Managed Care - March 2008 - (Page 9) NEWS AND COMMENTARY Proposed 2009 HEDIS Measures Address Immunization, Obesity Rates he National Committee for Quality Assurance, in its neverending effort to improve its own quality, wants to expand what the committee’s Healthcare Effectiveness Data and Information Set (HEDIS) measures look at in 2009. As part of what the NCQA calls its “effectiveness of care” measure, the committee will review how well health plans immunize adolescents. Proposed is a measure to evaluate the percentage of adolescents who have one dose of meningococcal (MCV4 or MPSV4) vaccine and one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), or diphtheria toxoids (Td) vaccine by the 13th birthday. Perhaps to reinforce that health care is a cradle-to-grave endeavor, the NCQA also wants to tweak the way it measures the sort of care health plans provide older adults. The NCQA wants to know who, 65 or older, receives a functional status assessment, pain screening, advance care planning, and medication review during the measurement year. The committee also wants to see how well plans track medication compliance by older people by measuring how many get their prescriptions filled after being discharged from the hospital. In addition, the NCQA wants to find out how many adults, 18–74, have their body mass index measured. In the same vein, how many children, 2–17, have evidence of BMI percentile assessment, counseling for nutrition, and counseling for physical activity during the measurement year? Those are the proposed new HEDIS measures. Meanwhile, the NCQA wants to tweak existing measures by adding diagnostic mammography to its breast cancer screening measure, adding hepatitis A, rotavirus, and influenza vaccines to its childhood immunization measure, and retiring the optimal practitioner contacts rate for its antidepressant medication management measure. T New Drug Abuse Codes Adopted The American Medical Association says that new CPT codes it developed should make it easier for health plans to determine whether doctors have screened for drug abuse and provided brief intervention when patients visit doctors’ offices, emergency rooms, health fairs, or community clinics. The AMA hopes that this in turn will mean that insurers will pay physicians promptly for providing such services. The new codes, 99408 and 99409, will streamline reporting and the payment procedure for doctors who perform alcohol or substance (other than tobacco) abuse screening and intervention, the AMA hopes. The process will increase the likelihood that those with substance abuse disorders will receive an appropriate intervention. The AMA developed the codes at the urging of the White House Office of National Drug Control Policy. Bertha K. Madras, MD, deputy director of National Drug Control Policy, says, “These new codes will enable physicians to reach those in harm’s way — during a doctor’s visit — and provide them with appropriate med- ical services. Widespread screening and brief interventions can effectively reduce substance use disorders.” Sample questions from the screening tool include: • Can you get through the week without using drugs? • Are you always able to stop using drugs when you want to? • Do you ever feel bad or guilty about your drug use? • Have you neglected your family because of your use of drugs? • Have you been in trouble at work because of your use of drugs? • Have you engaged in illegal activities in order to obtain drugs? Drug Caps Lower Spending, but . . . Drug caps — the maximum number of prescriptions or drugs that a health plan will cover — and copayment policies can decrease overall drug use as well as insurers’ pharmacy spending, according to “Pharmaceutical policies: Effects of cap and copayment on rational drug use,” a study published in the Cochrane Database of Systematic Reviews. Researchers combed through 21 studies that evaluated policies implemented by governments, not-forprofit agencies, and health insurance companies to evaluate five policies in which consumers pay directly for their drugs when they fill their prescription: caps, fixed copayments, tier copayments, coinsurance, and ceilings. The researchers found reductions in drug use for both life-sustaining drugs and drugs that are important in treating chronic conditions. These policies tend to make consumers shoulder some of the cost of pre- MARCH 2008 / MANAGED CARE 9
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