As part of a partnership between Blue Cross & Blue Shield of Rhode Island (BCBSRI) and ValueOptions, Rhode Island mental health clinicians have access to ValueOptions’ On Track program, a client-centered outcomes informed care program.
On Track does not make recommendations or decisions about appropriate clinical care. It is intended as an information aid to network clinicians.
Abbe Garcia, Ph.D., treasurer of the Rhode Island Psychological Association and a member of the multidisciplinary Coalition of Mental Health Professionals of Rhode Island (COMHPRI), has participated in meetings between COMHPRI and representatives of BCBSRI and ValueOptions, to discuss questions and concerns. Some Rhode Island mental health professionals expressed misgivings about the scientific credibility of On Track and Blue Cross’s intentions for using the measure.
Garcia says BCBSRI and ValueOptions are responsive to concerns and she recently participated in meetings regarding On Track’s psychometric properties and the need to streamline the process for providers to register and gain access to the measure.
“(On Track) passes muster from a psychometric standpoint,” Garcia says. “ValueOptions was very responsive to my feedback and feedback from a colleague of mine and they revised their manual for the On Track tool to make it more transparent. They provided every last drop of data that we asked for and the data are solid so I can endorse it psychometrically.”
BCBSRI announced in July 2013 that it chose ValueOptions as its partner and contracts with them for the management of facility-based services, case management and the implementation of innovative strategies and programs, according to Maria R. Sekac, AVP managing director, Behavior Health/Plan Quality Strategy, BCBSRI.
Sekac says programs like ValueOptions’ On Track have been shown to improve member outcomes.
She says the one-page On Track Client Feedback Form is administered before or during psychotherapy sessions and submitted by the clinician via fax to be processed and scored.
Questions are grouped in categories including global distress, risk of self-harm and substance use.
“Providers can view scored results online. The assessments provide feedback on how a member is progressing in treatment over time and take about two minutes to complete,” Sekac says, adding that the Client Feedback Form is not intended to be diagnostic or to substitute for clinical evaluation or other assessments that a clinician may routinely conduct.
Clients are assigned a code and remain anonymous to ValueOptions.
“Over time, you can plot a trajectory in terms of how this patient is doing,” Garcia says. Additionally, the clinician can see via a benchmark projection if a patient is deemed ‘on track’ or ‘off track,’ based on a large sample of data in terms of how people progress through treatment.
“This idea of measuring global distress is a little different than what practitioners might be used to with some common questionnaires they get patients to fill out,” Garcia says. “A lot of questionnaires are very symptom-based; specific symptoms for a specific diagnosis. This measure is at a higher order level.”
Garcia says that while the On Track questionnaire doesn’t take the place of symptom measures, it is also not as lengthy, so is user-friendly for repeated use.
She notes the On Track results should not be taken as gospel. “It’s complementary. This tool will help you look at broader level success and broader functioning.”
“What I think is essential to this effort and really any effort to measure outcome is the discussion that it prompts between the client and the therapist,” Garcia says. “I think that is where the real benefit of using this kind of system comes from. It’s like a springboard.”
Garcia says she is personally in favor of using objective tools to measure outcomes, but she understands why some of her colleagues have expressed concerns that this tool is being driven by an insurance company. “The idea of having a clinician choose a tool and look at objective feedback and discuss it with their patients – that’s what I endorse,” Garcia says. “But having an insurance company tell you what tool to use, and this idea of labeling your work as being ‘on or off’ track, that’s scary, and I understand why that’s scary.”
“The silver lining there is that a single clinician cannot amass enough data to make these kinds of comparisons just within their own practice and an insurance company has access to a huge number of patients,” she says. “That’s important for getting this comparative metric.”
The use of On Track is optional, Sekac says. “The use of the On Track Client Feedback Form is completely voluntary for both the provider and the member, though we are encouraging the use of the tool with a payment per submitted form.”