Trends in Quality Measurement for Alcohol Use Screening and Treatment
April 29, 2025 · Becky Kolinski
Alcohol use contributes to more than 200 health conditions and about 178,000 deaths in the U.S. each year. Early intervention is important for preventing and managing alcohol use disorders, but alcohol-related risks are not often addressed in health care settings. April is Alcohol Awareness month—an ideal time to reflect on the current state of quality measurement related to alcohol use.
Key Takeaways
- NCQA has a cascade of measures across the continuum of care for SUD: screening, diagnosis, treatment, emergency care.
- Stigma, resistance to treatment, lack of access to behavioral health providers and cost of care make it challenging for people to obtain treatment.
- Quality measurement is limited by inconsistent data collection capabilities in EHRs, and by low EHR adoption by behavioral health clinicians—often due to lack of funding.
Screening for Alcohol Use
Screening for unhealthy alcohol use—and timely follow-up after a positive screening—is an effective and cost-efficient way to identify or halt alcohol misuse in adults. NCQA’s HEDIS measure Unhealthy Alcohol Use Screening and Follow-Up evaluates the percentage of people 18 and older who are screened for unhealthy alcohol use, and receive brief counseling or other follow-up care within 2 months of a positive screen.
| Measure | Commercial HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| Screening | 0.7% | 0.2% | 0.8% | 4.7% | 4.7% |
| Follow-Up | 0.1% | 0% | 1% | 0.3% | 0% |
Analysis of Results
- NCQA publicly reported this measure for the first time in MY 2023.
- Screening rates are low across all product lines—and follow-up rates are even lower.
- Challenges to capturing EHR data might be a reason for lower than expected rates for this measure.
“Primary care clinicians may be uncomfortable screening for substance use due to stigma and a lack of places to refer patients for treatment,” says NCQA’s Sarah Sweeney, Assistant Director, Behavioral Health. “Ideally, people should be able to get addiction care wherever they get medical care—and NCQA is encouraging and incentivizing that—but it’s definitely a culture shift.”
Diagnosis of Alcohol Use Disorder
Diagnosis is the next step along the continuum of care. NCQA’s HEDIS measure Diagnosed Substance Use Disorders looks at the prevalence of alcohol use, opioid use and other drug use among people 13 and older. HEDIS MY 2023 prevalence rates for alcohol use—1.1% for commercial HMO and PPO, 2.6% for Medicaid HMO, 2.9% for Medicare HMO and 2% for Medicare PPO—are lower than the national estimate of 10.2%.
“National prevalence estimates come from anonymous survey data, whereas HEDIS measures are based on claims data,” says NCQA’s Margot Schwartz, Applied Research Scientist. “Due to the stigma associated with substance addiction, people may feel more comfortable sharing this information in a survey than talking about it with a health care practitioner.”
Treatment of Alcohol Use Disorder
NCQA’s HEDIS measure Initiation and Engagement of Substance Use Disorder (SUD) Treatment evaluates how quickly people begin treatment after they are diagnosed, and whether they continue to receive treatment.
- Initiation of Treatment looks at whether people 13 and older received any of these services within 14 days of a diagnosis of alcohol use disorder: inpatient admission, outpatient visit, telehealth or intensive outpatient encounter or partial hospitalization, medication.
- Engagement With Treatment looks at whether people 13 and older had two or more additional services or medications within 34 days of the initiation visit.
| Measure | Commercial HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| Initiation of Treatment | 36.7% | 38.9% | 42.6% | 39.2% | 40.8% |
| Engagement With Treatment | 12.5% | 13.9% | 12.4% | 4.8% | 4.4% |
Analysis of Results
- Rates for Initiation of Treatment and Engagement With Treatment have remained stable since NCQA began publicly reporting this measure in MY 2017.
- Rates for Engagement With Treatment are significantly lower than for Initiation of Treatment.
- Stigma, resistance to treatment and lack of access to behavioral health providers are factors that limit people from getting treatment.
- Many behavioral health clinicians and facilities do not accept insurance, so their data are not available for HEDIS reporting.
“Alcohol use disorder is a complex disease that involves intervention at multiple levels to facilitate recovery and prevent relapse,” says NCQA’s Julie Seibert, Associate Vice President, Behavioral Health. “We have a strong foundation for measurement, but systemic issues prevent us from fully realizing the potential for improvement. We need to continue to push for a more integrated and coordinated approach.”
Follow-Up After Emergency Department Visit for SUD
The ED provides immediate care and timely diagnosis for SUD, and connects individuals to other resources along the care continuum. NCQA’s HEDIS measure Follow-Up After Emergency Department Visit for SUD looks at the percentage of ED visits or discharges for any SUD (not just for alcohol use) where patients 13 and older received follow-up care within 7 and 30 days.
| Measure | Commercial HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| 7-Day Follow-Up | 21.9% | 20.9% | 24.1% | 24.3% | 22.7% |
| 30-Day Follow-Up | 32.5% | 32.3% | 35.5% | 38.4% | 36% |
Analysis of Results
- Follow-up rates are slightly higher within 30 days than within 7 days, with minimal variation across plan types.
Follow-Up After High-Intensity Care for SUD
Timely follow-up care after treatment can reduce the likelihood of relapse and disengagement from the health care system. NCQA’s HEDIS measure Follow-Up After High-Intensity Care for SUD looks at the percentage of inpatient, residential treatment and detoxification visits or discharges—for SUD, not only for alcohol use—where patients 13 and older received follow-up care within 7 and 30 days.
| Measure | Commercial HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| 7-Day Follow-Up | 42.2% | 47.1% | 32.8% | 21.6% | 19.7% |
| 30-Day Follow-Up | 61% | 64.7% | 51.8% | 40.2% | 38.2% |
Analysis of Results
- Follow-up rates are higher within 30 days than within 7 days.
- Commercial plans perform better than Medicare or Medicaid plans.
“NCQA proposed changes to this measure to capture more occurrences of follow-up care,” says Chrissy Craig, NCQA’s Senior Health Care Analyst. “We are allowing the substance use diagnosis to appear in any position on the claim, and adding peer support services as an option for follow-up care.”
Learn More
- Visit the Rethinking Drinking website to learn how alcohol impacts health.
- Visit the SAMHSA resource page for alcohol use.
- Clinicians can earn CME credits by visiting the Core Resource on Alcohol and taking the free training courses.
- The American Society of Addiction Medicine offers education and resources for clinicians.
Sources
- https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol
- https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-use-disorder-aud-united-states-age-groups-and-demographic-characteristics
- https://www.samhsa.gov/data/report/2023-nsduh-detailed-tables
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
