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Outcomes at SunCloud Health

Data to influence our ongoing clinical care

SunCloud Health’s Measured Outcomes

Though the field we are in has yet to identify a standardized set of outcome measurements we can all use to measure and identify “success”, this has not stopped SCH from measuring and using outcomes that we feel matter to our patients.  One of the several tools we use is the OQ-45.2.  This patient reported survey measures adult patient progress in therapy, and is designed to be repeatedly measured during the course of treatment and at termination.  Patient progress is measured along several important dimensions, based on Lambert’s (1983) conceptualization, suggesting that three aspects of the patient’s life be monitored:

    1. Subjective discomfort (intrapsychic functioning),
    2. Interpersonal relationships and
    3. Social role performance.

The OQ maintains high levels of reliability and validity, and SCH has collected thousands of these surveys since we started.  Though it is far too early to publish the results of the completed study we are doing, we are pleased to report the following with the hope that if nothing else we show our ongoing commitment to the movement away from pure fee for service and toward some form of value based model where outcomes and cost drive behavior.  (SIDE NOTE: If anyone reading this also treats co-occurring substance use, eating disorders, mood disorders and trauma and also uses this measurement, PLEASE LET US KNOW.  We would love to share and compare results.)

Treatment Outcomes – January 2020

Detailed in this report are the client characteristics and treatment outcomes for over 289 patients who have received services since 2018.

The purpose of this document is to examine the impact of treatment. It can serve as a tool to offer accountability to SunCloud’s clients, staff, and other stakeholders – it offers understanding of whether clients change, by how much, and what might foster that change. It can also be used to celebrate successes and examine areas for professional development and continuous quality improvement.

Overall, the evaluation tells us that SunCloud treatment helps clients reduce their mental health symptoms between admission and departure. Specifically, on areas of Symptom Distress such as Depression and Anxiety, clients who attend SunCloud experience significant improvements over the course of treatment.

View the Results

Outcome Questionnaire 45.2 (OQ45.2). The OQ45.2 is the treatment outcome indicator for this evaluation. It is a 45-item instrument with three sub-scales: Symptom Distress, which assesses internalizing issues such as depression and anxiety, Interpersonal Relations is a proxy for social relationships, and Social Role assesses compliance with the law and other social behavior. The OQ Total Score and each of the subscales have clinical indicator benchmarks to indicate the point above which can be considered clinically problematic and each has a known ‘reliable change index (RCI)’ for ease in understanding whether therapeutic change is significant. The Total score and all sub-scales have good validity, test-retest reliability (.78-.84), internal consistency (.74-.93).

At admission, average scores on all OQ sub-scales and on the Total score were above the clinical benchmark, indicating clinically problematic functioning. The amount of change on all OQ scores was significant, and exceeded the RCI on Symptom Distress and Total Score.

Table 2. Average OQ Total and Sub-Scale Scores for All SunCloud Clients Pre-to Post-Treatment

 Symptom DistressInterpersonal Relations 

Social Role

 

OQ Total

Clinical Benchmark36151263
Pre-Treatment52.619.115.086.7
Post-Treatment42.216.111.670.0
Reliable Change Index (RCI)108714
Average Change10.433.416.7

To view the complete results of this study and our methodology, the full report can be found here. 

Treatment Outcomes – February 2019

The primary metric evaluated is improvement per day as measured in average daily drop in OQ-45.2 scores between admission and discharge.  Current patients were omitted and sub-scales were not analyzed.  Results are all statistically significant using p<.01.

View the Results
1. The mean OQ 45 improvement per day is statistically significant and equal to 0.444 points/day or 3.11/week.  (n=106, p<.001)

2.  Patients with higher (worse) scores on intake improve faster.

Intake ScoreMean OQ drop per week
70

90

110

1.67

3.06

4.45

 

3. Predicted weekly improvement rates for a particular patient vary widely.  As we add more independent variables to the study, we hope to be able to explain this.

