Mental health conditions are among the most common health concerns in the United States, with 1 in 5 adults living with a mental illness. Yet those who need care have long been faced with issues of access, understanding, and stigma. While the coronavirus pandemic gave way for some of these issues to be addressed, allowing free-flowing conversations about mental health to become more commonplace, legislation to be put into place, and access to mental and behavioral health care to become more widespread with digital tools at our disposal, the field still has opportunity to more clearly define and measure patient outcomes to further demonstrate impact and continued investment.
Historically, therapy has broadly been considered a balance of “art” and “science,” with the nuance of the field requiring an understanding of human motivations, triggers, emotions, and behaviors – which can sometimes be unpredictable. For this reason, payers usually find the success of behavioral health care difficult to assess and measure. But there are real ways to create more transparency and add visibility to change. Measurement-informed care, for example, offers a solution for both providers and payers, while prioritizing patients and their care journeys. By prompting the collection of data on patient symptoms and experience regularly for providers to use as part of their care plan, measurement-informed care can help improve patient outcomes and show progress over time, further validating treatment effectiveness and bringing clarity to the previously opaque field of behavioral health care.
Why is measurement-informed care important now?
Measurement-informed care has been an evolving standard of practice within behavioral health care, along with closely-related practices such as feedback-informed treatment. These practices consist of two main concepts: collecting metrics on a patient, their journey, and their symptoms regularly using clinical measures, and incorporating the data into the patient’s treatment plan and care journey to enable a collaborative, dynamic approach to treatment. With an increase in digital care and the emergence of innovative technology that has propelled the industry forward, these practices have taken on new meaning and have raised patients’ and payers’ expectations when it comes to care. There is a reasonable expectation to bring data fidelity and standardization to mental health. Data has become the lifeblood of quality health care across all specialties and there has never been a more appropriate time to take advantage of technological tools to support and validate treatment, showcase outcomes, and improve patient and provider experiences while meeting payer standards and expectations. We can better understand and demonstrate the beauty and power of the therapeutic relationship, which is often only understood and seen by the provider and the patient.
The impact: payers, providers, and patients
A 2021 meta-analysis of more than 21,000 patients showed that when providers implement and follow measurement-informed care programs, patients tend to demonstrate improvement faster. According to the analysis, this type of practice helped reduce symptoms across all case types, especially for patients who were not improving as expected. This practice not only provides objective measures of progress for patients through the course of care, it provides a standard set of data points for the observation of different conditions and diagnoses. Self-report measures – like the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) – help providers inform their assessment of patients and their treatments in real-time and allow for the personalization of care while still standardizing processes to achieve better outcomes. Measurement-informed care can also enable health systems and payer organizations to observe progress across all patients, allowing for the broader analysis of populations, conditions, and diagnoses to better understand the impact and value of mental health treatment. All of this being said, simply measuring these outcomes is only half of the equation – it comes down to the use of these measures within treatment, collaboration with patients, and documentation that makes a difference within the course of care. In other words, administering measures is not sufficient on its own; we have to utilize them visibly in care and with the patient’s partnership to unlock the value.
Next steps: Increasing usage and understanding
The most impactful first step we can take toward a more standardized and well-informed approach to therapy is educating providers, payers, and patients on measurement-informed care – the what and the why. Continuing education should focus on how measures and patient self-assessments are tools to give providers more insight into treatment, while not interfering with their practices or clinical judgment. Providers remain the experts, and can tailor these measures to the diagnosis, interventions, and needs of their individual patients to be relevant and useful for each case. Providers are vital for helping educate their patients on the value of measures, and can demonstrate the utility by simply discussing the results in session. They can develop a shared language of progress and treatment experience with their patients that improve goal alignment, and a mutual understanding of “success.” It is important for both patients and providers to see that measures can enhance and inform the therapeutic relationship, but the care journey remains firmly within their hands.
Though therapy outcomes haven’t always been easy to measure, quantitative and qualitative data delivered anonymously on a quarterly basis can unlock new insights and information from which providers can learn and engage in continuous quality improvement. This data can provide digestible insights for providers to further inform decision making, which in the long term can help their clinical practice continue to grow and develop. Encouraging providers to engage with and embrace this process will, in turn, impact patients’ engagement in surveys, self-reporting, and feedback, creating a self-sustaining cycle.
Having the full context as to “why” measurement-informed care impacts treatment and the patient experience provides clarity for providers and patients, particularly in their ownership and role, which can encourage consistency, impact patient outcomes, and create the transparency and clarity in the space that payers have been looking for to further support therapy services, expanding coverage for all.
Kevin Ramotar is a clinical psychologist and health care executive.
