The Follow-up After Emergency Department Visit for People with High-Risk Chronic Conditions (FMC) measure is a key HEDIS metric that evaluates care coordination and timely follow-up for vulnerable adults, with chronic conditions—such as COPD, chronic kidney disease, Alzheimer’s disease, depression, heart failure, atrial fibrillation, stroke, or acute myocardial infarction—who receive a qualified follow-up service within seven days of the ED encounter. The measure aims to reduce fragmented care and prevent unnecessary return ED visits, hospital admissions, or complications by ensuring timely clinical reassessment after an acute event.

Important information about the measure: 

1. Follow up must be completed within 7 days of ED visit.
2. Eligible follow-up care to close the gap:
   • Outpatient office visits
   • Telehealth encounters
   • Virtual check-ins or e-visits
   • Observation visits
   • Transitional care management, complex care management, case management encounters
   • Behavioral health visits
   • Intensive outpatient or partial hospitalization services, community mental health center visits, and substance use disorder services
3. Proactive outreach:
   • Scheduling a visit before the member leaves the ED
   • Maintaining open appointment slots for post-ED patients
   • Conducting timely outbound calls
4. Importance of the measure:
   • Impacts health outcomes
   • Provides quality of life
   • Measure included in BCBSRI PCP Quality Incentive Program (PQIP)

By prioritizing early contact and prompt follow-up, providers can support better chronic condition management, reduce avoidable utilization, and improve health outcomes for high-risk members.