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Quality Measures for Mental Health and Substance Use: Gaps, Opportunities, and Challenges

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There has been little progress in the decade since the Institute of Medicine called for more rigorous assessment of the quality and safety of treatment for mental illness and substance use disorders. But incentives designed to improve behavioral health care in the Affordable Care Act, the Mental Health Parity and Addiction Equity Act, and other legislation are creating momentum for better performance assessment measures. In a Health Affairs study, Commonwealth Fund–supported researchers provide an overview of current measures of behavioral health, identify priorities for measure development, and outline the most significant challenges.

What the Study Found

There are 510 measures related to behavioral health, but only about 5 percent are used in quality-reporting programs and only 10 percent have been endorsed by the National Quality Forum. Quality reporting so far appears to have had limited effect on behavioral health: based on Healthcare Effectiveness Data and Information Set (HEDIS) reports from commercial health plans, patients receive recommended behavioral health care less than half the time, with slow improvement in recent years.

In terms of measure development, the authors identify five priorities:

  • expanded outcomes measurement
  • structural measures, such as accreditation programs for health homes
  • recognition of efforts to integrate physical and behavioral health care
  • attention to psychosocial interventions
  • attention to substance use disorders.


To promote measurement strategies and improve behavioral health care, the authors call for greater workforce investment and stronger coordination among leaders in the field. And they argue that a stronger evidence base, drawing from more robust data sources, is needed to support performance assessments.

Publication Details



Mary Mahon, Former Vice President, Public Information, The Commonwealth Fund

[email protected]


H. A. Pincus, S. H. Scholle, B. Spaeth-Rublee et al., “Quality Measures for Mental Health and Substance Use: Gaps, Opportunities, and Challenges,” Health Affairs, June 2016 35(6):1000–8.