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Published in: Administration and Policy in Mental Health and Mental Health Services Research 3/2011

01-05-2011 | Original Paper

A Collaborative Approach to Identifying Effective Incentives for Mental Health Clinicians to Improve Depression Care in a Large Managed Behavioral Healthcare Organization

Authors: Lisa S. Meredith, Robert B. Branstrom, Francisca Azocar, Ruth Fikes, Susan L. Ettner

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 3/2011

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Abstract

This descriptive study used stakeholder input to prioritize evidence-based strategies for improving depression care and to select incentives for mental health clinicians to adopt those strategies, and to conduct a feasibility test of an incentive-based program in a managed behavioral healthcare organization (MBHO). In two rounds of interviews and a stakeholder meeting, MBHO administrators and clinicians selected increasing combination treatment (antidepressant plus psychotherapy) rates as the program goal; and paying a bonus for case reviews, clinician feedback, and clinician education as incentives. We assessed program feasibility with case review and clinician surveys from a large independent practice association that contracts with the MBHO. Findings suggest that providing incentives for mental health clinicians is feasible and the incentive program did increase awareness. However, adoption may be challenging because of administrative barriers and limited clinical data available to MBHOs.
Literature
go back to reference Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall. Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall.
go back to reference Bailit Health Purchasing and Sixth Man Consulting. (March 2002). The Growing Case for Using Physician Incentives to Improve Health Care Quality, the National Health Care Purchasing Institute, December 2001. Bailit Health Purchasing and Sixth Man Consulting. (March 2002). The Growing Case for Using Physician Incentives to Improve Health Care Quality, the National Health Care Purchasing Institute, December 2001.
go back to reference Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.
go back to reference Barry, C. L., & Frank, R. G. (2006). Commentary: An economic perspective on implementing evidence-based depression care. Administration and Policy In Mental Health, 33(1), 21–25.PubMedCrossRef Barry, C. L., & Frank, R. G. (2006). Commentary: An economic perspective on implementing evidence-based depression care. Administration and Policy In Mental Health, 33(1), 21–25.PubMedCrossRef
go back to reference Bremer, R. W., Scholle, S. H., Keyser, D., Houtsinger, J. V., & Pincus, H. A. (2008). Pay for performance in behavioral health. Psychiatric Services, 59(12), 1419–1429.PubMedCrossRef Bremer, R. W., Scholle, S. H., Keyser, D., Houtsinger, J. V., & Pincus, H. A. (2008). Pay for performance in behavioral health. Psychiatric Services, 59(12), 1419–1429.PubMedCrossRef
go back to reference Dalkey, N. D. (1967). Delphi. Santa Monica, CA: RAND Corporation. Dalkey, N. D. (1967). Delphi. Santa Monica, CA: RAND Corporation.
go back to reference Dalkey, N. D. (1969). The Delphi method: An experimental study of group opinion. Santa Monica, CA: RAND Corporation. Dalkey, N. D. (1969). The Delphi method: An experimental study of group opinion. Santa Monica, CA: RAND Corporation.
go back to reference Davis, D. A., Thomson, M. A., Oxman, A. D., & Haynes, R. B. (1995). Changing physician performance: A systematic review of the effect of continuing medical education strategies. Journal of the American Medical Association, 274, 700–705.PubMedCrossRef Davis, D. A., Thomson, M. A., Oxman, A. D., & Haynes, R. B. (1995). Changing physician performance: A systematic review of the effect of continuing medical education strategies. Journal of the American Medical Association, 274, 700–705.PubMedCrossRef
go back to reference Dietrich, A. J., Oxman, T. E., Williams, J. W., Jr., Kroenke, K., Schulberg, H. C., Bruce, M., et al. (2004). Going to scale: Re-engineering systems for primary care treatment of depression. Annals of Family Medicine, 2(4), 301–304.PubMedCrossRef Dietrich, A. J., Oxman, T. E., Williams, J. W., Jr., Kroenke, K., Schulberg, H. C., Bruce, M., et al. (2004). Going to scale: Re-engineering systems for primary care treatment of depression. Annals of Family Medicine, 2(4), 301–304.PubMedCrossRef
go back to reference Feldman, M. D., Ong, M. K., Lee, D. L., & Perez-Stable, E. J. (2006). Realigning economic incentives for depression care at UCSF. Administration and Policy In Mental Health, 33(1), 34–38.PubMedCrossRef Feldman, M. D., Ong, M. K., Lee, D. L., & Perez-Stable, E. J. (2006). Realigning economic incentives for depression care at UCSF. Administration and Policy In Mental Health, 33(1), 34–38.PubMedCrossRef
