×

PCMH

Patient-Centered Medical Homes: creating a focal point for care

Patient-Centered Medical Homes: creating a focal point for care

A home is more than a place where one lives—it is the central place around which one organizes their life. A patient-centered medical home (PCMH) is focal point for coordinating a patient’s healthcare—an increasingly important goal in primary care. Is it worthwhile for a primary care practice to become designated as a PCMH? If so, what technology solutions can support this goal?

What is a PCMH?

In a PCMH, the care team places the patient at the center of its efforts. A primary care physician coordinates care.1 The team helps the patient navigate the healthcare system—including connecting him or her to community resources that support better health and well-being.

Today, there are numerous public and private initiatives to foster the growth of PCMHs.2 As the concept becomes more widespread, the qualities that define a PCMH may vary somewhat. A team-based approach to care—with a strong emphasis on managing care—is a common thread that runs through all PCMHs.3

Access to care is another important theme in this model. Many PCMHs, for example, offer extended hours to patients.

Goals of PCMHs include these:

  • Making sure each patient receives comprehensive care
  • Improving population health
  • Effectively implementing health IT solutions
  • Eliminating unnecessary or redundant tests and treatments
  • Reducing the cost of care4

How does a practice become a PCMH?

To establish itself as a PCMH, a primary care practices may seek recognition from an accrediting agency. There are several entities that confer the PCMH designation:

  • Accreditation Association for Ambulatory Health Care (AAAHC)
  • The Joint Commission
  • The National Committee for Quality Assurance (NCQA)
  • The Utilization Review Accreditation Commission (URAC)
  • State Medicaid programs
  • Private insurers5

These entities usually offer guidance on how to become a PCMH. Ideally, it should be a transformative process, not just an administrative exercise—a path to strengthening patient engagement and instituting a fresh, more effective approach to primary care.5

Why should a practice become accredited?

There are two reasons for a primary care practice to pursue accreditation. The first is to improve the quality of care they provide to patients. The second is to participate in payment incentive programs that require PCMH designation.5

Payers may require accreditation as a condition for getting an increase in reimbursement. For example, a payer in a global capitation arrangement may use PCMH accreditation to justify compensating certain primary care practices a higher amount compared to others.

The Medicare Access and CHIP Reauthorization Act (MACRA), enacted in 2015 and intended in part to guide the shift toward value-based payment models, establishes new pathways for PCMHs to receive incentive payment.6 This indicates that CMS perceives PCMHs as important to the overall transformation of healthcare.

What technology solutions support the mission of a PCMH?

PCMHs are tasked with being more effective in these areas:

  • Sharing information
  • Managing chronic conditions
  • Engaging patients
  • Managing referrals to minimize cost and reduce inappropriate care

To promote more effective care coordination, PCMHs should consider connected health solutions to facilitate efficient access to a greater variety of people, practices, and organizations, including hospitals, labs, specialists, and skilled care facilities.

As part of managing chronic conditions more effectively, PCMHs may also consider using population health solutions to identify gaps in care in the patient population and target individual patients most in need of enriched services. These solutions can also help PCMHs monitor referral patterns and reduce out-of-network referrals.

Population health solutions can also enable a PCMH to automate patient outreach—a powerful way to strengthen engagement.

NextGen Healthcare offers an integrated platform that includes connected health, population health, and patient engagement solutions. Our integrated approach can help PCMHs and practices seeking PCMH designation to transform their primary care practice and obtain payers’ incentives.

To learn more about the benefits of a PCMH, contact us at 855-510-6398 or results@nextgen.com.

 

 

1What is the Patient-Centered Medical Home?” American College of Physicians. Accessed October 11, 2018. https://www.acponline.org/practice-resources/business-resources/payment/models/patient-centered-medical-home/understanding-the-patient-centered-medical-home/what-is-the-patient-centered-medical-home.

2 ‘NCQA Analysis Shows PCMH Initiatives Growing Across the Country.” The National Committee for Quality Assurance (news), January 7, 2016. https://www.ncqa.org/news/ncqa-analysis-shows-pcmh-initiatives-growing-across-the-country/.

3 “The Patient-Centered Medical Home: Frequently Asked Questions (FAQ).” The Patient-Centered Primary Care Collaborative. Accessed October 11, 2018. https://www.pcpcc.org/about/medical-home/faq.

4 Jennifer Bresnick. “Breaking Down the Basics of the Patient-Centered Medical Home.” Health IT Analytics accessed October 11, 2018. https://healthitanalytics.com/features/breaking-down-the-basics-of-the-patient-centered-medical-home.

5 “PCMH accreditation: Is it worth it?” Medical Economics, July 2, 2015. http://www.medicaleconomics.com/health-law-policy/pcmh-accreditation-it-worth-it.

6 “The Patient-Centered Medical Home: Frequently Asked Questions (FAQ).” The Patient-Centered Primary Care Collaborative. Accessed October 11, 2018. https://www.pcpcc.org/about/medical-home/faq.