Raising the Bar: NCQA’s PCMH Program Excels in New Study

July 27, 2018 · Karen Proffitt

We’re proud to share the news from a recent study in the American Journal of Managed Care. It  documents that NCQA recognized Patient-Centered Medical Homes (PCMH) offer better cost and quality than their competitors.

The three-year study, by the RAND Corporation, compared Medicare beneficiary data from Level 3 NCQA PCMHs in Federally Qualified Health Centers (FQHC) to The Joint Commission (TJC) and the Accreditation Association for Ambulatory Health Care (AAAHC) PCMHs and non-PCMHs.

The findings show that NCQA Level 3 FQHC PCMHs clearly outperform all other practices in the study, with:

  • Higher quality scores, especially for diabetic patients.
  • Fewer hospitalizations.
  • Fewer visits to specialists—45 fewer visits per 1,000 beneficiaries (only NCQA-Recognized sites were associated with a relative decrease in visits).
  • More ambulatory care visits.
  • Better diabetic quality scores.

Medicare costs increased over time for all three PCMH programs, but only NCQA’s PCMH sites had a smaller rate of increase than non-recognized sites, leading to a decrease in total Medicare spending—($300 per beneficiary), inpatient costs ($214 per beneficiary) and Part B premiums ($72 per beneficiary)—in the third year.

The authors noted that NCQA’s PCMH program emphasizes use of Electronic Health Records (EHR) that incorporate meaningful use criteria, which can improve primary care delivery and population health management.

So, what’s the takeaway? Simply put, NCQA’s Level 3 sites had more improvements across a greater number of patient outcomes than TJC or AAAHC-recognized sites over a three-year period.

We’re not resting on our laurels. NCQA has updated the PCMH requirements to make them more rigorous and raise the bar for quality improvement, an important factor for the shift to value-based care. The result will be better care, better patient experience, reduced costs and improved patient outcomes—which, after all, should be everyone’s goal at the end of the day.

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