NQF examines emerging science in behavioral health issues

December 1, 2012

Last month, the National Quality Forum (NQF) endorsed 10 behavioral-health quality measures

NATIONAL REPORTS-Last month, the National Quality Forum (NQF) endorsed 10 behavioral-health quality measures and announced plans for additional endorsements, expected in a second phase next Spring. Helen Burstin, MD, senior vice president for performance measures, says behavioral-health issues are getting their due.

"Many plans carve out some of these services," Dr. Burstin says. "Since some measures do crossover in the healthcare system and the classic mental-health system, this is something that hits health plans as well as carve outs. It's a nice example of the important need for integration and crossover to understand the impact on the patient."

For example, two of the newly endorsed measures call for follow up after hospitalization for schizophrenia or mental illness. The measures-which originate with the National Committee for Quality Assurance (NCQA), an organization that measures health plan performance-increase the attention to care transitions, she says.

Throughout the industry, payers and providers are implementing new programs to improve care transitions, aimed at making a smooth connection between the inpatient and outpatient settings. It's an area of opportunity in terms of saving costs and improving outcomes.

"Many of these measures are process oriented, but one of the big issues is use of antipsychotic drugs," Dr. Burstin says. "Tracking outcomes becomes really important."

She says the committee that evaluated the measures considered outcomes measurement. Four NQF priorities call for screening of specific comorbid health risks for patients taking antipsychotic medications for schizophrenia or bipolar disorder, including diabetes and cardiovascular risk.

According to literature, the antipsychotic drugs associated with weight gain, worsening lipid profile and risk for diabetes include:
● Clozapine;
● Olanzapine;
● Risperidone (inconclusive evidence for worsening lipid profile and risk for diabetes); and
● Quetiapine (inconclusive evidence for worsening lipid profile and risk for diabetes).

Other drugs in the category as well as newer atypical antipsychotics have not been evaluated for worsening lipid profile and risk for diabetes.

GREATER PREVALENCE OF MENTAL HEALTH NEEDS

More than 26% of the U.S. population has a mental illness or substance-abuse health issue, according to the World Health Organization. The top 6% who have serious illness die 25 years earlier than the general population and suffer direct impact in their engagement and response to medical treatment.

"We don't want to endorse a measure before the science is there, and there is a lot of emerging science in the mental health field," Dr. Burstin says.

The next phase of the behavioral health endorsements will examine measures in bipolar disorder and depression. Measures for consideration may be submitted to NQF this month for endorsement in early 2013.

The organization has previously endorsed performance measures focused on mental health and substance abuse. In November 2011, NQF-at the request of the Department of Health and Human Services-began the two-phase project aimed at endorsing new behavioral health measures applicable to all care delivery settings, including primary and specialty care.

Endorsed Measures

● Initiation and engagement of alcohol and other drug dependence treatment (NCQA)
● Medical assistance with smoking and tobacco use cessation (NCQA)
● Preventive care & screening: tobacco use; Screening & cessation intervention (American Medical Assn.)
● Adherence to antipsychotic medications for individuals with schizophrenia (Centers for Medicare and Medicaid Services)
● Diabetes screening for people with schizophrenia or bipolar disorder who are prescribed antipsychotic medications (NCQA)
● Cardiovascular health screening for people with schizophrenia or bipolar disorder who are prescribed antipsychotic medications (NCQA)
● Cardiovascular health monitoring for people with cardiovascular disease and schizophrenia (NCQA)
● Diabetes monitoring for people with diabetes and schizophrenia (NCQA)
● Follow-up after hospitalization for schizophrenia (7- and 30-day) (NCQA)
● Follow-up after hospitalization for mental illness (NCQA)