Using big data and Population Health Management to assess care and costs for patients with severe mental disorders and move toward a value-based payment system
Abstract Background Mental health (MH) care often exhibits uneven quality and poor coordination of physical and MH needs, especially for patients with severe mental disorders. This study tests a Population Health Management (PHM) approach to identify patients with severe mental disorders using admin...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-023-09655-6 |
| _version_ | 1797453416152170496 |
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| author | Valeria D. Tozzi Helen Banks Lucia Ferrara Angelo Barbato Giovanni Corrao Barbara D’avanzo Teresa Di Fiandra Andrea Gaddini Matteo Monzio Compagnoni Michele Sanza Alessio Saponaro Salvatore Scondotto Antonio Lora |
| author_facet | Valeria D. Tozzi Helen Banks Lucia Ferrara Angelo Barbato Giovanni Corrao Barbara D’avanzo Teresa Di Fiandra Andrea Gaddini Matteo Monzio Compagnoni Michele Sanza Alessio Saponaro Salvatore Scondotto Antonio Lora |
| author_sort | Valeria D. Tozzi |
| collection | DOAJ |
| description | Abstract Background Mental health (MH) care often exhibits uneven quality and poor coordination of physical and MH needs, especially for patients with severe mental disorders. This study tests a Population Health Management (PHM) approach to identify patients with severe mental disorders using administrative health databases in Italy and evaluate, manage and monitor care pathways and costs. A second objective explores the feasibility of changing the payment system from fee-for-service to a value-based system (e.g., increased care integration, bundled payments) to introduce performance measures and guide improvement in outcomes. Methods Since diagnosis alone may poorly predict condition severity and needs, we conducted a retrospective observational study on a 9,019-patient cohort assessed in 2018 (30.5% of 29,570 patients with SMDs from three Italian regions) using the Mental Health Clustering Tool (MHCT), developed in the United Kingdom, to stratify patients according to severity and needs, providing a basis for payment for episode of care. Patients were linked (blinded) with retrospective (2014–2017) physical and MH databases to map resource use, care pathways, and assess costs globally and by cluster. Two regions (3,525 patients) provided data for generalized linear model regression to explore determinants of cost variation among clusters and regions. Results Substantial heterogeneity was observed in care organization, resource use and costs across and within 3 Italian regions and 20 clusters. Annual mean costs per patient across regions was €3,925, ranging from €3,101 to €6,501 in the three regions. Some 70% of total costs were for MH services and medications, 37% incurred in dedicated mental health facilities, 33% for MH services and medications noted in physical healthcare databases, and 30% for other conditions. Regression analysis showed comorbidities, resident psychiatric services, and consumption noted in physical health databases have considerable impact on total costs. Conclusions The current MH care system in Italy lacks evidence of coordination of physical and mental health and matching services to patient needs, with high variation between regions. Using available assessment tools and administrative data, implementation of an episodic approach to funding MH could account for differences in disease phase and physical health for patients with SMDs and introduce performance measurement to improve outcomes and provide oversight. |
| first_indexed | 2024-03-09T15:22:30Z |
| format | Article |
| id | doaj.art-7e9d7960635a4e15be0ef414fe2f12c0 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-09T15:22:30Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-7e9d7960635a4e15be0ef414fe2f12c02023-11-26T12:43:45ZengBMCBMC Health Services Research1472-69632023-09-0123111410.1186/s12913-023-09655-6Using big data and Population Health Management to assess care and costs for patients with severe mental disorders and move toward a value-based payment systemValeria D. Tozzi0Helen Banks1Lucia Ferrara2Angelo Barbato3Giovanni Corrao4Barbara D’avanzo5Teresa Di Fiandra6Andrea Gaddini7Matteo Monzio Compagnoni8Michele Sanza9Alessio Saponaro10Salvatore Scondotto11Antonio Lora12Center for Research on Health and Social Care Management, SDA Bocconi School of Management – Bocconi UniversityCenter for Research on Health and Social Care Management, SDA Bocconi School of Management – Bocconi UniversityCenter for Research on Health and Social Care Management, SDA Bocconi School of Management – Bocconi UniversityUnit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCSNational Centre for Healthcare Research and Pharmacoepidemiology, University of Milano- BicoccaUnit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCSGeneral Directorate for