Behavioral Health Measures

Date: 01/03/25

What is behavioral health?

Behavioral health generally refers to mental health and substance use disorders, life stressors and crises, and stress-related physical symptoms. Behavioral healthcare refers to the prevention, diagnosis, and treatment of those conditions.

Why is behavioral health important?

Behavioral health conditions affect people of all ages.¹ One in five adults in the U.S. have a clinically significant mental health or substance use disorder. Unfortunately, many people fail to receive treatment due in part to the long-standing shortage of behavioral healthcare providers.²

How do you help with behavioral health?

A potential solution for closing behavioral health gaps is behavioral health integration (BHI). BHI is the result of primary care teams and behavioral clinicians working together with patients to provide patient-centered care using a systemic approach.

Ambetter from Arkansas Health & Wellness is focused on the needs of people of all ages who we serve at every stage of life — people with or at risk of developing substance use disorders (SUDs), people with acute or chronic pain, and people with mental/behavioral health challenges.

Important behavioral health measures to consider when you are consulting with your patient:

• Depression screening and follow-up for adolescents and adults (DSF-E)
• Initiation and engagement of alcohol and other drug abuse or dependence treatment (IET)*
• Antidepressant medication management, effective acute phase treatment, and continuation phase treatment (AMM)
• Adherence to antipsychotic medications for individuals with schizophrenia (SAA)
• Use of pharmacotherapy for opioid use disorder, overall total (OUD)
• Diabetes screening for people with schizophrenia or bipolar disorder who are using antipsychotic medications (SSD)
• Use of opioids at high dosage in persons without cancer (OHD)
• Concurrent use of opioids and benzodiazepines (COB)
• Follow-up after emergency department visit for alcohol and other drug abuse or dependence (FUA)*
• Follow-up after emergency department visit for mental illness (FUM)*
• Follow-up after hospitalization for mental illness (FUH)* (w/ mental health provider)

*Follow-up can be provided via telehealth, telephone, e-visit, or virtual visit.

For additional measure-specific information on the above measures, please see the links below:

• For coding information and tip sheets regarding HEDIS® care gap closure, visit our Provider Resources page.
• For education materials about certain health conditions, visit our Member Resources page.

¹ https://www.cms.gov/files/document/cms-behavioral-health-strategy.pdf

² https://www.ama-assn.org/delivering-care/public-health/what-behavioral-health