Patient-Centered Medical Homes
The Patient-Centered Medical Home (PCMH) is a way of organizing primary care that emphasizes care coordination and communication to transform primary care into “what patients want it to be.” Medical homes can lead to higher quality and lower costs, and can improve patients’ and providers’ experience of care.
National Committee for Quality Assurance (NCQA) PCMH Recognition is the most widely-used way to transform primary care practices into medical homes. The journey to PCMH recognition is extremely comprehensive and requires dedication from all providers, management, and staff.
National Committee for Quality Assurance (NCQA) Structure of Concepts, Criteria, and Competencies
There are six concepts—the overarching themes of PCMH. To earn recognition, a practice must complete criteria in each concept area. If you are familiar with past iterations of NCQA PCMH Recognition, the concepts are equivalent to standards.
- Team-Based Care and Practice Organization: Helps structure a practice’s leadership, care team responsibilities and how the practice partners with patients, families and caregivers.
- Knowing and Managing Your Patients: Sets standards for data collection, medication reconciliation, evidence-based clinical decision support and other activities.
- Patient-Centered Access and Continuity: Guides practices to provide patients with convenient access to clinical advice and helps ensure continuity of care.
- Care Management and Support: Helps clinicians set up care management protocols to identify patients who need more closely-managed care.
- Care Coordination and Care Transitions: Ensures that primary and specialty care clinicians are effectively sharing information and managing patient referrals to minimize cost, confusion and inappropriate care.
- Performance Measurement and Quality Improvement: Improvement helps practices develop ways to measure performance, set goals and develop activities that will improve performance.
Underlying the six concepts are criteria: activities for which a practice must demonstrate satisfactory performance to obtain NCQA PCMH Recognition. Criteria are developed from evidence-based guidelines and best practices. A practice must pass all 40 core criteria and at least 25 credits of elective criteria across concept areas.
Competencies categorize the criteria. Competencies do not offer credit.