As we’ve announced in previous articles, Point32Health maintains a series of HEDIS tip sheets (available on the Harvard Pilgrim and Tufts Health Plan provider websites), which offer insight into specific HEDIS measures — one of health care’s most widely used performance improvement tools.
The best practices and tips highlighted on these tip sheets are intended to help in identifying opportunities to improve patient care and aid your practice in optimizing HEDIS scores by ensuring that the is data reported accurately and reflects your practice’s performance.
Because we’re always looking for ways to make it as easy as possible for our valued provider network to work with us in delivering exceptional patient care, we’d like to highlight some information and reminders that may help support you in your efforts to adhere to the guidelines and standards of care set forth by the Follow-Up After Hospitalization for Mental Illness (FUH) and Initiation and Engagement of Substance Use Disorder Treatment (IET) measures.
Point32Health’s HEDIS tip sheet for the FUH measure offers information including what constitutes appropriate follow-up care, which provider types can administer this care to satisfy the measure, and some provider best practices to keep in mind.
The follow-up care assessed by this measure can include telehealth visits with a behavioral health provider. In light of this, we’d like to remind providers that Point32Health recently entered into a collaboration with Valera Health to increase access to quality virtual behavioral health services and provide evidence-based care to Point32Health members in Massachusetts. Valera Health offers a convenient online referral tool you can use to refer patients for outpatient behavioral health treatment after hospitalization for treatment of mental illness or intentional self-harm diagnoses, and we encourage you to take advantage of this tool when appropriate.
You can find additional resources and information on the Behavioral Health Programs and Resources page on Tufts Health Plan’s provider website, as well as the Caring for Your Patient page on Harvard Pilgrim’s provider website.
The IET measure documents the follow-up care patients receive after a new episode of substance use disorder (SUD). Our HEDIS tip sheet for IET emphasizes the value of screening for early identification, as well as appropriate follow-up after an SUD — which is as vital as the screening and diagnosis process itself.
After a patient is diagnosed with SUD in the primary care setting, it’s crucial to ensure that the patient receives treatment with a behavioral health specialist. Treatment, including medication assisted-treatment, in conjunction with counseling or other behavioral therapies, has been shown to reduce Alcohol-and-Other-Drug-(AOD)-associated morbidity and mortality.
If you need help finding a behavioral health clinician for your Tufts Health Plan patients, you can use the online Find a Doctor search tool or call the Tufts Health Plan Provider Service Center. For assistance with behavioral health referrals for Harvard Pilgrim Health Care members, call Optum/UBH at 888-777-4742.
Editor’s note: Updated the behavioral health contact number on 9/5/23.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Susan Panos, Stephen Wong,