“The period immediately following discharge is one of the most vulnerable points in a member’s care journey.”
Laura Quigley – VP, Quality, Clinical Strategy
Health plans have made meaningful progress in expanding access to behavioral health care, yet one of the most persistent challenges remains: ensuring members receive timely follow‑up care after a hospitalization or emergency department visit. While screening and diagnosis have improved, gaps in follow‑up continue to impact both member outcomes and HEDIS performance.
HEDIS measures such as Follow‑Up After Hospitalization for Mental Illness (FUH) and Follow‑Up After High‑Intensity Care for Substance Use Disorder (FUI) focus on post‑acute care, while measures like Follow‑Up After Emergency Department Visit for Mental Illness (FUM) and for Substance Use Disorder (FUA) address follow‑up after emergency department visits.
These measures evaluate whether members receive follow‑up care within seven and 30 days and serve as indicators of evidence-based care pathways following an acute event.
Without effective transitions of care, members are at higher risk of readmission. Behavioral health readmissions continue to be a concern across the industry, with research showing that 30‑day readmission rates following psychiatric hospitalization can exceed 20 percent in some populations. This highlights significant gaps in follow‑through and care coordination.
Why follow-up matters
The period immediately following discharge is one of the most vulnerable points in a member’s care journey. Without timely follow‑up, individuals may struggle with medication adherence, symptom management or navigating next steps in care.
Timely follow‑up plays a critical role in:
- Reinforcing treatment plans
- Identifying early warning signs of recurrence
- Addressing medication errors or reconciliation needs
- Supporting smooth transitions from inpatient to outpatient care
Evidence shows that timely outpatient follow‑up is associated with lower readmission rates.
For health plans, this connection is significant. Follow‑up care is not only a clinical best practice, but also a key driver of quality performance and cost management.
Where gaps persist
Many organizations perform well in identifying behavioral health needs, but struggle with what happens next. Members often face barriers such as:
- Difficulty scheduling timely appointments
- Limited provider availability
- Unclear discharge instructions
- Competing life demands
At the same time, providers may lack visibility into recent hospitalizations or emergency department visits, leading to missed opportunities for follow‑up.
HEDIS data helps highlight these gaps. With more than 235 million people enrolled in plans that report HEDIS results, the measure set offers a broad view of where performance succeeds and where it falls short. In many cases, lower scores reflect challenges in care transitions, particularly gaps in coordination, timely follow-up and continuity of care after an acute event, rather than issues with initial identification alone.
Improving follow‑up rates requires a shift from reactive to proactive care models. Health plans that see stronger performance often prioritize engagement strategies that ensure members are supported beyond the initial point of care.
These strategies help transform follow‑up into a structured and supported process, rather than relying on members to navigate the system on their own.
“Health plans that see stronger performance often prioritize engagement strategies that ensure members are supported beyond the initial point of care.”
Laura Quigley – VP, Quality, Clinical Strategy
Improving follow-up measures through navigation
A common barrier to follow-up care is the gap between identifying a member’s need and successfully getting them to an appointment. Lucet’s NavConnect™ addresses this challenge by combining care navigation, provider matching and direct scheduling into a single experience.
Using real-time provider availability, members are matched to clinically appropriate in-network providers and can be connected to care in as little as one day. As a result, 85% of members are connected to care within seven days, with an average of just five days between booking and treatment.
By reducing scheduling barriers and accelerating access to care, this approach helps health plans strengthen care transitions and support performance on follow-up-focused HEDIS measures.
A path forward for health plans
Improving follow‑up is one of the most effective ways to strengthen outcomes, reduce avoidable utilization and improve quality performance.
By focusing on timely follow‑up, stronger coordination and proactive engagement, health plans can focus on reducing readmissions and high-cost utilization while also improving continuity of care. Additionally, strengthening HEDIS performance will play a vital role in achieving these goals.
The opportunity is clear. Identifying a need for care is only the first step. Ensuring that care continues is what ultimately drives better outcomes across the behavioral health continuum.
Supporting better decisions across the system
This approach is two-fold and critical — ensuring that progress is evaluated across depth of clinical improvement as well as holistic measurement of a patient’s overall acuity.
Standardized response and remission thresholds offer clear benefits for health plans. They enable fairer performance comparisons across providers. They provide real-time feedback to providers relative to treatment efficacy, so that adjustments can be made throughout the course of care. Decisions become grounded in clinical reality and care pathways, not just short-term gains. They also provide a more accurate picture of population health over time.
As measurement-informed care becomes a cornerstone of value-driven behavioral health care, the question is no longer whether members improved at all. The question is whether they improved enough, for long enough, to continue being well.
For health plans looking to invest in outcomes that matter, clinically significant response and remission are the benchmarks that count.
Laura Quigley is vice president of quality, clinical strategy at Lucet.
