Monitor Implementation Process and Clinical Outcomes

Now that you are providing Collaborative Care, you should begin monitoring your process and outcomes using whatever metrics you decided on in Identify a Population-Based Tracking System in Step 2: Plan for Clinical Practice Change. Remember, a systematic method for tracking the progress of your patients is crucial for the success of CoCM. Without it, you have no concrete idea if what you're doing is working or not.

Implementation Resources

If you haven't already done so, decide on how and when you'll review your metrics. You should review, re-evaluate, and adjust them as necessary on a regular basis. Maybe you need to change your goals now that you have real data to work with. Maybe you've met your stated objectives and now want to do even better. Maybe you set different goals for year 1, 2 and 3 and need to adjust them. Having a system in place for regularly reviewing your numbers keeps your entire effort on track. Here is one implementation's Quality Aims that gets reviewed and revised each year.

Looking at your metrics can also help in identifying ways to improve your care. For example, in one implementation we discovered that care manager A was consistently getting her patients better than care manager B. By looking at our metrics, we determined that care manager A did twice as many follow-up calls than care manager B and were able to test that theory.

Pay for performance may be one way to improve your clinical outcomes, as suggested by the following paper: Quality Improvement With Pay-for-Performance Incentives in Integrated Behavioral Health Care.