Demand psych outcomes that demonstrate benefits
Report more than patient satisfaction
Many behavioral health providers choose measurement tools that are unsophisticated, inappropriate, or more for marketing purposes than for outcome measurement. Case managers must demand meaningful outcome measures that address issues of patient function and cost savings, says Robert W. Shomer, PhD, president and CEO of Hawthorne Medical Group and a medical group consultant in Los Angeles.
"Too many behavioral health providers stop with patient satisfaction measures. Satisfaction is not a measure, and it has nothing to do with effectiveness," says Shomer. "Even clinical measurements, such as clinical depression scales, may not be truly relevant as measures of patient function."
"It’s true that a patient could conceivably love the care they received and still be sick," agrees Verna Carson, PhD, RN, CSP, national director of behavioral health programs for Staff Builders in Lake Success, NY. "Rehospitalization rates, medication compliance, and emergency room use tend to be more meaningful outcomes." (For a care study of a behavioral health outcomes model, see p. 208.)
Therapists often focus on therapeutic goals and outcomes, says Shomer. "What case managers should ask therapists to provide is actual practical measures about how functional mental health patients are in the real world."
Yes, but can she cook?
He suggests that case managers ask instead for answers to questions that address real-life function, such as the following:
• Does the patient understand appropriate child-rearing practices?
• Does the patient understand how to support and appropriately discipline his or her children?
• Does the patient understand how to function at work?
"It’s possible that the patient has an entire range of myths or beliefs about work that make them paranoid and unable to function well on the job," says Shomer. "Behavioral health measures should focus on function just as rehabilitation measures do. Ask providers to address issues such as where does this patient want to be, and what skills are necessary to do that?"
"We always look at patient’s ability to perform instrumental activities of daily living," says Carson. "Can the patient write a check? balance a checkbook? cook a meal? In other words, the things that you do that help you establish and maintain your independence."
Shomer recalls one patient who was taught how to use the laundromat. "That one piece of practical knowledge made more impact on her functioning and her subjective feelings of worth than any exploration of her psyche," he says.
Medical cost offsets are another important measure of the effectiveness of behavioral health care, says Shomer. "Is the patient a high utilizer of health care services? Medical care utilization is difficult for behavioral health carve-out plans to measure," he notes. "It’s easier for larger managed medical care groups because it’s easier to coordinate the medical records with the behavioral health services record."
However, managed behavioral health plans can turn to local academic centers for help with outcomes studies, says Shomer.
"When I was with another medical group, I was approached by a professor working at the University of California, Los Angeles to collaborate on a study of primary care treatment of depression," he says. "It’s perfectly appro- priate to contact the psychology department at a local university and start a discussion about their interest in research on outcome measures."
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