Why become a pcmh

Review our online and in-person training , which can help you better understand the recognition process and requirements.

When you are familiar with the concepts and have started to transform, create a QPASS account at qpass. Learn more about the steps to enroll and what is required at enrollment. Once enrolled, NCQA assigns a representative to guide your practice through the recognition process. Your Representative will schedule an initial call to introduce themselves, discuss the process and develop a review schedule of up to three check-ins over the course of your transformation work.

If you have more than one site, your representative can provide you guidance on setting up site groups and sharing evidence across sites. You may demonstrate other requirements in real time during the virtual review through screen-sharing technology. Screen-sharing technology eliminates the need to upload documentation in advance. In a global capitation arrangement, a provider is reimbursed per-member per-month PMPM for the entire network population.

A payer needs external validation to justify compensating one provider differently from another. PCMH accreditation signifies that a provider has become an advanced primary care practice. This designation means that the practice has undergone a transformation in quality and safety enhancement and has established a foundation for coordination across the continuum of care.

It offers extended hours, care management to patients with chronic illnesses, behavioral health integration, or other services, Nielsen says. In addition, Medicare likely will use some form of accreditation to justify bonuses and other payment boosts for PCMHs under its future value-based payment programs now that the Sustainable Growth Rate formula has been eliminated.

Patient engagement at this level of organizational change will need to become a much more earnest part of primary care reform if practices are truly going to transform into patient-centered medical homes.

As more primary care practices express interest in PCMH accreditation, stakeholders-from payers to policymakers and patients-have voiced concerns about variations in the qualifying criteria. Some programs have come under fire for being too administratively burdensome and overly focused on processes rather than outcomes. PCMH recognition programs vary in the amount of required documentation, application costs and overall efforts.

Practices should research these programs and determine which one best suits their needs. Most incentive programs, including state Medicaid options, specify the type of recognition that practices must achieve to participate. Whichever route a practice pursues, accreditation should be viewed as a starting place. Much like earning a medical degree, it takes ongoing education to fully adopt the PCMH model and realize its benefits.

Pursuing accreditation and recognition helps assess which components are already in place at various levels and functioning effectively, while identifying areas needing more attention to achieve results. However, it lends practices and systems guidance in making gradual and lasting changes and provides a structure around which to base transformation efforts.

The PCMH certification option builds upon Joint Commission accreditation, which affirms compliance with a wide range of both practice- and patient-focused standards, including environment of care, medication management and leadership.

You will be prompted to log in to your NCQA account. Share this page with a friend or colleague by Email. We do not share your information with third parties. Twitter LinkedIn Facebook. Overview of revenue sources and revenue potential. Reduce Fragmentation The PCMH model emphasizes team-based care, communication and coordination, which has been shown to lead to better care. Improve Patient-Centered Access PCMHs emphasize the use of health information technology and after-hours access to improve overall access to care when and where patients need it.