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Quality Assurance Group Makes Changes to Evaluation of Patient-Centered Medical Home Program

April 11, 2017

Recently, the National Committee for Quality Assurance (NCQA) introduced changes to its Patient-Centered Medical Home (PCMH) Recognition program.

The NCQA is an independent, not-for-profit organization, focused on improving the quality of health care through accreditation and performance report cards. Accredited health plans face a rigorous set of standards and must report on their performance in numerous areas in order to earn NCQA’s seal of approval.

The PCMH Recognition program is the most widely adopted Patient-Centered Medical Home evaluation program in the country. PCMH models, made more popular by the Affordable Care Act, are models in which a patient’s physical and mental health needs are directed and coordinated by his or her primary care physician. The models are patient-centric, based on coordinated, team-based, accessible care that is driven by quality and safety. Patient care needs could include prevention and wellness, acute care, and chronic care. The NCQA is one of multiple accrediting bodies for PCMH models.

Recognizing that providers need to minimize administrative burdens and focus on providing care to the patients they are serving, the new NCQA PCMH program offers additional flexibilities and an assigned point of contact. Most importantly, the program is moving from a three-year recognition cycle to an annual check-in. This change will help practices focus on continual performance improvement.

Medicare and commercial payers have implemented PCMH models across Pennsylvania. This year, the state’s Medicaid managed care program, HealthChoices, required that managed care organizations (MCO) enter into value-based purchasing strategies with providers, such as PCMH models, beginning January 1, 2017. 

MCOs will be required to make a certain percentage of their payments to providers based on value-based purchasing strategies during the next three years. This is all part of the change in health care delivery in which more payments are based upon the value of the services provided, not the volume of patients receiving services.

The goals set within the MCO contracts include:

  • 2017––7.5 percent
  • 2018––15 percent
  • 2019––30 percent

HAP will monitor the impact of the changes. For additional information, contact Kate Slatt, HAP’s senior director, health care finance policy.

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