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Provider Resources

May 2021

 

Table of Contents

Quality Measures for Behavioral Health
Medicare Advanage D-SNP Training

 

Quality Measures for Behavioral Health

The Network Health quality management team works with providers and members to improve the continuity of care between medical and behavioral healthcare through six quality measures. Our quality team builds these measures based on factors and standards set by the National Committee for Quality Assurance (NCQA), using Health Effectiveness Data and Information Set (HEDIS) measures wherever applicable. Quality campaigns include collaboration with providers for data exchange and medical record reviews, as well as member communications encouraging follow-up visits and informational articles in member newsletters, magazines, blogs and social media.

The six measures addressed for behavioral health include the following areas that impact the health and well-being of members.

  • Exchange of Information
  • Follow-Up Care for Children Prescribed ADHD Medication
  • Antidepressant Medication Management
  • Follow-Up After Hospitalization for Mental Illness
  • Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications
  • The Need for Depression Screening in Primary Care

 Exchange of Information (EOI) assesses the frequency that information is shared between primary care providers and behavioral health specialists regarding their mutual patients. Evidence of EOI is found through documentation in the primary care provider’s EMR. EOI assists providers in developing complete care plans, utilizing complimentary treatments, and avoiding undesired interactions and duplication of services.

Follow-Up Care for Children Prescribed ADHD Medication (ADD) assesses the percentage of members 6-12 years old who had at least three follow-up care visits within a 10-month period of initially starting an ADHD medication, or restarting after a period of 120 days with no ADHD medication being dispensed, mirroring best practice guidelines.

Antidepressant Medication Management (AMM) assesses the percentage of members 18 years and older who were prescribed an antidepressant for a diagnosis of major depression, and who continued taking the medication as prescribed. The goal of this measure is to identify barriers to medication compliance.

Follow-Up After Hospitalization for Mental Illness (FUH) assesses the percentage of members 6 years and older who were hospitalized for treatment of behavioral health diagnoses, and who had a follow-up visit with a mental health provider. Behavioral health specialists are uniquely qualified to identify treatment barriers or concerns for this population.

Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD) assesses the percentage of members 18-64 years old who were dispensed an antipsychotic medication, and who had a diabetes screening test during the measurement year. Members in this population have a higher risk of diabetes and obesity, increasing the need for monitoring of metabolic effects.

The Need for Depression Screening in Primary Care assesses the percentage of members who indicated experiencing depression symptoms on the annual Health Risk Assessment (HRA), and who then received screening by their primary care provider. Primary care visits are often the first opportunity to identify depression related concerns.

For more information on how Network Health evaluates the quality of care and services provided to members visit https://networkhealth.com/provider-resources/quality-health-integration.

 

Network Health Behavioral Health Care Managers Support Patients in Need

If your patient has recently been discharged from an inpatient behavioral health unit, he or she should have a follow up appointment with a behavioral health provider within 7 days of discharge for optimum stability of symptoms.

Finding the right behavioral health provider for your patient can make all the difference in the counseling experience, and sometimes it can be challenging to find the right fit.

Does your patient need a psychiatrist for medication management, a psychologist for neuropsychological testing or a therapist for talk therapy? Would he or she prefer a male or female therapist? Does the therapist have special interest and training in the issue your patient wants to address?

Referring your patients to a Network Health care manager is like giving them a personal GPS to navigate the health care system, find providers, explore patients’ benefits and offer supportive phone calls between appointments. If patients agree, care managers will collaborate with their primary care doctors and specialists for optimum coordination of their care.

It is key for members to connect with the right providers for treatment plans that best serve members’ needs. The care managers stress to members the importance of follow-up appointments with their providers, encourage members to follow through with treatment plans, and help members find additional resources within the community.

Network Health care managers may be reached at: 920-720-1340 or 1-800-555-3616.


Medicare Advantage D-SNP Training

 As part of our continued relationship to ensure the best service to our dual-eligible special
needs plan (D-SNP) members, the Centers for Medicare & Medicaid Services (CMS)
requires us to provide Medicare Advantage D-SNP training to our providers. CMS also
requests that we maintain documentation showing which providers completed the training. If
you are a Network Health Medicare provider, you may see members enrolled in our D-SNP
plan, so this training applies.
Please complete the training we’ve posted on our website. Once you’ve viewed the training,
please submit verification by completing the attestation. We can accept an attestation from a
panel of providers or it can be completed by each individual provider. These documents are available online and can found here: https://networkhealth.com/provider-resources/providertraining

Please fax or email the completed attestation to Network Health.
• Fax: 920-720-1974, Attn: Laura Reinsch
• Email: lreinsch@networkhealth.com


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