Improving Care Quality Starts with Better Measurement

The year 2020 has become a byword for all that went wrong: a once-in-a-century global pandemic, heightened racial unrest, and a stressful political climate.

As panic spread across the country (and world) in 2020, so did it bring to light the prominence and legitimacy of the behavioral health challenges people face, regardless of one’s age, race or religion. Recent headlines of Olympians’ own public struggles with mental health have only underscored that anyone, including those we see as pillars of strength, cannot escape the wrath of depression, anxiety, substance use disorders and behavioral health conditions.

Along with the undisputed realization that behavioral health issues are very real and at times, serious, the U.S. spent $225 billion on mental health treatment and services in 2019, according to an Open Minds Market Intelligence Report. That number has increased by 52% from 10 years earlier, and includes spend on treatments such as therapy, prescription medications, and stays in psychiatric or substance abuse rehabilitation facilities.

And, of course, headlines have been prominent about the venture capital community pouring $1.5 behavioral into the behavioral health technology and services space in 2020—more than 5 times what was invested 4 years prior.

All of the publicity and financial support has helped contribute to the long-overdue de-stigmatization of mental health. But even with all the resources being deployed into the field, there is a critical missing component to the conversation. It is a component that is both straightforward and yet so important that, without it, all the work going into helping those who struggle with behavioral health is almost counterproductive: measuring the quality of care via clinical outcomes.

After all, how can one improve something that they cannot measure?

Though widely understood that measurement-based care—the systematic evaluation of patient symptoms before or during an encounter to inform behavioral health treatment—is clinically validated to increase treatment effectiveness and improve patient outcomes, only 18% of psychiatrists and 11% of psychologists use it in routine practice.

One of the biggest reasons the adoption rate of measurement-based care has been so slow is because until very recently, such tools and approaches have not been easy to use. They were complex and would not integrate easily with existing clinical workflows, giving clinicians great pause. The good news is that there are some incredibly user-friendly measurement-based care solutions that exist today that seamlessly integrate with clinical workflow so that clinicians can easily incorporate measurement-based care without any wasted time or disruption of their regular routines. Furthermore, these solutions are very simple for patients to use, and not unlike any other app or online experience from which they have grown accustomed.

Until very recently, clinicians and patients had essentially no interaction with each other in between appointments, leaving the clinical decision-making process based solely on what is revealed in session. It is strictly the discussions and observed behaviors that take place during those timed walled-off meetings that inform clinicians of how to continue caring for their patients: Do they need medication? More talk therapy? Additional support? No objective form of measurement occurs, so how can clinicians confidently decide on the correct course of care for their patients?

Imagine if clinicians received patient-reported information on their moods, behaviors and feelings prior to their appointment. Clinicians would now have powerful context to focus on with the patient during the encounter, leading to a more personalized, targeted and efficient session. By answering evidence-based, clinically validated questionnaires delivered automatically to their phone, patients provide valuable outcome data that can be tracked longitudinally to monitor progress and measure outcomes. This is measurement-based care. And not only is it proven to improve clinical outcomes and efficiency, it also improves the therapeutic alliance between the clinician and patient.

Today, we spend a quarter of a trillion dollars on a healthcare issue that impacts 20% of our population, and unlike every other medical issue including hypertension, diabetes and cancer, we don’t have a widely adopted form of measuring treatment effectiveness. Can you think of a situation where an oncologist or cardiologist would not rely on measurements to prove patient progress? Of course not, so why should it be any different with behavioral health?

Measurement-based care is the leading, clinically validated, evidence-based answer. Here are four critical success factors to implement it in your organization:

1. High patient engagement. Measurement-based care only works if patients are engaged, so provide them with an easy approach to access and complete the clinical assessments with the user-friendly experience they have come to expect from every other online or app experience that they use daily. I’ve seen over 80% patient engagement rates when this is done right.
2. Ability to track treatment throughout the course of care. Measurement-based care isn’t a 1- or even 2-time occurrence at the beginning and/or end of treatment. It is a continual, regular part of the ongoing treatment approach to track and monitor progress and achieve the desired treatment target. With an automated solution, you can “set it and forget it,” so that the right assessments are sent to the right patients at the right time based on the nature of the condition, symptom severity and treatment approach.
3. Data that not only looks at the individual patient level, but the population in aggregate for the organization. Today’s behavioral health executives need analytical tools to understand their patient population and any trends and insights that can help them further improve clinical care and financial results. Understanding treatment and clinician effectiveness by individual and group empowers leaders to make decisions that improve clinical outcomes.
4. Data to communicate effectively with payers. As payment models move toward value-based care, behavioral health executives need critical data on patients, their conditions and effectiveness of care to share with their payers to inform accurate reimbursement models based on progress, not simply based on time.

Behavioral health executives who employ these four critical success factors as they implement measurement-based care will see improved patient outcomes and improved financial results. The more we measure care, the more we can show improvement and ultimately accelerate patient recovery times and improve patient access. With the global spotlight rightfully on behavioral health today, let’s improve how we’re tackling the problem: with measurements in place to prove a patient’s treatment is working with both existing treatments as well as the new modalities on the horizon.

Eric Meier is president and CEO of Owl.