Patient-Centered Medical Home Recognition

PCDC supports primary care practices across the nation — including community health centers, hospital clinics, private practices, and specialty practices — to improve the quality of their care and sustainability of their practices. To date, PCDC’s experts have assisted more than 800 practices to achieve National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) recognition with a 100 percent success rate. Our team of experts supports practices in building capacity, transforming practice, and measuring and improving outcomes. We meet practices where they are to create individualized plans for achieving PCMH recognition, including one-to-one coaching, tools, resources, and support. PCDC works with the major PCMH accrediting bodies, including the National Committee for Quality Assurance (NCQA) and Accreditation Association for Ambulatory Health Care (AAAHC).

1,000+

facilities

supported in Patient-Centered Medical Home (PCMH) recognition

A patient-centered medical home (PCMH) recognition can help practices operationally by Improving patient access needs; cultivating a care coordination process for tracking labs, imaging, referrals and follow-ups from hospitals; and increased communication among staff and patients. Practices will also be able to better serve the needs of their own diverse patient population; be better equipped on identifying and managing high-risk patients; and refine data-driven results across clinical quality, resource stewardship, and patient experience measures.

Service Options Include:

Personalized, One-on-One PCDC Practice Facilitation for PCMH Initial Recognition.

Over 12 months PCDC’s Certified Content Experts will conduct:
  • Weekly or Biweekly coaching phone calls or video conferences to guide your practice through the PCMH transformation process from start to finish
  • Virtual needs assessment
  • Individualized work plans, and guided support to meet requirements of PCMH standards including a plan for NCQA’s Q-PASS PCMH virtual check-ins;
  • Access to a library of example documentation and policy templates
  • Documentation review and annotation
  • Final documents loaded on NCQA’s QPASS system.
  • Preparation for and/or participation in NYS PCMH live virtual check-ins.

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Personalized, One-on-One PCDC Practice Facilitation for NCQA PCMH Annual Review.

PCDC’s Certified Content Experts will conduct:
  • 1:1 Weekly or biweekly coaching virtual conferences with Certified Content Expert (CCE) at your practice’s pace, and access to PCDC Expert throughout the week.
  • Individualized work plans, and guided support to meet requirements of PCMH AR 2020 standards
  • Deep dive review of gaps in policies and practices since last PCMH submission, and facilitated improvement to meet requirements
  • Access to a library of example documentation and policy templates
  • Documentation review and annotation
  • Final documents loaded on NCQA’s QPASS system

To have sufficient time to meet the NCQA requirements, contracts must be in place four months prior to the practice recognition anniversary date and practices must assign PCDC coach as the ‘Administrator’ role in QPASS to submit PCMH documentation.

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Annual Review PCMH Document Review and Feedback

PCDC’s team of NCQA Certified Content Experts are here to support your practice as you prepare for NCQA PCMH AR submission. Maintaining NCQA PCMH certification supports your practice in sustaining its high quality of care and potential additional revenues from the State and various payers.

Project Kick-Off
We will meet with your practice leaders and team to provide an overview of the engagement and outline roles and responsibilities for participants. In addition, we will review current NCQA PCMH standards and guidelines highlighting any changes that may impact the submission process.

Practice Submission of Documents
The practice project team will be given simple instructions on how to prepare submission documents for PCDC to review. PCDC prefers to receive documents at least 45 days prior to each practice site NCQA PCMH Reporting Date.

Review and Feedback
PCDC will review the submitted documents and provide feedback within 1-2 weeks. We then meet with the practice leaders and teams to discuss a timeline to finalize changes and provide recommendations to submit to NCQA.

Update, Final Review and Submission
Practices will be tasked with addressing any issues identified and re-submitting updated documents to PCDC for final review and feedback at least 2 weeks prior to each practice site NCQA PCMH Reporting Date. PCDC uploads and submits documentation to QPASS.

Additional activities outside of those listed above will require an expanded contract.

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