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Are you aware of the most recent Patient-Centered Medical Home updates?

The National Committee for Quality Assurance (NCQA) releases updates annually to the Patient-Centered Medical Home (PCMH) Standards and Guidelines. Any primary care practice, whether first transforming to achieve PCMH recognition, or a practice seeking to maintain recognition, must implement and demonstrate the core criteria of the PCMH standards and guidelines.

NCQA has added numerous elective criteria for practices to pursue to ensure they have an adequate amount of credits to achieve recognition between the mandatory core and elective criteria available. Practices should visit the NCQA website for the latest version (v8) of the standards and guidelines, released on July 1, 2022.

Health equity

An update made this year is to best align with the Health Equity Accreditation/Plus program offered by NCQA. Also, in response to lessons learned from the COVID-19 pandemic, PCMHs should be positioned to understand what vulnerabilities and social determinants may impact their patients' overall wellbeing.  Practices are being asked as a core criterion to collect from all patients:

  • race,
  • ethnicity,  
  • sexual orientation and gender identity, and
  • an additional measure of diversity, applicable to the panels they serve.

National benchmarks

Another key change to consider is for NCQA to provide national benchmarks to practices that report on clinical quality measures. Having standardized measures and reporting periods would assist in promoting this mission. Practices are being granted the ability to continue using customized measures and reporting periods for 2023, allowing more time to ready their quality reporting programs to rely on strictly standardized measures/eCQMs with set date ranges of the previous year. This will be made mandatory for practices seeking recognition in 2024.

Annual reporting requirements

Along with changes to the PCMH Standards and Guidelines, NCQA has also released their annual reporting requirements for 2023. Each year, sites are held accountable for sustaining their PCMH by demonstrating specific pieces of documentation, evidence, or reports from the program. The requirements change each year, so it is extremely important to keep all foundational processes and documentation of the medical home integrated into all daily practice operations.

Besides reporting annually, audits do randomly occur to 5% of all PCMH recognized practices. Practices should visit the NCQA website of to download the latest version PCMH Annual Reporting Requirements which were released on July 1, 2022.

New requests of the Annual Reporting Requirements for 2023 (but not foreign to the medical home) are a focus on access provided to patients outside of regular business hours, demonstrated in report format. Also, practices reporting in 2023 will be asked to show their panel breakdown by race, ethnicity, and third measure of diversity. Optionally, NCQA asks sites to show gender identity and sexual orientation, which align with the changes to the PCMH Standards and Guidelines that all sites should execute.

DataGen’s Practice Advancement Strategies has been working with practices nationally for more than 10 years. We pride ourselves on being a trusted advisor, ensuring you achieve NCQA recognition or accreditation. If you are seeking PCMH recognition, or want to maintain your PCMH recognition, please contact Mandi Diamond today at (631) 626-1062.


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