Point32Health is offering some reminders and strategies for improvement on the Follow-Up After Hospitalization for Mental Illness (FUH) and Initiation and Engagement of Substance Use Disorder Treatment (IET) HEDIS measures.
FUH measure:
To maximize the opportunity for success on the FUH HEDIS measure, we recommend that your practice consider the following strategies and reminders (in addition to the best practices highlighted on our HEDIS tip sheet):
- Appointments on the day of discharge do not count as compliant for this measure.
- In order to be compliant for the FUH measure, appointments must be with a behavioral health (BH) provider.
- Consider using telehealth or virtual appointments for greater convenience.
- For PCP offices with an integrated care model, it is important to have BH specialists keep appointments available for patients who have been recently discharged from an inpatient BH hospitalization.
- If the seven-day timeframe has passed, it is still vital that patients who have been hospitalized with a BH diagnosis receive follow-up care with BH providers. The 30-day timeframe for a follow-up appointment is also important.
- For help finding an available BH provider or community partner, the member or PCP office can refer to the Harvard Pilgrim or Tufts Health Plan Provider Directories or call the Member Services number listed on the member’s ID card. You can also find a wealth of BH information and resources in the Behavioral Health section of Point32Health’s provider website.
IET measure:
We’d also like to offer some suggestions for improvement on the IET HEDIS measure to promote engagement in substance use disorder treatment after diagnosis so that patients are aware of treatment options and empowered to take the necessary steps in their recovery:
- Before scheduling an appointment, consider factors such as transportation, location, and time of the appointment to ensure that the member does not experience barriers.
- If it is a virtual appointment, consider the level of access the member may or may not have to technology.
- Provide reminder calls to confirm the appointment and reach out proactively within 24 hours if the member does not keep a scheduled appointment to schedule another one.
- Ensure that the care transition plans are shared with the PCP.
Provide timely submission of claims with correct service coding and principal diagnosis. The initial diagnosis and follow-up diagnosis must be the same for the visits to be compliant for the IET measure.
Annmarie Dadoly,
Senior Manager, Provider Communications
Joseph O’Riordan,
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