Ensuring that employees receive quality health care—especially quality primary care—is a priority for employers. Research shows that effective primary care translates to fewer hospitalizations, fewer duplicated treatments and more appropriate use of resources.
But how can employers determine which primary care practices offer the best care?
NCQA’s Patient-Centered Medical Home (PCMH) Recognition program was developed to identify medical practices that have invested in a model of care that puts patients at the forefront and where continuous quality improvement is a priority.
For employers, understanding PCMH Recognition and how it can help identify quality is important for ensuring that employees receive quality care.
What Is PCMH Recognition?
The NCQA PCMH Recognition program is the most widely adopted PCMH evaluation program in the country. More than 13,000 practices (with more than 67,000 clinicians) are Recognized by NCQA.
For practices to receive this Recognition, they must meet standards in six areas:
- Team Based Care and Practice Organization: Practices are evaluated on leadership structure, care team responsibilities, how they engage with patients, families and caregivers.
- Care Management and Support: Practice clinicians use care management protocols to help them identify patients who need closely managed care.
- Know and Manage Patients: Practices must meet standards for data collection, medication reconciliation and evidence-based clinical decision support.
- Care Coordination and Care Transitions: Practices ensure that primary and specialty care clinicians share information and manage patient referrals.
- Patient-Centered Access and Continuity: Practices provide patients with convenient access to clinical advice and continuity of care.
- Performance Measurement and Quality Improvement: Practices have processes for measuring their performance and for quality improvement activities.
What Is Patient-Centered Specialty Practice Recognition?
NCQA’s Patient-Centered Specialty Practice Recognition program recognizes specialists that deliver high-quality, patient-centered care. The program focuses on sharing information with the primary care clinician and working as a team to coordinate care with other referring clinicians, community resources and secondary services. Care is focused on the patient, rather than on the care setting.
What Does PCMH Recognition Mean for Employers?
Employers looking for ways to ensure that their employees receive quality care should start with a strong foundation of primary care. NCQA’s PCMH Recognition identifies primary care practices that meet key standards for quality care.
Research across multiple payer types has shown that patients in NCQA-Recognized patient-centered medical homes have better management of chronic conditions, reduced fragmentation of care and lower health care costs overall.
What Should Employers Do?
Employers should work with their health plan to ensure that NCQA-Recognized PCMHs are part of their network and are designated for employees. Employers may want to develop a benefit design that steers employees to Recognized practices.
Have a question? NCQA’s Employer Relations Team can help!