Background
People with serious mental illness and those struggling with substance abuse use more medical resources than other patients, partly because behavioral health conditions can complicate efforts to treat diabetes, hypertension, and other chronic conditions. Although the integration of physical and behavioral health services has been shown to improve outcomes and reduce spending, it has failed to take hold. In a JAMA Viewpoint, Commonwealth Fund–supported authors say that the missing link to increased adoption of this model may be quality measures for assessing and rewarding well-integrated care.
Gaps in Measurement and Opportunities for Improvement
Because current quality metrics tend to focus on narrow, condition-specific targets and limited care processes, they often fail to capture whether the care provided to patients with comorbid physical and behavioral health conditions is consistent with best practices. The authors note only 31 of the 611 measures endorsed by the National Quality Forum focus on mental health or substance abuse; among those, just four target the interface between behavioral and physical health care.
Providers’ interest in the integrated model may increase, however, thanks to provisions in the Affordable Care Act that support behavioral health. The use of value-based contracting arrangements that reward providers for improving care for high-need, high-cost patients may further spur adoption because of the model’s potential to reduce spending. Tying financial incentives to performance on integration-specific measures may accelerate the process.
Conclusions
If designed and implemented correctly, measures associated with best practices and outcomes for integrated care may encourage providers to serve and treat these complex patients and broaden the dissemination of proven models.