Module 2: Recognition and Payment

Learning objectives

Highlights

Action steps and tools

Learning objectives

• Communicate goals and expectations for PCMH transformation
• Articulate the business case for transformation to senior leaders and stakeholders
• Help practices understand the costs and benefits of PCMH transformation
• Communicate the benefits of PCMH recognition

Highlights

Practices beginning the PCMH transformation journey often have questions and concerns about cost and payment. What will it cost my practice to become a PCMH? Will I be eligible for enhanced payment? Practices, particularly practice leadership, need to understand the business case for PCMH before investing resources in transformation efforts.

Coaches are not expected to be payment or policy experts, but they need to understand the "bigger picture"—the environment in which practices operate—in order to effectively guide change at the site level. Understanding the payment and policy environment in which your sites operate will help you understand their needs, and identify resources that may be able to support their transformation efforts. Coaches, and the organizations that employ them, can also play a key role in advocating for the alignment of PCMH initiatives at the local, state, and regional levels. They may also be able to collaborate with payers to help design PCMH initiatives that best meet the needs of sites in their communities.

As a coach, you should be prepared to articulate the business case for PCMH transformation to senior leaders (e.g., CEO, CFO), clinical teams, and community partners. You should also be prepared to describe the benefits of PCMH recognition and how external recognition is linked to payment.

The second module of Coach Medical Home, "Recognition and Payment," provides coaches with an overview of payment reform and PCMH recognition. It covers the following:

• Investing in PCMH: Data, examples, and resources to help you understand why payers are interested in PCMH transformation
• PCMH Payment 101: Basic information on the most common models used in PCMH payment demonstrations and pilots
• NCQA PCMH Recognition: The role of recognition in payment demonstrations and pilots
• Coaching Tip Summary: Additional tips and tools to help you understand your role as a coach, how to tailor payment and policy information to different audiences, and how to address practice concerns

Action steps and tools