Neighborhood Health Plan of Rhode Island (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 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 (SAMSHA), “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.” Neighborhood’s Behavioral Health partner, Optum, has specific resources available to all providers that will help you identify Substance Use Disorder treatment providers and schedule appointments for your patients.
What is Neighborhood’s Performance
Neighborhood’s Medicaid HEDIS Rate for 2019 is 40.48% for initiation and 17.21% for engagement. Both of these rates are well below the National Medicaid Quality Compass 90th percentiles. Neighborhood’s rate for the INTEGRITY-MMP population for initiation is 38.19% and 11.59% for engagement. These rates are below the performance incentive benchmarks for these measures established by CMS and the State for the Integrity program.
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.
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 searchingliveandworkwell.com using access code “clinician.”
- Screening tools are available onproviderexpress.com > Clinical Resources > Alcohol or Other Drug Disorders.
- You can also find additional tools and information about behavioral health issues onproviderexpress.com > Clinical Resources > Behavioral Health Toolkit for Medical Providers.
- Patient education information is available onliveandworkwell.com using access code “clinician.” See “Mind & Body” at the top, scroll down to find the links to specific topics.