This useful analysis from the Urban Institute Health Policy Center, funded by the Centers for Medicare and Medicaid, reviews and compares several national and state standards and recognition programs for patient-centered medical homes (PCMH).
Half of the tools reviewed were what could be called “off the shelf” products tabulated by national entities like the National Committee for Quality Assurance (NCQA), which are typically free to download but cost thousands of dollars for practices to use to apply for recognition. The other half could be called “one-off” tools that were either designed or appropriated for use in only one or a few states’ PCMH recognition programs; these tools are generally free to use to apply for recognition as part of such PCMH initiatives. Most tools had not been tested for validity, reliability, or association with patient outcomes. To provide a check on overly-positive practice self-assessments, most tools include mechanisms to verify responses, such as by requiring accompanying documentation and/or site visits. For this reason, most tools are administratively burdensome – taking days, weeks, or months to complete.
In general, the top five content domains that received the most emphasis in these tools were: 1) care coordination, 2) health information technology, 3) quality measurement, 4) patient engagement and self-management, and 5) presence of policies (a category used to denote items that merely asked if a written policy existed, and did not require such policies’ content to reflect specific benchmarks or requirements).
Since evidence does not yet exist on which PCMH recognition tool produces the best outcomes, payers will have to decide how much stock to put in such tools, and what role quality measurement should play (i.e., what should be the mix between measuring practice capabilities and measuring practice performance?). Payers will also have to decide how much administrative and financial burden they want to place on practices. Payers that tie performance on a PCMH recognition tool to payment may be more likely to require verification of responses, such as through documentation or site visits, even though it increases practice burden. Moving beyond measurement, payers interested in PCMH initiatives will also have to decide what accompanying strategies to use to facilitate practice transformation to a PCMH, such as technical assistance and learning collaboratives.
Ignatius Bau 