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Overview

This tool is for use by health centers interested in assessing their readiness for Patient Centered Medical Home (PCMH) recognition by the National Committee for Quality Assurance (NCQA) under the 2014 Standards. It can be used by first time users as well as those seeking a renewal. The tool walks organizations through the requirements for each of the standards, elements, and factors for NCQA PCMH recognition by providing a way of tracking what they currently have in place and what they are missing, a list of supporting materials to submit to NCQA, as well as Health IT tools that can support both the implementation of the required factors as well as the generation of the documents/reports needed for submission. It is recommended that this tool be completed by a multi-disciplinary team, assigning a lead various components to ensure follow-through and completion of tasks.

PCMH Recognition Levels and Point Requirements

There are three levels of NCQA PCMH Recognition; each level reflects the degree to which a practice meets the requirements of the elements and factors that comprise the standards. For each element’s requirements, NCQA provides examples and requires specific documentation.

The NCQA Recognition levels allow practices with a range of capabilities and sophistication to meet the standards’ requirements successfully. The point allocation for the three levels is as follows:

• Level 1: 35–59 points and all 6 must-pass elements
• Level 2: 60–84 points and all 6 must-pass elements
• Level 3: 85–100 points and all 6 must-pass elements

MUST-PASS elements are considered the basic building blocks of a patient-centered medical home. Practices must earn a score of 50% or higher on each. All six must-pass elements are required for recognition.

Instructions

• Complete the entire self-assessment for your current state
  • Review first the Information about Requirements section (Columns A through G) to familiarize yourself with each of the six NCQA PCMH standards and the elements and factors under each one. Elements that are Must Pass are highlighted in Red (one per standard); and factors that are critical to pass the element are highlighted in Yellow.
  • Assign a percentage (0%, 25%, 50%, 75% or 100%) in Column H for each of the 27 elements, using the scoring described in Columns D and E to assess your current ranking.
• Begin dissecting the Must Pass Elements
  • Focus first on the Must Pass Elements highlighted in Red on the Self-Assessment and listed separately on the Must Pass Elements tab. If you are not able to score at least 50% on these 6 must pass elements, you will not be able to receive NCQA PCMH Recognition.
  • Review Column J to see what documentation is needed for each of the factors under the Must Pass Elements.
  • List on Column M what materials you have and where to find them.
  • Use Columns N and O to track additional materials needed, steps to implement changes, etc., as well as responsible person to ensure action item is accomplished.
  • Check the cell in Column P when all items for that corresponding factor are in place and materials are ready to be uploaded into the NCQA PCMH electronic survey tool.
  • Check the Must Pass Element tab to be sure that, based on your self assessment and changes, all Must Pass elements are met.
• Next, look at the non-pass elements with the highest scores and follow steps 2b through 2e
  • Look at the scoring for each element under Column C and focus on those that have a score of 4 or higher.
• Follow above steps for all remaining elements.
• Update percentages in Column H as changes are made, as well as actions taken and needed in Columns M through P.
• Set a realistic goal for the NCQA PCMH Level (1, 2, or 3, based on point values above) your organization can achieve given your current scoring, resources and culture of change.
• Continuously track your total Self Assessment score (auto-calculated on Line 211 of Self Assessment tab) and Must Pass Elements to track progress towards your goal.