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Health Care Quality

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Consumer input is a critical component of efforts to improve the quality of behavioral health care services

In recent years, health insurance plans have increasingly relied on managed behavioral health care organizations (MBHOs)—organizations that specialize in the management of behavioral health care services—to oversee the care provided to their enrollees. Behavioral health care services include counseling, medications, and other inpatient and outpatient services for mental illness, personal or family problems, and alcohol and drug dependency.

In order for MBHOs and health insurance plans to be accredited by the National Committee for Quality Assurance (NCQA), they must collect, analyze, and use consumer evaluations of their services as part of their quality improvement efforts. Consumer surveys such as the Consumer Assessment of Behavioral Healthcare Services (CABHS) can identify which aspects of the plan and treatment are priorities for improvement, according to a recent study supported by the Agency for Healthcare Research and Quality (HS09205). The results from this study were also used to develop a new standardized instrument, the Experience of Care and Health Outcomes (ECHO™) survey.

Ten groups of adult patients (five in commercial health plans and five in public assistance plans) who received behavioral health services during the previous year from one of four organizations (three MBHOs and a health system) were surveyed.

Both commercial and public assistance respondents were least satisfied with the promptness of treatment from clinicians and aspects of care most influenced by health plan policies and operations, such as access to treatment and plan administrative services. These factors varied significantly among plans. Only 42 to 46 percent of respondents (median plan scores) were always able to get needed help over the telephone, and only 55 percent were always able to get an appointment as soon as they wanted one. Based on this feedback, three organizations in the study focused quality improvement efforts on access to treatment. Another MBHO, whose survey revealed low ratings in one of two geographic areas served by the plan, confirmed its concern about the adequacy of the provider network there.

About 60 percent of both commercial and public assistance respondents were satisfied with communication with clinicians. Most said that their doctors listened carefully, explained things well, spent enough time with them, and involved them in decisions. About 40 percent of respondents said that they were helped "a great deal" by their treatment. Overall treatment and main clinician ratings did not vary significantly among the plans.

See "Use of consumer ratings for quality improvement in behavioral health insurance plans," by James A. Shaul, M.H.A., Susan V. Eisen, Ph.D., Vickie L. Stringfellow, and others, in the April 2001 Joint Commission Journal on Quality Improvement 27(4), pp. 216-229.

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