go back to reference Fink, A., Kosecoff, J., Chassin, M., & Brook, R. H. (1984). Consensus methods: Characteristics and guidelines for use. American Journal of Public Health, 74(9), 979–983.PubMedCrossRef Fink, A., Kosecoff, J., Chassin, M., & Brook, R. H. (1984). Consensus methods: Characteristics and guidelines for use. American Journal of Public Health, 74(9), 979–983.PubMedCrossRef
go back to reference Frank, R. G., Huskamp, H. A., & Pincus, H. A. (2003). Aligning incentives in the treatment of depression in primary care with evidence-based practice. Psychiatric Services, 54(5), 682–687.PubMedCrossRef Frank, R. G., Huskamp, H. A., & Pincus, H. A. (2003). Aligning incentives in the treatment of depression in primary care with evidence-based practice. Psychiatric Services, 54(5), 682–687.PubMedCrossRef
go back to reference Frank, E., Novick, D., & Kupfer, D. J. (2006). Antidepressants and psychotherapy: A clinical research review. Focus, 7, 263–272. Frank, E., Novick, D., & Kupfer, D. J. (2006). Antidepressants and psychotherapy: A clinical research review. Focus, 7, 263–272.
go back to reference Grazier, K. L., & Klinkman, M. S. (2006). The economics of integrated depression care: The University of Michigan study. Administration and Policy In Mental Health, 33(1), 16–20.PubMedCrossRef Grazier, K. L., & Klinkman, M. S. (2006). The economics of integrated depression care: The University of Michigan study. Administration and Policy In Mental Health, 33(1), 16–20.PubMedCrossRef
go back to reference Helmer, D. (1966). Social technology. New York, NY: Basic Books. Helmer, D. (1966). Social technology. New York, NY: Basic Books.
go back to reference Hohman, A. A., & Shear, K. M. (2002). Community-based Intervention Research: Coping with the “Noise” of Real Life in Study Design. American Journal of Psychiatry, 159, 201–207.CrossRef Hohman, A. A., & Shear, K. M. (2002). Community-based Intervention Research: Coping with the “Noise” of Real Life in Study Design. American Journal of Psychiatry, 159, 201–207.CrossRef
go back to reference Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington DC: National Academy Press. Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington DC: National Academy Press.
go back to reference Jindal, R. D., & Thase, M. E. (2005). Integrating psychotherapy and pharmacotherapy to improve outcomes among patients with mood disorders. Focus, 3, 114–121. Jindal, R. D., & Thase, M. E. (2005). Integrating psychotherapy and pharmacotherapy to improve outcomes among patients with mood disorders. Focus, 3, 114–121.
go back to reference Katon, W., Robinson, P., Von Korff, M., Lin, E., Bush, T., Ludman, E., et al. (1996). A multifaceted intervention to improve treatment of depression in primary care. Archives of General Psychiatry, 53(10), 924–932.PubMed Katon, W., Robinson, P., Von Korff, M., Lin, E., Bush, T., Ludman, E., et al. (1996). A multifaceted intervention to improve treatment of depression in primary care. Archives of General Psychiatry, 53(10), 924–932.PubMed
go back to reference Katon, W., Unützer, J., Fan, M. Y., Williams, J. W., Jr., Schoenbaum, M., Lin, E. H., et al. (2006). Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. Diabetes Care, 29(2), 265–270.PubMedCrossRef Katon, W., Unützer, J., Fan, M. Y., Williams, J. W., Jr., Schoenbaum, M., Lin, E. H., et al. (2006). Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. Diabetes Care, 29(2), 265–270.PubMedCrossRef
go back to reference Katon, W., Von Korff, M., Lin, E., Walker, E., Simon, G. E., Bush, T., et al. (1995). Collaborative management to achieve treatment guidelines. Impact on depression in primary care. Journal of the American Medical Association, 273(13), 1026–1031.PubMedCrossRef Katon, W., Von Korff, M., Lin, E., Walker, E., Simon, G. E., Bush, T., et al. (1995). Collaborative management to achieve treatment guidelines. Impact on depression in primary care. Journal of the American Medical Association, 273(13), 1026–1031.PubMedCrossRef
go back to reference Keller, M. B., McCullough, J. P., Klein, D. N., Arnow, B., Dunner, Dl, Gelenberg, et al. (2000). A comparison of nefazodone, the cognitive behavioral analysis system of psychotherapy, their combination for the treatment of chronic depression. The New England Journal of Medicine, 342, 1462–1470.PubMedCrossRef Keller, M. B., McCullough, J. P., Klein, D. N., Arnow, B., Dunner, Dl, Gelenberg, et al. (2000). A comparison of nefazodone, the cognitive behavioral analysis system of psychotherapy, their combination for the treatment of chronic depression. The New England Journal of Medicine, 342, 1462–1470.PubMedCrossRef
