A Practice Based Behavioral Health Management Registry (BHMR): Implementation, Structure and Content

Previous commentaries in the Formulary Evaluation section of INNOVATIONS in Pharmacy have pointed to the difficulties of establishing the credibility of trial-based and modeled claims for therapy interventions. Claims for interventions in behavioral health are no exception. A recent report by The Kennedy Forum emphasizes the need for a system of measurement-based care using validated scales to assess the need for and response to therapy. To accomplish this, The Kennedy Forum proposed a core set of outcomes measures for behavioral health interventions. This core set provides the context for a proposed Behavioral Health Management Registry (BHMR). The purpose of this commentary is to describe the structure and content of the BHMR. The BHMR provides access to nine symptom rating scales for depression, mania, anxiety, PTSD, panic attacks, alcohol use, drug abuse and somatization, together with supplementary questions to capture socio-demographic characteristics of patients, pain experience and opioid use, medical marijuana, DSM-V criteria for PTSD diagnosis and sleep experience. As such, with patient and physician inputs over the course of treatment, the BHMR provides an evidence base for physician practices and health care decision makers to evaluate behavioral health interventions by tracking the cumulative response to therapy. In addition, the BHMR captures the perception of the patients as to whether or not their therapy has led to any substantive improvement in activity limitations, symptoms and quality of life. A particular focus of the BHMR is on monitoring and evaluating the impact of interventions on the overall experience of pain as well as tracking pain intensity and functional status by body location. This is important given the prevalence of pain and its association with conditions such as depression and anxiety. The BHMR can also support monthly reports to the practice to summarize patient throughput, the response to care by target pain patients and profiles of opioid use and abuse. The BHMR can be customized to meet the needs of individual practices.