5 drivers to earn — and maintain — PCMH recognition

The National Committee for Quality Assurance’s Patient-Centered Medical Home model advances high-quality, cost-effective care, but practices must be vigilant to earn and maintain their PCMH Recognition. Staff members, technology tools and workflows can change, and practices need to adopt criteria from new standards and guidelines.

Mandi Diamond, PCMH CCE, senior advisor of Practice Advancement Strategies at DataGen, offers five key capabilities to support PCMH Recognition.

1. Build a true team culture.
Does everyone in the practice understand what they do and why? Is that understanding clear, and is it reinforced? Practice leadership may assume yes when the answer is often no. Diamond terms this “doing things TO a team versus WITH a team.” To avoid this:

• Share knowledge. A lone individual cannot be the sole source of expertise, and single points of failure create crises in teams.
• Disrupt silos. Ongoing communication delivered in multiple formats that bridge clinical and clerical teams is an effective strategy.
• Define practice roles. This helps practices overcome barriers, navigate pushback, and build clarity and comfort among team members.
• Document! Everything from the practice plan, mission and aim statements to its policies, procedures and workflow should be detailed and reflect team culture.

2. Get organized.
NCQA PCMH Recognition includes six concept areas: team-based care and practice organization, knowing and managing your patients, care coordination and care transitions, care management and support, patient-centered access and continuity, and performance measurement and quality improvement.

Each requires policies, reports and workflows. As Diamond tells practices, “If it’s not documented, it’s not done.” Creating a PCMH playbook for the core criteria reveals gaps between what works and what doesn't and defines ownership, frequency and direction.

3. Assess where you are.
“Thriving PCMH practices know where they stand, and that evaluation is not a one-and-done activity.” During her hands-on consultations, Diamond has observed three activities that many practices fail to maintain:

• collect patient intake data consistently (e.g., race, ethnicity);
• follow up on outstanding orders (e.g., labs, imaging, referrals); and
• update care plans to reflect changing patient needs (e.g., risk levels, social drivers of health, co-occurring and high-cost conditions).

Diamond advises practices to maintain internal report cards as part of their PCMH efforts. “Report cards and audits are effective gauges of learning and progress to assess what has changed and what needs to be retooled or discarded.”

4. Leverage all associated opportunities.
Diamond notes that practices “must be an ambassador of their own achievement” and with all entities that reward PCMH recognition. For example, New York Medicaid offers a per-member, per-month reimbursement bonus for PCMH recognition. PCMH positions a practice to bear financial risk and negotiate larger incentives in their health plan contracts.

5. Monitor to evaluate and celebrate progress.
Practices that set achievable goals are more likely to meet them. There are two kinds of goals: fixed (those based on NCQA policies and requirements) and fluid (those that evolve based on patient population needs). Broadcast success to motivate and reinforce wins ─ it’s a team sport!

Two bonus PCMH drivers

Each PCMH driver reflects two overarching needs: documentation and communication.

Documentation should include what the practice wants to achieve, how it plans to do so, program results and evaluation, needed changes and next steps. “Don’t just tell your story, prove your story,” stresses Diamond.

Effective communication occurs when practices dissolve silos, retain and cross-train staff, and learn what they don't know — from updated NCQA PCMH standards and guidelines and annual reporting requirements to untapped electronic health record functionality that can help streamline practice management.

DataGen helps practices develop an effective plan and clearly articulate goals to achieve and sustain PCMH recognition. Contact us today to tap into our practice advancement strategies.