PCMH Updates

PCMH 2017 Program new Redesign - What You Need to Know

On March 31, 2017, NCQA will launch the Redesigned PCMH 2017 Program. PCMH 2017 is slated to simplify the documentation and reporting requirements and includes ongoing support from a designated NCQA representative. The new program offers a single recognition level with annual check-ins with your NCQA representative to evaluate and build on progress to meet the new NCQA PCMH 2017 objectives. All practices will eventually move from the traditional three-year recognition as a level 1, 2 or 3 PCMH.

The PCMH 2017 program will align with MACRA’s Quality Payment Program. As health care shifts to a value-based payment system, practices which are PCMH or PSRP recognized will have some advantages. Under the MACRA legislation there are two new payment tracks for practices:

Merit-Based Incentive Payment System (MIPS): The MIPS track includes a category called Clinical Practice Improvement Activities (CPIA) that is worth up to 40 points and contributes 15% of each provider’s MIPS final score. Providers in practices that earn NCQA PCMH recognition (either 2014 or 2017) would automatically get full credit for the CPIA category.

Alternative Payment Models (APM): Criteria for participating in eligible advanced APM programs, such as Comprehensive Primary Care Plus (CPC+) or certain Medicare ACOs (such as Next Gen), include being a PCMH.

PCMH 2017 Redesigned Recognition Process

The redesigned program will retain the principles of the PCMH model of care. The redesigned program’s recognition process will have three parts:

Commit: During this step the practice will complete a self-assessment and work with their designated representative to develop a plan.

Transform: During this time, practices show their progress by submitting documentation and data to NCQA through a new system designed to reduce paperwork and administrative hassles. Along the way, NCQA conducts virtual reviews—online check-ins—with the practice to gauge progress and to discuss next steps in the evaluation.

Succeed: Once the practice has earned recognition, it will continue to implement and enhance their PCMH model. There will be an annual check-in with their designated representative to attest to certain policies and procedures and submit their quality data.

Where to start

It is very important to begin your PCMH Renewal 9-12 months before the expiration of your current PCMH recognition. New Applicants should start 12 or more months before they intend to submit as this will allow time to educate your staff, implement new workflows and create or update required policies/procedures.

Practices looking to move to the PCMH 2017 program from the PCMH 2011 or PCMH 2014 program have a couple of options. Practices that want to stay with or become certified under the 2014 recognition levels should keep in mind that March 31, 2017 is the deadline to purchase PCMH 2014 survey licenses with a submission deadline of September 30, 2017.

Practices Currently Recognized Under PCMH 2011

·       Renew under the 2017 redesigned process

·       Convert to PCMH 2014

o   Conversion is an option for practices with significant time left on their recognition (at least 12 months when the conversion Survey Tool is submitted) and requires submission for 6 Elements instead of 27.

·       Renew under PCMH 2014 standards

o   Renew is for practices with an expiring recognition who are renewing for another three-year recognition period. 

For more information click here

Practices Currently Recognized Under PCMH 2014 Standards:

·       If you are a Level 3 2014 recognized practice, NCQA is offering a direct entrance into the “Sustain” process of the PCMH 2017 program when your recognition expires.

·       If you are a Level 1 or 2 2014 recognized practice you have three options:

·       Complete an Add-On Survey to earn PCMH 2014 Level 3 Recognition

·       “Transform” through the redesigned program.

·       Renew under PCMH 2014 for the established three-year period

For more information click here