National Performance Measures for SBHCs

By John Schlitt, President, School-Based Health Alliance

Performance Measures blogIt was always Linda Juszczak’s dream for the School-Based Health Alliance to create a national dataset for school-based health centers (SBHCs). Having every SBHC collect and report on a core set of universal performance measures would strengthen the field, she argued, and create a quality improvement imperative wherever deficiencies emerged. Performance tracking has two benefits: it offers the proof points we need to demonstrate our exceptional value and identifies strategic training and support opportunities for the field to shore up lagging indicators. Uniformity in how the field defines and reports its performance has an additional advantage: allowing SBHCs to compare themselves to other SBHCs, and even to other community providers according to industry-accepted standards.

In September, the federal Maternal and Child Health Bureau (MCHB) launched us headlong toward realizing Linda’s vision. With funding from MCHB, the Alliance will create a voluntary national performance measurement system for SBHCs. In partnership with the Center for School Mental Health at the University of Maryland, we have agreed to establish key performance indicators and, within two years, persuade one-quarter of the field to upload data into a national reporting system. By year four, MCHB expects 50 percent of all SBHCs to contribute data to the system.

Setting aside the Herculean challenge of getting 2,400 SBHCs to voluntarily report performance data, the national system has great appeal. SBHCs can demonstrate that, in an increasingly competitive health care landscape, “we’re relevant, accountable, capable, and committed to performance improvement.” With payors testing new payment strategies to incentivize better outcomes at a sustainable cost, we have an opportunity to show that SBHCs can deliver the goods, especially for children and adolescents most affected by health disparities.

There’s much to consider in achieving consensus about core performance indicators. What constitutes a good measure? What criteria should be used to judge our choices? The Agency for Healthcare Research and Quality (AHRQ), the national authority on such things, points us in the right direction: measures should be strategically important to stakeholders; effective at lessening the burden of illness; susceptible to being influenced by the health care system; linked to evidence of health improvements; and feasible with regard to being counted (i.e. data sources are available and easily extracted at little cost).

I’ve got my own criteria as well. The selected indicators ought to align with the model’s strengths, validate its value to stakeholders, and highlight opportunities for the field to engage in quality improvement. Ideally, measures should help SBHCs demonstrate that they:

  • excel where other providers are challenged (adolescent well visits; HPV completion rates)
  • can deliver on population-level outcomes (vaccinations and immunizations)
  • integrate medical and behavioral health care (depression screen)
  • generate cost-savings (asthma management, ER diversion)
  • are cost-efficient (cost per visit)
  • address social determinants (school days missed, classroom disciplinary actions)

However challenging the task, the field can and must rise to this auspicious occasion. There’s so much at stake.

Please weigh in: among the performance measures the field will consider, what would you prioritize?



  1. by Parrish Ravelli on October 3, 2014 at 11:03 am

    In addition to the fantastic thought put around SBHC performance measures, I think there is much need for thought to be put around performance measures for state associations. This is seems to be much needed infrastructure. The health of a state association directly impacts the health of Centers throughout the state, yet, so often I think that state associations can struggle with their identity (i.e. are we a non profit with our own outcomes or are we an organized group of Centers?). Just a thought.

  2. by Suzanne Flory on October 16, 2014 at 3:15 pm

    I agree with Parrish regarding Performance Measures for state associations – and would be curious what this might look like for emerging vs. established associations. I’m new enough to the field, I’m curious about what others have to weigh in on this matter. Great food for thought!

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