Product Lines:
Advantage MD, EHP, Priority Partners, and USFHP.

Measurement Period: January 1 - December 31

Description: 
The percentage of persons 13 years of age and older who were diagnosed with a substance use disorder during the measurement period. Four rates are reported:

1. The percentage of persons diagnosed with an alcohol disorder.
2. The percentage of persons diagnosed with an opioid disorder.
3. The percentage of persons diagnosed with a disorder for other or unspecified drugs.
4. The percentage of persons diagnosed with any substance use disorder.
   
   

Note: The measure provides information on the diagnosed prevalence of substance use disorders. Neither a higher nor a lower rate indicates better performance.

Stratifications:
Age as of the last day of the measurement period. 

• 13-17 years.
• 18-64 years.
• 65 years and older.

Data Collection:

• Administrative.
• Supplemental.

Initial Population:

• Measure Item Count: Person.
• Age: 13 years of age and older as of the last day of the measurement period.
• Benefits: Medical.
• Continuous Enrollment: The measurement period.
• Allowable Gap: No more than one gap of ≤45 days during the measurement period. 

Denominator:
The initial population minus denominator exclusions.

Numerator:

Numerator 1 - Alcohol Use Disorder
Persons who had an alcohol use disorder diagnosis (Alcohol Abuse and Dependence Value Set) during the measurement period.

Numerator 2 - Opioid Use Disorder
Persons who had an opioid use disorder diagnosis (Opioid Abuse and Dependence Value Set) during the measurement period.

Numerator 3 - Other Substance Use Disorder
Persons who had a diagnosis of SUD that was neither for opioid or alcohol (Other Drug Abuse and Dependence Value Set) during the measurement period.

Numerator 4 - Any Substance Use Disorder
Persons who had any substance use disorder during the measure period. Any of the following meet criteria.

• Alcohol Abuse and Dependence Value Set.
• Opioid Abuse and Dependence Value Set.
• Other Drug Abuse and Dependence Value Set.

Best Practice and Measure Tips

• Educate patients on the significance of follow-up appointments and adherence to treatment plans.
• Highlight the importance of timely, recommended follow-up visits.
• Promptly schedule follow-up appointments, especially for recently discharged patients.
• Coordinate care with behavioral health practitioners by sharing progress notes and updates.
• Reach out to patients who cancel appointments and assist them with rescheduling promptly.
• Consider telemedicine consultations when in-person visits are not feasible.
• Emphasize the importance of seeking follow-up care with a behavior health provider.
• Establish an outreach team or assign care managers to ensure members keep or reschedule follow-up appointments.
• Assess the need for Case Management and refer if necessary.
  • The Johns Hopkins Health Plans Care Management team offers a variety of services to help members who are living with substance abuse and mental health issues may receive confidential care management support and coordination of care from a Licensed Clinical Social Worker. These behavioral health clinicians help members navigate their treatment needs for conditions such as depression, anxiety disorders, addictions, and autism spectrum disorders. For Priority Partners members, we work with Carelon Behavioral Health of Maryland to manage mental health needs.
    • Please send us your member referrals by contacting us at:
      Phone: 800-557-6916
      Monday through Friday: 8 a.m. to 5 p.m.
      Voicemail messages received after normal business hours will be addressed the following business day.
      EHP Behavioral Health: 410-424-4891
      EHP Behavioral Health- Secured: 410-424-4765
      USFHP Mental Health: 410-424-4839
      Advantage MD Behavioral Health, Inpatient & Outpatient: 844-340-2217
      Email: [email protected]

Measure Exclusions

Denominator Exclusions:

• Persons in hospice or using hospice services any time during the measurement period.
• Persons who died any time during the measurement period.
  
  

Measure Codes

Alcohol Abuse and Dependence

• ICD-10-CM: F10.10, , F10.120, F10.121, F10.129, F10.130, F10.131, F10.132, F10.139, F10.14, F10.150, F10.151, F10.159, F10.180, F10.181, F10.182, F10.188, F10.19, F10.20, F10.220, F10.221, F10.229, F10.230, F10.231, F10.232, F10.239, F10.24, F10.250, F10.251, F10.259, F10.26, F10.27, F10.280, F10.281, F10.282, F10.288, F10.29
• SNOMED CT US Edition: 281004, 7052005, 7200002, 8635005, 15167005, 18653004, 34938008, 61144001, 66590003, 70701004, 73097000, 86325007, 87810006, 191475009, 191476005, 191478006, 191480000, 191811004, 191812006, 191882002, 191883007, 268645007, 284591009, 308742005, 713583005, 713862009, 714829008, 723926008, 723927004, 97571000119109, 135301000119103, 135311000119100, 135321000119107, 154211000119108, 288021000119107, 288031000119105, 10741871000119101, 10755041000119100 

Opioid Abuse and Dependence

• ICD-10-CM: F11.10, F11.120, F11.121, F11.122, F11.129, F11.13, F11.14, F11.150, F11.151, F11.159, F11.181, F11.182, F11.188, F11.19, F11.20, F11.220, F11.221, F11.222, F11.229, F11.23, F11.24, F11.250, F11.251, F11.259, F11.281, F11.282, F11.288, F11.29.
• SNOMED CT US Edition: 5602001, 14784000, 19445006, 20385005, 29733004, 52866005, 71328000, 75544000, 87132004, 88926005, 191819002, 191820008, 191909007, 191912005, 191913000, 230443000, 231477003, 231478008, 231479000, 231480002, 426001001, 703845008, 703846009, 724655005, 762320004, 762321000, 762322007, 1255013006, 1255015004, 1255018002, 1304039005, 1304040007, 1081000119105, 145121000119106, 288851000119106, 288861000119108 

