The National Committee for Quality Assurance (NCQA) is updating its standards for Patient-Centered Medical Home (PCMH) Recognition for the first time since 2011, as concern grows that standards like these that focus on structural elements of medical homes and not outcomes lead to programs that neither save money nor help patients.

The NCQA’s PCMH Recognition program is the most widely adopted medical home model in the country. According to the NCQA, almost 6,800 sites where roughly 35,000 clinicians work have achieved the recognition.

However, a recent Journal of the American Medical Association (JAMA) published study found that adoption of a medical home model for managing patient care did not correlate with health care cost savings. Furthermore, at the last meeting of the Medicare Payment Advisory Commission (MedPAC), the Commission Chair, Glenn M. Hackbarth, JD, stated that he’d become “increasingly concerned” about the medical home model.

While acknowledging that he was not an expert, Hackbarth stated that he was “worried that the medical home model has become gold-plated, and that in order to meet all of the NCQA requirements, et cetera, there are a lot of bells and whistles that have been added to it, and … my impression is that not all of them have really been validated as adding value, but they add cost.”

Echoing the JAMA study’s findings, he also expressed the concern that improvements in quality and lower costs achieved through a medical home model were highly situational and applying the same model in every clinic in every part of the country would not lead to exactly the same results.

While NCQA acknowledged in a white paper that its focus on structure of medical homes over outcomes was a valid concern, the new standards for the PCMH recognition generally stay close to the present focus on structure. They will launch on March 24 and include:

• Alignment with Meaningful Use Stage 2 (MU2). Previously, a provider only had to meet Stage 1 standards to earn the PCMH recognition.
• Enhanced emphasis on team-based care, including the patient and non-physician health care providers.
• Care management focus on high-need populations. This includes addressing socioeconomic factors that affect health.
• Alignment of quality improvement with the triple aim of patient experience, cost and clinical quality.
• Sustained Transformation, which will mean that practices must demonstrate that they are able to comply with NCQA standards for the long term.
• Integration of behavioral health, including informing patients about a practice’s behavioral health care capabilities and collaborating with behavioral health care providers.