Overview of Patient-Centered
Medical Home
Eileen Goode, RN BSN
Clinical Programs Director
1
HRSA Expectations

Quality as Recognized by:
– Accreditation


–
Patient-Centered Medical Home Recognition



2
The Joint Commission (TJC)
Accreditation Association for Ambulatory Health Care
(AAAHC)
National Committee for Quality Assurance (NCQA)
TJC – only available with full accreditation
AAAHC - only available with full accreditation
CHCs and Patient Centered Medical/
Health Home Initiative
PAL 2011-01: “HRSA encourages and supports health
centers as they strive to continuously improve quality and tailor
their care to the needs of the patients and communities that
they serve. The PCMHH Initiative will allow health centers to
demonstrate their leadership as providers of high-quality care”.
Health Centers are encouraged to undertake &
document practice changes that enable recognition
from NCQA PCMH program
3
PAL 2011-01



Fee for NCQA PCMH recognition is waived
Recognition as PCMH is distinct from
accreditation & distinct from TJC Primary
Care Home Initiative
At least six months of planning is
recommended
–
4
Includes self-assessment to compare HC processes and
practices with the standards
Core Components of PCMH
1)
2)
3)
4)
5)
6)
5
Enhance access and continuity;
Identify and manage patient populations;
Plan and manage care;
Provide self-care and community support;
Track and coordinate care; and
Measure and improve performance.
NCQA Specifics:






6
Recognition is by site – not by Health Center
organization
Multi-site applications are an option but eligibility
must be determined
Five percent of applications are audited
Recognition is granted by NCQA for a period of three
(3) years
Health Centers maintain recognition through the
renewal survey process
May increase recognition level through Add-On
Process
Clinical Performance Measurements


Three preventive care measures
Three chronic or acute care measures
–


7
One condition must be related to unhealthy
behavior, mental health or substance abuse (e.g.
obesity, depression, smoking, alcoholism)
Two utilization measures
Vulnerable Population Data (AHRQ
definition) – includes those at high risk for
frequent hospitalizations or ED visits
The Joint Commission (TJC)



Primary Care Home Initiative - scheduled to
launch July 2011
AHRQ Definition of Medical Home
Focus
–
–
–
–
8
Access
Coordinated Care
Patient Centered Care
Quality & Safety
Bureau Expectation Reminder
NCQA Patient Centered
Medical Home Recognition
OR
Accreditation through
The Joint Commission or AAAHC
(w/ or w/o Medical Home designation)
9
REALITY





10
Both accreditation & NCQA recognition symbolize
organization-wide quality
NCQA is most recognized by payer & may be
required by Medicaid in some states
Some FQHCs will seek both accreditation & NCQA
recognition – BPHC will pay for both
Meaningful Use probably needs to come first
Accountable Care Organizations are on the horizon
Key to Success: Engaged Leadership


11
PCMH transformation requires the visible
and sustained engagement and tangible
support of a wide range of leaders within the
practice.
To drive and sustain PCMH transformation,
leaders must provide the vision for change,
help identify changes to test, and build and
sustain the will within the practice for
transformation.
Where to Start?



12
Ask your CEO/Executive Director what your
Health Center is doing about PCMH
Utilize the NM Primary Care Association in
providing training & technical support
Learn what New Mexico Medicaid & other
payers are doing
Where to start?



13
Be sure your Health Center completed the
Baseline NCQA Self-assessment Tool (free
from the Primary Care Development
Corporation)
http://pcdcny.org/index.cfm?organization_id=
128&section_id=2047&page_id=9512
Review the Self-assessment results
Get involved!