Resource Directory of Incentives for NCQA Recognition
Updated August 2023
| Organization | Programs Supported | Type of Support | Program Description |
|---|---|---|---|
Wyoming Department of Health- WyHealth Care Management Program |
|
| Pays an additional PMPM case management fee to primary care practitioners that meet certain requirements including NCQA PCMH Recognition. |
Wellcare of Nebraska |
|
| For more information email .NE_PCMH@wellcare.com or call 402-547-0383 |
Vermont BluePrint for Health/MAPCP Demo |
|
| Eligibility requirements include achieving NCQA PCMH recognition; enhanced PMPM is tied to actual NCQA PCMH Recognition scores. |
UPMC Health Plan |
|
| 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. |
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. |
Tennessee PCMH Initiative |
|
| 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. |
Sunshine Health |
|
| Supports BH Distinction program |
South Carolina Medical Association |
|
| |
South Carolina MCO Provider Quality Incentive Program |
|
| Increased PMPM provided for PCMH recognition |
Simply Healthcare |
|
| Financial support toward the cost of NCQA PCMH Recognition |
SelectHealth |
|
| Provides clinics participating in the Select Health Quality Provider Program with enhanced reporting, a consultant resource, and the opportunity to earn quarterly performance payouts with an annual bonus structure. For more information contact medicalhome@selecthealth.org. |
Rocky Mountain Health Plan |
|
| |
Rhode Island Quality Institute |
|
| For more information email info@riqi.org or call 888-858-4815 |
Rhode Island Care Transformation Collaborative |
|
| Supplemental PMPM payments designed to drive practice transformation and quality improvement, and apply for national PCMH recognition. |
Qualidigm |
|
| QIO; for more information contact Michele Kelvey-Albert at malbert@qualidigm.org |
Providence Health Plan – Oregon |
|
| |
Presbyterian Health Plan, Inc. |
|
| For more information e-mail spreston6@phs.org or call (505)923-5255. |
Pittsburgh Regional Health Initiative (PRHI) |
|
| |
Physician Health Partners |
|
| Serving Denver metro area PHPprime contracted practices only. |
Pediatric Physician’s Organization at Children’s, LLC |
|
| Provides financial, transformation and technical support. |
Pediatric Innovation Center |
|
| QIO/CIN |
Pediatric Health Network |
|
| |
Peach State Health Plan |
|
| Mandates NCQA PCMH |
Partnership HealthPlan of California |
|
| |
Oregon Patient-Centered Primary Care Home |
|
| PCPCH deems NCQA PCMH for select requirements. |
Optimum Physician Alliance |
|
| For more information email shriver.melanie@opawny.com |
OneCity Health Services |
|
| Performing Provider System. For more information email ochsupportdesk@nychhc.org |
NYC Reach |
|
| For more information, visit nycreach.org/practice-transformation/#nys-pcmh . |
North Carolina Area Health Education Center |
|
| Regional network; For more information email practicesupport@ncahec.net |
NewHealth Collaborative |
|
| |
New York Medicaid PCMH Incentive Program |
|
| 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. |
New York eHealth Collaborative |
|
| |
New Mexico Centennial Care (NM MMC) |
|
| Practices receive an enhanced PMPM for receiving national recognition |
New Jersey Innovation Institute |
|
| |
New Jersey Chapter, American Academy of Pediatrics |
|
| |
New Jersey Academy of Family Physicians |
|
| For more information email sandi@njafp.org |
New Hampshire Healthy Families |
|
| Supports network providers in achieving and maintaining Recognition and Behavioral Health Distinction. |
Missouri Health Home Program |
|
| 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. |
Michigan SIM Initiative |
|
| Participants will receive quarterly payments for attributed eligible Medicaid beneficiaries; two types of payments are available – Care Management and Coordination and Performance Incentive Plan |
Meridian Health Plan |
|
| Contact your Meridian Provider Relations Representative to learn more about earning PCMH Recognition and the Meridian PCMH Incentive Program. |
Meridian Health Plan |
|
| |
Massachusetts Health Policy Commission PCMH Certification |
| As of 2019, the HPC adopted the NCQA Distinction in Behavioral Health Integration as the standard for certifying Massachusetts primary care practices as PCMHs. | |
Maine Primary Care Association |
|
| |
Maine Health Home Program |
|
| 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. |
MACRA |
| Clinicians in NCQA Recognized PCMHs/PCSPs automatically get full credit in the MIPS CPIA category | |
Lousiana Healthcare Quality Forum |
|
| QIO; for more information email info@lhcqf.org |
Lousiana Healthcare Connections |
|
| |
Kentucky Regional Extension Center |
|
| For more information email kyrec@uky.edu |
