Patient centered medical home recognition and key dimensions of PCMH among small, urban, high-volume Medicaid practices
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.
Learning Areas:Public health or related public policy
Describe 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 Describe potential barriers to achieving recognition among our sample of practices
Keyword(s): Primary Care, Evaluation
Qualified on the content I am responsible for because: I am a doctoral candidate in the public health program at NYU and am working as a graduate research assistant at the NYU school of medicine on a range of evaluation projects, mostly related to PCMH implementation and impact evaluation. My background includes experience with the qualitative and quantitative methodologies commonly associated with program evaluation, including those used in this study.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.