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

Measurement Period: January 1–December 31.

Description:
The percentage of persons 18 years of age and older who were screened for unhealthy alcohol use using a standardized instrument and, if screened positive, received appropriate follow-up care.

• Unhealthy Alcohol Use Screening. The percentage of persons who had a systematic screening for unhealthy alcohol use.
• Follow-Up Care on Positive Screen. The percentage of persons receiving brief counseling or other follow-up care within 60 days (2 months) of screening positive for unhealthy alcohol use.

Stratifications:
Age as of the start of the measurement period.

• 18–44 years.
• 45–64 years.
• 65 years and older.

Improvement Notation:
Increased score indicates improvement.

Data Collection:

• ECDS.

Initial Population:

• Measure Item Count: Person.
• Age: 18 years of age and older at the start 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. No gaps on the last day of the measurement period.

Definition:
Alcohol Counseling or Other Follow-Up Care:

Any of the following on or up to 60 days after the first positive screen:

• Feedback on alcohol use and harms.
• Identification of high-risk situations for drinking and coping strategies.
• Increase the motivation to reduce drinking.
• Development of a personal plan to reduce drinking.
• Documentation of receiving alcohol misuse treatment.

Unhealthy Alcohol Use Screening
A standard assessment instrument that has been normalized and validated for the adult patient population. Eligible screening instruments with thresholds for positive findings include:

Denominator:
Denominator 1: Initial population minus denominator exclusions.

Denominator 2: Persons from numerator 1 with a positive finding for unhealthy alcohol use screening between January 1 and November 1 of the measurement period.

Numerator:
Numerator 1: Unhealthy Alcohol Use Screening
Persons with a documented result for unhealthy alcohol use screening performed between January 1 and November 1 of the measurement period.

Numerator 2: Follow-Up Care on Positive Screen
Persons receiving alcohol counseling or other follow-up care. Either of the following on or up to 60 days after the date of the first positive screen (61 days total) meets criteria:

• Alcohol Counseling or Other Follow Up Care.
• A diagnosis of encounter for alcohol counseling and surveillance.
  
  

Best Practice and Measure Tips

• Explain to the patient the vital importance of attending follow-up appointments and adhering to the recommended treatment plan.
• Emphasize the critical importance of adhering to scheduled follow-up visits as recommended to ensure optimal patient care and outcomes.
• Immediately schedule follow-up appointments, especially for patients who have been recently discharged.
• Collaborate with behavioral health practitioners by regularly sharing progress notes and updates to ensure comprehensive patient care.
• Reach out to patients who cancel appointments and promptly help them reschedule at the earliest opportunity.
• Opt for telemedicine visits when in-person appointments are not feasible.
• Highlight the significance of pursuing follow-up care with a mental health provider to ensure ongoing support and effective management of mental health conditions.
• Create an outreach team or assign care managers to ensure members attend or reschedule follow-up appointments.
• Utilize flags in the EHR or create a tracking system to identify patients needing screenings and follow-up visits.
•  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 year period.
• Persons with alcohol use disorder that starts during the year prior to the measurement period.
• Persons with history of dementia any time during the member’s history through the end of the measurement period.

Numerator Exclusions:

• Laboratory claims (POS 81)

 

Exclusion Codes

Alcohol Use Disorder

• 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, F10.90, F10.920, F10.921, F10.929, F10.930, F10.931, F10.932, F10.939, F10.94, F10.950, F10.951, F10.959, F10.96, F10.97, F10.980, F10.981, F10.982, F10.988, F10.99, K29.20, K29.21, K70.10, K70.11
• SNOMED CT US Edition: 281004, 7052005, 7200002, 8635005, 15167005, 18653004, 34938008, 61144001, 66590003, 69482004, 73097000, 78524005, 87810006, 191471000, 191475009, 191476005, 191478006, 191480000, 191811004, 191812006, 191813001, 191882002, 191883007, 191884001, 231467000, 268645007, 284591009, 713583005, 713862009, 714829008, 723926008, 723927004, 97571000119109, 135311000119100, 288031000119105, 10741871000119101, 10755041000119100

