Neighborhood Health Plan of Rhode Island (Neighborhood) requests your help in improving plan performance on the HEDIS measure Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM).
How APM is Measured
The APM measure is based on the percentage of children and adolescents 1–17 years of age with two or more antipsychotic prescriptions who had metabolic testing during the past year. Metabolic testing has two components, blood glucose and cholesterol. The APM measure is stratified into the following three age groups: 1-11 years of age, 12-17 years of age, and 1-17 years of age (total population).
What is Happening Around the Country
According to an article published under the US National Library of Medicine National Institutes of Health by Joyce Nolan Harrison et al., “Approximately 14% to 20% of children and adolescents have a diagnosable mental illness, with an annual cost that is estimated to be $247 billion.” (Harrison, 2013) These costs can also be increased when factoring that antipsychotics carry an increased risk of weight gain, drowsiness, and diabetes. A supporting article in the psychiatric times, Addressing Obesity in Patients Taking Antipsychotics, published in April 2021 adds that ”…young, non-obese, drug-naive patients can gain significant weight within a matter of months when exposed to antipsychotic drugs with a high risk of weight gain. Once they have gained that weight, many of them will never be able to lose it.” (Mehrul Hasnain, 2021)
Based on these findings, a report from the Agency for Healthcare Research (AHRQ) on the APM measure recommends that “Due to the potential negative health consequences associated with children developing cardio-metabolic side effects from an antipsychotic, it is important to establish a baseline and continuously monitor metabolic indices to ensure appropriate management of side-effects”. (Metabolic Screening for Children and Adolescents, 2019)
Neighborhood’s Behavioral Health partner, Optum, has specific resources available to all physicians that will provide more information on antipsychotics. (See below.)
What is Neighborhood’s Performance
Neighborhood’s Medicaid HEDIS Measurement Year (MY) 2020 rate for APM total population (ages 1-17 years) is 25.60%. This rate is for children ages 1 – 17 years who had blood glucose and cholesterol testing during MY2020. This rate is well below the National Medicaid Quality Compass 90th percentile rate of 44.58%.
How You Can Help
- Schedule annual appointments to have metabolic testing completed for your children and adolescent patients currently on antipsychotic medications.
- Educate the parent or guardian of the child that properly monitoring cholesterol and glucose decreases risks of long-term illnesses.
- Talk with the parent or guardian about the importance of care coordination between primary care and behavioral health care providers.
- Talk to your patients about the importance of taking medications as prescribed and reporting any side effects that they may be experiencing.
Resources That Can Help You
Neighborhood’s Behavioral Health partner, Optum, has specific resources available to all physicians that will help you identify mental health providers and schedule appointments for your patients.
- 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 Optum’s website using access code “clinician.”
- You can also find additional tools and information about behavioral health issues on Optum’s website > Clinical Resources > Clinical Tools and Quality Initiatives.
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.
Harrison, J. N. (2013, September 19). Antipsychotic Medication Prescribing Trends in Children and Adolescents. Retrieved from US National Library of Medicine National Institutes of Health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3778027/
Mehrul Hasnain, M. (2021, April 28). Addressing Obesity in Patients Taking Antipsychotics. Retrieved from Psychiatric Times: https://www.psychiatrictimes.com/view/addressing-obesity-patients-taking-antipsychotics
Metabolic Screening for Children and Adolescents. (2019, February). Retrieved from ahrq.gov: https://www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-149-fullreport.pdf
Last updated: April 11, 2022 @ 12:58 pm