As we all know, healthcare is constantly changing and we have to keep up with those changes on a daily basis. NeKY RHIO and the National Committee for Quality Assurance (NCQA) are dedicated to keeping up with those changes for you.
NCQA redesigned Patient-Centered Medical Home (PCMH) recognition to align with the continuing changes in healthcare. As payers look to reward value and quality instead of quantity, PCMH recognition is on top of their lists for clinicians to earn higher reimbursement. Because the PCMH model can help patients avoid costly complications, public and commercial payers are increasingly turning to the PCMH model of care.
In March, NCQA released the new PCMH recognition process. Below is an outline of how practices will commit, transform and succeed with the one-on-one support of NeKY RHIO, and how NCQA will be involved.
COMMIT
Practices with the one-on-one support of NeKY RHIO will:
- Complete a gap analysis on current clinical practices and resources.
- Work with an assigned NCQA representative to develop an evaluation schedule.
NCQA will:
- Provide information and resources to assist in the practice’s decision-making process to pursue transformation and NCQA recognition.
- Assign a representative to the practice as its primary point of contact at NCQA.
- Give the practice access to an online self-assessment.
- Work with the practice to develop an evaluation schedule.
TRANSFORM
Practices with the one-on-one support of NeKY RHIO will:
- Implement changes necessary to transform into a PCMH.
- Participate in 3 online, virtual check-in sessions with an NCQA evaluator to submit documentation, confirm progress and accumulate credits toward recognition.
- Earn NCQA PCMH Recognition after demonstrating transformation.
NCQA will:
- Monitor the practice’s transformation progress.
- Assign an evaluator to conduct the recognition review.
- Conduct three virtual check-ins to ascertain whether the practice is transforming and meeting PCMH recognition requirements.
- Review the practice’s final submission and forwards it to the NCQA Peer Review Committee for evaluation and confirmation of initial approval.
- Notify the practice of its recognition status.
SUCCEED
Practices with the one-on-one support of NeKY RHIO will:
- Sustain current PCMH activities and continue to evolve as a medical home and improve patient care.
- Perform an annual check-in with NCQA to verify continued success as a PCMH.
- Earn another year of recognition as an NCQA PCMH.
NCQA will:
- Conduct an annual check-in to confirm that the practice continues ongoing transformation activities.
- Note and document any practice changes at the annual review.
- Evaluate the practice’s submitted data and documentation that demonstrate continued transformation.
- Audit a random sample of practice submissions to verify that PCMH requirements and guidelines are being met over time.