State Leadership Conference

Employers and government organizations that pay for health care are increasingly demanding outcomes data and want practitioners to be held accountable for the services they provide, according to Katherine Nordal, PhD, APA's executive director for professional practice.

Nordal's remarks opened a well-attended State Leadership Conference session on measuring therapy outcomes for patients and psychologist performance. The session featured two prominent psychotherapy researchers and two psychologists who work in senior management with health-care organizations.

Psychologist Michael Lambert, PhD, of Brigham Young University, described a commercially available measure called the OQ-45, a tool that alerts practitioners to how their patients are doing by detecting changes related to distress. A patient completes a 45-item questionnaire before each session, and if a patient is deteriorating, the program sends a "red alert" to the practitioner, with suggestions on ways to halt the slide.

When clinicians receive alerts and feedback, a larger percentage of patients improve, and a smaller percentage decline in functioning, Lambert said.

Another speaker, David Kraus, PhD, CEO of Behavioral Health Laboratories of Marlborough, Mass., described a measure he helped develop called the Treatment Outcome Package, in which patients answer 58 questions across 13 domains, including changes in physical health and life stress. The program predicts whether clients will respond rapidly, slowly or deteriorate during therapy, and even when someone will need hospitalization within the next six months.

Flagging patients heading toward hospitalization and helping the psychologist prevent hospitalization could save the health-care system $500 million annually, Kraus said. Research shows that a practitioner can gain valuable indications of how a patient is doing from the answers on a pre-session questionnaire, he said.

"Patients are more honest and open on a questionnaire than in a face-to-face interview," Kraus said.

The session also featured psychologist Bruce Bobbitt, PhD, vice president in charge of quality improvement for United Behavioral Health, a United Health Group company, in Golden Valley, Minn.

Bobbitt said the profession of psychology needs to adopt new methods of assuring and improving the quality of care delivered to patients. The payers who reimburse psychologists are developing ways to measure the clinical effectiveness of the work practitioners perform. To deliver more clinically effective services, psychology should consider adopting clinical practice guidelines that capture the discipline's "current professional knowledge" about effective treatments, Bobbitt said.

"The question is, how do we get techniques in place to make that process move forward?" he said.

At Blue Cross/Blue Shield of North Dakota in Fargo, N.D., George O'Neill, PhD, serves as clinical director for mental health, where he oversees a staff reviewing claims from providers for psychological services.

O'Neill explained that from the insurance industry's perspective, one aspect of accountability involves only paying for claims when the treatment is deemed "medically appropriate and necessary"—and typically at many insurers, a staffer with little or no psychiatric experience makes the initial decision.

To meet that standard, providers should always be sure to describe the severity of a patient's symptoms, the amount of impairment the patient is experiencing and explain how the intervention is addressing the symptoms, O'Neill said.

To be accountable in the health-care delivery system, psychologists need to collect outcomes data on their patients, so that the quality of psychological services delivered can be addressed, said Elena Eisman, EdD, executive director for the Massachusetts Psychological Association, who served as the session's discussant.

Eisman cautioned that as a scientific profession, psychology needs to ensure that outcome measures are practical for clinical use, and that such measures are used, analyzed and interpreted appropriately by the insurance companies.

"They won't take our word for it any more, it's a competitive marketplace," she said.