August 2019

Improving Care for Patients with Attention Deficit Hyperactivity Disorder

According to the 2016 National Survey of Children’s Health (NSCH), an estimated 6.1 million children, ages 2-17 years had been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) in the U.S. Of those children diagnosed with ADHD, 64% had also been diagnosed with another behavioral, emotional or mental disorder¹. Symptoms of ADHD include: inattention, hyperactivity and impulsivity, and can appear as early as age three. According to the National Institute for Mental Health (NIMH), symptoms can change with age and development².

As a provider, you are aware of the impact this condition has on the patient, and the need and benefit for continued follow-up care. Blue Cross and Blue Shield of Texas (BCBSTX) is committed to our partnership with you and our shared members to improve quality of care and health outcomes.

In 2020, BCBSTX will implement a Performance Improvement Project (PIP) to improve the HEDIS® measure: Follow-Up Care for Children Prescribed ADHD Medication. To improve care, clinical guidelines require that patients are seen within 30 days of receiving a prescription to ensure medication compliance and appropriate dosage. Additionally, two other visits for follow-up must occur within 7 months after the first visit to continually assess adherence, effectiveness and side effects of medication.

Demonstrated in the table below are the BCBSTX rates for the ADHD measures that include the first follow up (initiation phase), and second and third follow-up visits:

*Pending NCQA 50th percentile

BCBSTX recognizes opportunities for improvement and continually assesses interventions and outcomes. As we strive to improve this and other HEDIS measures, we invite you to provide suggestions and interventions that may assist in improving patient compliance, follow-up care and health outcomes.

Best Practice Summary:

1. Educate members on the importance of follow-up care within 30 days after prescribing ADHD medication.
2. Ensure that members continue to follow-up with you for continuation of care.
3. Ensure appointment availability for follow-up visits.
4. Educate your patients on the importance of medication continuation while making them aware of potential side effects and benefits.
5. Reach out to the following for assistance:
• Magellan Healthcare^® (Behavioral Health): 1-800-327-7390
• BCBSTX Case Management/Disease Management (STAR and CHIP): 1-800-214-5630
• BCBSTX Service Coordination (STAR Kids): 1-877-301-4394

Resources:

• Behavioral Health Toolkit for Medical Providers – Magellan's resources for coordinating a patient's behavioral health needs
• Clinical Practice Guidelines – Magellan's clinical practice guidelines and supporting resources for providers.
• Reference BCBSTX’s Preventive Care Guidelines and Clinical Practice Guidelines, and the Texas Health Steps for Providers website for more information on this and other important topics for treating your patients.
• American Association of Pediatrics ADHD Toolkit

References:
¹ Attention-Deficit/Hyperactivity Disorder. (n.d).
² Data and Statistics About ADHD. (Feb. 5, 2019).
³ Effectiveness of care: Diabetes, musculoskeletal, behavioral. (2019). In HEDIS 2019, volume 2, technical specifications (pp. 193-197).