This article was written by our guest blogger, Susan S. Maxsween, MS, Manager Healthcare Transformation Services.

The concept of “Patient Centered Medical Home” continues to grow with great momentum.  With gaining validation from organizations including The Centers for Medicare and Medicaid Services (CMS) and multiple payers across the country primary care practices are further engaging in healthcare transformation.  The National Committee for Quality Assurance’s (NCQA) Patient Centered Medical Home (PCMH) program is an innovative program which is aimed to provide primary care practices with a set of standards in which the practice demonstrates a facilitated partnership between the clinicians and the patients and when appropriate, their family members.  As of February 2012, approximately 3,571 primary care practices across the country have received their distinct recognition.  Practices demonstrate their commitment to providing quality driven patient care which is facilitated through use of information technology, patient registries and other means to ensure delivery of care in a culturally and linguistic appropriate manner.

In NCQA’s recently published newsletter, (January 2012) they reported that pediatric practices have increasingly become engaged in becoming Patient Centered Medical Homes.  In fact, the American Academy of Pediatrics (AAP), as well as the American Academy of Family Physicians (AAFP) and the American College of Physicians (ACP) were all instrumental in the development of the joint principles of the PPC-PCMH 2008 program.  With the development and launch of the 2011 standards, the focus on the pediatric patient population has become an increasingly integral component of the Patient Centered Medical Home Recognition program.

NCQA also reported that a Comprehensive Primary Care Initiative is also being initiated and is accelerating access to Patient Centered Medical Homes.  As part of this new initiative, efforts will be aligned with Medicare and other public and private insurers to promote evidence of coordinated and quality of care.  As part of this initiative, Medicare will provide a monthly care management fee to selected primary care practice on behalf of Medicare beneficiaries.  The CMS Center for Medicare and Medicaid Services is currently evaluating letters of intent for this initiative.

State updates were also provided, highlighting the impact of Patient-Centered Medical Home Pilot initiatives in states including Connecticut and Montana.  Connecticut’s “Person-Centered Medical Home” Medicaid pilot is part of their state’s shift away from fully-capitated managed care programs.  Montana’s multi-payer PCMH initiative was initially driven by the state agency that oversees Medicaid.  Now the Insurance Commissioner has convened a multi-stakeholder Advisory Council that is interested in the new Centers for Medicare and Medicaid Innovation Comprehensive Primary Care Initiative.

North Carolina commissioned a study in which the legislature found that Medicaid recipients in a medical home program got better care and utilized fewer services provided through state funding.  The study was commissioned by an actuarial form, Milliman, Inc. The firm found the state saved $103 million in fiscal year 2007, followed by #204 million in 2008, $295 million in 2009 and $382 million in 2010.

Visiting Nurses Agency for New England has been working to ensure that their services can successfully compliment the work of the patient centered medical home initiatives.  This integrated approach with the medical home paradigm has created a “balanced” approached to providing patient care demonstrating better patient outcomes.

Article Source:  www.NCQA.org.

RMS Healthcare has assisted primary care physician practices in healthcare transformation services and are pleased to share the following updates from NCQA with you.  We, like you, are committed to improving patient access to quality healthcare in the primary care setting.  We have assisted numerous practices in attaining PCMH Recognition across the country with proven success.  If you are interested in learning more about RMS Healthcare, check our website at www.RMSresults.com.  Take a moment to read our recent blogs on Healthcare Transformation Services by clicking here.  If you would like additional information, contact SusanM@rmsresults.com or contact me at 315-635-9802.