Varied group of 112 completes NCQA's training as medical home experts

They walked into the program as physicians, nurses, social workers, psychologists, administrators, consultants and naturopaths. And the 112 who passed the subsequent exam walked out as certified patient-centered medical home content experts—and now carry the credibility, marketability and visibility that come with that.

They were the first graduates of a National Committee for Quality Assurance program that provides a sanctioned method for distinguishing experts from a growing pack of consultants offering to lend a hand to medical practices seeking to adopt the medical home practice model. Medical homes emphasize care coordination, increased access and enhanced doctor-patient communication, while focusing on continuous quality improvement and whole-person orientation.

The NCQA began its medical home program in 2008 and has since recognized about 5,600 practices as being successful implementing the concept. It launched the medical home content expert program in January, and participants needed to attend two seminars and pass an exam for certification.

“It was not a rubber-stamp process,” said Connie Smith, a licensed clinical social worker, president of Stockbridge, Ga.-based HealthSmith Consulting, and now a certified medical home expert. “There are certifications out there that are an easy task—this was not one of those.”

Smith said she's been helping organizations prepare for one form of accreditation or another (usually NCQA or URAC) for nearly 20 years, but medical home recognition is a relatively new line of business.

“The potential is certainly there for it to grow,” Smith said. “Primarily because of the Affordable Care Act and the direction healthcare is going, there is going to be more expectation that practices move to the patient-centered medical home model. I think the concept is a good one and has the potential to transform how healthcare is provided.”

Smith added that the seminars she went to were well attended. “I was surprised to see the number of folks there.”

Those who passed the test were from 29 states. Kathleen Mudd, NCQA vice president of product delivery, would not say how many people took the exam, saying the NCQA doesn't publish denial rates. But Jennifer D'Alessandro, assistant NCQA director of clinical education, said 52% of participants had 10 or more years' experience with healthcare quality or NCQA recognition and accreditation programs, 50% had master's degrees or higher and 14% had a Ph.D. or a medical or law degree.

“This is a very well-educated group,” she said.

It's unknown how many consultants are out in the field promoting themselves as medical home experts, but Mudd said NCQA has heard stories of so-called experts dispensing wrong information. “We have heard the experience of practices working with someone who said 'I'm an expert, I can help you get NCQA recognition,' and then advise them incorrectly about our requirements,” Mudd said.

One person who used the certification to raise his profile as well as his company's was Dr. Randall Oates, president and founder of SOAPware, a Fayetteville, Ark.-based provider of electronic health records, who issued a news release about the achievement.

“Dr. Oates' certification represents a landmark achievement for himself and SOAPware Inc., as he believes the PCMH model is essential to survival in the future U.S. healthcare environment,” according to the release. “He states: 'The only approaches to achieving the Triple Aim of healthcare reform are those represented by PCMH and Patient Centered Specialty Practices.'”

While certification may help raise one's profile, Smith said many participants were there to enhance their ability to work internally within their organizations.

One such person is Kristi Van Sickle, a psychologist and executive director of the Brevard Healthcare Forum, a Melbourne, Fla.-based organization seeking to address unmet healthcare needs in Brevard County communities.

“One of the things we've been working on for a while is access,” said Van Sickle, also an assistant professor in community health and healthcare psychology at the Florida Institute of Technology (which serves as the Forum's sponsor). “We believe in this model from a planning perspective and want to help other providers in the community pursue it.”

Van Sickle noted, however, that physicians are getting weary of all the new requirements, and said asking them to now meet the criteria for medical home recognition adds fuel to this fire. But she said the NCQA program has helped her communicate the value of adopting the practice model.

“I think the biggest thing is communicating to providers that this is going to make things better,” Van Sickle said of the medical home. “It's going to make them more efficient and make them more patient-centered with better outcomes.”

Previously, the term itself has been a stumbling block with providers and patients who confused “medical home” with nursing homes and even funeral homes. Now, there is confusion between medical homes and accountable care organizations, Van Sickle said.

“Physicians in practice are asking, 'Why are we going through this when we could become an accountable care organization?' ” Van Sickle said, explaining that medical homes supply the primary-care foundation for the population health coverage provided by an ACO.

Dr. John Redding, senior manager of physician-hospital alignment for Indianapolis-based Blue Consulting Services, also received certification as a medical home expert and agreed with Van Sickle about medical homes serving as a good base for ACOs.

“I would predict that ACOs and clinically integrated networks that involve patient-centered medical homes as a fundamental part of their network will be more successful than those that don't,” Redding said. But he added that the process can't stop with medical home recognition.

“Healthcare is going through a transformation, and a lot of organizations are unsure of what their next steps should be, and the patient-centered medical home provides a foundation,” he explained. “But, by no means would I advise a client that recognition is the end of the journey. But it's a way to allow providers to speak the same language and move in a common direction.”

Redding said medical home recognition gets the attention of payers and employers who take the NCQA seal of approval as a sign the practice will deliver high-quality care. But if they don't see the positive outcomes, they will move on.

“Recognition says they're capable of playing the game, but the real work begins after recognition,” he said. “If they stop after recognition, they will become irrelevant and become irrelevant quickly. I tell them to celebrate the designation, take a day or two to bask in the glow, and then start on a more ambitious program.”

Redding agreed that medical home expert certification can give internal and external consultants the gravitas they need with doctors.

“Consultants are often asking practitioners to change the way they do business,” he said. “Certification gives them credibility with clinicians who can be—at times—adverse to change.”

Stefan Ripich, a nurse practitioner and naturopath in Santa Fe, N.M., has higher aspirations.

“I think that a lot of the participants achieved PCMH Content Matter Expert Certification because it will invariably increase their credibility and earning power,” Ripich wrote in an e-mail. “I am a little different. I became certified because I want to change the world.”

Ripich, author of the book “The 30 Day Diabetes Cure Featuring: The Diabetes Healing Diet,” added that he thinks the NCQA also wants to change the world and is doing its part by offering medical home recognition as a carrot toward reaching “the next wave of reimbursement.” But he wrote that recognition also serves as affirmation that a strong network of primary-care providers can keep people out of the hospital.

“After years of being the lowest providers in the healthcare pecking order—compared to high-priced specialists and hospitalists—finally, finally, they are being recognized as being the real change agents who might possibly salvage our ruined healthcare system,” Ripich wrote.

Follow Andis Robeznieks on Twitter: @MHARobeznieks