Skip to Main Content
Ready to renew your Medicaid coverage? Explore our step-by-step guide to Medicaid renewal. Here's how
Ready to renew your Medicaid coverage? Explore our step-by-step guide to Medicaid renewal. Here's how

QI Insights - Highlighting Substance Use Disorder Treatment HEDIS Measures During National Recovery Month

Date: 08/14/24

National Recovery Month in September focuses on increasing public awareness of mental health and addiction recovery. This is an ideal time to emphasize the essential HEDIS® measures related to substance use disorder (SUD) used to address care opportunities for your patients.

Review the information below from our Quality Improvement (QI) team for a refresher to enhance your practice’s performance.

Substance Use Disorder (SUD) Treatment & Engagement: IET, FUI, & FUA Measures and Codes

  • Initiation and Engagement of Substance Use Disorder Treatment (IET)
    The IET measure evaluates the percentage of patients 13 years of age and older with new SUD episodes who received:
    • Initiation of SUD treatment through an inpatient SUD admission, outpatient visit, telehealth or intensive outpatient encounter or partial hospitalization, or medication-assisted treatment within 14 days of diagnosis.
    • Engagement of SUD treatment through initiation of medication-assisted treatment or two or more additional SUD services within 34 days of the initiation visit.

    Learn more about the IET measure on page 62 of the HEDIS Quick Reference Guide (PDF).

  • Follow-Up After High-Intensity Care for Substance Use Disorder (FUI)
    The FUI measure evaluates the percentage of acute inpatient hospitalizations, residential treatment, or withdrawal management visits for a diagnosis of SUD among patients 13 years of age and older that resulted in a follow-up visit or service for an SUD with a mental health provider. Two rates are reported: follow-up within 7 days and follow-up within 30 days.
    Learn more about the FUI measure on page 60 of the HEDIS Quick Reference Guide (PDF).

  • Follow-Up After Emergency Department Visit for Substance Use (FUA)
    The FUA measure evaluates the percentage of Emergency Department visits among patients 13 years of age and older with a principal diagnosis of SUD, or any diagnosis of drug overdose, for which there was a follow-up. Two rates are reported: follow-up within 7 days of the ED visit and follow-up within 30 days of the ED visit.
    Learn more about the FUA measure on page 54 of the HEDIS Quick Reference Guide (PDF).

Tips for Improving SUD Treatment and Engagement Measures

  • Complete a comprehensive exam before diagnosing, use evidence-based screenings and treatment recommended by SAMHSA.
  • Offer virtual, telehealth, and phone visits.
  • Provide empathetic listening and nonjudgemental discussions to engage the patient and caregivers in decision making and relapse prevention planning.
  • Offer maintenance medications for patients with opioid use disorder, alcohol use disorder, and/or tobacco use disorder.
  • Ensure patients receiving maintenance medications can easily access follow-up appointments.
  • Partner with Meridian to address the member’s health-related social needs.
  • Offer information on community support options, like peer support, harm reduction, and peer recovery programs such as Alcoholics Anonymous, Narcotics Anonymous, and Rational.
  • Encourage coordination between physical and behavioral health providers, including transitions in care.
  • Develop working alliances with specialists in substance use disorders to support patients who would benefit from specialty care.
  • Provide timely submission of claims and code substance-related diagnoses and visits accurately.

Access the behavioral health training resources on our Provider Education page, including a presentation on how to optimize the IET, FUI, and FUA measures.

Reducing the Risk of Opioid Overdose and Misuse: POD Measure

  • Pharmacotherapy for Opioid Use Disorder (POD)
    The POD measure evaluates patients 16 years of age and older with a diagnosis of Opioid Use Disorder (OUD) and a new OUD pharmacotherapy that lasted at least 180 days.

    The treatment period of 180+ days begins on the new OUD pharmacotherapy event date through 179 days without a gap in treatment of 8 or more consecutive days.

Tips to Reduce the Risk of Opioid Overdose and Misuse

  • Follow established guidelines regarding co-prescribing naloxone to patients at risk of overdose.
  • Educate patients on opioid safety and risk associated with long-term use of multiple opioids from different providers.
  • Provide timely submission of claims with correct medication name, dosage, frequency, and days covered.
  • Encourage coordination between physical and behavioral health providers, including transition in care
  • Inform patients with an OUD of the risks and benefits of pharmacotherapy treatment.
  • Offer information on community support options, like peer recovery support, harm reduction, and 12-step fellowships (AA, NA, etc.).
  • Educate patients and caregivers about local naloxone access and Good Samaritan laws.

Questions? Contact Your Meridian Quality Practice Advisor

Contact the Meridian Quality Practice Advisor (QPA) or Associate QPA (AQPA) assigned to your practice. They are ready to answer your HEDIS questions and help improve outcomes for your members. For additional information, consult the HEDIS Quick Reference Guide (PDF), contact your assigned Provider Relations representative, or call Provider Services at 866-606-3700.