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Ideas and insights to help health care providers stay informed and profitable in today's challenging health care environment.

ATHN + NCQA = A Faster Path to PCMH

by Todd Rothenhaus, MD, Chief Medical Officer

Today, athenahealth announces the Patient-Centered Medical Home Accelerator Program, an exciting new initiative undertaken with the National Committee for Quality Assurance (NCQA) to help medical groups around the nation. Now, practices using athenahealth’s cloud-based EHR service will automatically receive credit for some of the requirements needed to achieve recognition as a patient-centered medical home (PCMH).

You can read the official press release here but to understand first what PCMH means, it’s a key component of achieving the triple-aim of:

  • improving the health of a patient population
  • enhancing the patient care experience through access, reliability, and quality
  • reducing health care costs

PCMH is not a new concept. The American Academy of Pediatrics came up with it in the late ’60s to describe a central location for archiving a child’s medical record—too bad there was no Cloud back then, eh? AAP expanded the concept to include (take a deep breath) "accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective" care. It was then reborn in the late 2000s with the adoption of PCMH models by a number of primary-care specialty societies, culminating with the adoption in 2007 of a joint position by the American College of Physicians, American Academy of Pediatrics, American Academy of Family Practice, and American Osteopathic Association.

Since then, thousands of practices have become medical homes nationwide. Providers in these practices typically receive additional payments, on a per-member per-month (PMPM) basis, to cover costs associated with care coordination and management. And data from PCMH pilots have been quite promising. The Patient-Centered Primary Care Collaborative (PCPCC) recently released a report summarizing a slew of PCMH pilots demonstrating increased quality of care and reductions in cost.

In order to become designated as a PCMH by insurance providers and other agencies, practices must be recognized by an approved agency. While a number of organizations have created pathways to achieve PCMH recognition, NCQA is the leader. NCQA’s program gives practices clear guidelines about organizing care around patients, working in teams, and coordinating and tracking care over time. Furthermore, NCQA clearly communicates an action plan for becoming a medical home. The PCMH standards are available from NCQA at no cost, and they provide education on how to succeed. Over 7,600 clinicians at more than 1,500 practices across the country have earned NCQA PCMH recognition.

Becoming a recognized PCMH requires thoughtful planning and a great deal of preparation, but athenahealth’s integrated solution and support services ease and accelerate the process for providers. 

Here's how Valley Medical Group did it:

 valley med

First, information technology is critical to achieving a high-functioning PCMH, as care coordination would be impossible without the ability to place reminders. Also, population management would be impossible without the ability to run reports against a practice’s entire panel. A significant number of measures required to achieve PCMH recognition are directly related to having IT infrastructure in place to support PCMH functions. Practices using the athenahealth EHR service will automatically receive credit from NCQA for these measures.

But it’s not just about IT. Practices need pre-validation for test and referral tracking and we enable this step with our document services operations. Our cloud-based services are a differentiator here as in so many other aspects of health care management.

athenahealth also eases the burden of achieving other non-IT measures. For instance, practices must meet a measure to ensure a proportion of visits are actually with the patient’s chosen clinician. For this measure, athenahealth captures the patients PCP preference and monitors the percentage of patient visits that occur with that provider.

Over time, our Quality Management Team will build further reports and functionality into athenaNet to streamline a practice’s renewal in the program.

Along with pre-validation, athenahealth is assembling a suite of additional services designed to ease the way for athenahealth clients to secure full NCQA PCMH recognition that include:

  • pre-filtered reporting for NCQA PCMH applications
  • additional quality management tools to track PCMH measures
  • identifying payer programs that can help subsidize the cost of certification
  • putting you in touch with consulting services to guide your practice to certification

Becoming a patient-centered medical home is a lot of work. athenahealth makes it a lot easier.

Rothenhaus is the chief medical information officer for athenahealth.

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