Hard agree, and not just because I'm a spreadsheet nerd. Why are we all here? Isn't it in the service…
Readers Write: What The (Behavioral) Health? Let’s Shift the Focus from Access to Care to Quality of Care
What The (Behavioral) Health? Let’s Shift the Focus from Access to Care to Quality of Care
By Eric Meier
Eric Meier, MBA is president and CEO of Owl of Portland, OR.
Expanding access to care has been a top challenge over the last two years in behavioral health due to a significant increase in demand for treatment services. Fortunately, traditional providers and new market entrants have quickly responded to this need and dramatically increased virtual care through telehealth and digital offerings to improve access for communities across the country.
While expanding access to care should and will remain a priority, the conversation should now include, are we providing quality care to improve outcomes? Are people actually getting better through our behavioral health services?
Delivering quality behavioral health services is focused on delivering the right treatment to the right person at the right time for the right duration. Essentially, quality is defined as effective and efficient delivery of care that improves patient outcomes at the lowest cost of care.
Now that we’ve defined quality, how do you know how to achieve it? That’s where the focus on measurement comes in. Measurement of health outcomes and quality in physical health is the status quo, but it isn’t yet a consistent practice in behavioral health.
Imagine if the nation had a hypertension crisis and we spent half a trillion dollars to get patients seen by a physician, yet failed to measure their blood pressure on an ongoing basis to confirm they were delivering quality care that improved patient health. That just doesn’t make sense in physical health, and with the availability of advanced and easy-to-use measurement-based care (MBC) technology, it doesn’t make sense for behavioral health either.
MBC incorporates the longitudinal use of evidence-based measurement assessments to gather patient-reported outcomes. This tool captures symptomatology as well as progress throughout treatment. The data from MBC provides clinicians with actionable insights to personalize treatment in real-time to therefore optimize patient care.
Two critical success factors of a MBC strategy are strong patient engagement (i.e. 90% of your patients are completing the assessments at their convenience, on any device, throughout treatment) and consistent, standardized use of MBC throughout the organization as part of patient care regimen. Armed with this critical data, organizations are equipped to screen and triage patients to the right level of care, individualize treatment based on each patient’s unique symptomatology, and guide the treatment plan to know when to step the patient up, down, or out of care.
Furthermore, behavioral health organizations are starting to recognize the critical role that MBC-derived data will play as the foundation for value-based reimbursement contracting. It is precisely these data insights that will prove how patient populations are improving and how your organization is delivering quality care. This data transparency on patient outcomes enables providers and payers to be on equal footing to create value-based payment contracts.
This sounds great in principle and has some evidence to back it up, even though the evidence from well done trials is actually very sparse and does not use generalizable samples. But the more pressing issues are that:
1. “advanced and easy-to-use measurement-based care technology” isn’t actually readily available
2. Existing rating scales are often not well validated across a broad range of socio-demographic groups
3. Commonly used scales such as the PHQ9 or GAD7 can help in screening and identifying the presence or absence of a disorder but they focus on symptom frequency (days with a symptom in the past 2 weeks) and not the severity of symptoms when they are present, which is just as crucial to know
4. The availability of validated and reliable patient reported outcomes differs depending on the patient’s diagnosis and can also be affected by comorbid conditions. Scales that are available on paper or used in research aren’t always available for clinical purposes in current electronic record systems. With some diagnoses (such as psychotic disorders), developing valid self report scales is challenging
5. Often, even when rating scales are available, the results are formatted as a pdf file and not discrete data that can be tracked.
6. Getting a 90% response to requests for completion of patient reported outcomes is challenging especially when many patients lack robust digital access or when patients have limited education, difficulty with reading, or low health literacy
7. Finally and most importantly, high quality care is more than just sequential rating scales!
Don’t get me wrong — I’m actually a proponent of using patient reported measures — it’s just naive to think that the infrastructure is sufficient to make it work well. And there’s a whole lot more that is needed to assure quality of care.
I agree that we need better measurement of the impact of mental health interventions. there’s a huge discussion about this on the Health Tech Nerds slack group right now (centering on Cerebral).
But I have to say that form this piece I had no clue what Owl actually does, and even looking at the website I can’t tell if Owl is a care provider, selling software to other providers to let patients measure their progress, or both. And if it’s the latter, what is Owl actually doing that is different/better etc than the current questionnaires and PHQ tests that most online companies already use?
My concern with this? The more metrics you gather, the more likely it will be used for cost savings and not quality of care.
You’d need to link payment to quality outcomes, and I’m not convinced this actually does that. Mr. Meier seems to think that “patient satisfaction” metrics are the key here. Sure, those are helpful but… statistically significant numbers of the general population believe in crystals, astrology, the yeti, and aromatherapy.
Often Quality of Care outcomes will lead to increased costs and not decreased costs.
I remain open to being convinced though.