Psychiatry’s Accountability Gap: Embracing Measurement-Informed Care in Value-Based Healthcare.

Psychiatrists don’t like being held accountable.

We like to think that the value of our work is beyond measure.

We have to stop thinking this way if we are going to be recognized for the contributions we make to overall patient wellness.

Deborah Scharf, Henry Cheng, and Joseph Parks just published one of the most important behavioral health papers of the year.

They authored a piece I’ve long been waiting for.

In it they outline a set of thoughtful recommendations to ensure psychiatry doesn’t fall behind in the race to value-based care.

If we’re not leading this discussion, payers will set standards and benchmarks for us.

The trio argues for measurement-informed care (MIC) as a way to ensure the clinical data we collect meaningfully drives care while offering value to payers.

They say, effective MIC should use…

1. Reliable and valid service user-reported outcomes or biometric indicators.

2. Repeated measurements at clinically meaningful, regular intervals.

3. Measures as a part of a larger set of data to drive clinical decisions.

4. The same measures to drive accountability and care efficiency.

Beyond these measures, the authors recognize the need to collection informaton about service user preferences, social factors, culture, quality of life, functional needs and goals, family supports, and health literacy, among others.

They split their recommendations into 2 tiers. Tier 1 represents those that can be readily implemented, while Tier 2 includes others for future consideration.

The Tier 1 group include 3 patient self-report measures: the American Psychological Association’s depression response, anxiety response, and alcohol use disorder outcome measures.

Tier 2 recommendations also call for ongoing monitoring of diabetes and cardiovascular risk factors, including HbA1c and blood pressure.

The authors collaborated on this paper as part of an effort led by National Council for Mental Wellbeing.

I so appreciate this paper and the leadership displayed by the authors and the NCMW. I’d love to see the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry step us as well.

Photo Credit: Jack Bell Photography