“Developing and validating a set of robust quality measures that targets this high-cost/high-need patient population and is tied to new payment mechanisms can play a powerful role to encourage more cost-effective care. If designed and implemented correctly, measures associated with best practices and outcomes for integrated care can increase accountability across health care settings, diminish disincentives to serve and treat these complex patients, broaden dissemination of research-proven models that improve patient outcomes, and enhance the efficiency of the health care system as a whole.” (JAMA)

Our Take: Behavioral Health is the next frontier for ACOs, once they have their diabetes and cardiovascular disease patients under management. For now, most CMOs see the problem but lack the tools and motivation to address this patient population. In an interview, one CEO told us:

The management is very difficult because evidence-based medicine usually is designed for one condition. So if you got hypertension, diabetes and COPD, you could be on eight or nine different medications and creates all sorts of complex pharmacological issues, cost issues, compliance issues, et cetera. So, not an easy solution to that problem and everybody's kind of struggling with it. But the best systems are the ones that have assigned a care manager to patients that have very complicated problems.

Care managers are an often-cited solution to managing patients with behavioral health issues, particularly the seriously mentally ill population. But currently, other than for depression screening, there are no performance measures in place for ACOs—nor are there metrics that address the complexity of comorbidities. NCQA and other standards bodies should recognize this gap in performance measurement and address them with more focused quality metrics.

Leave a comment