Behavioral Health Quality Framework: A Roadmap for Using Measurement to Promote Joint Accountability and Whole-Person Care


Mental health conditions and substance use disorders — collectively referred to as “behavioral health conditions” — are a leading cause of disease burden in the United States, surpassing both cardiovascular disease and cancer. As of 2019, nearly 1 in 5 adults in the United States had a diagnosed mental health condition, and 1 in 12 people over age 12 had a diagnosed substance use disorder. People with behavioral health conditions experience higher morbidity, poorer health outcomes, and a shorter life expectancy than the general population. These poorer outcomes occur even though care for people with behavioral health conditions accounts for a disproportionate share of total health care spending. Payers and stakeholders are increasingly looking to value-based payment models to integrate behavioral health and physical health care to improve people’s outcomes and manage costs.

The current fragmented and inequitable state of behavioral health care calls for a quality measurement framework that can be used to guide and hold entities jointly accountable for improving care access and outcomes for people with behavioral health conditions. To guide development of this framework, CHCF commissioned the National Committee for Quality Assurance (NCQA) to evaluate the current behavioral health quality measurement landscape and better understand the needs and challenges of entities responsible for behavioral health care across the health care system.

In its report, Behavioral Health Quality Framework: A Roadmap for Using Measurement to Promote Joint Accountability and Whole-Person Care (PDF), NCQA proposes a “Behavioral Health Quality Framework” to drive improvements in quality of care and to promote joint accountability across entities responsible for serving people with behavioral health needs. It is available as part of NCQA’s reports and research.

This framework prioritizes alignment and use of meaningful sets of quality measures, uniquely targeted to each level of the health care system, that coordinate and assess progress toward population-level goals. Bundles of measures and metrics are transparently defined, measured, and coordinated, and data use is based on each entity’s unique position and relationship with respect to goals and populations served.

By aligning and coordinating efforts across the delivery system, meaningful quality measures can spur accountability through transparency and payment. Purposeful alignment and coordinated quality measurement activities that consider each entity’s sphere of influence while keeping a line of sight to shared goals can empower stakeholders to make informed decisions and to minimize burden. There have recently been momentous federal and state investments to help mitigate the COVID-19 pandemic’s impact on behavioral health, but there is a critical need for a clear framework and approach to driving and measuring behavioral health care quality and outcomes. The Behavioral Health Quality Framework provides a testable model for guiding these efforts.

About the Authors

Lauren Niles, MPH, DrPH candidate, is a senior research associate in Performance Measurement, and Serene Olin, PhD, is assistant vice president, Research and Analysis, with NCQA.