This Hedis Measure
Assesses the percentage of inpatient, residential treatment and detoxification visits or discharges for a diagnosis of substance use disorder (SUD) among patients 13 years of age and older that resulted in follow-up care for a diagnosis of SUD within 7 and 30 days.
Why It Matters
In 2020, 40.3 million Americans 12 and older (about 14.5% of the population) were classified as having an SUD, including alcohol use disorder and illicit drug use disorder.1 Individuals with SUD have higher utilization of high-intensity care treatment such as inpatient hospitalizations.2 Timely follow-up care after treatment for SUD is critical to reduce negative health outcomes such as disengagement from the health care system and substance use relapse.3,4
Results – National Averages
Follow-Up Within 7 Days of High-Intensity Care
| Measurement Year | Commercial HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| 2022 | 41.1 | 47.8 | 31 | 21.4 | 19.6 |
| 2021 | 43.2 | 47.4 | 30.4 | 21.9 | 18.3 |
| 2020 | 44.4 | 48.6 | 32.5 | 20.4 | 19.3 |
Follow-Up Within 30 Days of High-Intensity Care
| Measurement Year | Commercial HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| 2022 | 60.3 | 64.8 | 49.8 | 39.7 | 37.3 |
| 2021 | 62.4 | 65.3 | 49.1 | 41.1 | 37.6 |
| 2020 | 62.9 | 66.6 | 50.7 | 38.2 | 36.0 |
This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.
Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.–>
References
- Substance Abuse and Mental Health Services Administration. 2021. Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
- Gryczynski, J., R. Schwartz, et al. 2016. “Understanding Patterns Of High-Cost Health Care Use Across Different Substance User Groups.” Health Aff (Millwood). January; 35(1): 12–19.
- National Institute on Drug Abuse (NIDA). 2018. Drugs, Brains, and Behavior: The Science of Addiction. July 2018. https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery.
- Proctor, S., P. Herschman. 2014. “The Continuing Care Model of Substance Use Treatment: What Works, and When Is ‘Enough,’ Enough?” Psychiatry Journal. Volume 2014, Article ID 692423, 16 pages.