Table 2.

Learning health care system framework for mental health care quality improvement

	Barriers	Leverage opportunities in learning health care systems
Patients	Medical and behavioral health conditions co‐occur The majority of patients are still seen in small primary care practices	Adopt mental health measurement‐based care (continuous use of validated outcome assessments that inform changes in treatment decisions) Consumer organizations link patients to recovery‐oriented services in the region
Providers	The majority of providers lack training in quality improvement and evidence‐based practice implementation Lack of incentives for non‐mental health providers to incorporate mental health services where patients are more likely seen (e.g., primary care), and lack of integration with social services	Professional organizations mandating training in quality measurement and improvement methods Same‐day billing for mental health and physical health care Mental health professional organizations adopt common quality measures, guidelines, and improvement strategies
Practices/Organizations	Limited electronic medical record use in the majority of mental health sites Lack of effective strategies to scale up and spread evidence‐based mental health treatments and models of care	Standard health information exchanges need to include mental health services Embed quality improvement experts to help identify, test and scale up treatment models to promote measurement‐based care
Purchasers/ National health systems	Primarily fee for service, few bundled payment models	Plan‐level mental health care coordination
	Instability in health insurance markets	Value‐based reimbursement payment models benchmark on improved quality rather than volume
Population	Stigma	Public reporting of quality measures