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