Why and How: Large Organization and Complex System Level Measurement-Based Care
We brought together a panel of behavioral health system leaders and experts to discuss the elevated need for, and rapid adoption of, Measurement-Based Care (MBC) across behavioral health services in North America. The conversation was moderated by our President and Co-founder, Simon Weisz, and features our guests Melinda Lehman, Executive Director of Behavioral Health Care and Human Services at the Joint Commission; Dr. David Clark, world-renowned applied psychologist and leading global expert on MBC; and Dr. Sandra Berg, CareSource’s Senior Director of Complex Health Solutions, Behavioral Health. We dove into the topic of MBC and each panelist shared their insights and key learnings to support large or complex organizations and health systems who are considering an MBC implementation.
We’ve gathered insights into a two part article that uncovers the ‘Why?’ and the ‘How?’ of MBC for large or complex organizations and health systems—featuring key learnings from our expert panelists on MBC, its role in Joint Commission Accreditation, and its foundational relationship to value-based care.
Let’s begin with part 1: Why Measurement-Based Care?
Why Measurement-Based Care?
Our experts made a clear case for MBC, using the knowledge and experience they’ve gathered throughout their careers.
1. MBC is an effective and foundational component of high quality, evidence-based care.
Melinda shared the clear perspective of the Joint Commission, which is that MBC is a necessary component at the foundation of any evidence-based behavioral health practice, and is integral to delivering effective behavioral health services:
2. Clients are empowered when we integrate objective client-reported data into their sessions.
Physical health has long leveraged objective data and measurement to guide treatment decisions and measure progress. Today, providers rely on these metrics, and people in care have come to expect objective data as a basic standard in nearly all physical healthcare interactions. In any care setting, measurement allows treatment to be informed by objective data to ensure that the care a person is receiving is effective and meets their needs as the client or patient, and is also leveraged to inform continuous iteration or changes in treatment plans based on objective outcomes and the client’s experience. We’ve seen the research and implementation data that clearly shows that our approach within behavioral healthcare should be the same, as it empowers clients to better engage in care and leads to drastically improved clinical outcomes.
3. Measurement-Based Care is the key to achieving parity.
MBC is the key to holding behavioral healthcare up to the same standards as physical healthcare, which means leveraging outcome data throughout care to ensure services are effective and continually improve, ensuring all people have access to the high-quality care they need.
4. Measurement-Based Care provides a pathway to value-based contracting.
With the data collected through MBC, it becomes simple for providers to engage in conversations with payors around the effectiveness of their services. They can measure their impact, they can share it and they can make continual improvements based off of client-reported outcomes. This allows any organization or system to leverage their data to inform value-based contracts that are aligned with their service model and sets them up for success. Not only can you collect data to ensure care is effective, but you can easily share it with payors to inform value-based contracts under which your organization can succeed and continually improve.
5. There’s a strong economic case for Measurement-Based Care.
Not only does MBC increase outcomes, but there is a significant ROI that can be achieved through its implementation—which is magnified when applied within large clinics or health systems. Research shows that 40% of people with anxiety & depression also have a long term physical health problem. Importantly, the cost of managing those physical conditions is about 50% higher when patients also have anxiety or depression.
By implementing MBC and meaningfully improving mental health outcomes as a result, we can significantly reduce the costs associated with mental and physical healthcare. Dr. Clark focused on the economic benefit in order to gain approval for NHS Talking Therapies– a program which ultimately leveraged MBC and can now clearly show the healthcare cost savings and economic impact it has driven over the last 15 years.
Dr. Clark shared with us the key stats that he uses within his core argument. Firstly, studies show that 40% of people with anxiety & depression also have a long term physical health problem. Additionally, the cost of managing physical conditions is about 50% higher when patients also have anxiety and depression. This means that by dedicating resources to improving treatment quality and innovating services, we can significantly reduce both mental and physical healthcare costs. The IAPT program has managed to raise average recovery rates from 38% in 2008 to 52% in 2018, reducing the strain on physical health and the overall cost of care in the process.
6. Measurement-Based Care can help us overcome social disparity and drive equitable care for all.
When applied across entire health systems, MBC empowers behavioral health leaders to easily identify which segments of the population including regional areas, ethnicities, ages, genders etc, are not improving. In doing so, they can understand where there are service gaps and strategically invest resources to better support their communities. Not every place or population type will need the same kinds of support—MBC is the key to identifying who’s improving, who’s not, and how to close that gap so everyone can thrive.
