The behavioral health field is increasingly shifting its value proposition away from productivity measures—such as the number of patients treated—and toward outcomes. The motivation comes from the fact that payers are focusing on the value of treatments and the return on their investment: Are the people being treated getting better?
And make no mistake, financial gain will follow the best outcomes.
Behavioral health professionals are familiar with a number of diagnostic, assessment and outcomes-management tools, but the need to track patients’ progress with them is becoming a business imperative. In addition, new tools that are emerging for improved outcomes assessment and management will help leaders establish accountability in the changing healthcare system.
“The Affordable Care Act (ACA) is pretty dead set on showing medical necessity,” says Willa Presmanes, MEd, MA, outcomes research, behavioral healthcare, MTM Services.
Presmanes is the creator of the DLA-20 (Daily Living Activities 20) tool, a free research-backed outcomes tool that measures mental illness’ impact on patients’ daily living areas, such as regular eating and sleeping schedules. MLM Services is a consultant to the National Council for Behavioral Health.
“The Centers for Medicare and Medicaid Services has said there has to be accountability,” Presmanes says. “If mental health centers are going to get opportunities to serve new clients—clients who didn't have insurance before the ACA—there’s going to have to be accountability as to who gets into what services. So whatever assessment tools you pick, you need to be able to tie them to the level of care.”
This means mental health professionals are going to need to measure symptoms. “I can’t tell you how many people have a mental status exam and cannot count symptoms or the severity of symptoms,” Presmanes says.
In addition, providers are going to have to show that their treatments are resulting in an improvement in functioning.
“The treatment plan should be designed to improve functioning and symptoms, or at least prevent their worsening,” she says.
A. Lee Solomon, MD, Behavioral Health Associates, Chattanooga, Tenn., says he uses assessment tools first for diagnostic purposes to rate the severity of patients’ illness, then to monitor patients’ progress and the effectiveness of his therapies. His goal, he says, is not just improvement, but remission.
“In depression, all the studies show that patients who improve with antidepressants but are not completely well have a tendency to relapse more often that patients who are completely well,” he says. “So just getting patients better is not a good enough goal. With depression you must get patients to remission.”
The only way to determine if that goal has been reached, Solomon notes, is through assessment and monitoring. While a provider’s education, experience and intuition are paramount in treatment, with today’s healthcare accountability push, documentation must be meticulous.
Christy Winter, LMSW, manager of clinical information and outcomes at Qualifacts Systems, a provider of EHR and billing systems for behavioral health providers, says the company is in the process of rolling out an outcomes assessment tool. She says there are four primary stakeholders that benefit from measuring and managing outcomes:
· Payers that see improved outcomes as a way to reduce the need for future services and thus inherently reduce costs;
· Organizations that can use performance management metrics to determine their progress toward their mission;
· Clinicians, who need accurate, real-time data to target their interventions and services to their clients; and
· The clients themselves, who benefit by being able to monitor their own progress and become more engaged in their own care.
Winter notes many payers are driving outcomes-based “incentive” payment programs that often share the downside risk as well as the financial rewards for cost savings. That trend is certain to continue.
“That’s why organizations should be thinking and acting now,” she says, “they need to get a solid measurement system in place before these penalties/incentives start coming.”
David Klements, president and CEO of Qualifacts, adds that as accountable care organizations seek to incorporate behavioral health care into their networks, they’re going to be asking for information on how outcomes trend over time. A consistent outcomes management tool will make that information available.
“If you have a standardized way to capture and report data, you can begin to compare that data very quickly and easily to other organizations that are providing the same service,” he says.
In addition, outcomes management systems can be used to discover best practices among a network of providers. Although outcomes management is sure to grow in importance, Winter says that outcomes measurement is a first step and not an end unto itself.
“It shouldn't be measurement for measurement’s sake,” she says. “It should be about using that data to really improve services for the individual client and at the program level.”