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.
- Intervention: A practicum for healthcare management students to help rural practices achieve Patient Care Medical Home (PCMH) status and identify quality improvement strategies.
- Results: Rural primary practices have achieved PCMH status and Blue Quality Physician Program Recognition.
Centered Medical Home Practicum in Primary Care (PCMH
Practicum) was developed to assist primary care practices
in North Carolina with improving their service quality
and patient experience. During the course of the PCMH
Practicum, Appalachian State University healthcare
management students intern at rural primary care
practices to help gain
Patient Centered Medical Home (PCMH) Recognition
through the National
Committee for Quality Assurance (NCQA) and quality
improvement strategies through the Blue Cross Blue Shield
Quality Physician Program Recognition (BQPP).
This PCMH Practicum received a 3-year
Multi-Payer Advanced Primary Care Practice (MAPCP)
grant from the Centers of Medicare and Medicaid Services
(CMS). Funds were awarded to 7 North Carolina counties, 3
of which were in the rural Blue Ridge Region: Ashe,
Avery, and Watauga.
The PCMH Practicum is a partnership of the Primary Care Quality Improvement Collaborative and the Beaver College of Health Sciences at Appalachian State University.
The program was the winner of the 2014 Kate B. Reynolds Charitable Trust
Innovations in Rural Health Award to recognize innovative
ideas to improve the health of people living in rural
North Carolina communities. View the impact of the PCMH
Practicum through this video produced by the Kate B.
Reynolds Charitable Trust:
The PCMH Practicum is an internship course for healthcare management students. During the course, students:
- Learn the NCQA PCMH recognition process standards
- Educate rural practices about the PCMH recognition process
- 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 Blue Quality Physician Program (BQPP) initiative, a program that rewards physicians for steps to further improve the quality of their care. BQPP recognition rewards practices with higher reimbursement rates and thus provides a vital monetary reward for rural practices
As practices have attained PCMH status, students are now placed with practices that have already attained PCMH recognition. In these placements, students:
- Help practices chose a quality improvement strategy to address decreasing care alerts (preventative healthcare screenings and needed follow-up testing).
- Assist practices to sustain and renew PCMH and BQPP
By the end of 2013, 18 PCMH applications had been submitted and successfully recognized by NCQA. All practices assisted through this partnership have achieved both PCMH and BQPP status.
In 2015, 7 practices in the Blue Ridge area participated in NCQA’s PCMH redesign pilots. Students provided feedback to NCQA on the challenges and barriers of small rural practices to attain and sustain PCMH.
Presentations on the PCMH Practicum have been shared with others on a national level at NCQA's PCMH 2015 Congress and the Institution for Health Care Improvement's 27th Forum.
In 2015, the program expanded to East Carolina University. A third site is planned for 2017.
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 electronic medical records and so could not even meet the PCMH requirements for e-prescribing or attaining meaningful use.
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 PCMH recognition.
The Collaborative's approach of pairing rural practices with universities and colleges would be easy to replicate. Any college or university that has a College of Health Sciences, School of Health Care Management, School of Public Health, medical school, or nursing school could institute the program. Rural practices could also initiate a program by reaching out to local colleges or universities.
The Primary Care Quality Improvement Collaborative group would be happy to share curriculum and resource materials with others interested in developing a similar program.
Health workforce education and training
April 21, 2014
May 11, 2017
Please contact the models and innovations contact directly for the most complete and current information 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 community should consider whether a particular project or approach is a good match for their community’s 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.