FAQs About Patient-Centered Medical Home Recognition Programs

By now you have likely encountered the term "Patient-Centered Medical Home" or PCMH. If you do not yet know what a "medical home" is, think of it this way - these are practices that use care teams to put the patient at the center of the healthcare delivery system. That means focusing on improving outcomes while reducing costs associated with inconsistent, duplicate, or fragmented care. Typically, PCMH practices are very accessible both physically and electronically, and utilize technology to be more proactive in managing patient care and communicating with their patients.

What programs are available?

There are several organizations that offer medical home programs. The most well known and widely used is a recognition program by the National Committee for Quality Assurance (NCQA). Others include Bridges to Excellence (BTE) and The Joint Commission, which has a Primary Care Medical Home model. And there are several more in development across the country.

Is it worth doing?

If you are in, or own, a private practice and are looking to transition to a medical home model, I recommend utilizing NCQA's PCMH recognition program. Why? For one, it is the most widely recognized program across the payers nationally. Several plans, including state Medicaid plans, are giving practices additional payments upon achieving NCQA recognition. Some of these payments are in the form of per-member-per-month stipends in addition to fee-for-service payments (Aetna is using this model). Others, such as Horizon Blue Cross Blue Shield, provide "care coordination" funded resources to help practices better manage and coordinate patient care. Some plans, such as Carefirst, offer a percentage increase over existing payment rates. While others, like United Healthcare, work PCMH recognition into pay-for-performance programs.

Where do I start?

First, get acquainted with NCQA's PCMH website. Start by reviewing the video which outlines in a simple fashion what the program is all about. Then review the standards that you will have to meet in order to achieve recognition. Be forewarned - it is not an easy program! However, you may find that there are plenty of areas in which you already meet the criteria; you may just need to formalize your processes and procedures in order to demonstrate them.

Tackle the project by identifying who you need on your team. At Patient Centered Solutions, we recommend having a physician champion, a clinical staff member, a front-desk staff member, and an office manager involved. You'll need your "champion" to help get buy-in from other providers in the group, and PCMH touches all aspects of your workflow so you'll really want to include resources from both the front end and clinical areas.

Is training available?

Take advantage of the training available on NCQA's site, and plan on attending the in-person training sessions too. If your practice is large enough, NCQA will even send a trainer to you (for a fee). Understanding what is required is absolutely critical to working through the program successfully and achieving the highest level of recognition.

How will I manage to get it all done?

Break the project down into manageable steps. Review all the standards and associated factors and determine which items you are currently doing and which ones you need to add to your workflow. Determining the "gaps" and focusing your efforts there first will allow you to move forward most easily. Be sure to celebrate reaching milestones! It will keep your team motivated and allow you to keep the project on track.

And utilize all available resources! For example, the AAFP and AAP have valuable tools and resources available to members. And don't be afraid to utilize consultants to help with the work - they are often less expensive than you think!

Susanne Madden, MBA, is founder and CEO of The Verden Group, a consulting and business intelligence firm that specializes in practice management, physician education, and healthcare policy. She is also COO, National Breastfeeding Center, and cofounder, Patient Centered Solutions. She can be reached at madden@theverdengroup.com or by visiting www.theverdengroup.com.