MANAGED CARE Q&A
The Patient-Centered Medical Home of the Future
FRMC: Can you describe some of the benefits offered by the Patient-Centered Medical Home (PCMH) and the Patient-Centered Specialty Practice (PCSP) Recognition programs to payers, providers, and patients?
The original intent of the PCMH model—as described in the Joint Principles of the PCMH (American Academy of Family Physicians; 2007)—was to describe and advocate for a way of practicing primary care that returned the focus to delivering care in a highly organized, safe, timely, efficient, effective, equitable, and patient-centered manner (ie, according to the Institute of Medicine’s six aims from Crossing the Quality Chasm: A New Health System for the 21st Century [National Academies Press; 2001]). The concept of the “medical neighborhood,” described in a position paper by the American College of Physicians (The Patient-Centered Medical Home Neighbor: The Interface of The Patient-Centered Medical Home With Specialty/Subspecialty Practices; 2010) led to the creation of the PCSP Recognition program by NCQA.
These two programs align very well and address the core elements of what leads to a high-performing practice. For medical specialists, the emphasis is less on longitudinal care and more on coordination and collaboration with referring practices—though clearly longitudinal relationships do exist within the specialty of oncology. In fact, in some cases, and especially in oncology, specialists do become the primary care physicians for their patients. Hopefully, this is a dynamic situation in that oncologists may return people to their primary care physicians once a person is cured or in remission.
It is clear that when practices transform and adhere to the PCMH model of care, the evidence suggests that quality improves, inappropriate and avoidable costs are reduced, clinicians experience less burnout, and people have a better experience. To make the transformation, practices need technical and financial support provided over a period of time sufficient to make the changes and anchor them in the culture of the organization.
Although we do not have comparable research on the PCSP Recognition programs, it is reasonable to expect that these same factors would contribute to success in specialty practices.
FRMC: In the recent redesign of the PCMH Recognition program, the biggest change seemed to be a shift from fully documented review every 3 years to virtual check-ins occurring annually. Why did NCQA feel this was a better format for PCMH?
The change from a 3-year cycle to initial recognition followed by annual check-ins was driven by several factors. We heard from key stakeholders that the performance of recognized practices sometimes regressed during the interval between renewal of their recognition status. Instituting the annual reporting requirement will help ensure that practices continue to pay attention to the key aspects of the PCMH model. More importantly, we believe that this new process will ultimately reduce the work involved in the recognition process because the requirements for sustaining recognition (ie, the annual reporting) will be significantly streamlined. We intend to provide choices for how practices can demonstrate aligned ongoing adherence to the program. The intent is to check on some fundamental aspects of the PCMH model that, if met, indicate that the practice is continuing to deliver patient-centered primary care. NCQA will also audit a minimum of 5% of practices’ submissions.
FRMC: What are some of the other key changes you’ve made to the program, and what shortcomings of the original design do you hope these changes address?
We believe the new process will address most—if not all—key concerns we heard during the focus groups that helped inform the redesign effort. For example, some of the issues we heard were that the previous effort:
• was too difficult for small practices;
• focused on process instead of performance;
• required too much documentation;
• provided too little contact with a real person at NCQA;
• allowed momentum to decline within the practice during the lengthy 3-year period before renewal;
• failed to inform practices of their submission’s status or need for revisions in a timely manner; and
• provided too little education and guidance.