Kentucky Mountain Health Alliance, Inc. (KMHA) was created in 2005 by a group of community healthcare and social service partners who shared a mission to create a healthcare safety net for the under-served or at risk for homelessness population. KMHA is proactive in their effort to protect the health of and deliver essential human services to the homeless or those at risk, especially for those who are least able to help themselves.

KMHA has been operating the Perry County HCH Program since 2006. They have one permanent service delivery site, Little Flower Clinic, located at 279 East Main Street, Hazard, KY in the heart of Perry County, Kentucky. They also have one mobile medical clinic that travels to the far outreach places within Perry County, Kentucky. KMHA believes in the importance of a holistic approach to health (i.e. attending to the physical, spiritual, mental, cultural, emotional and social well-being) and their role in contributing to health outcomes for the homeless population. This includes the environmental determinants of health such as food, water, housing and unemployment, as well as the social drivers of health and well-being, or socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it).

KMHA provides a full array of quality medical, behavioral, and oral health care, as well as chronic disease case management, transportation, outreach and an overall improved experience for patients and their families in ways that demonstrate our commitment to rural health care.

Little Flower Clinic has made Patient-Centered Medical Home recognition a high priority since 2015. And in 2023 Little Flower Clinic was recognized by NCQA with a distinction in Behavioral Health Integration.

When asked the question, “Why did Little Flower Clinic begin the journey of the Behavioral Health Distinction?”, Ellen Vance, CEO responded with one simple answer: “It knocks down barriers to behavioral health services and improves overall health”.

NCQA states: The Distinction in Behavioral Health Integration “helps practices provide comprehensive whole person care that acknowledges the behavioral health needs of the individual beyond the core requirements for NCQA PCMH Recognition.

With the help of Kentucky REC’s Vance Drakeford, a NCQA PCMH Certified Content Expert, Little Flower Clinic received the Distinction in Behavioral Health in 2023. Due to recent turnover, Ms. Vance was hesitant to add another recognition project to her new staff, so she contracted with the previous Quality Director, Vicky Hardin to take lead. The Kentucky REC was able to guide Vicky and her team through the process and maximize their efforts to achieve recognition.

We interviewed Vicky Hardin about Little Flower Clinic’s journey to Behavioral Health Recognition:

• Little Flower Clinic has been a recognized Patient-Centered Medical Home since 2015, so why was the journey to Behavioral Health distinction so important? “After analyzing UDS data over the course of several years, we identified that 25% of our patient population has a diagnosis of depression. Patients tend to seek help from their medical provider instead of being referred outside for behavioral services. It was really a no brainer to integrate a behavioral health care team within our primary care. Our patients who seek help with their behavioral health needs are now getting the whole-person care they deserve.
• What about the level of physician engagement? “We have wonderful providers who believe strongly in our mission to provide whole-person care. Our providers, whether it be medical, dental or behavioral health collaborate together to deliver the best quality of care.”
• How well did PCMH recognition prepare your practice for the Behavioral Health add-on? “Out of the 18 criteria related to behavioral health, 7 are included in the PCMH Recognition standards. For recognized practices, that means you are almost 50% complete. As we identified during PCMH transformation, we were already doing some of the work but weren’t documenting consistently. The same issue was identified for the remaining 11 criteria in the Behavioral Health Distinction. Also, the enrollment and submission process in QPASS for Behavioral Health Distinction are the same as PCMH recognition.”
• What are some processes implemented in the last year to receive BH distinction? “One of the major changes we implemented was CDS rules for our behavioral health providers. Our providers reviewed the different behavioral screenings and identified rules that would guide them in next steps of the treatment plan. Also, our policy changed in regards to medical patients who scored poorly on the PHQ-9. If patient scores poorly, our behavioral health team will examine the patient during the medical visit and provide recommendations to meet their current behavioral health needs.”
• How did the REC help? “Vance was instrumental in Little Flower receiving the Behavioral Health Distinction. His understanding of what NCQA is looking for and how he communicated to me is exactly what I needed to move forward. He was always available for any questions and shared appreciated feedback on documentation that I was using for submission. Also, he assisted with the enrollment and the submission process.”

Do you have questions about how to improve behavioral health services in your practice, or Patient-Centered Medical Home or Specialty Practice Recognition? Contact us at Kentucky REC with your questions. Our team of experts is here to help: 859-323-3090.