The National Council for Mental Wellbeing seeks to redefine how providers and payers in behavioral health assess quality outcomes and are calling it measurement-informed care.
In a webinar, the Washington, D.C.-based nonprofit industry group called for the term measurement-informed care to replace the incumbent measurement-based care. Professionals with the council also presented their analysis of potential outcome measures and called for a two-tiered scheme to define the industry in the future.
The webinar also teased a to-be-released report the National Council for Mental Wellbeing — through its entity, the Center of Excellence for Integrated Health Solutions — will release that details a year-long effort to define a widely applicable set of outcome measures to be the basis for clinical decision-making via measurement-informed care and payment innovation through value-based care.
It’s not clear when this report will be published.
The lack of authoritatively laid down measures for quality behavioral health care has been an issue for the industry for years. Industry insiders frequently hold it up as the great stumbling block for value-based care and reimbursement innovation. It’s also a cause for the disparate approaches that provider organizations take when it comes to internal assessments of care quality.
“I support anybody that’s pushing us to standardize; there are so many measures of healthcare out there,” Dr. Joseph Parks, medical director for the National Council for Mental Wellbeing, said on the webinar. “Part of the reason our appliances run great is that we have very rigid standards for how the electricity gets measured and put out. Part of the reason health care runs poorly is that we can’t agree on standards.
The National Council for Mental Wellbeing is an advocacy and member organization for mental health providers that focuses on certified community behavioral health clinics (CCHBCs).
“I don’t know if payers are the best to do it, but if they are in a position to make us standardize, then God bless them. If the regulators are in a position to make us standardize, God bless them,” Parks said. “It doesn’t always feel good, but it will do us good.”
Two tiers in measurement-informed care
While the webinar did not get granular about what measures are in the two tiers of outcome measurement, National Council for Mental Wellbeing experts spelled out the criteria for what goes into which tier.
Tier one measurements are those that align with care outcome measurements that are mandated or endorsed by Medicaid and the federal requirements for CCBHCs as well as widely recognized care quality entities such as the National Committee for Quality Assurance (NCQA) and the United States Preventive Services Task Force. They typically avoid process measures and epidemiological data.
Tier two measurements are intended to be transdiagnostic — informative for clinicians across several diagnoses. They are also meant to be patient-reported, have a low burden to administer and are sensitive to change over time.
Both tiers are focused on adult patients. Further work with be done on outcomes for pediatric patients.
“With tier 2, we see this as an opportunity for the field to begin thinking creatively and broadly about the most meaningful concepts, significant enough to warrant regular screening, that from our perspective as a field of behavioral health indicates savings and quality and that are broadly applicable across all of the populations that we serve,” Deborah Scharf, associate professor of psychology and health sciences for Lakehead University, said on the webinar.
What’s in a name?
Dr. Henry Chung, professor of psychiatry at the Albert Einstein College of Medicine, said the incumbent phrase, measurement-based care, inappropriately suggests that change decisions are to only be made based on limited measures.
“Measurement alone is not sufficient as a sole process for making treatment decisions,” Chung said. “We know because of the nature of our instruments, largely because they are patient-reported, that measurement errors can occur.”
Errors can come from providers and patients. Further, any measure must be considered within the context of social determinants of health, equity issues, patient preference and patient health literacy.
The tenets of measurement-informed care are familiar to measurement-based care. The measures must be based on repeatable validated measurements, be reported by patients, or be based on biometric data. Measures are also meant to be assessed in a broader context to inform care decisions. They are also meant to be assessed at the population level to assess accountability and efficiency, Chung said.
“We’re very intentional about trying to re-coin this phrase to measurement-informed care,” Chung said.