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Advancing patient-centered practice transformation

Healthcare market dynamics are shifting toward value-based care. For primary care practices seeking patient-centered care and the associated financial incentives, the Patient-Centered Medical Home (PCMH) model is the sweet spot. As sweeping delivery system reform kicks off in 2017, practices can look forward to a clear regulatory roadmap to align their efforts with the PCMH model and succeed in their journey to becoming truly patient centered.

Increasing focus on patient-centered care

Early attempts to define the framework for PCMH date back to the 1960s, with the goal of offering patient-centered, family-oriented and family-coordinated care delivery to families. Years of experience related to success of this model has led to the formation of many recognition programs. Today’s National Committee for Quality Assurance (NCQA) PCMH program is a widely known offering to recognize practices demonstrating patient centeredness. As of July 2015, NCQA recognized 11,388 sites across the country as Medical Homes.

MACRA, which stands for the Medicare Access and CHIP Reauthorization Act of 2015, is Medicare payment reform designed to help lower the cost of health care, while delivering better quality and improving health outcomes. It creates a more comprehensive value-based framework for payment and combines different quality-based measures into one system, in particular for primary care transformation programs like PCMH.

The Centers for Medicaid and Medicare (CMS) demonstrates its commitment to patient-centered care by including additional primary care funding in the 2017 Physician Fee Schedule released just this week and also encouraging practices to adopt the Medical Home model with new incentives. For example, the Merit-based Incentive Payment System (MIPS) track in the MACRA rule emphasizes the importance of recognized Medical Homes by offering a full 15% to such practices under the Clinical Performance Improvement Category (CPIA).

CMS awards even higher incentives for the Advanced Alternate Payment Model (Advanced APM) track, where PCMH recognition is an early opportunity to participate. CMS will be considering how to include some forms of the Medical Home as an Advanced APM.

Saving time and money with pre-validated solutions

Transforming a practice to be ready for PCMH is no small task. A typical PCMH recognition journey would require two or three full-time employees for 12-15 months to become ready, owing to the stringent quality standards. Why does it take so long? The answer often lies in health IT and workflow capabilities.

Recognizing the advantages health IT can offer, NCQA pre-validates solutions that demonstrate workflow capabilities that support PCMH. We have found through our experience with clients that use of a pre-validated solution reduces the transformation journey drastically to less than six months and requires fewer employees.

The NCQA PCMH pre-validation program offers two types of vendor recognition:

  1. Auto Credit: Practices that adopt these solutions can get points toward PCMH certification scores without submitting any additional documentation to NCQA.
  2. Practice Support: Practices seeking credit for individual PCMH factors can reduce their documentation burden by adopting these solutions.

How Allscripts can help with practice transformation

At Allscripts, we believe in being the catalyst for change in healthcare delivery through investment and innovation in smart health IT solutions.

Allscripts Professional EHR™ was recently awarded pre-validation by NCQA for PCMH 2014 standards. Clients using Professional EHR versions 15.0, 15.1 or 15.3 can benefit from the pre-validation scores:  21.25 points for Auto-Credit and 96 PCMH factors approved for Practice Support.

Clients seeking recognition from NCQA can contact Allscripts for the following documents for the submission process: 1) NCQA summary approval table, 2) NCQA product approval letter and 3) Allscripts product implementation letter.

To learn more about how Allscripts can help with PCMH certification or to upgrade your solution to a certified version insidesales@allscripts.com.

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