The late Peter Drucker said, “If you can’t measure it, you can’t improve it.”
I think that is a statement that most managers would agree with. So my question—raised by Roland Larkin, NP, Ph.D., MBA, Medical Science Liaison, Otsuka Neuroscience and Srikanth Gottipati, Ph.D., M.Phil, Associate Director, Think Team, Otsuka Pharmaceutical Development & Commercialization, Inc., in their 2018 OPEN MINDS Technology & Informatics Institute session, Measurement Informed Treatment Assistant for Mental Health—why do only 7% of psychiatrists routinely use measurement based psychiatric scales when planning consumer treatment?
We know measurement-based care works. One study found that response rate to treatment is 87% when measurement-based care is used, compared to 63% when the standard of care is used. Even more startling, measurement-based care results in a 74% remission rate, compared to 29% when the standard of care is used. (For more, see The Moving Target—Best Practices In ‘Complex’ Care Management and Using Measurement-Based Care to Enhance Any Treatment.)
So why the lack of adoption of measurement-based care? Especially now that digital technology gives provider organizations the decision support tools and ability to analyze data as they talk to consumers. Examples of these tools include mHealth sensors, digital interventions and assessments, and medication adherence technology.
A lot of it comes down to issues with digital tech adoption. First, both clinical professionals and consumers must accept the use of the technology and trust that it will improve care. There must be the infrastructure to support the technology and integrate it into clinical practice. Then there are the regulatory and privacy concerns. Finally, consumers must be comfortable with technology and engage with it. Many times, one (or more) of these elements isn’t present.
Another issue is the way in which the field approaches evidence-based practices. For example, of the 10 million adults in the United States who were living with serious mental illness (SMI), only 32% received medication management and only 19% received support for illness self-management (see Why Do Only A Third Of Consumers With SMI Receive Evidence-Based Treatment?). Culprits for this include not including EBPs as part of a clinical professional’s initial education and training, and a lack of continuing education around EBPs for front-line staff.
Also, there hasn’t traditionally been a lot of financial incentives (like value-based care) to drive this adoption. The performance expectations of value-based purchasing arrangements will likely be demand that more provider organizations invest in standardized treatment protocols—protocols that will need more digital tech to achieve the necessary scale, efficiency, and return-on-investment.
Whatever the challenges with measurement-based care and the use of digital tools in the treatment of mental illness, there will be increasing pressure to use these approaches as value-based reimbursement becomes more common. To be successful in VBR, there are a couple of steps organizations need to follow. The first is to set performance standards. In this stage, organizations decide what to measure and how to measure it. The second step is metrics-based management. This is where you develop the systems and processes to use performance measurement in management. The final step is creating a performance-driven culture. In this step, you use the metrics agreed upon and integrated into your management in the first two steps to make changes to the system as necessary (see Are You Really Ready For Value-Based Payment? Planning Your Move To Pay-For-Value). Without this your organization is much more likely to be surprised when reconciling your value-based reimbursement.
For more on preparing your organization for value-based reimbursement, join us at The 2019 OPEN MINDS Performance Management Institute in Clearwater, Florida on February 14 for the session, “Have You Optimized Your Organization For Value-Based Reimbursement? The OPEN MINDS VBR Assessment”, led by John F. Talbot, Ph.D., OPEN MINDS Senior Associate.