State Standards for PCMHs Continue to Evolve

BY BRENDAN ABEL
MMS ASSISTANT COUNSEL

Patient-centered medical homes (PCMHs) have emerged over the past several years as an impactful, data-driven innovation in the delivery of primary care. Rooted in team-based care, PCMHs emphasize coordination of care and communication between a care team and the patient. Mounting evidence indicates the PCMH model supports high quality and cost savings to practices that have transformed and reorganized practices to it.

In light of this evidence base, the Massachusetts legislature featured the promotion of PCMHs in its comprehensive health care cost containment bill, Chapter 224. Specifically, Chapter 224 charged the Health Policy Commission to create a PCMH certification program. The bill outlines two levels of PCMH certification — a baseline model and a best practice “Prime” certification.

The Health Policy Commission (HPC) had a tough task initially — the certification would be voluntary and it would lack defined incentives for providers who achieved it. Also, there is already an existing, well-established PCMH certification program through the National Committee for Quality Assurance (NCQA). The HPC established from the outset that it wanted to align its own certification with the NCQA’s but decided to add behavioral health integration as a key factor to its own certification.

The MMS engaged with the HPC throughout this process to advocate for and provide written comment for a state certification that was closely aligned with NCQA and offered flexibility to practices seeking this certification. Any substantial additions to the NCQA were suggested to be reserved for the heightened “Prime” certification.

After a lengthy development process and a few changes in direction, the HPC recently approved its plan for PCMH certification. For now, any practice who achieves NCQA Level II or Level III or 2014 Recognition will be eligible for the base HPC PCMH certification. Practices will be able to apply for an elevated Prime certification if they achieve NCQA Level II or Level III or 2014 Recognition and they complete an HPC/NCQA Assessment of Behavioral Health Integration. This behavioral health add-on includes factors such integration of developmental, depression, anxiety, and substance use disorder screenings into clinical practice using standardized screens and the promotion of evidence-based mental health and substance use disorder decision support.

The state has allocated funding to the HPC to be used to provide technical assistance to practices who are seeking to obtain the Prime certification. Discussions for the use of this funding include providing training on various behavioral health diagnostic tools, support or training for medically assisted treatments of substance use disorders, and directories for non-prescribing behavioral health directories.

Patient-centered medical home certification can be a great way to improve coordination of care, ultimately leading to high quality and lower cost care. The MMS will continue to provide additional details about the HPC certification process and the technical assistance it plans to provide to help facilitate behavioral health integration.

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