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The rapid growth of healthcare reform at the state and local level is aimed at controlling costs and improving the quality of care. Healthcare purchasers have increasingly demanded a way to measure the effectiveness of these efforts.

In response, a number of healthcare organizations and government entities have begun to gather and publish data that allow corporate purchasers, state agencies, and consumers to compare the performance of competing health plans. These documents are commonly referred to as "report cards."

In 1993, the Mental Health Statistics Improvement Program (MHSIP) of the Center for Mental Health Services convened a Task Force to develop a prototype consumer-oriented report card to assess the quality and cost of mental health and substance abuse services. Task Force members include mental health consumers; representatives of federal, state, and local mental health and substance abuse agencies; advocacy groups; researchers; and policy analysts.

In Phase I, the conceptual phase of the project, Task Force members outlined the major issues involved in the design of a mental health report card and defined the critical domains such a document should contain. These include access, appropriateness, outcomes, consumer satisfaction, and prevention.

Actual development of the report card began with Phase II in 1995. What followed was a progress report on Phase II activities, which included a review of the literature on performance measures related to mental health report cards, a review of the literature on consumer-based research, identification of concerns related to the various domains, and a consumer focus group to identify and prioritize concerns.

The result is a set of recommended indicators and measures for a mental health report card that is (1) consumer-oriented, (2) based on research and explicit values, (3) focused on, but not limited to, serious mental illness, (4) designed to emphasize the outcomes of mental health treatment, and (5) conscious of related costs and staff burden. An overview of this work is presented in the first section of the above report.

The technical appendices include a more in-depth definition of the specific indicators and measures. In addition, they contain suggested data sources needed to complete the report card, including a consumer survey, clinician-administered instruments, and enrollment/encounter data requirements; tables relating the measures to these data sources and to the populations for which the measures are relevant; an analysis of the validity and reliability of the suggested measures; and a report on development of the consumer survey. Sample report card formats are also included in the appendix.

The final phase of the Task Force's work involves pilot-testing the recommended report card. However, this was not to be the end of the process. Rather, it is the beginning of a national dialogue about the development of reliable, comparable, and relevant measures to determine the effectiveness of mental health and substance abuse services. When mental health consumers are empowered to choose services that provide the best value for their healthcare dollar, they will be true partners in the effort to improve healthcare in this country.

The idea of monitoring the quality of healthcare services is not new. Prior to the mid-1980s, however, quality assessment efforts focused largely on hospitals, and the results rarely were made available to the public. With the widespread implementation of managed care, public oversight of healthcare services has become a critical issue. Various healthcare organizations and government entities have begun to develop report cards to help purchasers and consumers assess the cost and quality of care, but individual consumers and consumer groups have had limited involvement in these efforts.

This tendency was noted by the General Accounting Office (GAO) in a 1994 summary of report card initiatives."Individual consumers have had minimal input into selecting report card indicators, and little is known about their needs or interests," the GAO reported. "As a result, their needs may not be met." The MHSIP Task Force recognized the importance of including people who are receiving or have received mental health services in significant roles at all stages of report card development and implementation. Established with a specific mandate to construct a report card that addresses the needs of mental health consumers, especially adults with serious mental illnesses (SMI) and children with serious emotional disturbances (SED), the Task Force included consumers as active participants in every step of the process.

Development of a report card designed to help mental health consumers make informed choices began with the discussion of national healthcare reform. Concerned that mental health and substance abuse services would not be included as part of the minimum benefit, the mental health community began to define the services consumers need and the outcomes they expect. With the demise of national reform efforts, and the subsequent increase in state and local healthcare initiatives, the need for a mental health report card that reflects consumer concerns has become even more critical.