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2020 MIPS IA_BMH_7: Implementation of integrated PCBH model

Activity ID

IA_BMH_7

Activity Weighting

High

Subcategory Name

Behavioral and Mental Health

Activity Description

Offer integrated behavioral health services to support patients with behavioral health needs who also have conditions such as dementia, or other poorly controlled chronic illnesses. The services could include one or more of the following:

  • Use evidence-based treatment protocols and treatment to goal where appropriate;
  • Use evidence-based screening and case finding strategies to identify individuals at risk and in need of services;
  • Ensure regular communication and coordinated workflows between MIPS eligible clinicians in primary care and behavioral health;
  • Conduct regular case reviews for at-risk or unstable patients and those who are not responding to treatment;
  • Use of a registry or  certified health information technology  functionality to support active care management and outreach to patients in treatment; and/or
  • Integrate behavioral health and medical care plans and facilitate integration through co-location of services when feasible.
  • Participate in the National Partnership to Improve Dementia Care Initiative, which promotes a multidimensional approach that includes public reporting, state-based coalitions, research, and revised surveyor guidance.

Validation

Provision of integrated behavioral health services to support patients with behavioral health needs and poorly controlled chronic conditions (May use certified EHR, QCDR, clinical registry or medical records)

Suggested Documentation

Documented integration of behavioral health services with primary care to support patients with behavioral health needs, dementia, and poorly controlled chronic conditions program and services including one or more of the six activities described in the activity description. Documentation could include EHR note that shows that the patient saw a BH professional and communicated with PCP or practice team; referral to BH; or staffing or BH co located in primary care practice.

Examples of Additional Activities that Qualify for Attestation

Completing these alternate activities can fulfill the requirements of this Improvement Activity; and Notes

Sub-IA-1: Participate in Improving Dementia Care Initiative;
Sub-IA-2: Participate in Comprehensive Obesity Prevention and Intervention Program;
Sub-IA-3: Participate in National Partnership to Improve Dementia Care in Nursing Homes

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