Today’s Environment

American hospitals, hoping to create more value for patients, are steadily implementing new models of patient-centered, coordinated care management processes like the primary care medical home, also known as the patient-centered medical home (PCMH).  The payoffs for achieving PCMH certification can be significant: medical practices can receive incentives of up to several hundred dollars per patient, per year.

The challenges can also be significant. Some of the issues that practices face are organizational ones: physicians who are slow to change, use different approaches, and get varied results. Your practice may want to take advantage of the new programs, but you may need guidance on achieving certification at the primary care office level.

Certification is an extension of the Physician Practice Connections (PPC), which is part of the National Committee of Quality Assurance (NCQA) program. NCQA PPC-PCMH Recognition is valid for three years and is subject to random on-site audits.

To achieve certification, your practice will need to meet standards across nine separate categories:

  • Access and communications
  • Patient tracking and registry functions
  • Care management
  • Patient self-management and support
  • Electronic prescribing
  • Test tracking
  • Referral tracking
  • Performance reporting and improvement
  • Advanced electronic communications copy

Your practice can apply for one of three levels of recognition, based on your capabilities. You can raise your recognition level by completing additional work toward meeting all 10 NCQA standards.

Point B’s Perspective

To help you move through the process, we recommend enlisting a partner who understands the regulatory space and can, in addition, provide a cost-savings approach to managing the practice. We’ve had success with the lean approach, which has been employed across dozens of industries, and generally results in these benefits:

  • Faster time to resolution
  • Correct solutions the first time
  • Greater visibility into the status of service requests
  • More predictable and stable processes
  • Clear process performance indicators

We recommend starting the process by assessing the current state of your practice, identifying any gaps in performance, implementing an improvement plan, applying for PPC-PMCH recognition, and then monitoring the success of your practice. Let’s go through those steps one by one.

Current assessment.

The first step is to assess how close you are to achieving PCMH certification. Start by analyzing your current primary care practice and creating a process map of how you currently manage patient flow.

Empower your partner to carry out detailed interviews with your healthcare workers to aid in developing a comprehensive assessment of your current practice. A candid evaluation of your current processes can help determine which activities are central to improved patient and enhanced capabilities for PPC-PCMH.

Identification of gaps.

Next, identify gaps based on the analysis of the current state against the desired performance outcomes. Be candid in comparing your current state with the desired performance levels in PPC-PCMH: What needs to be improved before you can proceed to certification? Your own local experts can help determine this, and should work with your partner to form recommendations for improvement.

Implementation of improvements.

Create a detailed project planning roadmap that identifies how and when each gap will be closed. Don’t shy away from accountability—assign owners who are responsible for meeting specific deadlines for improvements.

As you develop the roadmap, identify any risks that come with making changes to your practice, however small. Particularly when managing document migration, little changes can have big impacts—so be sure to have your subject matter experts in the room as you and your partner discuss risk.

Implementation plans should vary depending on the changes required to achieve your target level of recognition for PPC-PCMH.

Completion of the PPC-PCMH application.

When all implementation plans are completed, work with your local team to submit the updated PPC-PCMH application for certification. 

Achieving a recognition level is a significant accomplishment for your practice, and demonstrates superior utilization of systems and processes that have proven beneficial to patient care. You can further extend this concept into additional revenue opportunities through efficient processing of patients and streamlined processes.

Ongoing monitoring and support services.

After achieving certification, you may want to continue monitoring your program to make sure you’re getting the most out of the lean approach.

By regularly following up on the health of the improvements you’ve made, you can evaluate performance and identify further opportunities for improvement. This is an excellent way to continually improve your practice and achieve higher levels of recognition and financial rewards.

Rewards of PPC-PCMH recognition.

Thousands of physicians have completed and received the recognition of PPC-PCMH, reaping financial incentives provided by various health plans, employers, federal programs and state-sponsored programs.

Practices that earn NCQA PPC-PCMH can qualify for additional bonuses or payments, as well. Some of these programs offer financial rewards that can range from $50 to several hundred dollars per patient per year.

The Bottom Line

There are significant benefits in achieving PPC-PCMH that will provide financial rewards for years to come. The process of achieving certification is in direct alignment with the mission of providing improved patient care on a consistent basis. 

The challenge, of course, is having the time available to actually evaluate the practice and determine all the appropriate changes required to meet certification.  

Point B can solve this challenge by providing a well-trained expert who can guide you through the process of certification readiness and achieve an official certification. The money is there—let us help you get it.