Understanding the intersection between quality improvement, managed behavioral health accreditation, and the private...

Area of Science:

• Healthcare Management
• Quality Improvement Science
• Behavioral Health Services

Background:

• Multiple stakeholders are involved in behavioral health care, all prioritizing service quality.
• Accreditation of managed behavioral health organizations (MBHOs) parallels practitioner licensure and board certification in ensuring minimum care standards.
• Payers utilize accreditation to verify that MBHOs balance cost containment with quality assurance.

Purpose of the Study:

• To examine the role and impact of accreditation, specifically NCQA accreditation, on MBHOs.
• To understand how accreditation standards drive quality improvement (QI) programs within MBHOs.
• To assess the alignment between MBHO QI initiatives and the delivery of continuous, population-based behavioral health care.

Main Methods:

• Analysis of accreditation standards for MBHOs, focusing on QI program requirements.
• Evaluation of the current state of MBHO accreditation, noting the prevalence of full accreditation.
• Review of the relationship between accreditation, QI efforts, and practitioner engagement.

Main Results:

• Accreditation standards mandate MBHOs to implement QI programs for systemic care improvement.
• Currently, a limited number of MBHOs achieve full accreditation, indicating potential gaps in their QI programs.
• Many MBHOs struggle to adequately demonstrate efforts in assessing and improving continuity and population-based care.

Conclusions:

• Accreditation is crucial for regulating the MBHO industry and establishing quality care ideals.
• QI initiatives, driven by accreditation, are essential for defining and improving systemic behavioral health care.
• Effective QI and accreditation contribute to ensuring continuous, quality care for a population across various settings and over time.