What is Measurement-Based Care?
Measurement-based care is a term that’s been around since 2006, yet remains unfamiliar to many behavioral health professionals still today. It is defined as the systematic administration of symptom rating scales and other assessment tools to help initially assess behavioral health patients, inform beginning and ongoing treatment decisions, improve treatment outcomes, and measure results.
How Does Measurement-Based Care Work?
At its core, a measurement-based care practice uses outcome measures, typically symptom rating scales, delivered systematically to measure any baseline conditions, and then the impact of a service or intervention on a patient’s mental health status. Symptom rating scales can provide valuable insight if used in concert with a full clinical assessment. Once scores are assessed, the clinician is able to listen more freely and can provide more objective and focused treatment.
A measurement-based care practice will often push one or more general rating scales, for screening purposes, to patients before their first appointment. The scores allow the clinician to concentrate on areas that need further assessment and/or testing. The scores also provide a quantifiable evaluation of the patient’s symptom severity. That, coupled with a full clinical workup, helps the clinician create a targeted treatment plan.
After the first assessment, a measurement-based care practice will continue using symptom rating scales to track patient changes from baseline over time to show response to treatment either positively or negatively. These changes can then be aggregated in a graphical format and shared with them. This technique has been shown to help patients become more engaged in their own treatment. They become an active member of the team.
Measurement-base care is really about providing actionable intelligence to everyone involved in the patient’s care so they can prioritize interventions and target them towards specific goals for treatment.
Why Should You Use Measurement-Based Care?
If you haven’t started administering outcome measures or creating a measurement-based care practice, now is the time to begin the transition. Why? The answer boils down to three things: 1) you achieve better patient outcomes faster, 2) you get paid more for using it, and 3) it is becoming the standard of care.
The number one reason to create a measurement-based care model is better patient outcomes. In research from Fortney, et.al. 2016, they analyzed studies with nearly “300 therapists and more than 6,000 patients and found that those randomly assigned to measurement-based care had significantly and substantially better outcomes than patients randomly assigned to usual care.” Why does it work better? There are many reasons, but a few that come to mind include:
- Patient fluctuations are observed more frequently. Once a cadence is established, baseline changes are seen more quickly, and treatment plans adjusted accordingly.
- Rating scales help a clinician be objective about a patient’s care. Every day a clinician makes decisions about patients and it is important for them to have as much information as they can before making any adjustments to interventions, medication, referrals, etc.
- Patients become fully engaged in the process. When a patient learns more about their disorders, they become more knowledgeable about their symptoms and attune to the warning signs so that they seek help sooner. They also become a committed member of their own care team.
The second reason is you can get paid more for using outcome measures. Insurance carriers are starting to see the correlation between mental and physical health outcomes and are becoming motivated to pay clinicians more who use measurement-based care. For example, even using a simple CPT code—96127—can generate anywhere from 5% to 20% over your standard payment. If you use measurement-based care, carriers are more willing to negotiate your payment rates because you can show your results, which separates you from other providers in their network.
Within that, measurement-based care presents opportunities for additional legal protection because you are practicing in the most advanced, responsible manner. You get the protective benefit of having additional, objective data to support your treatment decisions when you are practicing measurement-based care.
Additionally, measurement-based care saves you time and money by allowing you to more efficiently focus on what matters most, clinically, at any given moment in treatment.
Finally, it is becoming the standard of care. Measurement-based care is gaining traction in the industry. As carriers want more data, more results, and better patient outcomes to bring down their costs, more mental health providers and clinics are adopting the model. And as carriers are now paying more for using measurement-based care, now is the time to start helping your patients achieve better results faster.
How To Adopt a Measurement-Based Care Philosophy
Following these recommended steps can help you set up a measurement-based practice:
- Automate the process—an easy way to get started is to invest in a robust EHR system that automates the administration of outcome measures.
- Become familiar with validated symptom rating scales—know what symptom rating scales are available to use. The Kennedy Forum supplement is a great place to start.
- Educate patients, providers, and staff—it is important that everyone in the practice, including patients, are on the same page—everyone needs to row the boat in the same direction. Simply make the decision that this is how you will practice going forward. Work with patients to show how symptom rating scales will help, not hinder. If adoption is slow, look at incentives. You can tell patients that appointments will be rescheduled if they don’t fill out the rating scale and you can use graphs to show them how they are progressing. For staff, you can create a profit-sharing model from using the 96127 CPT code.
- Start broadly—the first rating scale to administer should be a broad outcome measure that covers many diagnostic categories like the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult.
- Focus in on problem areas—after a broad outcome measure is administered, and issues are identified, you can use other scales to gather specifics. For example, if depression is detected, you might decide to give the PHQ-9. If the patient has experienced trauma, you might also give the PCL-5.
- Set goals—once you have a more focused understanding of the patient’s symptoms, you can set goals. The ultimate goal in most cases is to achieve remission but you will need smaller, more manageable goals along the way.
- Take action—discuss outcome measures with the patient on a regular basis. Discuss improvement, discuss deterioration, and discuss adjustments in treatment plans.
Measurement-Based Care is Easy with the Right Tools
Valant’s Behavioral Health EHR takes the barriers out of creating a measurement-based care practice. Over 65 rating scales come standard in Valant’s software. Staff can push an outcome measure automatically to a patient and once a patient completes it, the information automatically flows into clinical notes as narrative, saving the clinician valuable time and supporting higher-level coding when appropriate. The data can then be visualized graphically in the chart to support patient-clinician collaboration and data-driven decision making and treatment planning.
Valant allows the clinician to focus on the patient, not the tedium that comes with administration. Measurement-based care is easy to introduce into a practice and provides a myriad of benefits for clients, clinicians, and payers.
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