Other Drug Abuse and Dependence

• ICD-10-CM: F12.10, F12.120, F12.121, F12.122, F12.129, F12.13, F12.150, F12.151, F12.159, F12.180, F12.188, F12.19, F12.20, F12.220, F12.221, F12.222, F12.229, F12.23, F12.250, F12.251, F12.259, F12.280, F12.288, F12.29, F13.10, F13.120, F13.121, F13.129, F13.130, F13.131, F13.132, F13.139, F13.14, F13.150, F13.151, F13.159, F13.180, F13.181, F13.182, F13.188, F13.19, F13.20, F13.220, F13.221, F13.229, F13.230, F13.231, F13.232, F13.239, F13.24, F13.250, F13.251, F13.259, F13.26, F13.27, F13.280, F13.281, F13.282, F13.288, F13.29, F14.10, F14.120, F14.121, F14.122, F14.129, F14.13, F14.14, F14.150, F14.151, F14.159, F14.180, F14.181, F14.182, F14.188, F14.19, F14.20, F14.220, F14.221, F14.222, F14.229, F14.23, F14.24, F14.250, F14.251, F14.259, F14.280, F14.281, F14.282, F14.288, F14.29, F15.10, F15.120, F15.121, F15.122, F15.129, F15.13, F15.14, F15.150, F15.151, F15.159, F15.180, F15.181, F15.182, F15.188, F15.19, F15.20, F15.220, F15.221, F15.222, F15.229, F15.23, F15.24, F15.250, F15.251, F15.259, F15.280, F15.281, F15.282, F15.288, F15.29, F16.10, F16.120, F16.121, F16.122, F16.129, F16.14, F16.150, F16.151, F16.159, F16.180, F16.183, F16.188, F16.19, F16.20, F16.220, F16.221, F16.229, F16.24, F16.250, F16.251, F16.259, F16.280, F16.283, F16.288, F16.29, F18.10, F18.120, F18.121, F18.129, F18.14, F18.150, F18.151, F18.159, F18.17, F18.180, F18.188, F18.19, F18.20, F18.220, F18.221, F18.229, F18.24, F18.250, F18.251, F18.259, F18.27, F18.280, F18.288, F18.29, F19.10, F19.120, F19.121, F19.122, F19.129, F19.130, F19.131, F19.132, F19.139, F19.14, F19.150, F19.151, F19.159, F19.16, F19.17, F19.180, F19.181, F19.182, F19.188, F19.19, F19.20, F19.220, F19.221, F19.222, F19.229, F19.230, F19.231, F19.232, F19.239, F19.24, F19.250, F19.251, F19.259, F19.26, F19.27, F19.280, F19.281, F19.282, F19.288, F19.29
• SNOMED CT US Edition: 1383008, 1686006, 1973000, 2403008, 5002000, 5444000, 6348008, 7071007, 8837000, 10327003, 11387009, 15277004, 18689007, 20876004, 21647008, 22574000, 25753007, 26714005, 27956007, 28864000, 30491001, 31956009, 32009006, 32358001, 32875003, 37344009, 38247002, 39807006, 39951001, 40571009, 43497001, 46975003, 47664006, 50320000, 50933003, 51443000, 51493001, 53050002, 57588009, 58727001, 59651006, 61104008, 63649001, 63983005, 64386003, 70328006, 70340006, 70932007, 74851005, 74934004, 75122001, 77355000, 78267003, 78358001, 80868005, 82339009, 83367009, 85005007, 89451009, 91388009, 95661003, 191831000, 191832007, 191837001, 191838006, 191849000, 191850000, 191853003, 191855005, 191856006, 191891003, 191893000, 191894006, 191899001, 191900006, 191916008, 191918009, 191919001, 231462006, 231468005, 231469002, 231470001, 231472009, 231473004, 231474005, 268646008, 275471001, 312098001, 312936002, 361151007, 425339005, 425885002, 426095000, 426873000, 427229002, 427327003, 428370001, 441527004, 442406005, 699449003, 703848005, 703849002, 703850002, 723936000, 723937009, 724656006, 724660009, 724661008, 724663006, 724665004, 724666003, 724667007, 724668002, 724669005, 724670006, 724671005, 724672003, 724675001, 724689006, 724690002, 724691003, 724692005, 724693000, 724696008, 724701001, 724702008, 724706006, 724713006, 724715004, 724720004, 724726005, 724727001, 724728006, 724732000, 735750005, 737338002, 762324008, 762325009, 762326005, 762327001, 762333005, 762334004, 762335003, 762336002, 762337006, 762338001, 762339009, 762340006, 762344002, 762345001, 762346000, 762504005, 762505006, 762517008, 762672001, 785277001, 817962007, 838527002, 1230071005, 1230072003, 1230084001, 1230085000, 1230086004, 1230087008, 1230088003, 1230089006, 1231160001, 1231162009, 1231319004, 1231327008, 1231328003, 1231333004, 1231336007, 23601000119102, 34111000119108, 86391000119101, 86401000119104, 125851000119106, 144981000119109, 145101000119102, 145841000119107, 288461000119105, 12398281000119105, 12398651000119100