4. Patient age does not have any significant relationship with improvement.

5. Controlling for intake score, the longer a patient is in treatment, the worse the improvement rate.

The average time in treatment for patients who have been discharged with two or more tests is about 66 days.  The expected rate of improvement after 66 days is still, however, positive and statistically significant.

Intake Score Initial OQ drop per weekOQ 45 drop per week after 66 days
703.191.72
904.543.06
1105.884.41

This report was produced with the much needed help of Brett A. Saranati, Ph.D.  Brett is currently a Visiting Professor at Kellogg School of Management at Northwestern University and a Lecturer at Stanford University.  Brett’s primary fields of specialization include business statistics, game theory, managerial economics and competitive strategy.

SCH is thrilled to announce that it has agreed in principle to enter in to its first “value based” contract with a major payer

This agreement, with one of the country’s largest private insurance companies, holds us accountable for providing certain tasks which we know improve outcomes (aka results) for our patients and their families. It rewards us when our patients do better and in some ways penalizes us when they do not.  It requires us to be far more transparent with what we do (and don’t do!), which we embrace passionately and enthusiastically.

Though the program lacks certain characteristics of an ideal “value based program” such as true bundled payments (which forces bundled/coordinated care designed around our patients conditions) and appropriate risk adjustments, it is indeed a step in the right direction! David Newton, Director of Operations for SCH, says of the program, “We are so grateful for this opportunity to be a part of the future of all healthcare, which is finally embracing behavioral health.

Increasing value for our patients by improving outcomes that matter to our patients while at the same time reducing cost is built in to our DNA.  When our patients do well, we should do well.  And when they don’t do as well, when appropriate we should be held accountable for our provision of care.

This is how the rest of the world operates…Why should healthcare be so different?  It shouldn’t be.  We are thrilled to be a part of this journey and we look forward to sharing more as we implement the program”.


Dr. Lauren Pace, DO and Psychiatrist on the benefits transparency

Collecting Outcomes

We here at SunCloud Health are thrilled to announce that after two years of hard and persistent work, we are very close to being in a position to release the first results of our patient reported outcome measurements!

Built in to our DNA is appreciating the immense value this data provides to us, our patients, their families and our payers- and then figuring out what to do with it.

Seeking to be a pioneer in value based delivery of behavioral healthcare we are inspired by internationally respected healthcare thought leaders such as Michael E Porter, Thomas H Lee, MD and Leemore Dafny.

We aspire to be like hospital systems such as The Cleveland Clinic and Germany’s Schon Clinic who have already proven that a focus on value over volume is not only good for patients but it is good for business.

Currently we using the data we are collecting to influence our ongoing clinical care, providing our clinical team with patient reported information on outcomes that matter to our patients.

Our outcomes are incorporated in real time into the process of care, allowing us to track progress and make clinically appropriate changes as we interact with our patients.  We can see where and when patients report they are improving (or not) and compare that to clinical observations.  We are able to use this data when justifying level of care recommendations both to our patients and their payers.  We use the data to see where our patients feel we can improve, and where they feel we may be excelling.  We can drill down in to an individual patient’s results and we can see average trend lines among all of our patients.  We collect data on admit, weekly during treatment, at discharge and then post discharge.

Admittedly post discharge collection remains our biggest challenge, and this will likely always remain the case.  Not yet are we able to compare ourselves to other providers in our field, but we are one of the few who hope this is coming- and for our patients sake, the sooner the better.

We look forward to sharing our process and our results in an honest, transparent and meaningful way in the very near future.

We hope this will be an inspiration to all providers as we all seek a common goal of improving quality and reducing cost.

Although the process of collecting, using and sharing data like this can be time consuming and might appear at first to be scary, in the end doing so is ultimately in the best interest of our patients- and that is really what matters most.

Read more from David Newton, SunCloud Health’s Director of Operations, on today’s issues in behavioral health,  about the need for accountability, transparency and outcomes in behavioral health.

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