Iowa Health Home Program |
|
| 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. |
Idaho Healthy Connections |
|
| Tiered payment structure where the higher tiered payment is based on various factors including a practice’s PCMH Recognition. |
Humana, Inc. |
|
| 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. |
HealthTeam Works |
|
| |
Healthcare Association of New York State |
|
| Technical assistance vendor |
HealthArch |
|
| For more information email JoinHealthARCH@ucf.edu |
Health Resources Services Administration |
|
| Financial support for the cost of NCQA PCMH Recognition |
Hawaii QUEST Integration Managed Care PCMH Program |
| 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. | |
Georgia Medicaid P4P Incentive Program |
| Provider incentives available to support costs to transform and sustain PCMH recognition. | |
Georgia Chapter American Academy of Pediatrics |
|
| |
Florida MMA PCMH/PIP |
|
| 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). |
Florida Chapter-American Academy of Pediatrics |
|
| |
Florida Academy of Family Physicians |
|
| |
Excellus Health Plan |
|
| |
Emtiro Health |
|
| Consultant |
District of Columbia Health Home Program |
|
| DC has two Health Home Programs to serve populations with chronic conditions. PCMH Recognition is a requirement for practices to enroll in Health Home. |
CORHIO |
|
| |
Connecticut SIM Initiative |
|
| 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. |
Connecticut HUSKY Health |
|
| DSS PCMH program for practices serving Medicaid members |
Community Health Network of Connecticut |
|
| State mandated NCQA PCMH |
Community First Health Plans, Inc. |
|
| The specifics of the Community First Primary Care Provider Incentive program is on the secure provider portal. Please send questions regarding the Community First Primary Care Provider Incentive program to MLivingston@CFHP.com or chollis@cfhp.com. |
Community Care Plan |
|
| 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 |
Community Care of North Carolina |
|
| Regional network |
Community Care Network of Kansas |
|
| Primary Care Association for Kansas; provides training and technical assistance to member clinics |
Colorado Primary Care Advanced Payment Model |
|
| 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.” |
Colorado Community Health Network |
|
| For more information email qidteam@cchn.org |
Central New York Care Collaborative |
|
| |
Central California Alliance for Health |
|
| Financially supports initial PCMH recognition and Behavioral Health Integration |
Center for Advancement of Health IT |
|
| For more information email info@advancehealthit.org |
CareSource of Georgia |
|
| For more information call 855-202-0729 |
Capital District Physicians’ Health Plan |
|
| |
California Primary Care Association |
|
| 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 pdy@cpca.org |
BlueCross BlueShield of Alabama |
|
| Information on PCMH requires provider log in |
Blue Shield of California Promise Health Plan |
|
| |
Blue Cross Blue Shield of Tennessee |
|
| Mandates NCQA PCMH; pays application fee up to $25K per practice. |
Blue Cross Blue Shield of South Carolina |
|
| Practices in the PCMH program receive monthly care management fees to support enhanced care management activities and annual opportunities to earn performance-based incentives. |
Blue Cross Blue Shield of Rhode Island |
|
| Mandates NCQA PCMH; policies located in the Provider Tools section under the Tools & Resources once logged in |
Blue Cross Blue Shield of North Dakota |
|
| For additional information call 800-342-4718 |
Blue Cross Blue Shield of North Carolina |
|
| |
Blue Cross Blue Shield of Florida DBA Florida Blue |
|
| For information contact ValueBasedOperationsTeam@bcbsfl.com |
Blue Cross and Blue Shield of Vermont |
|
| |
BizMed Solutions |
|
| HIT Solution; for more information email mgurarie@bizmedsolutions.com |
Best Practices Academy |
|
| |
Arkansas Foundation for Medical Care |
|
| For more information email pcmhpt@afmc.org |
Arkansas BlueCross BlueShield |
|
| Provides increased care coordination payments for NCQA PCMH Recognition |
Amerigroup Community Care |
|
| For more information contact Mike Smith at 678-587-4843 |
Americares |
|
| Supports free, charitable, hybrid and look-alike clinics. Application process annually |
American Board of Physical Medicine and Rehabilitation |
|
| Recognizes PCSP |
American Board of Pediatrics |
|
| For more information email moc@abpeds.org |
American Board of Internal Medicine |
|
| |
American Board of Family Medicine |
|
| For more information email awilliamson@theabfm.org |
Alabama Coordinated Health Network |
|
| 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. |
Adirondack Health Institute |
|
| Regional collaborative. For more information email jmunger@ahihealth.org |
