Distinction in Behavioral Health Integration
NCQA Distinction in Behavioral Health Integration helps primary care practices better integrate behavioral healthcare into their practices and acknowledges practices that excel in this area.
Behavioral health conditions, such as mental illnesses and substance use disorders, are often under diagnosed or diagnosed late, causing delays in treatment. This leads to poorer health outcomes and higher costs of care. These conditions can often first be identified in a primary care setting, and there is growing consensus that behavioral health services should be integrated to achieve the full potential of comprehensive primary care.
Identifying and treating behavioral health conditions in a primary care setting can result in seamless care—not only improving treatment of behavioral health conditions, but also of other chronic medical conditions, resulting in better health outcomes overall.
What is Behavioral Health Distinction?
NCQA Behavioral Health Distinction is available for NCQA-Recognized PCMHs. The Distinction standards are based on input from clinicians and thought leaders, as well as on industry best practices. Primary care practices can download the standards, perform a gap analysis and implement changes to align with the standard requirements. Practices then submit evidence to NCQA to show alignment with the standards to earn its Distinction in Behavioral Health Integration.
Benefits of Distinction
- Stand out. Demonstrate to patients, payers and partners that they put the right resources, evidence-based protocols, standardized tools and quality measures in the primary care setting to support the needs of patients.
- Improve outcomes. Distinction results in an enhanced level of care and improved access, clinical outcomes and patient experience.
- Deliver whole-person care. Distinction helps practices provide comprehensive care that acknowledges patients’ behavioral health needs beyond the core requirements of NCQA PCMH Recognition.
- Practices in the process of earning NCQA PCMH recognition.
- Currently recognized practices that earned NCQA PCMH Recognition using standards version 2014 or later.
Distinction can be completed during PCMH Recognition process for no additional charge, or it can be added after a practice has earned PCMH Recognition for a fee.
The Distinction in Behavioral Health Integration module includes 18 criteria across 4 competencies related to behavioral health integration:
- Behavioral Health Workforce. The practice incorporates behavioral health providers at the site, utilizes behavioral health providers outside the practice and trains the care team to address the mental health and substance use concerns of patients.
- Information Sharing. The practice shares patient information in and outside the practice to support an integrated/coordinated patient treatment plan.
- Evidence-Based Care. The practice uses evidence-based protocols to identify and address the behavioral health needs of patients.
- Measuring and Monitoring. The practice utilizes quality measures to monitor the care of patients with behavioral health needs.
Seven criteria in the module are also criteria in PCMH Recognition. Practices seeking this Distinction must meet all core criteria and two elective credits.
There are no additional fees if included as part of the initial PCMH recognition transformation process.
If completed other than during PCMH Recognition:
The pricing for the Distinction is 50% of the initial per clinician fee paid by the practice for Recognition. Fees apply to each clinician associated with the practice’s Recognition.
Number of Clinicians
Distinction Fee Single-Site per Clinician
Distinction Fee Multi-Site per Clinician
To learn more about the Distinction in Behavioral Health Integration, download the PCMH standards and guidelines. Refer to Appendix 4: Distinction in Behavioral Health Integration for the standards. You can also access the Behavioral Health Distinction module in Q-PASS.
If you have any questions, submit them through My NCQA.