One of the biggest challenges in the behavioral health industry lies in the realm of measurement based care (MBC). Many companies struggle to understand HOW to effectively use measurement-based care to make informed decisions that will successfully increase their patient outcomes. After all, it is hard to quantify the quality of care and progress in any medical setting.
For starters, there are so many subjective factors to take into account. The person being served has their experiences, the administrator may have biases, and the different professionals providing treatment all have different interpretations. Can it get anymore convoluted?!
Here’s the good news: If you’re having trouble understanding the fundamentals of MBC, you’re not alone. In this guide, you’ll learn how to effectively use measurement based care to help you make the best treatment decisions for your facility.
Keep reading to discover:
- What measurement based care is
- 5 key components to successful implementation
- The top data collection and measurement based care tools
- Benefits of implementing measurement based care
- How to Overcome MBC Obstacles (paperwork, training, & more)
Let’s get into it.
What Is Measurement Based Care?
As a professional in the behavioral healthcare industry, you’ve probably heard the term “measurement based care” thrown around quite a bit. But, what exactly is it and how can it help improve your treatment success rates?
Measurement based care is the process of carefully making treatment decisions based on the treatment data & feedback of patients. The data is then used to track progress and improve patient outcomes.
While MBC is used for all types of medical treatment, it is especially helpful for providing quality behavioral health care. Now, let’s dive in a little bit deeper.
What is the Goal of Measurement Based Care?
More often than not, the primary goal of measurement based care is to inform improvements to the patient experience. While this is true, it only reflects one goal among many!
Most guides to MBC try to oversimplify it by claiming that measurement based care only requires 2 fundamental ingredients:
1. The routine collection of short, validated patient self-report questionnaires
2. To incorporate the results into treatment
Although you could narrow your overall approach to MBC with these 2 actions alone, you would be missing essential components that should go into the process if you want your results to be more meaningful and sustainable!
After all, your patients’ self-reports only show part of the story. And in some instances, self-reporting measures actually have unintended consequences.
Let’s take a look at an example.
Why Self-Reports Can Be Problematic: Pain Management
A good case in point is the role of only measuring patient satisfaction in pain management.
It is well documented that the linking of self-reported patient satisfaction scores in healthcare settings to higher reimbursements contributed to the rise in over prescribing of opiate pain medication. In turn, this led to a country-wide pandemic of opiate misuse, abuse, and dependence.
Obviously, this is a HUGE problem!
Furthermore, pain measurement in healthcare screening has become referred to by some as “the fifth vital sign,” which is an issue unto itself within measurement based care. Numerous articles and public health documentaries have been produced on this vital topic.
As you can see, patient satisfaction self-reports should not be the only way a behavioral healthcare center measures patient experience. Keep in mind that we’re not against self-reports! However, we believe they should be used in conjunction with many other measurement tools and reports.
Keep reading to learn how to use a multi-tool approach to generate effective measurement based care for your facility.
5 Key Components To Successful Measurement Based Care
Here’s a simple truth: Measurement based care is not as challenging as people make it out to be.
Although it requires some forethought and planning, it’s much easier to integrate than you think! But, in order to properly pursue measurement based care, you must have the right fundamentals under your belt first.
Here are 5 fundamentals to effective measurement based care.
1. Collection of Data
First and foremost, determine which form of assessment will be best for the person you serve. For example, in-person assessments during sessions is a great way to gather information on your patients.
Collect data at intake, before appointments, or between appointments as needed. Continuous data collection and monitoring can help makes decisions clear and point to areas that need improvement.
Pro-Tip: Collecting results weekly or between every session results in better outcomes.
How to Choose an Action to Measure
When you are first getting started, it is best to choose something specific that can be measured, such as a symptom of an issue. Choose a brief, validated outcome measure that is connected to your treatment goals and objectives.
These measures will be unique to each provider and practice. If you focus on several larger goals, such as addiction recovery (if you’ve started a rehab center), then pick a specific aspect of early recovery to measure. Measuring the reduction of cravings or urges to use substances is one example.
If your care addresses depression and/or anxiety disorders, you may want to select symptom measures for those specific concerns. There is no one right answer for the selection, so choose the measures that align with your treatment goals, the population you serve, and be sure to pick something that shows your work.
2. Review of Scores
After collecting all numerical and graphical scores over a period of time, analyze any data that is alarming or repetitive. It is important to know where you are starting from and set goals.
This way when you review these scores you have a comparative variable and can keep track of progress.
