Healthcare organizations are using digital health tools to gather more data about their patients, but the challenge has always been how to use that information.
At Ascension Illinois, care providers are using Measurement-Based Care (MBC) to improve outcomes in behavioral health treatment. The strategy is based on collecting information throughout treatment to assess outcomes, then modifying care management plans to improve treatment.
Chris Novak, vice president and chief operating officer for Ascension Illinois' behavioral medicine service line, says the process of gathering data to support treatment benefits not only the provider but also the patient. The health system uses a digital health platform developed by Owl to create a baseline assessment for each patient, then uses ongoing virtual questionnaires to demonstrate patient progress, giving providers the evidence they need to measure and then improve treatment.
The digital platform is important. It has allowed health systems like Ascension Illinois to move from paper-based questionnaires and subjective observations during visits to data collection at the point of care, saving valuable clinician time. It allows the provider to gain a better idea of what the patient is experiencing, and to collaborate with the patient on care management.
"It helps us to demonstrate to our patients in real time the improvements that we're seeing," he says. And in doing so, it allows clinicians to personalize patient care.
Data is often considered the cornerstone to improving clinical care, and innovations like digital health and telehealth have proven both beneficial and problematic. They allow healthcare providers to collect much more data than before, about patients as well as their home environment and daily habits, but that data must be sorted and analyzed. Without processing tools, providers are overwhelmed by data, unable to determine what information they can use.
"The field is evolving," says Novak, who sees home-based digital health platforms and wearables as the next evolution of MBC. The information contained in those platforms, he says, can greatly affect care management if used correctly. A care provider who can see into a patient's daily lifestyle can pinpoint activities or habits that affect health, and design care plans that reinforce good habits and steer the patient away from bad ones.
With the MBC platform used by Ascension Illinois, Novak and his colleagues gain insights from clinically validated assessments, offering objective data on a patient's care plan. The patient answers questionnaires electronically and submits the information to the care provider. For patients living with thought disorders or who might have problems answering questionnaires, the provider can administer those questionnaires with the patient during a session.
Those assessments give care providers the real-time information they need to improve care, and thus become the basis for value-based care.
MAKING THE CASE FOR MBC
A 2016 study by researchers at the University of Washington School of Medicine in Seattle gave high marks to what was then the relatively new concept of MBC, though they said the strategy needed more use to prove its full value.
"Across a wide range of treatment settings, there is a substantial gap between the outcomes achieved in randomized controlled trials and in routine mental health care," the study noted. "One of the main contributors to enhanced outcomes in randomized controlled trials is that treatment protocols include systematic measurement of symptom severity, followed by algorithm-based treatment adjustments when patients are not responding to care."
"Although there are numerous brief, validated symptom rating scales that reliably measure change in severity of symptoms over time, only 17.9% of psychiatrists and 11.1% of psychologists in the United States routinely administer symptom rating scales to their patients," the researchers continued. "On the basis of clinical judgment alone, mental health providers detect deterioration for only 21.4% of their patients who experience increased symptom severity. Detection rates are even worse for patients whose symptoms are not deteriorating but who also are not improving as expected. The failure to detect patients who are not responding to treatment contributes to clinical inertia (defined as not changing the treatment plan despite a lack of substantial improvement in symptom severity.) The use of symptom rating scales to monitor outcomes helps prompt clinicians to overcome treatment inertia and change the treatment plan when patients are not responding to treatment."
That study concluded that because behavioral healthcare providers weren't demonstrating the value of their treatments, payers weren't supporting the programs, leading to "chronic underfunding of mental health services." It argued that MBC could prove that value.
Then came the pandemic.
Novak says MBC proved its mettle during the pandemic, when most health systems shifted from an in-person model of care to a virtual platform to reduce the spread of the virus and enable care providers to treat patients in their homes. Through the platform, providers were not only defining the effectiveness of their treatments but also comparing the value of an in-person treatment program against a virtual program, or one that combines both virtual and in-person care.
It also allowed them to gain support from payers, who typically want to see proof that a new service will reduce costs and/or improve outcomes before they reimburse providers.
"Our discussions with payers have been positive," Novak says. MBC "quantitatively [demonstrates] that improvements are being made in a virtual setting, which is on par with in-person care."
The challenge, of course, lies in synching the data to the electronic health record (EHR), a process often complicated, if not hindered, by different platforms that store data in silos. Novak notes his health system currently works with four different EHRs, so it's easier right now to keep that data separate and integrate it later, when they move to one EHR.
That's where he sees this platform evolving. As the technology improves and systemwide integration is made easier, MBC will become a standard of care, with automated and adaptive testing that allows care providers to see the results in real time, adjust care management on the fly, and modify future assessments and tests to be more personalized.
"Behavioral health horizontally intersects all areas of medicine," he says, "and demonstrating the impact of effective care is critical."