The Behavioral Health Field Must Address Quality Part 2

When the 2009 State of Health Care Quality Report lists 5 trouble spots – and all are related to behavioral healthcare – it should catalyze our efforts to achieve quality goals in our field. How do we make it happen?

I am suggesting that we approach quality in our field the same way we’ve been forced to deal with Y2K, HIPAA, CPT codes, and NPI in the recent past: coerce ourselves through the change process. Mandate change. Require and enforce the adoption of quality measures and continuous quality improvement.

We must approach this situation with the utmost sense of urgency and importance. We cannot afford to continue doing things the way they have been done. I have been around long enough to see quality initiatives recycled agency after agency, re-tooled, considered, commented upon in learning collaboratives, researched and evaluated and still…not nearly enough progress in execution. Our problem is cultural in nature and culture rules. Our inclination must be one of accountability moving forward. Strategically speaking, if we do not force ourselves to stop “meeting and reviewing” instead of taking the  medicine, we will get sicker and be faced with grave consequences. Forcing ourselves to do the right thing is  difficult and requires sacrifice.

The behavioral health field – managed behavioral health organizations included – needs to address the following:

1. Establish national priorities and a deadline
2. Address the issue of normalizing and standardizing professional qualifications and criteria for licensure and accreditation
3. Become a “player” in the remainder of the national dialogue on healthcare. This means that behavioral health must be “present and accounted for” when talk turns to Patient-Centered Medical Home and other initiatives, especially as it relates to quality assurance and continuous quality improvement. Behavioral health care – access, cost and quality – spans across disciplines into primary care and general medical care so we best be at the table.
4. Agree upon and commit to a broad set of quality indicators and implement them fully. Very often, plans are measuring data that providers cannot relate to and vice versa. The full implementation should take 12 months or less.
5. Collaborate and accept responsibility. The fact that more than 60% of prescriptions for antidepressant medication originate in primary care offices and that nearly 50% do not receive adequate monitoring is indicative of opportunities for both collaboration and accountability.
6. Plans must enable providers to do the very things that result in greater quality.
   1. Primary care collaboration with behavioral healthcare must be enabled by health plans.
   2. Aftercare and follow-up after discharge must be reimbursed properly.
   3. Substance abuse screening tools and adequate numbers of substance abuse professionals will enable people to receive the care they require.
   4. If and when provider networks are inadequate, proper referrals are problematic if not impossible.
   5. Plans, payers and networks cannot continue to impose access barriers to care that produce better quality.

You can see the entire report at: http://www.ncqa.org/Portals/0/Newsroom/SOHC/SOHC_2009.pdf.