The Basics of PCMH

Transformation Process

The Triple Aim, defined by the Center for Medicare and Medicaid Services targets three areas for health care improvement:

3aimAs the triple aim becomes the benchmark of success, Patient Centered
Medical Homes (PCMH) and Accountable Care Organizations (ACO) take
center stage, aligning incentives among hospitals, providers, payers;
and, most importantly, patients. By making the patient the focus of
coordinated care, providers and hospitals unite to reduce costs and
transform healthcare into a system that rewards value over volume.

PCMH is a healthcare delivery system with a name coined by the
American Academy of Pediatric Physicians in 1967.  The concept was
brought to life again in 2006 by the National Committee for Quality
Assurance (NCQA). Over the past decade, NCQA has produced several
versions of their “survey tools” enabling primary care, internal
medicine, and pediatric practices not only to receive recognition for
PCMH but also raise the bar. Over the years, NCQA’s PCMH program has
gained momentum boasting over 8,300 recognized Medical Homes across the
United States.

A Patient Centered Medical Home (PCMH) is a team-based model of
care designed to help physicians maintain and improve their patients’
health. Providing quality healthcare requires a team of caring
professionals with unique skills centered on informed patients who
understand the importance of their own roles in excellent health.patient-centered-medical-home-e1397254240439


Groups who receive Level 3 Recognition from National Committee for
Quality Assurance (NCQA ) for Patient Centered Medical Home (the highest
level) have demonstrated that they focus on improving outcomes for
patients by:

  • Providing access to providers after hours by phone or in-person appointments.
  • Implementing evidenced-based medicine guidelines.
  • Coordinating care and proactive outreach to
    ensure that labs, images, specialist notes, and hospitalizations are
    documented in the patient’s chart prior to his/her next visit, allowing
    the care team to get a complete picture of the patient’s health.
  • Setting goals with the patient to improve his/her health and quality of life.
  • Holding daily “Huddling” conversations about patients with complex conditions or those with opportunities to improve care.
  • Contacting patients who need preventative and chronic treatment to proactively address those needs.
  • Continuous quality improvement to advance outcomes for patient satisfaction and clinical metrics.

Ultimately, combining preventative and chronic disease management and
streamlining workflow leads to more efficient and effective patient
care and better results for populations of patients. It allows each team
member to work to the highest level of their license and allows the
providers to focus more attention on medication management and their
relationships with their patients.

Three components of the Patient Centered Medical Home process:

  1. The application. – AAAHC, The Joint Commission, NCQA, and URAC- NCQA are often the most popular payers.
  2. The transformation
    process. – Practices must ask themselves, how do we change office
    behavior to become more team-based and patient centric, while meeting
    the criteria in the application? This often involves workflow and
    staffing changes.
  3. Establishing contracts with insurance companies. This ties payment to the application and the transformation processes.

Obtaining PCMH recognition is an in-depth process and can sometimes
be overwhelming; however, Quality HealthCare Consulting is experienced
in guiding practices through the process. Leveraging our diverse
industry experience, Quality HealthCare Consulting offers proactive
guidance and proven solutions. To date, QHC has completed 63 Level III
PCMH recognitions (the highest level of awarded by NCQA).

TransforMed PCMH Video

Transitioning Your Practice to the Patient Centered Medical Home