In an interview with Lindsay Cowee, the senior director of behavioral health network performance at Colorado Access, we delve into the profound impact of behavioral healthcare engagement on the total cost of care. 

At the largest Medicaid MCO in Colorado serving over 500,000 Medicaid members, Cowee’s extensive experience and insights shed light on the pivotal role that proactive behavioral health engagement plays in driving healthcare savings and improving overall well-being. Join us as we explore the compelling narrative of better healthcare outcomes through active participation in behavioral healthcare, as seen through the eyes of a Medicaid MCO leader.

Why measuring behavioral health outcomes leads to higher patient engagement

A fundamental connection exists between measuring behavioral health outcomes and increased patient engagement. 

In traditional healthcare, treatment has often been focused on addressing visible symptoms or physical ailments. As the understanding of healthcare has evolved, it’s become evident that mental health is intrinsically linked to physical well-being. We now understand that to achieve holistic health outcomes, we must engage patients not only in their physical treatment but also in managing their behavioral health.

Measuring behavioral health outcomes through evidence-based assessments provides a structured and quantifiable approach to monitoring and understanding an individual’s progress in treatment. This measurement goes beyond the subjective, such as asking “How are you feeling today?” or “How has the last week been?” –instead it provides a more systematic evaluation to help inform the behavioral health treatment over the course of time. It empowers both patients and healthcare providers with concrete data, allowing them to track progress, set goals, and make informed decisions about treatment. Measuring outcomes leads to higher patient engagement through:

• Objective evidence-based assessments: When patients see tangible data reflecting their progress, it reinforces the validity of their experiences and provides visual proof of their improvement, which motivates them to actively participate in their care. 
• Informed decision-making: Measurement-based care (MBC) provides clinicians with critical insights into a patient’s condition throughout the length of treatment. Armed with this information, they can tailor treatment plans to suit the individual’s needs, preferences, and progress. Not only does this lead to more patients getting better, it also allows patients to get better faster and for clinicians to provide a personalized approach to care.
• Goal setting: Measuring behavioral health outcomes allows patients and providers to set realistic, measurable goals. This goal-oriented approach fosters a sense of purpose and direction in treatment, making patients more committed to achieving positive outcomes.
• Continuous monitoring: Regular measurement ensures that progress is tracked consistently. Patients understand that their well-being is continuously monitored, which encourages them to stay engaged and adhere to their treatment plans.
• Empowerment: Measuring outcomes empowers patients to take charge of their mental health. It shifts the focus from passively receiving care to actively working towards improvement, instilling a sense of empowerment that is invaluable.
  

In essence, measuring behavioral health outcomes transforms mental health treatment from a passive experience into an active collaboration between patients and healthcare providers. It places the patient at the center of their care, making them partners in the process. This shift in perspective is a driving force behind higher patient engagement.

How better engagement in behavioral healthcare leads to savings across healthcare

“The more invested you are in your healthcare, the more engaged you are with your provider, and the more health literacy you have, the better your outcomes tend to be. Which is why I think behavioral health education is so important,” said Lindsay Cowee, the senior director of behavioral health network performance at Colorado Access.

“When someone is struggling with their behavioral health,” she continued, “It can often easily take over everything else. Even tasks like monitoring your blood sugar or your blood pressure–they both seem a lot less important when you’re struggling just to get out of bed every morning, for example.

“The more we can get people engaged in their treatment and in their behavioral health care, the more we’ll see positive impacts on their physical health. You don’t always see the inverse effect. For example, you can be engaged and checking your blood pressure regularly, but that doesn’t automatically mean that your anxiety is getting any better. When your mental health is in a better space, you’re more equipped to take care of things on the physical side.”

The Colorado Access example

Colorado Access has been at the forefront of managing the behavioral health benefit for Colorado Medicaid for over 25 years. Their experience sheds light on the significant impact that improved engagement in behavioral healthcare can have on the overall healthcare system.

Aurora Mental Health & Recovery (AMHR), a certified community behavioral health clinic, adopted a measurement-based care (MBC) approach with Owl to enhance their clients’ treatment experiences. When Colorado Access collaborated with AMHR and Owl to analyze client spend, utilization, and outcomes using MBC, the results were astounding:

• Owl sent over 4,200 suicidal ideation & self-harm alerts to the AMHR team. Over 90% of these alerts have a new or modified schedule change within a week of the alert, indicating that AMHR staff immediately responded to maintain the safety and well-being of their clients.
• 75% reduction in psychiatric inpatient admissions
• 63% reduction in emergency room visits
• 28% per member per month savings in total cost of care
• An estimated annual savings of $25 million for Colorado Access

These results demonstrate that consistent use of measurement-based care has not only clinical impacts but also substantial cost-saving benefits. The significant reduction in psychiatric inpatient admits and emergency room visits directly translates into lower healthcare expenses.

Read more about the measurement-based care data impact study.

The tangible impact of engagement

“What makes these findings so exciting is that they go beyond the narrative of trying to keep patients out of the emergency room. While that is undoubtedly important, the data shows that getting clients genuinely invested and engaged in their behavioral health care leads to improved overall health,” said Cowee.

“For clinicians, this shift in focus can be monumental,” she continued. “Instead of asking clinicians to focus on reducing emergency room utilization or inpatient admissions, they can just concentrate on the tangible goal of engaging clients in their healthcare journey. When clients are actively involved in their treatment, the rest naturally follows.”

Outcomes and patient engagement as a foundation for value-based care

In the realm of healthcare reimbursement, value-based care is gaining traction as a more holistic and outcome-focused approach. It contrasts with traditional pay-for-performance measures, which often rely on process indicators rather than true assessments of how patients are responding to care.

While pay-for-performance measures have their merits, they can be limited in their ability to gauge the effectiveness of treatment. They often miss the broader picture of patient well-being, focusing more on checking the box to indicate if providers complied with specific processes, such as if a patient remained on antidepressants for an acute and continuation phase. In contrast, value-based care prioritizes actual health outcomes, such as knowing if a patient who is on antidepressants is actually experiencing a decrease in depressive symptoms and increase in functioning, making it a more comprehensive approach. Measuring behavioral health outcomes allows providers, patients, and providers alike to understand the effectiveness of care–providing the foundation to make value-based care a reality.

Conclusion

The evidence is compelling: better engagement in behavioral healthcare leads to savings across healthcare. As we strive to improve the well-being of individuals, we must recognize the interconnectedness of behavioral and physical health. Engaging individuals in their behavioral healthcare journeys not only enhances mental health but also yields substantial cost savings by reducing hospital admissions and emergency room visits.

Colorado Access’s successful collaboration with Owl and Aurora Mental Health & Recovery showcases the transformative power of measurement-based care. It’s a testament to the potential of proactive, patient-centered approaches in healthcare.

The shift towards value-based care represents a step in the right direction, emphasizing measuring behavioral health outcomes to understand the effectiveness of care. As we continue to explore innovative ways to improve behavioral healthcare, engagement is the key to unlocking value.