go back to reference Klerman, G. L., Weissman, M. M., Markowitz, J., et al. (1994). Medication and psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behaivor change. Raven: New York. Klerman, G. L., Weissman, M. M., Markowitz, J., et al. (1994). Medication and psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behaivor change. Raven: New York.
go back to reference Korsen, N., Scott, P., Dietrich, A. J., & Oxman, T. (2003). Implementing an office system to improve primary care management of depression. Psychiatric Quarterly, 74(1), 45–60.PubMedCrossRef Korsen, N., Scott, P., Dietrich, A. J., & Oxman, T. (2003). Implementing an office system to improve primary care management of depression. Psychiatric Quarterly, 74(1), 45–60.PubMedCrossRef
go back to reference Labby, D., Spofford, M., Robison, J., & Ralston, R. (2006). The economics of depression in primary care: De-fragmentation in the Oregon Medicaid market. Administration and Policy In Mental Health, 33(1), 39–42.PubMedCrossRef Labby, D., Spofford, M., Robison, J., & Ralston, R. (2006). The economics of depression in primary care: De-fragmentation in the Oregon Medicaid market. Administration and Policy In Mental Health, 33(1), 39–42.PubMedCrossRef
go back to reference Lasker, R. D., & Weiss, E. S. (2003). Creating partnership synergy: The critical role of community stakeholders. Journal of Health Services Administration, 26, 119–139. Lasker, R. D., & Weiss, E. S. (2003). Creating partnership synergy: The critical role of community stakeholders. Journal of Health Services Administration, 26, 119–139.
go back to reference Locke, E. A., & Latham, G. P. (1990). A theory of goal setting and performance. Englewood Cliffs, NJ: Prentice-Hall. Locke, E. A., & Latham, G. P. (1990). A theory of goal setting and performance. Englewood Cliffs, NJ: Prentice-Hall.
go back to reference Meredith, L. S., Jackson-Triche, M. D. N., Rubenstein, L. V., Camp, P., & Wells, K. B. (2000). Quality improvement for depression enhances long-term treatment knowledge for primary care clinicians. Journal of General Internal Medicine, 15(12), 868–877.PubMedCrossRef Meredith, L. S., Jackson-Triche, M. D. N., Rubenstein, L. V., Camp, P., & Wells, K. B. (2000). Quality improvement for depression enhances long-term treatment knowledge for primary care clinicians. Journal of General Internal Medicine, 15(12), 868–877.PubMedCrossRef
go back to reference Meredith, L. S., Mendel, P., Pearson, M., Wu, S. Y., Joyce, G., Straus, J. B., et al. (2006). Implementation and maintenance of quality improvement for treating depression in primary care. Psychiatric Services, 57(1), 48–55.PubMedCrossRef Meredith, L. S., Mendel, P., Pearson, M., Wu, S. Y., Joyce, G., Straus, J. B., et al. (2006). Implementation and maintenance of quality improvement for treating depression in primary care. Psychiatric Services, 57(1), 48–55.PubMedCrossRef
go back to reference Minkler, M., & Wallerstein, N. (2003). Community-based participatory research for health. San Francisco, CA: Jossey-Bass. Minkler, M., & Wallerstein, N. (2003). Community-based participatory research for health. San Francisco, CA: Jossey-Bass.
go back to reference National Institutes of Health. (1983). Consensus development program staff: Assessing the NIH consensus development program: Study design. Santa Monica, CA: RAND Corporation. National Institutes of Health. (1983). Consensus development program staff: Assessing the NIH consensus development program: Study design. Santa Monica, CA: RAND Corporation.
go back to reference Pincus, H. A., Pechura, C., Keyser, D., Bachman, J., & Houtsinger, J. K. (2006). Depression in primary care: Learning lessons in a national quality improvement program. Administration and Policy In Mental Health, 33(1), 2–15.PubMedCrossRef Pincus, H. A., Pechura, C., Keyser, D., Bachman, J., & Houtsinger, J. K. (2006). Depression in primary care: Learning lessons in a national quality improvement program. Administration and Policy In Mental Health, 33(1), 2–15.PubMedCrossRef
go back to reference Rost, K., Fortney, J., Fischer, E., & Smith, J. (2002). Use, quality, and outcomes of care for mental health: The rural perspective. Medical Care Research and Review, 59(3), 231–265. discussion 266–271.PubMedCrossRef Rost, K., Fortney, J., Fischer, E., & Smith, J. (2002). Use, quality, and outcomes of care for mental health: The rural perspective. Medical Care Research and Review, 59(3), 231–265. discussion 266–271.PubMedCrossRef
