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NCQA Revamps Patient-Centered Medical Home to Ease Adoption

The NCQA has released a new iteration of its patient-centered medical home recognition program, which uses an online reporting system and aligns more closely with MACRA.
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– NCQA has announced a redesign of its popular patient-centered medical home (PCMH) recognition program that will lower the burdens of adoption and upkeep for primary care providers.

The new patient-centered medical home process promotes flexibility and incremental achievements in patient access to care, health IT use, population health management, and other key quality initiatives to provide healthcare organizations with a measured, standardized framework leading to comprehensive practice transformation.

One of the biggest changes is a shift away from the three-year recognition cycle to an annual check-in, which allows more contact with NCQA experts.

“We used feedback from practices, policy makers, payers and other stakeholders to redesign PCMH recognition,” said Michael S. Barr, MD, Executive Vice President, Quality Measurement and Research Group in a press release.

Providers have had mixed opinions about how effective and worthwhile PCMH recognition really is, with some stakeholders arguing that the costs and administrative burdens outweigh any potential benefits to patient care.

Others point out that expanding appointment hours, engaging in risk stratification, and improving patient engagement can produce gains in emergency department use, hospital readmissions, and other key quality metrics.

During NCQA’s conversations with stakeholders about a new direction for the patient-centered medical home, the organization also heard that providers wanted a program that included less documentation, more interaction with NCQA representatives, more guidance and education, and more emphasis on performance instead of care processes.

The redesign achieves these goals, said Barr. “This improved process makes the PCMH program more manageable for practices and concentrates on performance and quality improvement,” he stated.

The new framework also takes into account the growing impact of MACRA and other value-based care programs on the primary care environment by eliminating duplicated reporting processes, streamlining workflows to stay in step with regulatory and financial changes, and giving providers more options for success under the new regulations.

Recognized PCMH organizations can accrue more points under the Merit-Based Incentive Payment System (MIPS) than other primary care entities, and certified advanced PCMHs can apply for the Alterative Payment Model (APM) pathway without undertaking a two-sided risk arrangement, says the Patient-Centered Primary Care Collaborative.

While the fundamental principles of the PCMH will remain the same, the overhauled adoption and reporting system tweaks the way providers will undertake practice improvements.  The new process includes three main components:

Commitment to PCMH transformation.  Providers will complete a self-assessment to gauge their readiness to begin the recognition process, and will be assigned an NCQA representative to guide them through the next steps for evaluation and planning.

Beginning the transformation process. Using a newly developed online reporting system, providers will submit process and performance data.  NCQA will conduct virtual check-ins that include personalized feedback and recommendations for how to move forward through the framework’s quality improvement steps.

Achieving sustained success as a PCMH.  The theme of continuous improvement runs strongly through the PCMH framework.  The previous iteration of the NCQA recognition program relied on recertification every three years, but the new process will include annual check-ins to sustain progress and ensure compliance.

In conjunction with the new guidelines, NCQA has released a toolkit to help interested healthcare providers begin the recognition process.  The resources include information on the basics of the patient-centered medical home, as well as suggestions for how to engage staff members, how to enroll in the online portal, and what to expect from the NCQA after commitment.

Practices that are already certified under the previous 2014 criteria, or those in the process of pursing recognition under those guidelines, will have several options for transitioning to the new process in order to avoid disruption.

More information about the changes, including detailed transition options for patient-centered medical homes of all types and levels, is available on the NCQA website.