NCQA’s Patient-Centered Medical Home 2011 is an “innovative program for improving primary care.” In a set of standards that describe clear and specific criteria, the program gives practices information about organizing care around patients, working in teams and coordinating and tracking care over time.
1. Enhance Access and Continuity
2. Identify and Manage Patient Populations
3. Plan and Manage care
4. Provide Self-Care and Community Support
5. Track and Coordinate Care
6. Measure and Improve Performance
Here are the must-pass elements required by NCQA:
1) Access During Office Hours
2) Use Data for Population Management
3) Care Management
4) Support Self-Care Process
5) Track Referrals and Follow-up
6) Implement Continuous Quality ImprovementSo, there are different ways and reasons why some primary providers will identify themselves as patient-centered care providers. There is not to say that some primary providers aren't working hard to make sure that their patients receive the best care while during the visit and post visit. But, we do need to be very clear about who is accredited based on truly meeting the standards, and who is not and just uses the concept to draw in more patients. Another thing that I want to mention is the different "models" or "initiatives around the patient-centered care approach.. Take for example the Federal government investing in a new approach to patient-centered care, Health Home Services Option. New York State is in the beginning phases of this initiative. The idea is to establish health home services to reduce cost. I know I am merging tow things, but they are interrelated. Both the patient-centered care (Medical Home) and Health Home Services Option are to at the end lower health care cost, if done and implemented properly.
Federal Health Home RequirementsSection 2703 of the federal Patient Protection and Affordable Care Act (ACA) establishes authority for states to develop and receive federal reimbursement for a set of health home services for their state's Medicaid populations with chronic illness. Health home services support the provision of coordinated, comprehensive medical and behavioral health care to patients with chronic conditions through care coordination and integration that assures access to appropriate services, improves health outcomes, reduces preventable hospitalizations and emergency room visits, promotes use of health information technology (HIT), and avoids unnecessary care.
Health home services include:
- comprehensive care management,
- health promotion; transitional care including appropriate follow-up from inpatient to other settings,
- patient and family support,
- referral to community and social support services,
- use of health information technology to link services.