1. Schneider Institute for Health Policy, The Heller School for Social Policy and Management, Brandeis University Using Performance Measures for Quality Improvement in Behavioral Health: The Role of Stakeholders Constance Horgan Deborah Garnick Center for Behavioral Health Support provided by SAMHSA and NIDA through the Brandeis/Harvard Center on Managed Care Presentation for Implementing Evidence-Based Practices and Performance Measures for Massachusetts Mental Health Services: An Educational Forum at Brandeis University September 28, 2005

2. Center for Behavioral Health Premise Performance measures are tools, and as such, do not lead to improvements unless they are well designed, appropriately used and applied in a system or organization that is equipped to implement change.

3. Center for Behavioral Health Today’s Presentation Room for Improvement Stakeholders Tools to Improve Performance –Information Technology –Incentives

4. Center for Behavioral Health Room for Improvement Effective care for depression –57.7% of time (McGlynn et al, 2003) Effective care for alcohol dependence –10.5% of time (McGlynn et al, 2003) HEDIS – Behavioral health is flat from 1999-2002 (NCQA, 2004) –BH measures – 48 to 50 percent –Non-BH measures – 57 to 67 percent (Goplerud, 2004)

5. Center for Behavioral Health Critical Juncture for Stakeholders Purchasers Health Plans Clinicians/Provider Groups Consumers/Patients Researchers

6. Center for Behavioral Health Purchasers Use in purchasing decisions Select a benefit design that supports the full continuum of care Use in a quality improvement framework in contracts

7. Center for Behavioral Health Health Plans Use to provide feedback to individual clinicians on comparative performance Design programs for quality improvement that have a direct link to improving measures Improve capacity to link data across systems

8. Center for Behavioral Health Clinicians/Provider Groups Participate in quality improvement initiatives in practice setting Recognize clinicians who are delivering services of particularly high quality

9. Center for Behavioral Health Consumers/Patients Use published performance measures to become better informed Collaborate with community groups to encourage use of performance measures for accountability

10. Center for Behavioral Health Researchers Study the links among performance measures quality of care, and improved clinical and functional outcomes Study the organizational and system factors that result in effective use of performance measures

11. Center for Behavioral Health Tools for Improvement – Information Technology Uses of computer-based IT –screening –clinical decision-making –patient monitoring/reminders Automated databases and electronic medical record Diffusion is slow

12. Center for Behavioral Health Tools for Improvement - Incentives Financial – “pay-for-performance” Non-financial –reputational/recognition –reduction in administrative burdens Other economic –IT investment –variable co-payment rates for patients

13. Center for Behavioral Health Conclusion Having a performance measure is necessary but not sufficient How it is used and who uses it is key Seek solutions from multiple stakeholders THE CHALLENGE IS LARGE!