Magellan’s collection of HEDIS (Healthcare Effectiveness Data and Information Set) quality measures for 2017 has entered the final phase of data collection. You’ve probably heard of the acronym HEDIS – but what does it stand for and what does it mean to you? The Healthcare Effectiveness Data and Information Set – HEDIS — was created by the National Committee for Quality Assurance (NCQA) to measure the clinical quality performance of health plans.  This is accomplished through the collection and analysis of data documenting the clinical care received by individual plan members from providers, influenced through activities and programs delivered by the health plans.  The data is aggregated and reported collectively to reflect the ‘collective’ or population-based care received by the plan’s membership.  These reports have become a major component of quality rating systems that measure the clinical quality performance of health plans by Centers for Medicare & Medicaid Services, states offering Medicaid and other entities. Right now, Magellan has entered the final phase of data collection for HEDIS quality measures for 2017.

There are 91 HEDIS 2017 measures, but it’s important to note that the number may vary from year to year as new measures are added to the set and some are retired. The measures cover many aspects of healthcare including preventive care such as screening tests (e.g., mammograms) and immunizations, management of physical and mental health conditions, access and availability of care, patient experience, utilization and relative resource use.  Data is reported individually for each product and line of business

Measure data is collected is a variety of ways.  Claims are the major source of data, but specific measures may also allow plans to survey members or to access member medical records for additional data not captured in claims.  This type of data collection (combined claims and chart data) is called hybrid.  The final phase of data collection for health plans choosing to do hybrid runs from January through May and is often called MRR for medical record retrieval, or simply ‘chart chase.’  Final HEDIS data covering services rendered in 2016 and prior will be submitted to NCQA by June 15, 2017.  Final health plan ratings for all lines of business are published on the NCQA website by October 2017.

For health plans, HEDIS ratings can be very important. The scores on measures can help them understand quality of care being delivered to their members in some of the most common chronic and acute illnesses.  Higher scores can help compete more effectively in various markets. HEDIS score reporting are often required in public markets as well, where the results are often reported to the states, or occasionally counties, in which the plans reside.

Behavioral health and pharmacy are well represented in the HEDIS measure set. Behavioral health has multiple measures that include ensuring continuity of care, appropriate psychotropic medication management/adherence, and initiation and engagement of drug and alcohol abuse treatment.  Pharmacy measures focus on medication management of acute and chronic physical and mental illness, appropriate medications in the elderly, and management of polypharmacy.  Specialty measures are directed toward inappropriate imaging.

So, what is the value of HEDIS to Magellan?  Aside from being a collection and reporting contract requirement for many of our customers and our own health plan, HEDIS gives Magellan valuable information about the populations we serve.

By following the behavioral health data, we collect, for example, we can identify gaps in network performance in patient follow-up patterns, management of drug and alcohol abuse, and prescribing and adherence to medications.  This allows us to design and implement interventions that can improve outcomes and reduce cost of care.

The same type of analysis/intervention applies to physical health conditions.  Analysis of HEDIS data helps identify gaps in care, particularly preventive care, in such important and chronic populations as patients with diabetes mellitus, patients with cardiovascular disease, and patients with lung disease.  We can also identify and address at-risk pediatric populations who fail to complete preventive care such as immunizations, dental and well-child care.

As the healthcare industry moves more and more toward value-based purchasing, all providers, insurers and their vendors are necessarily increasingly focused on the quality of care that is delivered.  The impact of this should be better outcomes for our members.

Find more articles about NCQA here

According to the Kim Foundation, one out of four Americans experiences behavioral health issues. Of those, 60 percent are not receiving treatment.

Why are so many people not receiving treatment?

What does this mean for providers?

What more can be done to increase access to behavioral healthcare?

Learn more about this issue by downloading Magellan’s new infographic, “Mind the Gap: Increasing Access to Behavioral Healthcare.”

Opioid addiction has grown over the past fifteen years from a personal issue to a national emergency. A new infographic from Magellan Healthcare reveals the devastation that this epidemic is causing.

• In 2014, there were 18,893 overdose deaths related to prescription pain relievers
• There was a 3,203% rise insurance claims for opioid dependence diagnosis from 2007-2014
• Prescription opioid abuse is costing employers $25,000,0000 a year

The opioid addiction crisis is causing such an unprecedented amount of harm precisely because it is such a complex, multi-faceted issue. Those looking for answers as to how such an epidemic could have happened, will need to examine a swath of individual problems, including:

• The enormous quantity of prescription opiates
• The limited patient knowledge of opiate risk
• That diversion of opiates to family and friends is so common that only 20% of those with opioid abuse problems are actually using opioids prescribed to them
• The struggle to adequately assess patient’s substance use history and risk of addiction when prescribing opiates
• The lack of clear guidance as to who should receive opiates and for how long
• The difficulty in maintaining patient adherence to withdrawal management treatment plans.

