Organizational Transformation

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New York State Patient-Centered Medical Home

NYS and AHI seek to enroll primary care practices that…

  • want to prepare for major payment changes.
  • use a 2014 Certified Electronic Health Record (EHR).

What is a Patient-Centered Medical Home?

  • NCQA made significant changes to the Patient-Centered Medical Home (PCMH) Recognition process, launching the 2017 NCQA PCMH Standards on April 1, 2017, and moved to annual check-ins. As a result, practices must establish and maintain a sustainability approach to ensure that workflow, culture, and approaches are sustained in the long term. New York State is finalizing its agreement with NCQA on the details of what the New York State PCMH model of care will encompass.
  • The key difference between the PCMH 2017 model and the NYS-specific model is that 12 criteria that are indicated as elective in PCMH 2017 will now become core requirements in NYS PCMH. These new core criteria focus on behavioral health integration, care management and coordination, health information technology, and value-based payments.
  • Practices that were previously enrolled in Advanced Primary Care (APC) will automatically be shifted to pursuing NYS PCMH. Practices that have recently achieved PCMH 2014 level 3 will need to upgrade to NYS PCMH.
  • Fortunately, the funding from the state that was being used to provide free technical assistance to primary care practices for APC transformation will now be available to practices pursing NYS PCMH; therefore, AHI will be able to continue to provide free technical assistance for NYS PCMH.

Why does this matter?

  • Medicare, Medicaid, and commercial health insurance providers are changing how they pay health care providers.
  • Reimbursement is moving away from fee-for-service to new models that emphasize performance on quality measures, clinical outcomes and cost savings.
  • There is also a restructuring underway of the various incentive programs. Performance on quality measures, including clinical outcomes, will determine reimbursement levels.
  • Transitioning a practice through NYS PCMH will result in significant benefits as reimbursement becomes more and more quality-based.

Benefits to Practices

  • Increase clinician and staff member satisfaction.
  • Participate in new payment/reimbursement models.
  • Improve practice efficiency.
  • Integrate care management functions into your practice.
  • Concrete opportunities for improvements in patient care.
  • Maximize the practices’ health information technology investment and use of EHR data.

How will AHI help?

AHI is poised to support practices with new and existing recognitions.

  • Coaching and guidance related to transformation.
  • Skilled transformational assistance provided through a combination of remote and on-site training and support.
  • Access to a faculty of nationally-recognized experts and online modules (providing CME and MOC credits) related to the transformation process.
  • Services include, but are not limited to, assistance with maximizing incentives from payer contracts, avoidance of penalties, care management, quality improvement, networking, and more.