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3 Major Areas to Focus on After Receiving NCQA PCMH Recognition

3 Major Areas to Focus on After Receiving NCQA PCMH Recognition

First off, congratulations to you and your practice for achieving National Committee for Quality Assurance Patient-Centered Medical Home recognition! Gaining NCQA PCMH status is a big accomplishment for which you should be very proud. Now that you’ve completed the necessary steps to implement changes and earn recognition, you may be wondering what’s next.

In this guide, we’ll navigate what to do next, PCMH standards and guidelines to follow and 2024 annual reporting requirements to focus on. Let’s get into it!

What to do after earning NCQA PCMH recognition

Before you’re ready to start earning the great benefits of PCMH recognition, you need to plan what actions you’ll take to maintain your status. Remember, PCMH is not a project, but a continual progression of the way care is delivered to patients, meeting them where they are.

So, if you’re a practice that wishes to keep its PCMH, you’ll need to be accountable for each criterion you achieved when initially receiving PCMH recognition. Some key things to take into account include:

  • When NCQA publishes updates to the core criteria of the PCMH standards and guidelines, practices must adopt the latest changes and additions to their workflows and documentation.
  • NCQA randomly audits 5% of all recognized practices. NCQA could ask for documentation from any core criteria of the PCMH standards and guidelines.
  • NCQA annually mandates that all sites wanting to sustain their PCMH recognition must submit their annual report to NCQA through Q-PASS. The reporting requirements change from year to year, but they always stem from the PCMH standards and guidelines. Along with providing the requested evidence, practices attest each year that the integrity of their entire medical home is intact.

That’s a broad overview. Let’s dive further into the topic by exploring new PCMH criteria you’ll need to look out for.

3 Updates to the PCMH standards and guidelines to follow

On July 1, the updated PCMH standards and guidelines were released. These pertinent changes need to be implemented beginning Jan. 1, 2024. The most important updated standards and guidelines to note are:

  1. Practices must gather diversity identifiers from their patient population. This includes race, ethnicity, gender identity, sexual orientation and another pertinent measure of diversity. A practice has the liberty to pick another measure based on their vulnerable population. Some examples are zip code breakdown, insurance breakdown, transportation issues, disability status, education level and employment status. Although patients may decline to specify, the practice must attempt to collect this information. Gender identity and sexual orientation is not required for patients under 18.

  2. Thorough and current care planning must be evident for 75% or more of the patient panel identified for care management. Additional elective criteria have been added regarding a person-centered outcome approach using SMART goals.

  3. Quality reporting data must stem from standardized measures using the entire previous year as a date range. Available clinical quality, cost/utilization and coordination measures are outlined in the PCMH Standards and Guidelines appendix. Exception processes are also discussed for practices that can’t demonstrate certain measures; e.g., pediatric practices that don’t have standardized measures in the area of chronic/acute clinical quality measures.

Let’s get into the last piece, which is 2024 annual reporting.

PCMH 2024 annual reporting

Your reporting date will be here before you know it, so it’s best to always stay on top of your PCMH foundations. You’ll need to attest that the entire PCMH was sustained and demonstrate the following:

  1. medical home orientation process and materials;
  2. diversity and language reporting;
  3. evidence-based decision-supporting workflow;
  4. same-day frozen time slots;
  5. care plan monitoring with examples;
  6. lab and imaging order reporting; and
  7. quality reporting using standardized measures and previous year data.

Have PCMH recognition questions: DataGen can help

PCMH recognition is something you’ve worked hard to earn. DataGen is here to help you earn and maintain your status. We encourage you to contact us for assistance and guidance with interpreting the latest standards and guidelines, implementing these workflows within your practice using customized tools and templates, understanding the benefits and return on investment of PCMH recognition submitting your PCMH annual reporting and more. See how we can help and request a free demo today!


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