Measurement-based care leads to improved outcomes, resource efficiency
There’s a lot of discussion in health care about evidence-based care, measurement-based care, best-practice care, holistic care. The terms don’t stop there, and neither does their singular importance. Each term has its own significance in this larger puzzle of health care terminology.
However, today Beacon Lens wants to take a closer look at measurement-based care (MBC). Why is it becoming increasingly important to measure care in an ever-changing health care economy? Therein lies a clue. Economy.
First things first: What is MBC?
Simply put, on an individual case basis, MBC is “the systematic administration of symptom rating scales and use of the results to drive clinical decision making at the level of the individual patient,” according to a Psychiatric Services article, “A Tipping Point for Measurement-Based Care”. Through the use of symptom rating scales (e.g., Patient Health Questionnaire-9, Positive Symptom Rating Scale, etc.), clinicians can detect nonresponse to treatment and alter the treatment protocol accordingly.
Further, on a population-management basis, through the aggregation of data MBC can also drive performance improvement activities at subsequent levels of care: professional development for providers and quality improvement for health care organizations. In other words, MBC can serve many quality improvement masters while catering to the most important one of all: improving the health and lives of individual people.
An evolving health care economy
In recent years, mental health is finally getting its due. The health care system at large is recognizing mental illness and substance use disorders as a significant driver of not only overall health care needs, but also of cost, as behavioral health affects both mental and physical health status. As states work to figure out the best health care delivery system, such as the Accountable Care Organization initiative in Massachusetts with value-based care as a core principle, behavioral health plays a partnering role in that solution. In Massachusetts, for example, ACOs will be evaluated on outcome measures, a third of which focus on behavioral health.
Indeed, value-based care is at the frontier of health care delivery. The Affordable Care Act, regardless of its future, has set a precedent that looks to reward the value of care provided – not the quantity of services. There’s no looking back. Payers, and other system stakeholders, will need health data and outcomes to back any value-based purchasing going forward. MBC, therefore, becomes more important than ever in propelling a system that recognizes, and rewards, value.
Payers, and other system stakeholders, will need health data and outcomes to back any value-based purchasing going forward.
What does an MBC initiative look like?
Change is afoot. State and federal agencies are beginning to hold payers and providers accountable for measurement-based care. For example, in its draft MCO transition requirements and standards, the New York State Children’s Health and Behavioral Health Benefit calls for plans to “adopt, disseminate, and implement the State-selected and nationally recognized clinical practice guidelines for children,” 10 guidelines for which the state will provide “additional guidelines pertaining to EBPs [evidence-based practices]”.
The U.S. Department of Veterans Affairs has adopted the MBC in Mental Health Initiative, which “is a new national effort to establish a standard of care in VA mental health, using MBC principles, that supports Veterans and clinicians in treatment planning and in setting recovery goals.”
At Beacon Health Options, we’re looking to the future by embarking on initiatives that promote evidence-based clinical practice to produce better member health outcomes. For example, with several health plan clients, Beacon manages a depression identification program that uses PHQ-9 scores collected by health plan case managers to ensure that members are linked with appropriate care. These screenings are noted in the medical health record, which allows for measuring total health outcomes. Additionally, Beacon has built within its care management platform other rating scales that measure depression, alcohol disorders and symptoms of other diagnoses. It also includes the SF-12, which measures both physical and mental health over a span of time.
It’s one initiative at a time as we move towards accountability. The economics of health care will help us to get there, driving the change needed to promote value. And we can’t determine value without measuring care.