Few therapists measure outcomes. A startup's new framework aims to change that

Two-thirds of patients receiving three months of outpatient therapy will not reach remission, a new analysis of behavioral health therapy outcomes data reveals. 

The analysis was conducted by Blueprint, a startup focused on enabling measurement-based care for mental health practitioners, and was complemented by a new framework for communicating, comparing and improving outcomes at the national level. 

Practitioners can use the framework, known as the Blueprint Quality Index (BQI), to track quality improvement over time as well as assess the effect of programmatic or infrastructure changes on patient outcomes.

Measurement-based care is evidence-based and improves clinical outcomes. Outcome measures are assessments that measure change in patients' functioning, performance or participation over time.

Systematic outcome measurement can greatly strengthen national health policy, yet this standard remains largely unimplemented. Fewer than 20% of behavioral health practitioners use measurement-based care, which Blueprint said suggests a lack of available data for developing outcomes-based benchmarks.

“Most therapists do not like assessments in general,” said Melissa Bartholomew, a licensed mental health counselor, owner of a telehealth practice based in Hawaii and Blueprint customer cited in the company's release announcement.

While it’s possible to measure outcomes manually, it is a major workload that many practitioners are hesitant to take on, she told Fierce Healthcare. Though tools exist to help automate the process, “measurements are pretty expensive,” she added.

Bartholomew said she looked for a solution for a year before coming across Blueprint and becoming a customer.

Founded in 2019, Blueprint aims to help practitioners utilize measurement-based care. Since then, it has worked with more than 9,100 clinicians treating more than 200,000 patients and has thus accumulated what it says is the most comprehensive data set on outpatient behavioral health therapy outcomes. It consists of more than 2 million outcome measure administrations.

In analyzing its data, Blueprint found that only a third of patients achieve remission for depression and just over a third do for anxiety during a 12-week course of care. On average, a fifth of patients experience clinically meaningful symptom improvement for depression and a quarter do for anxiety.

After synthesizing all these data, Blueprint came up with the BQI. It is based on Achievable Benchmarks of Care, which are standards of excellence attained by top performers in a peer group. The BQI consists of effectiveness and efficiency and can be used to provide an organization with a 100-point quality composite score for outcomes. 

Effectiveness measures how significant care was at reducing symptoms, while efficiency measures how quickly change happens.

The attainable benchmark representing high-quality outpatient therapy outcomes of anxiety is a 9.3-point reduction in GAD-7 scores within 12 weeks and a 1.29-point rate of change for the first four weeks, according to Blueprint’s data.

The attainable benchmark representing high-quality outpatient therapy outcomes of depression, according to Blueprint’s analysis, is an 11.8-point reduction in PHQ-9 scores within 12 weeks and a 1.23-point rate of change for the first four weeks.

Providers can use the BQI to track and evaluate quality improvement. As payers move toward performance-based payments, practitioners who may struggle to adopt quality measures like HEDIS may be able to use the BQI as a more scalable and equitable measure, Blueprint says.

The company hopes that in the long run, the BQI can help promote quality improvement at a national level. Additionally, the startup hopes the continued development and refinement of this benchmarking methodology will eventually help consumers better choose and receive the highest quality care.

Blueprint advises practitioners that are not currently systematically measuring their outcomes to begin to do so. For those that are measuring outcomes, Blueprint encourages them to embrace a culture of transparency and quality improvement.