Quality Measures at the Interface of Behavioral Health and Primary Care

Abstract

The development of quality measures has gained increasing attention as health care reimbursements transition from fee-for-service to value-based payment models. As behavioral health care moves towards integration of services with primary care, specific measures and payment incentives will be needed to successfully expand access. This study uses a keyword search to identify 730 quality indicators that are relevant to behavioral health and general medical health. Measures identified have been coded and grouped into domains based on a taxonomy developed by the authors. The analysis reveals that quality measures focusing on general medical conditions exceed those focused on behavioral health diagnoses for evidence-based treatments, patient safety, and outcomes. Furthermore, measures predominantly concentrate on care during or following hospitalizations, which represents a minority of behavioral health care and does not characterize the outpatient settings that are the focus of many models of integrated care. The authors offer recommendations for future steps to identify the quality measures that can best evaluate the evolving behavioral health care system.

Community Interventions to Promote Mental Health and Social Equity

“…Policies that promote mental health equity are beyond the scope of this review but are detailed in our recent review on this topic [ 113 •]. Policies as varied as mental health insurance parity, assisted outpatient treatment statutes, quality metrics for social determinants of health, value-based payment reforms, and the integration of funds and services for health and social care have the potential to improve access to treatment and improve outcomes [ 114 – 117 , 118 •, 119 – 121 ]. Policies facilitating multi-sector health collaborations include the Accountable Health Communities model, California’s Whole Person Care pilots, the Certified Community Behavioral Health Clinics Demonstration Program, New York’s Home and Community-based Services, the UK’s Social Impact Bonds Trailblazers, and the National Health Service England’s social prescribing teams [ 122 – 127 ].…”

Evaluating the Implementation of Integrated Mental Health Care: A Systematic Review to Guide the Development of Quality Measures

“…Other efforts that have focused on integrated care have been limited by use of generic frameworks applicable to health care in general, a small number of measures focused on care processes for single diseases, exclusive focus on client experience and outcomes (foregoing measures of provider, system, or financial outcomes), and emphasis on the chronic care model without regard to identifying its critical components and how they can be transferred across contexts (32,34,35). One recent study queried major U.S. databases of quality measures, seeking those that could be applicable to integrated care (36). Although such measures may more easily gain acceptance, particularly for performance measurement when funding may be at stake, they may not be the most important, comprehensive, or balanced set of measures to evaluate and improve integrated care implementation.…”

EPA guidance on the quality of mental health services: A systematic meta-review and update of recommendations focusing on care coordination

“…There are various quality indicators for integrated care models in mental healthcare, particularly for evidence-based care processes, individual clinical outcomes, efficiency (cost-effectiveness), and client satisfaction [38]. However, quality indicators assessing safety of care, equitability, accessibility, and timeliness of care [39], as well as quality indicators that focus on outpatient settings as provided by models of integrated care [37] are largely lacking. We consider suggestions for quality indicators from the preceding guidance paper [2] as valid.…”