Payers have increasingly pushed for measurement-based care, but experts question whether the behavioral health industry has the tools to broadly implement the practice.
Measurement-based care, in which clinical data is collected throughout treatment, may increase the likelihood that a patient receives evidence-based care. Implementing the practice requires a whole-person approach that includes contextualization and cultural awareness, according to panelists who spoke at the 2023 HLTH conference.
There is no one measure to demonstrate that a behavioral health patient is improving, which complicates broad implementation of measurement-based care in the space.
“Behavioral health is complex,” Nicole Christian-Brathwaite, head of medical and clinical strategy at Headway, said at HLTH’s Measuring the Mind panel. “It’s both an art and a science. We know one of the best predictors of a positive outcome is a connection between the patient and the therapist. And you can’t accomplish that with just a patient health questionnaire (PHQ-9).”
Current measurement tools may misrepresent a patient’s recovery by not contextualizing the data.
“The problem with measurements is there’s so much noise,” Harvard-based psychotherapist Luana Marques said at HLTH. “In the trauma world, for example, when you start to do exposure therapy, somebody looks like they’re doing worse and they’re not. You just took their avoidance away, so now that they can’t avoid anymore.”
San Francisco-based BetterUp, tracks a number of metrics including the ability for patients to regulate emotions, awareness of their emotional state, cognition, depth of focus, quality of focus and the health of their relationships.
BetterUp is a mental health and coaching platform with 3,000 coaches providing care in over 70 countries, employing a whole-person assessment to avoid this pitfall.
“Well-being isn’t just the absence of symptoms of illness,” Damian Vaughn, chief program officer of BetterUp, said at HLTH. “It’s having a holistic view of really flourishing and thriving as a person.”
Beyond questionnaires like the PHQ-9, some clinicians use biological data to measure care. However, biological measures cannot be used on their own to make clinical decisions.
“When we have patients who are, despite every effort and intervention, just not getting better, or having abnormal responses to medications that just don’t make sense, then doing genetic testing and looking at metabolism of medications [may be helpful],” Christian-Brathwaite said. “But as I always tell my patients, it doesn’t tell me what will work. It just tells me what your body can’t tolerate.”
Providers can incorporate other metrics into clinical practice, including passive data measured by a cell phone or wearable device, with the caveat that providers must keep behavioral health data private. Data collection must then be used for actionable change.
“Instead of coming in to collect yet more data, [we need to ask], what are the data that you’re collecting, and how can it inform the outcomes that we’re looking for,” Marques said. “It’s not just being able to collect that data passively, but it’s using that data to ignite change as fast as you can.”
Even if the necessary tools are available, implementing measurement-based care can be complicated for payers who are left to determine what care should be reimbursed or which providers to make in-network, Ben Robbins, general partner at Google Ventures, said on the panel.
Payers must ensure that measurement-based processes do not overburden the clinician, become too complicated for patients to understand or ignore important factors regarding patients’ cultures.
Measurements must be tested for cultural validity and go beyond solely focusing on an individual, the panel of industry insiders said. Providers have biases and medical data is often based on a specific demographic, excluding people of color and diverse demographics.
“Perinatal mood disorders are twice as common in Black women, but half are likely to be treated,” Christian-Brathwaite said. “Certainly, let’s think about the individual work, but we’re missing a huge part of it. The most vulnerable people that we support are not being treated effectively.”
Hospitals and health systems should utilize data measuring care different populations receive, Christian-Brathwaite said, but the work cannot stop there.
Providers should use that information to create anti-racist policies and procedures and then measure that the interventions are effective.
“I would really push hospitals and systems to look at disparities and not just see the numbers, but actually incorporate anti-racism, not just as a one-time lecture, but really incorporating it into the policies and procedures,” Christian-Brathwaite said.
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