In this post we chat with Cynthia Grant, PhD, LCSW, Head of Clinical Excellence at Grow Therapy, about the work being done to raise the bar on quality in the telehealth space and how Grow is partnering with payors to collaborate on moving the industry forward. Cynthia shares her thoughts on the intersection of clinical practice and data as a way for payors and providers to tell the story of the impact of care delivery in a way that benefits all.  

Let’s start from the beginning.  How do you define quality?

Quality means very different things depending on who you ask. It may be a concept as simple as a client having a feeling that their therapist is helping, while a payor may view quality through a formal, value or performance-based lens defined by HEDIS measures. Providers tend to understand quality of care as delivering evidence-based, patient-centered care that leads to positive client outcomes.  

Ultimately, I believe that quality refers to how good something is — the degree of excellence it possesses. High quality behavioral healthcare (or what we call clinical excellence) leads to the achievement of the quadruple aim of better outcomes, lower per capita costs, improved patient experience, and clinician satisfaction.

Why is it so important to measure quality in behavioral health (and especially in a telehealth environment)?

Tracking quality is one of the ways we can transform behavioral care delivery for the better. Although many of us never imagined it would be possible pre-COVID, research consistently shows that telehealth can produce equal or better outcomes than in-person behavioral healthcare if implemented appropriately. We need transparent quality data to show that.

Data can drive accountability and value by tying payment and reimbursement rates to quality indicators like symptom improvements and client satisfaction. This incentivizes providers to deliver better care.  It allows us to identify gaps in care and opportunities for improvement related to important factors like timeliness, documentation practices, and client engagement.

What has Grow done to get provider buy-in to quality programs?

We need to be mindful of the wide range of provider perceptions of quality. For some people a quality program is seen as an opportunity to recognize clinical excellence and the impact their work is having on clients. Others view quality as a prescriptive or punitive approach imposed by organizations and payors. We don’t want to create an us vs. them mentality but want to be sure quality is viewed as a way to elevate and improve the work.

When I started at Grow I went on a listening tour and held focus groups with providers to hear about their perceptions of quality. I also used a survey to collect feedback from more than 150 providers on what quality indicators they felt would be good measures of their work. It was great to hear about provider beliefs of what quality means to them! This work allowed me to identify blind spots and potholes I could anticipate, to find quality champions among our provider group, and to plant seeds about the upcoming expansion of the quality program at Grow.  

We started by sharing quality with celebratory initiatives to let providers know of things we were tracking that they were doing right. We gave top performing providers information about their performance on key quality indicators and collected input from this group on how best to message quality results to others. One comment from a provider gave us a good indication that we were approaching this correctly. A therapist wrote to me: “It’s helpful for me to learn what areas I'm doing well in and what areas I'm struggling in so that I can improve my overall craft. Thank you Grow for all you've been doing and creating. It's greatly appreciated!”

What are some of the gold standards for measuring the quality of care by behavioral health providers?  

Great question! We’re getting closer and closer to standardizing what measures we should be tracking in behavioral health. The combination of client satisfaction, symptom change scores, functional assessments, hospital/ED usage rates and measurement-based care over time provides a robust picture of quality. The items we should be measuring aren’t behind the curtain anymore and are things we should all have at our fingertips. Here are some of the most common areas in behavioral health:

• HEDIS measures from the National Committee for Quality Assurance such as engagement in alcohol and substance abuse treatment, depression medication management, and follow-up care after mental health hospitalization. Anyone can compare apples to apples across providers when using these measures.
• CAHPS surveys that assess client satisfaction and experience of care through standardized questionnaires focused on accessibility, communication, shared decision making, perceived effectiveness and more.
• Measures of the therapeutic alliance (TA) allow providers to have timely feedback from the client on the strength of the relationship and if the care is helping. TA measures are also known to positively correlate with clinical outcomes overall.  
• Utilization rates for outcomes like emergency department visits and psychiatric hospital admissions/readmissions which signal unmet needs. Lower rates indicate better ambulatory care quality.
• Standardized symptom rating scales such as the PHQ-9 depression questionnaire and the GAD-7 anxiety scale, which measure symptom severity changes over the course of treatment. Improvement signals therapy efficacy.
• Functional assessment tools evaluate how much symptoms currently disrupt things like work, relationships, and self-care. Assessing patient changes across functional domains helps quantify clinical outcomes in terms of daily life impact rather than just reducing acute symptoms as an indicator of quality care. Higher functioning equates to better care.
• Measurement-based care using validated screeners and rating scales during nearly every encounter to systematically monitor clinical outcomes and adjust care plans accordingly.

Why is quality so valuable to share with payors?

Sharing data lays the foundation for mutually aligned provider and payor goals. It builds trust and transparency regarding clinical results and how dollars are being spent on interventions that work. It’s a win-win arrangement.

Quality data allows for providers to demonstrate the value of care delivered by objectively showing the efficacy of treatment. This evidence can justify reimbursement rates and support contract negotiations by providing tangible metrics that care leads to reduced risks and lower costs over time through elements like decreased ER visits. It’s powerful for providers to be able to see the impact of their work on the total cost of care.  

Having quality data enables payors to incentivize quality through value-based arrangements that tie reimbursements to outcomes via bonuses or shared savings plans. In addition, collecting and sharing quality measures allows for payors to compare providers, driving competition based on client experience and efficacy rather than cost alone. Access to quality data benefits all stakeholders and is something all of us should strive to offer.

Interested in learning more about Grow Therapy’s leadership in quality?

For strategic partnership inquiries, please contact: contracting@growtherapy.com

For general inquiries, please contact: support@growtherapy.com

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More about Grow Therapy

Grow Therapy (“Grow”) is building the highest quality system for mental health professionals to deliver care to patients. Grow has taken cues from health plans and other partners to develop a provider group and design a platform that enables the quadruple aim of enhancing the patient experience, improving the work life of providers, advancing population health, and reducing care costs.