The Behavioral Health Field Must Address Quality – Part 1

Last week, the President of the National Committee for Quality Assurance (NCQA), Margaret O’Kane, reported that quality of care in the United States did not improve in 2008. She went on to say that she believes health reform must address quality. A review of the report makes it abundantly clear to this author that one area in our healthcare system in particular needs immediate attention: behavioral health.

The 2009 State of Health Care Quality Report examines data from 979 participating health plans using the Healthcare Effectiveness Data and Information Set (HEDIS). Among the most glaring weaknesses in our system, NCQA found that care for mental health and substance abuse failed to improve significantly. While there were significant improvements to be celebrated in the treatment of certain medical conditions, all five trouble spots noted in the report were behavioral health related.

In five HEDIS measures, fewer than 50% of patients were receiving adequate and appropriate treatment.

• Only 34% of children prescribed medication for attention deficit hyperactivity disorder (ADHD) were seeing their physicians for follow-up care
• A dismal 47% of patients taking antidepressant medications were being monitored by their primary care doctors.
• When mental health patients were hospitalized, only 49.8% were receiving follow-up care or aftercare following their discharge.
• Only 42.6% of people screened, assessed and diagnosed with substance use disorders entered into treatment.

These numbers are alarming and – after twenty years in this field – they are not improving fast enough. What’s stopping us? Quality is not necessarily something that has to cost more. This and other reports have illustrated more than adequately that higher costs do not translate to improved quality. Frankly, where financial incentives are concerned, our current system only rewards providers for the volume of care they provide and the volume of patients they serve. ”More” is not better.

Pay-for-Performance needs to evolve so that we’re rewarding providers and plans that produce enhancements in quality measures and not simply improved administration and operations. Pay-for-quality needs to become part of our national dialogue.

Those of us in the behavioral health field should be appalled. This kind of national attention to five weaknesses in our healthcare system – all attributable to our field – does not help our cause. Parity and reform efforts need to galvanize our efforts to finally achieve quality goals. The next post will discuss how we make it happen.