Follow-Up HEDIS Measures for Substance Use Disorders

The Healthcare Effectiveness Data and Information Set (HEDIS) is one of healthcare's most widely used performance improvement tools. Three HEDIS measures focus on follow-up care for substance use disorders. These measures are:

1. FUI — Follow-Up After High-Intensity Care for Substance Use Disorder, which measures the percentage of substance use disorders (SUD) patients who had a follow-up visit after an acute inpatient stay, residential treatment, or detoxification. This measure's goal is to ensure timely transition to outpatient or continuing care after intensive treatment at: 
   • 7-Day Follow-Up (FUI-7) 
   • 30-Day Follow-Up (FUI-30)
      
2. IET — Initiation and Engagement of Substance Use Disorder Treatment, which measures:
   • Initiation: A follow-up visit within 14 days of a new SUD diagnosis
   • Engagement: At least 2 additional visits 34 days after initiation The goal of this measure is to promote early and sustained treatment engagement for newly diagnosed individuals. 
      
3. FUA —Follow-Up After Emergency Department (ED) Visit for Substance Use, which measures the percentage of ED visits with a principal diagnosis of SUD, or any diagnosis of drug overdose that had a  follow-up visit.  Using the same time frames as FUI (see #1 above), this measure's goal is to reduce relapse and improve outcomes by ensuring timely outpatient care after ED discharge. 

How Can Providers Ensure Timely Follow Up?

Encourage providers and staff to:

• Offer telehealth and phone visits. 
• Schedule the first visit within 7 days. 
• Code substance-related diagnoses and visits correctly on claims. 
• Partner with the Select Health and assess for peer support and care management referrals. 
• Coordinate care between physical and mental health providers. 
• Educate on relapse prevention and treatment options 

What Are Eligible Follow-Up Care Settings & Services for SUD?

Eligible care settings for SUD follow up include:

• Telehealth, telephone, or virtual visit 
• Outpatient visit 
• Observation visit 
• Intensive outpatient encounter or partial hospitalization 
• Nonresidential SUD facility 
• Community mental health center visit 
• Residential (BH) Treatment Center (for FUI only) 
• Acute and Nonacute Inpatient (for FUI and IET only)

Eligible care services for follow-up SUD care include: 

• Opioid Treatment 
• Substance Use Service 
• Medication-Assisted Treatment for Alcohol or Opioid 
• Peer support (for FUA only)