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

1. Using Performance Measures for Quality Improvement in Behavioral Health: The Role of Stakeholders Center for Behavioral Health Presentation for Implementing Evidence-Based Practices and Performance Measures for Massachusetts Mental Health Services: An Educational Forum at Brandeis University September 28, 2005 Constance Horgan Deborah Garnick Support provided by SAMHSA and NIDA through the Brandeis/Harvard Center on Managed Care

2. 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.

3. Today’s Presentation • Room for Improvement • Stakeholders • Tools to Improve Performance • Information Technology • Incentives

4. 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)

5. Critical Juncture for Stakeholders • Purchasers • Health Plans • Clinicians/Provider Groups • Consumers/Patients • Researchers

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

7. 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

8. Clinicians/Provider Groups • Participate in quality improvement initiatives in practice setting • Recognize clinicians who are delivering services of particularly high quality

9. Consumers/Patients • Use published performance measures to become better informed • Collaborate with community groups to encourage use of performance measures for accountability

10. 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

11. 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

12. 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

13. 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!