Resource Directory of Incentives for NCQA Recognition
Updated March 2021
|Organization||Programs Supported||Type of Support||Program Description|
Regional collaborative. For more information email firstname.lastname@example.org
ACHN is a care management system that requires Primary Care Physicians to participate with an ACHN entity in the region where the PCP practices. PCP practices that achieve PCMH Recognition will receive a five percent bonus payment.
For more information email email@example.com
For more information email firstname.lastname@example.org
Supports free, charitable, hybrid and look-alike clinics. Application process annually
For more information contact Mike Smith at 678-587-4843
Provides increased care coordination payments for NCQA PCMH Recognition
For more information email email@example.com
HIT Solution; for more information email firstname.lastname@example.org
Practice participation is by invitation only; some reimbursement available for initial recognition when participating in commercial value based program. For information contact ValueBasedOperationsTeam@bcbsfl.com
For additional information call 800-342-4718
Mandates NCQA PCMH; policies located in the Provider Tools section under the Tools & Resources once logged in
Practices in the PCMH program receive monthly care management fees to support enhanced care management activities and annual opportunities to earn performance-based incentives.
Mandates NCQA PCMH; pays application fee up to $25K per practice.
Provides $1.50 PMPM every 6 months (April and October) for primary care practices who have a practice size of at least 100 Medi-Cal members. Geographic region is Southern California, specifically Los Angeles and San Diego counties.
Information on PCMH requires provider log in
Provides training and technical assistance to member clinics; practice transformation coaching for PCMH available. Also offers PCMH + educational program for NCQA PCMH transformation process. For more info contact email@example.com
For more information call 855-202-0729
For more information email firstname.lastname@example.org
Financially supports initial PCMH recognition and Behavioral Health Integration
For more information email email@example.com
Program incentivizes care that improves both health outcomes and coordination in the health care delivery system. Recognized PCMH practices in the APM model will be awarded “credit.”
Primary Care Association for Kansas; provides training and technical assistance to member clinics
Reimburses providers for 80% of total costs incurred to become PCMH recognized – maximum compensation not to exceed $15K. For more information call 855-819-9506
State mandated NCQA PCMH
DSS PCMH program for practices serving Medicaid members
Available for FQHCs and private practices. Practices that receive the PCMH designation are eligible for enhanced reimbursements. Practices also receive state-funded practice transformation support.
DC has two Health Home Programs to serve populations with chronic conditions. PCMH Recognition is a requirement for practices to enroll in Health Home.
Providers paid at Medicare rate; many MMA plans use PCMH certification as a qualification for the Physician Incentive Program however plans can determine the model they want to use (state’s or their own).
Provider incentives available to support costs to transform and sustain PCMH recognition.
Recognized practices can be considered Tier 1 or Tier 2 PCMHs and plans develop a reimbursement methodology that provides higher payment to the more advanced Tier 2 PCMH.
Financial support for the cost of NCQA PCMH Recognition
For more information email JoinHealthARCH@ucf.edu
Technical assistance vendor
Provider engagement resources available to assist practices with transformation support. Provides PMPM payment for care coordination services and maintaining PCMH Recognition. PCMH program offered in most states nationwide, excluding Florida, California, Hawaii and Puerto Rico.
Tiered payment structure where the higher tiered payment is based on various factors including a practice’s PCMH Recognition.
Chronic Condition Health Home Program focused on whole-person, patient-centered, coordinated care for all stages of life and transitions of care. NCQA PCMH is required to become a Health Home.
For more information email firstname.lastname@example.org
QIO; for more information email email@example.com
Clinicians in NCQA Recognized PCMHs/PCSPs automatically get full credit in the MIPS CPIA category
Health Homes are a partnership between an enhanced Health Home primary care practice and one of ten Community Care Teams around the state. Both organizations receive a PMPM payment for Health Home services provided to MaineCare members who have two chronic conditions, or one chronic condition and at risk for another. Health Home services include care coordination, case management, individual and family support, and health promotion/education.
As of 2019, the HPC adopted the NCQA Distinction in Behavioral Health Integration as the standard for certifying Massachusetts primary care practices as PCMHs.
Contact your Meridian Provider Relations Representative to learn more about earning PCMH Recognition and the Meridian PCMH Incentive Program.
Additional PMPM and care coordination/management fees available with PCMH Recognition.
Participants will receive quarterly payments for attributed eligible Medicaid beneficiaries; two types of payments are available – Care Management and Coordination and Performance Incentive Plan
Provides intensive care coordination and care management as well as addresses social determinants of health for a medically complex population. NCQA PCMH Recognition is required to receive financial incentives.
Supports network providers in achieving and maintaining Recognition and Behavioral Health Distinction.
For more information email firstname.lastname@example.org
2020 program details pending
Practices receive an enhanced PMPM for receiving national recognition
Practices that participate in NYS PCMH transformation may be eligible to receive supplemental payments ($6 PMPM payment for eligible clinicians) through State Medicaid PCMH Incentive Program.
Regional network; For more information email email@example.com
Performing Provider System. For more information email firstname.lastname@example.org
For more information email email@example.com
PCPCH deems NCQA PCMH for select requirements.
Mandates NCQA PCMH
Provides financial, transformation and technical support.
Serving Denver metro area PHPprime contracted practices only.
For more information email firstname.lastname@example.org or call 505-923-5423
QIO; for more information contact Michele Kelvey-Albert at email@example.com
Supplemental PMPM payments designed to drive practice transformation and quality improvement, and apply for national PCMH recognition.
For more information email firstname.lastname@example.org or call 888-858-4815
Provides support to assist practices in transforming to a medical home delivery model, and provides care coordination payments to sites participating in SelectHealth Advanced Primary Care medical home program. For more information contact email@example.com.
Financial support toward the cost of NCQA PCMH Recognition
Increased PMPM provided for PCMH recognition
Supports BH Distinction program
Providers are compensated for supporting the initial start-up requirements of becoming a PCMH and for performing required new activities. Providers are also eligible for bonus payments for improvements in the quality and efficiency of the care they provide.
Texas Healthcare Transformation and Quality Improvement Program (aka Texas DSRIP)
Provides incentive payments to hospitals, physician practices, community mental health centers and local health departments to support their efforts to enhance access to health care, the quality of care, and the health of patients and families served. The waiver extended through September 2022. NCQA PCMH identified as desired model.
Covers the full cost of initial application recognition fee for PCMH, PCSP and PCCC. For additional information contact UPMC Health Plan at 1-866-918-1595.
Eligibility requirements include achieving NCQA PCMH recognition; enhanced PMPM is tied to actual NCQA PCMH Recognition scores.
For more information email PCMH_GA@wellcare.com
For more information email .NE_PCMH@wellcare.com or call 402-547-0383
Pays an additional PMPM case management fee to primary care practitioners that meet certain requirements including NCQA PCMH Recognition.