The Patient-Centered Medical Home And Your P4P Goals

Using six real-world examples, this white paper explains the technology and organizational components of a PCMH and how to use them to achieve results now.

The Agency for Healthcare Research and Quality, part of the U.S. Department of Health & Human Services, defines the Patient-Centered Medical Home (PCMH) as a model of primary care delivery that is patient-centered, comprehensive, coordinated, accessible and continuously improved through a systems-based approach to quality and safety.

Although adoption of the PCMH model is not mandated by any federal or state law, it is referenced in five areas of the Patient Protection and Affordable Care Act of 2010 (PPACA):

1. The Center for Medicare and Medicaid Innovation will test and evaluate models that include medical homes as a way of addressing defined populations with either poor clinical outcomes or avoidable expenditures.
2. Medical homes are one indicator for measuring health plan performance; state health exchanges are designing incentives to encourage high-performance plans, including those with medical homes.
3. Starting this year, the federal government will match state funds up to 90 percent for two years to states that provide options for Medicaid enrollees with chronic conditions to receive care under a medical home model.
4. PPACA will provide grants to community care teams that organize themselves under the medical home model.
5. PPACA created the Primary Care Extension Program, which provides primary care training and implementation of medical home quality improvement initiatives and processes.

The National Committee for Quality Assurance (NCQA), a private non-profit organization dedicated to improving healthcare quality, has taken a leadership role among medical home initiatives with its Physician Practice Connections (PPC) recognition program for PCMHs. PPC recognizes practices that use systematic processes and information technology (IT) to enhance the quality of care. According to NCQA, as of the end of 2010, almost 7,700 clinicians at more than 1,500 sites across the United States had received the organization's PPC-PCMH recognition.

On Jan. 31, 2011, NCQA released new standards for its PCMH program, with an emphasis on medical practices being more patient-centered and reinforcing "meaningful use" incentives (introduced in the HITECH portion of the American Recovery and Reinvestment Act of 2009), which provide Medicare/Medicaid reimbursement for practices and hospitals that utilize specified functions of certified electronic health records (EHRs).

Against this backdrop, physician practices should assess or revisit their readiness – from both a technological and organizational standpoint – to pursue participation in the PCMH model. Access This Content To Read This White Paper In Its Entirety.