Salt Lake City-based Intermountain Health is approaching behavioral health access challenges by first addressing one quality concern in particular: whether patients are actually getting better.
That’s the premise behind the health system’s push to embed measurement-based care across its behavioral health service line, Tammer Attallah, executive clinical director of Intermountain’s behavioral health clinical program, told Becker’s. The nonprofit system has locations in six primary states and additional operations across the western U.S., operating 34 hospitals and more than 400 clinics.
“We want more patients to get better faster. That’s all,” he said. “It’s as simple as that.”
The power of measurement-based care
It can be tempting to look at behavioral health’s access problems from the delivery, payer or consumer side alone, but that view is incomplete, he said.
“We have to measure and publish outcomes and whether or not at the individual level, patients are getting measurably better. That’s a requisite,” he said. “If you try to do more of the same thing, and people aren’t necessarily getting better, or you’re not catching them early enough, the economics gets really hard.”
Intermountain has an internal effort dedicated to driving measurement-based care across the system. Running alongside it, this year the health system began including behavioral health in a systemwide, multispecialty push on patient-reported outcome measures, or PROMs.
“Oftentimes behavioral health finds itself on an island,” Mr. Attallah said.
He said the goal is for outcome measurement to become so embedded that patients notice its absence.
“Imagine a world where you’re not going to see a therapist unless they do that, because they’ve been sort of socialized to realize that if they’re not doing that, I don’t know how good the quality of care is,” he said.
Without that foundation, he said, the system risks delivering a lot of ineffective, unnecessary care, and a limited workforce ends up treating patients who are not improving.
The unglamorous work
Mr. Attallah said the current focus is more on the “less desirable but really important” logistics of getting outcome measurement to stick. That, he said, is the biggest challenge. For starters, patients have survey fatigue, with constant surveys across every part of their lives making it hard for individuals to judge which one is worth their time. Providers, meanwhile, want to measure outcomes but face workflow burdens, such as having to pull data from an external website, that add friction to the process.
Two systemwide strategic priorities frame the work: proactive, value-based care and reducing complexity. Rather than chase clinical outcomes right away, Intermountain is piloting how outcome tools are visualized and used at select sites first.
“We try to focus on the outcomes right away, but we don’t focus on the process then wonder why people aren’t using it,” he said.
Today, completion rates for outcome questionnaires across Intermountain’s integrated behavioral health, primary care and specialty outpatient settings are around 60%, Mr. Attallah said. The system is targeting 70% by the end of the year. Getting patients to complete the survey is only “part of the piece,” he said. The next phase is ensuring providers use the results to inform care.
Five drivers
Drawing on Intermountain’s decades-long history of quality improvement work across medical specialties, Mr. Attallah said the system identified five drivers necessary for measurement-based care to succeed:
- Patient engagement. Tactics include clearly explaining to patients why the measures benefit them and giving them easy access to their own results. “I want to see it on my phone,” he said, comparing it to how patients want to view lab results.
- Clinician engagement. Many clinicians, particularly those in practice for years, were never trained to use outcome measures, Mr. Attallah said. Intermountain is working to identify clinicians already engaged with the practice to help bring others along.
- Workflow. The system is analyzing administrative and clinical workflow so that completing and using outcome measures does not burden clinicians or patients.
- Local accountability. Rather than relying on a single system-level executive to drive adoption, Intermountain is identifying leaders at the clinic level.
- EHR integration. The system is examining how outcome measurement is integrated into the EHR from end to end.
Intermountain has a measurement-based specialty council with representatives across the entire system. They report on tactics they have tried and whether they improved results, Mr. Attallah said, describing it as a “learning collaborative.”
“Oftentimes in healthcare, when we implement things, it doesn’t have stickiness to it, and it doesn’t become part of a culture,” he said. “We’re trying to embed this in a culture where there’s already a lot of complexity.”
Advice for leaders
Mr. Attallah said leaders cannot identify solutions until they understand the barriers and facilitators from the individuals doing the work. He described a “balcony versus dance floor” framing. Leaders often watch from the balcony, he said, but need to get onto the dance floor to understand what is actually happening in day-to-day care delivery.
He added that pushback from clinicians should not automatically be read as resistance to doing the right thing. Instead, he said, it is something leaders need to understand more deeply. He said he believes “people are doing the best they can with the resources they have,” adding that clinicians do not want more paperwork, they want time with patients and meaningful feedback that is not framed as criticism.
Mr. Attallah noted that behavioral health has historically relied on perceptual, rather than measurable, outcomes. Other specialties have published outcomes data for years, he said, citing A1c measurement in diabetes care as an example.
“At the end of the day, we want to use the tools that we’re given to help people that are suffering from mental health conditions that are impacting their lives to get better faster,” he said.
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
