Independent Health's PCMH Pilot Practices Achieve

Independent Health's PCMH Pilot Practices Achieve National Recognition

Thomas J. Foels, M.D. MMM, chief medical officer, Independent Health

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The 18 primary care practices involved in Independent Health’s Patient-Centered Medical Home (PCMH) pilot program have each achieved the highest recognition* by the National Committee for Quality Assurance (NCQA). It is the largest number of physician practices to achieve this recognition in Western New York.

The Independent Health PCMH pilot program includes 18 diverse primary care practices across Western New York, 130 physicians and nearly 50,000 Independent Health patients. The national recognition earned by the practices, NCQA’s Physician Practice Connections® - Patient-Centered Medical Home™ (PPC-PCMH), was developed as a roadmap for practices to improve delivery and experience of care for clinicians and patients. The recognition program promotes improving the patient experience and recognizes clinicians for their efforts.

“Each of these physician practices earning the highest level of NCQA recognition is an extraordinary achievement,” said Michael W. Cropp, M.D., president and chief executive officer, Independent Health. “It is a great testament to the hard work and dedication the practices have exhibited through this process. They have really embraced a new way of practicing medicine, which focuses on improved quality and satisfaction among patients, staff and physicians and cost control. We’re very proud of these accomplishments and the positive impact it’s had on their patients, office staff and the entire community.”

The PCMH pilot is a collaboration between Independent Health and the 18 practices to advance the delivery of primary care by assisting practices with developing systems which promote accessible, continuous and coordinated patient-centered care utilizing a team approach. The pilot program includes expanded access, enhanced technology to include electronic medical records, and continuous coordination of care among primary care physicians and specialty care physicians with patients and a comprehensive care team for those with or at risk of having a chronic condition.

Dr. Cropp said patient-centric models like Independent Health’s PCMH pilot are taking hold in communities across the country as a viable way to achieve what’s referred to in the health care reform movement as the triple aim: better care, improved satisfaction and bending the medical trend.

“Health care reform initiatives encourage this type of care delivery and Independent Health and these progressive primary care physician practices are at the forefront of what our nation will be doing as we move forward,” Dr. Cropp said.

The PPC-PCMH standards, developed by NCQA in 2008, consist of 30 individual elements that a primary care practice must meet in order to achieve NCQA recognition. Each element is measured to establish benchmarks and standards and practices had to hold themselves accountable to the standards. One of the standards is patient access where practices measured how long it took for patients to get an appointment and how long they waited prior to being seen. Now, patients can easily schedule same-day sick visits, get timely advice from staff members over the phone and have experienced much shorter wait times in the waiting room.

“These pilot practices have clearly achieved the “triple aim” of enhancing quality, service, and affordability,” Thomas J. Foels, M.D. MMM, chief medical officer, Independent Health. “We’re looking forward to expanding the PCMH initiative to further improve the health of Western New Yorkers by providing better care at lower costs.”

The pilot programs at Independent Health and Priority Health of Michigan are currently being evaluated through a $1.2 million grant awarded by the Department of Health and Human Services Agency for Health Care Research and Quality to Michigan State University. The research will evaluate the advantages and disadvantages of each pilot program based on patient experience, cost, quality and outcomes.

NCQA accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS®, the performance measurement tool used by more than 90 percent of the nation’s health plans. The Recognition Programs were developed to help clinicians and practices support the delivery of high-quality care.

The PPC-PCMH Program reflects the input of the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, the American Osteopathic Association and others in a revision of the PPC 2006 version to assess whether physician practices function as medical homes. Building on the joint principles developed by primary care specialty societies, the program’s nine standards emphasize the use of systematic, patient-centered, coordinated care management processes. There are 10 “must–pass” elements and 3 levels of recognition.

*PCMH practices can receive three levels of recognition, with level three being the highest. The levels are based on a scoring system of the required elements up to 100 points. All level three practices have earned between 85 and 100 points. The NCQA Recognition levels allow practices with a range of capabilities and sophistication to meet the standards’ requirements successfully. The point allocation for the three levels is as follows.

Level 1: 35–59 points and all 6 must-pass elements
Level 2: 50–84 points and all 6 must-pass elements
Level 3: 85–100 points and all 6 must-pass elements

Initial Recognition vs. Renewal
To acknowledge that practices with current NCQA Level 2 or Level 3 Recognition have taken steps toward practice redesign and have systems in place that enabled their recognition level, NCQA offers a streamlined process for renewal through reduced documentation requirements. Practices that satisfactorily demonstrated basic medical home transformation can focus on more advanced aspects of redesign for their renewal applications.

View list of PCMH participating practices