Using Performance Measures for Quality Improvement in Behavioral Health: The Role of Stakeholders

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Using Performance Measures for Quality
Improvement in Behavioral Health The Role of
Stakeholders

• Constance Horgan
• Deborah Garnick

Center for Behavioral Health
Presentation for Implementing Evidence-Based
Practices and Performance Measures for
Massachusetts Mental Health Services An
Educational Forum at Brandeis University Septemb
er 28, 2005
Support provided by SAMHSA and NIDA through the
Brandeis/Harvard Center on Managed Care
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Premise

• Performance measures are tools, and as such, do
  not lead to improvements unless they are well
  designed, appropriately used and applied in a
  system or organization that is equipped to
  implement change.

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Todays Presentation

• Room for Improvement
• Stakeholders
• Tools to Improve Performance
• Information Technology
• Incentives

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Room for Improvement

• Effective care for depression
• 57.7 of time (McGlynn et al, 2003)
• Effective care for alcohol dependence
• 10.5 of time (McGlynn et al, 2003)
• HEDIS Behavioral health is flat from 1999-2002
  (NCQA, 2004)
• BH measures 48 to 50 percent
• Non-BH measures 57 to 67 percent
• (Goplerud, 2004)

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Critical Juncture for Stakeholders

• Purchasers
• Health Plans
• Clinicians/Provider Groups
• Consumers/Patients
• Researchers

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Purchasers

• Use in purchasing decisions
• Select a benefit design that supports the full
  continuum of care
• Use in a quality improvement framework in
  contracts

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Health Plans

• Use to provide feedback to individual clinicians
  on comparative performance
• Design programs for quality improvement that have
  a direct link to improving measures
• Improve capacity to link data across systems

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Clinicians/Provider Groups

• Participate in quality improvement initiatives in
  practice setting
• Recognize clinicians who are delivering services
  of particularly high quality

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Consumers/Patients

• Use published performance measures to become
  better informed
• Collaborate with community groups to encourage
  use of performance measures for accountability

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Researchers

• Study the links among performance measures
  quality of care, and improved clinical and
  functional outcomes
• Study the organizational and system factors that
  result in effective use of performance measures

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Tools for Improvement Information Technology

• Uses of computer-based IT
• screening
• clinical decision-making
• patient monitoring/reminders
• Automated databases and electronic medical record
• Diffusion is slow

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Tools for Improvement - Incentives

• Financial pay-for-performance
• Non-financial
• reputational/recognition
• reduction in administrative burdens
• Other economic
• IT investment
• variable co-payment rates for patients

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Conclusion

• Having a performance measure is necessary but not
  sufficient
• How it is used and who uses it is key
• Seek solutions from multiple stakeholders
• THE CHALLENGE IS LARGE!