NCQA addresses integration of mental and behavioral health in medical home models

APA comments promote mental health screening and integration of mental and behavioral health services in NCQA medical home model

By Legal and Regulatory Affairs staff

December 8, 2011—The National Committee for Quality Assurance (NCQA) recently released a new version of the Consumer Assessment of Healthcare Providers and Systems Patient-Centered Medical Home Survey (CAHPS PCMH Survey) for use beginning in January 2012. Earlier this year, NCQA released its PCMH 2011 standards. Both the PCMH survey and standards reflect efforts to integrate mental and behavioral health into NCQA’s medical home model.

The APA Practice Directorate commended NCQA for these efforts and, during the development phase of these tools, submitted comments recommending specific changes to enhance behavioral health services. 

NCQA is a private, not-for-profit organization that develops quality standards and performance measures and provides accreditation, certification and recognition programs for health care providers and organizations. According to the NCQA, it accredits health plans covering 109 million Americans. 

NCQA often works to align its programs with relevant federal programs. For example, NCQA’s PCMH standards align with many elements of the federal program that rewards clinicians for using health information technology, and the CAHPS PCMH survey was developed in collaboration with the CAHPS Consortium, which is sponsored by the Agency for Healthcare Research and Quality.

NCQA’s medical home model emphasizes access to care, care coordination, health information technology and patient-centeredness. When NCQA released its updated PCMH standards earlier this year, it highlighted a “stronger focus on integrating behavioral health care and care management.”

For example, depression screening for all adults and adolescents is now included in the standard on comprehensive health assessments, as was requested in APA comments. (As initially proposed, depression screening would have been limited to adults with chronic health conditions and adolescents.) The PCMH standards also include “arranges or provides treatment for mental health and substance use disorders” as well as referral tracking and follow-up.

Beginning in 2012, NCQA PCMH-Recognized practices may use the CAHPS PCMH survey to obtain an additional “Distinction in Patient Experience Reporting.” The CAHPS PCMH survey collects patient and family feedback to address domains such as communication and information, access to care, care coordination and comprehensiveness of care.

APA praised NCQA for including in the “comprehensiveness” domain many questions related to mental and behavior health for both children and adults. Survey questions for adults ask whether anyone in the provider’s office addressed issues such as depression, stress, substance use, personal and family problems and mental illness. The child version of the survey (completed by a parent) asks whether developmental issues including learning ability, moods and emotions were addressed.

Although we appreciate the extent to which mental health care is integrated into NCQA’s PCMH tools, many of APA’s specific suggestions were not followed. For example, we requested use of the term “health home” instead of “medical home” to emphasize the importance of treating the whole person. We also requested expansion of the list of providers who can be included in the CAHPS PCMH survey. Currently the only clinicians who are clearly eligible are physicians, nurse practitioners and physician assistants. 

NCQA PCMH program information, access to standards and surveys and additional resources are available on the website.

For more information, contact the Legal and Regulatory Affairs department by email or at (202) 336-5889.