June 23, 2021
To support quality care, we are providing information to providers and members to encourage discussions on health topics. Watch for more on health care quality in News and Updates.
Mental health conditions are common, affecting people of all ages. The Centers for Disease Control and Prevention (CDC) estimates that half of Americans will be diagnosed with a mental illness or disorder at some point in their lives. The number of Americans seeking help for mental health has increased during the pandemic. We encourage providers to talk with our members about their mental health, including signs of depression and anxiety in adults and children. Encourage members to get help if needed.
Closing Care Gaps
As part of monitoring and helping improving quality of care, we track two measures related to mental health:
- Follow-up after Hospitalization for Mental Illness (FUH)
- Follow-up after Emergency Department (ED) Visit for Mental Illness (FUM)
Both are Healthcare Effectiveness Data and Information Set (HEDIS®) measures from the National Committee for Quality Assurance (NCQA). Follow-up care for people with mental illness is linked to fewer repeat emergency department (ED) visits and improved physical and mental function, according to NCQA.
As defined by NCQA, FUH applies to members ages 6 and older who had a follow-up visit with a mental health provider after they were hospitalized for the treatment of selected mental illness or intentional self-harm. FUH captures the percentage of discharges for which members had a follow-up visit:
- Within 30 days of discharge (31 total days)
- Within seven days of discharge (8 total days)
FUM focuses on follow-up visits for mental illness after an ED visit for members ages 6 and older with a diagnosis of mental illness, according to NCQA. FUM captures the percentage of ED visits for which members had a follow-up visit:
- Within 30 days of the ED visit (31 total days)
- Within seven days of the ED visit (eight total days)
For more information, see our behavioral health tip sheets.
Tips to Consider
For EDs and hospitals:
- Help our members schedule an in-person or telehealth follow-up visit with a mental health provider within seven days of discharge. The follow-up visit must be on a different date than the discharge date.
- Educate members about the importance of following up with treatment.
- Focus on member preference for treatment, allowing members to take ownership of the treatment process.
- Encourage members to bring their discharge paperwork to their first appointment.
- Educate members about the importance of following up and adhering to treatment recommendations.
- Use the same diagnosis for mental illness at each follow-up visit. A non-mental illness diagnosis code will not fulfill this measure.
- Coordinate care between behavioral health and primary care providers:
- Share progress notes and updates.
- Include the diagnosis for mental illness.
- Reach out to members who cancel appointments and help them reschedule as soon as possible.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.
HEDIS is a registered trademark of the NCQA.