Screening for Clinical Depression and Follow up July 2015

ACO Announcements • Reminders: – Return ACO Participating agreements – Conference calls – Changes to 2016-2018 contract – May Specialty meetings-Video available

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Agenda • ACO Depression Screening Measurement/Alignment with Clinical Integration Program • Depression Screening • Depression Follow up plan • Q&A section

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Depression Screening Rationale • According to American Family Physician, Depression is the second most common chronic disorder seen by primary care physicians • On average, 12 percent of patients seen in primary care settings have major depression • The degrees of suffering and disability associated with depression are comparable to those in most chronic medical conditions.

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Quality Measurement: Domains 33 quality measures are separated into the following four key domains that will serve as the basis for assessing, benchmarking, rewarding, and improving ACO quality performance: 1. 2. 3. 4.

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Patient/Caregiver Experience Care Coordination/Patient Safety Preventive Health Clinical Care for At Risk Population

ACO Preventive Health Domain

Measure Name

14

Preventive Health

Influenza Immunization

15

Preventive Health

Pneumococcal Vaccination

16

Preventive Health

Adult Weight Screening and Follow-up

17

Preventive Health

Tobacco Use Assessment and Tobacco Cessation Intervention

18

Preventive Health

Depression Screening

19

Preventive Health

Colorectal Cancer Screening

20

Preventive Health

Mammography Screening

21

Preventive Health

Proportion of Adults 18+ who had their Blood Pressure Measured within the preceding years

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PREV-12: Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan •

Description – Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen

•

WHAT is the Quality Action? – – – –

–

Screening includes completion of a clinical or diagnostic tool used to identify people at risk of developing or having a certain disease or condition even in the absence of symptoms This measure requires the screening to be completed in the office of the provider filing the code Follow-up plan may include a proposed outline of treatment to be conducted as a result of positive clinical depression screening Use a normalized and validated depression screening tool developed for the patient population where it is being utilized. Examples of depression screening tools include but are not limited to: Adolescent Screening Tools (12-17 years) Patient Health Questionnaire for Adolescents (PHQ-A), Beck Depression Inventory-Primary Care Version (BDI-PC), Mood Feeling Questionnaire, Center for Epidemiologic Studies Depression Scale (CES-D) and PRIME MD-PHQ-2

" Quality Measure and Performance Standards".Available online at http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/sharedsavingsprogram/Quality_Measures_Standards.html. Accessed May 2015 ©2011 Proprietary and Confidential

PREV-12: Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan • What are the DOCUMENTATION REQUIREMENTS relative to the Quality Action? The patient’s medical record must contain: The date and results of an age appropriate standardized depression screening tool; and If a follow-up plan is required, documentation of discussion and implementation of the plan. The follow-up plan must be specified as an intervention that pertains to depression; or If the quality action is not performed due to an exception (medical or patient reasons), documentation of these “reasons”;

" Quality Measure and Performance Standards".Available online at http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/sharedsavingsprogram/Quality_Measures_Standards.html. Accessed May 2015 ©2011 Proprietary and Confidential

33 Quality Measures-Continued Domain

Measure Name

27

At Risk Population- Diabetes

Diabetes Mellitus: Hemoglobin A1c Poor Control (>9%)

41

At Risk PopulationDiabetes

Diabetes Mellitus: Eye Exam

28

At Risk PopulationHypertension

Hypertension (HTN): Blood Pressure Control

40

At Risk PopulationDepression

Depression Remission at 12 months

30

At Risk Population- Ischemic Vascular Disease

Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

31

At Risk Population- Heart Failure

Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

33

At Risk Population- Coronary Artery Disease

CAD Composite: All or Nothing Scoring: ACE Inhibitor or ARB Therapy for Patients with CAD and Diabetes &/or LVSD

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MH-1: Depression Remission at 12 Months (NEW) • Description: Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at twelve months defined as PHQ-9 score less than 5. This measure applies to patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment. • What is the Quality Action? Remission attained at 12 months (+/- 30 days) from the index date. Remission is defined as a PHQ-9 score less than five. The index date is defined as the first PHQ-9 score greater than 9 between 12/1/2013 to 11/30/2014.

" Quality Measure and Performance Standards".Available online at http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/sharedsavingsprogram/Quality_Measures_Standards.html. Accessed May 2015 ©2011 Proprietary and Confidential

MH-1: Depression Remission at 12 Months (NEW) • Where may the Quality Action take place? The patient needs to be seen by an eligible professional to have the diagnosis of depression, but the actual tool does not have to be administered by an eligible provider. Multiple modes of administration are allowed: – – – – –

office visit/in-person, telephone encounter, e-visit, mail (post), electronic administration (email, patient portal, iPad/tablet, patient kiosk)

• Who may perform the Quality Action? Any healthcare professional may administer the screening tool.

