NCQA PCMH Redesign: Overview
NCQA has redesigned its PCMH Recognition program. The redesigned program includes ongoing, sustained recognition status with Annual Reporting instead of a 3-year recognition cycle.
The redesigned process offers:
- Flexibility. Practices take the path to recognition that suits their strengths, schedule and goals.
- Personalized service. Practices have more interaction with NCQA, and are assigned an NCQA representative who works with them throughout the recognition process as a consistent point of contact.
- User-friendly approach. Requirements remain meaningful, but with simplified reporting and less paperwork.
- Continuous improvement. Annual Reporting helps practices strengthen as medical homes. By reviewing your progress more often, you keep performance improvement at the top of your priorities list.
- Alignment with changes in health care. The program aligns with current public and private initiatives and can adapt to future changes.
NCQA based the redesign on feedback from practices, policy makers, payers and other stakeholders. It makes the program more manageable as it continues to concentrate on performance and quality improvement. It also reduces paperwork and increases practice interaction with NCQA.
How Does It Work?
The new recognition process has three parts:
- Commit. Complete a self-assessment before committing to transformation and the recognition process. After your practice commits, you work with your assigned NCQA representative to conduct an online assessment and develop an evaluation plan and schedule.
- Transform. Your practice gradually transforms, building on its successes. During this time, you submit data to NCQA to show your progress, using a new system designed to reduce paperwork and administrative hassles.
Along the way, NCQA conducts virtual reviews—online check-ins—with your practice to gauge progress and to discuss next steps in the evaluation. This helps reduce the documentation process and saves you time. The virtual check-ins, conducted online via screen sharing technology, give you immediate and personalized feedback about what’s going well and what needs to improve. Evaluation is educational and collaborative.
- Succeed. Your practice continues to implement and enhance its PCMH model to improve how it meets patient needs. Each year, you check in with NCQA to show that ongoing activities are consistent with the PCMH model of care. During Annual Reporting, you attest to certain policies and procedures and submit data. This process sustains your practice’s recognition and is designed to foster continuous improvement. Your practice strengthens its transformation, and as a result, improves patient care.
This table details practice and NCQA activities during each part of the process.