What is Happening Around the Country
According to an article published by American Psychiatric Association “An estimated 8.4 percent of children and 2.5 percent of adults have ADHD. ADHD is often first identified in school-aged children when it leads to disruption in the classroom or problems with schoolwork. It can also affect adults. It is more common among boys than girls.” The article also stated, “Behavioral therapy and medication can improve the symptoms of ADHD. Studies have found that a combination of behavioral therapy and medication works best for most people, particularly those with moderate to severe ADHD.” Neighborhood’s Behavioral Health partner, Optum, has specific resources available to our healthcare providers that will help you identify ADHD, find behavioral health providers, and schedule appointments for your patients.
How ADHD is Measured
The “Follow-Up Care for Children Prescribed ADHD Medications” HEDIS measure has two separate components. It is based on the percentage of children newly prescribed attention-deficit/hyperactivity disorder (ADHD) medication who had at least three follow-up care visits within a 10-month period, one of which was within 30 days of when the first ADHD medication was dispensed.
- Initiation Phase. The percentage of members 6–12 years of age with an ambulatory prescription dispensed for ADHD medication, who had one follow-up visit with a practitioner with prescribing authority during the 30-day Initiation Phase.
- Continuation and Maintenance (C&M) Phase. The percentage of members 6–12 years of age with an ambulatory prescription dispensed for ADHD medication, who remained on the medication for at least 210 days and who had at least two follow-up visits with a practitioner
Neighborhood’s Medicaid HEDIS Rate for 2020 is 46.91 for initiation and 56.19 for continuation and maintenance. Both of these rates are well below the National Medicaid Quality Compass 90th percentiles.
You Can Help
- For your patients newly diagnosed with ADHD, it is important to schedule a follow-up appointment within 30 days and then two follow-up appointments within nine months after the initial 30 days.
- Educate the parent or guardian that the child must be seen within 30 days of starting the medication to evaluate if the medication is working and assess any adverse effects.
- Talk with the parent or guardian about the importance of follow-up appointments and schedule additional follow-up appointments.
- It is also important that patients remain on prescribed medications during and after follow-up appointments.
Neighborhood’s behavioral health partner, Optum, has several resources to help you and your patient.
- Request coordination of care and referrals for your patients by calling the number on the back of the member’s Neighborhood ID card to speak to a licensed clinician or by searching liveandworkwell.com using access code “clinician.”
- Screening tools are available on providerexpress.com > Clinical Resources > Clinical Tools and Quality Initiatives.
- Behavioral health best practice guidelines are available on providerexpress.com > Clinical Resources > Best Practice Guidelines.
- You can also find additional tools and information about behavioral health issues on providerexpress.com > Clinical Resources > Behavioral Health Toolkit for Medical Providers.
- Patient education information is available on liveandworkwell.com using access code “clinician.” See “Mind & Body” at the top, scroll down to find the links to specific topics.