Measurement-based care has the potential to revolutionize behavioral health care. With its demonstrated improvements in patient outcomes and engagement, a strong argument can be made for adopting it as the standard method of care across the entire industry. The physical health disciplines have long relied on objective measurements to assess treatment outcomes, and we know from their results that patients, providers, practices, and payors all benefit when established measurements are used to assess care.
Yet this type of care can also be met with resistance in the behavioral health world—resistance from providers who don’t understand its value and from payors unused to reimbursing for it. Universal adoption of such a method likely raises a host of questions about whether measurement-based care is worth the effort, and how the industry would get there.
What are the pros and cons of universal adoption of measurement-based care within the industry, and what tools would help us reach the goal?
Pros of Universal Measurement-Based Care Across Behavioral Health
The arguments in favor of moving the industry toward measurement-based care are compelling. The benefits that would warrant the effort include the following.
Improved Patient Outcomes At Scale
The number one goal of any behavioral health practice is to improve the lives of our patients. Anything that achieves greater patient improvement in a faster timeframe should be utilized. In this area, measurement-based care delivers.
Research has consistently demonstrated improved patient outcomes with measurement-based care compared to traditional care models for medication and psychotherapy. Practitioners gain better insight into patient progress and are able to implement more targeted treatments. In addition, patients show stronger engagement with their treatments under this type of care.
Should measurement-based care become the standard across the behavioral health industry, it could monumentally enhance positive outcomes for patients across the country. In essence, the behavioral health industry could have a greater effect on quality of life within our society than ever before.
Efficiency is important for a number of reasons. Patients, of course, want better treatments that work faster, and providers want to make efficient use of the time given for each clinical encounter. But looking beyond that, efficiency also affects the state of the industry.
If we take a wide view of the market, we see a shortage of behavioral health providers. This is why new patients often face long wait times for first appointments with a therapist or psychiatrist. Growing the national number of providers takes time, so the best response in the short term is to make better use of the providers we have. This is where measurement-based care can help. Because evaluations are completed by the patient outside of the appointment time, providers need not devote portions of each appointment to data-gathering. This helps them get more done at each clinical encounter, yielding more work in the same number of hours.
In addition, hard data on patient wellbeing gives providers the ability to better triage patients. The current behavioral health market underinvested in improving triage—people are typically referred and scheduled without much context on the level of urgency or the scale of their needs. It’s rare to find the application of real data being used to make these decisions in behavioral health.
Furthermore, triage remains important throughout the patient journey, not just at the time of first referral. True outcomes data—the kind available in physical health disciplines—is needed to make good decisions about the appropriate level of care, not to mention the types of care, each patient should receive for the duration of their time under our care.
Calculating the Value of Treatment
Clinical measurement is the best way to quantify the value of a given treatment for a patient. It helps patient and practitioner understand if the results of therapy or medication match the time, money, and effort invested.
Anyone who is responsible for the costs of behavioral health care has a vested interest in making sure the outcomes are worth the cost. The greatest responsibility is on payors and employers, who cover much of the financial burden. As “value-based care” becomes more popular, providers will also begin to assume more risk and responsibility, and thus realize more financial incentive to identify the value of their treatments. On top of this, providers have an ethical responsibility to make good use of their resources, and that includes identifying the treatments that produce best results for each patient. And, of course, the patients themselves want to make sure they’re getting what they paid for, so to speak.
Capturing More Investment Share for Behavioral Health
It’s now well-established that mental health impacts physical health to a high degree. Comorbid mental health diagnoses are associated with increased costs for physical care. Financially responsible parties within the physical healthcare world, such as insurance companies and hospitals, are beginning to turn their attention to this mind-body connection.
Measurement-based care is one way to capture that attention and strengthen the tide of interest in the behavioral health field. Outcomes data can help show the relationship between the quality of mental health treatment and physical health savings. Show that relationship and you can attract more investment in behavioral health service delivery. Attract more investment, and you’ll soon see greater innovation, which could spur a new era of progress in the field.
Unfortunately, the opposite is also true. Without data to show the results of behavioral health care, investment is hard to find. Why invest in something if you don’t know whether it works? The behavioral health world must use measurement-based care to prove a “return on investment” in service delivery innovation.
Cons of Universal Measurement-Based Care
The rewards of universally adopted measurement-based care are promising, but are there downsides? What unexpected hurdles might arise as the industry tries to shift in this direction? Let’s consider some of the biggest challenges and the solutions to resolve them.
