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NCQA Redesigns Patient-Centered Medical Home Recognition Program

By Sandra Gittlen  
   March 22, 2017

Barrett expects the 2017 recognition program to eliminate the guesswork and confusion from the submission and review process. For example, multisite healthcare facility applicants will be assigned a relationship manager whom they can interact with via WebEx to ask questions and double-check requirements. Also, instead of a single review, the process will comprise three check-ins that afford applicants an opportunity to correct items and receive credits. "Recognition will no longer be one and done; it will be more of an ongoing evaluation process," she says.

Another notable change will be the flattening of levels from three to one, Barrett says, enabling a much clearer delineation between practices that are recognized by the NCQA and those that aren't. "Our goal is to get back to the core concepts of the medical home and make sure what we are asking for truly reflects those concepts," she says.

"I didn't agree with the levels in the first place," Mayer says; adding that it takes time to transform a practice, making Level 3 difficult to achieve. However, he is committed to pursuing 2017 certification. "We decided a long time ago that PCMH was the way we were going to get the practice in line for the future."

Getting Recognized
About 15 years ago, Avenel-Iselin began adding specialty care, including cardiology, podiatry, gastroenterology, urology, and nephrology. "We've grown from just a primary care provider to a primary care–based practice," he says, making the practice far more conducive to the recognition requirements of collaborative and coordinated care.

Mayer first applied for recognition knowing "insurance companies and Medicare were going to go toward this type of practice transformation for primary care," he says. "We wanted to be forward-thinking."

A clinical manager and an administrator head up the application submission and review process. "While it wasn't difficult to make the transformation to PCMH internally, we spent a lot of time documenting what we were doing," he says.


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