Megan Tooley, Cardiovascular Roundtable
This week, the National Committee for Quality Assurance (NCQA) launched a recognition program that aims to extend its successful Patient-Centered Medical Home (PCMH) model beyond primary care to specialty practices. The new Patient-Centered Specialty Practice (PCSP) designation program provides clear guidelines for specialists looking to establish a role in patient-centered “medical neighborhoods,” and will recognize practices committed to providing team-based, coordinated care and enhancing communication with providers and patients across the continuum.
The PCSP standards will be of particular interest to CV administrators, as they address the uncertainty specialists have felt over what their role is in the PCMH model. Some key implications of the program for our members are outlined below:
- PCSP recognition will require practices to clearly delineate the role of cardiologists and PCPs in the patient care pathway, which has proven an ongoing challenge when trying to manage an increasingly complex, comorbid CV population.
- This notion of recognizing specialty practices may provide a standard mechanism for inserting CV specialists into the referral stream, particularly with existing medical homes. Eventually, purchasers and health plans may use the PCSP recognition to drive referrals to preferred sites of specialty care.
- Health plans may also begin providing financial support–such as fee schedule enhancements and per-member-per-month payments for care management—to recognized PCSP practices, similar to incentives provided to official PCMHs.
- The detailed PCSP standards offer a blueprint for programs looking to elevate patient-centered care for cardiovascular patients.
NCQA defining specialist role in the medical neighborhood
With the proliferation of medical homes in recent years, there has been some uncertainty amongst CV service lines of what their role would be in this new model of care, and how it would impact their business. We’ve explored the impact of the medical home on CV services in-depth in past research. On the one hand, as PCP-led medical homes become more comfortable managing low-acuity CV patients, there’s the potential that CV programs will see a decrease in referrals. However, the medical home may also offer an opportunity for CV programs to replicate this gold standard model for team-based, top-of-license care.
Recognizing this opportunity, the NCQA intends for these new PCSP standards to provide specialty practices similar guidance on building a patient-centered approach as their PCMH designation did for primary care.
PCSP criteria focusing on access, communication, and team-based care
To become officially recognized as a Patient-Centered Specialty Practice, practices must apply to NCQA through a multi-step process (outlined here), and meet a robust set of criteria set forth in the PCSP standards and guidelines.
Criteria are grouped into six key buckets, listed below with representative examples:
- Track and coordinate referrals (e.g., form agreements defining methods of communication with PCPs and other referring clinicians, service standards for responding to referring physicians and patients)
- Provide access and communication (e.g., provide same-day appointments, create a team-based care model)
- Identify and coordinate patient populations (e.g., use patient data and evidence-based guidelines to proactively remind patients/families and primary care providers of condition-related services and follow-up)
- Plan and manage care (e.g., evaluate patient’s abilities to self-manage, proactively address potential barriers to compliance)
- Track and coordinate care (e.g., clearly communicate results and care plans to referring physicians in a timely fashion, track patients as they move throughout the system)
- Measure and improve performance (e.g., collect patient experience data to identify opportunities for improvement, track utilization data to reveal any unnecessary services or costs)
Full standards and FAQs about the submission process are available at the NCQA website, as well as a list of the fifty early adopters that have signed on to the program so far. Notably, the program has primarily targeted specialties that often take on a broader care-management role for patients, including cardiology.
How are you providing patient-centered CV care?
Are you considering applying for PCSP recognition? Or are you taking other avenues to increase access, coordinate services around patient needs, and elevate patient engagement? Either way, we would love to hear your experiences.
Contact Megan Tooley at email@example.com if you’d like to participate in our research on enhancing the CV patient experience.