NCQA recognizes Oregon clinics as medical homes
Three independent physician practices are the first in Oregon to be recognized as patient-centered medical homes (PCMHs) by the National Committee for Quality Assurance (NCQA). They are Chehalem Medical Clinic in Newberg, Pacific Medical Group in Tigard, and Davies Clinic in Canby.
To receive NCQA recognition, a practice must demonstrate that it coordinates care for patients through use of care teams, patient registries, health information exchange, and other means to ensure effective patient-centered care. The NCQA recognition standards include
- patient access and communication
- patient tracking and registry functions
- care management
- patient self-management support
- electronic prescribing
- test tracking
- referral tracking
- performance reporting and improvement
- advanced electronic communication
Redesigning care delivery around the PCMH model typically requires a practice to invest in IT equipment, electronic health record systems, and provider/staff education. The three clinics received grant funding from the InterHospital Physicians Association (Portland IPA), as part of a pilot project, to apply for NCQA recognition and to upgrade their technology systems to support more efficient data collection and reporting of practice standards. Expenses for practices in the pilot project were estimated at $10,000 to $20,000 per clinic, depending on need. The IPA plans to assist additional practices in applying for NCQA recognition this year.
Many health plans are considering offering higher reimbursements for care delivered by PCMH practices, based on added value in terms of better patient outcomes and lower costs (for example, due to reduced hospitalizations). NCQA recognition positions a practice to qualify for additional or increased payments in the event that payers adopt such programs. The employer-based Bridges to Excellence (BTE) program also offers medical home designation and bonus payments for physician offices that treat patients who work for participating employers. BTE uses the NCQA recognition program as the eligibility criterion for many of its incentive programs.
Other medical home programs
Other groups in Oregon have extensive medical home pilot programs underway. In October 2010, the Oregon Health Leadership Council launched a high-value medical home initiative for commercially insured and Medicare Advantage members with chronic and complex conditions. This two-year demonstration project brings together 14 medical groups, five health plans, and four state purchasing groups. Specially trained nurse “navigators” coordinate care for individual patients among team members that include the primary care physician, specialists, hospitals, and health plans. Participating providers receive standard fee-for-service payment and may share in any savings if they meet quality and cost targets. The partners hope the initiative will point the way to a sustainable payment approach for expanding the medical home model.
CareOregon, the state’s largest Medicaid managed care health plan, has funded efforts to transform safety-net clinics into PCMHs through its Primary Care Renewal project since 2006. Clinics in this project organize care for Medicaid clients around teams of medical and behavioral health professionals. A three-tiered payment system rewards providers for participating in a medical home learning collaborative, hitting targets on key clinical quality measures, and reducing ambulatory care-sensitive hospital admissions and emergency department visits. After six pilot sites demonstrated greater continuity of care and improved health screening and chronic care management, CareOregon expanded the program to 16 clinics serving nearly 45,000 enrollees, about one-third of the health plan’s membership. Since 2009, CareOregon and the Oregon Primary Care Association have coordinated efforts to expand the PCMH model among community health centers across the state, as part of a national Commonwealth Fund initiative, funded locally by the Northwest Health Foundation. The clinics in that initiative collectively serve 189,000 patients.