Health Prevention, Ministry of HealthAgency for Public Health, Lazio RegionNational Centre for Healthcare Research and Pharmacoepidemiology, University of Milano- BicoccaDepartment of Mental Health and Addiction Services, AUSL RomagnaGeneral Directorate of Health and Social Policies, Emilia-Romagna RegionDepartment of Health Services and Epidemiological Observatory, Regional Health AuthorityDepartment of Mental Health and Addiction Services, ASST LeccoAbstract Background Mental health (MH) care often exhibits uneven quality and poor coordination of physical and MH needs, especially for patients with severe mental disorders. This study tests a Population Health Management (PHM) approach to identify patients with severe mental disorders using administrative health databases in Italy and evaluate, manage and monitor care pathways and costs. A second objective explores the feasibility of changing the payment system from fee-for-service to a value-based system (e.g., increased care integration, bundled payments) to introduce performance measures and guide improvement in outcomes. Methods Since diagnosis alone may poorly predict condition severity and needs, we conducted a retrospective observational study on a 9,019-patient cohort assessed in 2018 (30.5% of 29,570 patients with SMDs from three Italian regions) using the Mental Health Clustering Tool (MHCT), developed in the United Kingdom, to stratify patients according to severity and needs, providing a basis for payment for episode of care. Patients were linked (blinded) with retrospective (2014–2017) physical and MH databases to map resource use, care pathways, and assess costs globally and by cluster. Two regions (3,525 patients) provided data for generalized linear model regression to explore determinants of cost variation among clusters and regions. Results Substantial heterogeneity was observed in care organization, resource use and costs across and within 3 Italian regions and 20 clusters. Annual mean costs per patient across regions was €3,925, ranging from €3,101 to €6,501 in the three regions. Some 70% of total costs were for MH services and medications, 37% incurred in dedicated mental health facilities, 33% for MH services and medications noted in physical healthcare databases, and 30% for other conditions. Regression analysis showed comorbidities, resident psychiatric services, and consumption noted in physical health databases have considerable impact on total costs. Conclusions The current MH care system in Italy lacks evidence of coordination of physical and mental health and matching services to patient needs, with high variation between regions. Using available assessment tools and administrative data, implementation of an episodic approach to funding MH could account for differences in disease phase and physical health for patients with SMDs and introduce performance measurement to improve outcomes and provide oversight.https://doi.org/10.1186/s12913-023-09655-6Population healthMental healthHealthcare deliveryBig dataHealth information interoperabilityMedical record linkage |
| spellingShingle | Valeria D. Tozzi Helen Banks Lucia Ferrara Angelo Barbato Giovanni Corrao Barbara D’avanzo Teresa Di Fiandra Andrea Gaddini Matteo Monzio Compagnoni Michele Sanza Alessio Saponaro Salvatore Scondotto Antonio Lora Using big data and Population Health Management to assess care and costs for patients with severe mental disorders and move toward a value-based payment system BMC Health Services Research Population health Mental health Healthcare delivery Big data Health information interoperability Medical record linkage |
| title | Using big data and Population Health Management to assess care and costs for patients with severe mental disorders and move toward a value-based payment system |
| title_full | Using big data and Population Health Management to assess care and costs for patients with severe mental disorders and move toward a value-based payment system |
| title_fullStr | Using big data and Population Health Management to assess care and costs for patients with severe mental disorders and move toward a value-based payment system |
| title_full_unstemmed | Using big data and Population Health Management to assess care and costs for patients with severe mental disorders and move toward a value-based payment system |
| title_short | Using big data and Population Health Management to assess care and costs for patients with severe mental disorders and move toward a value-based payment system |
| title_sort | using big data and population health management to assess care and costs for patients with severe mental disorders and move toward a value based payment system |
| topic | Population health Mental health Healthcare delivery Big data Health information interoperability Medical record linkage |
| url | https://doi.org/10.1186/s12913-023-09655-6 |
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