PCMH Benefits to Practices, Clinicians and Patients

Practice Benefits

• Align with where health care is headed. Payers continue to move from the fee-for-service model towards rewarding integration and quality care. They are increasingly contracting with organizations that can show they have strong infrastructure and quality improvement initiatives. NCQA PCMH Recognition prepares you to succeed.
• Integrate services across your entire organization. If you are a health system or clinically integrated network with specialty practices, urgent care centers and other types of practice sites, NCQA’s Patient-Centered Specialty Practice (PCSP) and Patient-Centered Connected Care programs mean your whole organization can evolve into a high-functioning medical home neighborhood. These programs are built off of the PCMH model and complement NCQA PCMH Recognition.
• Support revenue growth. Many Federal, state and commercial payers offer incentive programs to practices that achieve NCQA PCMH or PCSP recognition.
• Improve your practice. Use NCQA PCMH Recognition to do gap analyses and implement processes and procedures that improve care for your patients and make your practice more efficient.
• Keep your staff happy. The PCMH model helps standardize procedures and streamline processes and practice staff to allow staff to work at the top of their knowledge, skills and ability. It has been shown to result in higher staff satisfaction.⁴
• Market your practice. NCQA publishes all recognized practices and clinicians in its recognition directory at www.ncqa.org/pcmhdirectory. You can also use the NCQA seal to market your accomplishment to patients and partners.

Business Considerations for PCMH

NCQA PCMH Recognition has been shown to improve quality and reduce health care costs. Practices that implement the PCMH model also need to effectively plan for how the implementation impacts them financially. NCQA engaged Milliman, one of the world’s largest providers of actuarial services to develop a white paper that addresses the question: What are the operational and financial considerations for becoming a PCMH-Recognized entity from the perspective of a primary care practice? Get the White Paper.

Clinician Benefits

• Earn higher reimbursement. More than 100 payers and other organizations offer either enhanced reimbursements for recognized clinicians or support for your practice to become recognized.
• Succeed in MACRA. The Centers for Medicare & Medicaid Services (CMS) acknowledges both NCQA’s PCMH and PCSP Recognition programs as ways to receive credit in Medicare Access and CHIP Reauthorization Act (MACRA). Clinicians in NCQA-Recognized PCMHs or PCSPs automatically get full credit in the MIPS Improvement Activities category. Clinicians in NCQA-Recognized PCMH and PCSP practices will likely do well in other MIPS categories. The PCSP Recognition Program is the only specialty-focused evaluation program in the country recognized by CMS in MACRA.
• Earn Maintenance of Certification (MOC) credits. The American Board of Internal Medicine (ABIM), American Board of Family Medicine (ABFM) and American Board of Pediatrics (ABP) allow clinicians in NCQA-recognized practices to receive maintenance of certification (MOC) credits, reducing the burden on clinicians to take on additional activities.
• Focus on patient care. One aspect of the PCMH model is to ensure each team member operates at the highest level of their knowledge, skills, abilities and license within their assigned roles and responsibilities.

Patient Benefits

• Stay healthy. Patients who are treated in PCMHs tend to receive preventative services and screenings at a higher rate than patients not in PCMHs, helping keep them healthy.
• Better communication. A core concept of the PCMH model is to communicate with patients and their families/caregivers. The model emphasizes enhanced access so patients can get clinical advice or medical records when needed.
• Better manage chronic conditions. PCMHs are especially helpful for patients with complex chronic conditions. Research shows that these conditions are managed better in a medical home.
• Have a better experience. When attributes of team-based care are described to people, they say it is the type of care they want to receive.