The PCMH is a care delivery model whereby patient treatment is coordinated through their primary care physician to ensure they receive the necessary care when and where they need it; in a manner, they can understand.

1. PPCCMMHH –– AAnn IInnttrroodduuccttiioonn
Nisarg Khandekar
Nisarg has worked on a variety of healthcare IT products and helped medical professionals by understanding their pain
points and assisting them adapt to the rapidly changing healthcare IT spectrum, for almost half a decade. Experienced on
Meaningful Use and ONC HIT certification processes and currently hold a keen interest in learning how the analytics
and population health management areas are shaping up.

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Introduction
Health care in the United States is moving away from a volume-based payment system and toward a
value-based system. Medicare Access and CHIP Reauthorization Act (MACRA) puts major emphasis on
value based care delivery. If a practice is a certified Patient Centered Medical Home (PCMH), "right
away you are guaranteed the highest possible clinical improvement score," which represents 15
percent of the total value score for the Merit Based Incentive Payment System (MIPS). In addition to
this, Alternative Payment Model (APM) and Advanced APMs are value based programs which are given
great importance under MACRA; requirements for the PCMH program are almost in line with those for
APMs and advanced APMs. The effort that a clinic puts into transformation not only positions it to
better respond to this changing health care landscape, but with time, it also benefits the patients, the
practice, and the practice’s bottom line. More than 10 percent of U.S. primary care practices,
approaching 7000 altogether, are recognized as PCMHs by the National Committee for Quality
Assurance. 1
The PCMH is a care delivery model whereby patient treatment is coordinated through their
primary care physician to ensure they receive the necessary care when and where they
need it; in a manner they can understand. 2
PCMH is a way of organizing primary care that emphasizes care co-ordination and communication to
transform primary care into "what patients want it to be.”3
Originating in the 1960s, it is now
experiencing an increase in application with the changed outlook to healthcare in general. Primary
care medical practices are being called upon to do more, and to do it better, while managing resources
ever more wisely.
Figure 1: PCMH Benefits (Image Source: BaylorScott&White)

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At a PCMH accredited medical home, patients enjoy a better coordinated, more comprehensive and
personalized care. It also greatly improves access to medical care and services and health outcomes,
especially for patients who have chronic conditions.
Accreditation benefits for Providers and Clinics
All certified PCMHs automatically qualify for the highest possible score for CPIA category of the MIPS
program (15% of their total score). Furthermore, there has been a push to include PCMHs under the
Advanced APMs; even though PCMHs are currently not under Advanced APMs, there is a possibility
that they would get considered under the Expanded Medical Homes model. Once this happens all
PCMHs would get 5% Medicare FFS bonus and would be exempted from MIPS adjustments.
Private payers such as Aetna, Anthem, BCBS, Cigna have programs that provide financial incentives to
PCMHs. Aetna- Patient Centered Medical Home Program has 5 sub programs which provide financial
incentives to the providers for being NCQA PCMH certified and demonstrate that they are performing
the activities of a Medical Home.
There are also similar government programs running which require primary care practices to adopt the
functions of a PCMH; these programs might not require the primary care practices to be PCMH
accredited, but will need them to perform similar functions that a PCMH accredited practice would
perform.
Figure 2: Core of PCMH (Image Source: AAFA)
Following are some examples of such programs:
 CPC Initiative
 CMS Healthcare Innovation Award –
PCMN Demonstration
 CMS Dual Eligible Demonstration
More such programs can be viewed here.

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Nalashaa Solutions
Nalashaa believes in simple solutions to derive meaningful insights and in exceeding your expectations. Our
clarity of thought has earned us many laurels in this fast paced world where healthcare technology
advancements are rolling out continuously.
Headquarter Office: 555 US Highway 1 South, Suite 170, Iselin, NJ 08830, USA
tech@nalashaa.com 732-602-2560 x 200
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