I just returned from the National Council for Behavioral Health Board of Directors annual retreat, which was held this year in beautiful San Juan, Puerto Rico. It is always invigorating to network with colleagues from across the country, receive an update on the innovations of the National Council team, and plan together on how best to advance the cause of behavioral health in the coming year. I travelled 3,008 miles from Phoenix, Arizona to participate. I know that because the distance has been measured and the information is readily available… something that’s traditionally been lacking in the behavioral health care field.
One of the highlights of the 2014 meeting was having consultant David Lloyd, founder of MTM Services, participate. David will receive a Visionary Leadership award at the conference in Washington, DC in May for his tremendous impact on advancing the business practices of community mental health centers nationwide, largely because of his focus on measurement and data-driven performance improvement. When David first began in the behavioral health field, there was very little measurement going on at all (aside from agency financial statements).
Chuck Ingoglia, who introduced David to the board in San Juan, described the early days when the National Council urged member organizations to “measure something!” I first met David in the early 2000s when I had the privilege to partner with him on a speaking road trip across the state of Georgia. At the time, he was already equipping agencies to measure staff productivity as a means of evaluating organizational efficiency. In “How to Deliver Accountable Care,” David targeted the inefficiencies which drive up provider costs, e.g., lack of billable hour standards, redundant paperwork, and meeting culture, but these performance improvement efforts were only possible because of the productivity baseline data that he had helped agencies capture and report.
One of our homework assignments in preparation for the board retreat was to read Michael Porter’s “The Strategy that Will Fix Healthcare.” In the article, the Harvard professor describes the transformation to “value based health care,” which means focusing on improving the outcomes that matter to “patients,” while ensuring costs are kept constant, or lowered. He writes, “Indeed, rigorous measurement of value (outcomes and costs) is perhaps the single most important step…” Continuing, he says, “Wherever we see systematic measurement of results in health care – no matter the country – we see those results [outcomes and cost] improve.”
Porter pointed out that even when health care has measured things, it has tended to focus on process elements, the indicators that are easiest to capture and “least controversial.” This resonated strongly with me. For years, behavioral health agencies have been closely monitored as to whether they have faxed an annual coordination of care sheet to the primary care physician (despite knowing these papers largely went into a black hole, filed to the shredder, etc.) Value-based health care demands we center on the individual and their success in daily functioning. For decades, psychosocial rehabilitation has taught us that the symptoms are not the central issue, but rather how the person is doing with their job, relationships, housing, education, and spirituality… in other words, their day-to-day life. Health care is catching up with this important approach.
As David addressed the board, he talked about his more recent work supporting agencies in reducing the long wait times experienced by many individuals seeking behavioral health services in the past. National Council, motivated by initiatives such as same-day access and same-day medication, has begun exploring the concept of Behavioral Health Centers of Excellence, which would not have been possible without first measuring our results and improving them.
Agencies across the country now participate in SPQM, a data measurement system hosted by MTM Services that allows leadership to monitor utilization management, productivity, the cost of services delivered, no-shows, and cancellations. As a demonstration of his vision and leadership, David described the partnership with the National Council to pair these efforts with a focus on real outcomes by implementing the systematic administration of the DLA-20 (Daily Living Activities Functional Assessment 20-question survey).
The board discussion that ensued touched on how we are now taking this principle to countries, as well. GDP used to be the main measure of national success, but now countries tout Gross Domestic Wellness. The second annual World Happiness Report tells us that the residents of Denmark flourish more than the rest of us (the United States finished just outside the top ten).
In the early 1990s, the Harvard Business Journal published “The Balanced Scorecard – Measures that Drive Performance,” and businesses across the country augmented financial reporting with quality and business metrics, the customer experience, and innovation and learning. In 2008, the Council of State Governments published Dr. Keon Chi’s work onorganizational transformation, which emphasized collaboration, anticipation, and the transparent and public reporting of measurable outcomes.
We’ve seen many other fields travel quickly down this path, with informed consumers making choices based upon quality and experience. Crisis Access, LLC’s companies have been publishing online performance dashboards since the mid-2000s (including Crisis & Access Line, Access to Services, and Intensive Service Referral Linkages). Health care, and especially behavioral health care, have lagged far behind, seemingly unaware of the sea of change that is occurring, but pioneers like David Lloyd and MTM Services continue to blaze a bright new trail and offer tremendous support for agencies looking for a partner on the journey of improved outcomes.