Behavioral Health
NCQA recognizes the role behavioral health, mental health conditions and substance use disorders, plays in overall health, as well as the need for improved access to care; the need to evaluate the quality of care and patient experience of care across the behavioral health service continuum, and the demand for innovative payment models to adequately support high quality behavioral health care.
NCQA supports improvement in quality and access for behavioral health services in various ways. We accredit managed behavioral healthcare organizations (MBHO) and certified community behavioral health centers (CCBHCs), and have incorporated several behavioral health measures in HEDIS® (Healthcare Effectiveness Data and Information Set). Many of our HEDIS measures are used in quality reporting and value-based purchasing by Medicare, Medicaid and commercial insurance plans.
Access to behavioral health care is limited across the United States, and has not improved in recent years.
- In a 2023 study, 57% of individuals who sought care for a mental health or substance use disorder were unable to access care 2
Access is especially limited for vunerable individuals (such as the elderly and the unisured) and those living in rural America.
Common Barriers to Care Include:
- Workforce shortages, leading to limited access
- Cost
- Long wait times for an appointment
- Stigma
Our Impact
Programs
Listen
Resources
Access
The majority of Americans with a behavioral health condition do not receive treatment. Despite parity laws, there are widening gaps between access to behavioral health care and access to medical care, and there are higher out-of-network utilization and out-of-pocket costs for behavioral health services. 1,2
- NCQA conducted an environmental scan and stakeholder interviews to synthesize the state of evidence on behavioral health network adequacy standards and metrics in this white paper report.
- NCQA developed an issue brief expanding on workforce challenges that limit access to care
- Behavioral Health Integration (BHI)
Integrating behavioral health care into the primary care setting can improve access to mental health and substance use disorder treatment. Common arrangements are embedding behavioral health care providers in a primary care practice; consultation between primary care and behavioral health providers for managing patients’ behavioral health needs; and care coordination for behavioral health social services. Research demonstrates that behavioral health integration leads to: - NCQA’s Distinction in Behavioral Health Integration recognizes primary care practices that provide high-quality behavioral health integration
- To learn about challenges and opportunities for measuring the quality of behavioral health care in integrated settings, read NCQA’s white paper: Behavioral Health Care Integration whitepaper
Quality
NCQA is the steward for several behavioral health quality measures including:
Measures focusing on mental health conditions
| Measure Domain | Condition | Measure Name |
|---|---|---|
| Screening and Follow-Up | Depression | [DSF-E] Depression Screening and Follow-Up for adolescents and Adults |
| [PND-E] Prenatal Depression Screening and Follow-Up | ||
| [PDS-E] Postpartum Depression Screening and Follow-up | ||
| Monitoring | Depression | [DMS-E] Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults |
| Medication Management | Schizophrenia | [SAA] Adherence to Antipsychotic Medications for Individuals With Schizophrenia |
| ADHD | [ADD] Follow-Up Care for Children Prescribed ADHD Medication | |
| Psychosocial Care | Schizophrenia | [APP] Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotic |
| Continuity of Care | All | {FUM} Follow-Up After ED Visit for Mental Illness |
| [FUH] Follow-Up After Hospitalization for Mental Illness | ||
| Integration of Medical Needs | Schizophrenia and Bipolar | [SSD] Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications |
| Schizophrenia | [SMD] Diabetes Monitoring for People With Diabetes and Schizophrenia | |
| [SMC] Cardivascular Monitoring for People With Diabetes and Schizophrenia | ||
| [APM] Metabolic Monitoring for Children and Adolescents on Antipsychotics | ||
| Outcomes | Depression | [DRR-E] Depression Remission or Response for Adolescents and Adults |
| Diagnosed Prevalence | All | [DMH] Diagnosed Mental Health Disorders |
Measures focusing on substance use disorders
| Measure Domain | Substance | Measure Name |
|---|---|---|
| Screening | Alcohol | [ASF-E] Unhealthy Alcohol Use Screening and Follow-Up |
| Medication Management | Opioids | [HDO] Use of Opioids at High Dosage |
| [UOP] Use of Opioids from Multiple Providers | ||
| [COU] Risk of Continued Opioid Use | ||
| Continuity of Care | All | [FUA] Follow-Up After Emergency Department Visit For Alcohol |
| [FUI] Follow-Up After High Intensity Care for Substance Use Disorder | ||
| Opioids | [POD] Pharmacotherapy for Opioid Use Disorder | |
| Access to Care | All | [IET] Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment |
| Diagnosed Prevalence | All | [DSU] Diagnosed Substance Use Disorder |
Accreditation and Recognition Programs
NCQA is using our experience and capacity as a national accreditor to expand our behavioral health Accreditation and Recognition products to include Certified Community Behavioral Health Clinics. This new CCBHC program is designed to help organizations meet the Substance Abuse and Mental Health Services Administration’s (SAMHSA) CCBHC Certification criteria through a standardized survey process. Our survey staff can provide prompt assistance to support CCBHCs during Certification, including presurvey training, help desk support and a self-assessment tool to ensure CCBHC readiness. By using existing staff and capacity, NCQA can provide this program to CCBHCs and states at a reasonable cost, maximizing the use of federal funding for behavioral health care.