" Quality Measure and Performance Standards".Available online at http://www.cms.gov/Medicare/Medicare-Fee-for-ServiceAccessed May 2015 ©2011Payment/sharedsavingsprogram/Quality_Measures_Standards.html. Proprietary and Confidential

MH-1: Depression Remission at 12 Months (NEW) •

•

When must the Quality Action be performed? An initial PHQ-9 score greater than 9 between 12/1/2013 and 11/30/2014. A follow-up PHQ-9 score less than 5 at 12 months (+/- 30 days) from the index date. What are the documentation requirements relative to the Quality Action? The patient’s medical record must contain: •A diagnosis of major depression or dysthymia; and •A PHQ-9 score greater than 9 during an outpatient encounter between 12/1/2013 and 11/30/2014; and •A follow-up PHQ-9 score less than 5 at 12 months (+/- 30 days) of the initial PHQ9 score greater than 9;

" Quality Measure and Performance Standards".Available online at http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/sharedsavingsprogram/Quality_Measures_Standards.html. Accessed May 2015 ©2011 Proprietary and Confidential

Catholic Medical Partners Clinical Integration • Catholic Medical Partners Clinical Integration Program – Prevention measures, At Risk Populations (Mental Health, Diabetes, Heart Failure, Coronary Artery Disease), Care Management – 8 Prevention related measures – Depression screening goal is 53.76%!

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DEPRESSION SCREENING/ FOLLOW UP PLAN

Depression CAN be treated, BUT ... • Only half of depressed older adults are “recognized”, fewer are treated • Older men, African Americans and Latinos have particularly low rates of depression treatment • About 1 in 10 Americans aged 12 and over take antidepressant medication • Fewer than I0% seek care initially from a mental health specialist, most prefer treatment by their primary care physician • Less than one-third of persons taking a single antidepressant have seen a mental health professional in the past year • Only one in five older adults treated for depression in primary care improve ©2011 Proprietary and Confidential

Annual Medical Expenditures w/specific Chronic Condition, with and without a BH Condition

• • • •

Cost w/out BH Condition

Cost with BH Condition

All Adults Heart Condition High BP Asthma

All Adults Heart Condition High BP Asthma

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$1,913 $4,697 $3,481 $2,908

$3,545 $6,919 $5,492 $4,028

Recognition of Comorbid Depression Coronary Artery Disease • • • • •

17-27% of pts w/CAD have Major Depressive Disorder Depression associated with a 1.5 to 2-fold ↑in risk for onset of CAD Depression predicts increased morbidity /mortality in pts w/ CAD Post-MI pts w/depression have higher mortality Treatment of MDD w/SSRI’s appears to be safe/effective in pts w/CAD Type 2 Diabetes • As many as 10-25% pts w/type 2 diabetes may have MDD • Depression is an independent risk factor for the development of type 2 diabetes • Depression is associated with poor Rx adherence & glycemic control, ↑ healthcare costs, worsening vascular complications & higher rates of death

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*Source: A Pocket Guide for treatment and Recognition of Comorbid Depression

Description- Screening for Clinical Depression and Follow-up Plan • Percentage of patients aged 12 yrs and older screened for clinical depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen. ©2011 Proprietary and Confidential

Follow-up Plan (Required!) Follow-up for a positive depression screening must include 1 or more of the following: • Additional evaluation for depression • Suicide Risk Assessment • Referral to a practitioner who is qualified to dx and treat depression • Pharmacological interventions • Other interventions or f/u for the diagnosis or treatment of depression ©2011 Proprietary and Confidential

Guidance – Screening Tools • The name of the age appropriate standardized depression screening tool utilized must be documented in the EMR – Consult your EMR vendor – Contact your Clinical Transformation rep for assistance if needed

• The depression screening must be reviewed and addressed in the office of the provider filing the code, on the date of the encounter • The screening and encounter must occur on the same date • Follow-up Plan must be related to a positive screening, (e.g., example: “Patient referred for psychiatric evaluation dur to positive depression screening”)

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If using PHQ9… Scoring 1. Count each item in column 2 labeled “Several Days” and multiply by one. 2. Count each item in column 3 labeled “More than half the days” and multiply by two. 3. Count each item in column 4 labeled “Nearly every day” and multiply by three. 4. Add the totals for each of the 3 columns together for Severity Score.  Be aware of response to question #9 – lethality: = ANY POSITIVE RESPONSE must be addressed!

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Care Management Resources Care management resources available on CMP website: • Behavior Health CMP Network-contracted providers *remember to state “CMP-member provider” for same day/next day appointment • Depression Action/Care Plan and Relapse Prevention Care Plan • Patient education materials ©2011 Proprietary and Confidential

MH-1: Depression Remission at 12 Months (NEW)

Adults age 18+ with Major Depression or Dysthymia and an initial PHQ-9 score >9 who demonstrate remission at 12 months defined as PHQ-9 score