NCQA’s new redesigned PCMH program has a lot of the same features but there are some important changes you need to know.

Getting recognized as a patient-centered medical home (PCMH) is not easy, but it can be a great way to help develop greater cohesion in your care teams, improve the quality of care for patients and be more prepared for value-based payment initiatives. In Kentucky, the most common form of PCMH recognition is from the National Committee for Quality Assurance (NCQA). In April 2017, NCQA released new guidelines for receiving recognition that are really different from the old approach.

So recognized PCMH practices have been scratching their heads and wondering what do they need to do differently under these new guidelines.

What Changed?

This new recognition process has three parts:

  • Assess: During this step the practice will complete an assessment and work with its Relationship Manager to develop a plan.
  • Transform: During the transformation process the practice will have virtual reviews and submit documentation to its Relationship Manager until it earns recognition.
  • Sustain: Once recognition is earned, the practice will continue working towards implementing and enhancing their PCMH model. There will be an annual check-in with their Relationship Manager to attest to certain policies and procedures and submission of quality data.

Other changes include:

New nomenclature – Standards, Elements, and Factors are now called Concepts, Competencies, and Criteria.

  • “Must-Pass” Standards are now called Core Concepts.
  • Recognition is valid for one year (versus three) and must be renewed annually.
  • An NCQA representative will be assigned to your practice and will conduct three virtual check-ins with you during the process.
What should you do now?

Begin your transformation journey 9-12 months before the expiration of your current PCMH program. Below are options for practices looking to move to the PCMH 2017 program from the PCMH 2011 or PCMH 2014 program.

  • If you are a 2011 recognized practice: you should renew under the 2017 redesigned process by starting in the “Transform” phase. This applies to Level 1, 2 or 3 recognized practices
  • If you are a PCMH 2014 Level 1 or 2 recognized practice: you can renew under the 2017 redesigned process by starting in the “Transform” phase.
  • If you are a PCMH 2014 Level 3 recognized practice: NCQA is offering a direct entrance into the “Sustain” phase of the PCMH 2017 program when your recognition expires.
How can the Kentucky REC help?

Although there are many similarities between the old and new PCMH standards, the Kentucky REC has a team of trained experts to help guide you through the new 2017 process. Let us help you make your path to renewal as easy as possible! Our team is offering a new PCMH renewal service beginning in January 2018 for anyone interested in scalable, tailored support during your renewal process. Give us a call today at (859) 323-3090 for more information.