FemalePedPatient 845x422 - Considering Pediatric PCMH? 8 Things You Should Know

Considering Pediatric PCMH? 8 Things You Should Know

So your practice is thinking about applying to become a recognized Patient-Centered Medical Home (PCMH). What do you need to consider before deciding whether PCMH is right for you?

1. NCQA is the most prominent body for PCMH recognition.

If you’re applying for PCMH recognition, you’ll most likely work with the National Committee for Quality Assurance (NCQA). Founded in 1990, NCQA is a non-profit that focuses on identifying measures and standards for healthcare. Its initiatives include Health Plan Accreditation, HEDIS(R) & Performance Measurement, and PCMH Recognition. To participate, your practice must provide:

  • Whole-person care
  • personal clinician provides first contact, continuous, comprehensive care
  • care is coordinated or integrated across the health care system
  • team-based care
  • NCQA offers a short guide and a video to help clarify eligibility requirements. Be sure to find out if your practice is eligible before proceeding on the path to PCMH.

    2. PCMH incentives are regional.

    PCMH is a national program, but incentive levels vary regionally. Some regional payors build PCMH initiatives that provide significant financial incentives to practices that become recognized patient-centered medical homes. In other areas, these initiatives are not backed strongly, and thus, the corresponding incentives are not as great. For example, we’ve learned that regional payors in North Carolina, Florida, and New York provide significant incentives for practices that are PCMH recognized whereas regional payors in California do not.

    When considering whether PCMH is right for your practice, the first thing you should do is find out how active PCMH initiatives are in your area. Use this map and click on your state to find out how actively payors in your state are backing PCMH. Then, contact payors in your area to find out if there are any incentives your practice could receive for becoming a Level 3 recognized PCMH.  You can also ask other pediatric practices in your area about their experience with PCMH recognition. Or, post a region-specific question on a pediatric forum like the AAP’s Section On Administration and Practice Management (SOAPM).

    3. To receive Level 3 recognition, you’ll need an EHR.

    NCQA offers three levels of PCMH recognition.  If your practice has not yet begun using an EHR for charting purposes, you may still be able to receive Level 1 or Level 2 recognition.  Without an EHR and functionality such as electronic charting, e-prescribing, a patient portal including secure messaging, and computerized provider order entry for referrals and labs, you will find it very difficult if not impossible to meet the requirements for level 3 recognition.  Implementing an EHR is a big undertaking for any practice and by comparison, your PCMH application process may seem like a breeze.

    4. PCMH is not just designed for pediatrics.

    The U.S. Department for Health and Human Services Agency for Healthcare Research and Quality (AHRQ) says that “the medical home model holds promise as a way to improve health care in America by transforming how primary care is organized and delivered.” Because PCMH is designed for all primary care models, including pediatrics, family medicine, and geriatrics, some requirements will fit more easily into a pediatric workflow than others.

    5. PCMH is an ongoing effort.

    Like the government’s requirements for the ARRA Meaningful Use program, NCQA’s standards for PCMH change over time. The 2011 PCMH standards were recently replaced with 2014 standards, and a new set of standards is expected in 2017.

    Once you are recognized as Level 1, 2, or 3, your status remains in effect for three years. If your practice is planning on becoming a recognized PCMH, consider how your practice can participate in a sustainable way. You may want to include time and money for the PCMH recognition process in your strategic plan. You can also determine how best to maintain recognition once you’ve earned it.

    6. Your EHR vendor may help with PCMH.

    Depending on your vendor, you may have access to tools and resources that will support your effort to receive PCMH recognition. Find out if your vendor provides reporting, training, support, or documentation outlining how you can leverage your system for PCMH.

    Some vendors also go through a certification process directly with NCQA to receive prevalidation points. These vendors “successfully demonstrate their technology solution has functionality that completely meet one or more factor level requirements within the PCMH standards.”  Practices using these systems receive autocredit points from NCQA toward PCMH, saving time and effort as you work toward recognition.

    7. Practice-wide commitment is essential.

    PCMH involves more than the managing partner at your practice making a decision to participate. Everyone at your office, from clinical staff to your office manager and even your patients, will be impacted by your decision to meet the care model required to pursue PCMH recognition. 

    It’s essential that your office is on board and that you have identified key clinical and administrative stakeholders on your path to PCMH.  Include them in your planning process and consider their input when determining how best to proceed. Some practices appoint or hire a member of their staff to manage the care coordination required for PCMH or to lead the office-wide effort to meet the requirements for recognition.

    8. Remember: the benefits are financial AND clinical.

    While the financial rewards of Level 3 PCMH recognition can be significant, the purpose of the program the purpose of the program is to help practices improve cost, quality, and patient experience. If you’re interested in the clinical as well as the financial rewards, the effort required to apply will be an engaging learning experience that could benefit your practice for years to come.