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The American Journal of Managed Care October 2019
Inflammatory Bowel Disease Readmissions Are Associated With Utilization and Comorbidity
Shirley Cohen-Mekelburg, MD, MS; Russell Rosenblatt, MD, MS; Beth Wallace, MD, MS; Nicole Shen, MD, MS; Brett Fortune, MD, MSc; Akbar K. Waljee, MD, MSc; Sameer Saini, MD, MS; Ellen Scherl, MD; Robert Burakoff, MD; and Mark Unruh, PhD
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Michael E. Chernew, PhD
The Long-term Social Value of Granulocyte Colony-Stimulating Factors
Alison Sexton Ward, PhD; Mina Kabiri, PhD; Aylin Yucel, PhD, MSc, MBA, MHSA, PharmD; Alison R. Silverstein, MPH; Emma van Eijndhoven, MS, MA; Charles Bowers, MD; Mark Bensink, PhD, MSc, MEd; and Dana Goldman, PhD
Physician Clinical Knowledge, Practice Infrastructure, and Quality of Care
Jonathan L. Vandergrift, MS; and Bradley M. Gray, PhD
Variation in US Private Health Plans’ Coverage of Orphan Drugs
James D. Chambers, PhD; Ari D. Panzer, BS; David D. Kim, PhD; Nikoletta M. Margaretos, BA; and Peter J. Neumann, ScD
Ease of Ordering High- and Low-Value Services in Various Electronic Health Records
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Real-World Outcomes Among Patients With Early Rapidly Progressive Rheumatoid Arthritis
Andrew J. Klink, PhD, MPH; Tammy G. Curtice, PharmD, MBA, MS; Kiran Gupta, PhD, MPharm; Kenneth W. Tuell, RPh, BCGP; A. Richard Szymialis, RPh; Damion Nero, PhD; and Bruce A. Feinberg, DO
Can Accountable Care Divert the Sources of Hospitalization?
Jangho Yoon, PhD; Lisa P. Oakley, PhD; Jeff Luck, PhD; and S. Marie Harvey, DrPH
Patients’ Expectations of Their Anesthesiologists
Charlie Lin, MD; Jansie Prozesky, MBChB; Donald E. Martin, MD; and Verghese T. Cherian, MD
A Deep Learning Model for Pediatric Patient Risk Stratification
En-Ju D. Lin, PhD, MPH; Jennifer L. Hefner, PhD, MPH; Xianlong Zeng, MS; Soheil Moosavinasab, MS; Thomas Huber, PhD, MS; Jennifer Klima, PhD; Chang Liu, PhD; and Simon M. Lin, MD, MBA
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Low Screening and Follow-up for Unhealthy Alcohol Use Among Health Plan Beneficiaries
Junqing Liu, PhD; Fern McCree, MPH; Doug Kanovsky, BA; Patricia Santora, PhD; Kazi Ahmed, PhD; Chirag Bhatt, MBA; and Sarah H. Scholle, DrPH

Low Screening and Follow-up for Unhealthy Alcohol Use Among Health Plan Beneficiaries

Junqing Liu, PhD; Fern McCree, MPH; Doug Kanovsky, BA; Patricia Santora, PhD; Kazi Ahmed, PhD; Chirag Bhatt, MBA; and Sarah H. Scholle, DrPH
Screening and follow-up for unhealthy alcohol use are low among plan members. Use of standardized screening tools, documentation, and care for alcohol misuse need improvement.
ABSTRACT

Objectives: Alcohol misuse is a leading cause of preventable death in the United States. This pilot study examined rates of screening and follow-up for unhealthy alcohol use among health plan beneficiaries.

Study Design: We analyzed medical records and claims data from 4 health plans—2 nonintegrated Medicaid plans and 2 integrated plans serving Medicaid, Medicare, and commercial product lines. The nonintegrated plans used medical records, case management, and claims data to identify alcohol screening and follow-up services using a random sample of 108 (plan 1) and 120 (plan 2) adults. The integrated plans (plans 3 and 4) used provider electronic health record data for all adults.

Methods: We adapted the Physician Consortium for Performance Improvement Foundation’s measure, Unhealthy Alcohol Use Screening & Brief Counseling, and applied it to plan populations for the 2014 and 2015 calendar years. We calculated rates of screening and follow-up for unhealthy alcohol use for each plan.

Results: Results from the Medicaid plans showed that between 40% and 46% of members had documentation of alcohol screening, but standardized alcohol screening tools were rarely used and screening results were inconsistently documented. Results from the integrated plans with multiple product lines showed wide variation: 5% to 69% of members were screened; of those, 3% to 31% screened positive. Among members who screened positive, 1% to 46% received follow-up care.

