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Monitoring Antidepressant Medication Management

UPMC Health Plan Behavioral Health Services, together with UPMC Health Plan, monitors three clinical indicators related to antidepressant medication management: Optimal Practitioner Contacts, Effective Acute Phase Treatment and Effective Continuation Phase Treatment. To monitor these rates, UPMC Health Plan Behavioral Health Services uses a standard national methodology contained in the Health Plan Employer Data and Information Set (HEDIS).

Optimal Practitioner Contact (OPC) is defined as having 3 follow-up visits within the first 12 weeks of treatment after an initial diagnosis of depression is made and a member is treated with anti-depressant medication. One of the follow-up visits must be with a prescribing clinician. Effective Acute Phase Treatment is defined as members newly diagnosed with depression remaining on anti-depressant medications for at least 12 weeks. Effective Continuation Phase Treatment is defined as members newly diagnosed with depression and treated with anti-depressants, remaining on the medications for at least 6 months. Rates for these measures include:

Based on the annual survey results, UPMC Health Plan Behavioral Health Services identifies areas for improvement to increase member satisfaction ratings. The following areas for improvement were chosen:

• Access to routine and urgent treatment
• Being informed about self help or support groups
• Getting the help needed when calling Customer Service

Our 2004 calendar year rate for Optimal Practitioner Contacts is much higher than the national HEDIS average of 20.72% and is also higher than the 90th national percentile of 31.85%. Our 2004 rate for Acute Phase Treatment is also higher than the national HEDIS average of 61.26% and higher than the 90th national percentile of 69.31%. Additionally, our 2004 rate for Continuation Phase Treatment is above the national HEDIS average of 44.50% and above the 90th national percentile of 53.59%.

Although our rate for Optimal Practitioner Contacts has increased over the last 5 years, it is still considered low from a clinical perspective. As a result, we analyzed barriers interfering with members seeing clinicians frequently enough and developed interventions to improve this rate.

Barriers identified include:

• High caseloads and scheduling difficulties of practitioners
• Members and practitioners may lack knowledge of treatment guidelines and expectations
• Members may feel better after starting antidepressant medication and discontinue treatment prematurely

UPMC Health Plan Behavioral Health Services has implemented the following interventions to improve the rate of Optimal Practitioner Contacts:

• Treatment guidelines for depression are made available to practitioners
• Letters that encourage Optimal Practitioner Contacts are sent to practitioners treating members newly diagnosed with depressive disorders
• Care Managers prompt practitioners to schedule at least 3 contacts within 12 weeks of the start of anti-depressant medication treatment
• The Depression Case Management Initiative has been initiated with specific PCP groups for identifying members newly diagnosed with depression and providing them with appropriate behavioral health referrals.

UPMC Health Plan Behavioral Health Services and UPMC Health Plan will continue to monitor these antidepressant medication management measures and will develop additional interventions, as needed, to improve these rates.

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