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Decisions about Recognition and Renewal. NCQA PCMH 2014. Linda J. Pepper, Ph.D., PCMH CCE Executive Director Transformational Healthcare. June 18, 2014. Discussion. Timeframe for Transitions Comparison of PCMH 2011 to PCMH 2014 What’s Best for Your Practice? Differences in PCMH 2014

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Ncqa pcmh 2014

Decisions about Recognition and Renewal


Linda J. Pepper, Ph.D., PCMH CCE

Executive Director

Transformational Healthcare

June 18, 2014



  • Timeframe for Transitions

  • Comparison of PCMH 2011 to PCMH 2014

  • What’s Best for Your Practice?

  • Differences in PCMH 2014

  • What are your PCMH Options?

  • Decisions and Considerations

  • How Visualutions Can Help

  • Recommendations

  • Q&A

2011 2014 timelines

2011 & 2014 Timelines

Only 10 months left!

Ncqa is raising the bar

NCQA is Raising the Bar!

  • 2011 PCMH Standards

    • MU Stage 1

    • 28 Elements

    • 152 Factors (2 not scored)

  • 2014 PCMH Standards

    • MU 2

    • 27 Elements

    • 178 Factors (10 Not Scored)

    • Increased emphasis on:

      • Team Care

      • Mental/behavioral health

      • Processes

      • Analytics

      • Quality Improvement

      • High-Need Populations

      • Transformation

    • More Documentation

Increased emphasis on team based care

Increased Emphasis on Team-Based Care

Care management focuses on high need populations

Care Management Focuses on High-Need Populations

Enhanced alignment with triple aim

Enhanced Alignment with Triple Aim

Increased emphasis on behavioral health

Increased Emphasis on Behavioral Health

Enhanced focus on sustained transformation

Enhanced Focus on Sustained Transformation

Pcmh 2014 change summary

PCMH 2014 Change Summary

  • New Factors

    • 37 new requirements

    • 6 new MU2 measures

    • Higher thresholds on most MU factors

  • Increased emphasis in several areas

  • Technology

    • For 30% of factors you MUST have an eHR!

    • An additional 20% of factors are extremely difficult without an “advanced” EHR (registry)

What is an advanced ehr

What is an “Advanced EHR?”

  • 2014 Edition – Complete product with CQM

  • Flexible, customizable “registry” with ability to run complex clinical and demographic queries

    For Example: Obtain list of patients that…

  • Are over 65

  • Are dual eligible (Medicare/Medicaid)

  • Have 10 or more active meds

  • Have a Dx of Depression

    • And CHF and COPD

    • Or DM with A1c > 9

  • Have been discharged from hospital 2 times or more in last year

    • Or have been to the ED 2 times or more in last year

    • Or have 6 or more specialty referrals in last year

Pcmh 2014 6 standards 27 elements 100 points

PCMH 2014 (6 Standards/27 Elements/100 Points)

Deeper dive into pcmh 2014

Deeper Dive Into PCMH 2014

  • PCMH 2011 Must Pass

  • Access during office hours

    • Same Day Appointments

    • Clinical advice by phone

  • Outreach

  • Care Management

  • Self-Mgt Care Support

  • Referral Tracking

  • Quality Improvement

  • PCMH 2014 Must Pass

  • Access during and after hours

    • Same Day Appointments

    • Access analysis

  • Advanced Team Care

  • Outreach

  • Case/Care Management

  • Referral Management

  • Quality Improvement

Access to care

Access to Care

The care team

The Care Team

Ncqa pcmh 2014



  • No big change in MUST PASS

  • One extra mental/behavioral health

  • Overuse/appropriate use

  • A few new items you may not be recording:

    • Occupations

    • Contact info for specialists

    • Health literacy level

Care management

Care Management

Care coordination

Care Coordination

Quality improvement

Quality Improvement

Decisions decisions

Decisions, Decisions?





The easy decisions

The Easy Decisions

  • Your practice already has PCMH 2011 recognition – you do nothing until renewal.

  • You decide not to pursue PCMH recognition.

  • Your practice is working on your PCMH 2011 application – no time to lose!

  • You are submitting a multi-site 2011 – your corporate tool must be in by December 31, 2014 and all sites completed by March 31, 2015.

Do you go for 2011 or do 2014

Do you go for 2011 or do 2014?

If you are…

  • In a Medium to Large Practice

  • With standardized & documented processes

  • An emphasis on integrated behavioral health

  • With an advanced HER and state of the art Registry

  • Able and willing to do Meaningful Use Stage 2

More work in with more time…

Less work in less time…



When is 2014 the only choice

When is 2014 the only choice?

If you are…

  • A health system with a large number of physicians and dozens of sites under one Corporate application.

    and/or you are…

  • Starting now with little to no prior experience or knowledge of PCMH.

Everyone else should be going for 2011

Everyone else should be going for 2011!

  • PCMH 2011 Advantages for Small Practices

  • With smart work & ingenuity, practices on paper can obtain Level I recognition

  • Level III recognition is straightforward even for small practices with MU 1 (or equivalent)

  • Contrary to mythology, lean small practices can become 2011 PCMH recognized

  • The increased 2014 emphasis on Team Care, Mental/behavioral health, Processes and Analytics is particularly challenging for small practices



What if i try but can t finish in time

What if I try but can’t finish in time…?

What can visualutions do to help

What can Visualutions do to help?

  • Use these slides to see if the new or expanded factors present a challenge for your practice.

  • If you go for 2011 or 2014, sign up for our Visualutions PCMH reports and dashboard with a consulting package.

  • Either way, Visualutions has the reports, training, consulting and technology that can help you reach Level III recognition.

Visualutions pcmh program

Visualutions’ PCMH Program

A quick look at some of our materials

A Quick Look at Some of Our Materials



  • Make an informed PCMH decision…even if it is to do nothing!

  • Find out if there are any incentives – current or planned.

  • Learn and better understand what PCMH means and the effort involved

    • Ignore the myths

    • Your medical home is yours to build

  • With a few exceptions, go for 2011 recognition

    • Your current preparedness and EHR capabilities

    • Raising the bar on your future

  • Let us help you

    • Talk to us

    • Take a look at our reports, services and tools

    • Let us do a quick assessment to help you plan

Some resources

Some Resources

Visualutions resources

Visualutions Resources

  • Your sales executive! Contact them at

  • Schedule a demo with your sales executive to see how our system works.

  • Linda J. Pepper, PhD, PCMH CCE at

Presentation resources

Presentation Resources

  • MargalitGu-Arie, M.Sc., NCQA PCMH CCE, Founding Partner for BizMed Solutions

  • NCQA PCMH 2014 Guidelines,






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