At the individual client level, MBC is key to ensuring care is equitable for everyone. Access to results helps each individual better understand their mental health and develop a shared language with their clinician so they can better communicate their needs and experiences with their provider. This process is critical to ensuring care can be centred around their experiences and goals, regardless of their background, level of community/family stigma or past experience with mental health services.
How to Implement Measurement-Based Care
1. Empower MBC champions to achieve widespread buy-in.
When beginning your MBC implementation, as with any significant change, there may be some expected and natural hesitation from stakeholders on your team. While your ultimate goal is to have everyone on board, change is a process that takes time to secure full buy-in across large teams.
According to our panelists, how you introduce MBC matters. It’s vital to focus on the specific ways it will benefit each stakeholder and engage them as much as possible in the implementation planning. If people feel involved in the process—such as by providing input, testing workflows, collaborating, and engaging in a culture of learning and ongoing process improvement—it will ultimately foster a more successful MBC implementation and ensure that others recognize the benefits along the way.
That said, it may be helpful to initially focus on piloting with a smaller group that is already optimistic and excited about MBC. This approach allows you to demonstrate its impact through that group of engaged providers, make adjustments based on their feedback, and then roll out a broader implementation as others begin to share the excitement for the impact that MBC has on client experience and clinical outcomes.
2. Focus on the process and results.
Melinda Lehman from the Joint Commission shared that the key to securing buy-in from the broader clinical team is to focus on results—beyond clinical outcomes alone. When MBC is done effectively, clients are more satisfied with their care.
At Greenspace, we refer to the “4 C’s of MBC” to guide this process, which includes client visibility and collaboration:
- Client Visibility refers to the client having access to their results so they can better understand their progress throughout treatment and become more active participants in their care. Providing clients access to their personal outcome data empowers them to better understand their mental health, communicate their needs, and bring up topics they may not have otherwise, ultimately enhancing their engagement in the care process.
- Collaboration encourages clinicians to elevate the client’s voice in sessions, empowering them to be partners in their care. Clinical decisions are guided by the clinician’s expertise and can be informed by rich client insights and objective data, which the client and clinician can explore and learn from together. This process allows both parties to identify symptom-change patterns or adjustments that may enhance treatment plans, encourages collaborative discussions, strengthens the therapeutic alliance, and improves the quality of care.
This change in the care process can be transformative and will ultimately help drive a culture of curiosity and collaboration across your organization. By encouraging clinicians to focus first on the process of MBC and the value derived from data in sessions—rather than solely on the results—you can help build a strong initial foundation and facilitate overall adoption. It’s natural for outcomes to increase your implementation matures, but by prioritizing the process, building a robust data set, and ensuring that clinicians see the value of MBC in their sessions, will help drive greater outcome improvement overall. A strong foundation in MBC will also help clinicians and leadership leverage the data to identify areas for improvement, gaps in programming, and opportunities for meaningful service iterations.
3. Tips to Ensure Comprehensive MBC Data Collection.
Dr. Clark shares the steps NHS Talking Therapies took in order to collect 99% of outcome data on everyone who entered the program:
- Have clients complete measures prior to, or during, every session (this is critical to engaging in MBC) in order to ensure you have a complete data set;
- Leverage technology to meet clients where they are and provide multiple ways for them to complete assessments, while eliminating any measurement burden on clinicians through automated assessment delivery. This empowers most clients to complete assessments outside of care, without taking time away from sessions.
- Train clinicians to leverage measures throughout the care process. When clinicians see the value of outcome data in treatment planning and clinical discussions, they’ll understand the immense difference between past measurement processes—largely a reporting exercise—and MBC, which first and foremost, focuses on providing clinical value to both clinicians and their clients.
- Integrate with existing systems to ensure that there is no manual or duplicate data entry required, and that insights can be automatically provided and visualized for both clients and clinicians. It’s important that data can be made available immediately (with or without an integration) so that it can be used to inform treatment in real time. While many organizations begin MBC without, or never require, an integration, it can be very helpful for large or complex implementations.
