Recent Data Suggests Substance Abuse is Going Untreated
The 2013 State of Health Care Quality Report compiled by the National Committee for Quality Assurance (NCQA) outlined several positive trends in American health care. For example, physicians are paying more attention to childhood obesity, immunizations are on the rise, and more Medicaid enrollees are satisfied with the care they’re receiving. Unfortunately, the most recent HEDIS results also identified a decline in the proportion of diagnosed chemically dependent patients who receive treatment for their condition. This statistic was most pronounced among individuals with Medicare plans, suggesting seniors are especially susceptible to this troubling trend.
HEDIS and Substance Abuse
The NCQA has long considered substance abuse diagnosis and treatment worth tracking. Its annual HEDIS, or Healthcare Effectiveness Data and Information Set, assesses the percentage of adolescent and adult members of a given health plan who are diagnosed with alcohol or other drug (AOD) dependence. It then follows those patients to see whether newly diagnosed individuals receive treatment and notes what kind of treatment they receive. HEDIS distinguishes between inpatient admissions, outpatient visits, intensive outpatient encounters, and partial hospitalizations.
Ideally, all members of a given health plan who have been diagnosed as having substance abuse problems will seek some kind of treatment within 30 days of their first consultation. When physicians working for a specific plan fail to counsel AOD dependent patients about available treatment options and a diagnosed patient goes untreated, the data reflects negatively on that health plan as a whole. While an unfavorable HEDIS report can easily affect a health plan’s bottom line, the same data can also reveal important things about healthcare practices.
How Data Can Improve Care
Encouraging a chemically dependent patient to undergo treatment is one of the more complicated tasks a provider must perform. Whereas it is usually easy to guide a patient with a broken arm towards receiving medical attention, it can be far more challenging to convince an addict to seek help. By citing statistics that identify an area where providers need improvement, health plans may be able to secure resources that will increase future success. There are more deaths, illnesses and disabilities from substance abuse than from any other preventable health condition. Addicts place an incredible strain not only on the entire health care system, but also on the police and the judicial system as well. Counseling a confused or stubborn patient about therapy options may keep them healthy and out of trouble.
Only through the dedication of trained HEDIS abstractors and the commitment of health plan representatives can HEDIS generate accurate data about the state of health care in our country today. Identifying areas of opportunity is the first step to fixing them. Health plan representatives seeking knowledgeable and passionate assistance with HEDIS projects and Nurses interested in aiding this important cause while working a flexible schedule should consider visiting HEDIS Nurses today.
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