Perceived Burden on Provider
Provider resistance may pose a barrier to overcome before measurement-based care can be universally adopted. Providers may understandably worry that the demand for documented results in measurement-based care will impinge on their autonomy as caregivers. Historically, conflict has arisen between providers and payors when payors limit reimbursement to manage costs. However, this has always been done without a strong, universal system of measurement in place, which made limitations on care seem arbitrary and unrelated to patient outcomes.
The good news is that measurement-based care, by its very nature, provides that universal system of measurement, which will allow for more evidence-based decision-making about the limits and, more importantly, additional investments in behavioral health care service delivery. In the long run, this could work to providers’ advantage, since providers who help patients improve will have valuable data to bring into their discussions with payers, which will help make the provider-payor partnership more collaborative.
Lack of Automation Poses Risks
One of the great benefits of measurement-based care is that, when automated properly, it can collect patient data outside of clinical hours and integrate the results into clinical notes without creating extra work for the practitioner.
Unfortunately, if corners are cut on automation, administering measurements manually may create a burden on patients and providers. When patients must complete their evaluations at the appointment, or on paper, and providers must enter the results into records manually, measurement adds to the daily workload rather than achieving the greater efficiency discussed above.
An EHR capable of measurement automation is a simple solution. The right EHR can send evaluations electronically for patients to complete at their convenience, and then automatically integrate the results into each patient’s record for reference by the provider. There is no extra paperwork and no extra time taken during appointments.
Valant software was engineered from the ground up to support measurement-based care automation right within the EHR. With quality software in place, no mental health practice should have to struggle to implement this care model.
Uneven Reimbursement of Value-Based Care
At the national level, policies guide payors on reimbursement for measurement-based care. The 96127 code allows providers to bill for outcomes measurement. However, national policies may not be evenly implemented in all geographical regions. Providers may need to educate themselves on how to get paid for measurement-based care and how to educate payors on the value of these services.
In the long view, behavioral health is moving toward value-based care, meaning more payors will eventually get up-to-speed on reimbursing for these services.
How to Get Provider Buy-In
To adopt measurement-based care across the industry will require buy-in from countless providers around the nation. How can we get more providers to become enthusiastic about this new approach to care? Two main incentives will help them recognize the value of measurements to their practice.
Monetary reimbursement for capturing the value of services will certainly motivate more providers to make the transition. This does, of course, require payors to be willing to make that reimbursement. Helping payors get on board is a matter of coming to the table with hard data to show the value of measurement-based care.
This is a bit of a chicken-and-egg scenario, wherein you need plenty of data to get payors on board, but you need payors on board with reimbursement to motivate providers to generate more data. However, there are good strategies for negotiating with payors to speed their acceptance of measurement-based care. Employers can play a role by pressuring payors to reimburse for outcomes, and providers can learn how to advocate for themselves and get paid for their efforts.
Providers care about efficiency and about the quality of the care they deliver. From a professional standpoint, apart from promises of reimbursement, providers should consider the many benefits of measurement-based care to their work:
- Improved outcomes for patients
- More context on patient progress between appointments
- Increased patient engagement in the treatment process
- Less note-taking due to automatic inclusion of outcome-measure content in clinical notes
- Access to evaluations during clinical encounters to enhance the quality of the session
Tools Needed to Universally Adopt Measurement-Based Care
A strong toolkit is needed to make the transition to measurement-based care successful. With these tools, individual clinicians and behavioral health practices can get the most from this model.
- Technology: As indicated above, a system of automation is critical. Behavioral health practices will need to adopt EHRs capable of handling this automation smoothly. An EHR for measurement-based care should also include a library of outcome measures, be mobile-friendly, and generate reports on collected data. Products such as Valant are built to meet these and other specific needs for measurement-based care.
- The right measures: Individual practices will need to thoughtfully select the outcome measures that make the most sense for their patient population. Some of the simplest and most common are rating scales, also known as progress monitoring tools. A selection of outcome measures for common mental health concerns can be found at the Kennedy Forum supplement.
- A workable process: Each practice must clearly lay out how the workflow of measurements will be managed. When will outcome measures be administered, and who decides that? What will be done with the data taken from the measures? With a solid process in place, measurement should be a seamless part of your daily operations.
- Dedicated staff: Staff will need to understand their roles within the measurement process, as well as establish clear communication channels. Who is responsible for administering the measures? Who will results be communicated to?
Putting It All Together
The transition to measurement-based care as an industry is not only possible, it is critical. It has the potential to improve the lives of countless patients and jump-start a new era of innovation and progress within behavioral health.
Accomplishing this goal will take mindful planning and the right tools. Valant’s Behavioral Health EHR is one of the strongest tools on the market to make the transition to measurement-based care simple and effective.
Request a demo today by clicking the button below to see how Valant can help you make the transition.