NCQA updates medical home standards

New standards for patient centered medical homes (PCMHs) focus on behavioral health, care management for high-needs populations and team-based care, among other updates.

The National Committee for Quality Assurance (NCQA) updated the most widely adopted way of organizing and evaluating PCMHs by releasing the latest generation of NCQA medical home standards, PCMH 2014.

NCQA uses the standards to assess primary care practices seeking NCQA PCMH Recognition. This release is the third iteration of the NCQA medical home program since 2008. Currently, over 10 percent of U.S. primary care practices—more than 35,500 clinicians at more than 7,000 practice sites—have earned NCQA PCMH Recognition. Many insurers pay higher reimbursement rates to practices that have earned the NCQA PCMH seal.

Changes affecting the advantages and requirements of NCQA PCMH Recognition include the following:

• Integration of behavioral health: Expectations rise, as they did in previous NCQA standards, that a practice support patients’ behavioral health. Practices are expected to collaborate with behavioral healthcare providers and to communicate behavioral healthcare capabilities to patients.
• Care management focus on high-need populations: Practices are expected to address socioeconomic drivers of health and poorly controlled or complex conditions. Practices also should focus on the special needs of patients referred from the “medical neighborhood” of practices that surround and inform the medical home.
• Enhanced emphasis on team-based care: Revised standards emphasize collaboration with patients as part of the care team and establish team-based care as a “must-pass” criterion for NCQA Recognition.
• Alignment of improvement efforts with the triple aim: Practices must show that they are working to improve across all three domains of the triple aim: patient experience, cost and clinical quality.
• Sustained transformation: In keeping with the goal of continuous improvement, practices show that they comply with NCQA standards over long periods.