely focus on the processes of care with the goal to accurately reflect the care that patients actually receive. The scope of HEDIS is significant, currently covering more than 90 different measures of care. These can roughly be divided into six areas:
- Effectiveness of care
- Access/Availability of care
- Experience of care
- Utilization and risk-adjusted utilization
- Health plan descriptive information
- Measures collected using electronic clinical data systems
An important aspect of HEDIS measures is that they should be directly actionable. Measures are added and revised annually. For example, when legislation changed to mandate a minimum length of stay after birth, the HEDIS measure relating to the length of stay after birth was removed.
HEDIS measures for behavioral health
Behavioral health features significantly in the HEDIS measures. In 2020, there were 16 measures that relate to behavioral health. Eight fall under the heading of ‘Effectiveness of Care’ ranging from antidepressant medication management to diabetes and cardiovascular disease screening for people with schizophrenia or bipolar disorder.
Relating to behavioral health in the category of ‘Measures collected using electronic clinical data systems’ measures are primarily focused on client follow-up and monitoring, ranging from utilization of the PHQ-9 to monitor depression symptoms to follow-up after unhealthy alcohol use.
Effectiveness of care
- Antidepressant Medication Management
- Follow-Up Care for Children Prescribed ADHD Medication
- Follow-Up After Hospitalization for Mental Illness
- Follow-Up After Emergency Department Visit for Mental Illness
- Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence
- Diabetes and Cardiovascular Disease Screening and Monitoring for People With Schizophrenia or Bipolar Disorder
- Adherence to Antipsychotic Medications for Individuals With Schizophrenia
- Metabolic Monitoring for Children and Adolescents on Antipsychotics
Access/ Availability of Care
Measure collected using electronic clinical data systems
- Depression Screening and Follow-Up for Adolescents and Adults
- Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults
- Depression Remission or Response for Adolescents and Adults
- Unhealthy Alcohol Use Screening and Follow-Up
- Prenatal Depression Screening and Follow-up
- Postpartum Depression Screening and Follow-up
Why should clinicians care about HEDIS measures for behavioral health?
At first glance, HEDIS measures may seem divorced from the daily practice of behavioral health clinicians. When sitting face to face with clients, it might appear that there are many more important things to focus on. While no one would suggest that HEDIS measures become the primary focus, they do offer important input for the experience of our clients.
HEDIS measures are designed to improve consumer services. By quantifying the measures needed to provide clients with high-quality treatment, HEDIS measures are a driving force behind the incremental improvement of care.
Unfortunately, there are times when clients ‘fall through the cracks,’ either by non-compliance on their behalf or by lack of follow up from within the healthcare system. Many of the HEDIS measures for behavioral health focus on client follow-up ensuring that there is a timely response once a client enters the system or is flagged as having a certain challenge.
As a publicly available indication of a healthcare service’s successes, HEDIS measures help to bring the necessary funding to areas of behavioral health that might be overlooked otherwise. Good care is incentivized for the benefit of clients.
What is the future of HEDIS?
The NCQA which administers the HEDIS measures has identified five core areas for future growth. These are intended to allow some degree of flexibility within the implementation of the measures, increase the ease with which data is shared, and embrace the benefits that can be found within digital health technologies, including telehealth.
To meet this vision of the future, dedicated digital tools are now available that streamline the process of HEDIS compliance. Eleos Health is a unique example as it not only streamlines the reporting process, it also helps increase compliance by automating key functions helping healthcare systems and providers meet more HEDIS milestones.
Created as a dedicated platform for behavioral health providers, the digital Eleos platform integrates with established EHRs and within existing workflows. It offers automated consumer prompts encouraging them to complete the PHQ-9 and other feedback within the designated time period. The admin dashboard gives key insights and flags clients who are due to receive further follow-up. Not only does the Eleos system help healthcare systems comply with HEDIS measures, it also streamlines the documentation process with automated collation of data, ready to be exported to the various formats required.
It is clear that HEDIS is here to stay. The measures are helping to improve and standardize care across healthcare systems. With best practices for follow-up and case tracking, our clients only stand to gain from our HEDIS compliance.