Decide How to Use the Measurement Based Care Data
Once you’ve analyzed the numbers, hone in on how you want the information to be used. Be specific on how you want to integrate the information gathered into the care process and how the information gathered can show your work.
Think through how you’ll integrate the information into treatment planning, compliance considerations, organizational metrics for demonstrating the value of your care and service. There is a tendency for most people to focus mostly on improving outcomes for patients, a benefit of practicing measurement based care is it allows you to show your work to others, if you hone how to properly use the data.
Qualifying for grants and negotiating better reimbursement rates with payers are two examples. Be sure to consider how collecting these measurements of change shows your work in ways to improve every aspect of your organization.
3. Collaboration
One of the biggest advantages of measurement based care is the collaborative aspect. Review the results with the person you are serving during sessions and allow them to reflect on any progress they’ve made, their challenges, and their goals.
This may not only give you new insight but encourage their engagement in their recovery.
Engagement is Key!!
Engagement means getting everyone in the organization involved. This includes developing plans for informing providers, staff, stakeholders, and especially the persons served in your plans, and process for implementing and integrating measurement based care.
If you engage some of the resources referenced above, there are systems and processes recommended for informed consent.
Engagement should also include clarity on collecting and storing the information gathered, how collaboration of using the information gathered will take place and examining the results over time to improve the care process for a specific person served and the organization’s overall care and treatment services.
Everyone in the organization should be able to understand who is involved, what is being measured, where the measures are being employed, when the measures will be deployed and the results processed, and why the information is being measured to include how to share the results of the information gathered. Most important, engagement needs to include sharing how this information is being used to improve the care process. Engagement is literally showing your work in every step!
4. Examine Results
Now that you have the quantitative numbers from the questionnaires and the qualitative data from the person you served, it is time to examine it all together.
Evaluation & examination are essential steps in the MBC process. Evaluate not only the results for improving the care for each person served, but also the process of your efforts.
Ask the Right Questions
Are there ways to improve the measurement based care process as you grow?
Assuredly, you’ll encounter the lessons of experience referenced earlier about measuring the process, the outcomes, and the experience. One of the barriers practitioners often encounter is learning how to practice measurement based care efficiently and authentically.
Examine any patterns in progress or how you are in relation to the goals you set. From there, you can begin to ask the right questions to determine if a change in course is needed.
Pro-Tip: This data can also be used to aid your mental health marketing efforts.
5. Take Action
Act on the results by making the necessary changes to improve results and continue towards your goals. This may mean making small adjustments to their specific treatment or larger systemic changes. For example, when treating symptoms of Adverse Childhood Experiences (ACES), using MBC data to make treatment decisions, can be extremely helpful since ACEs are so diverse in their effects on individuals.
Revise Your MBC Process Based on Your Results
Revise, revise, revise!
Once you’ve evaluated, you can then revise your measurement based care practices, which really means, you can revise your approach to any part of the care and services. This could include revising a treatment plan, revising the way we understand a person, or the way we engage communication with a stakeholder.
Revising is where measurement based care can really help an organization understand its true impact. Amending systems and processes is a constant in behavioral healthcare, as we strive to meet the evolving needs and goals of those we serve.
Essential Measurement-Based Care Tools
Now, let’s talk about effective MBC tools for your organization.
Using data is key for consistent data measurement throughout medical professionals and treatments. When collecting qualitative data in a way that requires answers from the person you serve, it is crucial to keep it simple.
The first step is to collect the reported symptoms with symptom rating scales like:
- Personal Health Questionnaire 9 (PHQ-9) – a self-administered, longer questionnaire to assess depression.
- Personal Health Questionnaire 2 (PHQ-2) – consists of the first two elements of PHQ-9 to screen for depression before being fully evaluated with the PHQ-9.
- General Anxiety Disorders 7 (GAD-7) – a seven-item simple initial screening tool for generalized anxiety disorder.
- Primary Care Screen For Post-Traumatic Stress Disorder (PTSD-5) – identifies if the person served has had exposure to traumatic events and their probability of PTSD.
- Concise Health Risk Tracking (CHRT-7) – a self-report that measures suicidal severity and risk.
- Quick Inventory of Depression Symptomatology (QIDS-16) – rates depression symptom severity based on mood, sleep, and risk of suicide.
- Social Phobia Inventory (SPIN) – 17-item self-report for social anxiety disorders rating symptoms such as fear and avoidance.
- Quality of Life and Enjoyment (Q-LES-Q) – shows how the treatment is affecting the quality of life of the person you serve when they are more functional.
