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CloudView blog

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

No More Excuses for Avoiding PCMH Certification

by Todd Rothenhaus, MD, Chief Medical Officer

What if you knew your team could make the playoffs simply by selecting a particular coach?  And that you could win the championship just by following that coach’s game plan? Well, when it comes to Patient-Centered Medical Home (PCMH) recognition, athenahealth is that coach – and we have a game plan that just about guarantees our clients take home the title.

In 2011, athenahealth pioneered support for PCMH recognition through an innovative pre-validation program with the National Center for Quality Assurance (NCQA), the most widely used and fastest-growing PCMH recognition program.

Since we launched our PCMH Accelerator program soon after, clients seeking PCMH recognition have received advanced credit from NCQA just for using our suite of cloud-based services (integrated practice management, EHR and patient engagement services). By following our straightforward guidance, practices could obtain Level 3 recognition with far less effort than starting from scratch.

That was then. Now, for the newer PCMH 2014 standards, we have taken our support to a whole new level.

Today, athenahealth announced that NCQA pre-validation has given our services 35.25 PCMH auto credits significantly lowering the threshold for PCMH recognition.

What does that mean for practices? For starters, it’s a streamlined pathway towards Level 1 PCMH recognition just for using our services. Then, by following our NCQA-approved practice-supported workflows, combined with our auto-credits, practices can collect 80.75 of the 85 points required for Level 3 certification. That means the total number of points athenahealth clients need to achieve on their own for Level 3 recognition is just 4.25. When we talk about the athenahealth commitment to provider success, this is what we’re talking about.

An Old Concept Finally Takes Hold

The idea of the Patient-Centered Medical Home is not new. The American Academy of Pediatrics first used the term “medical home” in 1967 to describe a partnership between families and physicians to deliver primary health care that was “accessible, family-centered, coordinated, comprehensive, continuous, compassionate, and culturally effective.”

Since its introduction, the term “medical home” has been adopted, interpreted, and promoted by the World Health Organization (WHO) and the Institute for Medicine. Evaluations of PCMH models have found significant cost savings, decreases in utilization, and improved outcomes in chronic disease management. The growing proof of the model’s effectiveness is in improving primary care to lower overall costs.

Many payers already reward PCMH recognition and, with recent legislation stating that Medicare will provide an additional 5% payment to PCMH practices, it is clear that such incentives are growing.

Thecore competencies needed to become a PCMH practice are not exclusive to the medical home model – they can be found in new delivery models like ACOs, pilot programs like the Comprehensive Primary Care Initiative (CPCI), and the majority of state Medicaid of Children’s Health Insurance Programs (CHIP).

At athenahealth, we love PCMH because the tenets of the philosophy – open access, patient activation, continuity of care, and focus on outcomes – speak to our aspiration to equip all our clients with what they need to optimize performance and deliver better care: To schedule appointments more easily, engage patients via online tools, get connected to hospitals, labs, and other trading partners, and leverage our quality management insight narrow gaps in care.

We are thrilled that NCQA recognizes our offering as being well-positioned to advance PCMH goals. The high number of auto credits they awarded our services is clear acknowledgement of that fact. 

As always, athenahealth is committed to doing the hard work required to lessen the burden of providers – and ensure they thrive through these changes. The athenahealth PCMH Accelerator Program gives primary care practices of all sizes another leg up in getting paid what they deserve, making it easier to get recognized for the crucial, high quality care they provide.

To learn more about our commitment to helping practices achieve Patient-Centered Medical Home recognition, read our press release. 

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Cloudview Blog

Ideas, insights and analysis to help physicians, medical groups and health systems stay informed and profitable in today's challenging health environment.

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Submitted by Maria a. Herrera - Wednesday, August 12, 2015

How do you become PCMH Certified?

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