Patient Centered Medical Home: Transforming Your Health Center

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1 Patient Centered Medical Home: Transforming Your Health Center A Guide to Obtaining PCMH Recognition

2 What is a Patient Centered Medical Home? The Patient Centered Medical Home (PCMH) is a healthcare delivery model that improves the quality of care for patients through increased access, planning, management, and monitoring of care. It is an approach to providing comprehensive primary care for community members of all ages, which facilitates partnerships between individual patients, their providers, and when appropriate, the patient s family. PCMH is defined by several care principles, outlined on page 7. The PCMH model offers many benefits including increased patient, staff, and provider satisfaction, reduced hospitalization and emergency room visits, reduction in overall health costs to health centers and patients, and reduced strain on the healthcare system. PCMH benefits have been acknowledged by national organizations as well as state legislation. Twenty-two states define, test, implement, or promote PCMH in their laws. The AIDS Education and Training Centers (AETC) National Center for HIV Care in Minority Communities (NCHCMC), led by HealthHIV, is the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau s (HAB s) major effort to expand HIV/AIDS care and treatment within highly impacted communities of color served by community health centers. The AETC NCHCMC increases access to comprehensive HIV care by developing the organizational capacity of health centers, and includes both clinical and practice transformation training, as well as capacity building. HIV in the Patient Centered Medical Home HIV impacts many populations across the United States that have historically lacked access to the health care system, including support and prevention services. These communities include low-income and medically underserved communities, ethnic and racial minorities, the homeless, and substance abusers. Within the last decade, there have been major advances in treatment, which have significantly increased the length and quality of life for people living with HIV. However, disparities in access to HIV treatment and quality care persist. As people living with HIV age, and lead longer lives, they face additional health challenges for which a PCMH is well equipped to provide care. By integrating services across specialties, PCMHs provide comprehensive HIV care in high-risk and severely impacted communities, thus promoting health equity. 2

3 Frequently Asked Questions: What types of facilities become PCMHs? Almost every type of health facility can be a PCMH. Many Federally Qualified Health Centers and look-alikes have been recognized. The majority of accredited PCMH facilities are family medical practices. An increasing percentage of PCMH facilities offer primary and specialty care. How long does it take to be recognized? Time periods vary. Recognition timeframes depend on the practice s starting point, financial situation, health plan, and choice of accrediting body. What are the challenges? The top five challenges cited by a Medical Group Management Association (MGMA) survey were: Establishing care coordination agreements with referral physicians, Financing the transformation, Coordinating care for high-risk patients, Projecting financial effects (e.g. practice revenue and costs), Modifying or adapting an EHR system to support PCMH related functions. How long will my health center be recognized for? All recognizing bodies, except for URAC, provide PCMH recognition for three years. URAC recognizes PCMH for two years before reaccreditation must take place. Health centers can reapply for recognition before the previous recognition expires in order to remain continuously recognized. Where can I get more information on PCMH? For more information on PCMH recognition, go directly to the websites of the recognizing bodies (found on pages 4 and 5). For more information on the benefits of PCMH, visit the website of the American College of Physicians ( For a more extensive checklist of requirements and guidelines, visit the American Academy of Family physicians ( Visit the HRSA Bureau of Primary Health Care ( for information on funding for PCMH recognition. How can I apply to participate in the AETC National Center for HIV Care in Minority Communities? For applications, news, updates and information, please visit 3

