Thoughts from our PCMH Recognition Consultant

Patient Centered Medical Homes – Why they are important and the benefits of achieving recognition.

November 22, 2017

Over the past seven years, accreditation focus of The Patient Centered Medical Home model (PCMH) has grown in popularity, fueled by evidenced-based results across three domains: reducing cost, improving quality of care, and rightsizing utilization. Physician practices and other organizations can expound on their recognition of a PCMH model by choosing to be a PCMH recognized practice. Recognition as an accredited PCMH means that the entity meets national standards in providing continuity of care for each patient, and preventative care is fostered by creating a stronger ongoing relationship between patient and clinician by facilitating patient healthcare access to their providers.

History of PCMH:

The Patient Centered Medical Home model (PCMH) is a concept of coordinating care for patients between their Primary Care Provider and multiple types of healthcare specialists while reducing costs, improving the quality of patient care outcomes and promoting better teamwork and greater staff satisfaction. The centralized coordination of care reduces the potential for unnecessary repetition of treatments, re-admissions, reduction in harmful medication interactions, and promotes medication adherence and coordination of care for patients with chronic care conditions.

In February 2007, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic published a set of joint principles describing the key characteristics of a Patient-Centered Medical Home (PCMH).

The main characteristics of a Patient Centered Medical Home (PCMH) are:

  • Personal physician: Each patient at a Patient Centered Medical Home practice has a designated physician, who leads a collaborative team which provides primary care services.
  • Coordination of care: The Patient Centered Medical Home coordinates the patient’s care with other providers and facilities to ensure that information about all medical care of the patient is consolidated and communicated among all providers.
  • Access to care: Patients have easy access to care, with open scheduling of same day appointments and after-hours access to primary care providers when needed.
  • Technological solutions: Patient Centered Medical Homes make full use of electronic health records and information technology tools to accurately record and analyze care provided to each patient.

Patient Centered Medical Home Recognition:

Currently there are at least three voluntary organizations already engaged in providing recognition or educational resources to transform practices into a PCMH. These accrediting bodies include URAC (formerly known as the Utilization Review Commission), the National Committee for Quality Assurance (NCQA), and the Accreditation Association for Ambulatory Healthcare (AAAHC). Professional Services Network, Inc. (PSN) provides expert consultation in preparation to assist practices  to meet national standards for the NCQA PCMH Recognition program and the URAC PCMH Certification program.

NCQA PCMH Recognition:

A year after the initial set of joint principles describing the key characteristics of PCMH was presented, NCQA released its own standards for recognition of Patient Centered Medical Home practices. NCQA recently released their new set of PCMH 2017 Standards. Highlights of the standards include:

  • Flexibility: practices choose the path to recognition that meets the needs of the practice;
  • Personalized Service: Practices have a greater interaction with NCQA and are assigned an NCQA representative who works with the practice throughout recognition process and acts as point of contact;
  • User Friendly Approach: Requirements remain meaningful both with simpler reports and less paperwork;
  • Continuous Improvement: Annual Check-ins help organizations to strengthen as a medical home by maintaining performance improvement at the top of their priorities;
  • Alignment with Changes in Health Care: Aligns with current public and private initiatives and can adapt to future changes.

URAC PCMH Certification:

According to URAC, URAC’s Patient-Centered Medical Home (PCMH) Certification process “focuses on development over time, an approach to a more sustainable transformation of primary care practices.  This process is also a teaching and learning experience as the organization implements best practices and methods for providing value-based, quality medical services.”

The URAC-certified patient-centered medical home:

  • Provides enhanced access to primary care
  • Improves delivery of preventive services
  • Helps patients make healthy lifestyle choices
  • Uses the latest health information technology and evidence-based medical approaches
  • Reduces emergency room visits and hospitalizations
  • Improves care coordination
  • Provides high-quality disease management

PCMH recognition helps distinguish a practice by showing patients and payers that the organization, through a rigorous review process, meets national standards designed to ensure quality in the coordination of patient care. In successfully completing the Recognition or certification process, the PCMH practice earns a seal of approval that can be proudly displayed in showcasing their achievement.

About the Author:

Jean Lockington, MA, RN, PLNC, PCMH CCE has worked for Professional Services Network as a consultant for many years. She has over 25 years’ experience working as a Senior Executive in managed care. Her areas of expertise include quality improvement, regulatory compliance, new business development, process improvement and accreditation preparation.

About Professional Services Network, Inc. 

Professional Services Network, Inc. (PSN) works with clients nationwide in the search and recruitment of experienced healthcare professionals in managed care and clinical roles for temporary assignments and direct hire opportunities.  Additionally, PSN’s consultants work with organizations and providers seeking accreditation or re-accreditation with URAC or NCQA. For additional information regarding our services contact us at 301-460-4089 or email us at [email protected].