Learn how NCQA’s Certified Community Behavioral Health Clinics Accreditation gives organizations a roadmap to increased confidence in the quality of care.
NCQA Managed Behavioral Healthcare Organization Accreditation demonstrates to health plans, employers, regulators and consumers an organization’s commitment to follow evidence-based practices to provide high-quality care.
NCQA Distinction in Behavioral Health Integration helps primary care practices better integrate behavioral healthcare into their practices. This Distinction acknowledges PCMH recognized practices that excel in this area.
Education
- Person-Centered Outcome Trainings (6)
- Using Goal Attainment Scaling to Document and Track Person-Centered Out-come Goals (Behavioral Health Version)
- Using Patient-Reported Outcome Measures to Document and Track Person-Centered Outcome Goals (Behavioral Health Version)
- Ready, Set, Go! Catalyzing CHW Programs for Health Care Orgs
- The Managed Behavioral Health Organization (MBHO) Primer
- NCQA's Introduction to PCMH Online Course
- Race, Ethnicity, SOGI, Income, and Language in Patient Reg
- SOGI - LGBTQ+ Health Care: Quality
- Substance Abuse and Mental Health Services Administration. (2023). Key Substance Use and Mental Health Indicators in the United States: Results from the 2022 National Survey on Drug Use and Health (HHS Publication No. PEP23-07-01-006, NSDUH Series H-58). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2022-nsduh-annual-national-report
- Bowman, MB, Harbin, HT, Raines, L, Sky, J, Wells, L. & Yuhas, M. (2023) Equitable Access to Mental Health and Substance Use Care: An Urgent Need. Available: https://search.issuelab.org/resource/equitable-access-to-mental-health-and-substance-use-care-an-urgent-need.html
- Reinert, M, Fritze, D. & Nguyen, T. (2022). “The State of Mental Health in America 2023” Mental Health America, Alexandria VA. Available: https://mhanational.org/issues/state-mental-health-america
- Davenport, S, Bridget, D, Gray, T. & Spear C. (2023) Access across America: State-by-state insights into the accessibility of care for mental health and substance use disorders. Available: https://www.milliman.com/en/insight/access-across-america-state-insights-accessibility-mental-health-substance-use#
- Hostutler, Cody, Noelle Wolf, Tyanna Snider, Catherine Butz, Alex R. Kemper, and Eric Butter. 2023. “Increasing Access to and Utilization of Behavioral Health Care Through Integrated Primary Care.” Pediatrics 152 (6): e2023062514. https://doi.org/10.1542/peds.2023-062514.
- Maeng, Daniel D., Ellen Poleshuck, Tziporah Rosenberg, Amie Kulak, Thomas Mahoney, George Nasra, Hochang B. Lee, and Yue Li. 2022. “Primary Care Behavioral Health Integration and Care Utilization: Implications for Patient Outcome and Healthcare Resource Use.” Journal of General Internal Medicine 37 (11): 2691–97. https://doi.org/10.1007/s11606-021-07372-6.
- Balasubramanian, Bijal A., Deborah J. Cohen, Katelyn K. Jetelina, L. Miriam Dickinson, Melinda Davis, Rose Gunn, Kris Gowen, Frank V. deGruy, Benjamin F. Miller, and Larry A. Green. 2017. “Outcomes of Integrated Behavioral Health with Primary Care.” Journal of the American Board of Family Medicine: JABFM 30 (2): 130–39. https://doi.org/10.3122/jabfm.2017.02.160234.