Improving medication management of depression in health plans.
OBJECTIVE
Improving depression treatment is critical given low rates of appropriate care. Health plan performance measures that address quality of antidepressant medication management, specifically, have been stagnating at relatively low levels. Identifying health plan characteristics associated with better performance could contribute to quality improvement for this aspect of depression treatment.


METHODS
Data for 2003 were linked from two sources: a nationally representative survey of 368 health plans about their behavioral health services and the National Committee for Quality Assurance's Health Plan Employer Data and Information Set (HEDIS) antidepressant medication management (AMM) scores, which reflect the percentage of eligible members whose care met specified criteria. The analytic sample present in both data sets totaled 361 products offered by 183 plans. Plan characteristics were grouped into organizational, provider, and consumer domains. Bivariate tests and regression analyses were conducted to estimate the relationship between these characteristics and health plan performance on three AMM measures: effective acute-phase treatment, effective continuation-phase treatment, and optimal practitioner contact.


RESULTS
Mean HEDIS AMM scores were 60% for effective acute-phase treatment, 43% for continuation-phase treatment, and 22% for optimal practitioner contact. Individual feedback to clinicians about their performance, lower cost sharing for outpatient mental health, and greater access to selective serotonin reuptake inhibitors were significantly associated with better plan performance in terms of antidepressant medication management.


CONCLUSIONS
Health plan characteristics were significantly associated with the quality of one important aspect of depression care, antidepressant medication management. Many of the factors that were identified suggest actionable ways for plans to improve quality of depression care.
Horgan
Constance M
CM
Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454, USA. horgan@brandeis.edu
Merrick
Elizabeth L
EL
Stewart
Maureen T
MT
Scholle
Sarah H
SH
Shih
Sarah
S
D000928:Antidepressive Agents / Q000627:therapeutic use*; D003159:Community-Institutional Relations; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D004358:Drug Therapy / Q000592:standards / Q000706:statistics & numerical data*; D017723:Drug Utilization Review; D019983:Guideline Adherence; D006279:Health Maintenance Organizations / Q000592:standards; D006801:Humans; D008605:Mental Health Services / Q000592:standards*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires; D014481:United States
D000928:Antidepressive Agents