I was fortunate to attend NCQA’s 2^nd Annual PCMH Congress this past weekend in Chicago. There were nearly 1,000 attendees, including a unique blend of folks from policymakers, primary care and specialty providers, healthcare administrators, healthcare IT and quality & practice administrators from a variety of HCOs across the country–the core folks you need in your organization to work together to be successful in today’s changing healthcare model, with more focus on quality and less on quantity to transform your practice!

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Here are some of the key themes throughout the 3-day conference:

• MACRA was THE hot topic! Attendees learned everything from basics of the MACRA program, including the Quality Payment Program (QPP), to a deeper dive into two categories under QPP: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). QPP begins just a few months away on January 1^st, 2017.
  • The final rule is expected to be released soon. In the proposed rule, NCQA-recognized PCMH and PCSP practices will receive full credit under the MIPS arm in a new category called Clinical Process Improvement Activities (CPIA). Additionally, practices are well positioned to receive full credit for Advancing Care Information (ACI), formerly known as MU, another category of MIPS.
  • For those organizations who are currently recognized and ready to take the next step in their quality program and bear risk, CPC Plus is a natural fit for those seeking to participate in the APM model.

• For those just starting out on their PCMH journey, I walked away with two important concepts that every practice will need to embrace to be geared for success.
  • PCMH is not a project; it is a care model.
  • Understand change management concepts and the culture of your organization. Without thoroughly understanding both of these, how these are defined, and how they will impact your actual organization, you may face challenges!

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• Networking is a given at most of these type of events, and it is not news to us that are frequent flyers to such venues. What I found special at this particular conference was the genuine exchange among everyone from presenters to attendees on what worked and what didn’t for their journey. This wasn’t just “sit back and watch” but true engagement with real “how-tos,” lessons learned, and troubleshooting to overcome challenges practices have experienced. Here’s an example of what I mean:
  • There were a couple of sessions on empanelment, where a total of four different organizations shared their process for patient panel assignments and how they tiered their patient population to adjust provider panels and care based on risk stratification of their panel. For those of you already thinking that it is common at conferences to hear something like this, well I am in the same boat as you. However, the Q & A sessions on each topic truly allowed sharing between organizations on what worked and what didn’t with honest-to-goodness tips and tricks. One item that struck a chord with me in particular was “what obligation do you have organizationally and as a clinician on patient’s lost to care whether they moved or selected another provider for care and are still on your panel list?” How far do you reach out? How often do you attempt to reach them to ensure they are cared for?

Michael Barr, MD, MBA, FACP, discussing NCQA 2017 PCMH redesign

• The last item I’ll bring up is the PCMH 2017 redesign that is coming. NCQA redesigned the PCMH recognition program primarily based on feedback they’ve received from practices, and I find this very refreshing. As a PCMH Certified Content Expert (CCE), I had the honor to attend a special breakfast with the NCQA leadership team and have had early education opportunities over the last couple of months regarding the upcoming PCMH redesign that becomes available on March 31, 2017. During the main conference, there was also a panel session where pilot practices who were the initial pilot group undergoing the new 2017 redesign process and model shared their experience of the new model. An overwhelmingly positive experience was expressed by each pilot group. Here are some of the highlights of the 2017 redesign changes coming:
  • Every practice will need to meet Core requirements as well as a subset of additional criteria to become recognized.
  • Further aligns with other regulatory programs (e.g., MU).
  • Levels of recognition will not exist under the redesign model; you either are or aren’t practicing as a patient-centered medical home.
  • More engagement by an NCQA reviewer team throughout your transformation process with regular check-ins and virtual demonstrations.
  • Annual audits to ensure continual practice of transformation.
  • Current concepts of the Standards are similar to the 2011 and 2014 Standards: Team-Based Care and Practice Organization, Knowing and Managing Your Patients, Patient-Centered Access and Continuity, Care Management and Support, Care Coordination and Care Transitions and Performance Measurement and Quality Improvement.

It is important for organizations – whether currently recognized as PCMH 2011, 2014, or thinking about being recognized – to become aware of the 2017 PCMH redesign as there are important dates and pathways (depending where you are starting from) to ensure you don’t miss out based on set deadlines. If you are interested in a 30-minute complimentary session with me to discuss your organization’s roadmap of transformation, click here or contact us below for more information: