January 16, 2016

Helping Practices Become Patient-Centered Medical Homes

Among New York communities, Hempstead, on Long Island, has a relatively high poverty rate, 38 percent higher than the average for the state. As is often the case, this has led to a large population of people and families who are utilizing state-based assistance plans such as Medicaid to cover their medical expenses. For practices like 609 Fulton Pediatrics, Medicaid reimbursement is a significant source of their income, making Medicaid incentive programs critical to their ability to treat patients.

The practice’s five physicians treat a huge patient population of more than 7,500 children, the majority of whom are covered under Medicaid. As a patient-centered medical home (PCMH) their Medicaid reimbursement relies heavily on recognition by the National Committee for Quality Assurance (NCQA). With the help of PCDC’s PCMH Team, the practice successfully completed the submission process for NCQA’s most current recognition program, PCMH 2014, qualifying them for better incentives from Medicaid as well as some commercial insurers.

“The process was extensive, but PCDC’s team was very helpful throughout,” noted 609 Fulton office manager Priya Shah, who oversaw the PCMH recognition process. “They showed us that much of what we needed to do could be accomplished through the electronic medical record system.”

609 Fulton Pediatrics is part of a larger trend occurring across the country, as more practices recognize the value of PCMH in reducing healthcare costs and improving quality of care. Today there are more than 160 PCMH incentive programs (up from 29 in 2009) covering 48 states, Puerto Rico and Washington, D.C.

While challenging, Shah said the effort was worth it. “Our practice runs much better now. For the first time, we have contracts with providers where we refer patients, and we are better able to coordinate care. The additional reimbursement we expect from Medicaid and other insurers will enable us to maintain this higher level of care for our patients.”