The Field Can Make Progress Toward a Quality-Driven Model

Evaluating the quality of care in addiction and mental health treatment has proven challenging historically. Leaders in the treatment field have lacked consensus on what it even means to be a high-quality care provider. The absence of an accepted definition of quality has stymied efforts to apply standardized outcome measures across the industry.

Combine that with concerns about an already overburdened behavioral health workforce, one that hasn’t been widely trained in using data to measure quality, and you can see the obstacles substance use and mental health treatment providers have continued to face as they try to catch up to other health care sectors in taking a quality-driven approach.

Behavioral health consultant and former addiction treatment executive John Driscoll cited these persistent barriers during a workshop session at last month’s National Association of Addiction Treatment Providers (NAATP) conference. In recalling the early efforts of the NAATP Foundation for Recovery Science and Education’s ambitious outcome evaluation project, Driscoll said the provider community had to be reminded, “We can measure outcomes in this industry.” To many, that wasn’t always a given.

At the same conference session last month, NAATP Director of Research and Education Annie Peters, Ph.D., warned colleagues, “We can’t rely on … miracles and alumni stories” as the tools for demonstrating treatment success. Peters referred to peer-reviewed research as “the language in which policymakers and payers speak.”

Last October in Washington, D.C., the nonprofit Cohen Veterans Network brought together a multidisciplinary group of 28 experts from the public and private sectors. The panel discussed obstacles to establishing benchmarks for outpatient mental health treatment and proposed solutions. A newly released report based on the proceedings frames the challenge this way:

“Program and practice decisions in outpatient mental health care continue to be driven by a variety of factors including individual provider preferences, state guidelines, or requirements of private or public payors as opposed to standardized evidence-based best practices which demonstrably improve treatment outcomes, thereby optimizing the value and impact of limited resources.”

The report from the proceedings offers a number of recommendations that, if adopted across the behavioral health field, could offer a major breakthrough in the pursuit of a quality-driven system. Among the recommendations are:

• Leveraging the innovative and fast-growing Certified Community Behavioral Health Clinic model by using CCBHCs as a laboratory for adoption of measurement-based care.

• Convincing professional licensing authorities to define the use of measurement-based care as a component of behavioral health providers’ professional ethics standards.

• Ensuring that patient perspectives are taken into account in any effort to establish quality care standards. Quality of care should not be measured solely by assessing whether patients achieved symptom reduction or abstinence from substance use, but should incorporate broader quality-of-life goals in recovery, the experts stated.

The report’s authors also make it clear that sound technology holds the key to making measurement-based care more widespread — and at the same time not adding undue burden to program staff. They wrote, “Electronic health records must be designed to make measurement tools easy to access, transmit, complete and review. Make ‘doing the right thing the easy thing’ by ensuring compliance with a [measurement-based care] protocol without encroaching excessively on limited patient-clinician time.”

In order to execute this strategy, the industry can rely in part on commonly used measures such as the PHQ-9 for depression, but the authors suggest that an over-reliance on a small set of measures will not allow measurement-based care to reach its full potential. “Validated tools need to be continually updated, refined and tested in real-world clinical settings,” they wrote.

We at Sigmund Software also believe that the effort to improve quality never stops. Our AURA software solution was designed using the expertise of behavioral health professionals, and we remain committed to gathering information from its users to continue to improve the product. This in turn will help our customers continue to improve their programs’ outcomes.

As the authors of the expert panel’s report wrote, “Establishment and use of common data elements and mechanisms for sharing and aggregation across service providers is necessary to inform the field and answer basic questions related to benchmarks, standards, and thresholds.” Only with this consistent commitment to quality improvement can the behavioral health industry move fully toward a more standardized approach to care — a necessity as all of health care transitions to value-based payment for services.