Patient centered medical home recognition and key dimensions of PCMH among small, urban, high-volume Medicaid practices

Objective: The Primary Care Information Project (PCIP) is a program administered by the New York City Department of Health and Mental Hygiene to assist primary care providers adopt a fully-functional electronic health record (EHR) and focus more on population health. One of the auxiliary services provided by PCIP is to provide assistance to pursue Patient Centered Medical Home (PCMH) recognition by the National Committee for Quality Assurance (NCQA). The objectives of this study are to determine how formal PCMH recognition by the National Committee for Quality Assurance (NCQA) is related to the presence of key dimensions of PCMH among PCIP practices and to describe potential barriers to achieving recognition.

Methods: This analysis relied on data collected from a comprehensive practice assessment survey of PCIP practices. The survey was developed to assess the dimensions of PCMH model implementation proposed by Rittenhouse et al., including: 1) each patient has a personal physician; 2) whole person orientation; 3) team-based care; 4) coordination and integration of care across the health system; 5) a focus on quality and safety; and 6) timely access to care and communication. The survey also included content about other practice characteristics, including details of application/award status of PCMH recognition by NCQA.

Population: The study population includes practices for which survey results are available among PCIP practices with fewer than 5 providers and high volumes of patients who are enrolled in Medicaid or who have no insurance converage (64% response rate; n = 94).

Findings: At the time of survey, 40% of practices had received some level of NCQA recognition (n = 38) and these practices were significantly more likely to have care teams in place relative to those without recognition (92% and 64%, respectively; p = 0.002). However, NCQA status was not significantly associated with many other characteristics associated with PCMH, including but not limited to: 1) use of care managers; 2) patients see the same provider; 3) staff meet to review care plans; 4) provider availability on evenings/weekends; 5) e-prescribing; or 6) systematically monitoring patients with chronic illness. The most common self-reported barrier to applying for NCQA recognition among those who had not applied (n = 58) was that they did not know enough about PCMH (30%).

Conclusions: This discrepancy between NCQA recognition and presence of key PCMH components suggests formal recognition mechanisms may not adequately capture PCMH in the small practice environment.