by Alicia Caramenico
March 9, 2016
With health care stakeholders increasingly focused on how to address barriers to mental and behavioral health services, a health plan and a community-based provider of mental health and substance abuse counseling services are working together in Georgia to improve patient access to these important programs. Amerigroup and Georgia HOPE teamed up to become the nation’s first National Committee for Quality Assurance(NCQA) level-three Patient-Centered Specialty Practice(PCSP), the highest level of recognition for meeting specific standards for providing timely access to care and continuous quality improvement. We spoke with leaders from Amerigroup and Georgia HOPE to learn more about the partnership.
Jeryl Williams is senior patient-centered care consultant for Amerigroup, working with practices to help them understand NCQA guidelines and create real strategies and solutions for practice operations and patient outcomes. According to Williams, the PCSP approach brings alignment among the different health care providers – providers, clinicians, health plans – in the continuum of care. Nikki Raymond, the CEO of Georgia HOPE, says a willingness to make a lot of change to practice culture and processes is essential to successfully implementing a model focused on integration and care coordination.
Can you describe what it means to be the country’s first NCQA level-three Patient-Centered Specialty Practice?
Raymond: It’s nerve-wracking; there’s pressure to set a standard for what a level-three PCSP means in the behavioral health world. It’s also really exciting and sets us apart from our peers. There are several things we have done that have been more forward in the behavioral health space – such as telehealth and informal school-based services.
Williams: People who ultimately benefit from this recognition are patients throughout Georgia. They can rest assured they can receive behavioral health service from a practice that has become an expert in coordinating care. It ensures that a lower likelihood of disease onset or exacerbation. For Georgia HOPE, they’re setting the example of what specialty care should look like – more coordinated and more connected.
What is Amerigroup’s role in the Patient-Centered Specialty Practice model?
Williams: We’re not exclusively helping practices get recognition, we’re helping them transform. Our role is to help different practices understand what the standards and guides require, what that means for practice operations, and how to integrate that based on their resources and the populations they serve. More importantly, we want to lay groundwork to help practices sustain it.
How does the patient-centered medical home approach meet patients’ mental health and substance abuse needs?
Raymond: People with mental illness have a lifespan that is 14-32 years shorter. Research shows being a patient-centered specialty practice improves health outcomes. So we’re hoping to help our clients live longer. Patient care is just a lot more comprehensive. Were asking different questions like, “Do you have a primary care physician?” And if the answer is no, we’re working to help those patients find a primary care doctor.
Williams: The PCSP focuses on key areas – enhanced access, continuation of care, population health management, care coordination, performance monitoring, and improvement. It brings patients to where the services are and helps practices use their electronic health records systems as a tool for proactive patient care and outreach. No longer will we expect patients to come to us. It’s a really great opportunity to not only improve how practices do business internally but also enhance their communications with patients.
What types of outcomes have you seen with regard to quality, costs, and patient experience?
Williams: As a result of primary care practices improving operational policies and procedures and prescribing to a more proactive method for the provision of health services, their patients have benefited tremendously. We’ve seen enhanced patient compliance indicative by the timely receipt of preventive and chronic care services and enhanced continuity of care with their assigned primary care provider. Our patient-centered medical homes have had reduced ER utilization and avoidable hospital admissions among their patient population. This has led to significant reductions in medical-loss ratio and has enhanced earning potential in value-based initiatives. Collectively, patients of recognized medical homes have experienced enhanced access via same day appointments, extended hours, and patient portal use; better exposure to community and educational resources; and seamless care transitions along the care continuum where communication and information exchange is optimized.