New York is Moving to Use Social Determinant Related Measures for People
with Behavioral Health Conditions in the Value Based Payment Environment
by Harvey Rosenthal NYAPRS December 7, 2016
As we move to a value based payment environment where providers will be paid according to outcomes, what we measure drives the kind and intent of the care we provide. Traditionally, measures relating to care for people with behavioral health needs have confined themselves to process and medical measures, like follow up after discharge and the use of medication and diabetes and tobacco screenings.
Yet, it’s clear that social outcomes like improved housing, economic stability and employment and reduced criminal justice involvement directly effect and promote successful health and recovery outcomes and there’s an increasing body of evidence that recovery and rehabilitative services promote those outcomes.
A recently published blog in Health Affairs (see link below) authored by top NYS Office of Mental Health officials Drs. Robert Myers, Lloyd Sederer and Thomas Smith and Columbia Public Psychiatry Fellow Joshua Berezin looking at “How Value-Based Payment Arrangements Should Measure Behavioral Health” emphasized that “many behavioral health conditions contribute directly to functional deficits in employment and education status, social connectedness, quality of life, and independent living skills. Yet there are no currently endorsed outcome measures for these domains, which are the targets for evidence-based behavioral health interventions such as motivational interviewing and supported employment.”
The authors conclude that “providers and stakeholders participating in VBP arrangements should advocate that VBP network providers incorporate standard elements in their EHRs defining key social determinants and functional capabilities to create a source of reliable information and also to generate the data necessary to validate measures of social and functional outcomes. Until such measures are validated and endorsed, VBP arrangements should include pay-for-reporting rules to incentivize providers to incorporate these data elements into their EHRs.”
Accordingly, attached are the current recommendations put forth by the Behavioral Health Clinical Advisory Group, where NYAPRS is a member, regarding outcome measures relating to people with more extensive behavioral health conditions that should be used in New York’s emerging Value Based Payment environment.
You’ll note that the last 3 measures relate to social determinant related outcomes:
- Percentage of members who maintained/obtained employment or maintained/improved higher education status
- Percentage of members with maintenance of stable or improved housing status
- Percentage of members with reduced criminal justice involvement
There’s also one regarding the percentage of members who are receiving psychiatric rehabilitation and recovery services (PROS or HCBS) to achieve those outcomes, for at least 3 months in the reporting year.
Data relating to these measures is being collected in New York via the assessments that establish eligibility to receive Home and Community Based Services. The group’s recommendation is that providers should track these outcomes and be reimbursed via a pay for reporting system, until the measures are formally validated. Several VBP pilots will be looking specifically at the impact of the use of such measures.