Noah Nordheimer, Founder & CEO of APN, a mind-body health company.
More than one in five U.S. adults live with mental illness today. While we have a variety of diagnostic metrics available, I find that measuring and monitoring patient progress during and after receiving mental health treatment is routinely absent from the behavioral health industry, hindering our chances of successfully treating people.
Behavioral health providers typically stick to a fee-for-service model, meaning the longer a patient is in treatment, the more the provider makes. From an economic standpoint, this can limit the incentive for providers to pursue the most rapid and effective treatments for their patients.
There’s another obstacle, though. New and emerging treatments—or even a hybrid approach of new and old— could be more effective for those grappling with mental illness, yet without keen attention to measuring outcomes, the industry may never know.
However, I believe that once there is an outcomes tracking system in place, patient providers will have access to the data needed to customize treatment plans, implement new and emerging treatments and ensure long-term results.
Standardizing Success While Maintaining Customized Care
To implement outcomes-based behavioral healthcare counters, I believe that we must begin with a clear definition of desired results and the implementation of a formal system in place to track progress over time. Historically, we’ve considered this too difficult to achieve. Because each patient is different, and (hopefully) receives unique treatment, it can be hard to standardize measures for achievement. A successful outcomes-based behavioral health model tracks the effectiveness of providers and treatments based on the actual value delivered to each individual patient.
The good news is, there are many existing metrics for mental health. You can even create your own as long as you’re consistent. Widely accepted mental health metrics like the patient health questionnaire-9 (PHQ9) for depression severity and the general anxiety disorder-7 (GAD7) score for anxiety can be good places to start with standard setting, as can industry-wide resources like ACORN (a collaborative outcomes resource network) and ERPHealth, which both deploy proprietary questionnaires and assessments.
Consistency In Questionnaires
I find that patient questionnaires are the best resource we have for measuring outcomes. The ideal questionnaire will ask a variety of questions pertaining to how the patient is feeling in the moment and about the care being provided, and it should only take a few minutes for patients to complete. Anything too long is likely to be ignored. Incentivizing patients with gift cards or other rewards can ensure participation goals are met.
As a best practice, questionnaires should be administered to patients at regular intervals and consist of the same set of strategic questions each time, getting the most accurate depiction of patient well-being and distress levels at the moment in addition to the treatments they’re using as part of their program. Comparing the results of these questionnaires can tell us not only how patients are feeling firsthand but also how things are improving or worsening.
Knowing every day can differ from the next when struggling with mental illness, these surveys should be administered regularly, and the results should be analyzed and shared not only with the therapist directly working with a patient but all personnel within the organization. This way, providers can adapt care for patients who have worsened or plateaued, making the appropriate changes needed to produce better outcomes on an ongoing basis.
Software such as the earlier mentioned ACORN and ERPHealth essentially do the work for you and demonstrate not only how you’re improving but also where you rank within the industry. I find that the ongoing use of patient questionnaires to share data is crucial to better inform ongoing and future treatment. After all, if you’re in the dark about how impactful your care is over time, how will you ever help your patients get better in the short and long term?
Patient Data Drives Change In Treatment Modalities
When behavioral health providers receive data from questionnaires and assess results against their own prior performance and other provider results, they are more likely to see how well (or in most cases, poorly) traditional methods serve patients. Data has the power to inspire us as an industry to step outside the box and embrace non-traditional treatments. It’s simple: If a patient is not improving from the traditional psychotherapy process, it may be time to implement alternative therapies into the treatment plan.
Emerging treatments like deep transcranial magnetic stimulation, hyperbaric oxygen therapy, stella ganglion block, neurofeedback and even fitness classes in conjunction with traditional psychotherapy can be cycled into a patient’s care plan to test their results. Behavioral health is no different from other forms of healthcare where there are various approaches and solutions for each patient. Unfortunately, I witness how many behavioral health providers have an antiquated model of care that is a “one-size-fits-all” approach or a single modality that does not lend itself to what could be an iterative process.
Treatment without a focus on results is not the standard in the larger healthcare industry and should not be our standard in the behavioral health sector. By using an outcomes-based measurement system, behavioral healthcare providers not only keep track of how patients are doing in therapy or other forms of treatment but also hold themselves accountable with a better understanding of how they compare to others in the industry. This not only has the potential to lead to higher quality care but to even more customized treatment plans, encouraging all of us to think outside the box about how we can generate the best outcomes possible for our patients.
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