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How Collective Medical Helps Health Plans Close the Care Gap for Follow-Up After Emergency Department Measures

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In November 2020, we touched on the impending time-sensitive Healthcare Effectiveness Data and Information Set (HEDIS) measures related to care provided in the emergency department (ED). For Measurement Year (MY) 2021 there are three HEDIS Follow-Up after ED utilization measures that have significant clinical and financial impact to individuals and the healthcare system.

Follow-Up After ED Visit for People with High-Risk Multiple Chronic Conditions (FMC) is a newer HEDIS measure and is critical to providing value-based care. One study found that older adults discharged from the ED had an average mortality rate of 10%, an average ED readmission rate of 24%, and an average post-discharge hospitalization rate of 24% within the first three months after the ED visit.1

Follow-Up After ED Visit for Mental Illness (FUM) is another primary area of focus in the United States, where 18% of adults and 13%–20% of children under 18 years of age experience mental illness.2 3 Research suggests that follow-up care for people with mental illness is linked to fewer repeat ED visits, improved physical and mental function, and increased compliance with follow-up instructions.4 5 6

Follow-Up After ED Visit for Alcohol and Other Drug (AOD) Abuse or Dependence (FUA) is crucial, because timely follow-up care for individuals with AOD who were seen in the ED is associated with a reduction in substance use, future ED use, hospital admissions and bed days.7 8 9

Health plans are the most successful in supporting their members and providers in closing these care gaps when they invest in an intervention that alerts their care managers and provider community that one of their members has used the ED and requires follow up care. Collective Medical is working with health plans through a combination of our Care and Utilization Management and Quality and Coding programs. This allows health plans to identify their members in real time when they present in the ED, and gather comprehensive and up-to-date contact information. With this information, the case managers can then create workflows and direct notifications to their identified providers to ensure a follow-up visit is scheduled that meets the HEDIS technical specifications.

Often times, our health plan customers have difficulty meeting or exceeding performance goals regarding ED follow-up measures and need assistance with building a clinical and technical infrastructure to address these care gaps. Collective Medical is uniquely positioned to support health plan members and providers through real-time information sharing that facilitates collaboration, and ultimately, whole-patient care.

1 Aminzadeh, F., and W.B. Dalziel. 2002. “Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions.” Annals of Emergency Medicine 39(3), 238–47.

2 Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/

3 Perou, R. et al. (2013). Mental Health Surveillance Among Children — United States, 2005–2011. Centers for Disease Control and Prevention- Morbidity and Mortality Weekly Report, 62(02), 1-35. Retrieved from: https://www.cdc.gov/mmwr/preview/mmwrhtml/su6202a1.htm?s_cid=su6202a1_w

4 Bruffaerts, R., Sabbe, M., Demyffenaere, K. (2005). Predicting Community Tenure in Patients with Recurrent Utilization of a Psychiatric Emergency Service. General Hospital Psychiatry, 27, 269-74.

5 Griswold, K.S., Zayas, L.E., Pastore, P.A., Smith, S.J., Wagner, C.M., Servoss, T.J. (2018) Primary Care After Psychiatric Crisis: A Qualitative Analysis. Annals of Family Medicine, 6(1), 38-43. doi:10.1370/afm.760.

6 Kyriacou, D.N., Handel, D., Stein, A.C., Nelson, R.R. (2005). Brief Report: Factors Affecting Outpatient Follow-up Compliance of Emergency Department Patients. Journal of General Internal Medicine, 20(10), 938-942. doi:10.1111/j.1525-1497.2005.0216_1.x.

7 Kunz, F.M., French, M.T., Bazargan-Hejazi, S. (2004). Cost-effectiveness analysis of a brief intervention delivered to problem drinkers presenting at an inner-city hospital emergency department. Journal of Studies on Alcohol and Drugs, 65, 363-370.

8 Mancuso, D., Nordlund, D.J., Felver, B. (2004). Reducing emergency room visits through chemical dependency treatment: focus on frequent emergency room visitors. Olympia, Wash: Washington State Department of Social and Health Services, Research and Data Analysis Division.

9 Parthasarathy, S., Weisner, C., Hu, T.W., Moore, C. (2001). Association of outpatient alcohol and drug treatment with health care utilization and cost: revisiting the offset hypothesis. Journal of Studies on Alcohol and Drugs, 62, 89-97.