Outcomes at SunCloud HealthData to influence our ongoing clinical care
Listen to Melissa Hill, LCSW, ACHT, Director of Business Development and Organizational Wellbeing (SunCloud Health) at the Kennedy Forum, discuss the need for outcomes reporting to help employers and insurance companies understand what providers do and don’t do well. The goal is give employers the data to compile a list of preferred providers based on performance, not a relationship or reputation.
If anyone should be interested in value creation for people struggling with mental health and addiction it should be the employers who rely on their employees to be productive and healthy members of the workforce. By one estimate substance use disorders cost the nation an estimated 276 billion dollars per year with much of the cost resulting from lost work productivity and increased healthcare spending. Given that 3/4 of the people with drug or alcohol problems are employed, employers have a major stake in supporting employees in engaging in effective and timely treatment.
Kim Cimino, LMFT and Clinical Director on the transparency of outcomes
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.)
—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.
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 Score||Mean OQ drop per week|
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 week||OQ 45 drop per week after 66 days|
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
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.