5 Minute Read.

As a seasoned professional in integrated care, I’ve been part of a pioneering generation that sought to blend medical and behavioral health services to improve patient outcomes, particularly with the advent of the Primary Care Behavioral Health service delivery model (PCBH). Reflecting on this journey, it’s clear that while we’ve made significant strides, we missed a crucial step early on: the widespread adoption of measurement-based care (MBC) in integrated care.

Some of you are already rolling your eyes and getting ready to stop reading and I’m afraid I and some of my cohort are to blame for that. While the Collaborative Care Model (CoCM) had measurement based care baked in, those of us leading the way in PCBH in the late 90s and early 2000s downplayed the role of outcome tools because we were overwhelmed by the breadth of need we face in our clinics and because we were searching for the holy grail of outcome tools and never found it. So, we gave up and stopped trying. I honestly regret this and the negative messaging that then developed around using measurement tools and strategies. And if we are honest, the foolish competition between PCBH and CoCM at the time influenced the development of camps pro/against MBC.

Measurement, the systematic tracking of patient symptoms and progress, is a backbone of effective care. It is a huge component of standard primary care. Yet, in the rush to integrate services, my generation of leaders often overlooked it. We focused on breaking down silos between medical and behavioral health disciplines, which was crucial, but in doing so, we didn’t prioritize the establishment of robust measurement practices.

Why does this matter? Without measurement, we operate in the dark. We miss out on critical data that can inform treatment adjustments, predict patient trajectories, and ultimately, improve outcomes. Behavioral health, with its nuanced and subjective nature, especially benefits from the objectivity that measurement can provide. And of course it makes describing and enumerating our impact nearly impossible to payers and health systems.

Let’s be clear: the fault isn’t with the concept but with its implementation. Instead of looking for the holy grail of outcome tools for PCBH, we should have been developing behavioral health labs or sets of tools that we use in particular situations. And we should have been investing in systems and technologies to support this as easily as medical providers order labs and other procedures. In short, we should have been making it easier to administer tools prior to visits, evaluate progress during visits and schedule follow-up assessments after visits.

Trust me. I’m not a big fan of the PHQ-9. I know it’s relative lack of utility at the point of service for a large percentage of primary care visits. However, if you see it as just one of a set of tools you have at your disposal, like a panel of labs, you then have the makings of a MBC pathway. My favorite these days is the Outcome Rating Scale which I use to gauge whether what I am seeing in terms of patient function is what the patient is seeing in their life domains. News flash: I’m not always right.

Yes, I know. I’m a Behavioral Health Consultant and I know how challenging it can be to get everything done in a 20-minute visit – that’s the point. If a medical provider can order labs, review those labs, and adjust a treatment plan in the space of a 15-minute visit, then there has to be a way for me to do it as a BHC. And I’m convinced that the way is related to having the same set of robust tech support that providers have with their labs. Without this tech I totally get how difficult it is to track and use outcomes in care.

So, what can we do to rectify this? First, it’s essential for healthcare professionals, particularly those in behavioral health, to embrace measurement as a core component of care. This means not just acknowledging its importance but actively integrating it into daily practice.

For clinicians, this integration could start with routine use of symptom rating scales and feedback systems that track patient progress over time. Perhaps your PCBH team could create behavioral health labs for a few common situations and then develop pathways for measuring, tracking and discussing with patients. For health systems, it means investing in the infrastructure that supports the collection, analysis, and interpretation of this data.

Technology plays a pivotal role. We’re in an era where digital health platforms can streamline gathering and analyzing patient data. These tools can provide real-time insights into patient progress, facilitating more dynamic and responsive care plans, and many can integrate them with electronic health records. And frankly with the advent of artificial intelligence, data summaries should get easier to create, digest and use with patients soon.

In practical terms, here are some steps clinicians and health systems can take to begin engaging with MBC practices:

1. Educate and Train: Staff need training on the importance of MBC and how to effectively implement it.
2. Adopt and Adapt: Select measurement tools that fit your patient population and care settings. Customize standardized labs panels.
3. Invest in Technology: Utilize digital platforms that integrate MBC seamlessly into clinical workflows.
4. Analyze and Act: Regularly review the data collected to inform clinical decisions and organizational strategies.
5. Foster a Culture of Measurement: Encourage an environment where ongoing measurement and data-driven care are valued and practiced.

To support this shift, I recommend joining the Measurement Based Care Workgroup within the Collaborative Family Healthcare Association (CFHA) (check the calendar for registration details). This group is at the forefront of advancing MBC in integrated care and is charged with advising CFHA as to how we can champion MBC.

Lastly, keep an eye out for a series of video shorts that CFHA will be releasing in the coming months on TikTok, YouTube shorts and this platform (see below). The shorts will highlight the why and the how of using health tech to make MBC possible.

In conclusion, my/our bad. We can do better. We need to do better for our patients and for integrated care as a leading field within the team-based care movement. The transition to value based care hinges on it. The transition to negotiation power with health systems and payers hinges on it. The transition to systematic implementation of integrated care delivery models hinges on it.

Photo by Celpax on Unsplash