4. Be strategic with how your report on your MBC outcome data.
How you report on the data you collect will contribute to the clinical value you’re able to draw from it. In the NHS Talking Therapies program, Dr. Clark shared a deliberate choice they made to maximize the benefits of their data set. They reported on ‘demonstrated recovery,’ which involves considering any client for whom no outcome data was collected as not recovered or having no improvement at all. Not only did they believe that is the most accurate way to report on outcomes, it also helped to motivate clinical leaders and clinicians to ensure assessments were completed and that their clients were fully engaged in the process.
This approach enabled the NHS program to improve from less than 10% assessment completion rates to over 90%, driving an average recovery rate of more than 50% in the process.
5. Leverage your MBC outcome data to learn, iterate, and meaningfully improve treatment offerings
There is much to be learned from the data you collect through MBC, especially at a system level. Dr. Clark shares examples of this, such as when treating people with both depression and diabetes. Clients experienced greater improvements in their depression symptoms and diabetic control when placed in specialized programs that addressed both coexisting issues, rather than only targeting their depression symptoms.
This model can be applied across any subset of a population. Your team can collaboratively dive into the data to find commonalities among specific groups (e.g., demographics, employment status, co-occurring issues) that can inform improvements or lead to additional programming. These efforts may significantly enhance service quality and clinical outcomes for these populations while ultimately delivering more equitable care.
You can also engage in this process at an individual level with clinicians, where supervision sessions empower clinicians to get curious about treatment non-response or challenging cases. Building a culture of curiosity and learning is critical to supporting each individual client, and it also ensures that clinicians experience the value of MBC, have a strong understanding of how client outcome data will benefit them, and can enhance the overall quality of services being delivered.
6. Empower all stakeholders with MBC data and everyone will benefit.
Melinda shares that Joint Commission-accredited organizations that saw the most success with MBC were those using it in multiple ways and engaging all stakeholders:
- Clinicians used outcome data to inform treatment planning and decision-making;
- Clients and families gained visibility into care progress and felt empowered as a result;
- Outcome data was also used in conversations with payors to secure higher reimbursement rates under VBC contracting.
There is significant value to be drawn from MBC across your organization. By finding ways to leverage this data, you can enhance excitement within your team and encourage others to explore how it can benefit them.
7. Choose flexible MBC technology.
When it comes to large-scale and complex MBC implementations, technology plays a crucial role. Melinda emphasizes the importance of choosing technology that is flexible enough to adapt to the needs of your various programs and workflows while also enabling you to easily and effectively present and report on your data.
Features such as automated assessment scheduling, remote delivery and completion, real-time data visualizations, data exports, and automated insights can significantly influence the adoption of your implementation among staff. To ensure a successful implementation, MBC technology needs to be able to adapt to your workflow, not the other way around.
8. Achieving Joint Commission Accreditation.
The Joint Commission has long recognized MBC as a vital component of evidence-based practice. More recently, they began requiring organizations to engage deeply with MBC as part of their accreditation process. Their goal is to ensure that organizations go beyond merely collecting outcome measures and actually leverage their data to inform care and assess organizational performance.
These additional requirements are crucial to ensuring that accredited organizations deliver high-quality MBC to all the people they support.
9. Securing VBC contracts.
The foundational component of any value-based contract is the ability to demonstrate ‘value.’ While value-based agreements will look different and can vary across states, we know that MBC is empowering organizations to secure and meet VBC requirements. With a robust data set demonstrating outcomes, organizations can leverage MBC to negotiate contracts that align with their goals, demonstrate value, and easily adapt to new and evolving reporting requirements.
When arranging value-based contracts, Dr. Berg emphasizes the importance of surveying providers to uncover the challenges and goals that should be considered in the process. By establishing agreements that align with the experiences of your providers and the measures or results that truly impact care, you can highlight your organization’s outcomes while also securing beneficial contract agreements.
Final Thoughts
While there’s immense value in implementing MBC for providers and organizations of all sizes, when MBC is applied within large and complex organizations and health systems, there are several highly impactful benefits that help to substantially improve care quality and ensure success under VBC payment models. Thank you to our guests for sharing their perspectives on why and how to effectively implement Measurement-Based Care within large or complex organizations and health systems.
If you have any questions about Measurement-Based Care at your organization, you can schedule a call with one of our implementation experts or reach out anytime at info@greenspacehealth.com.
In the meantime, register for our next MBC educational session, featuring the researchers and psychologists from the Yale Measurement-Based Care Collaborative.
