Antidepressant Medication Management (AMM)

Why is it important?

Major depression is considered a serious medical illness, affecting approximately five to eight percent of American adults.¹ Depression is the leading cause of disability in the United States. Symptoms include persistent sadness, loss of energy, loss of appetite, and inability to concentrate.² The Antidepressant Medication Management (AMM) measure assesses short-term and long-term medication adherence rates for adults newly diagnosed with depression. Reasons for improving and adhering to medication management for major to severe depression include the following:

According to evidence-based guidelines, medication management reduces the risk of relapse and reoccurrence for patients with depression.
Without antidepressant medication, 50 to 80 percent of patients have major depressive relapses and reoccurrences.
The need for antidepressant medication increases as the severity of depression intensifies, which can lead to negative health outcomes if not properly managed.

How is it measured?

MBHP assesses performance outcomes for antidepressant medication management using HEDIS measure specifications to determine if Members 18 years of age and older were treated with antidepressant medication, had a diagnosis of major depression, and remained on an antidepressant medication treatment. MBHP refers to the two outcome measures below to assess our performance against national Medicaid benchmarks:

Effective Acute Phase Treatment: The percentage of Members who remained on an antidepressant medication for at least 84 days (12 weeks)
Effective Continuation Phase Treatment: The percentage of Members who remained on an antidepressant medication for at least 180 days (six months)

How does MBHP perform?

MBHP's performance rate for effective acute-phase treatment is 71.4 percent of Members remaining on antidepressant medication for at least 12 weeks and 56.1 percent of Members remaining on an antidepressant medication for at least six months for effective continuation-phase treatment.

How does MBHP perform against national Medicaid Benchmarks?

The following table compares MBHP's performance against 2021 HEDIS national Medicaid benchmarks n the 50th, 75th, and 90th percentiles for the AMM measures.

Table 1 AMM

* MY 2022

Based on MY 2022 rates on AMM, MBHP met the 90th percentile national Medicaid benchmark for Initiation Phase at 71.4 percent and nearly met the 90th percentile benchmark for Continuation Phase at 56.0 percent.

Performance Goal

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

•	Initial Phase rate: Continute to exceed the 90th percentile national Medicaid benchmark of 71.3 percent and improve on MBHP's MY 2022 performance of 71.4 percent
•	Continuation Phase rate: Meet the 90th percentile national Medicaid benchmark of 56.2 percent

Improvement Initiatives

PCC and Behavioral Health Provider Education:

MBHP continues to increase awareness of AMM best practices and effective options in treating Members with depression among behavioral health and PCC providers by disseminating one-page fact sheets that include instructions and guidance for treating Members with depression. The goal is to encourage patient-centered care management for Members who are taking antidepressant medications in order to identify cause for non-adherence and intervene to support adherence when appropriate. MBHP is also developing training opportunities for clinicians and providers to increase engagement among diverse Members to address disparities in care for depression treatment and management.

Use a Patient-Reported Survey to Evaluate Member Self-Efficacy Related to Medication Adherence, Provide Real-Time Intervention, and Improve Depression Symptoms (Implement the ASK-20 Questionnaire): MBHP continues to promote opportunities for community health centers to administer the ASK-20 survey to assess barriers to Member adherence to antidepressant medication.

AMM Education for Primary Care and Behavioral Health Providers: MBHP hosted an AMM education session for primary care and behavioral health providers in MBHP's Northeast region. The education session was titled "Optimizing Antidepressant Use in Members with Major Depression" and was co-led by the VP Medical Director and the Medical Director of Integration at MBHP. The presentation focused on increasing providers' knowledge of key barriers to medication adherence, as well as promoting strategies to address medication adherence with patients. Content of the presentation was informed in part by an earlier panel that MBHP hosted titled "Using Person-Centered Care to Improve Experience with Antidepressant Medication Management and Treatment: From the Member Perspective," where a panel comprised of people with lived experience addressed topics such as:

How to improve communication between prescribers and patients
The role of family and social supports for patients managing their depression
How prescribers can help to mitigate individual-level barriers to medication adherence early in the patient's treatment
The role of cultural beliefs and attitudes, and the importance of cultural humility and person-centered care

Partner with MBHP: If you are interested in collaborating with MBHP on the ASK-20 survey, the pharmacy notification project, or other initiatives to improve Member depression management and adherence to antidepressant medication, please contact the Quality Department.

What you can do:

Follow the face sheet on depression managment for providers:

•	Use a standardized tool when screening for depression (e.g., the Patient Heath Questionnaire (PHQ-9) or ASK-20 Survey).
•	When assessing a patient with depression, assess for level of severity and distinguish between single-episode depression versus recurrent depression; document this information in the patient's record.
•	Use screening and motivational interviewing to assess patient self-efficacy when prescribing a new antidepressant medication. Use results to facilitate discussion around patient concerns and address challenges that they feel might be barriers to medication adherence.
•	Obtain and document all available medication and other treatment response history.
•	Provide education to the patient regarding potential side effects of antidepressant medication, and encourage the patient to secure a relational support system during the treatment period.
•	Establish a protocol for following up with the patient, providing the opportunity to communicate with you regarding their experience taking the medication and the onset of any side effects if applicable.
•	Complete a Release of Information Authorization form, so that communication can occur between the patient's primary care clinician and behavioral health provider.
•	Ensure integration of care by establishing a communication pathway between the patient's primary care clinician and behavioral health provider.
•	Utilize the diagnosis codes for major depression when filing claims (see below for a list of codes).

Utilize Integrated Care Management Program (ICMP) services for eligible Members managing depression:

Identify Members who are eligible for ICMP.
Complete the ICMP referral form.
Share informational resources about the services and benefits ICMP provides to eligible Members in care management.
- ICMP Member brochure
- Website information on ICMP for Members and families

Diagnosis Codes for Major Depression

References:

¹	The National Alliance on Mental Illness. 2009. Major Depression Fact Sheet. (December 2016)
2	American Psychiatric Association; Washington, DC: 2000. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; Washington, DC: 2013.