MBHC Leverages CareManager Data to Improve Outcomes

For behavioral health organizations across the country, quality care is more than a reporting exercise. Excellent care quality is the cornerstone of success for organizations built to improve people’s lives. That becomes especially important when providers are serving individuals with complex mental health needs and co-occurring physical health conditions such as diabetes.

One such organization facing this challenge head-on resides in America’s Heartland. The Missouri Behavioral Health Council (MBHC) and Netsmart demonstrated what becomes possible when clinical data is used effectively. Working with a Missouri managed care organization (MCO) associated with MBHC, Netsmart helped aggregate clinical data documented in CareManager to support quality measurement, improve visibility into care delivery and help close care gaps that claims data alone may not capture. CareManager is a population health platform that brings together clinical, claims and social data to support population-level management. It applies rules-based logic and workflow tasking to help providers identify risk, prioritize interventions and support care delivery for targeted populations. Advanced analytics are used to strengthen risk stratification by translating large, disparate data sets into actionable signals that aim to enable earlier and more targeted intervention for individuals with complex needs.

Problem

For managed care plans and provider networks alike, claims data often only tells part of the story. While claims are essential for reimbursement and retrospective analysis, they often do not contain the level of clinical detail needed to fully reflect the services already delivered to consumers. In the case of MBHC, that gap in clinical information can be especially significant when measuring diabetes-related complications and metabolic screening activity for individuals receiving mental health services.

MBHC, which helps oversee Missouri’s Certified Community Behavioral Health Clinic network, recognized the importance of visualizing the big picture. MBHC’s member provider organizations were already documenting key clinical information in CareManager, including lab and lipid panel results captured during standard comprehensive metabolic screenings. But without a streamlined way to aggregate and share that supplemental data, important evidence of quality care remained outside the measures that matter most to payers and reporting bodies.

Our mission is to ensure individuals with complex behavioral and physical health needs receive coordinated, high-quality care. Leveraging clinical data from CareManager allows us to demonstrate the work our providers are doing and identify opportunities to intervene earlier and more effectively.”

Natalie Cook, Sr. Vice President, Health Technology & Data Solutions, MBHC.

Solution

During the closing quarters of 2025, Netsmart worked with MBHC and the MCO to aggregate clinical data from CareManager on a recurring basis for quality reporting. The effort focused on collecting supplemental clinical data related to diabetes management and other metabolic indicators for people with mental health conditions.

This data often does not appear in claims submissions but can still satisfy quality measure numerator criteria. By having the data available in a timely and consistent way, MBHC providers and the MCO gained stronger visibility into the work being done across MBHC’s 32-member provider organizations.

The approach also created value well beyond reporting. More frequent access to clinical data enables providers to intervene earlier when patient values fall outside recommended ranges, and potentially reduces the need for unnecessary repeat screenings.

Result

The results were striking. The supplemental data reported from CareManager closed 91.5% of care gaps across 4 quality measures,* further supporting what is already known by the National Committee for Quality Assurance (NCQA) and payers in the industry: clinical data often bolster HEDIS rates significantly for health plans, and lab-dependent measures see the highest increase.**

The results affirmed what we’ve long known: our providers are delivering high-quality care every day but claims data alone doesn’t always capture it. Leveraging supplemental CareManager data allows that work to be seen and counted.”

Natalie Cook, Sr. Vice President, Health Technology & Data Solutions, MBHC.

The MCO was able to leverage this clinical data to enhance the measure rates they report to the State and NCQA while simultaneously being able to see a more complete picture of the quality of care being delivered in a timely manner by MBHC providers, highlighting the value of their work on a daily basis.

Providers and payers should be working together and sharing data to improve clinical care, identify individuals who need outreach, and make sure all appropriate services are credited for quality outcome measures. I look forward to exploring additional data sharing opportunities with our MCO partners to improve care for individuals and families being served in our system and ways to incentivize and reward that work.”

Brent McGinty, Chief Executive Officer, Missouri Behavioral Health Council

The potential benefits of collecting this supplemental data routinely extend across the ecosystem. With regular visibility into gap closures and timely data, providers can prioritize patients who still need intervention rather than repeatedly outreaching everyone in the entire measure denominator—making care delivery more efficient and targeted. The MCO is able to monitor performance more frequently, without needing to wait for claims data. Finally, the automated collection of supplemental clinical data aligns with NCQA’s broader push to digital quality measurements by 2030.

MBHC’s work with Netsmart shows how thoughtful use of clinical data can do more than support provider compliance. It can help strengthen collaboration between providers and payers and improve quality performance, both with the same goal in mind: care delivered is care counted.

By leveraging CareManager to aggregate and share supplemental clinical data, MBHC helped create a model for how behavioral health organizations can bring more visibility to whole-person care. In a healthcare environment that increasingly depends on timely, accurate and interoperable data, that kind of partnership has the power to improve outcomes for providers, health plans and the people they serve.

*In aggregate, 226/247 care gaps were closed by clinical data for the APM, GSD, SMD and SSD measures over a 4 month period in 2025.

** https://www.medicaid.gov/medicaid/quality-of-care/downloads/hybrid-brief.pdf