New York PCMH Recognition Program

July 23, 2018

The National Committee for Quality Assurance (NCQA), in collaboration with the New York State
Department of Health (NYSDOH) has developed the New York State PCMH Recognition
Program, supporting New York’s initiative to improve primary care through the medical home
model. This program promotes better health, lower costs and improved patient experience.

Although the content is consistent with the updated NCQA 2017 Standards and Guidelines, New
York State has defined specific elective criteria that is now mandatory for practices seeking
recognition. The intent of this change is to help support New York’s healthcare initiatives and address
many issues focusing on patient needs, which are often can be overlooked leading to higher costs
down the road.

There are twelve (12) additional core criteria required for recognition. It is important to note that these
are not additions, but rather elective criteria from the 2017 guidelines which New York State wanted
to emphasize under their version of the PCMH model. Additional areas of focus include:

  • Routine Behavioral Health screenings for all patients, along with coordination of care when
    needed to assist patients with mental health needs;
  • Utilizing risk stratification to help identify patients in need of services, identifying population
    level needs based on the diversity of the practice and community to help ensure that all
    patients receive the same level of care;
  • Having practices fully utilize their electronic medical record systems to foster continuity of
    care, ensure that security updates are in place and enable secure electronic exchanges of
    information from one facility to another; and
  • Having practices engage in up-sided Value Based Contracts, awarding them for the quality of
    care provided as opposed to the quantity of care.

The State Innovation Model (SIM) grant awarded to New York State allows authorized PCMH
vendors to partner directly with primary care practices statewide and assist them through NYS PCMH
transformation process. Important to highlight that these services are at no cost to the practices.

Contact RRHS to find out how our certified and dedicated PCMH team can assist you.

Cristina Oliveri
PCMH Facilitator, RR Health Strategies