Measurement-Based Care in Behavioral Health: Let’s Keep Moving Forward

March 31, 2025 · Guest Contributor

By Tom Valentine, PhD, Applied Research Scientist, Behavioral Health, NCQA

Implementing measurement-based care supports person-centered care and makes it easier to evaluate care quality. My work at NCQA focuses on improving behavioral health outcomes—one way to do that is to get more clinicians to deliver measurement-based care.

I’m a clinical psychologist who was trained in measurement-based care in graduate school. No one taught me that it was a novel approach—I thought it was the norm. After I finished my PhD and started working in the real world, I discovered that it’s the exception.

What Is Measurement-Based Care?

The Interdepartmental Serious Mental Illness Coordinating Committee says measurement-based care is “a clinical process that uses standardized, valid, repeated measurements to track a client’s progress over time and to inform treatment, utilizing a shared patient-provider treatment-planning and treatment decision-making process.” It is often used interchangeably with measurement-informed care, which offers a more flexible approach to tracking treatment progress and making care decisions.

The goal is to measure consistently across patients and care settings using standardized measures. Measurements are repeated at regular intervals to track a patient’s symptoms, response to treatment and overall progress. Consistent measurement helps reveal patterns (whether a patient is worsening, stagnating or improving.) Most important, patients and clinicians work together to determine if a treatment approach is effective, or if it needs to be adjusted.

Benefits of Measurement-Based Care

• Improves treatment outcomes for a variety of conditions—including higher rates of response and remission, and lower rates of relapse.
• Provides concrete data to inform adjustments to treatment, such as changing medications or intensifying support.
• Improves communication and increases engagement by providing a structure for clinicians and patients to discuss treatment progress and goals.
• Increases provider accountability and transparency through objective data to show measurable improvements for value-based reimbursements.
• Enhances research efforts and supports analysis of real-world effectiveness of interventions and treatment response.

Support Is High, But Adoption Is Slow

Key professional organizations and federal agencies (e.g., the American Psychiatric Association, the Substance Abuse and Mental Health Services Administration, the Centers for Medicare & Medicaid Services) support measurement-based care, but studies show that fewer than 20% of behavioral health clinicians implement it—even though clinicians believe it enhances clinical decision making, strengthens therapeutic relationships and increases focus and efficiency of encounters.

One major barrier to adoption of measurement-based care is EHR integration—systems are simply not designed to capture, manage and share this type of data. Lack of interoperability and data standardization contribute to the problem. Clinicians also need more training on how to implement measurement-based care, and time in their schedules to do it. Reimbursement limitations can also impede adoption.

How NCQA’s Work Supports Measurement-Based Care

I’d like to highlight two areas where NCQA’s work supports adoption of measurement-based care.

HEDIS Measures for Depression Care. NCQA developed five measures related to depression care—two are focused on the prenatal and postpartum periods; three focus on the general population:

• Depression Screening and Follow-up for Adolescents and Adults (DSF-E). The percentage of members 12 years of age and older who were screened for clinical depression using a standardized instrument and, if screened positive, received follow-up care within 30 days.
• Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E). The percentage of members 12 years of age and older with a diagnosis of depression and an outpatient visit with a PQH-9 (Patient Health Questionnaire) score present in their record.
• Depression Remission or Response for Adolescents and Adults (DRR-E). The percentage of members 12 years of age and older with a diagnosis of depression and an elevated PHQ-9 score, who had evidence of response or remission within 4–8 months of the elevated score.

HEDIS measures encourage clinicians to measure and track patients’ progress over time—an important component of measurement-based care. These measures are reported using Electronic Clinical Data Systems, so they require integration with EHRs.

Person-Centered Outcome Measures for Behavioral Health. With support from The John A. Hartford Foundation, The SCAN Foundation and The Gordon and Betty Moore Foundation, NCQA developed Person-Centered Outcome measures to identify and track progress against patient-defined goals within a standardized framework. These measures have three components:

• Identify a goal and document it using goal attainment scaling or a patient-reported outcome measure.
• Follow up on the goal.
• Measure achievement of the goal.

The PCO measures were initially designed for individuals with complex care needs, but NCQA adapted them for behavioral health and tested them in Certified Community Behavioral Health Clinics to understand the opportunities and implementation challenges.

Conclusion

Measurement-based care is a collaborative effort that empowers patients to make progress toward their goals and achieve better outcomes. Support from key organizations and robust research evidence underscore its importance, but slow adoption highlights the need for systemic change. By addressing barriers to implementation, we can pave the way for a future where measurement-based care becomes the standard of care in behavioral health.

Learn More

• Get more information about HEDIS Depression Screening measures.
• Read about PCO Measures for Behavioral Health.
• Take one of our free online courses.
  • Identifying and Developing a Person-Centered Outcome Goal (Behavioral Health Version)
  • Using Goal Attainment Scaling to Document and Track Person-Centered Outcome Goals (Behavioral Health Version)
  • Using Patient-Reported Outcome Measures to Document and Track Person-Centered Outcome Goals (Behavioral Health Version)
• Download the Person-Centered Outcomes Approach Toolkit.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).