- Work and Social Adjustment Scale (WSAS) – see how symptoms are affecting the person you serve in their daily lives.
You can distribute assessments in-person before sessions or digitally through the patient portal or EMR secure email 24 hours in advance of appointments. This decision will depend on the likelihood of engagement and if the person you serve has the ability to self-report.
Benefits Of Implementing Measurement Based Care
The use of measurement based care benefits both behavioral health professionals and the people they serve. It is a powerful tool that can improve outcomes resulting in a stronger community and business.
1. Improves Care & Experience
Having data also allows you to personalize care for the people you serve. There is no exact linear line for mental health recovery, therefore you need to be able to continuously reassess treatment.
You can also use data to open up communication with the people you serve because you have all of their information readily available. As opposed to having to ask them if they remember how things went during their last visit you can have the information and discuss their progress.
measurement based care is a very collaborative experience and therefore you and the person you serve can share decision-making allowing them to buy into the process.
2. You Can Learn From It To Inform Clinical Decisions
Data provides insight that is objective across all care teams. Monitoring changes and patterns in symptoms can provide insight into opportunities and predict outcomes.
This can help improve interventions, services, and staff training. Patterns can suggest the person you serve may need medication management, who needs to stay longer in inpatient or whos ready for outpatient, or who may terminate treatment.
3. Objectivity and Reliability
When you can compare numbers instead of qualitative input you can evaluate progress from visit to visit. All information will be measured the same no matter who administers or interprets the reports.
This is important to overcoming subconscious biases medical professionals or observers may have.
This is especially helpful in behavioral health where the person you serve’s input is mostly based on their experiences. measurement based care helps you set a standard that can be compared.
4. Manage Off-Track Members
With measurement based care, you can assess patterns to see if clients are going off-track and may be likely to discontinue treatment. If you see these patterns you can then adjust treatment to fit their needs in real-time.
measurement based care monitors symptom reduction and deterioration allowing you to make adjustments, and improve retention.
Learning from the data you can evaluate treatment effectiveness to pinpoint areas where the people you serve may be going off track. Implementing successful measurement based care practices drastically reduces rates and improves outcomes.
5. Increase Engagement
Measurement based care is proven to help increase the engagement of the people you serve. It empowers them with more transparency and visibility into their results and the chance to collaborate.
Opening the door for the people you serve to communicate their goals and make decisions enhances communication and participation.
6. Build Relationships With Stakeholders
While behavioral health is all about helping the people you serve, as an organization you may have some stakeholders you need to report to. By collecting baseline data of the people you serve before they start with you and proof of improvement, you can have the objective evidence you need.
Additionally, third parties may reward or penalize your organization for its lack of proof of improved care.
Medicare and Medicaid are requiring payers and providers to have objective documentation of improvement. Payers want proof to give support, you need to show that new services can reduce costs and improve outcomes before giving reimbursement.
How to Overcome MBC Obstacles
Now while measurement based care can help your organization become incredibly successful, when not implemented correctly you can hit roadblocks.
Tedious Paperwork
One of the biggest obstacles clinics often face with doing assessments on paper is the costs and time that go into managing and manually analyzing data trends.
Finding the right digital questionnaire can that can embed in electronic health records (EHR) while still keeping data secure is crucial. This can completely streamline the scoring, charting, and tracking processes.
Lack of Training in Measurement Based Care
Another area organizations may face roadblocks is utilizing the data they have collected. They are not training their staff to adopt and incorporate the results into their regular practices.
They need to be trained to be able to change their plan when recovery isn’t linear and they need to create a new solution.
Future Considerations for Measurement Based Care
- Monitor Routinely – the successful practice of MCB includes routine monitoring throughout treatment.
- Person-Centered Approach – the only way to be able to fully get data on the symptoms and condition of the people you serve you need to involve them.
- Timeliness is Key – in order to get accurate data, it needs to be collected during or right before sessions.
- Implement the Right Technology – tech enables medical professionals to collect more data from patients outside of the clinic, saving time at point of care.
Navigate Measurement Based Care with C4
Ready to take the next steps but need some extra help? Our consultants are here for you! At C4 Consulting, we empower your business to navigate the ever-changing behavioral health industry with confidence.
Our mental health consulting services are designed to assist you at every stage of your journey, from start to finish. With our behavioral health consulting services, get expert guidance and industry insights to navigate regulatory complexities, identify growth opportunities, optimize operations, and make informed decisions that drive success.
Contact us at C4 Consulting at (866) 329-7170 or hello@c4-consulting.com.
