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Quality measurement in healthcare is critical in the management of clinical processes, outcomes, patient preferences, and implementation of systems changes. While physical medicine has clearly defined outcomes, measurable outcomes in behavioral health have been more elusive.

Valera Health is honored to announce accreditation in Credentialing and Recredentialing by the National Committee for Quality Assurance (NCQA). Valera Health is a leading behavioral healthcare practice that provides comprehensive, longitudinal care delivered through a team-based care model of coaches, therapists and physicians augmented by proprietary digital technology and analytics. From therapy to medication management, patients with mild depression to schizophrenia are treated with expert care.

Quality measurement in healthcare is critical in the management of clinical processes, outcomes, patient preferences, and implementation of systems changes. Quality experts, Federal agencies and consumers want effective, safe, efficient, patient-centered, equitable, and timely care. While physical medicine has clearly defined outcomes such as fasting glucose measurements and blood pressure, measurable outcomes in behavioral health have been more elusive. 

As a former staff member who worked on the development of the Affordable Care Act on the Ways and Means Committee, I had a bird’s eye view as Accountable Care Organizations were launched by CMS to focus on well-defined metrics of quality. The stewards of quality measurement, like the National Quality Forum (NQF) and National Committee for Quality Assurance (NCQA), have made significant progress on improving the national inventory of mental health quality measures using EMR and claims datasets that can capture both process and patient-reported outcomes. 

Valera Health’s foundation is built on this premise of measurable quality. The broader ecosystem, including health plans, quality experts, patients, providers and policymakers, needs to collaborate on redefining quality as it continues on the path of value-based models.

The next generation of mental health organizations will require three competencies to be well-positioned to drive high-quality care in this new paradigm:

  • Robust quality strategy consisting of process and outcome measurement
  • Feedback loops with provider network for continuous quality improvement
  • Elevating standards to align with new evidence and research

Quality strategy- is it real? 

Perceptions of healthcare quality vary widely by stakeholder. While patients may prioritize convenience and access, clinicians may focus more on ensuring the right care team for a given patient. Accrediting organizations like NCQA, on the other hand, may evaluate quality based on overall outcomes across a panel, while insurers may try to quantify process improvement. Given the complex interfaces between these stakeholders, thorough quality measurement includes not only outcomes but also the processes by which care is delivered. 

This is especially true given the disproportionate impact the process of receiving care has on a patient’s experience. For example, following up with a patient after a positive screening or a discharge from an inpatient stay is an example of a process measure that is both within the control of a provider organization and associated with improved outcomes.

Process metrics tend to be most actionable on a day-to-day basis and should ideally provide leading indicators of at-risk patients. Moreover, choosing appropriate process metrics is critical for converting the enormous amounts of data generated by telemental health services into valuable insights that can drive the outcome that matters most to the patient: “am I feeling better?”

Valera Health’s hyper focus on high-quality requires capturing a mix of process and outcome measures. 

Two-way communication with the provider network

It is the outcome measures, though, that ultimately are most important in providing an overall picture of patient health. For this picture to be clear requires communication across care settings, locations, and organizations. 

Building these communication channels is a long-term journey that involves a constant stream of data being shared with and captured from the provider network, care managers, and anyone else on the care team. Valera Health utilizes a team approach in the delivery of care to high and moderate acuity individuals. 

We facilitate a feedback loop by using one electronic medical record and one digital platform system that measures patient-reported outcomes at various intervals. Organizations with limited longitudinality of care will struggle to improve outcomes for individual patients as well as to improve their own care processes more generally. 

Today’s standard might not be tomorrow’s standard

At Valera Health, expanding access to care is a guiding principle; for an organization to continually improve its quality over time, it must expand the types of conditions it treats and patients it serves. In mental health, for example, while many organizations can manage care for a patient with mild anxiety, there are far fewer that are equipped to address serious mental illness in an evidence-based way at scale. 

For these higher acuity patients, the use of clinically validated assessments over time provides critical insights to clinical effectiveness of treatment. For example, antipsychotic medications over time may increase weight gain for certain individuals; Can we identify this trend and intervene early? 

Delivering truly high quality care requires having the capacity to collect data from providers and patients. It also requires actively staying up to date on the latest national standards and most recent research, and incorporating them into quality measurement and improvement efforts. 

Skate to where the puck is - develop measures that matter

Behavioral health organizations best positioned to continue elevating the quality bar share three characteristics: an emphasis on process as well as outcomes measurement, ability to provide a feedback loop to their network providers, and incorporating new data, research and standards to elevate practice.

The National Quality Forum almost two decades ago had created a group of experts called the “Gretzy group” to develop a national strategy in creating measures that matter. My hope is that patients, health plans and providers along with organizations like NQF and NCQA can re-invigorate a collaborative effort to create robust measures that matter. 

Article written by Dr. Thomas Tsang, MD, MPH, Co-Founder & CEO of Valera Health.

1  Muench J, Hamer AM. Adverse effects of antipsychotic medications. Am Fam Physician. 2010 Mar 1;81(5):617-22. PMID: 20187598