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Research Questions

  1. How do civilian health plans measure the quality of psychological health care delivered by providers in their networks?
  2. How extensively do health plans use quality measures to monitor plan performance and guide quality improvement strategies?
  3. What challenges and opportunities emerge in health plans' efforts to assess the quality of psychological health care?
  4. How do health plans actively assess the value of psychological health care, and to what extent are value measures used to monitor plan performance and guide cost reduction efforts?

The Military Health System (MHS) strives to provide high-quality care and improve outcomes for individuals with psychological health conditions. Over the last decade, the MHS has provided care to a growing number of individuals with psychological health conditions, such as post-traumatic stress disorder (PTSD) and major depressive disorder (MDD). However, little is known about the extent to which the MHS delivers care that is consistent with evidence-based clinical practice guidelines or if it is achieving positive outcomes for its service members. To better understand these issues, the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) asked the RAND Corporation to describe civilian health plans' approaches to systematically measuring the quality of psychological health care delivered by providers in their networks. This work was part of a larger effort by RAND to develop a framework and identify a set of measures for monitoring the quality of care provided by the MHS for psychological health conditions.

Key Findings

Psychological health quality measurement is common in health plans

  • Health plans studied track quality measures using administrative data, medical record review, member feedback, and patient-reported outcomes.

Health plans primarily focus on collecting and reporting measures of the process of care

  • The quality measurement efforts of studied health plans were limited in scope and scale but most consistently assessed processes of care.

Health plans use quality measures to improve the quality of psychological health care

  • Quality measures are used primarily to plan and monitor quality improvement efforts.

Measuring the quality of psychological care is challenging

  • Collection of patient-reported outcome data is a particularly difficult aspect of quality measurement initiatives.

Measuring the value of psychological health care is more difficult and less common

  • Admissions, diagnosis rates, and utilization rates are often tracked, but the extent to which plans measure the actual costs of care among members with psychological health diagnoses varies.

Recommendations

  • Continue and expand tracking of access and process of care measures.
  • Engage providers in the process. Clinician autonomy is often a barrier to quality improvement efforts.
  • Implement measures of costs and utilization, which provide an essential foundation for assessing value.

This research was sponsored by the DCoE and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

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