How PHQ-9s Are Helping Oceans Prepare for Behavioral’s Transition to Value-Based Care

Many behavioral health providers are excited about the prospect of leveraging value-based care in order to be paid more for the high-quality outcomes they deliver. But there is no one universal strategy for how such care should be delivered or tracked, as behavioral health lacks many of the empirical measures used in physical health care.

As such, many providers interested in breaking into value-based care are unsure where and how to start.

For Oceans Healthcare, the solution could be the PHQ-9, a patient health questionnaire used to measure the severity of depression. Over the past couple years, the assessment has become particularly helpful for gauging the efficacy of the provider’s services, according to Melynda Boothe, executive vice president of process improvement and outcomes for Oceans.


“The whole concept around value-based care is, ‘Are you leaving people better off? And is it worth paying for?’” Boothe told Behavioral Health Business.

Based in Plano, Texas, Oceans is a behavioral health provider that operates 42 hospital and outpatient locations across Texas, Louisiana and Mississippi. Backed by the venture capital firm General Catalyst Partners, Oceans focuses on underserved populations, such as seniors and people in rural geographies.

The company does not currently participate in value-based care arrangements with the Centers for Medicare and Medicaid Services (CMS), one of its most significant payers, as CMS does not have a value-based model set up for psychiatric care.


However, Oceans does participate in pay-for-performance arrangements with two insurers — Blue Cross Blue Shield of Louisiana and Texas Health Aetna — and Boothe believes the use of  PHQ-9s will be integral in the industry’s ongoing transition toward value-based care.

Oceans’ adoption of the PHQ-9 started back in 2019, when it began an organization-wide quality improvement initiative. Company managers consulted with clinicians, psychiatrists and social workers to find out which tools worked best in tracking patient outcomes. They landed on PHQ-9s, which Oceans started using at all of its care locations, with the specific goal being to help patients reduce their levels of depression.

“We ran all of the data around our most prevalent diagnoses [and] who we are seeing the most,” Boothe said. “Once we had identified the depression patients [as those] we were treating regularly,… we went through and made the selection of the [PHQ-9].”

The PHQ-9 assessment gauges patients’ mood using nine questions. Scores range from zero (indicating they are experiencing no symptoms of depression) to three (indicating the prevalence of symptoms nearly every day).

Once Oceans made the assessments available at all its facilities, it subsequently tracked the levels of depression that patients were experiencing. What Oceans found made them take note.

The assessment showed that 53% of patients were experiencing levels of depression categorized as moderately severe or severe upon admission, according to the company. But by the time patients were discharged, only 7% reported experiencing depression at those levels. Meanwhile, 86% of patients were discharged with the lowest level of mild to minimal depression.

Overall, Oceans achieved a PHQ-9 assessment improvement of 43% within an average 9-day patient stay.

“First and foremost, you want to make sure your patients [are] safe,” Boothe said. “That goes without saying, and … we’re really good at that.”

Boothe believes PHQ-9 assessments can be ideal for providers interested in value-based care because they help constantly assess the quality of services rendered.

“Payers want to know, ‘What is the value that we’re getting for the money that we’re paying you to care for people?’” she said. “This [tool] is what positions us to be able … to provide that.”

Beyond that, evidenced-based measurement tools like the PHQ-9 are important because they provide a way for providers in the behavioral health care industry to hold each other accountable, she said.

“If we have a hospital … [where] the improvement rate for a patient … is markedly below all the other hospitals, then that allows us to go in and say, ‘What kind of interventions are you employing, in general, in your hospital?’” she said. “‘Do we need to bring in additional resources? What are some of the programs that are working very well? Can we mirror those programs at other hospitals?’ It allows us to really learn from each other about how to improve the care that we’re providing.”

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