Depression is a leading cause of disability in the U.S. Major depression affects woman at a rate of 2:1 in relation to it affecting men. Woman have a lifetime prevalence of 21% for a major depression episode. 8% of pregnant women experience major depression and depressed mothers may have infants that display delayed psychological, cognitive, neurologic, and motor development. Studies have found that more than half of pregnant and non-pregnant women experience depression that was undiagnosed.

Outline

1.  Review the definition of HEDIS Electronic Clinical Data System (ECDS) and the 6 quality measures

1. List examples of ECDS data sources (e.g., EHRs, files, HIEs, registries, etc.)

2. Include examples of how PH MCOs are using ECDS for the Depression Measure

1. For each PH MCO:
   1. Which ECDS data sources are you using (HIE, EHR, etc.)?
   2. Getting feeds from providers or vendors?

3. Review the USPSTF recommendation / evidence for depression screening/follow-up

4. Review an example of a depression screening and follow-up workflow using the PHQ-2/PHQ-9

1. Direct people to resources for clinical workflows

5. Describe the numerators and denominators for the quality measure, "Depression Screening and Follow-Up for Adolescents and Adults"　

6. List and summarize the "standardized instruments" for the adolescent population and the adult population, and define what constitutes as a positive score for each tool (per HEDIS specs)

7. To develop an infrastructure for ECDS, explain why discrete data fields are needed for the ECDS reporting

8. List examples of discrete data fields that would enable ECDS reporting for this measure (e.g., drop down list of validated depressing tool used, the score, the date it was administered, referral (y/n), and the follow-up date)

9. Describe what qualifies as a "follow-up on a positive screen" and how to operationalize the definition of the "follow-up date" under different "follow-up" care scenarios (e.g., clarify that the "follow-up date" is when the patient received the follow-up care and not the date of the referral to follow-up care)

1. Mention that "follow-up" can include but is not limited to a separate billable BH code/visit
2. Identify the appropriate codes and not they should be used for HEDIS credit even if they are not being paid
3. How is "BH diagnoses" defined in the context of Follow-up Service

10. Refer PCMHs to the PCMH Learning Network’s existing presentations, guides, and resources that the Network covered during the summer of 2020 on how to use the billing codes for collaborative care management (e.g., 99492, 99493, and 99494 for non-FQHCs/RHCs or G0512 for FQHCs/RHCs) and general integrated care services (e.g., 99484 for non-FQHCs/RHCs or G0511 for FQHCs/RHCs) T1015 billed to BH MCO for BHC services (SEPA FQHCs billed to BH MCOs)

1. https://www.tomorrowshealthcare.org/home/communities/pcmh/pcmh-learning-sessions/july-16-2020-virtual-learning-session-western-pa/2965-anna-ratzliff-cocm-workflow-and-billing-2020/file
2. https://www.tomorrowshealthcare.org/home/communities/pcmh/pcmh-resources/behavioral-health-integration

11. Discuss challenges and experiences

1. PCMH Question: Where do you currently document depression screening and follow-up?
2. MCO Question: If the PCMHs document in these discrete data fields, will it be pulled from this place? How will the data validation steps assure it is pulled from the right place?
3. Suggested action: Talk with your MCOs about this.