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“I’ve been a nurse since 1971, and I worked on the trauma ward in the intensive care unit [ICU] for many years,” says Ms. Parker. She then went into primary care, following her desire to create strong patient relationships and move into private practice. Now her practice, A to Z Primary Care, has been operating for nine years.
“Though I became the first independent nurse practitioner [NP] in the state, it took the insurance companies a while to recognize that. I’ve also opened up an urgent care, which I currently have a per diem relationship with, and both practices have worked together beautifully,” she says. “For me and my team, it’s all about relationships, being kind and helping others. We like to say that we offer concierge medicine without the extra cost.”
The National Committee for Quality Assurance (NCQA) defines PCMH as:
“... a model of care that puts patients at the forefront of care. PCMHs build better relationships between patients and their clinical care teams. Research shows that PCMHs improve quality and the patient experience, and increase staff satisfaction — while reducing health care costs. Practices that earn recognition have made a commitment to continuous quality improvement and a patient-centered approach to care.”
Janel Snowden, A to Z Primary Care’s practice manager, further explains PCMH as, “bringing the patient into the practice so that they feel like they are part of a team. It’s about making patients the priority, which means understanding their barriers and their needs and adapting to them.”
For example, she notes, if patients are hard of hearing, they may be contacted via text rather than a phone call. If a family does not have access to child care, they can make an appointment for a Saturday visit; same-day and urgent appointments are also available. In addition, patient copays have decreased due to PCMH status. With our Case Manager Maryellen Caniglia, RN, CDOE, who follows up with patients seen in the emergency and urgent care settings, our numbers of visits have decreased. She also manages the practice’s patients with diabetes, whom have shown better glucose control and disease management.
Plus, as the COVID-19 pandemic continues to affect communities throughout the United States, the PCMH model is particularly suited to address patients’ needs. The NCQA’s PCMH guidelines include recommendations to encourage social distancing, telehealth, flexible teams, proactive care management, coordination across health care teams and ongoing quality improvement measures.
“My patients are a part of my family,” Ms. Parker says. “It’s important for them to stay home and stay well. I’ve said, ‘If you need assistance, I’ll come to you or I can help with your health technology needs.’ Whatever happens, we’re adapting to keep them safe and at home."
To become recognized by the NCQA as a PCMH, a primary care practice should review the concepts and required criteria in order to begin the transformation process.
The Care Transformation Collaborative Rhode Island (CTC-RI) checked in with A to Z Primary Care several times to gauge its progress in making changes to align with the PCMH criteria. After a final review and once approval was granted, the practice officially became a Recognized PCMH; however, annual reporting is required to sustain recognition.
“What the NCQA reviewed included key quality measures; practice performance and patient communication were a few items. We have always done this, but now they are measured and reported. We had a CTC-RI practice facilitator, Jayne, meet with us who helped guide our practice throughout the recognition process, and my practice manager was an amazing resource for our reporting requirements,” Ms. Parker shares.
“You can’t do it alone, but it’s worth it, and I wish more NPs would seek out recognition. The health care system is realizing the importance of NPs. Insurance providers are learning the value of good primary care providers. We’re the voice of the future, and the PCMH model gives patients the power to make themselves healthy in alignment with their dedicated care team."
As states experiment with and deploy new models of care delivery and reimbursement during the COVID-19 pandemic, policy decisions must include NPs as primary care providers and leaders of Accountable Care Organizations, PCMHs and other coordinated care initiatives. The American Association of Nurse Practitioners® (AANP) is tracking the federal and state-level response and is providing up-to-date policy and practice updates.
Get the facts related to telehealth-delivered care for patients suspected of having or diagnosed with COVID-19. Review the Centers for Medicare and Medicaid Services (CMS) guidance and billing information. Plus, as states are invoking new measures to ensure a health workforce is available to meet increased demands, explore where emergency state licensure has been enacted and the steps states have taken to address COVID-19.