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), the National Center for Medical Home Implementation(medicalhomeinfo.aap.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 Plus (CPC+): The CPC+ model is an opportunity for primary care to receive better, more flexible payment and participate in a robust learning community to better meet patient needs. CPC+ is currently being tested in two rounds in 18 regions supported by 66 aligned payers.
  • Transforming Clinical Practice Initiative (TCPI): The Transforming Clinical Practice initiative (TCPI) is a four-year (September 2015-2019) technical assistance program designed to help clinicians expand their quality improvement capacity, engage in greater peer-to-peer learning, and utilize health data to determine gaps and target intervention needs.

Note: PCMH incentive programs may 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.

Get Paid Now For PCMH-related Work

Medicare began paying for chronic care management on January 1, 2015. Get knowledge and tools necessary to get paid for the work you and your staff provide in treating Medicare patients with multiple chronic conditions.

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