If your practice is thinking about adopting a patient-centered medical home (PCMH) model, evaluating the significance of accreditation should become part of the equation. First, is accreditation necessary? Second, what are the benefits of fulfilling the requirements? Then, how would a practice successfully undertake and complete the process?
Accreditation can provide a roadmap for becoming a PCMH. A subset of practices already have received PCMH accreditation from a certifying body. There are several national programs that award this distinction, including the Accreditation Association for Ambulatory Health Care (AAAHC), The Joint Commission, the National Committee for Quality Assurance (NCQA), and the Utilization Review Accreditation Commission (URAC). Some states and private insurers also offer accreditation.
“Many of these programs provide support and technical assistance to the practices, and this can be invaluable,” says Marci Nielsen, PhD, MPH, chief executive officer of the Patient-Centered Primary Care Collaborative in Washington, D.C. It has been tracking the impact of PCMH adoption, most recently in its January 2015 report, “The Patient-Centered Medical Home’s Impact on Cost and Quality: Annual Review of Evidence 2013-2014.”
Why you should become accredited
PCMH accreditation often is required to obtain an increase in reimbursement from a health plan. In a global capitation arrangement, a provider is reimbursed per-member per-month (PMPM) for the entire network population. A payer needs external validation to justify compensating one provider differently from another.
PCMH accreditation signifies that a provider has become an advanced primary care practice. This designation means that the practice has undergone a transformation in quality and safety enhancement and has established a foundation for coordination across the continuum of care. It offers extended hours, care management to patients with chronic illnesses, behavioral health integration, or other services, Nielsen says.
In addition, Medicare likely will use some form of accreditation to justify bonuses and other payment boosts for PCMHs under its future value-based payment programs now that the Sustainable Growth Rate formula has been eliminated.
From a patient’s perspective, accreditation indicates that a practice offers enhanced services and higher quality of care. “We have a fair amount of work to do because patients are still unfamiliar with the term ‘medical home,’ ” Nielsen says. “PCMHs are increasingly looking to engage patients and families as partners in quality improvement. Patient engagement at this level of organizational change will need to become a much more earnest part of primary care reform if practices are truly going to transform into patient-centered medical homes.”