New Massachusetts Program Focuses on Behavioral Health Care

The National Committee for Quality Assurance (NCQA) announced today an exciting new opportunity for patient-centered medical home (PCMH) practices in Massachusetts.

February 18, 2016

Certification program rewards patient-centered care, behavioral health integration

WASHINGTON, DC— The National Committee for Quality Assurance (NCQA) announced today an exciting new opportunity for patient-centered medical home (PCMH) practices in Massachusetts. The Massachusetts Health Policy Commission (HPC), in partnership with NCQA, developed the PCMH PRIME certification program. The program, available in Massachusetts, endorses practices that pass NCQA’s rigorous guidelines for patient-centered care and succeed in maintaining additional behavioral healthcare services for their population.
“The under-diagnosis of behavioral health conditions is a serious public health problem, nationally and across the Commonwealth,” said David Seltz, Executive Director of the HPC. “The HPC’s PCMH PRIME program will aim to tackle that issue, among others, to help identify behavioral health conditions early and before emergencies arise, just as the system does with other conditions.”

“Integrating behavioral health into the delivery of primary care offers great promise for identifying and treating individuals in need of these services,” said NCQA president, Margaret E. O’Kane. “We look forward to working with the Commission to advance this worthy goal and make integration a staple of high-quality health care in the Commonwealth.”

PCMH PRIME is available for practices that are recognized, or that are working toward recognition, under NCQA PCMH 2011 (Level 2 or 3) or PCMH 2014 (Level 1, 2 or 3) program guidelines.

NCQA PCMH Recognition requires practices to meet rigorous, evidence-based standards. Practices that go through the recognition process can earn PCMH PRIME certification if they meet at least 7 out of 13 behavioral health criteria, including:

  • Co-locating or entering into formal agreements with behavioral healthcare providers.
  • Integrating behavioral healthcare providers into the practice site.
  • Performing comprehensive health assessments that include screening for behavioral health conditions, including depression, post-partum depression, anxiety, developmental delays and/or substance use disorder (SUD).
  • Having a system for identifying high-risk patients for targeted care management.
  • Tracking and following up on referrals to specialists, including behavioral healthcare providers.
  • Providing medication-assisted treatment (MAT) for patients with addiction.
  • PCMH PRIME certification is voluntary for practices in Massachusetts. The HPC will offer technical assistance to practices that undergo certification. For more information regarding PCMH PRIME certification, visit https://www.ncqa.org/prime and here.
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