It likely comes as no surprise—we’re in the midst of a behavioral health crisis.
Rising behavioral health costs, surge in demand for services, increasing staff turnover, and a lack of evidence-based treatments have intensified the need for change. In fact, at $225 billion, behavioral health accounts for nearly 5.5% of all healthcare spending.
As behavioral health leaders grapple with these issues and prepare for the future, it’s important to consider how payers and providers can better partner to deliver high-quality, cost-effective care which reduces symptoms, improves health outcomes, and delights patients.
Patient outcomes data from evidence-based practice is the foundation of strong partnerships between payers and providers. After all, you can’t manage what you can’t measure. Yet, behavioral health still lags in objectively measuring patient outcomes.
In this article, we’ll explore how providers and payers can partner to truly define what quality means in behavioral health (hint: It’s not just HEDIS measures), adopt measurement-based care to create evidence-based standards, and invest in data-sharing technology infrastructure.
Payers and Providers Need To Redefine Quality in Behavioral Health
Physical health has well-established, clear outcomes data that both providers and health plans agree indicate quality of care. Physicians systematically measure blood pressure to monitor hypertension and A1C levels to monitor diabetes, for example. Unfortunately, measurement and definitions of quality care in behavioral health aren’t status quo.
In behavioral health, the only consistent data that health plans gather are duration and type of treatment through claims data. Some health plans try to measure quality with HEDIS measures–which may include readmission rates, utilization, follow-up, and screening measures. While HEDIS measures are useful for measuring processes, they don’t measure patient outcomes, nor do they measure how a patient is responding to and progressing through care.
Similarly, most behavioral health providers aren’t systematically evaluating patient outcomes using measurement-based care (MBC) despite its proven ability to increase response rates to treatment, reduce required sessions, and lead to more patients in remission.
Research supports, and leaders in behavioral health advocate for, the use of MBC to measure behavioral health outcomes to indicate quality of care. With greater alignment on behavioral health quality and how to measure it, plans and providers can help members improve their overall health, increase efficiencies in care, and reduce total cost of care. (Learn more about how to use MBC to maximize the value of your behavioral health network from Companion Benefit Alternatives, the leading behavioral health plan in South Carolina.)
Providers Need To Adopt a Consistent Practice of Measurement-Based Care (MBC)
Research consistently shows that the practice of MBC improves clinical outcomes across all treatment approaches, populations, and settings. MBC enhances clinical decision-making and quality of care, enriches communications between patient and provider, and objectively documents the value of treatment to health plans.
Clinical studies have shown that patients who receive measurement-based care are 2.5 times more likely to reach remission, and treatment response time is reduced by half. Real-world data support these clinical findings. In fact, patients using Owl see a 56% faster time to remission and a 30% increase in capacity with existing resources (learn more here).
Unfortunately, MBC is still not the standard of care in practice. A 2019 MBC literature analysis revealed that less than 20% of behavioral health practitioners are integrating it into their practice.
Let that sink in–despite the proven and documented value of MBC, less than 20% of behavioral health providers are using an evidence-based approach to care. We wouldn’t find this acceptable for physical health. We argue it no longer makes sense for behavioral health.
Common barriers to using MBC in practice include the potential impact on clinical workflows, lack of technology to implement assessments, and the perception that capturing patient measures are time-consuming, cumbersome, and/or complicated. Yet innovative technology, like Owl’s measurement-based care platform, removes all of these barriers.
When providers adopt a consistent practice of MBC, they’ll have the data to demonstrate they are providing quality care to their health plans. This data empowers providers to hold meaningful discussions with their payers regarding how they are providing higher-value care and, therefore, should be reimbursed at higher rates (hint: payers want to incentivize better value for their members).
While there’s been a lot of buzz in behavioral health about the promises of value-based reimbursement for years, we’ve seen limited success. When providers and payers are working together with the same, mutually agreed upon outcomes data, everyone wins, including (and most importantly) patients.
Payers Need To Invest in the Technology Infrastructure To Support Providers to Capture and Share Objective Data
Currently, many providers don’t have the technology to systematically measure if their patients are getting better. In turn, payers are unable to objectively assess their behavioral health network. With no true transparency or understanding of care quality, health plans don’t have the necessary data to have meaningful reimbursement conversations–leaving many providers feeling dissatisfied with payment rates.
With the availability of easy-to-use measurement-based care solutions like Owl, it’s time for payers and providers to collaborate on deploying the software infrastructure that supports gathering and sharing outcomes, data, and insights to measure and improve quality of care.
When health plans invest in MBC solutions, they can assess their network in areas of care quality, therapeutic alliance, and outcomes-driven treatment length benchmarks, which will incentivize and attract providers to deliver high-quality, cost-effective care for their members–a win-win for both providers and payers.
“We’re working on moving our behavioral health network to value-based reimbursement and away from fee-for-service models. We didn’t have a great way to choose quality metrics that make sense in behavioral health. Now, Owl gives us the evidence-based outcomes metrics we need and a platform that reduces burden for providers and easily integrates into their workflows. Owl also allows us to share data in a way that isn’t a burden on the providers.” – April Richardson, M.D., Medical Director, Companion Benefit Alternatives
While payers and providers will continue to be challenged by the behavioral health crisis for years to come, the opportunity is now to better align on improving health through a well-thought-out partnership that redefines quality and elevates outcomes measurement and transparency.