Thresholds

Leading the Way: The Shift To Value-Based Care in Behavioral Health

Evaluation Department Field Notes

Here at Thresholds, the Evaluation Department is helping to drive improvements in our programs by providing relevant, timely data to staff across our 100 treatment teams. In the process, the department is also documenting Thresholds’ performance as we move to value-based care in an increasingly competitive health care market.

Behavioral Health Providers Poised to Lead

Specialty behavioral health providers like Thresholds historically have utilized person-centered, trusting relationships and done whatever is needed to support individuals with complex social and health needs. These providers have served a valuable function within the healthcare system for many years by disrupting the cycle of high-cost and inappropriate institutional care like emergency rooms, hospitals, and jails. Our approach helps people with serious mental illnesses live successfully in the community. Community behavioral health care providers like Thresholds are poised to take the lead in the shift to value-based care by continuing to improve outcomes and document value, two activities that depend on harnessing data.

As calls increase to transform the health care delivery system from one designed to treat acute conditions to one that is also able to treat chronic conditions, including behavioral health conditions, community behavioral health providers have a lot to offer as both partners and leaders. Evidence increasingly shows that health outcomes are improved by employing intensive, evidence-based practices to activate patients to work toward health goals and lifestyle modifications.

Data Helps You Stand Out in a Competitive Healthcare Market

As insurers and hospitals are encouraged to work towards better outcomes, increased efficiency, and better quality care, they are looking to behavioral health providers for guidance and partnerships, and Thresholds is positioned to play that role. One way to prepare for and attract such healthcare partnerships is to identify the most complex patients and examine operational and care processes. We gathered data to identify those who were experiencing frequent inpatient re-admissions for reasons like unmanaged diabetes, blood pressure, or schizophrenia, targeting groups whose improvements would impact both social and health sector systems. While re-admissions and volume of services used is not the only way to define high need, it allows providers to start with a small, high acuity group (4% in Thresholds’ case) who with better support in managing their illness would also reduce costs for the larger health system.

Data Improves Quality of Care

To help our teams work most effectively with high-need patients and to measure our performance in doing so, Thresholds Evaluation Department created interactive dashboard reports that merge Medicaid claims data with Thresholds electronic health care data so that we can track outcomes over time for clients who are struggling with managing their multiple conditions. These semi-automated reports allow teams to better manage their caseloads based on need, ask different questions about the most high-need patients, and make decisions about clinical intervention effectiveness over time by tracking frequency of emergency room visits, hospitalizations, and incarcerations.

Doing this improves outcomes, orients staff to value-based care, and will contribute to a generation of new best-practices in engaging and supporting individuals with the most complex needs. Behavioral health specialty providers have a long history of addressing the social determinants of health as the first and most important step in engaging and treating serious mental health conditions. Indeed, such providers have incredible skill in building trusting relationships, linking individuals to and helping them maintain housing, and providing care management to those who have not been able to access or have not been well engaged in other healthcare settings. Through the use of data to inform front-line practice and client care, Thresholds is making strides in demonstrating our commitment to helping the most high-need clients who are shared across social and health sectors. Thresholds’ Evaluation Department is happy to discuss the design of these interactive dashboards – and will continue to partner with Thresholds clinical staff to refine and optimize them for clinical use.

Kristin Davis, PhD, is the Director of Evaluation at Thresholds, where she leads information-based decision making and uses data to improve organizational performance. She has also designed and led grant-funded research studies for Thresholds, with a focus on integrated healthcare and wellness.