Successful MBC Implementation Requires Organizational Buy In, Strategic Approach

While numerous studies have demonstrated the benefits of measurement-based care, many behavioral healthcare organizations have been slow to adopt MBC principles into their operations.

At the West Coast Symposium on Addictive Disorders on Thursday, Annie Peters, PhD, LP, director of research and education for the National Association of Addiction Treatment Providers (NAATP), Nicholas Hayes, PhD, chief science officer for the Cumberland Heights Foundation in Nashville, Tennessee, and Jake Cornelius, senior vice president of product management for Sunwave Health in Delray Beach, Florida, discussed keys of MBC implementation.

Ahead of their session in Palm Springs, California, Behavioral Healthcare Executive caught up with Dr Peters to discuss why organizations have been slow to embrace MBC, the do’s and don’ts for developing a systemwide outcomes-focused initiative, and the types of data providers should concentrate on.

Editor’s note: This interview has been edited for length and clarity.

Behavioral Healthcare Executive: Why have behavioral healthcare organizations largely been slow to integrate measurement-based care into their operations?

Annie Peters: Behavioral healthcare organizations, especially those that receive public funding, already have a high measurement burden—they are required to report on many performance and quality measures that providers don’t see value in. I think there is concern about the time and cost involved in doing “more measurement.” The workforce is currently overloaded and stressed, and there is hesitancy to ask clinicians to add measurement or documentation of any kind. There is often not a “culture of measurement” that is built by leadership and infused throughout the organization, so often staff and patients alike may not see the value in it. It may be seen as “something else we have to do.” There’s a need for training on how good measurement practices can improve individualization of care, clinician/patient relationships, patient outcomes, reimbursement, etc. so that all are motivated to integrate MBC into practice.

BHE: What are some do’s and don’ts for providers looking to develop a systemwide outcomes initiative that establishes program goals, increases stakeholder engagement, and drives organizational change toward delivering better treatment outcomes?

AP: Do use standardized tools with good psychometric properties. Use available health technology products to collect and summarize data. Use measures repeatedly at regular intervals throughout and after care. Provide feedback on measurement to every patient at every session, and use it to collaboratively plan treatment. Participate in collaborative programs such as the FoRSE Outcomes Program to benchmark outcomes with other organizations, and work together to use data for advocacy. Partner with researchers to do systematic investigations of patient outcomes. Disaggregate admission, progress monitoring, discharge, and outcome data by gender identity, sexual orientation, race, ethnicity, age, veteran status, and social determinants of health to identify disparities and areas for improvement in processes. Be transparent about your outcomes and how you use outcomes data to improve treatment.

Don’t modify standardized tools. Don’t worry about using the perfect tools; there aren’t any.  Don’t try to do it all yourself; there’s lots of support and guidance available.

BHE: What facility, provider, and patient-level data types should organizations be concentrating on?

AP: Facility — The Substance Abuse and Mental Health Service Administration’s (SAMHSA) N-SSATS survey and the Shatterproof ATLAS Treatment Facility Survey are national initiatives that collect important data about treatment facilities. 

Provider — Evidence-based practices used (and which are used with fidelity), types of services offered including recovery support, levels of care, length of stay, readmission rate, and other process measures.

Patient — Demographics (see above) and social determinants of health e.g. in the AHC HRSN Screening Tool. Also: substance use disorder (SUD) diagnosis, mental health diagnosis, medical diagnoses. American Society of Addiction Medicine dimensional assessment. For outcomes, use quality tools examining SAMHA’s national outcome measure domains. Use SUD and mental health symptom rating scales as repeated measures. Monitor medication use and compliance. Look at recovery capital and quality of life measures that are important to patients and families. 

Reference

Peters A, Hayes N, Cornelius J. Preparing for Value-based care: measurement, documentation, and analysis of patient outcomes. Presented at West Coast Symposium on Addictive Disorders; June 1-3, 2023; Palm Springs, California.