Brief Description of Measure:

​CMS137: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment:
Percentage of patients 13 years of age and older with a new episode of alcohol or other drug abuse or (AOD) dependence who received the following. Two rates are reported.
a. Percentage of patients who initiated treatment including either an intervention or medication for the treatment of AOD abuse or dependence within 14 days of the diagnosis
b. Percentage of patients who engaged in ongoing treatment including two additional interventions or a medication for the treatment of AOD abuse or dependence within 34 days of the initiation visit. For patients who initiated treatment with a medication, at least one of the two engagement events must be a treatment intervention.

Description of Issue:

In the HEDIS MY2022 Initiation and Engagement of Substance Use Disorder Treatment (IET) measure, a revision was made to allow for the full engagement criteria to be met if an individual received a long-acting medication for the treatment of alcohol use disorder (AUD) or opioid use disorder (OUD) within 34 days following initiation. 
 
This change was deemed appropriate by expert panel members, who agreed that because the duration of long-acting medications lasts from 30-160 days, the engagement period is covered by active treatment if a patient elects to use that treatment approach.
 
The measure developer proposes aligning CMS137 with the HEDIS MY2022 IET measure to allow for the full engagement criteria to be met if an individual received a long-acting medication for the treatment of SUD.
 
The measure developer proposes to update the logic by separating out drug medications by short-acting vs long-acting. Please note the  following indications:
-All drug medications (short-acting and long-acting) are used to test for negative substance use disorder (SUD) medication history.
-All drug medications (short-acting and long-acting) can be used to meet criteria for Initiation (1 required).
-A single event of long acting medication or long acting medication administration makes patient compliant for engagement.
-A single event of short acting medication or short acting medication administration meets criteria for 1 of 2 required events for engagement.

Proposed Solution:

//Note: requirement that psychosocial treatment accompany pharmacotherapy is removed. This is documented separately in another CRP issue.
 
//Header: Description
//Before
…b. Percentage of patients who engaged in ongoing treatment including two additional interventions or a medication for the treatment of AOD abuse or dependence within 34 days of the initiation visit.
 
//After
…b. Percentage of patients who engaged in ongoing treatment, including two additional interventions or short-term medications, or one long-term medication for the treatment of SUD, within 34 days of the initiation visit.
 
//Header: Numerator
//Before
Numerator 2: Engagement in ongoing treatment within 34 days of initiation includes:
1. Patients that initiated treatment with a psychosocial visit, and whose engagement criteria was fulfilled by a dispensed medication.
2. Patients that initiated treatment with a psychosocial visit, and whose engagement criteria was fulfilled by two further psychosocial visits.
3. Patients that initiated treatment with a dispensed medication, and whose engagement criteria was fulfilled by both a further medication dispense and a psychosocial visit.
4. Patients that initiated treatment with a dispensed medication, and whose engagement criteria was fulfilled by two psychosocial visits.
 
//After
Numerator 2: Engagement in ongoing SUD treatment within 34 days of initiation includes:
1. A long-acting SUD medication on the day after the initiation encounter through 34 days after the initiation encounter.
2. At least two of the following (any combination) on the day after the initiation encounter through 34 days after the initiation encounter: 1) engagement visit, 2) engagement medication treatment event.
 
//Terminology
Remove valueset "Opiate Antagonists" (2.16.840.1.113883.3.464.1003.198.12.1132)
 
Add the following value sets:
 - valueset "Substance Use Disorder Long Acting Medication" (2.16.840.1.113883.3.464.1003.1149
 - valueset "Substance Use Disorder Short Acting Medication" (2.16.840.1.113883.3.464.1003.1150)
 - valueset "Substance Use Disorder Short Acting Medication Administration" (2.16.840.1.113883.3.464.1003.1157)
 - valueset "Substance Use Disorder Long Acting Medication Administration" (2.16.840.1.113883.3.464.1003.1156)
 
//Logic
//Before
define "History of Dependence Diagnosis or Treatment":
( ( ["Intervention, Performed": "Alcohol and Drug Dependence Treatment"]
    union ["Intervention, Performed": "Psych Visit - Psychotherapy"] ) Interventions...
)
  union ...
  union ( ["Medication, Order": "Opiate Antagonists"] Opiates...
  )
 
