In September 2018, the Centers on Medicare and Medicaid Services (CMS) announced that APA, among six other organizations, were awarded funding for measure development under section 102 of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. APA subsequently entered into a cooperative agreement with CMS to pursue this effort, while also contracting with the National Committee on Quality Assurance (NCQA) for technical expertise in measure development.

The goal of the funding award was to promote the development of meaningful quality measures that fill CMS-designated high priority areas. The measures under development as part of this project were intended to assess key aspects of performance for clinicians who provide care to patients with mental health and substance use disorders, while avoiding burdensome data collection requirements.

These measures were defined by APA-member experts with consultation from outside experts, and focused on promotion of measurement-based care (MBC) and assessment of important patient outcomes such as function and recovery. The measures were intended for use by a wide swath of healthcare providers, including psychiatrists, social workers, and other behavioral health providers, as well as primary care providers and others; the measures were planned for use as part of the CMS value-based payment program for clinicians, the Merit-Based Incentive Payment System (MIPS).

Measure Concepts

The concepts planned for development under the cooperative agreement were defined by APA-member experts with consultation from outside experts and will focus on measurement-based care (MBC), evidence-based care, and care experience. Major diagnostic categories included opioid use disorder, first episode psychosis and suicidal thoughts and behavior. This was not to the exclusion of other psychiatric conditions. These measures were intended for use by a wide swath of healthcare providers, including psychiatrists, social workers, and other behavioral health providers, as well as primary care providers, and others.

Measure-Based Care Domain

• Process Measures:
  • Initial assessment
  • Monitoring of symptoms, functioning, and recovery
  • Treatment adjustment
• Outcome Measures:
  • Improvement or maintenance of symptoms, functioning, and recovery
• Target Population:
  • All patients seen for mental health and substance use (MH/SU) care

Suicide Prevention Domain

• Process Measures:
  • Initiation and update of Suicide Safety Plan for individuals with suicide risk
• Outcome Measures:
  • Reduction in Suicidal Ideation or Behavior Symptoms
• Target Population:
  • Individuals with suicidal ideation and/or behavior symptoms OR deemed a suicide risk based on their clinician's evaluation