PCMH Certification
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.
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.
Get Certified
Learn more about how we help medical practices get certified.
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?
- We will provide a complimentary Gap Analysis of your practice at NO COST
- 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.