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NCQA PCHM Recognition Support

GLO-PRV-Clinical Resources - NCQA PCHM Recognition Support page

Excellus BlueCross BlueShieldUnivera Healthcare ("Health Plan") encourages provider practices to access the New York State Patient-Centered Medical Home (NYS PCMH) Recognition Program, which is the statewide initiative, in conjunction with the National Committee for Quality Assurance (NCQA), to improve primary care and promote better health, lower costs and better patient experience.

New York State Department of Health (NYSDOH) provides transformation assistance and enhanced reimbursement opportunities as part of the NYS PCMH Recognition Program. Please visit the NYS PCMH Recognition Program website for the most up-to-date information regarding the current status of this program, and for additional resources and contact information.

In addition to the support that is available through the NYSDOH, the Health Plan provides transformation support through many avenues

  • Enhanced Reimbursement - The Health Plan provides reimbursement according to the enhanced reimbursement opportunities for NCQA PCMH, as directed by the NYSDOH.
  • Arcadia - The Health Plan provides monetary support to our Accountable Cost and Quality Arrangement partners and Rewarding Physician Excellence programs for the implementation of an electronic health record and claims data integration and analytics platform through its contract with Arcadia Solutions, an independent company. This platform provides real-time data metrics to practices about patient management, performance data, utilization, cost data and care management tools. Arcadia has earned NCQA PCMH 2017 pre-validation status. Full credit has been awarded for several competencies in the Knowing and Managing Your Patients (KM) and Performance Measurement and Quality Improvement (QI) domains. Practice support status has been granted for multiple competencies in the KM, QI, Care Coordination (CC) and Care Management and Support (CM) domains.
  • PCMH Collaborative - Participation is open to all practices in the counties that are part of our service area. The collaborative meets monthly and agenda topics focus on best practice sharing, deep dives into the PCMH guidelines, sustainability after recognition and New York state updates.
  • Clinical Consulting Services - Clinical consultants are RNs with expertise in population health management. They provide the clinical lens necessary to analyze and interpret black and white data, translating it into patient-centered opportunities to achieve the quadruple aim (improved quality, reduced cost, improved patient and provider experience).
  • Quality Symposiums - The Health Plan holds semi-annual meetings where best practice sharing and educational information on quality, patient management, cost, utilization and administrative topics are covered.
  • ACQA Advisor Newsletter - This quarterly publication shares pertinent information with primary care practices to support population health management, with a focus on increasing quality while capitalizing on opportunities for cost and utilization containment.
  • NCQA Website - For the most up-to-date information about the NCQA Patient-Centered Medical Home.

For information about any Health Plan programs, please contact the clinical consulting team.