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Measurement-Based Care Needs Executive Leadership to Reach Its Full Potential
One day measurement-based care (MBC) may be the envy of every other healthcare specialty. Its benefits are diverse and substantial. However, we will not realize MBC’s full potential unless we reject some flawed approaches. For instance, some mistakenly think it is nothing more than using client self-report questionnaires, while others diminish core components like data analytics or clinical feedback.
Some clinicians are reluctant to give up misgivings about MBC despite evidence it improves treatment decisions, boosts clinical results, and validates increased funding for services. MBC creates a degree of accountability long absent in our field by generating performance ratings against benchmarked data. Yet to achieve these goals, executives must implement MBC’s sophisticated technology and analytics.
It’s More Than Using Behavioral Health Measures
Client self-report questionnaires fuel the system. They objectively measure behavioral symptoms, clinical risks, and improvement during care. We need measures that are reliable, valid, and sensitive to clinical change, but it is unproductive to focus too much on the superiority of one tool over another. Tools derive their value in large part from their normative databases.
We need norms to understand changes on a scale. MBC’s power goes beyond a total scale score and its level of severity. The greater value lies in being able to plot how people’s initial score is expected to change over time with treatment. MBC tells us the average expected change, as well as how to evaluate deviations from expected change. This is the power of a normative database.
Data are analyzed statistically just as in research studies, but the goal is more pragmatic. Graphs and reports are generated on expected vs. actual care trajectories, along with warning messages when clinical progress is off-track. Executives can aggregate outcomes at the clinician, clinic, or system level. This gives leaders valuable information that payers and the public have long wanted.
Technology Can Solve System Issues at Scale
Clinicians have long objected to the burden of data collection, and the ideal MBC system removes this burden through automation and digital devices like computers, phones, and chatbots. Conversational AI is emerging in many consumer and healthcare settings today to make data gathering inquiries less burdensome. Executives must embrace this and decide which technology fits their business best.
Data collection at the point of service is one system issue, but the bigger issue to solve may be monitoring clinical status outside of visits. This not only has value for active treatment cases, but also for detecting behavioral problems in medical settings. Generally speaking, our healthcare system needs to become more agile and effective at gathering and using clinical information. MBC is our leading edge.
The engine for MBC is statistical analysis, and a few specialty companies have developed good products for this. By contrast, the procedural steps from data collection to reporting are not yet standardized and automated. Technology can solve these administrative issues at scale, but it must be tailored to the setting. MBC will be delayed and limited in scope to the extent we do not invest in these tech solutions.
Gauging the Value of MBC Investments
MBC brings a new transparency to behavioral healthcare. Payers can finally see the results of services, rather than simply who used which services. This can help reorient the field financially. We can move from decrying the chronic underfunding of behavioral healthcare to using new metrics to justify increased funding. This is why many are excited about value-based care (VBC) contracting.
VBC is no guarantee our field will be more richly funded, but it shifts focus from volume to service outcome. We can seize the opportunity it presents by fully investing in MBC. While a lesser version of MBC is possible with lower capital costs (e.g., less automation), this undermines our ultimate financial goal. Our field is now squarely in the healthcare arena, where funding is predicated on delivering results.
MBC is a unique quality initiative that improves care at the client level, validates effectiveness at the clinician level, and helps garner increased funding at the system level. Executives rarely encounter multifaceted benefits from a single investment. Nonetheless, short-term cost savings could motivate some leaders to scale back their MBC system.
How then should MBC be prioritized as an investment? MBC is comparable to healthcare investments like new blood pressure and glucose monitors. Patients rely on them for good care. Medical practices are rated on their consistent use. Improving how they work (e.g., new devices, wireless technology) is always worth the cost. Investing in core technology is not considered a discretionary improvement.
This long-term vision should lead executives to allocate resources to MBC as a top priority. If short-term gain is a more pressing concern, early adopters should have a competitive advantage for some time.
Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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