What is the Patient-Centered Medical Home Model?

The patient-centered medical home (PCHM) model puts the patient at the forefront of care. The model is based on providing high-quality, low-cost primary care and coordinates patient care across the health system by taking a patient-centered, culturally appropriate, and team-based approach.

A physician-led, multidisciplinary care team manages the patient’s ongoing care in a PCMH model, including recommended preventive services, chronic condition care, and access to social services and support. PCMH providers generally seek recognition from organizations such as the National Committee for Quality Assurance (NCQA). PCMHs are frequently paid a per-member per-month (PMPM) fee in addition to regular fee-for-service (FFS) payments for their Medicaid patients (either directly by state Medicaid agencies or through MCO contracts).

Better Patient Outcomes

Nearly 20% of primary care physicians are in NCQA-recognized PCHMs, according to a report by Milliman, and more than 100 payers currently support NCQA PCHM Recognition through financial incentives, contracting arrangements, or by providing technical assistance. Those looking to transform their primary care delivery model are not starting from scratch. The NCQA PCMH model provides a clear road map for the organization and transformation of primary care. Practices get assistance with developing leadership structures, care-team responsibilities, and partnerships with patients, families, and caregivers. 

The PCMH model has been linked to better chronic disease management, higher patient and provider satisfaction, overall cost savings, higher quality of care, and access to more preventive care, according to the Centers for Disease Control and Prevention (CDC). A Hartford Foundation study discovered that the PCMH model created a better patient experience. Likewise, 83 percent of patients highlighted that partaking in a PCMH helped their health and wellbeing. 

In addition, PCMHs save money by reducing hospital and emergency department visits and mitigating health disparities. 

PCHM Model Aligned with State/Federal Initiatives

Value-based care is gaining more traction. Thus, numerous state and federal programs are embracing the patient-centered model of care, according to the NCQA.

  • The Medicare Access and CHIP Reauthorization Act (MACRA) grants clinicians who earn NCQA PCMH and Patient-Centered Specialty Practices (PCSP) Recognition.
  • 29 public sector initiatives in 25 states require or use NCQA PCMH Recognition as part of their medical home initiative.

About One80 Intermediaries/Manchester Specialty

Manchester Specialty, a division of One80 Intermediaries, provides comprehensive business insurance solutions for for home care, medical staffing, misc. medical facilities, and elder care organizations. Licensed to do business as a program administrator in all 50 states and D.C., our agent/broker partners and their Allied Health clients look to us for our expertise, broad product capability, and commitment to the market and the quality and stability of our insurance programs.

For more information call us at 1-802-472-1500 or visit Allied Health Care Firms – One80 Intermediaries.