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

Measurement Period: January 1 - December 31

Description: 
The percentage of persons 12 years of age and older with a diagnosis of major depression or dysthymia who had an outpatient encounter with a PHQ-9 score present in their record in the same assessment period as the encounter.

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

• 12–17 years (commercial and Medicaid only).
• 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: 12 years of age and older as of 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: 

Assessment period: The measurement period is divided into three assessment periods with specific dates of service:

• Assessment period 1: January 1–April 30.
• Assessment period 2: May 1–August 31.
• Assessment period 3: September 1–December 31.

Interactive outpatient encounter: A bidirectional communication that is face-to-face, phone based, an e-visit or virtual check-in, or via secure electronic messaging. This does not include communications for scheduling appointments.

Denominator:
Diagnosis of major depression or dysthymia.
Persons with at least one interactive outpatient encounter that starts during applicable assessment period with a diagnosis of major depression or dysthymia.

• Assessment period 1: January 1–April 30.
• Assessment period 2: May 1–August 31.
• Assessment period 3: September 1–December 31.

Numerator:
For all numerators, a PHQ-9 score (LOINC code 44261-6 for persons 12 years of age and older; LOINC code 89204-2 or 44261-6 for persons 12–17 years of age) in the person’s record during the applicable assessment period.

Numerator 1—Utilization of PHQ-9 Period 1
A PHQ-9 score in the member’s record during assessment period 1 (January 1–April 30).

Numerator 2—Utilization of PHQ-9 Period 2
A PHQ-9 score in the member’s record during assessment period 2 (May 1–August 31).

Numerator 3—Utilization of PHQ-9 Period 3
A PHQ-9 score in the member’s record during assessment period 3 (September 1–December 31)

Note:

• Persons may have an eligible encounter in any or all three assessment periods, and may be included in the measure up to three times during the measurement period.
• PHQ-9 assessment may occur during a face-to-face encounter, telephonically or through a web-based portal.[

Best Practice and Measure Tips

• This measure requires the use of an age-appropriate screening instrument. The member’s age is used to select the appropriate depression screening instrument.
• Depression screening captured in health risk assessments or other types of health assessments are allowed if the questions align with a specific instrument that is validated for depression screening. For example, if a health risk assessment includes questions from the PHQ-2, it counts as screening if the member answered the questions, and a total score is calculated.
• 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 mental health provider.
• Establish an outreach team or assign care managers to ensure members keep or reschedule follow-up appointments.
• Utilize flags in the EHR or develop 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 die any time during the measurement period.
• Members with any of the following any time during the member's history through the end of the measurement period:
  • Bipolar disorder.
  • Personality disorder.
  • Psychotic disorder.
  • Pervasive developmental disorder.

Exclusion Codes

• Bipolar Disorder
  • ICD-10-CM: F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4, F30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78
  • SNOMED CT US Edition: 162004, 1499003, 3530005, 4441000, 5703000, 9340000, 10875004, 10981006, 13313007, 13581000, 13746004, 14495005, 16506000, 17782008, 21900002, 22121000, 26203008, 26530004, 28663008, 28884001, 29929003, 30935000, 31446002, 33380008, 35481005, 36583000, 38368003, 40926005, 41552001, 41832009, 41836007, 43769008, 45479006, 46229002, 49468007, 49512000, 51637008, 53049002, 53607008, 54761006, 55516002, 59617007, 61403008, 63249007, 64731001, 65042007, 66631006, 68569003, 70546001, 71984005, 73471000, 74686005, 75360000, 75752004, 78269000, 78640000, 79584002, 82998009, 85248005, 86058007, 87203005, 87950005, 111485001, 191618007, 191620005, 191621009, 191623007, 191627008, 191629006, 191630001, 191636007, 191638008, 191639000, 191641004, 191643001, 192362008, 231444002, 371596008, 371599001, 371600003, 723903001, 765176007, 767631007, 767632000, 767633005, 767635003, 767636002, 1343347009, 261000119107, 271000119101, 23741000119105, 133091000119105, 16238741000119105
• Other Bipolar Disorder
  • ICD-10-CM: F31.81, F31.89, F31.9
  • SNOMED CT US Edition: 1196001, 12969000, 16295005, 19300006, 20960007, 22407005, 30520009, 30687003, 34315001, 35722002, 35846004, 43568002, 48937005, 67002003, 71294008, 81319007, 83225003, 371604007, 723905008, 789061003
• Personality Disorder
  • ICD-10-CM: F34.0, F60.3, F60.4, F68.10, F68.11, F68.12, F68.13
  • SNOMED CT US Edition: 20010003, 55341008, 191765005, 191773001, 231527003
• Psychotic Disorders
  • ICD-10-CM: F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F21, F23, F25.0, F25.1, F25.8, F25.9, F28, F29
  • SNOMED CT US Edition: 4926007, 5464005, 7025000, 12939007, 14291003, 16990005, 26025008, 27387000, 29599000, 30336007, 31373002, 31658008, 35218008, 35252006, 38368003, 39610001, 42868002, 51133006, 58214004, 63181006, 64905009, 68890003, 68995007, 69322001, 70814008, 71103003, 76566000, 79204003, 79866005, 83746006, 84760002, 85861002, 111482003, 111483008, 111484002, 191526005, 191527001, 191531007, 191542003, 191547009, 191548004, 191554003, 191555002, 191559008, 191567000, 191569002, 191570001, 191571002, 191572009, 191574005, 191577003, 191680007, 231437006, 231489001, 247804008, 268617001, 268624000, 270901009, 271428004, 278853003, 416340002, 441704009, 441833000
• Pervasive Developmental Disorder
  • ICD-10-CM: F84.0, F84.3, F84.8, F84.9
  • SNOMED CT US Edition: 35919005, 43614003, 71961003, 191689008, 191690004, 231536004, 373618009, 408857007, 442314000, 39951000119105

Measure Codes

LOINC 44261-6 Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]

• The PHQ-9 is the standard (and commonly used) depression measure, and it ranges from 0-27 Scoring (the scores are the codes that appear in the answer list for each of the PHQ-9 problem panel terms). Add up all checked boxes on PHQ-9.
  • For every check:
    • Not at all = 0
    • Several days = 1
    • More than half the days = 2
    • Nearly every day = 3
  • Interpretation:
    • 1-4 = Minimal depression
    • 5-9 = Mild depression
    • 10-14 = Moderate depression
    • 15-19 = Moderately severe depression
    • 20-27 = Severe depression

LOINC 89204-2 Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen]

• The Patient Health Questionnaire-9: Modified for Teens (PHQ-9 Teen) total score is the sum the first of 9 items (the answers to the other 4 items are used to assess the functional impairment due to depression and screen for dysthymia and suicide risk). These 9 items are scored from 0 to 3, with higher scores indicating more severe symptoms of depression.