2014 PCMH Standards

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This wiki serves as an informal repository of PCMH documentation related to the 2014 PCMH Standards. Much of the content here comes from PCC clients who have generously allowed us to use their material. Nothing in this wiki is official PCC documentation and should be used at your own risk.

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PCMH 1: Patient-Centered Access (10 points)

The intent of this standard is:

PCMH1A - Patient-Centered Appointment Access (4.5 points) (Must Pass)

PCMH1B - 24/7 Access to Clinical Advice (3.5 points)

PCMH1C - Electronic Access (2 points)

PCMH 2: Team-Based Care (12 points)

The intent of this standard is:

PCMH2A - Continuity (3 points)

PCMH2B - Medical Home Responsibilities (2.5 points)

PCMH2C - Culturally and Linguistically Appropriate Services (2.5 points)

PCMH2D - The Practice Team (Must Pass) (4 points)

PCMH 3: Population Health Management (20 points)

The practice uses a comprehensive health assessment and evidence-based decision support based on complete patient information and clinical data to manage the health of its entire patient population.

PMCH3A - Patient Information (3 points)

PMCH3B - Clinical Data (4 points)

PMCH3C - Comprehensive Health Assessment (4 points)

PMCH3D - Use Data for Population Management (Must Pass) (5 points)

PMCH3E - Implement Evidence-Based Decision Support (4 points)

PCMH 4: Care Management and Support (20 points)

Intent of Standard: The practice systematically identifies individual patients and plans, manages and coordinates care, based on need.

PMCH4A - Identify Patients for Care Management (4 points)

PMCH4B - Care Planning and Self-Care Support (4 points) (Must Pass)

PMCH4C - Medication Management (4 points)

PMCH4D - Use Electronic Prescribing (3 points)

PMCH4E - Support Self-Care and Shared Decision Making (5 points)

PCMH 5: Care Coordination and Care Transitions (18 points)

The practice systematically tracks tests and coordinates care across specialty care, facility-based care and community organizations.

PMCH5A - Test Tracking and Follow-Up (6 points)

PMCH5B - Referral Tracking and Follow-Up (Must Pass) (6 points)

PMCH5C - Coordinate Care Transitions (6 points)

PCMH 6: Performance Measurement and Quality Improvement (20 points)

The practice uses performance data to identify opportunities for improvement and acts to improve clinical quality, efficiency and patient experience.

PMCH6A - Measure Clinical Quality Performance (3 points)

PMCH6B - Measure Resource Use and Care Coordination (3 points)

PMCH6C - Measure Patient/Family Experience (4 points)

PMCH6D - Implement Continuous Quality Improvement (Must Pass) (4 points)

PMCH6E - Demonstrate Continuous Quality Improvement (3 points)

PMCH6F - Report Performance (3 points)

PMCH6G - Use Certified EHR Technology (0 points)