Behavioral health and care management for high-need populations are among the latest updates to the National Committee for Quality Assurance’s (NCQA) medical home standards, PCMH 2014, according to NCQA.
The standards, which NCQA uses to assess primary care practices (PCPs) seeking NCQA patient-centered medical home (PCMH) recognition, are the third iteration of the NCQA medical home program since 2008.
Currently over 10 percent of U.S. PCPs — more than 35,500 clinicians at more than 7,000 practice sites — have earned NCQA PCMH recognition. Many insurers pay higher reimbursement rates to practices that have earned the NCQA PCMH seal.
Changes affecting the advantages and requirements of NCQA PCMH recognition include the following:
- Integration of behavioral health — Practices are expected to support patients’ behavioral health, by collaborating with behavioral healthcare providers and communicating behavioral healthcare capabilities to patients.
- Care management focus on high-need populations — Practices are expected to address socioeconomic drivers of health and poorly controlled or complex conditions. Practices are also expected to focus on the special needs of patients referred from the “medical neighborhood” of practices that surround and inform the medical home.
- Enhanced emphasis on team-based care — New standards emphasize patients’ placement in care team; team-based care is a “must-pass” criterion for NCQA recognition.
- Alignment of improvement efforts with the Triple Aim — Practices must show that they are working in conjunction with the three domains of the Triple Aim: patient experience, cost and clinical quality.
- Sustained transformation — In keeping with the goal of continuous improvement, practices must show that they comply with NCQA standards over long periods.
PCMH 2014 retains strengths of earlier NCQA standards, including alignment with contemporary federal requirements for “meaningful use” of health information technology — now meaningful use stage 2.
Source: NCQA, March 24, 2014
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