Neighborhood requests your help in improving access to substance use treatment as measured by the HEDIS measure: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET).
How IET is Measured
The IET measure has two separate components. It is based on all members 13 years of age and older with a new episode of alcohol or other drug (AOD) use or dependence.
- Initiation of Treatment: The percentage of members 13 years of age and older with a diagnosis of alcohol or other drug (AOD) dependence who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization, telehealth or medication assisted treatment (MAT) within 14 days of the diagnosis.
- Engagement in Treatment: The percentage of members 13 years of age and older with a diagnosis of alcohol or other drug dependence who initiated treatment as described above and who had two or more additional AOD services or medication assisted treatments (MAT) within 34 days of the initiation visit.
What is Happening Around the Country
According to an article published by The Substance Abuse and Mental Health Services Administration, “In 2016, 20.1 million Americans over 12 years of age (about 7.5% of the population) were classified as having a substance use disorder involving alcohol or other drugs (AOD).” The article also stated, “Despite strong evidence, less than 20% of individuals with substance use disorders receive treatment.” These facts have also been compounded due to the COVID-19 pandemic.
A survey of 1,079 individuals with SUDs conducted by the National Commission on COVID-19 and Criminal Justice found that 20% of respondents reported an increase in substance use, 34% reported changes in treatment or recovery support, 14% were unable to access needed services, and 4% reported an overdose. The article also stated that, “While both non-fatal and fatal overdoses began increasing prior to the emergence of COVID-19, the rate of opioid-related overdoses accelerated during the pandemic.” This fact is further backed by the CDC stating that overdose deaths overall increased from 67,736 in a twelve month period ending in April 2019 to 97,990 in a twelve month period ending in April 2021.
What is Neighborhood’s Performance?
Neighborhood’s Medicaid HEDIS Rate during the measurement year (MY) 2020 is 42.35% for initiation of AOD and 16.45% for engagement of AOD. Both of these rates are well below the National Medicaid Quality Compass 90th percentiles for MY 2020. Neighborhood’s rate for the INTEGRITY (Medicare-Medicaid dual eligible) population for initiation of AOD is 40.60% and 9.32% for engagement of AOD. These rates are below the performance incentive benchmarks for these measures established by CMS and the State for the INTEGRITY membership.
How You Can Help
For your patients newly diagnosed with Substance Use Disorder (SUD), it is important to begin treatment with a substance abuse provider within 14 days of diagnosis and have two additional visits within 34 days after their first visit. Follow up visits can occur in person or through the utilization of telemedicine.
Resources That Can Help You
Neighborhood’s Behavioral Health partner, Optum, has specific resources available to all physicians that will help you identify SUD treatment providers and schedule appointments for your patients.
- Substance Use Disorder Helpline: 1-855-780-5955 – Provides 24/7 support for providers and patients – Once a member calls the help line, the member then speaks directly with a licensed clinician who takes the time to understand the member’s needs, educate the member on appropriate treatment options, and then arranges a face-to-face evaluation by a licensed substance use treatment provider.
- Request coordination of care and referrals for your patients by calling the number on the back of the member’s health plan 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 > Alcohol or Other Drug Disorders.
- You can also find additional tools and information about behavioral health issues on providerexpress.com > Clinical Resources > Behavioral Health Toolkit for Medical Providers.
- Training Modules and Webinars from Optum are also available on provider express at the link below:
- 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.