4 Key Features of PCMH Recognition Four national organizations offer recognition for health centers to become PCMHs. Each offers a unique recognition process. National Committee for Quality Assurance (NCQA) Joint Commission Utilization Review Accreditation Commission (URAC) Accreditation Association for Ambulatory Health Care (AAAHC) Program Name Physician Practice Connections Patient-Centered Medical Home Program Primary Care Medical Home Option, as part of the Ambulatory Care Accreditation Patient Centered Health Care Home Program Medical Home On-Site Certification/ Medical Home Accreditation Key Components Survey tool Training on PCMH standards and guidelines A state-wide program manager that provides individual guidance Webinars and seminars available (additional cost: $990) Site visit available (additional cost: $3,000) Accreditation handbook Access to the Joint Commission Business Development Staff and Standards Interpretation Group Online survey activity guide Access to the Targeted Solutions Tool online Three day site visit by an accredited Ambulatory Care Surveyor Two workshops explaining the URAC accreditation process A toolkit that includes practice assessment standards, interpretive guidance, and checklist Site visit by a URAC Certified Auditor or Reviewer Medical Home On-Site Certification Certification handbook with specific standards Site visit by AAAHC surveyors Medical Home Accreditation Excerpts of the Handbook for Ambulatory Health Care on Medical Home Comprehensive medical home survey process conducted by AAAHC surveyors Recognition Process NCQA recognition is based solely on the application and self assessment. The self assessment is very specific and is guided through a survey tool. An on-site, three day survey to validate the information provided in the application and to further educate the health center staff. Recognition is based on the application and site visit results. After sending preliminary background information via an application, an URAC Certified Auditor or Reviewer performs an on-site practice audit. The process includes review by a licensed health professional who evaluates the processes and documentation on-site. Accreditation consists of an on-site survey of staff, facility, equipment, medical protocols, and the coordination of care procedures. Costs Application price varies by number of providers, starting at $500, and the survey tool is $80 per site. Seminars cost $1,000 on average, ranging from $850 to $1,250. For health center sites with an average daily patient census of under 30 individuals the cost is $5,150 for the first year, and $1,100 every year after - for a total of 3 years of accreditation. For sites with higher average daily censuses and multiple sites or providers, costs can reach to $15,000. $1,155 for toolkit. Total cost ranges from $720 to $2,400. On-site visits cost $1,500 per day and vary according to length of stay and level of achievement requested. For on-site certification, including application and survey fee, cost is $3,500 per site. For full accreditation, contact AAAHC. Costs vary greatly according to size, range and type of services provided by the organization. Unique Aspects NCQA is endorsed by HRSA, and offers a 20% discount for applicants working with health plans, employers, and other programs. NCQA PCMH awards are recognized by many states for monetary and legislative benefits. Check your state s Association of Family Physicians or department of health for details. This program is connected to ambulatory care accreditation and was initiated in The recent creation of the program limits its recognition from other organizations and states. The on-site audit is low-cost and offers basic requirements for full accreditation. URAC released their toolkit in This program offers an on-site certification program, which allows for rapid completion when compared to the others. The handbooks for both programs are very extensive. Getting Started Call: pcmh@ncqa.org Call: Call: Call: mwallander@aaahc.org 4

5 PCMH Checklist: Questions to ask if your health center is considering becoming a PCMH* PCMH Principles Yes In Progress No Do patients have a designated primary care provider? Does your health center allow patients to select their primary care provider? Are health services delivered by a provider-directed care team? [Check to see if NPs, PAs are allowed to lead the team with each accrediting body.) Does your health center foster collaboration among providers, staff, patients, and their families to ensure that decisions respect patients wants, needs, and preferences? Does your health center provide resources to ensure that patients have the education and support needed to make decisions and participate in their care? Does your health center offer support for patient self-management? Does your health center offer coordinated or integrated care with other organizations, including local hospitals, community services, and specialty care practices? Does your health center use internal and external resources to meet patients needs? Do the partnerships with other organizations allow transfer of patient information and ensure quality follow-up? Are all providers and staff trained in the cultural, linguistic, and educational needs and preferences of the patient population? Have patients been informed on how to obtain medical care 24 hours a day, 7 days a week? Does your health center use advanced health information technology, including electronic prescribing and patient registries? * In order to be recognized, these principles need to be formally adopted and implemented. Each component varies by recognizing organization. This checklist is intended to be representative of the components and principles of PCMH. 5

6 About HealthHIV Mission HealthHIV advances effective prevention, care, and support for people living with, or at risk for, HIV/AIDS through education, technical assistance, and health services research to organizations, communities and professionals. Programs The AIDS Education and Training Centers (AETC) National Center for HIV Care in Minority Communities (NCHCMC) works to increase access for ethnic and racial minority communities to culturally competent HIV care through the nation s community health centers. The AETC NCHCMC is a three year effort supported by HRSA-HAB and the Minority AIDS Initiative (MAI), to develop the clinical and organizational capacity of health centers not directly funded through the Ryan White HIV/AIDS Program to offer comprehensive HIV/AIDS care and treatment within highly impacted communities of color. The Fiscal Health: Systems to Sustainability program helps ensure the fiscal sustainability of Ryan White funded grantees by delivering trainings that builds participant s organizational fiscal management capacity, diversifies and improves income streams, and enhances operational fiscal systems. The HIV Education & Learning Program (HELP) is an exclusive, free online resource providing AIDS Service Organizations (ASOs) and Community Based Organizations (CBOs) access to current, relevant HIV educational materials to share with their clients. The Exchange and Engage: Mayors and HIV Prevention project, funded through a cooperative agreement with the Centers for Disease Control and Prevention, supports mayors nationwide in leading implementation of the National HIV/AIDS Strategy. These efforts impact the health of the communities within their jurisdictions and influence other leaders nationwide to address HIV prevention. HIV Primary Care Plus, a ground-breaking continuing medical education activity that focuses on building primary care providers skills and performance in the screening, treatment, and management of HIV. The following sources were used in developing this guide: MGMA: Most Medical Practices in Process of Transforming to PCMH Model, Healthcare Finance News, 10 August American Academy of Family Physicians, 1 August American College of Physicians, 1 August Patient-Centered Primary Care Collaborative, 1 August

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8 For more information on HealthHIV, S Street, NW Washington, DC Tel: Fax: Special thanks to Hannah Grill for contributions to this guide.