Patient Centered Medical Home Practicum in Primary Care
- Need: Improvement in service quality and patient experience in primary care practices in North Carolina's Blue Ridge region and across the state.
- Intervention: A practicum for healthcare management students was developed to help rural practices achieve Patient Care Medical Home (PCMH) status, identify quality improvement needs, and develop strategies.
- Results: With the help of practicum students, rural primary practices have have tackled a number of important quality improvement projects, achieved PCMH status and Blue Quality Physician Program Recognition.
of North Carolina (CCNC) received funding in 2011
from the Centers for Medicare & Medicaid through the
MAPCP (Multi-payer Initiative). CCNC used the grant funds
to help primary care practices in North Carolina develop
the medical home model more fully. A large part of this
endeavor was to help primary care practices achieve
Patient Centered Medical Home (PCMH) Recognition
through the National
Committee for Quality Assurance (NCQA).
Because of the amount of work involved, Access Care of
the Blue Ridge, a network within CCNC, reached out to
Appalachian State University to pair undergraduate
healthcare management majors with primary care practices.
The PCMH Practicum in Primary
Care was born, giving students hands-on experience in
rural healthcare administration and helping primary care
facilities achieve PCMH Recognition Blue Cross Blue
Quality Physician Program Recognition (BQPP).
While Appalachian State
University's Beaver College of Health Sciences
students were the first to participate in the program, it expanded to East
Carolina University and McDowell Technical
In 2012, the PCMH Practicum received a Blue Cross Blue
Shield of North Carolina Foundation grant that provided
stipends for students and financial support for the
program. In 2014, the program was winner of the Kate B. Reynolds Charitable Trust
Innovations in Rural Health Award, recognizing innovative
ideas to improve the health of people living in rural
North Carolina communities. Due to the ending of grant funds, the PCMH Practicum will not continue.
produced by the Kate B. Reynolds Charitable Trust, shares the impact of the program:
A syllabus was developed for each PCMH Practicum semester
and included weekly instructions that equipped students
in the following:
- Learn the NCQA PCMH recognition process standards.
- Educate rural practices about the PCMH recognition
- Identify a team of "PCMH Champions" within the
practice to work on the PCMH recognition process.
- Document workflows within the practice, make
suggestions for improvement, and help write policies and
procedures for the rural practices.
- Help practices participate in the BQPP initiative, a
program that rewards physicians for steps to further
improve the quality of their care.
- Help practices choose quality improvement strategies
to address gaps in care for the practices.
- Technology training and improved skills working in
electronic medical records (EMRs), registries and
- How to accurately collect, measure, and report data
- Participate in experiential
quality improvement labs and pharmacy labs
The Practicum in Primary Care team matches students to
practices that give them experiences in their desired
field of study. They also provide mentoring and support
for each individual student as well as attending didactic
sessions about PCMH, quality improvement, and workflows,
etc. Students also attend community meetings to learn
about the medical neighborhood's challenges and meet
other healthcare professionals.
From 2012-2018, the PCMH Practicum saw the following
- 110 student participants
- 28 primary care practice participants
- 15,644 Medicaid patients served
- 93,986 total patients served
Presentations on the PCMH Practicum have been shared on a
national level at NCQA's PCMH 2015 Congress and the
Institution for Health Care Improvement's 26th
and 27th Forum.
The following journal publications provide more
information about the PCMH Practicum:
Sasnett B., Watkins R.W., Ferlazzo M. (2017). Health
Service Management Interns Serve as Practice Facilitators
for Patient-Centered Medical Home Recognition: East
Carolina University-Appalachian State University
Initiative. The Health Care Manager, 36(1)
Lane S.J., Watkins R.W. (2015). Using a Facilitation
Model to Achieve Patient-centered Medical Home
Recognition, The Health Care Manager, 34(2)
Lane, S. (2014).
Measures of Student Competence Following Participation in
a Patient-Centered Medical Home Demonstration
Project-Practicum in Primary Care. The Journal of
Health Administration Education.
Lane S.J., Watkins R.W. (2013). Helping
Primary Care Practices Attain Patient-centered Medical
Home (PCMH) Recognition Through Collaboration with A
University. Journal of the American Board of
Family Medicine, 26(6), 784-786.
Watkins, RW. (2012). Partnering with Universities And
Colleges to Facilitate the PCMH Process. An Innovative
Plan to Place Healthcare Management Students Into
Practices to Promote Healthcare Transformation. The
Journal of Medical Practice Management,
In order to participate in MAPCP, practices had to attain
PCMH status, but most lacked the resources to pursue NCQA
recognition. Few primary care practices in these counties
had begun the transformation to EMRs and could not meet
PCMH requirements for e-prescribing or attaining
The PCMH recognition process is time-intensive, requiring
an estimated 100-200 hours of time to complete the
application. Most applications must contain 120-150
documents. For smaller, rural primary care practices, it
can be difficult to allocate adequate staff time to gain
Rural practices interested in achieving NCQA or BQPP can
start a practicum program in order to gain assistance in
their goals. A good place to start is by reaching to a
post-secondary institution that has a healthcare
management program, a college of health sciences, school
of healthcare management, school of public health, a
medical school, or a nursing school.
Because the time needed to run this practicum is
extensive, getting a commitment can be a struggle because
those working in rural practices are already spread thin.
Securing a provider champion, office manager, and other
staff who will be working closely with the students is
foundational. It will be necessary to regularly meet with
these people to hear their concerns, support, and educate
them on the processes. Patients and persistence are
The goal of the program was less about checking boxes and
more about applying the tenets of population health
management. This made a difference in the way patients
were treated and improved health outcomes.
Health workforce education and training
April 21, 2014
Date updated or reviewed
May 20, 2019
Suggested citation: Rural Health Information Hub,
Patient Centered Medical Home Practicum in Primary Care [online]. Rural Health Information Hub. Available at:
[Accessed 8 August 2022]
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about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
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needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.