News & Events

PCMH Update

We now have 33 practices that have received NCQA PCMH Level 1 recognition. We have 12 practices that were submitted this month for recognition. In the meantime there are now 12 nurse care managers working in 45 practices following approximately 5000 complex patients plus working with the champion physician to obtain Level 3 NCQA PCMH recognition.

Our BCBS RI contract states that the NCMs will contact 80% of the patients that are on the Complex Patient List that haven’t been seen 90 days prior to the practice receiving NCQA recognition. They must also contact any of these patients that are discharged from the Emergency Room or Hospital within three days of notification from the hospital. All of this work requires systems be put in place in the office to notify the NCM as soon as the practice is notified.

One of the barriers that have been identified by the NCMs is the fact that many offices do not have room where an NCM can meet with these patients. This is an issue every practice should consider as soon as an NCM has been assigned to that practice. It is essential that they have space to meet with the patients and that provides for patient confidentiality.

We now have a Patient Centered Medical Home Committee. It is comprised of PCPs who have gone through the NCQA Level I process. One of the NCMs and the project manager sit on this committee.

Our new PCMH committee will be speaking at the POD meetings on best practices and how to set up evidence based medicine guidelines in the EMRs. They will be available at every POD meeting to answer any questions anyone has on the NCQA process or the Care Management process.

Beginning in April of 2011 we will choose 12 more practices and hire 4 more NCMs. In the meantime, anyone that has not started the program should call Shirley Carter at RIPCPC and she will give you information so that you can start working on Standards that need to be met.