| Core Metric |
Description |
Threshold |
|---|
| 1. 7- and 30-day Psychiatric Hospital / RTF Readmission Rate |
|
|
- 7- and 30-day psychiatric hospital / RTF readmission rate – 7 days
|
Rate of psychiatric hospital or RTF readmissions within 7 days |
≤5.00% |
- 7- and 30-day psychiatric hospital / RTF readmission rate – 30 days
|
Rate of psychiatric hospital or RTF readmissions within 30 days |
≤13.00% |
| 2. Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA) |
Percentage of members 19–64 years of age during the measurement year with schizophrenia or schizoaffective disorder who were dispensed and remained on an antipsychotic medication for at least 80% of their treatment period |
≥65.00% |
| 3. Antidepressant Medication Management (adults only)- Effective Continuation Phase (AMM) |
Percentage of members 18 and older who were treated with antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication for at least 180 days (6 months) |
≥40.00% |
| 4. Child & Adolescent Well-Care Visits (WCV) |
Percentage of enrolled members 7-21 years of age who had at least one comprehensive well-care visit with a PCP or OB/GYN during the measurement year |
>65.00% >57.00% >39.00% |
| 5. Controlling High Blood Pressure (CBP) |
Percentage of members 18-85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled (<140/90 mm Hg) during the measurement year |
≥52.00% |
| 6. Diabetes Screening for People With Schizophrenia or Bipolar Disorder (SSD) |
The percentage of members 18–64 years of age with schizophrenia, schizoaffective disorder or bipolar disorder, who were dispensed an antipsychotic medication and had a diabetes screening test during the measurement year |
≥82.00% |
| 7. Eye Exam for Patients With Diabetes (EED) |
Percentage of members 18-75 years of age with diabetes (type 1 and type 2) who had an eye exam (retinal) performed |
≥51.00% |
| 8. Follow-Up After Hospitalization for Mental Illness (FUH) |
Percentage of discharges for mental health illness which the member received follow-up to within 7 days of discharge |
≥38.00% |
| 9. Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) |
The percentage of children and adolescents 1–17 years of age who had two or more antipsychotic prescriptions and had metabolic testing |
≥38.00% |