Why focus on unhealthy alcohol use?
Unhealthy alcohol use is a common and serious issue, ranging from risky drinking to alcohol dependence.1 About 30% of the U.S. population misuses alcohol, and 21% of adults report engaging in risky or hazardous drinking.2 Alcohol misuse accounts for 1 out of 10 deaths in the United States.3
Even though this issue is widespread, there is a lack of screening and follow up with intervention services. The U.S. Preventive Services Task Force recommends that clinicians “screen adults aged 18 and older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse.” Work done by NCQA has shown low screening and follow-up rates—there is room for improvement.
What is the Unhealthy Alcohol Use Screening and Follow Up measure?
With funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) and FEi Systems, NCQA developed the Unhealthy Alcohol Use Screening and Follow-Up measure, the first to evaluate health plan performance on unhealthy alcohol use screening and follow-up care for the general adult population. In June 2017, the measure was added to HEDIS4 for health plan reporting.
Unhealthy Alcohol Use Screening and Follow-Up
The percentage of members 18 years or older who were screened for unhealthy alcohol use using a standardized tool and, if screened positive, received appropriate care.
Two rates are reported:
- Screening: The percentage of members who were screened using a standardized tool for unhealthy alcohol use.
- Denominator: Adults 18 or older
- Numerator: Those who were screened for unhealthy alcohol use
- Counseling or Other Follow-Up: The percentage of members who received brief counseling or other follow-up care within 2 months of a positive screening.
- Denominator: Adults 18 or older who scored positive for unhealthy alcohol use
- Numerator: Those who received follow-up care
The measure is reported with the use of electronic clinical data sources (ECDS), which includes EHRs, registry and case management.
What now?
With funding from the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Association (SAMHSA), NCQA has been working to improve the quality of care and health plan reporting of the HEDIS Unhealthy Alcohol Use Screening and Follow Up measure through a Learning Collaborative. The Collaborative includes regular meetings with health plans, experts, patient partners and other stakeholders, culminating in a Change Package outlining best practices and lessons learned.
NCQA is pleased to announce the release of the Screening and Follow-Up for Unhealthy Alcohol Use: Quality Improvement Change Package for Health Plans, a toolkit to help health plans address unhealthy alcohol use among their members and improve reporting of the HEDIS alcohol measure using electronic clinical data. The Change Package outlines successful strategies and lessons learned from the Learning Collaborative and can be downloaded here5.
One topic participating health plans were interested in was the correct interpretation of the federal regulation, ‘42 CFR Part 2 – Confidentiality of Substance Use Disorder Patient Records.’ This regulation governs the confidentiality and exchange of information related to substance use. NCQA hosted a webinar presentation given by Cicatelli Associates Inc. (CAI) and Legal Action Center (LAC) in May 2019 to address questions and misconceptions about the regulation. CAI and LAC received funding from SAMHSA to establish a Center of Excellence for Protected Health Information (CoE-PHI). CAI verified that the regulation only applies to federally funded practices and programs that hold themselves out as an entity for substance use treatment and does not apply to general primary care practices. You can listen to the full recording here. You can also view and download the PowerPoint slides here.
Questions regarding NCQA’s Learning Collaborative can be directed to alcohollearningcollaborative@ncqa.org.
- Jonas, Daniel E. et al., 2012. “Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force.” Annals of Internal Medicine 157:645–54.
- Vinson, D.C., B.K. Manning, J.M. Galliher, L.M. Dickinson, W.D. Pace, B.J. Turner. 2010. “Alcohol and sleep problems in primary care patients: a report from the AAFP National Research Network.” Ann Fam Med 8(6):484-92
- Stahre M, Roeber J, Kanny D, Brewer RD, Zhang X. Contribution of Excessive Alcohol Consumption to Deaths and Years of Potential Life Lost in the United States. Prev Chronic Dis 2014;11:130293. DOI: http://dx.doi.org/10.5888/pcd11.130293
- HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
- Liu, J., Rainis, D., Strohmeyer, J., McCree, F., Barnes, A., Morden, E., Clair, C., Olin, S., Omar, N., Spaulding, B., McKnight-Eily, L. & Santora, P. (2020). Screening and Follow-Up for Unhealthy Alcohol Use: Quality Improvement Change Package for Health Plans. Washington, DC: National Committee for Quality Assurance.