To improve outcomes, experts have sought to build consultative relationships between mental health specialists and primary care physicians (PCP) and to more fully educate PCPs about mental health issues. Wells and colleagues (in press) reported on the development of a systematic consultation arrangement between PCP practitioners and psychiatrists that has resulted in marked improvements in depression treatment in primary care settings.
In another instance, MCC Behavioral Health Care is collaborating with academic health scientists on the Large National Airline Carrier Study. The study's goal is to improve primary care practitioners' recognition of major depression and the appropriate use of treatment intervention guidelines for patients with major depressive disorder; the guidelines were developed by the U.S. Agency for Health Care Policy and Research.
The study compares the effect of traditional primary care detection and treatment practices for major depression with the effect of integrating psychiatric specialists in the primary care setting, combined with case management and mental health care training for PCPs. Outcome measures include changes in depression, life activities, work performance, disability and medical care costs. In addition to providing longitudinal assessment of clinical outcomes, the study should permit evaluation of the economic impact of this intervention on the health system (including claims costs as well as medical and pharmacy utilization) and on the workplace (including job performance, productivity and absenteeism).
Analysis of quality of care issues has been hampered by several factors, according to the report. These include a competitive environment emphasizing price, the developmental and operational costs of outcome data systems, and the lack of standardized methodology for collecting and reporting outcome data.
"Within the managed care industry, current incentives generally do not encourage an emphasis on quality of care and its assessment. Consolidation...has created intense pressure for competition based almost exclusively on price," the report said. "It has also created disincentives for capital investment to develop comprehensive quality information systems that would allow competition on the basis of quality."
Most quality reporting systems in managed behavioral health systems are based on administrative data rather than on clinical outcome data. Comprehensive clinical quality information systems are more expensive and complicated than administrative data systems, but "have much greater potential for evaluating the actual impact of programs and practices on patient outcomes."
With the help of NIMH, one managed behavioral health care organization implemented a clinical quality system. They found that the initial development costs for the system was less than one cent per member per month (Kane et al., 1998).
Some companies, such as MCC Behavioral Care, are currently testing the feasibility of implementing systemwide collection of clinical outcome data, according to the report.