xxAACP Newsletter, Volume 13, Number 3, Summer 1999
The AACP Establishes a Work Group on Quality Management
The Health Systems Committee of the AACP has spawned several projects since its inception that have had much to do with the organization’s recent success. Under the direction of Ken Minkoff, M.D., much has been accomplished. In the Spring of 1998 a position paper entitled "Standards for Quality Management in Implementing Public Sector Managed Care Systems" was issued which outlined broad principles for this activity (Community Psychiatrist; Vol 12, No. 2, P.6). The paper generated significant interest and the importance of quality in protecting systems of care from financially driven resource management is obvious. With this principle in mind, a work group on quality management was formed with Barbara Rohland and Wes Sowers serving as Co-chairs. Needless to say, many groups have been considering quality management and developing guidelines in this area, so the mission of the work group was not so much to reinvent the wheel, but rather to give it a good inspection and make some suggestions for improvement if possible. During the course of its work in the past year, a great deal of information has been collected and reviewed. The work group has focused on the indicators that make managed care systems responsive to the needs of communities and of persons with severe mental illnesses that are being treated in those communities. Among the many documents reviewed, the work of the American College of Mental Health Administrators (ACMHA) stood out. Their initial document, "Preserving Quality and Value in the Managed Care Equation" provided a broadly based structure for guiding quality in the managed care environment. After developing a dialogue with the ACMHA, the opportunity for a more extensive collaboration was determined.
On March 17, 1999 in Santa Fe, the ACMHA hosted an all day mini-summit on quality assurance measures. ACMHA invited a diverse group of organizations, e.g., JCAHO, CARF, The Council, NCQA, small to large behavioral health providers, state quality assurance representatives, chairmen of academic centers, for profit managed care organizations, consumer groups, etc. The purpose of the meeting was to discuss the feasibility of defining and ultimately implementing a core set of quality of service indicator variables that would be adopted by all major accrediting organizations. The AACP sent Mario Cruz, MD as a representative.
The discussion was stimulating and facilitated skillfully by ACMHA's conference organizers: Neal Adams, M.D., M.P.H., Medical Director for Santa Cruz County, California; May Jane England, M.D., President of the Washington Business Group; H.G. Whittington, M.D., National Medical Director of Menninger Care Systems. Dr. Adams provided the historical background for the mini-summit. He very clearly expressed the present need for a "Core Set" of indicators that would be used to universally measure the clinical performance of any mental health provider. Dr. England provided an "Environmental Scan" that anchored the discussion within the present revolution going on in health care. She highlighted key stakeholders and motivation that have brought about the shift to managed care paradigms in healthcare. She expressed how public and private purchasers of healthcare, due to the universal use of managed care principles now have similar issues related to the types of service provided and the quality of those services. This convergence of the needs and expectations for all purchasers and consumer groups was the catalyst for the summit.
The summit ended with the group of representatives recognizing that on the surface it would appear that a "Core Set" of indicators would be very difficult to agree upon given the diversity of motivations and perspectives presented by the representatives at the mini-summit. The difficulty of moving in this direction has as many political obstacles to overcome as substantive issues, and these may be much more difficult to resolve. It appears in any case, that the AACP would benefit from an ongoing relationship with ACMHA. Both organizations have a strong investment in the development of quality and utilization benchmarks of mental health services. Working together with an organization that has a broad mental health professional and non-professional constituency such as ACMHA can help us fulfill our mission, and presents an opportunity to ensure that community oriented principles are not overlooked.
Final summary information on the summit can be obtained through the web at http://www.bhos.com. Information on ACMHA itself can be obtained by e-mail from ACMHHA.org.lawhel@aol.com. Any members who may be interested in working with the Quality Management Work Group can contact Wesley Sowers at sowers@sfhs.edu.
Mario Cruz, M.D
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