Comparing, Contrasting, and Selecting a Medical Home Model

The medical home model is a primary care practice model that was formally defined in 2007 by the Joint Principles of the Patient-Centered Medical Home (PCMH) memo released by the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), the American Academy of Pediatrics (AAP), and the American Osteopathic Association based on prior models first devised in the late 1960s.(1) The PCMH model emphasizes high-level goals in providing care to populations of children and adults that are reflected in the milestones set by accrediting organizations in regard to specific metrics and clinical indicators. In recent years, this model has seen significant acceptance as a core component of the Alternative Payment Models (APMs) emphasized as alternatives to the Merit-Based Incentive Payment System (MIPS) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).(2) Thus the medical home model provides an important potential pathway for primary care physicians to springboard into CMS-approved versions in the future that avoid having to compete for reimbursements under MIPS. The simple question often arises, however—what exactly makes a practice a medical home, and what is necessary to be accredited as a medical home? This presents key selection factors that may influence adoption of one of the PCMH models established by the National Committee for Quality Assurance (NCQA), the Joint Commission, the Accreditation Association for Ambulatory Health Care (AAAHC), or the Utilization Review Accreditation Commission (URAC).

Comparison of PCMH Incentives and Requirements

Depending on the practice site’s capabilities and its previous relationship, if any, with the four PCMH accrediting/recognizing organizations, practices may find that the benefits of one over the others make it an obvious choice for their specific circumstance. Because the first and third levels of the NCQA PCMH recognition are roughly equivalent with the Joint Commission’s ACC and full PCMH accreditation, respectively, the primary motivating factors for choosing one versus the other would most appropriately rest on minimizing compliance costs in both time and manpower, with a goal of maximizing patient outcomes and overall revenue generation from any subsidies or PCMH grants from third-party payers or federal funds. Although these financial incentives may change yearly, a few subsidies historically have been available as an incentive for practices to adopt a medical home model (Table 1). Furthermore, choosing accreditation from any of the national programs also will rest on previous accreditations with each organization and comparing current practice capabilities with the specific requirements and attributes of each organization’s PCMH award (Table 2).

Complexity versus Convenience versus Cost

On average, NCQA accreditation is one of the more cost effective and least complex options for practices that operate at either a single site or a limited number of sites. This option is also very appealing for organizations that have independent departments that may require accreditation that the remaining portion of the organization does not require, such as at academic centers and multispecialty, multi-site practices.(7,8) However, for organizations that have preexisting relationships with either the Joint Commission, the AAAHC, or the URAC, seeking medical home accreditation with these organizations may be more convenient, because preexisting relationships can help smooth the adoption of processes and standards necessary to meet compliance criteria. Because many of the medical home requirements are in line with each organization’s basic ambulatory care accreditation for receiving CMS approval for reimbursements, preexisting cost savings from program-specific processes already in place to meet basic requirements may offset any additional program costs for accreditation.

Despite differences in complexity and cost, all four national programs require use of healthcare IT and have embedded CMS Meaningful Use requirements in their compliance standards. Although Joint Commission PCMH accreditation appears to be the most complex due to its number of standards, this is not necessarily a deterrent from pursuing this route if the organization has processes established from other concurrent Joint Commission accreditation, because the additional costs associated with PCMH certification are negligible. The decision to choose one medical home model over another is highly specific to the circumstances of the practice or organization seeking recognition or accreditation, and those interested should reach out to these organizations to determine suitability for their individual practice requirements.

Other Resources

As mentioned previously, this article is designed to provide an executive overview of the four major national PCMH accreditation/certification/recognition programs currently approved by the CMS. Many of the primary care–centered physician professional organizations provide further tools and educational resources for those interested in pursuing transformation to a PCMH practice. The AAP provides pediatric-centered medical home resources including educational modules and further information on PCMH models as they apply to pediatric primary care.(9) The AAFP provides extensive information regarding PCMH incentives, recognition, and accreditation programs, along with contact information for local AAFP chapters and interactive maps to help practices evaluate which initiatives and incentives are applicable in their geographic region.(10) The ACP likewise provides comprehensive overviews of PCMH topics, cost–benefit analysis, and a number of resources and tools for practices to further assess capabilities for PCMH adoption.(11)

References

1. Joint principles of the patient-centered medical home. AAFP.org . March 7, 2007. www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PCMHJoint.pdf . Accessed April 10, 2017.

2. Self RH, Coffin J. Finding the best MACRA rout to provider reimbursement. Medical Economics. February 8, 2016. http://medicaleconomics.modernmedicine.com/medical-economics/news/finding-best-macra-rout-provider-reimbursement?page=0,3 . Accessed April 10, 2017.

3. HRSA accreditation and patient-centered medical home recognition initiative. HRSA.gov . https://bphc.hrsa.gov/qualityimprovement/clinicalquality/accreditation-pcmh/index.html . Accessed April 10, 2017.

4. Primary care medical home comparisons. JointCommission.org . www.jointcommission.org/assets/1/6/compare_tjc_pcmh_ncqa_pcmh.pdf . Accessed April 10, 2017.

5. Comparison of NCQA 2014 Medical Home Recognition to 2014 Joint Commission Primary Care Medical Home Certification for Ambulatory Care Organizations. JointCommission.org . www.jointcommission.org/assets/1/18/PCMH_cross_ncqa.pdf . Accessed April 10, 2017.

6. Gans DN. A comparison of the national patient centered medical home accreditation and recognition programs. MedicalHomeSummit.com . January 30, 2014. www.medicalhomesummit.com/readings/A-Comparison-of-the-National-Patient-Centered-Medical-Home-Accreditation-and-Recognition-Programs.pdf . Accessed April 10, 2017.

7. Patient-centered medical home resources: comparison chart. HRSA.gov . Updated February 19, 2015. https://bphc.hrsa.gov/qualityimprovement/clinicalquality/accreditation-pcmh/pcmhrecognition.pdf. Accessed April 10, 2017.

8. Zimlich R. The costs of becoming patient-centered. Medical Economics. May 25, 2013. http://medicaleconomics.modernmedicine.com/medical-economics/content/modernmedicine/modern-medicine-feature-articles/costs-becoming-patient-cen . Accessed April 10, 2017.

9. American Academy of Pediatrics. Medical home. AAP.org . www.aap.org/en-us/professional-resources/practice-transformation/medicalhome/Pages/home.aspx . Accessed April 10, 2017.

10. American Academy of Family Physicians. The patient-centered medical home (PCMH). AAFP.org . www.aafp.org/practice-management/transformation/pcmh.html . Accessed April 10, 2017.

11. American College of Physicians. Patient-centered medical home. ACPOnline.org . www.acponline.org/practice-resources/business-resources/payment/models/pcmh . Accessed April 10, 2017.