*A newer piece is available on NCQA PCMH 2025 annual reporting standards and guidelines.
The National Committee for Quality Assurance (NCQA) consistently strives to enhance the quality of healthcare and improve patient outcomes. With the changing Patient-Centered Medical Home (PCMH) 2025 annual reporting requirements, it’s essential for healthcare professionals, providers and administrators to stay updated on the latest developments to enhance quality care and patient outcomes.
Here, DataGen’s Mandi Diamond, senior practice transformation advisor, covers the three biggest changes you need to know about for next year's annual PCMH reporting related to quality improvement worksheets, the importance of diverse patient examples in care management plans and enhanced communication protocols.
Let’s dive into the most important PCMH reporting requirement changes.
1. Re-introduction of the mini quality improvement worksheet
One significant update is the re-introduction of the mini quality improvement (QI) worksheet, which was used a few years back. This updated worksheet requires organizations to do more than just share data on clinical quality and patient experience measures; it also emphasizes the need to provide specific goals and actionable steps.
Why it matters
This new requirement fosters a culture of accountability, encouraging healthcare practices to own their performance measures. Diamond explains how consistent QI meetings and minutes can better position her clients to use the worksheet since they’re accustomed to elaborating on these results:
“I have been taking advantage of the ‘notes for your evaluator’ section of the Q-PASS evaluation tool with clients prior to the reintroduction of this worksheet. For instance, if any QI measure is lower than 80%, I had them detail what occurred during the measurement period and what they plan to pursue to improve when they measure in the future,” says Diamond. “By doing so, it helped keep the sites honest in their reporting and delivered greater focus on improvement. It was not a 'check the box' activity, it was a deep dive into data analysis and team collaboration to generate actionable interventions.”
2. Diverse examples in care management
Another important PCMH update pertains to care management. When demonstrating care plans, healthcare providers must ensure that their examples encompass a diverse range of patients. Specifically, providers are required to demonstrate care plans for at least three different conditions identified in their care management panel.
Understanding the categories
NCQA clusters care management patients into five distinct categories and it’s crucial for providers to showcase patients from various groups. Failing to demonstrate diversity in patient examples may hinder the evaluation process, as NCQA seeks a comprehensive understanding of how practices cater to their patient population.
3. Enhanced communication requirements
Effective communication is vital for reducing hospital admissions and ensuring quality care. One new requirement highlights the importance of documenting clinical advice both during and after hours. Additionally, healthcare professionals are expected to document follow-up phone calls, particularly for patients released from emergency rooms or outpatient settings.
Importance of documentation
By meticulously recording these communications, healthcare providers can reduce the chance of readmissions and improve the likelihood of patients relying on their primary care physician before utilizing more expensive services, such as urgent care and the emergency department. This practice not only helps maintain compliance with NCQA standards but also promotes better patient-centered follow-through.
Additional NCQA insights to consider
Attestation and evidence
NCQA allows attestations in some areas. However, it can request concrete evidence to support claims made by healthcare practices at any time.
Diamond explains, “It’s advisable to ensure you can demonstrate your compliance rather than rely solely on attestations. Being proactive in showing adherence to standards is crucial to avoiding complications down the line—because you never know when NCQA selects you for an audit.”
Focus on population diversity
Each year, NCQA emphasizes the need for practices to demonstrate population diversity within their patient base. Healthcare providers must ensure compliance with the Office of Management and Budget (OMB) guidelines, showcasing enough diversity across all healthcare categories.
A diverse patient population allows for a more comprehensive understanding of healthcare needs and disparities. By reflecting on this diversity, practices can tailor their services to better meet the needs of their communities, ultimately advancing equitable care.
Next step: How to begin implementing NCQA’s changes
NCQA’s recent changes emphasize accountability in quality reporting, the importance of diverse patient examples in care management, effective communication and a focus on population diversity. By adapting to these changes, healthcare organizations can improve their practices and align with NCQA’s mission to advance healthcare quality.
For further assistance and guidance on navigating these updates, investigate DataGen’s Medical Practice Consulting solution. Our experts, like Mandi Diamond, can provide you with tailored support to ensure your practice meets NCQA standards effectively. Contact us today to start taking the guesswork out of practice transformation.
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