📊 Measurement-Based Care

Systematic Outcome Monitoring for Evidence-Based Psychiatry

General Psychiatry Topic 17

1

🎯 Why MBC Matters

Clinical Outcomes

0.36

Effect size favoring ROM with CST

20%

Reduction in dropout rates

Regulatory Reality

HEDIS 2025: Digital PHQ-9 required for DR-E measure

VBP: Outcome-based contracts tie payment to data

2

📏 Core Instruments

Instrument	Score Range	Clinical Cut-points
PHQ-9	0-27	10+ moderate, 15+ mod-severe, 20+ severe
GAD-7	0-21	5+ mild, 10+ moderate, 15+ severe
Y-BOCS	0-40	≤14 remission, ≤12 wellness target

3

⚡ Action Rules

4-Week Rule: 0% improvement = immediate pivot (check adherence, optimize, switch)
8-Week Rule: <50% reduction = step up care (intensity, augment, refer)
Item 9 Alert: Any score >0 = hard stop for suicide assessment

4

💰 Billing Codes

96127: Brief behavioral assessment (PHQ-9, GAD-7 scoring)
96130/96131: Evaluation/integration (per hour)
96146: Automated testing (no professional intervention)
99492-99494: CoCM registry-based codes

5

🔧 Implementation

Phase 1: Infrastructure

Select core set (PHQ-9, GAD-7)
Choose digital platform
Test EHR integration

Phase 2: Workflow

Tablet kiosks
Remote pre-visit links
CDS alerts for Item 9

Phase 3: Sustain

Monitor >80% adherence
Review aggregate outcomes
Identify outliers

6