New solutions are needed to tackle each of these individual issues. At Magellan Health, we intend to do precisely that. The opioid addiction crisis has already taken a huge toll and it grows worse every day. It is manifesting itself in myriad ways among thousands of communities across the nation. At Magellan Health, we have an unyielding commitment to ending this epidemic.

Magellan Health marked October as Substance Abuse Prevention Month, with its chief medical officer, Dr. Karen Amstutz, releasing the following statement:

“Substance abuse does not discriminate. It pays no mind to gender, race, age or income level. According to the National Institute on Drug Abuse, the abuse of alcohol, tobacco and illicit drugs costs the United States more than $700 billion annually related to crime, lost work productivity and healthcare. Substance abuse, and in particular, our nation’s opioid epidemic, is gripping families and communities all across the country. Chances are, you know someone who is coping with substance abuse, though they might be doing so in silence.

“Magellan Health has worked in the field of behavioral health management for over 40 years, and we believe strongly that the treatment of substance abuse, including opioid misuse and addiction, is possible. Magellan Health advocates for medication assisted treatment (MAT), a well-researched and highly effective approach combining medication to treat the physical effects of opiate dependence, with counseling and recovery support services. Magellan Health is poised to support treatment professionals, legislators, third-party payers and patient advocates in the implementation of prevention efforts, best clinical practices, and elimination of potential barriers to treatment and recovery. Working together, it is important to shine a light on this dark epidemic and provide hope to people seeking to live a healthier, more vibrant life.

“If you or someone you know is dealing with substance, please call the Substance Abuse and Mental Health Services Administration’s Help Line at 1-800-662-HELP (4357). For Magellan’s resources related to substance abuse, please visit http://magellanhealthcare.com/opioids“

Magellan Health marked September as Suicide Prevention Awareness Month, with Barry M. Smith, chairman and chief executive officer of Magellan Health, and Sam Srivastava, chief executive officer of Magellan Healthcare, releasing the following statement:

“Suicide produces a ripple effect through communities of friends, family, loved ones and co-workers, and its effects are devastating. There are people in our own communities, too, who have attempted suicide and may be coping with the after-effects of their decision, both physically and emotionally.

“Magellan Health has long believed that suicide should be a ‘never’ event, and that even one suicide is one too many.

“Consider these facts:
• Every 13 minutes, someone dies from suicide in the United States.
• Suicide is the second leading cause of death in the military, with roughly 20 veterans each day committing suicide.
• For each suicide, six other people are directly impacted.
• Ninety percent of individuals who die by suicide have experienced mental illness.

“During Suicide Prevention Awareness Month, and always, we each have an obligation to extend a hand to individuals at risk, as well as to their families, and the five million survivors of suicide living among us.

“If you or someone you know is considering suicide, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).”

Mosquitoes carrying the Zika virus have been identified in Florida, so it’s critical that individuals living in the affected region and across the country know where to go to access information about prevention, detection and treatment. The Substance Abuse and Mental Health Services Administration (SAMHSA) has put together a website with resources about Zika, including those specific to certain groups of people, including pregnant women, parents, travelers and employers and workers. 

The impact of Zika in the United States is more than just physical. Many individuals, particularly those who live in a region where Zika has been found, may be experiencing anxiety or stress simply as a result of hearing about the disease from newspapers, television and on social media. SAMHSA has put together a tip sheet to help people cope with these feelings.

In their tip sheet, SAMHSA makes two important points:

• Set limits on how much time you spend reading or watching news about the outbreak. You will want to stay up to date on news of the outbreak, particularly if you have loved ones in places where people have become sick. But make sure to take time away from the news to focus on things in your life that are going well and that you can control.
• Find people and resources you can depend on for accurate health information. Learn about the outbreak and how you can protect yourself against illness if you are at risk. You may turn to your family doctor, a state or local health department, U.S. government agencies, or an international organization. Check out the sidebar on the next page for links to good sources of information about infectious disease outbreaks.

With 24/7 news cycles and the prevalence on social media and online news sites, it’s critical to set boundaries around how often and where you get your news. SAMHSA or other government websites, such as the Centers for Disease Control and Prevention, offer an updated overview of the current situation.

If you feel you need additional assistance, please call SAMHSA’s Disaster Distress Helpline at 1-800-985-5990 to access additional services in both English and Spanish.