Q&A from Beyond Outcomes: The ROI of MBC
We had an incredible turnout for Beyond Outcomes: The ROI of Measurement-Based Care. Hosted by Simon Weisz, Co-Founder and President of Greenspace, the session brought together three exceptional voices from across the behavioral health sector:
- Denise Dickerson, LCADC, LCPC, Director of Behavioral Health at Calvert County Behavioral Health, who shared how MBC data has directly strengthened the organization’s grant strategy and community impact;
- Andy Kelly, Chief Commercial Officer at Boulder Care, who offered a rare and candid payor-side perspective on value-based contracting in substance use;
- Nick Forand, PhD, ABPP, Principal Clinical Research Scientist at Two Chairs, whose work on MBC and early dropout has produced some of the most compelling research in the field.
The discussion covered a lot of ground, and there were more thoughtful questions to explore than time allowed. Attendees flooded the Q&A with thoughtful, specific, and genuinely challenging inquiries about implementation, measurement design, culture change, payer dynamics, and more. We wanted to make sure those questions didn’t go unanswered, so we’ve gathered them below, along with responses informed by our panelist and the session itself, organized by theme.
Need a refresher on the session? Watch the full recording here before coming back to the questions and answers below.
Assessment Tools and Measurement Approach
MBC often focuses narrowly on validated group-level tools like the PHQ-9 and GAD-7. Have you incorporated more individually tailored approaches such as goal attainment scaling?
This is an important distinction. Standardized, validated tools like the PHQ-9 and GAD-7 are foundational for population-level comparison, benchmarking, and reporting, but they are not the whole picture. Individually tailored approaches, including goal attainment scaling (GAS) and measures specific to a client’s unique experiences, add meaningful clinical value by capturing what matters most to each individual client.
We often see a combination of both approaches. Organizations can configure a standardized core battery for consistency across programs while giving clinicians the flexibility to assign additional client-specific measures. Goal attainment scaling in particular is well-suited to complex populations where standardized symptom measures may not capture the full scope of progress. If your organization uses or wants to use GAS, our team can work with you on how to incorporate it effectively within your MBC program.
Is there a specific tool recommended to measure therapeutic alliance?
Therapeutic alliance is a core component of MBC and is measured through validated self-report tools rather than qualitative data alone. The most widely used is the Working Alliance Inventory (WAI), with a brief revised version (BR-WAI) available for routine administration. When therapeutic alliance measures are included as part of a standard assessment battery, Greenspace can surfaces alliance scores alongside symptom data in the clinical dashboard, so clinicians can see both dimensions of the therapeutic relationship in one view.
How do you collect valid and reliable information on a continuing basis without adding to the workload of already stretched clinical staff?
This is one of the most common concerns we hear, and it is the right question to ask before implementing MBC. The answer lies in automating MBC in a way that fits into clinicians’ existing workflows. When assessments are delivered directly to clients via email or SMS on a set schedule, scored automatically upon submission, and returned to the clinical record without manual steps, the burden on clinicians is minimal. The clinician’s role shifts from administering and scoring measures to reviewing results and using them in session, which ultimately adds clinical value rather than administrative load.
That said, it takes intentional workflow design to get there. Greenspace’s implementation team works with each organization to configure assessment schedules, delivery methods, and EHR integration in a way that fits existing clinical routines. The goal is for MBC to feel like a natural extension of how care is already delivered, not an additional task.
Clinician Buy-In and Culture Change
How do you change the culture to get buy-in for MBC from providers?
Implementing MBC in a way that encourages buy-in from providers comes down to making it easy to embed into their workflow, and ensuring providers understand the meaningful impact MBC can have on their clients’ outcomes. When they can see that outcome data helps them understand their clients better, identify who is drifting, and have more productive conversations in session, they start to see MBC as a clinical asset rather than a compliance requirement.
Practically, the organizations that have done this well tend to share a few approaches:
- They start with a clear, shared rationale, explaining not just what MBC is but why it matters for the clients they serve.
- They embed MBC into supervision rather than treating it as a separate accountability measure.
- They identify clinician champions early who can model the practice and help peers problem-solve.
- They use data to celebrate wins, not just flag problems, so clinicians can connect measurement to visible clinical impact.
For Dr. Forand: in terms of the change management required, what were the most important implementation lessons for dealing with resistance and buy-in issues?
Dr. Forand shared two things that stood out as most important in Two Chairs’ implementation.
The first was leadership alignment. Before rolling out MBC, it was critical to get leadership aligned not just on the goal but on the timeline and the level of investment required. Behavior change takes work and time, and the results of that work won’t be seen immediately. Getting leaders to genuinely commit to that reality, rather than expecting quick wins, was foundational.
