Quality Improvement With Pay-for-Performance Incentives in Integrated Behavioral Health Care

Unützer, Jürgen; Chan, Ya Fen; Hafer, Erin; Knaster, Jessica; Shields, Andrew; Powers, Diane; Veith, Richard C.

doi:10.2105/ajph.2011.300555

Cited by 144 publications

(118 citation statements)

References 23 publications

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“…In response to prior observations of variation in care, MHIP initiated quality improvement efforts, including pay-forperformance incentives for timely follow-up, psychiatric review for patients not improving, and regular medication tracking, that have led to substantial improvements in performance measures and patient outcomes. 20 It would be possible to tailor performance metrics further to account for additional indicators of clinical status, such as suicidality.…”

Section: Discussionmentioning

confidence: 99%

Characteristics, Management, and Depression Outcomes of Primary Care Patients Who Endorse Thoughts of Death or Suicide on the PHQ-9

et al. 2012

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BACKGROUND: With increasing emphasis on integrating behavioral health services, primary care providers play an important role in managing patients with suicidal thoughts. OBJECTIVE: To evaluate whether Patient Health Questionnaire-9 (PHQ-9) Item 9 scores are associated with patient characteristics, management, and depression outcomes in a primary care-based mental health program. DESIGN: Observational analysis of data collected from a patient registry. PARTICIPANTS: Eleven thousand fifteen adults enrolled in the Mental Health Integration Program (MHIP). INTERVENTIONS: MHIP provides integrated mental health services for safety-net populations in over 100 community health centers across Washington State. Key elements of the team-based model include: a disease registry; integrated care management; and organized psychiatric case review. MAIN MEASURES: The independent variable, suicidal ideation (SI), was assessed by PHQ-9 Item 9. Depression severity was assessed with the PHQ-8. Outcomes included four indicators of depression treatment process (care manager contact, psychiatric case review, psychotropic medications, and specialty mental health referral), and two indicators of depression outcomes (50 % reduction in PHQ-9 score and PHQ-9 score<10). KEY RESULTS: SI was common (45.2 %) at baseline, with significantly higher rates among men and patients with greater psychopathology. Few patients with SI (5.4 %) lacked substantial current depressive symptoms. After adjusting for age, gender, and severity of psychopathology, patients with SI received follow-up earlier (care manager contact HR=1.05, p<0.001; psychiatric review HR=1.02, p<0.05), and were more likely to receive psychotropic medications (OR = 1.11, p = 0.001) and specialty referral (OR=1.23, p<0.001), yet were less likely to achieve a PHQ-9 score<10 (HR=0.87, p<0.001). CONCLUSIONS: Suicidal thoughts are common among safety-net patients referred by primary care providers for behavioral health care. Scores on Item 9 of the PHQ-9 are easily obtainable in primary care, may help providers initiate conversations about suicidality, and serve as useful markers of psychiatric complexity and treatment-resistance. Patients with positive scores should receive timely and comprehensive psychiatric evaluation and follow-up.KEY WORDS: suicidal ideation; primary health care; community health centers; mental health services; disease management.

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Section: Discussionmentioning

confidence: 99%

Characteristics, Management, and Depression Outcomes of Primary Care Patients Who Endorse Thoughts of Death or Suicide on the PHQ-9

et al. 2012

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“…These initiatives reward providers for outcomes improvement and are also increasingly becoming used in mental health care 90,91 . Other innovations involve care beyond the clinic walls, including the measurement of recovery-oriented services 92 and incorporation of mobile health to capture outcome data 65,93 .…”

Section: Innovations In Mental Health Care Quality Measurement and Immentioning

confidence: 99%

Measuring and improving the quality of mental health care: a global perspective

et al. 2018

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Mental disorders are common worldwide, yet the quality of care for these disorders has not increased to the same extent as that for physical conditions. In this paper, we present a framework for promoting quality measurement as a tool for improving quality of mental health care. We identify key barriers to this effort, including lack of standardized information technology-based data sources, limited scientific evidence for mental health quality measures, lack of provider training and support, and cultural barriers to integrating mental health care within general health environments. We describe several innovations that are underway worldwide which can mitigate these barriers. Based on these experiences, we offer several recommendations for improving quality of mental health care. Health care payers and providers will need a portfolio of validated measures of patient-centered outcomes across a spectrum of conditions. Common data elements will have to be developed and embedded within existing electronic health records and other information technology tools. Mental health outcomes will need to be assessed more routinely, and measurement-based care should become part of the overall culture of the mental health care system. Health care systems will need a valid way to stratify quality measures, in order to address potential gaps among subpopulations and identify groups in most need of quality improvement. Much more attention should be devoted to workforce training in and capacity for quality improvement. The field of mental health quality improvement is a team sport, requiring coordination across different providers, involvement of consumer advocates, and leveraging of resources and incentives from health care payers and systems.

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“…First, we were unable to comprehensively measure PCMH qualities (including co-location of MHPs, quality improvement initiatives, and payment reforms) that are likely to be important for MHS in primary care settings. [59][60][61][62][63] Second, our analyses were cross-sectional, raising concerns of reverse causality bias. It may be the case that patients with prior MHS use are more likely to describe their provider as a usual source of care.…”

Section: Limitationsmentioning

confidence: 99%

Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use

et al. 2015

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Quality Improvement With Pay-for-Performance Incentives in Integrated Behavioral Health Care

Cited by 144 publications

References 23 publications

Characteristics, Management, and Depression Outcomes of Primary Care Patients Who Endorse Thoughts of Death or Suicide on the PHQ-9

Characteristics, Management, and Depression Outcomes of Primary Care Patients Who Endorse Thoughts of Death or Suicide on the PHQ-9

Measuring and improving the quality of mental health care: a global perspective

Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use

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