Behavioral Health – Primary Care Integration Partnerships: Measure Outcomes

MEASURING OUTCOMES

The value of shared outcomes
It should be no surprise to either behavioral health nor primary care partner that measuring outcomes is important. Each organization has a number of metrics that are tracked routinely.  Measuring outcomes of the integrated partnership are just as important. These outcomes should be jointly agreed upon early in the project. Periodic re-evaluation of the outcomes is beneficial to assuring that they remain relevant to each partner. Be prepared to modify as needed.

Identifying outcomes to be measured and faithfully tracking them provides the necessary data for the organizations’ decision makers. The data serves to demonstrate the effectiveness to others as well as for use in securing additional funding in the future.  Outcome measures need not be expensive or overly complicated. The important thing is to be consistent.

Measuring the benefits of the partnership 
The integrated behavioral – health primary care partnership is far greater than the sum of its parts. The synergistic effect of the partnership results in enhancing the lives of the individuals served to a degree that cannot be matched by either organization alone. Treating the hypertension of a person who also suffers from schizophrenia has a far greater impact that in treating either of the comorbid disorders separately. Measuring the outcomes clearly demonstrates the value of the partnership and the significant impact on the life of the individuals served. While most healthcare professionals are driven by the day to day intrinsic value of helping, successes identified in objective reports serve as further motivation to dedicated members of the team.

There is a clear benefit in having fewer services that must be duplicated when the behavioral health and the primary care is provided separately. When exams and diagnostic tests are done by one provider, there is considerable cost savings. Tracking these savings will demonstrate the added value of the partnership.

Quality of life and client satisfaction surveys are effective ways of determining the value that is provided through the collaborative approach to treatment.

It is not enough to feel that you are doing a good job when it comes to demonstrating success. Through measuring the value of services provided in an integrated behavioral health – primary care partnership, the value of the partnership can be indicated in undisputable terms.

This is the last in the series of steps for a successful behavioral health – primary care partnership. These eight steps have been adapted from “Strategies to Preserve Public-Private Partnership ‘Best Practices’: Keys to Genuine Collaboration” by Greg Schmieg and Bob Climko, MD, Behavioral Health Management May/June1998. Vol. 18 . No. 3:

  1. Establishing the Mission of the Partnership
  2. Identifying a Common Language
  3. Maintain Pacing, Flexibility, and Capacity
  4. The Value of Shared Solutions
  5. Determining Expectations
  6. Delegate Trust
  7. Create Empowerment
  8. Measure Outcomes
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Behavioral Health – Primary Care Integration Partnerships: Create Empowerment

According to BusinessDictionary.com:

Empowerment:
“Management practice of sharing information, rewards, and power with employees so that they can take initiative and make decisions to solve problems and improve service and performance. It is based on the concept of giving employees the skills, resources, authority, opportunity, motivation, as well as holding them responsible and accountable for outcomes of their actions.” 

Some of the most successful companies in the world understand the added-value of empowering their employees (think Starbucks or Ritz-Carlton). After reading the definition from BusinessDictionary.com, it begs the question of why ANY company would not insist on the promotion of employee empowerment.

CREATE EMPOWERMENT 

Champions at all levels promote success
The success of a partnership between a primary care organization and a behavioral health organization for the provision of integrated service delivery is dependent on the involvement of everyone from the onset. This requires empowering champions at all levels to move the mission forward and create accountability.  Not only is it important for the people at the top to believe in the project, it is even more important for the people who will be providing the services, coordinating the flow, scheduling the appointments, etc. to be empowered to do whatever is necessary to make sure that the clients get the service they require and deserve. This empowerment promotes buy-in among staff. The level of commitment that the members of the team have determines whether a project succeeds or not.  

Encourage communication…don’t shoot the messenger
Communicating with everyone and soliciting feedback ensures ongoing focus on the mission. Be sure to create a forum that allows both positive and negative feedback. Many promising endeavors have failed because the front line staff were not encouraged to share observations of trends or occurrences that were early indicators of problems. Frequent communication among everyone on the team is vital. Management, clinicians, and support staff from both organizations should be included in meetings, emails, and conference calls that allow and encourage an exchange of information and ideas among everyone. In addition, frequent treatment team meetings with clinicians from each organization will ensure an integrated approach for the services provided.

Adapted from “Strategies to Preserve Public-Private Partnership ‘Best Practices’: Keys to Genuine Collaboration” by Greg Schmieg and Bob Climko, MD, Behavioral Health Management May/June 1998. Vol. 18 . No. 3.

Behavioral Health – Primary Care Integration Partnerships: Delegate Trust

The delicate subject of trust is the focus of this installment in the series devoted to creating a healthy integrated partnership between behavioral health and primary care. This has been adapted from “Strategies to Preserve Public-Private Partnership ‘Best Practices’: Keys to Genuine Collaboration” by Greg Schmieg and Bob Climko, MD, Behavioral Health Management May/June 1998. Vol. 18 . No. 3.
 
DELEGATING TRUST
 
Trust is necessary to overcome expected conflict
When team members of the behavioral health and the primary care organizations come together for an integrated partnership, typically everyone is on their best behavior. It is easy to have a harmonious relationship at this stage. However, when conflict first intrudes, particularly regarding shared goals and outcomes, the amount of trust between partners can make or break the partnership. Create the forums at the onset to maintain a system of checks and balances. Face-to-face time creates a forum for maintaining checks and balances to ensure fidelity to the mission. Constantly solicit feedback from partners at all levels. The transparency also breeds trust.
 
Focus on building trust at all levels
It takes a significant amount of trust for a person to commit to any partnership; the behavioral health primary care integrated partnership is no different. Often the partnership is created when two leaders, most likely chief executive officers of the organizations, decide to bring together their collective expertise. The two CEOs build upon their mutual shared experiences of serving on committees, community boards, etc. together. They travel in similar circles and have developed reciprocal trust and respect. Unfortunately, a frequently overlooked aspect of this process is the fact that the managers and frontline staff who must join together to make the collaborative partnership a reality have NOT had the opportunity to develop that same level of trust. The wise leader recognizes the importance of building the trust necessary for a solid foundation between partners. Trust does not automatically filter down. Devoting considerable face time during the planning stage aids in establishing a firm foundation of trust. Dedicated time for regular interaction (weekly/monthly meetings, conference calls, etc.) helps to maintain the connection. Maintaining the flow of communication helps everyone to stay current with expectations and reduces the chance of surprises, which can quickly erode trust. Bringing together staff with their counterparts allows for those relationships to develop separately in addition to the collective partnership/relationship. It also allows issues and solutions to be addressed at the appropriate level. Medical Directors must communicate with Medical Directors; nurses communicate with nurses. When the CEOs communicate with each other in their decision-making process, they will benefit from the solidarity among the matched pairs in gathering input. Making informed decisions prevents leaders from forcing issues and promotes the trust that is so vital to success relationships.
 
“The glue that holds all relationships together – including the relationship between the leader and the led is trust, and trust is based on integrity.” –Brian Tracy