ADHD and HEDIS Adherence

By: AvMed News AvMed News

Is your pediatric patient exhibiting problems with focus, attention and behavior control? They could have attention deficit hyperactivity disorder (ADHD), a common disorder that affects roughly 11 percent of children in the United States; it can also affect teenagers and continue into adulthood.

According to the Centers for Disease Control and Prevention (CDC), patients with ADHD often display symptoms such as:

  • Problems with concentration
  • Trouble staying organized
  • Difficulty remembering details

ADHD is often treated with medications. Since 2006, the National Committee for Quality Assurance’s (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®) surveys have included a measure to assess adherence to best practice protocols regarding follow-up care for children prescribed ADHD medication.

There are two phases in this measure: The initiation phase that looks for newly prescribe patients to have a follow-up visit within 30 days of initial prescription, and the continuation/maintenance phase that requires 2 or more additional follow-up visits within 9 months after the initiation phase.

Here are some best practices you can follow to help us improve quality and coordination of care:

  • Follow up with the patient to be sure dosage is correct, the patient is not experiencing side effects, and to monitor the patient for risks and benefits.
  • Monitor dosage after 30 days to determine if any adjustment is needed.
  • Instruct parents to call you if the patient experiences any serious side effects.
  • Refer the patient to a behavioral health provider for psychosocial support and skill building.

AvMed’s behavioral health partner Magellan Healthcare also provides an array of resources, including appointment assistance, utilization review and case management options. Telehealth options are also available. In addition, Magellan offers a behavioral health toolkit for medical providers, which can be accessed here.

On Monday, July 8, AvMed and Magellan Health are co-hosting a behavioral health webinar discussing “Antidepressant Medication Measurement” and “Follow Up Care for Children Prescribed ADHD (ADD) Medication.” This is an excellent opportunity to learn and ask questions directly to providers.

To register for the webinar, please follow the link for your preferred time slot:
Session 1 (12 p.m.-1p.m.) OR Session 2 (3 p.m.-4 p.m.)

To refer a patient to a behavioral health provider, call the number on the back of the Member’s benefits card. A Magellan care manager will work with you to determine the most appropriate resource based on patient need and preference, Provider specialty and Provider location as well as other specific Member requests or considerations.