Alcohol Screening: A Measure that Matters

We all know someone who has struggled with alcoholism. Now, consider this: The majority of adults who drink excessively are not dependent on alcohol. Still, their health is at risk.

A 2014 Centers for Disease Control and Prevention (CDC) Report indicates that alcohol misuse accounts for 1 of every 10 deaths among working adults aged 20-64. Excessive use of alcohol causes an estimated 88,000 deaths and costs $249 billion a year in health care, insurance, lost productivity, and criminal justice-related costs. Further, it is associated with chronic illnesses like heart disease, stroke, birth defects, violence, and accidental injuries.

Only one in six adults reports that his or her doctor or other health professional ever discussed alcohol use.

Nearly 30% of our country’s population misuses alcohol. 21% of adults engage in risky or hazardous drinking—consuming more than the recommended daily, weekly, or per-occasion amounts.

Clearly, alcohol misuse is a troubling public health issue. Yet, in many exam rooms, the possibility the patient is misusing alcohol is not addressed often enough. Work conducted here at NCQA and in studies around the world, confirms—screening and follow-up for unhealthy alcohol use isn’t happening enough.

In fact, the CDC found only 1 in 6 adults report that their doctor or other health professional ever talked with them about alcohol use. Those disappointing results come even as the U.S. Preventive Services Task Force recommends 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.” We must do better.  And we can.

Alcohol Screening: What We’ve Done

At NCQA, we often say, “You can’t improve what you don’t measure.” How can we possibly improve, unless our progress is defined and tracked? That concept applies in a new effort to encourage screening.

With support from the Substance Abuse and Mental Health Services Administration (SAMHSA) and FEi Systems, NCQA introduced a measure for alcohol screening. Admittedly, we did not reinvent the wheel—rather, we adapted and tested the American Medical Association provider-level measure for Unhealthy Alcohol Use: Screening and Brief Counseling. Essentially, we took a measure designed for doctors, and transformed it into one for reporting at the health plan level.

Now, the Unhealthy Alcohol Use Screening and Follow-up measure is part of the Healthcare Effectiveness Data and Information Set (HEDIS®). It is the first to evaluate unhealthy alcohol use screening and follow-up care for adults in the general health plan population. It is also one of the first HEDIS measures to be reported using electronic clinical data sources (ECDS).

Alcohol Screening: What We (and Plans) Can Do

Our next step in this effort? With additional funding from the CDC and SAMHSA, NCQA formed the Unhealthy Alcohol Use Screening and Follow-Up (ASF) Learning Collaborative. We want health plans—early adopters—to work with us to improve measure reporting and performance.

The ASF Learning Collaborative is an interactive opportunity to strengthen understanding of quality improvement practices in terms of this measure. It includes monthly check-ins with NCQA, bimonthly collaboration opportunities, coaching webinars with other participating health plans and in-person meetings to share experiences and best practices.

NCQA will be selecting one plan to join our existing collaborative teams (three diverse health plans) in using quality improvement activities to affect change.

Joining the Alcohol Learning Collaborative will allow your plan to…

  1. Become innovators in the space of ECDS and unhealthy alcohol use care.
  2. Gain experience collecting ECDS measures at a plan level.
  3. Address unhealthy alcohol use screening and follow-up for all individuals in your plan.
  4. Connect with other innovators in this space to share successes and overcome barriers.

We hope you will see it as we do. As an exciting, life-saving opportunity that ultimately helps reach and treat those who face the devastating effects of alcohol misuse.

If you are interested in joining the Collaborative or want to learn more, contact our team at alcohollearningcollaborative@ncqa.org.

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