The second was explaining the ‘Why?’ to clinicians in a way that built trust. Two Chairs was deliberate about framing MBC as something designed to help clinicians become better at their work and improve clinical outcomes, not something imposed by a payer or used to evaluate performance. That distinction mattered in ensuring clinicians understood the intent and could be more excited about adoption.
Dr. Forand also emphasized that making MBC feel like less of an administrative burden at Two Chairs required automation and genuine clinical integration, so clinicians were not manually collecting or scoring measures and the data was actually being used in session. When clients can see that the measures they’re completing are being reviewed, discussed, and acted upon, they will engage more deeply with the process.
How do you train a large number of therapists to understand the measures and get on board with MBC?
Training at scale requires a combination of structured onboarding, ongoing reinforcement, and peer support. A single training session at go-live is rarely enough. The organizations that sustain high adoption tend to build MBC into supervision, provide training in cohorts so clinicians can learn together, and identify clinical champions who can support colleagues over time.
On the platform side, clinicians need to understand not just how to use the platform but how to interpret what they are seeing. That means training on what scores mean clinically, how to recognize reliable change versus normal fluctuation, and how to bring results into a session in a way that feels natural rather than clinical or procedural.
Greenspace provides implementation support and training resources as part of onboarding, and our partnership with the Yale MBC Collaborative gives organizations access to practical, evidence-based guidance on introducing MBC to both clinicians and clients.
Are there any employee-led projects in Measurement-Based Care worth highlighting?
Yes. Some of the most successful MBC implementations we have seen have been driven bottom-up by clinicians and program staff in addition to top-down support from leadership. Clinician-led working groups, peer learning circles, and internal champions who share outcome data wins in team meetings can be powerful drivers of sustained adoption. When clinicians feel ownership over the process, rather than having it imposed on them, engagement tends to be higher and more durable.
Measurement-Based Care with Greenspace
Ready to discover the clinical and financial impact of MBC at your organization?
Book a CallImplementation and Adoption
How can we maximize response rates for clients who have already completed treatment?
Response rates for post-discharge assessments are a genuine challenge, particularly in inpatient and short-stay settings where the therapeutic relationship ends abruptly and clients may not have a strong ongoing connection to the program.
To improve response rates for clients who have already completed treatment, frame follow-up assessments as a way for the client to check in on their own mental health, see how their doing, and monitor their progress. Catching deterioration earlier and signalling the need for re-intervention will help the client access support before symptoms get worse.
How did you benchmark pre-implementation outcomes when you had no existing system for outcome measures?
If your organization was collecting standard pre- and post-treatment outcome measures before implementing MBC, you may be able to compare end-of-treatment outcomes to assess how results have changed since implementation. However, if you weren’t measuring clinical outcomes previously, you won’t have historical data to make a direct comparison. In that case, the best approach is to establish a baseline when you begin implementing MBC and consistently measure outcomes from that point forward to track progress and demonstrate improvement over time.
The more important question is what you want to compare against: your own outcomes over time, expected progress trajectories for similar client presentations, or outcomes from peer organizations. All three are available within Greenspace. Your organization’s outcomes are tracked longitudinally from the point of implementation. Expected progress benchmarks are built into the platform and based on published recovery trajectories. And industry benchmarking allows you to compare your aggregate outcomes against other organizations using Greenspace, giving you meaningful context even without a historical baseline of your own.
How are precision psychiatry developments affecting the issue of measurement?
Precision psychiatry, the movement toward matching treatments to individuals based on biological, psychological, and contextual factors, is an emerging area that intersects meaningfully with MBC. Both emphasize understanding individual differences in treatment response and using data to inform clinical decisions.
Routine outcome measurement plays an important role in this development. By consistently tracking how individuals respond to treatment over time, organizations can begin to identify patterns in what works, for whom, and under what circumstances.
Organizations that build strong MBC infrastructure now are better positioned to participate in and benefit from precision psychiatry developments over time. The data you collect today, if structured and stored consistently, becomes the evidence base for more individualized treatment decisions in the future. This is one of the reasons we encourage organizations to think about MBC not just as a clinical quality tool but as a long-term, infrastructural asset.
Benchmarking and Outcomes Data
Do you provide benchmark data that allows us to compare our MBC outcomes against similar behavioral health organizations, programs, or levels of care?
Yes. Greenspace’s industry benchmarking feature allows organizations to compare their aggregate outcomes against data from across the Greenspace network, with comparisons available at the overall organization level as well as by program type and level of care. Benchmarks include median performance and the 75th percentile, so organizations can see not just where they stand relative to peers but what top-performing organizations achieve.
