I recently spent several days at a behavioral health leadership conference, and out of all the conversations around leadership, managed care, technology, data and the future of behavioral health, one question stood out because it gets right to the heart of where I believe behavioral health is headed.

Every organization should be able to answer….”Are your patients getting better?”

It sounds like a pretty simple question, but I am not sure most behavioral health organizations can answer it as easily as they think they can or have the data to support what they believe to be true about whether their patients are actually getting better.

We collect an enormous amount of information. We complete assessments, develop treatment plans, write progress notes, submit claims, track HEDIS measures and generate reports from our electronic health records. Leadership teams have dashboards and spreadsheets filled with data. But having a lot of data and being able to demonstrate that the people you serve are actually getting better are two very different things.

That was one of my biggest takeaways from listening to managed care organizations talk about what they need from behavioral health providers. The conversation is moving beyond how many services you provided. They want to understand whether those services are making a difference.

What Does “Getting Better” Actually Mean?

This is where I think organizations can quickly get themselves into analysis paralysis. There is so much available to measure that we can spend all of our time trying to determine what data to collect, how to get it out of the EHR and what belongs on the next dashboard.

Maybe we need to make it simpler.

What would tell you that the people receiving your services are doing better today than they were when they entered treatment? Depending on the population you serve, that might include:

• Fewer emergency department visits or hospitalizations
• Improved symptoms, functioning or stability
• Movement through levels of care when clinically appropriate
• Returning to work or becoming more stable in employment
• Fewer legal problems
• Improvement in meaningful HEDIS or other quality measures
• Reduced need for crisis services or other high-cost care

Not every organization needs to measure the same things, and certainly not every patient is going to have the same definition of improvement. The point is to decide what matters for the populations you serve, establish where you are today and start measuring whether something is actually changing.

And please do not wait until you have the perfect EHR to start doing it.

Technology matters. I see community behavioral health organizations struggle all the time with systems that do not give leadership the information they need without an enormous amount of manual work. That needs to be addressed. But even the best EHR cannot answer a question the organization has never clearly defined.

Before you build another dashboard, decide what you actually want it to tell you.

The Documentation Has to Be Part of the Story

Of course, I cannot talk about outcomes without bringing this back to documentation.

If the data says your patients are getting better, would I see evidence of that if I reviewed their records?

This is exactly why I continue to talk about documentation telling the patient's story. When I look across an episode of behavioral health treatment, I should be able to understand what changed. Maybe symptoms improved. Maybe risk decreased. Maybe functioning changed. Maybe the patient moved to a different level of care. Maybe treatment was not working, and the plan had to change.

Even the diagnosis deserves another look along the way. I am certainly not suggesting changing a diagnosis simply to demonstrate improvement. I am asking whether the diagnosis continues to represent the patient's clinical picture as treatment progresses. Carrying the same diagnosis from the beginning to the end of a lengthy episode of care without ever reconsidering it may not tell the whole story either.

The assessment, treatment plan, progress notes, diagnosis and outcomes being reported should not feel like separate pieces of information. Together, they should help us understand what happened to this patient during treatment.

But Your Organization Does Not Have All the Data

This may have been the part of the managed care conversation that interested me the most.

Your organization knows what happens when a client receives services from you. You know what your clinicians document, what services were provided and what your own EHR can tell you.

The managed care organization may know much more about what is happening outside your four walls.

Remember, your patient is also their member. The MCO may be able to see emergency department visits, hospitalizations, pharmacy activity, services from other providers and the broader healthcare spend associated with that individual. They may see patterns that your organization simply cannot see.

That is exactly why I think behavioral health organizations need to build better relationships with their managed care organizations. Do not wait until contract renewal, a reimbursement problem or a request for additional data to start the conversation.

Ask them what they are seeing. What is happening with our population outside of the services we provide? Are emergency department visits decreasing? Where do you see unnecessary utilization or spend? What outcomes are important to you? What information would be helpful for us to share with you?

And then ask the question that I think matters just as much: What information can you share with us that would help us take better care of your members?

This Has to Work Both Ways

Providers absolutely have work to do here. Behavioral health organizations need to get better at deciding what they want to measure, getting usable information from their systems and being transparent about what is working and what is not.

But I think managed care organizations have some responsibility here too.

If an MCO can see that members receiving services from an organization continue to use the emergency department, experience repeated hospitalizations or access other costly services, the provider needs to know that. How are providers supposed to help change an outcome they cannot see?

And I do not think we should be afraid of the data that tells us we did not get it right.

If something did not work, tell us. If there is a pattern we are missing, show us. Knowing where we fell short gives us an opportunity to figure out why, change what we are doing and hopefully get a different result the next time.

So I keep coming back to the question I heard at the conference:

Are your patients getting better?

Behavioral health organizations should be able to answer that question, but I am becoming convinced that neither the provider nor the managed care organization can answer it completely on their own.

Maybe that is where the real opportunity is. What can we learn from the information we each have to help them get better?

That feels like a conversation worth having.