Conclusions: Rates of screening and follow-up for unhealthy alcohol use are low in plan populations. There is room for improvement in documentation and quality of care for alcohol misuse.

Am J Manag Care. 2019;25(10):e316-e319
Takeaway Points

Screening and follow-up for unhealthy alcohol use are low among plan members. Healthcare organizations need to improve care through:
  • Reporting the Unhealthy Alcohol Use Screening and Follow-Up measure that was included in the Healthcare Effectiveness Data and Information Set 2018
  • Wider use of this measure in programs such as the Medicare Star Rating System, the Medicaid Adult Core Set, and the Quality Rating System for qualified health plans in the Marketplace
  • Training providers on the Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach and on reimbursement requirements of SBIRT claims
  • Using standardized screening tools and Logical Observation Identifiers Names and Codes to document screening tools and results
About 30% of the US population misuses alcohol, and 21% of adults report engaging in risky or hazardous drinking.1 Risky or hazardous alcohol use means drinking more than the recommended daily, weekly, or per-occasion amount, resulting in increased risk of adverse health consequences such as heart disease, cancer, and stroke. Alcohol misuse is a leading cause of preventable death in the United States, accounting for 1 of every 10 deaths.2 More than 2200 deaths every year are caused by alcohol overdose.2 A 2010 report estimated the economic costs due to excessive alcohol use at $249 billion.3

Alcohol screening and follow-up have been shown to reduce alcohol misuse,4 but they remain underutilized health services in primary care.5 The grade B recommendation of the US Preventive Services Task Force (USPSTF) states that clinicians should screen adults 18 years or older for unhealthy alcohol use and provide brief behavioral counseling interventions to persons engaged in risky or hazardous drinking to reduce unhealthy alcohol use.6 The Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach is the most common prevention and early intervention model for unhealthy alcohol use.7 Health plans play an important role in addressing the issue of unhealthy alcohol use because not only do they pay for services, but they can also conduct screening for unhealthy alcohol use, provide brief counseling by clinical case managers, and encourage their network providers to deliver SBIRT services. Keeping in mind the crucial role of identification and appropriate intervention, this study evaluated health plan performance on unhealthy alcohol use screening and follow-up and examined the extent to which 3 standardized alcohol screening tools (Alcohol Use Disorders Identification Test [AUDIT], AUDIT-Concise [AUDIT-C], and National Institute on Alcohol Abuse and Alcoholism [NIAAA] single-question screener) were used. We adapted the Physician Consortium for Performance Improvement (PCPI) Foundation’s provider-level measure, Unhealthy Alcohol Use Screening & Brief Counseling, for health plan reporting because it is endorsed by the National Quality Forum and used by national quality payment programs.8 The adapted Unhealthy Alcohol Use Screening and Follow-Up measure is the first plan-level measure for use in the general adult population.

METHODS

Measure

The plan-level Unhealthy Alcohol Use Screening and Follow-Up measure captures members 18 years or older who were screened for unhealthy alcohol use during the year or the year prior using 1 of 3 standardized alcohol screening tools (AUDIT, AUDIT-C, NIAAA single-question screener) and received counseling or other follow-up within 2 months of a positive screen. We made the following measure adaptations: (1) allowing brief counseling and other unhealthy alcohol use treatment (eg, detoxification, crisis intervention) as follow-up care (the PCPI Foundation measure captured only brief counseling), (2) specifying that follow-up care should occur within 2 months of a positive alcohol screen (the PCPI Foundation measure allowed brief counseling anytime within 2 years of a positive screen), and (3) excluding plan members with a diagnosis of alcohol use disorder or dementia (the PCPI Foundation measure excluded only members with limited life expectancy). These adaptations were helpful for the plan-level measure because (1) the claim codes for follow-up care, provided across care settings and time, were available to health plans; (2) timely follow-up was clinically appropriate; and (3) the measure focused on preventive screening of members who did not have an existing alcohol diagnosis. Members with dementia were excluded because of unclear reliability of alcohol screening results for them. To be consistent with other health plan measures used in national programs, we did not exclude members with limited life expectancy.

Study Site

To examine variation in measure performance, we conducted outreach through health plan trade organizations and used a list of health plans maintained by the National Committee for Quality Assurance (NCQA) to recruit diverse plans that serve different types of populations. Four health plans representing diversity in geographic location, product line, and enrollment size agreed to participate in the study—2 Medicaid plans (in 2 states in the South and Northwest regions) and 2 plans with integrated delivery systems representing Medicaid, Medicare, and commercial product lines (in 2 states in the West). All plans were responsible for medical, pharmacy, and chemical dependency benefits and have been in business for at least 20 years. Two plans are NCQA accredited.


 
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