Patient-Centered Medical Home - CMS Solutions


Patient-Centered Medical Home


The Agency for Healthcare Research and Quality recognizes that revitalizing the Nation’s primary care system is foundational to achieving high-quality, accessible, efficient health care for all Americans. The primary care medical home, also referred to as the patient centered medical home (PCMH), advanced primary care, and the healthcare home, is a promising model for transforming the organization and delivery of primary care.

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Benefits to Practice

In addition to the benefits to patient care, the PCMH model has tangible benefits to practices and its staff. Practices can align with where health care and payers are headed, and clinicians can see benefits like enhanced reimbursement, MOC credit and the ability to better focus on patient care.

​Almost all payers recognize the benefits transitioning to the Patient-Centered Medical Home offers the patient, health plan and the practice and provide incentive-based reimbursement for the entire patient panel. The improvement activity (IA) category is a performance category in the QPP Merit-based Incentive Payment System (MIPS). It contains activities similar to the medical home functions. The IAs are designed to improve clinical practice or care delivery that, when effectively executed, lead to improved outcomes.

Eligible clinicians (EC) in a practice that have received PCMH recognition from accrediting organizations such as NCQA will automatically receive full credit for the MIPS IA category:

    Automatically receive PCMH incentivized payments for each patient on your panel once Recognized
    Increased practice productivity better integration of clinical IT into practice workflow
    A practice that is better prepared for enhanced payment under the Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APMs)
    A practice that is primed to participate in accountable care organizations
    A more efficient use of practice resources, resulting in cost savings
    Increased physician and staff member satisfaction

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Benefits to Patients


As the most widely adopted Patient-Centered Medical Home evaluation program in the country, NCQA-recognized Patient-Centered Medical Homes deliver high quality care that research has shown can lead to lower costs, improved patient experience and better health outcomes.

    More efficient, well-coordinated care

    Comprehensive services

    Patient-centered, personalized care
    Better test and referral tracking

    Happier, healthier patients!

Benefits to Payors

Patient-Centered Medical Homes are driving some of the most important reforms in healthcare delivery today. A growing body of scientific evidence shows that PCMHs are saving money by:

    Reducing hospital and emergency department visits,

    Mitigating health disparities, and

    Improving patient outcomes.

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