CipherHealth Helps Practices Meet NCQA’s PCMH KM12 Criteria

CipherHealth Helps Practices Meet NCQA’s PCMH KM12 Criteria

The healthcare industry has faced various changes over the past few years. In the center of these changes is a shift from volume to value-based care. As this shift takes place, there is a rising focus on innovative care delivery models such as the Patient-Centered Medical Home (PCMH). Under the PCMH model, a patient’s primary care physician coordinates treatment to ensure he or she receives proper care when and where they need it. In order to earn various incentives under this program, physician practices look to become PCMH-recognized.

The National Committee for Quality Assurance’s (NCQA) Patient-Centered Medical Home (PCMH) recognition program is one of the most well-known, requiring practices to meet a combination of core and elective criteria to become NCQA PCMH-recognized. Having earned NCQA PCMH Prevalidation, CipherHealth’s patient engagement solutions are pre-validated by NCQA for practice credit towards nine criteria towards a practice’s PCMH evaluation.

Among the core auto-credit criteria that CipherHealth is prevalidated for is KM12: Proactive Reminders. This criteria falls under the “Knowing and Managing your Patients” concept area, which focuses on practices’ use of data to conduct population health management. This requirement encourages increased access to patients regarding appointments, as well as for practices to proactively identify populations of patients and remind them of needed care based on patient information, clinical data, health assessments, and evidence-based guidelines.

An example of this program would include practices identifying an outreach cohort for preventive screenings with an applied focus of patients that are lacking those services. For example, patients with an overdue mammogram or colorectal cancer screening.

Using CipherHealth’s care management platform, integrated with automated outreach, practices are also able to meet Care Management requirements of the PCMH program.

  • Use the power of big data to discover insights into gaps in care, population-specific trends, and outcomes.
  • Better coordinate care teams across multiple disciplines and institutions in one centralized location to manage care plans, set goals, and track activity.

Engage with patients via phone call, text, or email to remind them of needed care, such as upcoming immunizations, wellness appointments, or preventive screenings to meet these requirements.

Big data and care coordination are improving population health and lowering cost. To learn how CipherHealth solutions can help your organization meet criteria KM12 and a host of other criteria, contact us today.

Ben Kraus, Market Manager, is based in CipherHealth's headquarters in New York City. He focuses on issues concerning ambulatory care and alternative payment models, and has a special interest in how technology can spur the shift from volume to value in healthcare and enhance care coordination. In the wee hours of night, you just might find Ben jamming on stage with his bass guitar in one of the many music venues throughout the five boroughs.