Why PCMH?

The PCMH model can be an effective way to provide care to persons with complex or chronic conditions, but it requires significant investment in time and resources. We often get the question of “Why PCMH?” – why a health center should choose to invest in the PCMH model of care and what type of financial incentives are available. This post seeks to address that question.

Outcomes

The Patient Centered Primary Care Collaborative (PCPCC) publishes an Annual Review of the Evidence report which provides a summary of PCMH cost and utilization results from peer-reviewed studies, state government evaluations, industry reports, and independent federal program evaluations. Based on that report and our experience working with practices, we list below some outcomes that have been associated with primary care practices who implemented the PCMH model.  Please note that not every report cited all of these outcomes; it is a comprehensive listing of outcomes seen across multiple organizations and studies.

  • Reduced emergency department (ED) use
  • Reduced preventable hospital admissions
  • Reduced readmissions
  • Appropriate utilization of services
  • Increased access to primary care services
  • Improved quality of care
  • Improved patient and family experience
  • Improved patient outcomes through Care management
  • Reduced no show rates
  • Coordinated and Integrated care
  • Better internal communication within the practice

Why PCMH for Health Centers?

Benefits for Health Centers
The PCMH model of care can help build better relationships between patients and their clinical care teams. NCQA’s PCMH Recognition program provides guidance to help health centers develop streamlined workflows and adopt a team-based approach to health care that leads to improved quality of care, improved efficiency of the health center, increased patient and staff satisfaction and reduced costs.

Alignment to Social Determinants of Health
Health centers care for patient populations with unique characteristics and SDOH that create significant health disparities. The Health Center Program Compliance Manual requires centers to assess their patient populations and identify SDOH and health disparities. Similarly, NCQA’s PCMH Recognition program considers identifying, assessing and addressing SDOH to be a fundamental component of the medical home transformation process.

Alignment to HRSA Requirements
HRSA uses the Uniform Data Systems (UDS) Resources to assess the operational, financial and clinical quality performance of health centers and uses the Health Center Program Compliance Manual to assess compliance with required tasks. These criteria are also the building blocks of NCQA’s PCMH Recognition program.

Alignment to Medicaid Requirements
Medicaid requirements are designed to monitor and improve aspects of care and services that are also found in key NCQA PCMH concept areas such as access, health care costs and clinical quality outcomes.

PCMH Incentives

  • HRSA medical home initiative pays for survey tool or other recognition cost
  • HRSA grant of $25,000 added to center base funding for PCMH recognition
    • Additional $5,000 for each additional site
  • In other states there are PMPM care management fees for PCMH recognition
    • Colorado, Minnesota, New York