TRENDS

Has the hour for outcomes measurement come round at last?

Consultants and industry insiders have been telling us for 10 or 15 years that outcomes measurement is the next big thing. But implementation has been slow. When it comes right down to it, clinical outcomes have ranked a distant third in importance behind: 1) cost; and 2) basic customer service issues such as how quickly the first session is scheduled.

But now a number of the largest MCOs are taking a more serious look at outcomes. In fact, some companies have instituted incentives to encourage clinicians to collect and use outcomes data.

"I think managed care will use outcomes as a carrot," says Jason Seidel, a Denver clinician who trains other therapists in the use of outcomes measurement tools. "If they start rewarding their outstanding therapists by sending them more cases, they’re going to get better outcomes."hhhh

UBH gets serious about outcomes
   United Behavioral Health (UBH), the second largest company in the field behind Magellan, launched its outcomes program in January, 2007. Essentially, UBH adopted the program already in use by PacifiCare Behavioral, which merged with UBH in January, 2006.
   PacifiCare had five years’ experience collecting outcomes data prior to the merger. During that time, it had a participation rate of between 60% and 67%, according to Rhonda Robinson Beale, UBH chief medical officer. Clinicians who didn’t turn in outcomes surveys received telephone follow-ups.
Use of outcomes data with PacifiCare was tied to authorizations. But the UBH program is being refined because the company no longer requires pre-authorizations.
   Even so, use of outcomes tools are, technically, required for all 70,000 practitioners in the network. So far, though, the compliance rate is only about 37%.
   “What we’re doing now is reaching out to the high volume providers, going to their offices, making phone calls,” Beale tells us. “We’re talking about the barriers that might be preventing them from using the evaluations ...We’ve had quite a few skeptics, but we find they’re getting more and more receptive.”
Will UBH tie positive outcomes data to incentives such as higher pay or more clients? (This is the direction MHN is heading in—see above.)
“That’s something we’re looking at for the future,” Beale says. “Right now we’re concentrating on increasing the volume of surveys. We need a critical volume to have a statistically significant population to review.”
   In the UBH program, clinicians test patients before therapy and during therapy to see what progress is being made. Information is faxed to UBH, but a Web-based survey is expected to be available by the end of the year.
   Contact Rhonda Robinson Beale through Brad Lotterman in Santa Ana, CA, (714)445-0453.

United Behavioral Health (UBH) started a major push for outcomes data earlier this year. (See the box below.) Here’s where some of the other companies stand right now:

MHN launched a "pay for performance" pilot program this fall. According to Medical Director Ian Shaffer, the plan is to pay clinicians who achieve the best results a bonus over and above the contracted rate. The program will be expanded eventually to cover the whole network, Shaffer says. But it’s been slow going. MHN started developing the program in mid-2006, and expected to implement it sooner.

Magellan has an "outcomes monitoring initiative," in which members self-report their progress on the Web. Clinicians can view the reports online.

CIGNA has a series of assessment and outcomes tools on its provider Web site, and encourages clinicians to use them. But data is not compiled by the company. "Clinicians use them for their own information," a spokesperson says.

WellPoint Behavioral has no requirements for collection of outcomes data at this time.

Of course, many clinicians remain resistant to outcomes requirements. Carol Goodheart, a member of the American Psychological Association’s board of directors, says outcomes measurement at managed care companies is a "wolf in sheep’s clothing issue, because it’s really not about improving quality--it’s about reducing costs."

Nevertheless, she feels, outcomes are "what’s coming down the pike." She adds that some practitioners are "terrified" of using outcomes measurements--but needlessly. "I think we’re doing a terrific job."

Goodheart, a former president of the APA’s private practice division (Division 42, concludes: "Demands for evidence will escalate. No amount of kvetching, howling, or resolutions will alter it."

But for now, Seidel says fewer than 1% of clinicians in private practice are using outcomes measurement tools. Those in group practices and in clinics are the most interested, he says.

Interestingly, when PacifiCare launched an outcomes program several years ago, it required clinicians to participate. Even so, says Seidel, "their rate of return wasn’t that great. No one wanted to do it."

Where is all of this headed? "My feeling is that there’s going to be a slow ramp-up," Seidel concludes. "It’ll start dripping down from an institutional level, whether it’s managed care companies requiring it or community health centers using it. You’ll need to justify your existence."

ValueOptions’ select network

   After two years of a hit-and-miss outcomes program with few of its practitioners actually participating, ValueOptions is starting a new “Select” network of providers on January 1.
   In return for completing outcomes surveys, participating providers will get preferred treatment by the company—including a Web-based boost to attract more clients.
   Reimbursement rates will remain the same, says Don Christiansen, corporate chief clinical officer.
“But we’ll indicate on our MemberCon-nect—which more and more of our members are accessing to get names of providers—that the provider is ‘ValueSelect.’ Hopefully that will steer more members their way.
   “We’re looking for clinicians who are able to demonstrate that they have expertise in the areas they say they have. We want evidence of their training.
“Also, they agree to give us the outcomes data at two points. (At the start and completion of treatment.) And they agree to transact business with us using our Web-based interface. The adoption rate with that has been slow.”
   The providers will also get discounts on CEUs and other training opportunities, Christiansen says.
“We’re actively recruiting high volume providers. Ultimately we’d like to have enough to accommodate at least half of our member needs.”
ValueOptions covers about 24 million lives and has a network of 50,000 providers.
   You can contact Don Christiansen at ValueOptions in Norfolk, VA, (757)459-5100, email: don.christensen@ valueoptions.com

An outcomes measurement advocate who offers training in this area, Seidel says outcomes data can have marketing advantages for clinicians. He refers to the data "whenever I have face-to-face meetings with doctors or lawyers. I let them know I have a validated system to make sure my clients are getting what they need from therapy. I have a self-pay practice so I better be able to justify the fees I’m charging."

Contacts: 1) Carol Goodheart, 114 Commons Way, Princeton, NJ 08540, (609)987-8844, www.drcarolgoodheart.com; 2) Jason Seidel, 360 S. Monroe St., Ste. 300, Denver, CO 80209, (720)570-8440, www.jasonseidel.com. The outcomes tools Seidel uses are downloadable at www.talkingcure.com. He charges $180 an hour to consult in this area, and will work with clinicians by phone.

November 2007