Quality Metrics Tool

Review Healthcare Effectiveness Data, and Information Set (HEDIS) and National Quality Forum (NQF) endorsed measures for schizophrenia all in one easy-to-use tool.

A number of quality metrics focused on behavioral health care have been developed by various national organizations. The measures created by these health care quality entities focus on different aspects of population health management and vary in scope from process-related to clinically-focused metrics, as well as medication adherence and other aspects of health care quality measurement.*

*This tool provides summaries from select, nationally-recognized, quality entities. Note: Other quality organizations may offer additional measures for individuals with schizophrenia.

Behavioral Health Quality Metrics

Select a health care quality entity to expand and read more.

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  • About National Committee for Quality Measures (NCQA) HEDIS Measures1


    HEDIS is a standardized set of measures used by more than 90% of United States health plans to measure performance in different areas of care and service.1

    NCQA developed HEDIS as a means to:

    • Provide the managed care industry with a way to compare performance among plans
    • Allow health plans a way to obtain information on specific areas that need improvement
    • Assist consumers in selecting the health plan that best meets their needs


    HEDIS measures are reviewed and updated on an annual basis. As of 2018, HEDIS consists of 94 measures across 7 domains of care that include preventive care services and chronic disease management.1

  • HEDIS Measures Related to Mental Health1,2


    HEDIS measures have focused on mental health since before 2012, including aspects of care coordination, medication management, and overall mental health care utilization. In reports, the NCQA has indicated that behavioral health is a common, but sometimes hidden, driver of health care costs. Treatment can present a quality challenge, such as increased risk for diabetes and other metabolic diseases in individuals who take antipsychotic medications. As such, HEDIS measures related to mental health measures have expanded in recent years.

  • HEDIS Measure for Follow-up After Hospitalization for Mental Illness1,2


    Description: Assesses adults and children 6 years of age and older who were hospitalized for treatment of selected mental health disorders and had an outpatient visit, an intensive outpatient encounter or a partial hospitalization with a mental health practitioner. The measure identifies the percentage of members who received follow-up within 7 days of discharge and within 30 days of discharge

    • Applicable to:
      • Commercial insurance, Medicaid, and Medicare
      • Covers ages 6 and over
  • HEDIS Measure for Metabolic Monitoring for Children and Adolescents on Antipsychotics1,2


    Description: Assesses the percentage of children and adolescents with ongoing antipsychotic medication use who had metabolic testing during the year

    • Applicable to: Commercial insurance and Medicaid
  • HEDIS Measure for Use of Multiple Concurrent Antipsychotics in Children and Adolescents1,2


    Description: Assesses the percentage of children and adolescents who were on two or more concurrent antipsychotic medications for an extended period of time during the year.

    • Applicable to: Commercial insurance and Medicaid
  • HEDIS Measure for Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics1,2


    Description: Assesses whether children and adolescents without an indication for antipsychotic medication use had documentation of psychosocial care as first-line treatment before being prescribed an antipsychotic medication.

    • Applicable to: Commercial insurance and Medicaid
  • About NQF-Endorsed Measures3


    Description: NQF endeavors to promote and ensure patient protections and health care quality through measurement and public reporting. The federal government relies on NQF-defined measures or health care practices as the best, evidence-based approaches to improving care. In addition to the federal government, states and private-sector organizations use NQF’s endorsed measures, which must meet thorough criteria, to evaluate performance and share information with patients and their families.3

  • NQF 2800: Metabolic Monitoring for Children and Adolescents on Antipsychotics4


    Description: The percentage of children and adolescents 1 to 17 years of age who had two or more antipsychotic prescriptions and had metabolic testing

    • Measure Steward: National Committee for Quality Assurance (NCQA)
    • Applicable to: Commercial insurance and Medicaid
  • NQF 2801: Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics4


    Description: Percentage of children and adolescents 1 to 17 years of age with a new prescription for an antipsychotic, but no indication for antipsychotics, who had documentation of psychosocial care as first-line treatment

    • Measure Steward: NCQA
    • Applicable to: Commercial insurance and Medicaid


 

References:

  1. National Committee for Quality Assurance. HEDIS® & Performance Measurement—Measuring Performance. www.ncqa.org/tabid/59/Default.aspx.  Accessed on May 4, 2018.
  2. National Committee for Quality Assurance. 2017 State of Health Care Quality—HEDIS Measures of Care. www.ncqa.org/report-cards/health-plans/state-of-health-care-quality/2017-table-of-contents. Accessed May 4, 2018.  
  3. National Quality Forum. NQF’s History. www.qualityforum.org/about_nqf/history. Accessed on May 4, 2018. 
  4. National Quality Forum. NQF-Endorsed Measures. www.qualityforum.org/QPS/QPSTool.aspx. Accessed on May 4, 2018.  


HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). To purchase copies of this publication, contact NCQA Customer Support at 888-275-7585 or visit www.ncqa.org/publications