Report cards may show state of mental health care

Critics charge that managed care organizations have cut expenditures so severely for mental health care that many patients no longer have access to adequate treatment. Consumer-oriented report cards and accreditation reports may soon provide information to either bolster or refute those claims.

The federal Center for Mental Health Services in Rockville, MD, is testing a report card in 20 states. It has released a draft set of recommended, consumer-oriented indicators in these areas: access, quality/appropriateness, promotion/prevention, and outcomes.

The proposed report card incorporates a patient satisfaction survey, a symptom distress scale, alcohol and drug use scale, and portions of the SF-36 developed by the Medical Outcomes Trust in Boston, a 36-item survey that provides information on physical and social functioning and other quality of life issues.

"This is exceptionally important for the mental health field at this point in time," says Ronald Manderscheid, PhD, chief of the center’s survey and analysis branch, which is part of the Substance Abuse and Mental Health Services Administration. Currently, managed care competition in mental health care is based purely on price, not on quality, and the price paid per member per month is dropping, he says.

"We hope that ultimately these kinds of report cards will get written into accreditation standards and state contracts," he says.

In a parallel effort, the Center for Mental Health Services released a draft set of methodological standards and is working on content standards that could be used to evaluate outcomes measures developed by other entities.

Here are some examples of indicators included in the mental health report card that is currently being tested:

• the average length of time from request for services to the first face-to-face meeting with a mental health professional (access);

• the percentage of consumers who actively participate in decisions concerning their treatment (appropriateness);

• the percentage of consumers who experience a decreased level of psychological distress (outcomes);

• the percentage of inpatient readmissions that occur within 30 days of discharge (outcomes);

• expenditures per enrollee on dissemination of preventive information (prevention).

Meanwhile, the National Committee for Quality Assurance (NCQA) in Washington, DC, is developing mental health care-related accreditation standards for managed care organizations that will be included in each organization’s overall accreditation review.

In addition, NCQA is launching a program for behavioral health review organizations.

NCQA released standards for the Managed Behavioral Health Accreditation Program in January, and the first surveys are set to begin this month. The standards cover such areas as quality improvement, accessibility of services, utilization management, and preventive behavioral health services.

"Until now, there has been no standardized system of accountability for those organizations," says NCQA spokesman Barry Scholl, who notes that an estimated 120 million Americans are covered under managed behavioral health plans.

The Health Employer Data and Information Set 3.0, a set of standardized performance measures for managed care health plans, contains several mental health items, including readmission for specified mental health disorders and readmission for chemical dependency. Several other clinical measures, such as a patient-reported behavioral health measure and availability of medication management for schizophrenia, are under consideration as a part of the testing set.