MEASUREMENT BASED CARE IN BEHAVIORAL HEALTH. Travis Atkinson & Laura Vredeveld TBD Solutions
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1 MEASUREMENT BASED CARE IN BEHAVIORAL HEALTH Travis Atkinson & Laura Vredeveld TBD Solutions
2 THE WHY
3 THE WHY
4
5 THE WHY OF MEASUREMENT-BASED CARE Measurement-based care is routine practice throughout the medical and surgical fields from blood pressure cuffs to A1c tests for diabetes. Only 18% of psychiatrists and 11% of psychologists routinely administer simple measurement tools, such as symptom rating scales, to monitor their patients progress. It is time to make Measurement-Based Care a standard in behavioral health. -Kennedy Forum, 2015
6 RESEARCH On the basis of clinical judgement alone, mental health providers detect deterioration for only 24% of their patients who experience increased symptom severity. Source: A Tipping Point for Measurement-Based Care John C. Fortney, Ph.D., Jürgen Unützer, M.D., M.P.H., Glenda Wrenn, M.D., M.S.H.P., Jeffrey M. Pyne, M.D., G. Richard Smith, M.D., Michael Schoenbaum, Ph.D., Henry T. Harbin, M.D.
7 RESEARCH Six studies with nearly 300 therapists and more than 6,000 patients found that those randomly assigned to MBC had significantly and substantially better outcomes than patients randomly assigned to usual care
8 WHAT IS IT? Measurement Based Care (MBC) refers to the use of an objective measure to track the impact of care, treatment, or services over the course of those services. Data are routinely collected at multiple points in time Data are typically collected at first contact and then at regular intervals Progress (i.e., toward the desired outcome) is monitored and evaluated
9 WHAT IS IT? After data are collected through a standardized instrument: They are analyzed and delivered to the service provider as objective feedback Analysis can be used to inform goals and objectives, monitor individual progress, and inform decisions related to changes in individual plans for care, treatment, or services. Can be used to identify individual cases that may benefit from treatment team discussion and supervision
10 FOR THE INDIVIDUAL Validation Patient Knowledge Patient Engagement Effectiveness
11 FOR CLINICIAN/STAFF LEVEL Prioritize work Change approach/clinical intervention Reinforce effective treatments/reinvest in effective approaches and people
12 FOR THE ORGANIZATION/PROGRAM How data collected through standardized instruments can be aggregated to: Initiate quality improvement Evaluate progress on organizational performance improvement efforts Demonstrate the effectiveness of services with: Stakeholders in the community Prospective clients and families Payers/Insurers/Employers
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15 ASSESSMENTS & PERSON CENTERED PLANNING Assessments are used to inform the PCP process, but are not a substitute for the process. Functional assessments must be undertaken using a person-centered approach Assessments and PCP work together to assist in identifying goals, risks, needs Assessment scales and tools should NOT be used to set a dollar figure or budget that limits the PCP process
16 STANDARDIZED TOOLS: LEVEL OF CARE Standardized tools for individuals served by public behavioral health systems are typically used for 4 main purposes: 1. Level of Care: to assist in determining a set of services, supports, or programs that an individual may be eligible for. These tools are typically used : a) for initial eligibility determinations b) to assist in establishing medical necessity c) as a guideline for the type of care or supports an individual requires Examples: LOCUS, CAFAS, ASAM, SIS
17 STANDARDIZED TOOLS: FUNCTIONAL ASSESSMENT 2. Functional Assessment: to assess the functional ability in key life domains and/or assist in determining the specific support needs of an individual. a) used to help formulate treatment goals and/or determine need for specific services and/or supports. b) may also assist in differentiating diagnoses and/or clarifying eligibility based on functional status. Examples: DLA, ANSA, CAFAS, SIS, ICAP, MCHAT, NC-SNAP
18 STANDARDIZED TOOLS: OUTCOMES 3. Outcomes: to determine the effectiveness or impact of services/support or treatment- at an individual or population level Examples: DLA, ANSA, CAFAS
19 STANDARDIZED TOOLS: SYMPTOM SEVERITY/RISK 4. Symptom Severity/Risk: to assess the severity of symptoms or impairment due to a behavioral health condition or the level of risk an individual presents to themselves or others. Examples: PHQ-9, GAD-7, CIWA, UNCOPE, CAGE-AID
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21 TYPES OF MEASUREMENT Structure What are the things? Examples: Number of clients served without insurance, number of noshows, number of clients served in a given month Process Did we do the things? Examples: % of patients receiving a H1C3 level, number of people who completed discharge paperwork each month Outcome Did the things we did make a difference? Examples: Customer satisfaction, recidivism, decreased symptoms
22 MBC IN ACTION: SUPPORTS INTENSITY SCALE (SIS)
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26 MBC IN ACTION: CAFAS
27 NEW JACHO STANDARDS Joint Commission on Accreditation of Healthcare Organizations (JACHO) Uses a standardized tool or instrument to monitor the individual s progress in achieving his or her care, treatment, or service goals Gathers and analyzes the data generated through standardized monitoring, and the results are used to inform the goals and objectives of the individual s plan for care, treatment, or services as needed Evaluates the outcomes of care, treatment, or services provided to the population(s) it serves by aggregating and analyzing the data gathered through the standardized monitoring effort
28 INSTRUMENTAL ELEMENTS OF INSTRUMENTS Reliability and Validity Appropriate as a repeated measure Sensitivity to change Discriminate between populations
29 WHAT INSTRUMENTS ARE CURRENTLY IN USE? September Health-Screening-Assessment-and-Outcomes-Tools.pdf
30 BARRIERS TO MBC Time Consumer Burden Ease of administration Cost Staff Burden What else?
31 IMPLEMENTATION Success will be highly dependent upon leadership s ability to manage change Creating a shared need Making change last Shaping a vision Monitoring progress Mobilizing commitment
32 GETTING BUY-IN FROM PROVIDERS 1. Pay providers to use the tool. Many good ideas in health care are also supported with financial incentives to assure their adherence. Payers can create a CPT code for completing an assessment or outcomes measure. 2. Ensure the tool can be completed quickly enough to avoid patient burnout. Self-report measures are a gold mine of information in the behavioral health field; assuring client engagement through reasonable requests for information is an important step to gathering this information.
33 GETTING BUY-IN FROM PROVIDERS 3. Create an efficient workflow for the tool. For outcomes measures, administer the tool online prior to an appointment through a PC, tablet, or with the client s own smartphone, so that the results can be available to the providers to use and discuss. 4. Integrate data from the tools into the electronic health record and as a routine part of clinical practice. When care teams have objective selfreport data to support clinical observations, providers can effectively partner with clients to achieve the ultimate goal of reducing symptoms and improving individuals quality of life.
34 WHAT S YOUR WHY?
35 QUESTIONS? Travis Atkinson: Laura
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