PCMH as Public Policy

States and the federal government use NCQA’s PCMH model to help make primary care more efficient and effective in meeting patient’s needs.

Many efforts are underway at the state and federal level to deliver higher-quality health care at lower costs. NCQA is at the forefront of these efforts, with rigorous programs to make sure that delivery-system reforms protect consumers and deliver results.

NCQA recognizes practices that follow the medical home model and transform their operations to meet patients needs. PCMHs provide:

  • Enhanced access to care through expanded hours, online communications and long-term partnerships with clinicians, rather than sporadic, hurried visits.
  • Highly coordinated care — especially for preventive services and those with chronic conditions — that includes connections to other clinicians and community supports.
  • Shared decision-making between providers and patients.

Our Patient-Centered Medical Home (PCMH) recognition program plays a key role in primary care reform initiatives across the country.

PCMH & The States

Twenty-five public sector medical home initiatives across 22 states require or incentivize NCQA PCMH Recognition. More information here.

  • What’s the value to states?
    • Provides a standardized model of care.
    • Improves outcomes, lowers utilization.
    • Aligns with MACRA/MIPS and CPC+.
    • Builds provider capacity, improves access.
    • Supports value-based payment initiatives.
    • Enhances state quality improvement efforts.
    • Foundation for building accountable care organizations/clinical integration networks.
    • Drives savings.

State Spotlight: Tennessee. Tennessee uses NCQA PCMH Recognition to improve care delivery for their Medicaid patients. Read more on how they incorporated the program here.


PCMH & The Federal Government

Under the new Quality Payment Program created by MACRA, Medicare awards full automatic credit for completion of Improvement Activities to recognized PCMH practices.

Beyond this benefit, PCMH recognition can help practices to prepare for and thrive under MACRA.  See our MACRA Toolkit to learn more.

NCQA has worked with the Departments of Defense and Health and Human Services to help transform primary care facilities into NCQA PCMHs.


PCMH & The Medical Neighborhood

But what about the other doctors people see? That’s where the “medical home neighborhood” comes in. NCQA has products that bring the medical home model to all points of care: specialists, urgent care clinics, case managers and more

NCQA’s Patient-Centered Specialty Practice (PCSP) recognition program addresses gaps in quality that occur due to a lack of coordination between primary care and specialty practices.

NCQA’s Patient-Centered Connected Care program for urgent care sites ensures a relationship between clinics and primary care doctors.

NCQA has developed a School-Based Medical Home program that recognizes high-quality school health centers that provide comprehensive medical care to children and adolescents in their districts.

Learn more about the PCMH and other medical neighborhood programs here.


PCMH Evidence

Patient-centered medical homes are driving some of the most important reforms in health care delivery today. A growing body of scientific evidence shows that PCMHs save money by reducing hospital and ED visits, reducing health disparities and improving patient outcomes. Check out our PCMH Evidence Report here.

Support in your state. Many entities offer support to practices going through the NCQA Recognition process. Here’s a list of public, private and multi-payer initiatives, by state, that support a variety of NCQA Recognition programs. Check out the Directory of Incentives.

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