PCMH Certification for Primary Care Providers

As a recognized leader in PCMH Certification patient-centered medical home (PCMH) transformation, Insight Management has developed proven approaches and tools to assist practices. Our hands-on approach consists of eight concepts that are used to induce actionable steps, which then lead to change. They include:

Engaged Leadership

Quality Improvement Strategy

Empanelment

Continuous Improvement Systems

Patient-centered Interactions

Organized, Evidence-based Care

Enhanced Access

Care Coordination

Individual & Small Practices

We help single site providers with their individual practice or small teams.

Multi-site Practices

We help practices with sites spread across several geographic locations.

Large Groups & Hospitals

We help large practices, as well as small and large hospital systems.

PCMH Transformation

We work collaboratively with our clients to assess their needs and develop customized PCMH support package. Typical services include:

Assessment and Planning

We conduct assessments to determine the readiness of practices to implement the PCMH Model using a tool appropriate for the interests and needs of the client (e.g., PCMH-A, NCQA PCMH™ Recognition Readiness Assessment).

This includes an analysis of existing gaps and preparation of technical assistance plans to address those gaps.

Consultation Services

We deliver professional consultation and technical assistance services to support and empower clinical practices through the stages of redesign that evolve PCMH transformation into a sustainable model of practice.

In addition to providing technical assistance on a full spectrum of PCMH topics, our consultants help clients identify and solve problems in the interest of improving healthcare delivery and administrative practices, systems of care, cost and quality.

Practice Coaching

We provide individual and group coaching on PCMH concepts with a focus on implementation assistance. Coaching may include telephonic or on-site consultation, webinars, workshops and learning collaborative-style events.

To promote local and regional capacity and foster sustainability, we also provide train-the-trainer services that focus on skills-building for future practice coaches.

Learning Collaborative Management

For learning collaborative projects, we offer full-scope administration services.

We can develop selection criteria for participants, assist with the recruitment and selection of qualified practices, support learning communities, plan and conduct in-person and distance learning events, and monitor and evaluate progress.

Recognition Support

We provide comprehensive support for practices pursuing NCQA PCMH™ Recognition including administration of a readiness assessment, recommendations for improvement, assistance developing policies and protocols, final review and submission support.

We have guided practices towards successful completion of single site and multi-site applications towards NCQA PCMH™ Recognition.

Our Approach

Step 1: Gap Analysis

We will conduct a gap analysis to determine the readiness of a practice to implement the PCMH model. This gap analysis compares your current practice model to the certification requirements.

Step 2: Timeframe

We define a timeframe for application submission, which is usually between 45-90 days.

Step 3: Action Plan

We develop a detailed action plan, outlining your needs, and describing exactly how we will tackle each issue.

Step 4: Training & Implementation

Once a plan of implementation is finalized, Insight Management Corp will take a hands-on approach to transforming your practice into a PCMH. We provide a complete turn-key program with on-site training and implementation. This includes developing the PCMH standards and elements for your practice, writing protocols, implementing standards in your EMR, and training your staff (doctors and non professionals).

Step 5: Certification

Lastly, we will handle the preparation, writing, submission and tracking of the application for PCMH certification.

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Get Certified

Learn more about how we help medical practices get certified.

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Patient-Centered Medical Home

Learn more about the process from the NCQA brochure.

We have been recognized by NCQA as PCMH Certified Content Experts.

FAQ

What Is a Patient Centered Medical Home?

The patient-centered medical home (PCMH), is a team based health care delivery model led by a primary care physician, P.A., or N.P. that provides comprehensive and continuous medical care to patients with the use of Electronic Health Records (EHR)–with the goal of obtaining maximized health outcomes.

The principles that define a PCMH have been established and endorsed by the AAP, AAFP, ACP, and AOA.  Certification by the National Committee for Quality Assurance’s (NCQA) under its Physician Practice Connections – Patient-Centered Medical Home Program (PPC-PCMH) is required to become a PCMH.

Who is eligible to become a PCMH?

The requirements of becoming a medical home vary according to your states medicaid.

Click Here For a List of States Who Participate, and Their Eligibility Requirements

What is the Certification Process?

The NCQA has designed a recognition program to objectively measure the degree to which a primary care practice meets the operational principles of a patient-centered medical home.  The program emphasizes:

  • Enhanced care through improved access
  • Open scheduling
  • Expanded hours
  • Communication between patients, providers and staff
How Much Money Can I Make?

*Estimated incentives for PCMH Level 3 Providers

# of Capitated Managed Care Patients/Month $/Month $/Year $/5 Year
500 $3,750.00 $45,000.00 $225,000.00
1000 $7,500.00 $90,000.00 $450,000.00
2000 $15,000.00 $180,000.00  $900,000.00
5000 $37,500.00 $450,000.00  $2,250,000.00

 

*Will vary from state to state. Figures above reflect NY state incentives.

As you can see, PCMH certification can be very lucrative. If your practice sees 5000 capitated patients per month, that could mean $480,000 in incentives per year!

What are the general standards & requirements for PCMH Certification?

Each practice needs to meet 6 standards and 27 elements of:

  • Clinical care
  • Record keeping
  • Patient data
  • Patient access
  • Test and referral tracking
  • Performance reporting and improvement
  • Advanced electronic communications
  • Quality Improvement
  • Patient Centered Practice Philosophy
  • Standardized Policies and Procedures

These standards embody the principles of the NCQA “Triple Aim”, which includes:

  • Lower Costs
  • Higher Quality
  • Better Patient Experience

Each doctor must identify 3 significant clinical conditions and demonstrate the elements and standards are being used.

The NCQA program features two tiers of medical home recognition. Achievement of a given tier is dependent upon a point-scoring system whereby points are awarded if the practice has achieved competency in a given business/practice management process.  Level 2 requires some electronic functions. Level 3 requires a fully functional EHR.  To receive full monetary incentives, practices achieve level 3.  At Insight Management we guarantee you achieve at least level 2 certification.

 

Why Become a PCMH?
  • Certified PCMH’s earn monetary incentives from State Health Departments
  • Improved operating performance and efficiency
  • Better patient care and health outcomes
  • Likely adoption by Medicaid Managed Care for Credentialing
  • Higher likelihood of receiving a grant
  • Improved marketing
How Much Will PCMH Certification Cost Me?
  1. We will provide a complimentary Gap Analysis of your practice at NO COST
  2. We will determine the cost of services based on how well you are using your EMR, total number of practitioners, and total number of patients.

Get A Complimentary GAP Analysis

Fill out the form below to contact us regarding a complimentary GAP analysis.

We have been recognized by NCQA as PCMH Certified Content Experts

Ready to transform your practice? Let’s get started

Address

660 White Plains Road – Suite 460
Tarrytown, NY, 10591
Phone: (914) 524-0500
Fax: (914)-206-4240

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