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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

December 2014

Schizophrenia and the Risk of Metabolic Syndrome 

Because individuals diagnosed with schizophrenia may be more likely to develop diabetes and heart disease — and the antipsychotic medications used to treat this condition can also raise these risks — it’s important for primary care providers and behavioral health care providers to work closely with each other to monitor the individual’s overall health.

The National Committee for Quality Assurance’s (NCQA) HEDIS measures on antipsychotic medication management underscore the need for diabetic and cardiovascular screening for patients taking antipsychotic medications, as well as the importance of medication compliance.

In 2013, the NCQA released four measures for adults, and in 2015 the NCQA is introducing the following additional measures for children and adolescents who are prescribed antipsychotic medications. The new measures record the percentage of children and adolescents (ages 1–17) who

  • Were on two or more concurrent antipsychotic medications.
  • Had two or more antipsychotic prescriptions and metabolic testing.
  • Had a new prescription for antipsychotic medication and documentation of psychosocial care as a first-line treatment.

The NCQA measures are aimed at encouraging health plans and providers to offer psychosocial care for children and adolescents diagnosed with schizophrenia and conduct regular screenings for diabetes, heart disease, and metabolic syndrome.

Based on these measures and clinical research, Harvard Pilgrim’s behavioral health partner Optum/UBH recommends that behavioral health care providers:

  • Assist patients who have been diagnosed with schizophrenia and are taking an antipsychotic medication in being screened for diabetes with a glucose test (Glucose Tests Value Set) or an HbA1c test (HbA1c Tests Value Set).
  • Assist patients diagnosed with schizophrenia in receiving a low-density lipoprotein cholesterol (LDL-C) test  in their primary care setting.
  • Educate patients on how antipsychotic medication works and reinforce the importance of speaking with their doctor before stopping the medication. Since many people stop taking antipsychotic medications due to associated weight gain, preemptive weight management advice can help keep patients on track with their treatment.

These guidelines may be helpful, not only in cases of schizophrenia, but whenever an antipsychotic medication is used.

The following resources provide further guidance on monitoring for metabolic disorders:

How Optum/UBH can help your patients — For complex clinical situations, Optum/UBH is available to provide consultative assistance. Practitioners can call the Optum/UBH Physicians Consultation Service at
800-292-2922. To refer a patient for behavioral health services and to facilitate the coordination of care, call Optum at 888-777-4742.

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Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,

Joseph O'Riordan,
Contributing Writer

Kristin Edmonston,
Production Coordinator