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NCQA Redesigns Patient-Centered Medical Home Recognition Program

By Sandra Gittlen  
   March 22, 2017

To assist the primary care group practices, Physician Alignment hired an IT director for its EMR platform with the focus of creating reproducible and trusted data in line with NCQA PCMH requirements. "For primary care groups, we've had internal quality measures for more than three years. Our IT director was instrumental in creating the trust for our doctors in our data being valid. We also have a Quality Committee of primary care physicians who have a voice in measure performance review and measure development."

But as streamlined as internal data-gathering has become, Brown sees room for improvement on NCQA's part and is encouraged with the recognition redesign process NCQA is initiating this year. The primary care group practices received recognition under the more-difficult 2014 standards, and Brown is expecting that practices participating in NCQA recognition will be able to maintain their recognition after 2017 more easily, she says.

Brown says that the PCMH recognition process can be costly in terms of training and support, including employment of quality improvement coaches, and that the return on investment possibly won't be recognized for three to five years. However, CMS' Quality Payment Program may reward certain PCMH-recognized practices with favorable Merit-based Incentive Payment System scoring, including NCQA, she says. For these reasons, the practice transformation has to be about improving patient care, "not financially focused. It's the right thing to do," she says.

A Group Effort
Randy Pritza, MD, MMM, chief medical officer at Omaha, Nebraska–based CHI Health Clinic, a network of primary care and specialty services with 100 locations in Nebraska and southwest Iowa, has collaborated with other CHI providers on NCQA PCMH recognition, including Barry Hoover, MD, MBA, FACEP, vice president and chief medical officer at The Physician Network, a wholly owned subsidiary of CHI with 50 primary, specialty, and urgent care practice sites throughout Nebraska.


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