Benchmarking is most meaningful when it accounts for clinical context, which is why Greenspace’s comparisons are severity-adjusted where possible, ensuring that organizations serving higher-acuity populations are compared against peers with similar populations rather than a generic average.
What were the client assessment completion rates in the Two Chairs study, and how were you encouraging clients to complete assessments on a monthly basis?
Two Chairs’ assessment completion rates have been notably high throughout their MBC program. Before the implementation described in the published study, completion rates were already in the 90 to 95% range. After the implementation, they increased slightly to around 95 to 96%. Dr. Forand attributed this to completion being built into clinician performance metrics, where clinicians are required to ensure their clients are completing measures at a defined rate, which has driven consistently high engagement.
Beyond the structural accountability piece, Dr. Forand emphasizes that the most effective way to encourage completion is to make the purpose visible. Clinicians explain to clients why they are completing the measures and what value the process holds. If assessments are completed and never discussed, engagement drops. When clients can see that their responses are being used to adjust care, drive insights, and guide the conversation in session, they understand that what they are providing actually matters, and completion follows naturally.
On the broader question of encouraging completion in other settings, automated delivery via SMS or email, clear communication about the purpose of completing measures at intake, and consistent use of results in session all drive client adoption.
Complex Service Models and Provider Types
We provide services in a Wraparound model with clinicians, case managers, and behavioral health associates providing social-emotional support, skill practice, and therapeutic foster care. How might MBC data point to the differential impact between different modes of service?
This is a great use case for MBC and one that more complex, multi-service organizations are increasingly exploring. When outcome measures are tracked consistently across service types, the aggregate data can start to reveal patterns. Do clients receiving wraparound services show different rates of improvement than those in standard outpatient care? Do certain combinations of services correlate with better outcomes for specific client presentations?
The key is having consistent measurement across all service modalities, even when the work looks different. For the work being done by clinicians, behavioral health associates, and case managers to be aggregated effectively, they need to be administering the same core measures at consistent intervals, with enough sample size to draw meaningful conclusions. Greenspace’s program and provider-level analytics are designed to support exactly this kind of analysis, allowing organizations to filter outcomes by service type, provider role, or program and look for patterns over time. It takes time to accumulate sufficient data for confident conclusions, but building that data infrastructure now is what makes those comparisons possible later.
How does MBC implementation and practice vary when working with medical providers versus those who primarily offer psychotherapy? Has the approach been different for those provider types?
Medical providers and psychotherapists tend to have different starting points when it comes to MBC. Physicians and nurse practitioners are often more familiar with standardized screening tools, since measures like the PHQ-9 and GAD-7 have been part of primary care practice for years. The challenge in medical settings is less about introducing the concept of measurement and more about connecting scores to treatment decisions and tracking progress over time, rather than relying on one-time screening.
For psychotherapists, implementation may involve a greater focus on integrating routine measurement into the therapeutic process. This includes helping clinicians understand how to use assessment results to guide conversations with clients, identify when treatment may need to be adjusted, and support collaborative decision-making. When used effectively, MBC can also strengthen the therapeutic alliance by giving clinicians and clients a shared understanding of progress.
Andy Kelly addressed the core difference as seen from a payer perspective, emphasizing the importance of demonstrating treatment effectiveness in outpatient psychotherapy. As utilization of talk therapy continues to grow, payers are increasingly interested in understanding whether treatment is leading to meaningful clinical improvement. Consistent outcome measurement can help providers demonstrate the value of care and support more informed conversations about treatment effectiveness.
Payer and Value-Based Care Considerations
What about when payer data suggesting reduced service utilization conflicts with outcome data suggesting consistent utilization?
Andy Kelly’s argument is that payers and providers want the same thing: for people people to get healthier in a way that is sustainable. The problem is that most conversations get stuck on unit cost and individual session disputes instead of longitudinal health. Getting to a shared definition of success is key.
In terms of consistent utilization, Andy’s point is that in mental health, tracking change over time is simply the best methodology available. Unlike physical health, where a scan or a lab result can tell you objectively how healed a bone is, mental health has not historically has a similar tool. Repeated measurement over time is what makes improvement credible to a clinician, to a payer, and to the client themselves. A single data point is always missing context. Longitudinal data is what allows everyone to say, with confidence, that what is happening in treatment is real.
MBC gives organizations the infrastructure to have that conversation with payers from a position of evidence rather than anecdotally. This is one of the reasons organizations using Greenspace are increasingly using outcome data in value-based contracting conversations, bringing evidence of clinical effectiveness to the table alongside utilization figures and making the argument for reimbursement models that reward outcomes rather than volume reduction alone.
If you have further questions or would like to discuss MBC implementation at your organization, book a call with our team or reach out at info@greenspacehealth.com.
