Like other chronic conditions, behavioral health issues often persist throughout a patient’s life, and can be marked by periods of worsening symptoms. This reality contributes to a fragmented care system and tight reimbursement rates. In response, behavioral health leaders are leaning on clear patient outcome data to strengthen trust with payers and demonstrate the value of care provided.
“If there’s no way to know whether people are getting better or not, it’s really hard for payers to understand whether or not their members are getting quality care. What is [quality] defined by?” Tammer Attallah, executive clinical director of Salt Lake City-based Intermountain Health’s behavioral health program, told Becker’s. “In order for payment models to change, there needs to be greater accountability for clinical outcomes by providers.”
The challenge of consistently capturing data persists; establishing baselines and tracking patients over what can be a lifelong care journey is complex. Still, Mr. Attallah said the process generates insights that support proactive population health strategies. Quantitative and qualitative data — collected from standardized tests and patient questionnaires — provides actionable feedback on treatment effectiveness.
“If we’re not doing both of those [identifying early and treating effectively], then we don’t know,” Mr. Attallah said. “It’s not fair to be asking for more money, more money, more money, when we don’t know whether people are getting better or not.”
At Hartford (Conn.) HealthCare Medical Group, efforts to strengthen data collection through the collaborative care model have become routine.
“We have been very intentional about entering those baseline PHQ-9 scores and GAD-7 scores … entering the interval scores when [psychiatrists are] doing systematic case review … and also entering the resolve date and the score, so that way we can track in Epic various outcomes,” Ashley Shattuck, the group’s program manager for integrated care and primary care, told Becker’s.
Data collection has shown that the model’s evolving registry of about 150 patients experienced a 78.3% positive change in PHQ-9 scores and an 82% positive change in GAD-7 scores, with average enrollment ranging from three to six months, Ms. Shattuck said.
Amid rising demand for behavioral health services, providers are increasingly being pushed to produce measurable outcomes, a dynamic that has given payers more leverage in the care equation.
The Mental Health Cooperative in Nashville, Tenn., has centered conversations with payers around moving away from fee-for-service and toward per-member-per-month models that include outcome-based incentives.
“Fee-for-service incentivizes volume such as more labs, more medications and more referrals. In contrast, value-based care rewards us for improving outcomes and lowering the total cost of care,” Chief Medical Officer Corey Cronrath, DO, told Becker’s. “That shift allows providers the time and flexibility needed to deliver high-quality, person-centered care.”
Plano, Texas-based Oceans Healthcare has made transparency a core tenet of its quality strategy. The organization recently published an enterprise behavioral health quality report, part of a broader effort to share data internally and externally, Vice President of Quality Kristen Tefft told Becker’s.
Quality reports are distributed to leaders across the organization throughout the week, helping guide operational priorities. Oceans also developed infrastructure within its EHR to provide systemwide visibility into quality performance and accelerate changes. This real-time access eliminates the need to wait for quarterly meetings to assess or address performance, Ms. Tefft said.
The organization publicly shares key quality priorities — including restraint and seclusion use, de-escalation before restraint, patient experience scores and crisis safety planning at discharge — along with national benchmarks.
Internally, the initiative has also driven staff engagement. Oceans involves physicians, nurses and pharmacists and solicits their feedback in efforts to improve quality measures.
“In the quality world, transparency is key to learning and improvement,” Ms. Tefft said. “The more consistency we get across the behavioral health world from a quality perspective, the more we can learn from each other and expand on that.”
