Payers and providers are increasingly pushing for more measurement-based care in behavioral health.
However, in order for the change to work, key stakeholders, including clinicians and other behavioral health providers, need to buy in. This puts the onus on operators to make it easier for clinicians to implement measurement-based care, and for payers to foster a culture of transparency around data use.
Make it easy
One of the major obstacles in implementing measurement-based care is adding to provider’s workloads.
“I think to the extent that there’s pushback, to give the clinicians a fair shake, it’s work, and it’s uncompensated work,” Dr. Ravi Shah, chief medical officer at Geode Health, said during Behavioral Health Business’ VALUE events. “I think it’s really, really incumbent upon us as platforms to make this as seamless and as easy as possible.”
Geode Health was founded in 2021 by the global investment firm KKR. The Chicago-based startup provides in-person and virtual outpatient treatment nationwide.
Shah noted that at Geode, patients have surveys as part of their check-in process that populate the electronic health record (EHR) directly making it easier on the clinician.
The ease of use is critical in settings where clinicians are busy and addressing the needs of patients in crisis. For example, at Connections Health Solutions clinicians are caring for patients with high acuity levels.
“There’s not a lot of room for extra documentation, and it’s not customary,” Colin LeClair, CEO of Connections Health Solutions, said at VALUE. “So we’ve had to build this into our workflows to make it really easy in the EHR, give people ipads to walk around with so they’re not going back to the workstation to put in notes, using Dragon or other types of interpretive technology, making it as easy as possible and effortless as possible. Because it’s just extra work and in the emergency environment, that’s a big burden.”
PE-backed Connections Health Solutions offers a 23-hour observation unit, crisis stabilization, outpatient mental health services, and discharge planning. It also has community partnerships to help patients access appropriate resources.
The other key factor in getting clinicians onboard with collecting and sharing measurement-based care data is more payer transparency. According to a report by behavioral health company Alma, 77% of therapists say they think insurance companies will use data from patient’s clinical assessments to reduce or restrict the length of care their patients will be covered for.
Payers can help remedy this issue by sharing their own data and creating a two-way partnership between payers and providers.
“I think that models work best when we can come to the table as a partner to provide data back to the provider,” Bill Harlan, director of clinical programs and strategy at Point32Health, said at VALUE. “We get all the claims, and we have a full holistic view of how patients look, depending on the contract or the agreement. We have the ability to share that level of information. Our goal here is to get to a place where we’re not asking for additional work to happen. We want to be a partner so that we can say, ‘Here’s what’s going on from our vantage point, and what can we do to make an impact there?'”
Point32Health was formed when Tufts Health Plan and Harvard Pilgrim Health Care merged in 2021. The health plan – which offers Medicaid, Medicare and commercial plans – has about 2.2 million members in the New England region.
Provider-led measures
Measurement-based care is in its infancy in behavioral health. Payers, provider groups and clinicians are still hammering out the right metrics to measure and important data to collect.
The tools used to measure patient outcomes might be different depending on the provider organization, and there needs to be some flexibility from payers.
“We want to listen to the voice of providers and what tools they’re finding the most effective,” Harlan said. “From the payer standpoint, I think we know that there are lots of tools, and providers are trying to figure out what’s the right one for the organization to use and how we can share that data in a meaningful way. We are counting on providers to look at what quality metrics make sense for them and for the groups that they’re working with. It’s not a blanket you can apply to all behavioral health types of practices. We have different tools for different populations in different areas.”
While the bulk of the industry uses the PHQ-9, GAD-7 and level of care utilization system (LOCUS) scores as measures for care, that’s only a starting point.
“The problem with all those tools is they’re still pretty rudimentary, particularly for really high-complexity patients,” LeClair said. “We’ve had to develop our own proprietary methodology for assessing risk.”
In the future, measurement-based care can go deeper and potentially collect information specific to a relevant diagnosis, as well as risk assessment tools, Shah said.
Functional assessments could also be necessary for demonstrating patient outcomes. He noted that Geode is starting to use the Sheehan Disability Scale to ask questions about a person’s functional abilities, including how often they miss work and their productivity levels.
“[Providers] are starting to get to functional status [measures], but I haven’t seen to date… easy-to-use excellent functional status [measures], and that’s what ultimately patients want,” Shah said. “They want to be functioning well. That’s what the payers want. And of course, that’s what their employers who are paying for these plans want as well.”
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