Community Behavioural Health (Philadelphia) Provider outcome requirements

Community Behavioural Health (CBH) is a nonprofit 501(c)(3) behavioural health managed care organization contracted by the City of Philadelphia to administer Medicaid behavioural health services for Philadelphia County residents. CBH is overseen by the Department of Behavioural Health and Intellectual disAbility Services (DBHIDS) and operates under Pennsylvania's HealthChoices program.

CBH provider obligations are set out in the CBH Provider Manual and related clinical practice guidelines. At the highest level, CBH requires three layers of outcome measurement: pay-for-performance system metrics, individualized treatment plan documentation, and use of evidence-based clinical tools aligned with CBH's Clinical Practice Guidelines.

CBH's Pay-for-Performance (P4P) and Value-Based Purchasing (VBP) programs are where outcome reporting is most explicitly required. These metrics track access, continuity, and retention in treatment, not symptom change, and are reported by level of care (inpatient, ASAM 3.5 residential, children's inpatient, etc.).

For each P4P metric, HiBoop captures the clinic-side event (scheduled follow-up appointment, completed contact, scale score at that contact) and stamps it with a structured date so that when the metric is computed later, the clinic's data lines up cleanly with the claims-derived side.

At the individual client level, the CBH Provider Manual requires each client to have an individualized treatment plan containing:

• Short-term goals that can be measured – the manual uses this phrase directly
• Interventions tied to each goal
• Progress documentation against each goal on a defined cadence

HiBoop's scale library is how most clinics satisfy the "measurable" requirement. A depression goal ("reduce PHQ-9 from 18 to under 10 by session 8") is objectively measurable because the score is captured at every contact. The alternative, clinician-rated progress notes, is harder to audit and less actionable for CBH's pattern recognition.

CBH does not mandate a single universal scale. Providers choose validated tools appropriate to the population and condition, so long as the choice aligns with CBH's Clinical Practice Guidelines. Those guidelines draw on SAMHSA and American Psychiatric Association recommendations and reference these commonly used scales:

• PHQ-9 for depression
• GAD-7 for generalized anxiety
• C-SSRS for suicide risk
• AUDIT for alcohol use
• DAST-10 for drug use
• PCL-5 for PTSD symptoms
• CANS / ANSA (Child / Adult Needs and Strengths) for population-specific level-of-care decisions
• ASAM multidimensional criteria for substance use placement and continued service

For substance use services specifically, CBH frames outcomes around ASAM-style multidimensional domains: substance use severity, biomedical conditions, emotional and behavioural conditions, readiness for change, relapse risk, and recovery environment. These domains guide both placement and ongoing outcome evaluation.

HiBoop ships every CPG-aligned symptom scale CBH providers commonly use. CANS, ANSA, and ASAM multidimensional assessments are specialized level-of-care tools, they're population- or service-specific rather than universal symptom measures, and are typically captured in level-of-care or ASAM-specific workflows outside HiBoop.

Pennsylvania is a CCBHC demonstration state, and many Philadelphia community providers hold both a CBH network contract and federal CCBHC certification. The two requirement sets overlap substantially but are not identical:

• PHQ-9 satisfies both CBH's depression monitoring expectation and the CCBHC depression screening + remission measure
• C-SSRS satisfies both CBH's suicide screening guideline and the CCBHC suicide risk assessment measure
• CBH's 7-day and 30-day post-discharge follow-up metrics align with CCBHC's Follow-Up after Hospitalization (FUH) measure, though CBH's windows are tighter
• CCBHC's BMI and tobacco measures are not core CBH mandates but are still reported separately for CCBHC submission

For the federal CCBHC measure set and scale-to-measure mapping, see the CCBHC quality measures guide.