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.

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
  • In 2022, HRSA ended ‘quality award’ payments for PCMH recognition
    • However, they are still looking at PCMH recognition as a factor when awarding funding
  • In other states there are PMPM care management fees for PCMH recognition
    • Colorado, Minnesota, New York

Making the Value Case for PCMH

CLICK HERE to view a CHC learning session from 2019 Making the Value Case for PCMH