NCQA PCMH Recognition: Concepts

The American Academy of Pediatrics introduced the medical home concept in 1967. Leading primary care-oriented medical professional societies released the Joint Principles of the PCMH in 2007. NCQA released its PCMH Recognition program—the first evaluation program in the country based on the PCMH model—in 2008. Today, NCQA’s PCMH Recognition program has evolved to feature a set of 6 concepts that make up a medical home.

A Structure of Concepts, Criteria and Competencies

Concepts. There are 6 concepts—the overarching themes of PCMH. To earn recognition, a practice must complete criteria in each concept area. If you are familiar with past iterations of NCQA PCMH Recognition, the concepts are equivalent to standards.

Criteria. Underlying the six concepts are criteria: activities for which a practice must demonstrate satisfactory performance to obtain NCQA PCMH Recognition. Criteria are developed from evidence-based guidelines and best practices. A practice must pass all 40 core criteria and at least 25 credits of elective criteria across concept areas.

Competencies. Competencies categorize the criteria. Competencies do not offer credit.

Program Concept Areas

• Team-Based Care and Practice Organization: Helps structure a practice’s leadership, care team responsibilities and how the practice partners with patients, families and caregivers.
• Knowing and Managing Your Patients: Sets standards for data collection, medication reconciliation, evidence-based clinical decision support and other activities.
• Patient-Centered Access and Continuity: Guides practices to provide patients with convenient access to clinical advice and helps ensure continuity of care.
• Care Management and Support: Helps clinicians set up care management protocols to identify patients who need more closely-managed care.
• Care Coordination and Care Transitions: Ensures that primary and specialty care clinicians are effectively sharing information and managing patient referrals to minimize cost, confusion and inappropriate care.
• Performance Measurement and Quality Improvement: Improvement helps practices develop ways to measure performance, set goals and develop activities that will improve performance.

How You Can Review the Concepts, Criteria and Competencies

The PCMH standards and guidelines document contains the NCQA PCMH Recognition program requirements. This publication includes the PCMH concepts and a table with the criteria and what evidence is needed to submit to NCQA to earn recognition.