NCQA PCSP Recognition: Concepts

The Patient-Centered Specialty Practice (PCSP) standards identify best practices and core activities for specialty practices in delivering high quality, patient-centered care. This ensures that a specialty practice is a “good neighbor” to other clinicians in the medical home neighborhood. The program highlights performance and quality improvement and aligns with many other initiatives that affect practices, such as MACRA.

A Structure of Concepts, Criteria and Competencies

Concepts. There are 7 concepts—the primary themes of PCSP. To earn recognition, practices must complete criteria in each concept area. If you are familiar with past iterations of NCQA PCSP Recognition, the concepts are equivalent to standards.

Criteria. Underlying the 7 concepts are criteria: activities for which a practice must demonstrate satisfactory performance to obtain NCQA PCSP Recognition. Criteria are developed from evidence-based guidelines and best practices. A practice must pass all 38 core criteria and at least 20 credits of elective criteria across concept areas.

Competencies. Competencies categorize the criteria and do not offer credit.

PCSP Concepts

Team-Based Care and Practice Organization.
Helps structure practice leadership, care team responsibilities and how practices partner with patients, families and caregivers.

Initial Referral Management.
Helps practices set expectations for referrals and care transitions from primary care and other specialty clinicians to deliver high quality, coordinated care.

Knowing and Managing Patients.
Sets standards for data collection, medication reconciliation and evidence-based clinical decision support.

Patient-Centered Access and Continuity.
Guides practices to provide patients with convenient access to clinical advice and helps ensure continuity of care.

Plan and Manage Care.
Helps clinicians set up care management protocols based on the needs of the patient population and identify appropriate patient resources.

Coordinating Care and Care Transitions.
Makes sure specialty care clinicians, primary care clinicians and health care facilities share information and manage patient referrals. Cost, confusion and inappropriate care is minimized.

Performance Measurement and Quality Improvement.
Helps practices develop ways to measure their performance, to set goals and to develop activities that will improve performance.

Download the PCSP Requirements

The PCSP Standards and Guidelines document contains the NCQA PCSP Recognition program requirements and concepts. Also included is guidance describing the requirement and description of what evidence is needed for demonstration to NCQA.

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