Health Plan Performance on HEDIS
Antidepressant Medication Management:
Relationship with Organizational Characteristics
Brandeis University
Constance M. Horgan, Sc.D. (Project Director)
Elizabeth Levy Merrick, Ph.D., M.S.W.
NCQA:
Sarah Hudson Scholle, Dr. P.H., M.P.H.
Sarah Shih, M.P.H.
Center for Behavioral Health
Schneider Institute for Health Policy
Heller School for Social Policy and Management
Brandeis University
Support provided by the Robert Wood Johnson Foundation Depression in Primary Care Initiative
Objective
Determine whether performance and
improvement over time on three
antidepressant medication management
(AMM) measures in HEDIS differ by how
health plans organize, finance, and
administer behavioral health care.
Context
• HEDIS AMM measures overall are low
compared to other HEDIS measures
• AMM measures are generally not
improving over time (unlike other measures)
• Most privately insured individuals are in
managed care
• Need to learn what health plan features are
associated with better performance
HEDIS Antidepressant Medication Management
(AMM) Measures
• Effective Acute Phase Treatment
• Effective Continuation Phase Treatment
• Optional Practitioner Contact
Health Plan Domains
• Organization
• Provider
• Consumer
Research Design Overview
• Linkage of two datasets: Brandeis
Health Plan Survey and NCQA’s HEDIS
and CAHPS data
• Analyzing relationships between key
plan characteristics and performance on
AMM measures
• Both cross-sectional and longitudinal
(1999 to 2003) analyses
Data and Sample
Brandeis Survey: 2003 health plan survey on alcohol,
drug, and mental health services. Nationally representative,
linked to 60 Community Tracking Study market areas. N =
368 (812 products). Response rate = 83%.
NCQA: 2003 health plan participants in HEDIS.
N = 300.
Study Sample: All health plans present in both datasets.
N = 183 plans, covering 361 HMO and POS products.
Analytic Approach
• Describe health plans’ 2003 performance
on the three HEDIS AMM measures and
relationship with key plan characteristics
• Conduct multivariate analysis to control for
effects of other health plan and market
variables.
Effective Acute Phase Treatment
Percentage of eligible members who received
effective acute phase treatment after a new
episode of depression by remaining on
antidepressant medication during the first 12
weeks following diagnosis
• Mean
= 59.5%
• 10th percentile = 53.6%
• 90th percentile = 66.2%
Effective Continuation Phase Treatment
Percentage of members who received effective
continuation phase treatment by remaining on
antidepressant medication continuously in the 6
months after the initial diagnosis and treatment.
• Mean
= 42.9%
• 10th percentile = 37.8%
• 90th percentile = 50.5%
Optimal Practitioner Contact
Percentage of eligible members who received at
least 3 follow-up office visits with PCP or mental
health provider in the 12-week acute treatment
phase after diagnosis of depression and
prescription of antidepressant medication.
• Mean
• 10th percentile
• 90th percentile
=
=
=
22.1%
12.6%
36.8%
Organization Domain
• Product Type
HMO
POS
50%
50%
• Contracting Arrangement
Specialty
Comprehensive/Internal
80%
20%
• Depression Disease Management Program
47%
• Degree of PCP/BH Coordination (0-6 methods)
3.0
Provider Domain
• Provide training on depression guidelines
74%
• Provide feedback on individual performance
re: guideline adherence
36%
• Provide feedback on network performance
re: guideline adherence
20%
• Degree of support provided for guideline
adherence (0 – 3 activities)
1.3
• Plan allows PCP to bill for psychiatric
procedure codes
38%
• MH screening required by plan
36%
Consumer Domain
• High Cost Sharing for MH Outpatient Visits
(> 20% co-insurance or > $20 co-pay)
33%
• Pharmacy Tier 2 Cost Sharing (mean)
$22
• Access to new SSRIs without restrictions
on Tier 2 (0-4 medications)
2.5
• Direct Access – No MH Gatekeeping
39%
Rate of Effective Acute Phase Treatment
5.8
Specialty Contract a
4.1
Disease Management a
-1
Degree of PCP/BH Coordination
Feedback Individual Performance
4.3
a
-4.9
PCP Psychiatric Billing
-2.5
High MH Cost Sharing a
SSRI Choice b
0.9
-2.6
-4.5
-4
a
= P < .01
b
= P < .05
a
MH Screening b
-3.6
-5
b
-3.5
Adjusted R2 = 0.53
-3
Direct Specialty Access
-2.5
-2
-1.5
-1
-0.5
0
0.5
1
1.5
2
2.5
3
3.5
b
4
4.5
5
Regression model included all variables in the three domains, as
well as enrollment, tax status and region. Only significant domain
variables shown.
5.5
6
Rate of Effective Continuation Phase Treatment
Specialty Contract a
4.5
Feedback-Individual Performance a
4.7
PCP Psychiatric Billing a
-4
High MH Cost Sharing a
-5.2
Direct Specialty Access a
-3.7
-6
a
-5.5
-5
-4.5
-4
= P < .01
Adjusted R2 = 0.45
-3.5
-3
-2.5
-2
-1.5
-1
-0.5
0
0.5
1
1.5
2
2.5
3
3.5
4
Regression model included all variables in the three domains, as
well as enrollment, tax status and region. Only significant domain
variables shown.
4.5
5
Rate of Optimal Provider Contact
1.5
Product Type HMO b
Degree of PCP/BH Coordination
-1.8
a
Feedback Individual Performance a
5.9
-3.6
MH Screening b
Tier 2 Cost Sharing a
-0.9
-4
-3.5
a
= P < .01
b
= P < .05
-3
-2.5
Adjusted R2 = 0.49
-2
-1.5
-1
-0.5
0
0.5
1
1.5
2
2.5
3
3.5
4
Regression model included all variables in the three domains, as
well as enrollment, tax status and region. Only significant domain
variables shown.
4.5
5
5.5
6
Conclusions
• Patient cost sharing and choice of
SSRIs affect HEDIS AMM
performance
• Individual feedback to providers helps
• Some approaches geared towards
improving quality seem to do so
(disease management)
• Others (e.g., PCP/BH coordination)
raise more questions