Dementia

• ICD-10-CM: F01.50, F01.51, F01.511, F01.518, F01.52, F01.53, F01.54, F01.A0, F01.A11, F01.A18, F01.A2, F01.A3, F01.A4, F01.B0, F01.B11, F01.B18, F01.B2, F01.B3, F01.B4, F01.C0, F01.C11, F01.C18, F01.C2, F01.C3, F01.C4, F02.80, F02.81, F02.811, F02.818, F02.82, F02.83, F02.84, F02.A0, F02.A11, F02.A18, F02.A2, F02.A3, F02.A4, F02.B0, F02.B11, F02.B18, F02.B2, F02.B3, F02.B4, F02.C0, F02.C11, F02.C18, F02.C2, F02.C3, F02.C4, F03.90, F03.91, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A0, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B0, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C0, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, F04, F10.27, F10.97, F13.27, F13.97, F18.17, F18.27, F18.97, F19.17, F19.27, F19.97, G30.0, G30.1, G30.8, G30.9, G31.83
• SNOMED CT US Edition: 281004, 4817008, 6475002, 9345005, 10349009, 10532003, 12348006, 14070001, 15662003, 25772007, 26852004, 26929004, 32875003, 51928006, 52448006, 54502004, 55009008, 56267009, 59651006, 62239001, 65096006, 66108005, 70936005, 82959004, 90099008, 111480006, 191449005, 191451009, 191452002, 191454001, 191455000, 191457008, 191458003, 191459006, 191461002, 191463004, 191464005, 191465006, 191466007, 191493005, 191519005, 230265002, 230266001, 230267005, 230268000, 230269008, 230280008, 230283005, 230285003, 230286002, 230287006, 230289009, 268612007, 278857002, 312991009, 371024007, 371026009, 416780008, 416975007, 420614009, 421023003, 421529006, 425390006, 429458009, 429998004, 442344002, 698624003, 698625002, 698626001, 698725008, 698726009, 698781002, 698948009, 698949001, 698954005, 698955006, 713488003, 713844000, 715737004, 722600006, 722977005, 722978000, 722979008, 722980006, 723123001, 723390000, 724776007, 724777003, 724992007, 725898002, 733184002, 733185001, 733190003, 733191004, 733192006, 733193001, 733194007, 762350007, 762351006, 762707000, 774069007, 783161005, 783258000, 788898005, 788899002, 789170003, 833326008, 838276009, 840464007, 840465008, 1148924004, 1156789004, 1156798001, 1156800008, 1186724002, 1186877003, 1186879000, 1186880002, 1186881003, 1186883000, 1186887004, 1187004001, 1187126002, 1259128002, 1259465009, 1259467001, 1259469003, 1259471003, 1259473000, 1259476008, 1259478009, 1259480003, 1259485008, 1259488005, 1259492003, 1259494002, 1259496000, 1259499007, 1259501004, 1259503001, 1259511006, 1259513009, 1259517005, 1259519008, 1259522005, 1259524006, 1259529001, 1259531005, 1259579003, 1259581001, 1259584009, 1259586006, 1259591007, 1259656006, 1259661008, 1259663006, 1259665004, 1259667007, 1259675001, 1259677009, 1259679007, 1259990004, 1263555006, 1263585001, 1339031006, 1581000119101, 1591000119103, 2421000119107, 22381000119105, 31081000119101, 79341000119107, 82361000119107, 82371000119101, 82381000119103, 97751000119108, 101421000119107, 105421000119105, 106021000119105, 130121000119104, 141991000119109, 142001000119106, 142011000119109, 288631000119104, 293671000119109, 428051000124108, 428351000124105, 429161000124103, 430771000124100, 16219201000119101, 16276361000119109

Measure Codes

Follow-Up Care on Positive Screen

• A diagnosis of encounter for alcohol counseling and surveillance ICD-10-CM code Z71.41
• Alcohol Counseling or Other Follow Up Care
  • CPT: 99408, 99409
  • HCPCS: G0396, G0397, G0443, G2011, H0005, H0007, H0015, H0016, H0022, H0050, H2035, H2036, T1006, T1012
  • SNOMED CT US Edition: 20093000, 23915005, 24165007, 64297001, 386449006, 408945004, 408947007, 408948002, 413473000, 707166002, 429291000124102