Follow-Up Care for Children Prescribed ADHD Medication (ADD)

Why is it important?

The American Academy of Child and Adolescent Psychiatry (AACAP) has published guidelines for psychopharmacological treatment for children diagnosed with ADHD and how medication can be dispensed properly. It is well established that ADHD is considered a neurobiological condition that causes significant impairment and requires comprehensive clinical care management and medical treatment to ensure healthy development. While the symptoms of ADHD can impact multiple areas related to a child’s daily functioning both at school and at home, proper and timely medication and follow-up treatment can significantly improve behavioral health outcomes.

How is it measured?

Quality initiatives for follow-up care for children prescribed with ADHD medication applies the following HEDIS measure specifications to assess levels of performance and outcomes improvement and ensure MBHP services continue to meet national standards in delivering quality care for young Members with ADHD:

1.	Initiation Phase: The percentage of Members 6-12 years of age who had one follow-up visit with a practitioner with prescribing authority during a 30-day timeframe after the Index Prescription Episode start date
2.	Continuation and Maintenance (C&M) Phase: The percentage of Members 6-12 years of age who remained on the medication for at least 210 days (7 months) and who had at least two follow-up visits with a practitioner within 270 days (9 months) after completing the "Initiation Phase."

How does MBHP perform?

MBHP's plan-wide performance is 39.9 percent for the Initiation Phase and 44.7 percent for the Continuation and Maintenance Phase of ADD treatment.

How does MBHP stack up to Medicaid providers nationally?

The table below presents MBHP's ADD performance rates compared against 2021 National Medicaid benchmarks in the 50th, 75th and 90th percentile.
Table 1

* MY 2022

Based on MY 2022 rates on ADHD, MBHP met the 50th percentile national Medicaid benchmark for Initiation at 39.8 percent and was below the 50th percentile benchmark for Continuation and Maintenance at 51.8 percent.

Performance Goal

MBHP will aim to meet the following MY 2023 year-end goals:

Initiation rate: Meet the 75th percentile national Medicaid benchmark of 44.1 percent
Continuation and Maintenance rate: Meet the 50th percentile national Medicaid benchmark of 51.8 percent

Improvement Initiatives

MBHP's Quality Department organizes and implements improvement initiatives and educational opportunities that aim to improve rates that meet ADD benchmarks. Here are some examples of our recent initiatives:

Massachusetts Child Psychiatry Program (MCPAP) newsletter: MBHP published and distributed the MCPAP monthly newsletter including an alert to PCCs highlighting the AAP clinical practice guidelines in treating patients prescribed ADHD medication and the importance of follow up after prescribing ADHD medication to children. The MCPAP program also developed ADHD guidelines and "clinical pearls," or recommendations for primary care providers in treating Members with ADHD. More information about these guidelines can be found here.
Provider Quality Management (PQM) site visits: PCCs and behavioral health providers continue to receive education about the ADD initiative through ongoing outreach from MBHP's Primary Care Clinician Support Managers (PCC SMs) and Provider Quality Managers (PQMs) during their site visits. Also, MBHP's Children's Behavioral Health Initiative (CBHI) and In-Home Therapy (IHT) program continue to support and educate children and families on medication adherence and management.
MCPAP for Moms consultation with PCCs treating children with ADHD: As part of ongoing program activities, MCPAP continues to provide child psychiatric consultation directly to PCCs. Approximately 20 percent of MCPAP's consultations with PCCs focus on children who have a diagnosis of ADHD in the first 10 months, indicating that there is an ongoing need for educating PCCs on treating Members with ADHD.
Webinar on Supporting providers to Address BH Issues During COVID-19: In light of the COVID-19 pandemic, MBHP provided training on “Supporting PCCs to Address COVID-19 Behavioral Health Issues,” which included recommendations for addressing externalizing disorders that are likely to exacerbate during COVID, including ADHD, and how to address pediatric-specific, COVID-19-related considerations, including ADHD during latency/pre-adolescence, non-addictive medications for insomnia for ADHD and pediatric patients, as well as recommended pediatric-specific assessment screenings for ADHD. The webinar was presented to support BH and PCC providers in addressing BH issues most likely to present in primary care during COVID-19 with recommended response strategies and provide informational resources to best address BH needs.

What can I do?

Follow best practices for treatment of ADHD:
The American Academy of Pediatrics (AAP) recommends the following action to help primary care clinicians evaluate, diagnose, treat, and monitor children and adolescents with ADHD:

Conduct a face-to-face follow-up visit on a monthly basis during initial stage, and then follow up with subsequent visits every three months in the first year of treatment. Subsequent visits occur at least twice a year.
Schedule follow-up appointments when the Member is discharged with the index prescription to promote timely follow-up.

Resources

ADHD Assessment and Treatment Practice Parameter

AACAP Official Action: Practice Parameter for the Assessment and Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

Provider HEDIS ADD Rate Requests

If you are interested in learning more about your HEDIS ADD rate as a provider, please contact the Quality Department.