Quality Assurance Metrics & Interventions to Address Substance Use Disorders

The National Committee for Quality Assurance (NCQA) measures performance on the following metric:

Initiation and Engagement of Alcohol, or Other Drug Abuse or Dependence Treatment (IET)

This metric focuses on ensuring that adolescents & adults who are diagnosed with a new episode of alcohol or other drug dependence are able to receive the treatment they need to combat this chronic illness. 

The aim of this metric is for patients to receive:

• A follow-up appointment with a medical or behavioral health professional within 14 days of being newly diagnosed.
• The same patient will have two additional services within 34 days thereafter 

For more information click here for Alcohol and Other Drug Dependence: Initiation and Engagement in Treatment flyer.

Tips for Diagnosing:

• Use a screening tool integration.samhsa.gov/clinical-practice/sbirt
• All diagnoses related to substance use will be included in this measure UNLESS they are specified as being “In Remission”
• Avoid using the ICD-10 specifier  “Unspecified Use”
• Use the ICD-10 specifier “In Remission” for patients who have been able to maintain sobriety for 3 months or more

Talking to your Patients:

Discussing complex emotional and behavioral needs can be difficult. To support you, Optum has posted a variety of training and educational videos on the Psych Hub Video Library for you:

Video Training: Effective Listening

Video Training: SUD Presentation & Treatment

PsychHub Video Library (30 videos and counting)

Treatment Options:

The following treatment options will meet IET requirements for a follow-up appointment:

• A follow-up appointment with a PCP to address the SUD diagnosis
• Virtual visits addressing the SUD diagnosis
• Outpatient therapy with a substance use provider

Optum supports members by providing a variety of treatment resources. These include:

• Optum SUD Helpline Opioids member flyer. - a dedicated Substance Use Treatment Helpline
• Access to behavioral health providers within a member’s local community or via virtual visits appointments. For more information please view this flyer detailing how to access providers
  
• MAT or Medication Assisted Treatment
  
• Live and Work Well - our member centric resource that provides educational materials, access to resources, and treatment options

Additional Resources:

• Opioid Use Disorder Quick Reference Guide
• Live and Work Well
• Psych Hub
• Behavioral Health Toolkit for Medical Providers