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NCQA PCMH Recognition: Concepts

NCQA PCMH Recognition: Concepts

The American Academy of Pediatrics introduced the medical home concept in 1967, and in 2007 leading primary care-oriented medical professional societies released the Joint Principles of the PCMH. The next year, NCQA released its PCMH Recognition program, the first evaluation program in the country based on the PCMH model. 

Today, NCQA’s PCMH Recognition program has evolved to feature a set of six concepts that make up a medical home. Underlying these concepts are criteria (activities for which a practice must demonstrate adequate performance to obtain NCQA PCMH Recognition) developed from evidence-based guidelines and best practices. 

The PCMH standards and guidelines document contains these PCMH Recognition program requirements and information your practice needs to demonstrate to NCQA that you meet criteria. Refer to the PCMH concepts and criteria within this document, available for free download from the NCQA store. In this publication you will find table with the criteria and what evidence is needed to submit to NCQA to earn recognition. 

Structure of Concepts, Criteria and Competencies

Concepts. There are six concepts—the overarching themes of PCMH. To earn recognition, your practice must complete criteria in each concept area. If you are familiar with past iterations of NCQA PCMH Recognition, the concepts are equivalent to standards. 

Criteria. Specific activities in which a practice engages to demonstrate that it meets recognition requirements. The practice must pass all 40 core criteria and at least 25 credits of elective criteria across concept areas. 

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

Concept Areas 

Team-Based Care and Practice Organization
Helps structure a practice’s leadership, care team responsibilities and how the practice partners with patients, families and caregivers.  
  Knowing and Managing Your Patients
Sets standards for data collection, medication reconciliation, evidence-based clinical decision support and other activities. 
Patient-Centered Access and Continuity
Guides practices to provide patients with convenient access to clinical advice and helps ensure continuity of care. 

Care Management and Support
Helps clinicians set up care management protocols to identify patients who need more closely-managed care. 
  Care Coordination and Care Transitions
Ensures that primary and specialty care clinicians are effectively sharing information and managing patient referrals to minimize cost, confusion and inappropriate care. 

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

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PCMH Recognition?

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Medical Boards Awarding Maintenance of Certification Credit for Recognition

For information on medical boards that may be offering maintenance of certification credit for recognition, please visit our Recognition Program Resources page.