//After
define "History of Dependence Diagnosis or Treatment":
( ( ["Intervention, Performed": "Alcohol and Drug Dependence Treatment"]
    union ["Intervention, Performed": "Psych Visit Psychotherapy"]
    union ["Intervention, Performed": "Substance Use Disorder Long Acting Medication Administration"]
    union ["Intervention, Performed": "Substance Use Disorder Short Acting Medication Administration"] ) Interventions...
)
  union ...
  union ( ( ["Medication, Order": "Substance Use Disorder Long Acting Medication"]
      union ["Medication, Order": "Substance Use Disorder Short Acting Medication"] ) SUDMedication...
  )
 
//Before
define "Treatment Initiation With Medication Order":
["Medication, Order": "Opiate Antagonists"] TreatmentInitiatedWithMedication
...
 
//After
define "Treatment Initiation With Medication Order":
( ["Medication, Order": "Substance Use Disorder Short Acting Medication"]
  union ["Medication, Order": "Substance Use Disorder Long Acting Medication"]
  union ( ( ["Intervention, Performed": "Substance Use Disorder Short Acting Medication Administration"]
      union ["Intervention, Performed": "Substance Use Disorder Long Acting Medication Administration"] ) SUDMedAdministration
      return "Medication, Order" { authorDatetime: date from start of Global."NormalizeInterval" ( SUDMedAdministration.relevantDatetime, SUDMedAdministration.relevantPeriod ) }
  ) ) SUDMedication
...
 
//Before
define "Treatment Initiation With Non Medication Intervention":
"Psychosocial Visit" TreatmentInitiatedWithIntervention
  ...
 
//After
define "Treatment Initiation With Non Medication Intervention":
"Psychosocial Visit" PsychosocialVisit
  ...
  return "Medication, Order" { authorDatetime: date from start of Global."NormalizeInterval" ( PsychosocialVisit.relevantDatetime, PsychosocialVisit.relevantPeriod ) }
 
//Before
define "Numerator 2":
...
 
//After
exists "Treatment Engagement With Long Acting Medication"  
 or "Treatment Engagement With Short Acting Medication or Non Medication Intervention"
 
 
Add the following definitions:
 
define "Treatment Engagement With Long Acting Medication":
"Long Acting Medication" LongActingSUDMedication
  with ( "Treatment Initiation With Medication Order"
    union "Treatment Initiation With Non Medication Intervention" ) InitiatedTreatment
    such that date from LongActingSUDMedication.authorDatetime 34 days or less after date from InitiatedTreatment.authorDatetime
 
define "Treatment Engagement With Short Acting Medication or Non Medication Intervention":
Count("Short Acting Medication or Non Medication Intervention" ContinuedTreatment
    with("Treatment Initiation With Medication Order"
      union "Treatment Initiation With Non Medication Intervention")InitiatedTreatment
      such that date from ContinuedTreatment.authorDatetime 34 days or less after date from InitiatedTreatment.authorDatetime
)>= 2
 
define "Long Acting Medication":
["Medication, Order": "Substance Use Disorder Long Acting Medication"]
  union ( ["Intervention, Performed": "Substance Use Disorder Long Acting Medication Administration"] LongActingMedication
      return "Medication, Order" { authorDatetime: start of Global."NormalizeInterval" ( LongActingMedication.relevantDatetime, LongActingMedication.relevantPeriod ) }
  )
 
define "Short Acting Medication or Non Medication Intervention":
( ( "Psychosocial Visit"
    union ["Intervention, Performed": "Substance Use Disorder Short Acting Medication Administration"] ) ShortActingTreatment
    return "Medication, Order" { authorDatetime: start of Global."NormalizeInterval" ( ShortActingTreatment.relevantDatetime, ShortActingTreatment.relevantPeriod ) }
)
  union ["Medication, Order": "Substance Use Disorder Short Acting Medication"]

 Rationale for Change:

​The goal of this change is to allow for the full engagement criteria to be met if an individual received a long-acting medication for the treatment of SUD, which better aligns the measure with the intent and is supported by stakeholders.