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Changes to HEDIS measures coming in 2025

More appointment types to count as follow-up, in effort to improve outcomes

HEDIS^® (Healthcare Effectiveness Data and Information Set) measures are a set of performance indicators developed by the National Committee for Quality Assurance (NCQA) to assess the quality of care and services provided by health plans.

For providers, HEDIS measures are essential for evaluating and improving the effectiveness, access, and patient satisfaction associated with mental health and behavioral services. These measures often focus on aspects such as follow-up care after hospitalization and emergency department visits for mental illness, initiation and continuation of treatment for substance use disorders, and metabolic monitoring for members on antipsychotic medications. Meeting HEDIS standards can help providers align their practices with evidence-based guidelines, improve patient outcomes, and support commercial, Medicare, Medicaid HMO, POS and PPO plans in delivering high-quality, consistent care.

More than 90% of America's health plans use HEDIS to measure performance on critical dimensions of care and service.

Changes to behavioral health HEDIS measures coming in 2025 include:

• Follow-up visits can now be with any outpatient provider, including PCPs, for any diagnosis of mental illness (FUH, FUM*).
  • This broader range of providers will allow for greater success in follow-up rates.
  • Phobia and anxiety diagnoses are now included in the FUH and FUM measures and require timely follow-up care.
  • For the FUH and FUM measures, peer support services and residential treatment services can now be utilized for follow-up appointments.  
  • For the FUM measure, follow-up visits can now include behavioral healthcare settings and psychiatric collaborative care management services.

The changes allow more appointment types to count toward follow-up rates, affording health plans a greater chance of meeting HEDIS measures and improving member outcomes.

*Follow-Up After Hospitalization for Mental Illness (FUH) and Follow-up After Emergency Department Visit for Mental Illness (FUM)

Ways you can support your patients:

• Communicate closely with the discharging facility or emergency department regarding specific cases.
• Encourage patients after discharge to complete follow-up appointments in a timely manner.
• Consider PCP or other physical health appointment availability for follow-up.
• Use medication management as an opportunity to encourage follow-up.
• Educate patients regarding the importance of the following:
  • Follow-up
  • Medication side effects
  • Suicide risk assessment
  • Increase your awareness of patient groups who characteristically have low rates of follow-up after hospitalization or emergency department visits.

Find more information about behavioral health HEDIS measures at www.ncqa.org/hedis/.