12 de mayo de 2021
To support quality care, we are providing information to providers and members to encourage discussions on health topics. Watch for more on health care quality in News and Updates.
More than 20 million people ages 12 and older in the U.S. struggle with a substance use disorder each year. Fewer than 20% of them receive treatment, according to the Substance Abuse and Mental Health Services Administration 
.
We encourage providers to talk with our members about the signs of substance abuse disorder y how alcohol can affect them . Consider urging the member to seek help, if appropriate.
Treatment, including medication-assisted treatment (MAT) with counseling or other behavioral therapies, can help reduce substance abuse mortality, according to the National Committee for Quality Assurance (NCQA). Treatment may also help improve health, productivity and social outcomes.
Closing Care Gaps
As part of monitoring and improving quality of care, we track two measures related to substance abuse:
- Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
- Follow-up after Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA)
Both are Healthcare Effectiveness Data and Information Set (HEDIS®) measures from the NCQA.
What IET Measures
IET applies to members ages 13 and older with a new episode of alcohol or other drug (AOD) abuse or dependence. The measure captures two stages of adequate and timely follow-up treatment:
- Initiation of treatment, one treatment within 14 days of the diagnosis
- Engagement of treatment, at least two additional treatment sessions within 34 days of the initiation appointment
Treatment may occur in an inpatient, residential, outpatient or telehealth setting or as MAT.
What FUA Measures
FUA applies to members ages 13 and older with a principal diagnosis of AOD abuse or dependence during an emergency department (ED) visit. The measure captures rates for AOD follow-up visits after an ED visit:
- Within seven days of the ED visit (eight total days)
- Within 30 days of the ED visit (31 total days)
If the first follow-up visit is within seven days after discharge, both rates are counted for this measure.
For more information, see our HEDIS tip sheets.
Tips to Consider
- Discuss the importance of timely follow-up visits.
- Use the same diagnosis for substance use at each follow-up.
- Coordinate care between behavioral health and primary care physicians. Share progress notes and include the diagnosis for substance use.
- Reach out to members who cancel appointments and help them reschedule as soon as possible.
- For FUA, ED providers can help members schedule an in-person or telehealth follow-up visit within seven days. Send ED discharge paperwork to the appropriate outpatient provider within 24 hours of discharge.
El material que se muestra anteriormente tiene fines informativos únicamente y no reemplaza el juicio médico independiente de un médico u otro profesional médico. Se recomienda a los médicos y otros profesionales médicos que usen su propio criterio médico basado en toda la información disponible y en la condición del paciente para determinar el curso de tratamiento apropiado. La descripción de un servicio o tratamiento en este material no garantiza que el servicio o tratamiento sea un beneficio con cobertura, y los asegurados deben consultar su certificado de cobertura para obtener más detalles sobre los beneficios, las limitaciones y las exclusiones. Independientemente de los beneficios, la decisión final sobre cualquier servicio o tratamiento la toman el asegurado y su médico.
HEDIS is a registered trademark of the NCQA.
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