Annual Testing and Monitoring for Patients with Schizophrenia

October 2021

Schizophrenia is a condition that occurs in between 0.25% and 0.64% of the general population and severely impacts a patient’s mental wellbeing as well as their friends and family. With the various treatment options available to aid a patient’s mental condition, it is important that physicians work with patients to keep patients physically healthy as well. As schizophrenia carries a higher likelihood for obesity and decreased attention to preventive health care, it leads to an increased risk of contracting diabetes and cardiovascular disease in particular. According to the National Alliance on Mental Illness “People with schizophrenia are subject to many medical risks, including diabetes and cardiovascular problems, and also smoking and lung disease. For this reason, coordinated and active attention to medical risks is essential.”[iii] The National Committee for Quality Assurance (NCQA) has developed and implemented a number of HEDIS measures to monitor the annual testing of people who are prescribed antipsychotic medication, including patients with schizophrenia. Neighborhood produces periodic rates for these HEDIS measures to assist us in monitoring and improving adherence to the required annual testing for our members who are prescribed antipsychotic medication.  This oversight helps to ensure that our members receive high quality of health care services that will improve their health outcome and quality of life. The following are the HEDIS measures that monitor the required annual testing for patients with schizophrenia:

  • Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication
    • Annual completion of a Glucose test or HbA1c Test
  • Diabetes Monitoring for People with Diabetes and Schizophrenia
    • Annual completion of an LDL-C test and HbA1c test
  • Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia
    • Annual completion of an LDL-C test

How Can Primary Care Providers Help?

Neighborhood and Neighborhood’s Behavioral Health partner, Optum, recommends that primary care providers help to ensure that this member population gets the required annual testing. During visits with the member, make sure that all necessary testing is discussed so that they understand the importance of having those tests. Next, it is important that you follow-up with the member to ensure that testing is completed timely and that reminder phone calls be placed prior to the member’s next appointment. Lastly, to ensure care coordination, make sure that you as the primary care practitioner receive all information from specialist providers, especially behavioral health providers.

Schizophrenia is a complicated illness that can become even more complicated when including other physical co-morbidities. Please see below for more information that can help with learning about and treating this member population: