Recognition Redesign: Practice Details Graph

  Commit  Transform Succeed
Practices do this...  Assess to determine priorities and capabilities for transformation based on current clinical practices and resources.
Commit with NCQA to pursue transformation and recognition as an NCQA PCMH. 
Complete an online guided assessment.
Work with an assigned NCQA representative to develop an evaluation schedule, identify support and education for transformation. 
Review new NCQA online education resources designed to support transformation.

Implement changes necessary to transform into a PCMH.
Submit initial documentation and review in an online, virtual check-in session with an NCQA evaluator.
Participate in two additional virtual check-ins with an NCQA evaluator to submit documentation, confirm progress and accumulate credits toward recognition. 
Earn NCQA PCMH Recognition after demonstrating transformation.
Sustain current PCMH activities and continue to evolve as a medical home and improve patient care.  
Implement activities to meet new PCMH requirements, when necessary.
Perform an annual check-in with NCQA to verify continued success as a PCMH; submit documentation according to reporting requirements.
Earn another year of Recognition as an NCQA PCMH. 
While NCQA does this...  • Provides information and resources to assist in the practice’s decision-making process to pursue transformation and NCQA Recognition.
Answers all questions and addresses concerns leading up to the practice’s decision to commit to transformation. 
Assigns a representative to the practice as its primary point of contact at NCQA. 
Gives the practice access to an online self-assessment. 
Works with the practice to develop an evaluation schedule.
Identifies resources and education to support the practice’s transformation. 

(Representative) Monitors the practice’s transformation progress. 
(Representative) Reaches out to practices (or to their Certified Content Expert) whose transformation is slower than expected, to discuss possible barriers and recommend resources and education opportunities to resolve them.
Assigns an evaluator to conduct the recognition review.  
(Evaluator) Conducts three virtual check-ins to ascertain whether the practice is transforming and meeting PCMH recognition requirements. 
Reviews the practice’s final submission and forwards it to the NCQA Peer Review Committee for evaluation and confirmation of initial approval. 
Notifies the practice of its recognition status. 

 • Conducts an annual check-in to confirm that the practice continues ongoing transformation activities. 
Notes and documents practice changes (i.e., new clinician, new site address) at the annual review.
Evaluates the practice’s submitted data and documentation that demonstrate continued transformation. 
Audits a random sample of practice submissions to verify that PCMH requirements and guidelines are being met over time (focusing on areas addressed through practice attestation in the annual reporting requirements).