go back to reference Rubenstein, L. V., Meredith, L. S., Parker, L. E., Gordon, N. P., Hickey, S. C., Oken, C., et al. (2006). Impacts of evidence-based quality improvement on depression in primary care: A randomized experiment. Journal of General Internal Medicine, 21(10), 1027–1035.PubMedCrossRef Rubenstein, L. V., Meredith, L. S., Parker, L. E., Gordon, N. P., Hickey, S. C., Oken, C., et al. (2006). Impacts of evidence-based quality improvement on depression in primary care: A randomized experiment. Journal of General Internal Medicine, 21(10), 1027–1035.PubMedCrossRef
go back to reference Schoenbaum, M., Unützer, J., Sherbourne, C. D., Duan, N., Rubenstein, L. V., Miranda, J., et al. (2001). Cost-effectiveness of practiced-initiated quality improvement for depression: Results of a randomized controlled trial. Journal of the American Medical Association, 286(11), 1325–1330.PubMedCrossRef Schoenbaum, M., Unützer, J., Sherbourne, C. D., Duan, N., Rubenstein, L. V., Miranda, J., et al. (2001). Cost-effectiveness of practiced-initiated quality improvement for depression: Results of a randomized controlled trial. Journal of the American Medical Association, 286(11), 1325–1330.PubMedCrossRef
go back to reference Sherbourne, C. D., Wells, K. B., Duan, N., Miranda, J., Unutzer, J., Jaycox, L., et al. (2001). Long-term effectiveness of disseminating quality improvement for depression in primary care. Archives of General Psychiatry, 58(7), 696–703.PubMedCrossRef Sherbourne, C. D., Wells, K. B., Duan, N., Miranda, J., Unutzer, J., Jaycox, L., et al. (2001). Long-term effectiveness of disseminating quality improvement for depression in primary care. Archives of General Psychiatry, 58(7), 696–703.PubMedCrossRef
go back to reference Thomas, M. R., Waxmonsky, J. A., McGinnis, G. F., & Barry, C. L. (2006). Realigning clinical and economic incentives to support depression management within a medicaid population: The Colorado access experience. Administration and Policy In Mental Health, 33(1), 26–33.PubMedCrossRef Thomas, M. R., Waxmonsky, J. A., McGinnis, G. F., & Barry, C. L. (2006). Realigning clinical and economic incentives to support depression management within a medicaid population: The Colorado access experience. Administration and Policy In Mental Health, 33(1), 26–33.PubMedCrossRef
go back to reference Unützer, J., Katon, W., Callahan, C. M., Williams, J. W., Jr., Hunkeler, E., Harpole, L., et al. (2002). Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. Journal of the American Medical Association, 288(22), 2836–2845.PubMedCrossRef Unützer, J., Katon, W., Callahan, C. M., Williams, J. W., Jr., Hunkeler, E., Harpole, L., et al. (2002). Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. Journal of the American Medical Association, 288(22), 2836–2845.PubMedCrossRef
go back to reference U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. (1999). Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institues of Health, National Institutes of Mental Health. U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. (1999). Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institues of Health, National Institutes of Mental Health.
go back to reference Wells, K. B., Sherbourne, C., Schoenbaum, M., Duan, N., Meredith, L., Unutzer, J., et al. (2000). Impact of disseminating quality improvement programs for depression in managed primary care: A randomized controlled trial. Journal of the American Medical Association, 283(2), 212–220.PubMedCrossRef Wells, K. B., Sherbourne, C., Schoenbaum, M., Duan, N., Meredith, L., Unutzer, J., et al. (2000). Impact of disseminating quality improvement programs for depression in managed primary care: A randomized controlled trial. Journal of the American Medical Association, 283(2), 212–220.PubMedCrossRef
go back to reference Wells, K., Sherbourne, C., Schoenbaum, M., Ettner, S., Duan, N., Miranda, J., et al. (2004). Five-year impact of quality improvement for depression: Results of a group-level randomized controlled trial. Archives of General Psychiatry, 61(4), 378–386.PubMedCrossRef Wells, K., Sherbourne, C., Schoenbaum, M., Ettner, S., Duan, N., Miranda, J., et al. (2004). Five-year impact of quality improvement for depression: Results of a group-level randomized controlled trial. Archives of General Psychiatry, 61(4), 378–386.PubMedCrossRef
Metadata
Title
A Collaborative Approach to Identifying Effective Incentives for Mental Health Clinicians to Improve Depression Care in a Large Managed Behavioral Healthcare Organization
Authors
Lisa S. Meredith
Robert B. Branstrom
Francisca Azocar
Ruth Fikes
Susan L. Ettner
Publication date
01-05-2011
Publisher
Springer US
Published in
Administration and Policy in Mental Health and Mental Health Services Research / Issue 3/2011
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI
https://doi.org/10.1007/s10488-010-0313-0

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