What is PCMH and Why Become a PCMH Certified Provider?

A Patient Centered Medical Home is a Primary Care provider that agrees to coordinate care for their patients and adhere to certain guidelines and/or certification as designated by their payer(s).

Many insurance companies currently pay extra incentives to providers designated as PCMH by the insurer.  Insurers can use different programs or means to determine a provider’s PCMH status.  NCQA (the National Committee for Quality Assurance) is the most widely recognized certification body used by insurers for PCMH.  However, insurers may have a customized version of the NCQA model or another approach for determining PCMH status.

The Patient Centered Primary Care Collaborative maintains an excellent website for understanding more about PCMH.  Click on the map and then select your state(s) on the right to learn more about available PCMH programs in your state.

Beyond the $s:

Many insurers are promoting PCMH providers on their websites.  Some are now requiring PCMH to join their Preferred Provider Organizations.

Patients and their families may also begin to request (or expect) PCMH status – or at least the attributes of a PCMH provider.

Making it Easier:

Most PCMH providers I have talked with tell me they were already PCMH champions (in actions if not in name).  They then took action to learn about the PCMH programs available to them.  Some retained a consultant while some asked their practice manager or another employee to attain PCMH expertise.  All acknowledged that becoming PCMH is more than an attestation program, it is a way of life affecting the way your practice operates – for the better.

In addition to knowing the requirements and following them, most practices find that having an EHR is a requirement in order to track their PCMH adherence and improve their workflow.  In addition, some EHRs, like Sevocity are pre-validated, allowing you to earn PCMH auto credits.