Recorded presentation

Nancy Claiborne, PhD, ACSW, University at Albany, SUNY, School of Social Welfare, Albany, NY 12222, 518-442-5349, nc@albany.edu and Trudy Millard Krause, DrPH, Dynamic Health Strategies, Inc., 1009 Tall Pines Drive, Friendswood, TX 77546.

This study investigates the effectiveness of care as indicated by managed care organizations’ (MCO) health plans providing appropriate follow-up for members after a hospitalization for mental illness as delineated by the National Committee for Quality Assurance (NCQA) utilizing their Health Plan Employer Data and Information Set (HEDIS) measures. HEDIS is a standardized, audited report for assessing quality of care provided by MCOs. It allows for the comparison across diverse MCOs, including those providing Commercial, Medicare, and Medicaid care. Employers purchasing health care, public purchasers, regulators, advocacy groups and consumers have utilized HEDIS results to compare MCOs’ care.

The data set was obtained from reported rates spanning the reporting years 2001, 2002, and 2003 from participating plans. The reported rates and the aggregate data were selected from 94 lines of business, originating from HMO health plans. Lines of business included Medicaid, Medicare, and commercial health plans. Follow-up within 7 and 30 days by a mental health practitioner after hospitalization from mental illness was identified as appropriate care.

An analysis of variance was utilized to measure the relationship between members being followed-up after a mental illness hospitalization, and provider network and health plan design characteristics, and plan type. Provider network and health plan design characteristics included number of mental health practitioners in the plan, rate of plan’s mental health practitioner turnover, mental health practitioner payment mechanisms, monthly volume of claims, geographic factors, contracting behavioral health to outside vendors, and type of plan.

Learning Objectives:

• Attendees will understand NCQA as a reporting entity.
• Attendees will know HEDIS quality of care indicators related to mental illness.
• Attendees will be able to identify the relationship between provider and MCO health plan design characteristics and the effectiveness to provide quality care for patient follow-up after a mental illness hospitalization.

Keywords: HEDIS, Mental Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation