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NCQA Program to Evaluate Patient-Centered Medical Homes

Posted on: Tuesday, 8 January 2008, 12:00 CST

The National Committee for Quality Assurance (NCQA) today launched a new version of its Physician Practice Connections (PPC) program designed to assess how medical practices are functioning as patient-centered medical homes. The new Physician Practice Connections -- Patient-Centered Medical Home (PPC-PCMH™) emphasizes the systematic use of patient-centered, coordinated care management processes.

The new standards are aligned with the joint principles of the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP) and the American Osteopathic Association (AOA), which define the key characteristics of the patient-centered medical home. NCQA worked closely with the four medical specialty organizations and other interested stakeholders to develop the PPC-PCMH and the specialty societies have supported the standards as the tool to use to recognize practices as medical homes in demonstration projects around the country.

The medical home is a promising approach that seeks to strengthen the patient-physician relationship by replacing episodic care with coordinated care and a long-term healing relationship. The AAFP, AAP, ACP, and AOA have defined the medical home as a model of care where each patient has an ongoing relationship with a personal physician who leads a team that takes collective responsibility for patient care. The physician-led care team is responsible for providing all the patient's health care needs and, when needed, coordinating care across the health care system. A medical home also emphasizes enhanced care through open scheduling, expanded hours and communication between patients, physicians and staff. Many large health plans, as well as Medicare and Medicaid, are planning demonstration projects to learn more about how practices can become medical homes and the quality and cost advantages of doing so.

"The Patient-Centered Medical Home has the potential to change the interaction between patients and physicians from a series of episodic office visits to an ongoing two-way relationship," said NCQA President Margaret E. O'Kane. "Patients can no longer be silent partners in their care -- they are active participants in managing their health with a shared goal of staying as healthy as possible."

"The Patient-Centered Medical Home offers the opportunity to improve health care quality for all Americans," said John Tooker, Executive Vice President and Chief Executive Officer of the American College of Physicians. "Through the PPC-PCMH, NCQA is helping physicians understand what functioning as a patient-centered medical home means on a day-to-day basis for their practices and establishing standards to recognize physicians who provide this type of care."

PPC-PCMH includes nine standards for medical practices to meet, including use of patient self-management support, care coordination, evidence-based guidelines for chronic conditions and performance reporting and improvement. To be recognized as a patient-centered medical home, practices will need to demonstrate the ability to sufficiently meet the criteria of these standards (i.e. achieve a minimum of 25 points out of 100 to attain the first of three levels of recognition) and specifically pass at least five of the following 10 elements:

Written standards for patient access and patient communication

Use of data to show standards for patient access and communication are met

Use of paper or electronic charting tools to organize clinical information

Use of data to identify important diagnoses and conditions in practice

Adoption and implementation of evidence-based guidelines for three chronic conditions

Active patient self-management support

Systematic tracking of test results and identification of abnormal results

Referral tracking, using a paper or electronic system

Clinical and/or service performance measurement, by physician or across the practice

Performance reporting, by physician or across the practice

Large employers have also embraced the patient-centered medical home concept. "The comprehensive and coordinated care that the medical home promotes leads to better health, longer lives, higher patient satisfaction and less expensive care," said Paul Grundy, chairman of the Patient-Centered Primary Care Collaborative and IBM's Director of Healthcare, Technology and Strategic Initiatives for IBM Global Wellbeing Services and Health Benefits. "The question isn't whether we should implement the medical home, but how. These standards clearly assess and identify effective medical homes."

PPC-PCMH joins four NCQA programs designed to recognize excellence in patient care in medical practices. Along with PPC, the programs focus on caring for patients with diabetes, cardiovascular disease or stroke, and back pain. For more information about all NCQA Recognition programs, visit http://web.ncqa.org and click on "Recognition".

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes physicians in key clinical areas. NCQA's Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices. For more information, visit http://www.ncqa.org/.

Source: Business Wire

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