Vermont Medicaid (Global Commitment) (GC-21)

FUH: Follow Up After Hospitalization for Mental Illness - within 30 days* (GC-21)

73.4%2021

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Notes on Methodology
  • The target trendline in the graph above represents an accepted national benchmark percentile for Medicaid programs across the country. The value graphed historically was the national 50th percentile for comparison purposes. In 2020 (for measurement year 2019) we modified the value shown to demonstrate a target based on our actual performance.  For this measure, the target is the 90th national percentile.
  • The annual reported rate captures activity during the previous calendar year. 
  • This is a Healthcare Effectiveness & Data Information Set (HEDIS) administrative measure.
    • Through data analysis performed in 2014 during the FUH performance improvement project (PIP), Vermont Medicaid learned that administrative claims data alone was not capturing all of the follow-up care actually being provided. Follow-up visits at the Department of Mental Health's Designated Agencies (DA's) were not included in the rates prior to 2014. As you can see from the chart, once the DVHA Data Unit incorporated those mental health follow-up visits our rates rose considerably for Medicaid Primary beneficiaries.
  • DVHA’s rates only include Medicaid Primary beneficiaries in HEDIS administrative measures.
Partners

•Medicaid beneficiaries and families
•Mental health practitioners
•Hospitals
•Department of Mental Health
•Department of Children and Families
•Department of Aging and Independent Living
•Vermont Department of Health

Story Behind the Curve

This measure looks at continuity of care for mental illness. It measures the percentage of Medicaid beneficiaries 6 years of age and older who were hospitalized for selected mental disorders and who were seen on an outpatient basis by a mental health provider within 7 days, or within 30 days after their discharge from the hospital. The specifications for this measure are consistent with guidelines of the National Institute of Mental Health and the Centers for Mental Health Services.

It is important to provide regular follow-up therapy to patients after they have been hospitalized for mental illness. An outpatient visit with a mental health practitioner after discharge is recommended to make sure that the patient’s transition to the home or work environment is supported and that gains made during hospitalization are not lost. It also helps health care providers detect early post-hospitalization reactions or medication problems and provide continuing care.

The trend lines above show that Vermont Medicaid's actual performance was in decline but then improved during measurement year 2019. The national average remains lower than Vermont's performance.

Last updated:  September 2021

What Works

•Schedule follow-up appointments when a patient is discharged, as part of the treatment or case management plan.
•Educate patients and practitioners about the importance of timely follow-up visits.
•Consider reminder systems or “re-schedule” notices that are delivered to patients.
•Develop outreach systems or assign case managers to encourage recently discharged patients to keep follow-up appointments or reschedule missed appointments.

Action Plan

DVHA led a formal Performance Improvement Project (PIP) on this topic from 2013-2015. When that PIP cycle ended, Vermont Medicaid continued to focus on improving follow-up after hospitalization for mental illness by participating in a joint payer project, lead by the Vermont Program for Quality in Healthcare (VPQHC), also with the goal of increasing the number of mental health follow-up appointments after an individual has been hospitalized for mental illness. This project wrapped up in June 2018.

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy