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NCQA PCMH Recognition Redesign Overview

NCQA has redesigned its PCMH Recognition program! The redesigned program includes ongoing, sustained recognition status with annual check-in and reporting instead of the current program's three-year recognition cycle.

The process offers:

  • Flexibility. Practices take the path to recognition that suits their strengths, schedule and goals.
  • Personalized service. Practices get more interaction with NCQA, and are assigned an NCQA representative who works with them throughout the recognition process and is a consistent point of contact.
  • User-friendly approach. Requirements remain meaningful, but with simplified reporting and less paperwork.
  • Continuous improvement. Annual check-ins help practices strengthen as medical homes. By reviewing your progress more often, we hope to keep performance improvement at the top of your priorities list.
  • Alignment with changes in health care. The program aligns with current public and private initiatives and can adapt to future changes

Why redesign? 

NCQA based the redesign on feedback from practices, policy makers, payers and other key stakeholders. It makes the program more manageable as it continues to concentrate on performance and quality improvement. It also reduces paperwork and increases practice interaction with NCQA.

NCQA PCMH Recognition Redesign from NCQA on Vimeo.

How does it work? 

The new recognition process has three parts: 

  • Commit. The practice completes a self-assessment before committing to transformation and the recognition process. When the practice commits, it works with the assigned NCQA representative to conduct an online assessment and develop an evaluation plan and schedule. 
  • Transform. Practices gradually transform, building on successes. During this time, they show their progress by submitting documentation and data to NCQA through a new system designed to reduce paperwork and administrative hassles.

    Along the way, NCQA conducts virtual reviews—online check-ins—with the practice to gauge progress and to discuss next steps in the evaluation. The virtual check-ins, which are conducted online via screen sharing technology, provide practices with immediate and personalized feedback on what is going well and what needs to improve. Evaluation is now more educational and collaborative. 
  • Succeed. The practice continues to implement and enhance its PCMH model to improve how it meets the needs of patients. Each year, the practice checks in with NCQA to show that its ongoing activities are consistent with the PCMH model of care. The annual check-in includes attesting to certain policies and procedures and submission of key data. This process will sustain the practice’s recognition. Better yet, it’s designed to foster continuous improvement. That means the practice succeeds in strengthening its transformation, and as a result, patient care. 

This graph details practice and NCQA activities during each part of the process

Electronic Clinical Quality Measures (eCQMs)
Beginning with launch of the PCMH 2017 program, practices will have the option to submit electronic clinical quality measures (eCQMs) to NCQA in support of their recognition process. The list of measures from which to choose can be found here. Measures can be submitted through electronic health records, health information exchanges, qualified clinical data registries (QCDRs) and data analytics companies as long as they can use the electronic specifications as defined by the Centers for Medicare & Medicaid Services for the ambulatory quality reporting programs. More details about the submission process to NCQA will be forthcoming with the publication of the final PCMH 2017 standards.

Crosswalk to the 2017 Standards

Need to know how the 2017 standards align with the 2014 standards? Download this crosswalk.

Transition to the Redesigned Process

PCMH 2014 Level 3 Practices: If you are a PCMH 2014 Level 3 practice, you may bypass submission of evidence for criteria under the new process entirely and skip directly to the Annual Reporting part of recognition. Do this by enrolling in Q-PASS. Annual Reporting begins 30 days prior to the expiration of your current recognition cycle. This date becomes your anniversary date. You provide annual reporting data by this date each year. NCQA assigns your practice a representative after you enroll in Q-PASS. Your representative can answer your questions and provide more detail about next steps.

All Other Currently Recognized Practices: If you are approaching renewal, transition to the redesigned PCMH program will save you time. Practices that achieved recognition in PCMH 2011 at Level 1, 2 or 3, or PCMH 2014 at Level 1 or 2, can earn recognition at an accelerated pace. These practices may attest to meeting certain criteria without providing the evidence required of practices seeking recognition for the first time. 

Download this table to learn more. 

Additional Resources

Pricing: Because the process will move from a three-year recognition to an ongoing, sustained recognition with annual reporting, the pricing structure for the NCQA PCMH Recognition Program will change. Learn more about the new pricing structure.

Annual Reporting: Check-ins will help practices strengthen as medical homes by reviewing progress and encouraging performance improvement more frequently. Learn more about these annual check-ins, including what information will be required for reporting.

Frequently Asked Questions: See frequently asked questions about the redesigned PCMH recognition program.