Cost Free Program for Behavioral Health Hospitals to Secure HEDIS Stars by Meeting New NCQA Mental Health Guidelines

SAN DIEGO, CA, UNITED STATES, March 12, 2025 /EINPresswire.com/ -- M3 is proud to announce a groundbreaking program to earn Stars for behavioral health hospitals to meet the new National Committee for Quality Assurance (NCQA) guidelines to reduce readmissions. This effort leverages the latest advancements in mental health assessment (the M3 Checklist) with care coordination to improve outcomes while reducing administrative burdens.

On August 12, 2024, the National Committee for Quality Assurance (NCQA) expanded the Healthcare Effectiveness and Data Information Set (HEDIS) measure related to follow-up after mental health-related emergency department visits and hospitalizations. The conditions for which follow-up will be tracked will now include phobia diagnoses, anxiety diagnoses, intentional self-harm X-chapter codes, and the R45.851 suicidal ideation code.


Meeting HEDIS Measures

The trials for this program took place in California at Behavioral Health Hospitals, where Medicare Advantage or Blue Cross is accepted. The program seamlessly aligns with the latest HEDIS measures, emphasizing improved monitoring of mental health patients' post-emergency department visits and hospitalizations. It operates within existing CPT codes, ensuring no incremental costs to the facility.

Seamless Integration with Leading EHRs - Epic, Cerner, Athena and eClinicalWorks

The venture will connect through Mirah with hospital electronic health record (EHR) systems like Epic, Cerner, Athena, and eClinicalWorks to facilitate easy and confidential implementation. This platform allows a familiar workflow and includes the M3 Checklist, a validated, multidimensional mental health assessment meeting HEDIS requirements. It also enables real-time data collection and actionable insights.

By embedding the M3 Checklist within EHRs, hospitals can seamlessly assess patients at discharge, monitor their progress to meet NCQA guidelines, and leverage collaborative and remote patient monitoring using CPT codes to fund ongoing care.

Advancing Mental Health Measurement: Addressing the PHQ-9's Limitations

The new HEDIS measures shine a spotlight on the shortcomings of traditional tools like the PHQ-9, which fail to capture the full spectrum of anxiety disorders, PTSD, and bipolar disorder. In his remarks at the recent Kennedy Forum, Dr. Samuel Nordberg of Atrius Health critiqued the over-reliance on PHQ-9: "Measurement must be as complex as the patients we treat. PHQ-9's don't cut it."

The program will enable hospitals to address these gaps directly. Unlike mono-care approaches to limit costly problems, the program allows for validated approaches to minimize issues from a broad range of mental health and other detriments related to:

Recurring Readmissions
Manage Chronic Conditions
Reduced Utilization
Meeting New HEDIS Measure
Improving Workforce Satisfaction

Why the USPTF Guidelines Stress the Importance of Multi-dimensional Comprehensive Screening

The latest U.S. Preventive Services Task Force (USPTF) guidelines now recommend simultaneous assessment for anxiety, mania, and depression. Anxiety disorders, depression, and suicidal ideation affect millions of Americans, yet traditional approaches often fail to identify comorbid conditions.

A recent New England Journal of Medicine case study highlighted the critical need for improved screening protocols. The study found that reliance on the PHQ-9 (depression only) led to missed diagnoses of bipolar disorder and potentially harmful treatment decisions. These findings underscore the importance of tools like the M3 Checklist, which systematically integrate comprehensive assessments into clinical workflows.

NCQA Guidelines for Assessment at Discharge: and After using Remote Patient Monitoring and Collaborative Care Codes

The M3 Checklist provides a validated tool to assess mental health risks immediately upon discharge. Monitoring for Compliance: Facilities can opt to monitor patients post-discharge to meet NCQA guidelines and ensure continuity of care. Using collaborative care and remote patient monitoring codes, hospitals can provide tailored care plans, reducing readmissions and improving outcomes. This infrastructure aligns with the expanded reimbursable diagnoses under HEDIS, including anxiety disorders, PTSD, and mood disorders, creating an all-encompassing approach to patient care.

A Transformative Partnership for Mental Health Care

M3's program enables collaboration in a behavioral hospital and provides a transformative step forward in mental health care. It allows hospitals to meet emerging standards while improving patient outcomes. By embedding the M3 Checklist into EHR systems, the partnership offers a scalable, interoperable solution that is easy to implement and maintain.

The California program will serve as a blueprint for nationwide adoption, addressing critical mental health assessment and care delivery gaps. The M3 program redefines measurement-based care and ensures no patient is left behind in pursuing better mental health outcomes while earning Stars for the hospital. To participate, don't hesitate to contact M3.

Michael Byer
M3 Information
email us here

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