Person-Centered Medical
Home Recognition Program
Connecticut Department of Social Services
Presented by Community Health Network of Connecticut, Inc.
Person-Centered Medical Home
Recognition Program
What is a Person-Centered Medical Home?

A Person-Centered Medical Home is a Practice that places the patient at
the center of the health care system, and provides primary care that is
“accessible, continuous, comprehensive, family-centered, coordinated,
compassionate, and culturally effective.”

The patient has a personal relationship with the provider/care team. The
care team knows the patient and their health care needs.

A method to merge modern technology with traditional primary care
What are the benefits of a PCMH?

Financial Incentives

Improved staff morale: Provider champion leads Care Team

Improved patient satisfaction: Patient has a personal relationship with
Provider and Care Team

Embraces quality improvement and improves patient outcomes
NCQA Chosen for PCMH Recognition

During PCMH program development at the state level, the committee
evaluated a number of PCMH Recognition Programs.

It was determined that the National Committee for Quality Assurance
(NCQA) PCMH program of recognition would be the one that the
Department of DSS would use for their program.

It was decided that only Levels 2 or 3 would be recognized by DSS. Level 1
NCQA PCMH recognition requires participation in the Glide Path Process.
Eligibility to Become A PCMH in CT
•
NCQA recognized, Level 2 or 3
•
Not recognized or Level 1 – with completed PCMH & Glide Path
Application
•
Enrolled as CMAP provider (CT Medical Assistance Program)
• Active unrestricted CT license as MD, DO, NP or PA.
• Function as PCP with panel of patients
• Provide primary care services for at least 60% of the time across all
payers
Eligibility (continued)
•
Share all medical records within the practice and use the same system
support for all clinical and administrative service
•
Meet State/Federal requirements for EPSDT, Smoking Cessation (R2Q),
addressing Racial and Ethnic Disparities, and Adherence to Consumer
Protections
•
Will not require APRN and PA practitioners to have their own panel of
patients to qualify as PCMH providers if they are serving to support or
extend the panel of a primary care physician
Glide Path Process

Submit state PCMH application

Agree to Glide Path milestones/timeframes

Demonstrate progress toward NCQA PCMH recognition

Complete Gap Analysis (practice’s ability to substantiate compliance with
standards contained in NCQA PCMH application)

Complete Work Plan (contained in Glide Path Application)

Provide ongoing documentation in accordance with established Work
Plan
Practice Transformation Supports

The ASO’s Community Practice Transformation team, comprised of RNs,
APRNs, JD, MPH and other professionals, are dedicated to support
PCMH/Glide Path practices.

The team is specially trained to assist Primary Care Practices to make
meaningful changes designed to improve patient outcomes.
o Review the practice’s NCQA work plan to assess implementation
timelines
o Conduct gap analysis of the practice’s work plan
o Monitor, track and assess progress of work plan to ensure practices are
accomplishing PCMH/ Glide Path tasks
o Provide resources and tools for NCQA recognition
o Provide access to patient utilization data
o Evaluate practice performance
How to Start
•
Form PCMH Core Teams with a clinical lead, administrative personnel,
ancillary staff (3-4 people)
•
NCQA: (888) 275-7586, Monday through Friday from 8:30 a.m. to 5 p.m.
•
http://www.ncqa.org/tabid/631/Default.aspx
•
Download NCQA 2011 Standards
•
Training Calendar – participate in workshops, Web Ex
•
On-Boarding Guide Multi-Site/Single Site
•
NCQA Recognition Process, brochure, scoring
NCQA

NCQA – Get free online application account

“Free” one for all sites

Submit Multi-Site Eligibility

NCQA will schedule a personal conference call.

They will walk you through Multi-Site Process.

Focus on 6 NCQA Must Pass Elements

NCQA Standard 1G – correlates with 1D of Glide Path
NCQA
(continued)

Develop Care Teams (MD, APRN, PA, DO, nurse, care coordinator, MA,
receptionist)

Need Physician champion

Identify populations you will be managing – Need to have three months
worth of data

Policies and procedures, job descriptions need to be in place at least
three months prior to NCQA submission
CT DSS PCMH/Glide Path

Develop your work plan

When do you plan to submit to NCQA?

Submit PCMH/Glide Path Accordingly

Start to develop job descriptions, policies

Educate staff on PCMH, keep a log of education activities

Determine populations you will manage/track
Resources

www.ncqa.org


www.huskyhealth.com
 “For Provider” tab
 “Pathways to PCMH”
 2 Introductory Webinars on PCMH
www.chnct.org

www.cms.gov

www.pcpcc.org

www.ahrq.gov
DSS PCMH Program
Questions?