NCQA's Proposed Changes Regarding Behavioral Health

Proposed Changes and New Standards for NCQA PCMH 2014

NCQA is updating its 2011 PCMH standards and guidelines to reflect current trends in the health care field, place greater emphasis on outcome measures, and meet the tenets of the triple aim: improved outcomes, enhanced patient experience and reduced cost of care.

Details on the draft-revised standards are available on NCQA's public comment website; access draft proposals here.

The proposed changes for 2014 PCMH recognition standards emphasize outcome measures, resource stewardship (e.g., avoiding unnecessary/duplicate testing and services) and a focused approach to targeting resources to patients based on need.  One of NCQA’s high-level goals for this next version of PCMH recognition is to further integrate behavioral health. 

Examples for this integration include:

  • Element 2E delineates unhealthy behaviors and conditions related to mental health or substance abuse and evaluates capability to provide care reminders and use clinical decision support
  • Element 1E asks practices to communicate the scope of services available including how behavioral health concerns are addressed.
  • Element 4B (Referrals) includes specific factors on establishing relationships with behavioral health providers.

What are your thoughts on this new version as it relates to behavioral health integration?  Too little, too much, or right on?

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