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...

A common misconception in healthcare practices: Organizations can quickly reap the benefits of value-based payment transformation. To launch a successful value-based payment program , practices must implement a variety of foundational pieces. It may take time, resources and data before a practice can successfully engage in VBP. In this blog, we'll cover what goes into VBP and its potential benefits. We'll also dig deeper into practice advancement strategies and how they can help you achieve your practice goals. What goes into VBP? Many practices want to implement VBP because of its payment structure and return on investment. Yet, they might not consider how to nurture a successful VBP program in their organization. It starts with a gap analysis regarding people, processes and technologies. It’s important to celebrate what is working well and intervene where improvement can be made. Successful VBP starts with the practice team. There are many perceptions vs. realities that exist...

Multiple organizations have prioritized provider health equity requirements — from new CMS priorities in their Framework for Health Equity to accreditation standards from The Joint Commission. NCQA’s Health Equity Accreditation is one of its newest programs . Introduced in 2021, HEA expands accreditation from payers to multiple stakeholders including medical practices and health systems. A second NCQA accreditation, Health Equity Accreditation Plus, takes practices further into the social drivers of health and community partnerships. With so many existing demands, it’s natural for a medical practice to ask: Why should we pursue HEA or HEA+, and what are the benefits for our patients and practice? In this blog, we’ll cover three ways NCQA accreditation helps medical practices improve health equity and achieve full practice transformation under this new model of care. How NCQA Health Equity Accreditation can reduce health disparities 1. Increase patient awareness NCQA’s HEA standards hel...

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. ...

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 team...

Everybody knows: Conferences aren’t just about what you learn but who you meet. Anyone attending the annual National Association of ACOs conference this week in Baltimore should take full advantage of the experts in attendance. This will include executives from leading accountable care organizations, private payers and CMS. NAACOS 2023 will zero in on what you need to know now and who best to learn it from. That includes the industry partners who have helped build incentive-generating infrastructure for the past decade’s most successful ACOs. Analytics first, last and everywhere If there’s any question as to what ACOs need to succeed with alternative payment models, simply look at the topic of NAACOS’ opening session: advanced analytics. There isn’t a single aspect of value-based care that doesn’t happen without analytics: better prevention and primary care; enhanced care coordination; managing risk; benchmarking; and a stronger bottom line. NAACOS sessions will detail these topics wi...

To build a better medical practice, you must transform and then sustain the change. Through customized engagements and best practice experience, Practice Advancement Strategies guides clinical teams through the following challenges and opportunities: staff shortages/burnout; practice culture; payer negotiation and contracting; and value-based care outcomes These will be hot topics at the next Medical Group Management Association event: the Medical Practice Excellence: Financial and Operations Conference , just around the corner in Orlando, March 19-21. To help you prepare — for the conference or progress in general — DataGen Practice Advancement Strategies offers the following insider tips for practice advancement. 1.   Transformed teams can transform patient care. Research shows that earning Patient-Centered Medical Home Recognition from the National Committee for Quality Assurance can reduce staff burnout by more than 20%. While workforce shortages clearly impact burnout, c...