Meeting HEDIS FUI Requirements: How Post-Discharge Support Reduces SUD Readmissions and Costs
January 4, 2026
The period immediately after discharge from residential treatment, partial hospitalization programs (PHP), or inpatient care represents the most vulnerable time for individuals in substance use disorder recovery. Without proper support, this critical window often leads to relapse and a costly cycle of readmissions to detox, residential treatment, and emergency departments. Recognizing this challenge, the National Committee for Quality Assurance (NCQA) introduced the Follow-Up After High-Intensity Care for Substance Use Disorder (FUI) measure to ensure coordinated care transitions.
Addressing the Most Vulnerable Moment in Recovery
The FUI measure emerged in response to a mounting crisis. By 2022, 48.7 million Americans were classified as having a substance use disorder, contributing to costs exceeding $700 billion annually across healthcare, lost productivity, and crime-related expenses. Hospital costs for treating SUD are staggering; In 2017, costs reached $13.2 billion per year, with commercial health insurance spending over $15,000 annually per enrollee with an SUD diagnosis in 2018.
NCQA developed the FUI measure based on compelling evidence: individuals leaving high-intensity care settings are critically vulnerable to losing contact with their healthcare system and support networks. Research demonstrates that lack of timely follow-up results in continued substance use, return to use, increased utilization of intensive services, and mortality. Studies consistently show that timely follow-up after intensive treatment improves patient outcomes, reduces healthcare utilization, and decreases overall care costs. The measure tracks whether individuals receive follow-up care within both 7 and 30 days of discharge, recognizing that early connection to ongoing support is essential for sustained recovery.
Impact on Health Plans and Providers
The FUI measure has transformed expectations for both health plans and providers. Plans must now demonstrate coordinated care transitions and ongoing support during this vulnerable period, with performance data revealing significant room for improvement across all plan types. Providers bear responsibility for scheduling follow-up appointments before discharge and ensuring warm handoffs to outpatient care, along with continuous support during this critical transition period and throughout the treatment and recovery journey.
For health plans, individuals with poorly managed SUD generate an additional $15,640 in annual medical expenditure per enrollee. These costs compound through repeated crisis interventions. For providers, high readmission rates signal inadequate care coordination, damaging reputation and referrals while each patient who drops out represents direct revenue loss of $2,325 to $21,404 per treatment episode.
The Cost of Inadequate Post-Discharge Support
Patients with substance use disorders face a 24% higher risk of unplanned hospital readmission within 30 days, with opioid use disorder showing readmission rates approaching 40%. These preventable readmissions carry steep financial consequences: the annual medical cost of SUD in US hospitals exceeded $13.2 billion in 2017, with each inpatient readmission averaging $9,693.
Bridging the Gap with Integrated Digital Support
The hours and days immediately after leaving residential treatment or PHP, when formal healthcare isn’t readily available, are precisely when risk peaks. Integrated digital peer support programs like CHESS Health’s suite of recovery support tools provide 24/7 access to professional peer-engagement teams and coping and recover tools offering always-on support during these critical “in-between” moments.
These tools complement traditional follow-up visits by maintaining continuous engagement as an extension of treatment programs. The measurable impact directly supports FUI performance:
- Improved care coordination that meets the FUI measure’s core intent.
- Fewer readmissions and reduced ED utilization through early intervention when warning signs emerge.
- Better adherence to outpatient treatment and MAT/MOUD via consistent engagement and accountability
- Lower overdose risk with 24/7 crisis support during the highest-risk period
Research demonstrates what the FUI measure now requires: sustained recovery demands sustained support, especially in the vulnerable days following high-intensity treatment. Peer-powered 24/7 recovery support integrated into the care ecosystem ensures continuity, prevents costly gaps, and reduces readmission risk during the critical 30-day window.
The ROI is compelling: every $1 invested in continuous SUD treatment and recovery support returns $4 to $5 through prevented readmissions and sustained recovery. By ensuring coordinated follow-up care with ever-present digital support, health plans reduce preventable costs while providers protect revenue and improve quality metrics—transforming the vulnerable post-discharge period from a liability into a competitive advantage.
