July 2021
Neighborhood Health Plan of Rhode Island (Neighborhood) requests your help in improving performance on the HEDIS measure Follow Up Care for Children Prescribed ADHD Medications (ADD).
How is ADD Measured?
The ADD measure has two separate components, and is based on the percentage of children newly prescribed attention-deficit/hyperactivity disorder (ADHD) medication who had at least three follow-up care visits within a 10-month period, one of which was within 30 days of when the first ADHD medication was dispensed.
- Initiation Phase – The percentage of members 6–12 years of age with a prescription for ADHD medication dispensed by an ambulatory care provider, who had one follow-up visit with a practitioner with prescribing authority during the 30-day Initiation Phase.
- Continuation and Maintenance Phase – The percentage of members 6–12 years of age with a prescription for ADHD medication dispensed by an ambulatory care provider who have had a follow-up visit during the Initiation Phase who remained on the medication for at least 210 days and who had at least two additional follow-up visits with a practitioner with prescribing authority within 270 days (9 months) after the Initiation Phase ended.
What is happening with ADHD Treatment around the Country?
According to an article published by the American Psychiatric Association1 “An estimated 8.4 percent of children and 2.5 percent of adults have ADHD. ADHD is often first identified in school-aged children when it leads to disruption in the classroom or problems with schoolwork. It can also affect adults. It is more common among boys than girls.” The article also stated, “Behavioral therapy and medication can improve the symptoms of ADHD. Studies have found that a combination of behavioral therapy and medication works best for most people, particularly those with moderate to severe ADHD.” The COVID-19 pandemic has impacted the care provided patients with ADHS in several ways. For example, according to an article from the Psychiatric Times there have been issues with the distribution of ADHD medications due to supply line interruptions. The article also notes that there have been some positive advancements including telemedicine that allow providers to observe patients with ADHD in their homes.
What is Neighborhood’s Performance on the ADD Measure?
Neighborhood’s Medicaid HEDIS Rate for CY 2020 is 50.83% for initiation and 61.79% for continuation and maintenance. These rates fell respectively into the 75th and 66th percentiles, placing them below the 2020 National Medicaid Quality Compass 90th percentiles.
How You Can Help
- For your patients newly diagnosed with ADHD, it is important to schedule a follow-up appointment within 30 days and then two follow-up appointments within nine months after the initial 30 days.
- Educate the parent or guardian that the child must be seen within 30 days of starting the medication to evaluate if the medication is working and assess any adverse effects.
- Offer parents or guardians of patient’s telehealth options when discussing follow-up appointments as a way to alleviate issues with access.
- Talk with the parent or guardian about the importance of the follow up appointments and schedule additional follow up appointments.
- It is also important that patients remain on prescribed medications during and after follow-up appointments.
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 liveandworkwell.com using access code “clinician.”
- You can also find additional tools and information about behavioral health issues on Optum – Provider Express > Clinical Resources > Behavioral Health Toolkit for Medical Providers.
- Patient education information is available on Optum – Live and Work Well using access code “clinician.” See “Mind & Body” at the top, scroll down to find the links to specific topics.
1 Ranna Parekh, M. M. (2017, July). American Psychiatric Association. Retrieved from What is ADHD?: https://www.psychiatry.org/patients-families/adhd/what-is-adhd