How do you measure outcomes in behavioral health?

As more behavioral health providers shift away from fee for service models of care towards value-based payments, the key question becomes: how do you define value? 

Value-based payments typically involve rewarding providers for better outcomes. Key metrics may include rehospitalization rates, emergency department utilization, and more. 

But in behavioral health, outcomes can be harder to measure than they are in other types of healthcare. 

Take, for example, knee replacement surgery. It’s fairly straightforward to measure the outcomes – you can either walk or you can’t, and it is clear how much physical therapy it took to get back into walking shape. 

But how do you measure the quality of life changes that behavioral health providers are concerned with?  

Stuart Archer, the CEO of Oceans Healthcare, says that “our patients are different. A good outcome may be that this patient is safely maintained in a residential setting for the rest of their life, or, maybe that this person is able to return to work. It gets really complex in behavioral health.” 

And as HealthAffairs states, “There are few endorsed measures of key behavioral health processes and outcomes such as: control of core symptoms of psychiatric illnesses; engagement and retention in care; establishment of family/community supports; access to recovery-oriented services; and personal and public safety.” 

But just because the measures needed are complex, doesn’t mean that value-based care should be thrown out in favor of fee for service models. The upside of value-based payments is too large.  

What is needed is a collaborative approach between payers and providers to define, measure, and report outcomes that paint a holistic picture of what is going on with mental health patients. 

In addition, “In certain circumstances, process measures may be more relevant and useful than outcome measures. One example involves suicide: over 40,000 individuals commit suicide in the United States each year, but the frequency of suicides in smaller populations of patients attributed to VBP arrangements will likely be too low to allow for opportunities to demonstrate improvement.” 

Since the sample size will be too small at an individual level to determine suicide rate definitively in a limited population, process measures such as medication adherence can be useful in those situations. 

As always, value-based payments will evolve and improve as adoption increases. 

The more behavioral health providers and payers switch to value-based payments, the more data there will be around what outcomes matter most in terms of keeping costs down. 

Sources:

https://bhbusiness.com/2021/10/24/behavioral-health-execs-on-the-move-to-value-based-care-we-want-a-seat-at-the-table/  

https://www.healthaffairs.org/do/10.1377/forefront.20161129.057660/full/