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Humana's FIT Results

The Humana management team recently asked for a summary of results for practices and agencies participating in the Feedback Informed Treatment (FIT) initiative. This page summarizes the findings, while protecting the identities of the participating practices and agencies. These results are similar to what has been observed with other health plan initiated support for FIT among their providers.

Participating practices

For the purpose of this discussion, only those practices which met a minimum threshold for patients completing treatment during a baseline period (first 6 9 months of participation, and a follow-up period (first 6 months of 2016).

The inclusion criteria were as follows:
  • Cases with intake scores in the clinical range
  • Two or more assessments per case
  • Minimum sample of at least 50 cases in both baseline and follow-up period
In some instances, the baseline period was extended up to 9 months in order to allow a sample size of at least 50 in the base line. Some practices were slower to fully implement than others.

Nineteen (19) practices were identified that met these criteria.

Benchmarking Outcomes: Defining Excellence

The ACORN collaboration is the unquestioned leader in establishing benchmarks for outcomes behavioral health care, as evidenced by the numerous peer reviewed journal articles documenting and validating the statistical methodology embedded in the ACORN clinical information system.

Four decades of well conducted psychotherapy studies have confirmed that psychotherapy is effective, with an average effect size of .8. This result has been unchanged for four decades. For this reason, the ACORN collaboration criteria for highly effective care is an effect size of .8 or larger. The past decade of evidence based practice has demonstrated that this benchmark is attainable for providers who practice feedback informed treatment.

Humana Results

During the baseline period, the average effect size of the practices ranged from .4 to .91. Of the nineteen practices, 4 had a baseline effect size of .8 or higher. At the follow-up period (first six months of 2016), 13 (68%) of the practices had effect sizes of .8 or higher.

The average effect sizes (unweighted) for the 19 practices was .71 at baseline and .82 at follow-up, a gain of over 15%.

Five (26%) of the practices showed a modest decrease in effect size, ranging from -.02 to -.1 effect size. All of these practices had baseline effect of .69 or higher, indicating the regression in effect sizes observed was in part due to regression to the mean. Those with effect sizes well above .8 at baseline would be expected to exhibit some regression towards the mean. Of the 4 practices with baseline effect sizes of .8 or higher, 2 had reduced effect sizes at follow-up. However, none of the practices with baseline effect sizes of .8 or higher had follow-up effect sizes below the .8 benchmark.

The following graph displays the change in effect size (vertical axis) as a function of baseline effect size (horizontal axis). HumanaResultsGraph.jpg

Discussion

The results observed in this sample of providers is similar to results observed across the entire ACORN collaboration. In this sample of providers, the time between the baseline period and follow-up period varied, with several providers having more than 3 years of experience with ACORN. However, prior analyses of effect size gains over time indicate that the majority of the gains occur within the first 24-36 months of measurement and feedback. Beyond that, effect sizes tend to stabilize at a higher level, usually greater than .8.

The results provide further evidence of the potential impact of feedback informed treatment for improving the value of treatment for Humana members.
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