PCMH Incentive, Recognition, and Accreditation Programs
PCMH Incentive Programs
Patient-centered medical home (PCMH) incentive programs are local, state, and public/private payer initiatives that offer payment incentives to participating practices that adopt the functions of a PCMH. To determine whether such initiatives exist in your area, visit the Primary Care Innovations and PCMH Map(www.pcpcc.org) or contact your local AAFP chapter.
Examples of national initiatives that may be operating in your state include the following programs from the Centers for Medicare and Medicaid Services:
- Comprehensive Primary Care (CPC) Initiative: The CPC Initiative operates in seven U.S. states and offers bonus payments to family physicians who improve care coordination for their patients.
- Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration(innovation.cms.gov): This demonstration project operates in many U.S. states and offers bonus payments to FQHCs to improve the quality and coordination of patient care. Participants in the project are required to achieve Level 3 PCMH recognition from the National Committee for Quality Assurance (NCQA).
Note: Many PCMH incentive programs require participation in a designated PCMH recognition or accreditation program (learn more below).
PCMH Recognition and Accreditation Programs
A number of local, state, and national PCMH recognition and accreditation programs are available. Some practices are required to complete a PCMH recognition program (e.g., for participation in an accountable care organization [ACO] or PCMH incentive program), but PCMH recognition for many practices is voluntary.
To determine whether your practice is required to participate in a recognition or accreditation program, refer to your ACO, PCMH incentive program, federal grant (e.g., Health Resources and Services Administration), and major practice payer (e.g., Medicaid, private insurance, etc.) agreements. If recognition is required, your agreement will typically designate a specific recognition program for you to complete.
If you are not required to participate in a recognition program but choose to do so anyway, research the available programs to determine which is most appropriate for your practice. Be sure to consider the application cost, data and documentation requirements, and staff resources required to complete the application process. Use this information to formulate a complete picture of the total costs—monetary and resource-wise—associated with each program.
National Recognition and Accreditation Programs
- Accreditation Association for Ambulatory Health Care (AAAHC) Medical Home On-site Certification(www.aaahc.org)
- National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH 2014) Recognition(www.ncqa.org)
- The Joint Commission (TJC) Designation for Your Primary Care Home(www.jointcommission.org)
- URAC Patient-Centered Medical Home Accreditation(www.urac.org)
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