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Vermont Medicaid (Global Commitment) (GC-19)

FUH: Follow Up After Hospitalization for Mental Illness - within 30 days* (GC-19)

Current Value

69.8%

2019

Definition

Line Bar

Notes on Methodology

  • The annual reported rate captures activity during the previous calendar year. 
  • This is a Healthcare Effectiveness & Data Information Set (HEDIS) administrative measure.
    • Through data analysis performed in 2014 during the FUH performance improvement project (PIP), Vermont Medicaid learned that administrative claims data alone was not capturing all of the follow-up care actually being provided. Follow-up visits at the Department of Mental Health's Designated Agencies (DA's) were not included in the rates prior to 2014. As you can see from the chart, once the DVHA Data Unit incorporated those mental health follow-up visits our rates rose considerably for Medicaid Primary beneficiaries.
  • Based on the advice of their External Quality Review Organization (EQRO), DVHA’s rates include only Medicaid Primary beneficiaries in HEDIS administrative measures as of 2014.
  • The red dashed trend line above is the 50th percentile national benchmark for Medicaid programs. The solid blue trend line is Vermont Medicaid's actual values.

Story Behind the Curve

This measure looks at continuity of care for mental illness. It measures the percentage of Medicaid beneficiaries 6 years of age and older who were hospitalized for selected mental disorders and who were seen on an outpatient basis by a mental health provider within 7 days, or within 30 days after their discharge from the hospital. The specifications for this measure are consistent with guidelines of the National Institute of Mental Health and the Centers for Mental Health Services.

It is important to provide regular follow-up therapy to patients after they have been hospitalized for mental illness. An outpatient visit with a mental health practitioner after discharge is recommended to make sure that the patient’s transition to the home or work environment is supported and that gains made during hospitalization are not lost. It also helps health care providers detect early post-hospitalization reactions or medication problems and provide continuing care.

The trend lines above show that Vermont Medicaid's actual performance has declined over the past three years. The national average, while lower than Vermont's performance, also showed a downturn in 2019.


Last updated:  July 2019

Author:  DVHA Quality Unit

Partners

•Medicaid beneficiaries and families
•Mental health practitioners
•Hospitals
•Department of Mental Health
•Department of Children and Families
•Department of Aging and Independent Living
•Vermont Department of Health

What Works

•Schedule follow-up appointments when a patient is discharged, as part of the treatment or case management plan.
•Educate patients and practitioners about the importance of timely follow-up visits.
•Consider reminder systems or “re-schedule” notices that are delivered to patients.
•Develop outreach systems or assign case managers to encourage recently discharged patients to keep follow-up appointments or reschedule missed appointments.

Action Plan

DVHA led a formal Performance Improvement Project (PIP) on this topic from 2013-2015. When that PIP cycle ended, Vermont Medicaid continued to focus on improving follow-up after hospitalization for mental illness by participating in a joint payer project, lead by the Vermont Program for Quality in Healthcare (VPQHC), also with the goal of increasing the number of mental health follow-up appointments after an individual has been hospitalized for mental illness. This project wrapped up in June 2018.

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