This blog post was written by our guest blogger Susan Maxsween, Director of Healthcare and Practice Transformation at Research & Marketing Strategies (RMS).

In February of this year, RMS Healthcare posted a blog entitled NCQA to launch new 2014 PCMH standards, which highlighted the core components of the Patient Centered Medical Home (PCMH) Model and what they include.  Since we posted this blog, there have been many articles published that debate the impact and value of PCMH and the challenges which primary care practices face while achieving and retaining this recognition. No question, the journey to PCMH recognition continues to be an engaging, enlightening, challenging and at times daunting transformation process for primary care practices across the country. This evolving process continues to support an enhanced focus on the patient centered approach to delivery and management of patient care, and now encompasses the triple aim model, which focuses on better quality, experience and cost.  At the core of the PCMH movement is the National Committee for Quality Assurance (NCQA), who has the nation’s largest PCMH program.  As of March 17, 2014, NCQA has recognized approximately 7,066 primary care practices and this number continues to grow exponentially. To date, 37 states have public and private Patient-Centered Medical Home initiatives that use NCQA Recognition.

PCMH Success

NCQA recently launched a white paper entitled, The Future of Patient-Centered Medical Homes Foundation for a Better Health Care System The white paper speaks to the power of PCMH in improving quality, cost and experience of primary care, and also recognizes that this is just the foundation of work underway that is being done in the broad sense of changing the landscape of our healthcare delivery system.  There are many steps underway to continue the momentum, beginning with the evolution of the Patient-Centered Specialty Practice (PCSP) programs which is providing the specialty care providers to become an integral part of the Patient Centered Neighborhood which focuses on improving quality and access to care.  The emergence of Accountable Care Organizations (ACOs) has enabled healthcare systems to build on the foundation of PCMH to better integrate and coordinate doctors, hospitals, pharmacies, ancillary providers and other members of the healthcare delivery system to ensure patients are getting the care that they need.

In the white paper, NCQA addressed the key facets of a Patient-Centered Medical Home, as detailed below:

Patient-Centered Medical Home

The adoption of these key facets will require the valiant and dedicated efforts of the entire health care team within the primary care practice, which includes clinical and administrative staff and even those who do not have direct patient contact (e.g., billing specialists, performance management outreach staff, etc.).  These key facets are the building blocks of long-term journey and commitment for the entire care team.  It will take multiple resources (financial, IT, legal, etc) to ensure long-term adoption and implementation of the PCMH model within the physician practice setting, as well as sustainable integration within the healthcare community.  This integration is essential for long-term management of high risk patients and those with multiple co-morbidities, including behavioral health, which can often be seen with chronic co-morbid conditions.  Very often, more than not, it is our high risk and complicated patients that utilize the most healthcare services and require the most well-coordinated level of complex care.

NCQA Revealed Goals for PCMH and beyond, which included:

  • Primary care clinicians will improve quality, patient experience, coordination and value through better prevention and access to reduce emergency department and hospital care.
  • Primary care will be the foundation of a high-value health care system that provides whole person care at the first contact.  Everyone in primary care practices – from physicians and advanced practice nurses to medical assistants and front-line staff – should practice to the highest level of their training and license in teams to support better access, help with self-care, and coordination.
  • PCMHs will show the entire health care system what patient-centered care looks like. Patient-centered care is respectful of and responsive to individual preferences, needs and values, and ensures that patient values guide all clinical decisions. Individuals and families get help to be actively engaged in their own healthy behaviors, health care, and in decisions about and their care.
  • PCMHs will revitalize the “joy of practice” in primary care, making it more attractive and satisfying.

The white paper also further discusses how PCMH alignment can reach beyond the primary care setting to include the Medical Neighborhood, Accountable Care Organizations, Behavioral Health, Public Health, and employer worksites.

NCQA stated in the white paper that there are many paths to becoming successful PCMHs – recognizing that no two practice sites look alike and that they also reflect local circumstances and preferences which drive the program.  Several key attributes that contribute to PCMH success, include:

  • The most successful practices have received financial or technical assistance, or both to transform.  They particularly value practice examples and support for meeting requirements, and worry about maintaining their financial sustainability.
  • Organization leadership, a team-based approach, health information technology and delegating self-management education to non-physician team members are also features.
  • Involving patients and families in practice improvement efforts through advisory committees, ombudsmen or navigators.
  • Practices take a system approach, and as a result, have data, standard measurements, technical assistance, leadership and personnel.
  • Having quality improvement systems in place.

A significant salient point addressed in the white paper is that despite the successes of NCQA PCMH Recognition and their approach to the Recognition, there are many that feel that there are concerns that may be specific to NCQA and even broader.  Those concerns represent significant hot touch points for a practice aspiring to achieve and retain PCMH recognition, including: concerns about the NCQA approach; concerns about financial and practice support as well as broader concerns including how to bring in a specialist, dealing with the small practices, building patient demand for PCMHs, small practice management and incorporating medication compliance.  NCQA further provided solutions to the challenges which were presented.

The whitepaper accurately displayed many of the challenges which physician practices encounter as they take on the PCMH journey.  No doubt, NCQA is truly an exemplary leader in setting a standard for achieving and sustaining PCMH Recognition. Overall, PCMHs have made significant contributions in advancing quality driven patient centered care.  No question the challenges will remain, but the accomplishments and progress attained throughout the ongoing journey contribute to the continued growth and support for PCMHs across the country.

RMS Healthcare, a division of Research and Marketing Strategies, Inc. (RMS) focuses on optimizing relationships with its healthcare clients.  With a dedicated team of healthcare consultants, RMS Healthcare offers targeted healthcare consulting and research services directed to the specialized needs of our healthcare clients in their practice transformation journey.

RMS Healthcare operates as an extension of our clients’ business in providing operational support functions.  We work in tandem with our clients, developing customized work plans to ensure successful achievement of operational goals while maximizing use of technology as well as guidance and assisting in achieving operational goals to achieving Patient-Centered Medical Home (PCMH) recognition. Our team works with hospitals, health-related facilities and primary and specialty care practices.  Our firm understands that from a business perspective, transformation must focus on delivery of quality driven patient centered care, while also focusing on managing overall administrative expenses and increasing practice revenue.

RMS Healthcare has over 50 years of collective and proven experience in healthcare practice transformation, staff training and development, strategic planning, business plan development and patient experience measurement specific to the healthcare industry. Our compliment of clients includes physician practices, healthcare delivery systems, hospitals, physician organizations and community healthcare organizations.  We have assisted over 100 practices in their transformation journey to become a recognized Patient-Centered Medical Home.

If you are interested in learning more, please contact Susan Maxsween, Director of Healthcare and Practice Transformation at or telephone her at 1-866-567-5422.