On February 1, 2016, Amerigroup Community Care announced that its network provider organization, Georgia HOPE, had earned recognition from the National Committee for Quality Assurance (NCQA) as the first level three Patient Centered Specialty Practice (PCSP) for behavioral health in the United States. Georgia HOPE provides in-home and community-based mental health and addiction counseling to children and adults in 14 counties in Northwest Georgia. The PSCP program stems from the patient-centered medical home (PCMH) concept and shares many of the core components, but is geared toward specialists rather than primary care practices (PCPs). As a PCSP, Georgia HOPE can partner with PCP’s from the point of referral to discharge in order to meet the mental health and physical needs of the clients.

The PCSP program focuses on proactive coordination and information sharing among specialists and PCPs, and requires specialty practices to organize care across all the practices a patient visits, and to center care around the patient rather than the care setting. In the PCSP model, the patient and family or other caregivers are partners in managing conditions treated by the specialist. NCQA offers three levels of PCSP recognition. Level 1 represents a practice that meets the minimum score of 25 points (out of 100) and meets the mandatory elements. Practices earning additional points can qualify for higher levels of recognition, allowing growth within the PCSP program over time. PCSP certified practices must meet six standards:

  1. Track and coordinate referrals
  2. Provide access and communication
  3. Identify and coordinate patient populations
  4. Plan and manage care
  5. Track and coordinate care
  6. Measure and improve performance

The standards encompass the following functions:

  • Develop and maintain referral agreements and care plans with primary care practices to facilitate communication and timely agreements on a plan for coordinating and sharing care management for patient referrals.
  • Provide superior access to care, including electronically, when patients need it.
  • Track patients over time and across clinical encounters to assure the patient’s care needs are met.
  • Provide patient-centered care that includes the patient (and the patient’s family or caregiver, if appropriate) in planning and goal setting.

The PCSP criteria also evaluate medication management, including medication reconciliation and electronic prescribing; test tracking and follow-up; information flow over care transitions improvement, such as when people are discharged from a hospital to home; and performance measurement improvements on clinical outcomes and patient experience of care. The program elements are aligned with the federal electronic health record (EHR) Meaningful Use criteria for Stage 1 and Stage 2; however, meeting the Meaningful Use criteria is not required to gain the PCSP certification.

Since launching the PCSP certification program in March 2013, an NCQA spokesperson said that as of January 2016, 90 individual specialty practice sites have earned the level 3 designation. Georgia HOPE is the second Behavioral Health specialty practice in the state to earn PCSP certification. Behavioral health PCSPs are rare: The NCQA confirmed that Georgia HOPE is the first traditional behavioral health clinic in the country to receive this recognition level.

To earn the three-year PCSP recognition, Georgia HOPE worked with Amerigroup, which provided support and consultation with NCQA PCMH-certified content experts, Jeryl Williams and Mike Smith, who guided the process. Beginning in October 2014, Amerigroup provided regular in-person consultations where they explained features of the patient centered specialty program and guidelines, and assisted Georgia HOPE in transforming their practice. As part of this transformation, Georgia HOPE is working towards connecting with a regional Health Information Network to enhance communication and coordination with other provider organizations. Georgia HOPE also plans to hire additional administrative and clinical staff to handle relationships and care compact agreements with other provider organizations

Amerigroup is one of three Georgia Medicaid care management organizations (CMO); the Amerigroup plan has more than 375,000 members. In September 2015, Amerigroup was awarded the next Georgia Families 360° statewide contract which becomes effective July 1, 2016, to coordinate care for children in Georgia’s foster care and non-secure juvenile justice systems. Amerigroup Georgia currently has over 700 PCPs and 150 sites within its PCMH network, which serve more than 80,000 members. It continues to work with its network providers to gain PCMH recognition and with its behavioral health and specialty provider organizations to earn NCQA recognition as PCSP practices.

Amerigroup is currently working with recognized patient centered medical homes and other primary care providers in the Amerigroup network to establish care compacts with behavioral health specialists. These care compacts are key, must pass components of the PCSP model that operationalize coordinated care transitions and facilitate the onset of the medical neighborhood. The organization anticipate enlisting two additional behavioral health specialty groups in 2016 that will participate in the PCSP transformation engagement with Amerigroup’s PCMH certified content experts.

Georgia HOPE was founded in 2000 under the name Family and Children First, LLC as a Family Preservation and Foster Care services agency solely serving the Department of Family and Children Services in Northwest Georgia. The company was rebranded as Georgia HOPE in 2006 to reflect the name of a newly developed program of care. It now provides an integrated network of family preservation services, behavioral health services, and addiction treatment services for about 3,000 underserved and at-risk children, adults and families throughout Northwest Georgia. It partners with DCFS, the Georgia Department of Juvenile Justice, primary care providers, hospitals, schools, the legal system and other governmental and non-governmental agencies. Georgia HOPE accepts all forms of Georgia Medicaid, and accepts self-pay consumers.

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