Translate This Page Print This Page Email a Friend Newsletter Sign-Up
Text Size : Sm Med Lg

Health Care Providers
Patient Centered Medical Home

Background | Reimbursement | Get Started | More Information

Background

Patient-Centered Medical Home (PCMH) is a care model in which the primary care physician, supported by staff, coordinates the care of patients across the health system. Key functions of the PCMH include providing timely follow-up for patient care involving labs, coordinating referrals, receiving information on diagnostic imaging, specialist care, follows up on emergency room visits, and maintaining a comprehensive medical record for the patient. Access to these records and the continuity of the doctor-patient relationship allow a Patient-Centered practice to deliver appropriate care and keep up with preventive services for their patients.

The National Committee for Quality Assurance (NCQA) launched a certification program for practices that embrace the standards of the Patient-Centered Medical Home which include elements that:

  • Enhance access and continuity
  • Identify and manage patient populations
  • Plan and manage care
  • Provide self-care and community support
  • Track and coordinate care
  • Measure and improve performance

An increasing number of studies of Patient-Centered primary care suggest that patients who have a primary care clinician coordinating their care and tracking outcomes are much more likely to receive evidence-based preventive care and better health outcomes.

Reimbursement

Achieving this certification allows health plans and patients to recognize your care coordination and quality improvement work within this groundbreaking model of care. Empire BlueCross BlueShield and New York State Medicaid both offer incentive payments to providers who meet the NCQA criteria under a unified initiative aimed to promote development of Patient-Centered Medical Homes. With successes from the project already being realized, Empire has begun to expand the medical home concept into a patient-centered primary care program to further reward physicians' impact on population health.

For more information on the New York Medicaid initiative, please visit The New York State Department of Health. For an update on the patient-centered primary care program, please visit EmpireBlue

Get Started

Interested practices are encouraged to request a free copy of the NCQA Standards and Guidelines to help you decide if your practice is ready for a medical home transformation. Then, determine if your practice is eligible and review the educational opportunities from the NCQA that are available throughout the process.

If you’re a member of NYCReach, attend a PCMH webinar for more information. Providers are also encouraged to join the conversation at On The Record and contact pcip@health.nyc.gov with questions about PCMH services.  

More Information

Visit these links for detailed information on the PCMH criteria and recognition process.