NCQA’s Advanced Primary Care Pilot: What We Learned

NCQA is working collaboratively with healthcare organizations to define the next generation of primary care. We recently completed an Advanced Primary Care pilot aimed at evolving our programs to better support high-performing primary care organizations and reflect current real-world care delivery practices.

The pilot was structured in two phases. In phase one, we worked closely with participants to review and refine NCQA’s proposed standards through discussions and working sessions. In phase two, organizations applied the standards and submitted evidence to NCQA so we could assess the feasibility of the standards and requirements.

Thank You to Our Pilot Participants

NCQA selected four organizations through a competitive process based on their readiness and ability to lead change in primary care and their dedication to innovation and excellence. We appreciate the time and effort they dedicated to the pilot.

• Aledade, a national care enablement company supporting over 3,000 independent primary care practices.
• Bluegrass Community Health Center, a Federally Qualified Health Center serving 11,000 underserved Kentuckians.
• Jefferson Health, a 33-hospital, 700-site system serving patients in Pennsylvania.
• NYC Health + Hospitals, the nation’s largest public health system, serving over 1 million patients across 11 hospitals and 29 health centers.

“Our pilot participants showed us how all this work aligns with what matters to them and to their patients,” says Jeff Sitko, Assistant Vice President of Product Management at NCQA. “Their insights, along with feedback we received from public comment, helped us strengthen the model and ensure that it is both practical and scalable across a wide range of care delivery organizations.”

What We Learned

Here are the top insights from the pilot participants.

Focus on outcomes over process documentation. One participant stated: “Focusing on outcomes is the most important thing. If your outcomes are high, it most likely means that you have aligned policies and procedures to support those outcomes. If you focus on your outcomes, everything will fall into place.”

Patient-Centered Medical Home (PCMH) Recognition provides a strong foundation. A participant from a PCMH Recognized practice said: “Having the Patient-Centered Medical Home Recognition was helpful in that we were familiar with NCQA’s expectations of quality. A lot of the evidence and documented processes that we already had in place translated to the new program. It didn’t feel like it was adding a lot of unnecessary extra work to what we were already doing.”

Specific metrics drive broader system improvements. As one participant explained: “I think we can all agree that hypertension control matters. But individual metrics can also help to direct attention and resources toward building systems of care for patients who have chronic disease in general. The work we do as an organization to improve our hypertension control rates also teaches us about team-based care, registry development, patient engagement and how to think about equity.”

Robust data analytics capabilities are essential. Another participant focused on the value of analytics: “Our data analytics capabilities have grown tremendously over the years. This includes robust homegrown dashboards and key metrics for population health, access, utilization, care coordination and various health drivers including social determinants of health, insurance status, race and ethnicity. The dashboards allow our users to track, trend and act on data, which is critical to improving patient care.”

Early cross-functional collaboration is critical. According to one participant, collaboration is key: “Through this pilot, we learned that we have a lot of subject matter experts and we need to include them from the inception when we start to do things like this. That was one of the hurdles we had to climb in order to understand our systems and how they can work better.”

Accreditation helps payers identify true value-based care performers. A participant expressed the benefits of Accreditation for purchasers: “Some employers, particularly those who are self-insured, might hear all these buzzwords at industry conferences, but they don’t know how to find the right group of practices who are actually doing the work. I think that an Accreditation from NCQA will help those purchasers understand who can help them positively impact their total cost of care while improving quality.”

About NCQA’s Primary Care Advancement Program

This program defines and advances high-quality, coordinated primary care in today’s rapidly evolving environment. It is organized across six domains:

• Population Health Management.
• Coordinated Team-Based Care.
• Patient Safety and Experience.
• Behavioral Health.
• Clinical Quality.
• Data Management and Exchange.

“This program is intentionally designed to Accredit at the highest level of accountability, so instead of filling out an application for every individual site, organizations will be evaluated once and the results will apply across all sites,” says Sitko. “The goal is less paperwork and more time spent on care.”

Learn More

Listen to our webinar recording, Shaping the Future of Primary Care: Insights from the Advanced Primary Care Pilot, to learn more about the pilot program and what we learned.

Purchase the 2027 Primary Care Advancement Accreditation Survey Readiness Package in the NCQA Store.