For practices recognized under the National Committee for Quality Assurance’s (NCQA) Patient-Centered Medical Home (PCMH) model, understanding and meeting the NCQA PCMH 2025 annual reporting requirements is critical to sustaining recognition.  NCQA continues to refine its NCQA PCMH standards and guidelines , emphasizing team structure, care continuity and data integrity. Here’s what your practice needs to do to stay compliant and ensure a smooth reporting process. This blog is a continuation of our piece back in July 2024, which listed three updates to NCQA PCMH's 2025 annual reporting requirements . What is NCQA PCMH?  The NCQA Patient-Centered Medical Home (PCMH) is a model of care that emphasizes care coordination, patient engagement and continuous quality improvement. The PCMH framework is designed to improve healthcare outcomes by fostering strong patient-provider relationships and enhancing team-based care.  Since its inception, the NCQA PCMH program has evolved to...

In April, we wrote about the updated New York state Section 1115 Medicaid Redesign Team (MRT) Waiver and how it was a game changer for New York state primary care practices.   Almost a year later, we have updates to share so you can drive meaningful change for your practice — while solving some of the biggest pain points in primary care. Keep reading for key summaries or to check out our complete New York 1115 Medicaid Waiver white paper that includes:    an essential summary of the 1115 Medicaid Waiver;  enhanced payment overview;  anticipated challenges and how to navigate them;  next steps for practices with or without NCQA Patient-Centered Medical Home (PCMH) status; and  how DataGen can help you achieve and retain NCQA PCMH status.  [Access it here] New York 1115 Medicaid Wavier updated summary  Primary care practices in New York state have an unprecedented opportunity to boost their revenue, improve care quality and strength...

Preparing for a Patient-Centered Medical Home (PCMH) audit can seem daunting, but with the right approach, it doesn't have to be. This guide aims to demystify the process and offer practical advice for healthcare administrators, PCMH participants and medical practices. Focusing on DataGen's Medical Practice Consulting services , we'll show you how to streamline annual reporting to ensure core criteria are consistently met in your workflow, so you can focus on coordinated care management and quality improvement within your care team or healthcare system.  Understanding the PCMH audit  PCMH annual reporting is essential for maintaining the integrity, effectiveness and recognition for the National Committee for Quality Assurance’s (NCQA) PCMH model . Each year, practices submit requirements to renew their recognition, showcasing a small portion of documentation across six concept areas. However, a PCMH audit requires a more comprehensive review. About 5% of annual reporters ar...

In today’s rapidly evolving healthcare landscape, quality assessment and performance improvement (QAPI) are crucial. These practices are essential for healthcare organizations that aim to enhance patient care while meeting regulatory and payer expectations.   That’s why we sat down with Mandi Diamond, senior practice transformation advisor at DataGen, to discuss the nuances. Read on for essential information on QAPI and how to measure your quality data.  What is quality assessment and performance improvement?  Defining quality assessment  The National Institutes of Health (NIH)  defines quality assessment (QA) as "the measurement of the technical and interpersonal aspects of health care and the outcomes of that care."   Diamond expands upon that definition, describing QA as the systematic evaluation of outcomes within an organization to measure the success of essential workflows.  Both definitions touch on the use of repeatable and systematic...

*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 th...

Health equity isn’t a one-size approach  The COVID-19 pandemic highlighted the crucial connection between Social Determinants of Health (SDOH) and patient outcomes. Addressing medical and behavioral health needs requires a comprehensive understanding of a patient’s social context.   Effective interventions and care plans must meet patients "where they are," and one-size-fits-all approaches fail to address diverse vulnerabilities and needs.  For healthcare organizations looking to begin or enhance their equity initiatives, the National Committee for Quality Assurance's (NCQA's) Health Equity Accreditation (HEA) is an excellent starting point. HEA is a comprehensive framework that aligns with many other recognized programs, such as those from the Joint Commission and CMS, providing a holistic approach to advancing health equity. It aims to improve the quality of care and patient experience within the United States.  3 Reasons why NCQA HEA is the perfect starting ...

The National Committee for Quality Assurance defines a patient-centered medical home (PCMH) as “a model of care that puts patients at the forefront.” The PCMH highlights the importance of care coordination and provides pathways to ensure that the medical neighborhood is tangible to the patients served.   The tenants of the medical home ask care teams to treat patients for their medical, behavioral and address their social and economic needs to achieve desired outcomes. As one of the 6 concept areas of the PCMH, it is imperative to implement policies, workflows and partnerships that will promote relationships outside of the primary care setting.   Medical homes are not just care settings but care connectors. Read on to learn:  how to sustain the medical home through effective care coordination;  why practices shouldn’t exclude community-based organizations; and  the key technical components for an effective, sustainable PCMH care coordination model.  Su...

On Jan. 9, the Biden administration and CMS approved New York state's $7.5 billion Medicaid Section 1115 demonstration amendment. This New York Health Equity Reform amendment includes nearly $6 billion in federal funding, effective until March 31, 2027.   Using these funds, "NYS seeks to build on the investments, achievements, and lessons learned from the Delivery System Reform Incentive Payment (DSRIP) 1115 waiver program to scale delivery system transformation, improve population health and quality, deepen integration across the delivery system, and advance health-related social need (HRSN) services," according to the New York State Department of Health .  Under CMS’ 1115 waiver, participating New York state primary care practices with Patient-Centered Medical Home recognition from the National Committee for Quality Assurance are eligible to receive increased Medicaid Incentive Payment.   Specifically, under Population Health, one of the three main NYHER progr...