Driving Improvement in the New Landscape of Behavioral Health

The first requirement for any organization is defining its purpose. For the leadership that means determining who is to be served (target population), toward what aims (outcomes), in what way (services), and at what acceptable cost (revenue and expense). In the last decade the landscape for each of those categories has changed dramatically.

Redefining the Industry

The ways in which populations have been defined has broadened as the interaction between the mind and the rest of the body has come to be better understood. Whereas many behavioral health organizations used to focus primarily on those with a serious psychiatric or substance use disorder, they are now more likely to also see people whose mental illness or substance use treatment was precipitated by a general health issue, the treatment of which requires “lifestyle” (i.e., behavioral) changes.

This change in the population of interest has also redefined outcomes. Patients focus on quality of life, local (often governmental) entities focus on employment and community tenure (lessening the demand for social services and law enforcement), and payers want to reduce total cost of care. Treatment providers struggle with a lack of clear measures to determine improvement as most treatment related measures are proxies – community tenure, lack of hospitalizations, reduced symptoms reported or evident.

Services now encompass not just treatment but also care coordination, to ensure the patient’s needs are addressed holistically (involving numerous healthcare and social services entities) and in concert, and support, often utilizing peers – individuals with lived experience. Payers want to reduce costs and improve satisfaction with services and use complex and proprietary algorithms to approve or deny care and rely on overly generic proxy measures to evaluate how effective any given provider is. That has driven payers to expect specific outcomes and to tie reimbursement to those outcomes in some form of value-based contracting.

It's a complex labyrinth that intersects with a professional workforce the training of which seldom included these factors now in play. Most behavioral health providers’ training focused on using evidence-based models of change, some with fairly specific techniques, but ultimately driven by the relationship with the patient as the most powerful change agent. Their individual effectiveness as therapists was not measured but rather discussed with supervisors and supported by patient report (or completion of treatment”). In the current environment, the demands described above are a jolt to young professionals, and effective managers know that they need to onboard new staff to function within a complex and rapidly changing landscape.

COVID led to a rapid and significant increase in telehealth, and focused attention on computer-assisted treatments, apps, and more previously not being used in large numbers by professionals and organizations. In fact, many of these techniques were resisted as inconsistent with good therapeutic practice by many professionals. Necessity overcame much of that resistance, but staff may require additional training to ensure it is being used effectively – and that will require measurement.

Leveraging Technology in a Value-Based Environment

There is no question that technology-assisted treatment and hybrid work environments are here to stay. So are patient and payer expectations around access, population health/social determinants, data, and outcomes as drivers to treatment adherence for patients and reimbursement incentives from payers. All of which make usable and timely data more critical than ever.

The key for the successful organization will be data integration and information transfer within the organization accomplished in a manner that focuses on the needs of the end user of that information at every level within the organization. It will be critical that data from a variety of sources can be aggregated and parsed to become actionable information in real time. Clinicians will need accurate patient data that is presented to them just-in-time and, if it’s critical, in a way they cannot ignore.

Technology can also be used to clear clerical work away from clinicians to allow them to focus on the drivers to the desired outcomes and practice at the top of their credential. They will also need to know how they can adjust their practice and adopt emerging new evidence-based approaches more quickly than before, and measurement-based care can help them see how effective their interventions are in a timely way. Transitioning to measurement-based care that provides individual patient data can help them adjust practices by providing timely feedback. Managers will need to know how well their staff and team does in key performance areas that include volume of services, patient improvement and satisfaction. Organizations need to be able to ramp up programs and measure their impact quickly so that the organization’s resources are deployed efficiently as well as effectively.

Old data and information systems that function in departmental silos – Finance, HR, Clinical – will no longer keep pace. The data has to come together to provide information at all levels that can drive improvement, perform well in a complex value-based environment, and provide a competitive edge.