For mental health organizations, growth is often measured by how many new clients enter care.<\/p>\n
How many inquiries came in? How many intakes were booked? How quickly can a new client be matched with a provider?<\/p>\n
But there is another metric that can have just as much influence on both clinical outcomes and financial performance.<\/p>\n
How many clients stay in care long enough to benefit from it?<\/p>\n
Early dropout has long been a challenge in mental health. A large meta-analysis encompassing 669 studies and more than 83,000 clients found that approximately one in five clients prematurely discontinue psychotherapy<\/strong>.1<\/sup>\u00a0The exact rate varies considerably depending on the population, setting, treatment and even how dropout is defined, but the broader, consistent finding is that a meaningful portion of clients who begin psychotherapy leave before treatment is complete.<\/p>\n And disengagement can happen very early. In one study of insured adults seeking psychotherapy for depression in community practice, 22% never attended an initial appointment and only 42% attended three or more sessions.2<\/sup> Another study found that 34% of patients who completed an initial psychotherapy visit did not return for a second within 45 days.3<\/sup><\/p>\n What does this mean for mental health organizations, both from a clinical and financial perspective?<\/p>\n There are plenty of good reasons for therapy to end. A client may achieve their treatment goals. Their symptoms may improve to the point that regular treatment is no longer necessary. They may collaboratively decide with their provider to reduce the frequency of care or transition to another service.<\/p>\n Early dropout is different because it occurs when a client disengages before receiving the intended course of treatment or achieving the goals they entered care to address.<\/p>\n Given that starting therapy isn\u2019t the same as receiving an effective course of care, that distinction matters. Although there is no universal number of sessions that every client needs, a systematic review of psychotherapy delivered in routine clinical settings found that the number of sessions associated with optimal outcomes ranged from approximately 4 to 26 sessions across different settings and populations.4<\/sup><\/p>\n When someone attends only one or two sessions before disappearing from care, the organization may have successfully provided access<\/em>, but that does not necessarily mean the client received enough care to meaningfully benefit. That makes retention an important part of the outcomes conversation.<\/p>\n The goal isn’t to keep clients in therapy indefinitely. It is to help more people remain engaged for the right amount of care<\/strong>, demonstrate meaningful improvement, and successfully complete treatment when it is clinically appropriate.<\/p>\n For mental health organizations, early dropout also has a relatively straightforward economic consequence. Whether care is reimbursed through Medicaid, commercial insurance, or paid out of pocket, each prematurely ended episode of care represents sessions that otherwise may have occurred as part of a clinically appropriate course of treatment.<\/p>\n Consider two clients who begin weekly therapy.<\/strong><\/p>\n One attends an intake and one follow-up appointment before prematurely disengaging. The other remains engaged for eight sessions, demonstrates meaningful improvement and is successfully discharged.<\/p>\n Both count as new clients. But their clinical and financial trajectories are very different.<\/p>\n Consider a reimbursement rate of $120 per session:<\/p>\n For an organization serving 10,000 clients annually<\/strong>, helping just 5% of clients who would otherwise disengage after two sessions remain engaged through an eight-session course of care would result in 3,000 additional completed sessions, representing $360,000 in additional annual session revenue.<\/strong><\/p>\n<\/div>\n<\/div>\n The actual economics will vary significantly by organization, payor mix, reimbursement, treatment model, and clinically appropriate treatment duration. But the underlying relationship is simple. When clients prematurely leave care, organizations lose future sessions. At the same time, clients lose the opportunity to receive the intended course of treatment.<\/p>\n Organizations invest significantly in attracting new clients, building referral relationships, improving intake processes and keeping clinician caseloads full. But acquisition becomes less valuable when a significant portion of those clients disappear after the first few sessions.<\/p>\n The objective isn’t to maximize the lifetime value of every client by keeping people in treatment longer than necessary. In mental health, successful treatment should ultimately result in people receiving the care they need and completing treatment when clinically appropriate.<\/p>\n A healthier economic model is one in which organizations reduce premature dropout at the front end, deliver an appropriate course of treatment in the middle, and support successful discharge when clients have achieved their goals.<\/p>\n Early dropout also has implications for organizations increasingly being asked to demonstrate outcomes to health plans, employers, funders and other stakeholders.<\/p>\n Imagine that 100 clients begin treatment, but only 40 remain engaged long enough to complete a follow-up outcome assessment. If an organization reports outcomes based exclusively on those 40 clients, an important question remains: what happened to the other 60?<\/strong><\/p>\n This is the denominator problem.<\/p>\n<\/div>\n<\/div>\n Clients who remain engaged enough to provide follow-up data may differ meaningfully from those who disappear after one or two sessions. As a result, strong outcomes among treatment completers do not necessarily tell the full story of the population that entered care.<\/p>\n This is becoming increasingly important in value-based care discussions, where payors are beginning to look beyond improvement rates and ask how much of the population is actually represented in the outcomes being reported. An impressive improvement rate carries less weight if it reflects only a small fraction of the clients who entered care.<\/p>\n For organizations competing on quality, a stronger outcomes story shows both how many clients improve and how comprehensively outcomes are being measured across the population served.<\/strong> Strong retention and high measurement coverage make that data more representative, more credible, and ultimately more valuable in conversations with payors.<\/p>\n","protected":false},"excerpt":{"rendered":" For mental health organizations, growth is often measured by how many new clients enter care. How many inquiries came in? How many intakes were booked? How quickly can a new client be matched with a provider? But there is another metric that can have just as much influence on both clinical outcomes and financial performance. […]<\/p>\n","protected":false},"author":22,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":"","_links_to":"","_links_to_target":""},"categories":[45,3],"tags":[],"class_list":["post-22810","post","type-post","status-publish","format-standard","hentry","category-mbc-education","category-blog"],"acf":[],"_links":{"self":[{"href":"https:\/\/greenspacehealth.com\/en-ca\/wp-json\/wp\/v2\/posts\/22810","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/greenspacehealth.com\/en-ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/greenspacehealth.com\/en-ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/greenspacehealth.com\/en-ca\/wp-json\/wp\/v2\/users\/22"}],"replies":[{"embeddable":true,"href":"https:\/\/greenspacehealth.com\/en-ca\/wp-json\/wp\/v2\/comments?post=22810"}],"version-history":[{"count":0,"href":"https:\/\/greenspacehealth.com\/en-ca\/wp-json\/wp\/v2\/posts\/22810\/revisions"}],"wp:attachment":[{"href":"https:\/\/greenspacehealth.com\/en-ca\/wp-json\/wp\/v2\/media?parent=22810"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/greenspacehealth.com\/en-ca\/wp-json\/wp\/v2\/categories?post=22810"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/greenspacehealth.com\/en-ca\/wp-json\/wp\/v2\/tags?post=22810"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}<\/a>Early dropout is a clinical problem first<\/h2>\n
<\/a>Early Dropout also has a financial impact<\/h2>\n
\n
<\/a>Acquisition only tells half the growth story<\/h2>\n
<\/a>Early dropout distorts your outcomes data<\/h2>\n