PCMH: A Framework for Practice Transformation

By Heather Rothrock

The term ‘Medical Home’ maintains rank among buzzwords in today’s health care industry, specifically as the term relates to seeking formal, national recognition from major accrediting bodies like the National Committee for Quality Assurance (NCQA), The Joint Commission (TJC), or the Utilization Review Accreditation Committee (URAC). However, the term itself dates back to a concept first-introduced by the American Academy of Pediatrics (AAP) in 1967.

In 1967, the term referred to centralized record-keeping in ultimate pursuit of delivering coordinated, defragmented care for children. After surviving and evolving through decades of change (and with ties to North Carolina’s Child Health Plan), the AAP in conjunction with the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and the American Osteopathic Association (AOA) operationalized the term into the Joint Principles of the Patient-Centered Medical Home (PCMH). This version of the term contains the familiar attributes that we recognize today. For example, this version details how patients have enhanced access to a personal physician within a physician-directed medical practice oriented towards the whole person and offering care that is patient centered, comprehensive, coordinated, and committed to quality and safety.

And so emerged recognition programs which encouraged providers to not only incorporate these concepts into their practices, but to do so in measureable, certifiable ways. Plenty of research exists that shows how becoming a medical home saves money for the practice in reducing waste and duplication. Some providers willingly accept this challenge and sprint across recognition finish lines with flying colors, while others reluctantly await a mandate all but requiring them to demonstrate recognition from a program like PCMH, or risk being left behind to fold under the mounting pressures of quality and value-based care in today’s healthcare environment.  

Emtiro Health seeks to help the provider somewhere in between. Pursuing recognition can be intimidating, and many providers struggle to get past the idea of investing the perceived amount of time, effort, or money required to become a PCMH. But are these perceptions inflated or based in reality?

Emtiro starts by helping providers understand that the recognition programs, especially the widely-accepted NCQA model for PCMH, are based on a system of achieving credits, with much of the criteria being selectable. This allows providers to choose many of the components they would like to demonstrate. There are some components that are required, as they are the components that really demonstrate and reinforce the roots of the Medical Home. These required components include understanding access needs and preferences across the population (same day appointments), holding daily individual patient care meetings (huddles), and sending proactive reminders to patients for needed services (breast cancer screening, colorectal cancer screening, etc.). Other components are optional and might not be a priority for your practice, such as involving patients/families in practice governance or adopting shared decision making aids.

The latest iteration of NCQA’s PCMH standards (PCMH2017) is organized into six concepts:

  • Team-Based Care and Practice Organization

  • Knowing and Managing Your Patients

  • Patient-Centered Access and Continuity

  • Care Management and Support

  • Care Coordination and Care Transitions

  • Performance Measurement and Quality Improvement

Once a practice understands the competencies within each of these, Emtiro assesses practice operations and workflows in accordance with PCMH competencies and helps the practice develop a work plan that fits the practice and lessens the lift associated with becoming a recognized PCMH.

The big question remains: Is achieving recognition worth the time, effort, and cost required?

That’s for your individual practice to decide. But at a minimum, pursuing recognition requires your practice to analyze workflows and establish supporting policies/procedures that standardize things that might have historically been inconsistent. There may also be simple tweaks within your practice- like documenting after hours clinical advice, or utilizing a tool like the Teachback Method to understand patient health literacy- that increase patient safety and satisfaction.  Additionally, becoming a PCMH can align nicely with many initiatives your practice is already facing, like Merit Based Incentive Payments System (MIPS), the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Blue Cross and Blue Shield’s Blue Quality Physician Program (BCBS BQPP), and North Carolina Medicaid’s Advanced Medical Home (AMH) program.

If your interest is peaked in what becoming a PCMH would look like in your practice, here are a few suggestions:

  • Get your Electronic Health Record (EHR) to work for you. Does your current EHR vendor offer any support/alignment for quality programs like PCMH? Some EHR vendors have been pre-validated by NCQA for recognition support, giving customers automatic credit in several PCMH competencies just by using the product and alleviating your documentation and evidence burden. Check here for your vendor and version: http://www.ncqa.org/programs/recognition/prevalidation-program/vendor-list

  • Identify any potential overlap in quality programs you’re already participating in. Some quality programs offer representatives working in the field to support your practice’s work toward their initiatives. Express your plans to pursue PCMH recognition to these individuals and find out if there’s a way to maximize your efforts. 

  • Reach out to Emtiro Health for support. Our team of NCQA-certified PCMH Content Experts have partnered with individual practices and multi-site groups, both independent and corporately supported, in successful submission of over 100 PCMH or PCSP surveys, all resulting in top-level recognition. We partner with practices to fundamentally effect practice level quality and patient-level outcomes. Our objective is not mere recognition as a PCMH, but to align organization and practice goals with sustainable opportunities, teeing up a practice for success in its long-term mission. E-mail Info@EmtiroHealth.org today to see what we can achieve together.

Brea Neri