In January of 2008, the National Commission on Quality Assurance (NCQA) released certification standards for physician practices to be recognized for providing care that "seeks to strengthen the physician-patient relationship by replacing episodic care based on illness and patient complaints with coordinated care and a long-term healing relationship." By achieving this certification, physicians can demonstrate to their peers, payors, and the general public that they provide quality patient care.

The American College of Physicians, The American Academy of Family Practice, the American Academy of Pediatrics, and the American Osteopathic Association have jointly defined a medical home as a model of care in which the following principles are followed:

Personal physician — each patient has on ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.

Physician directed medical practice — the personal physician leads a team that takes collective responsibility for the patient's ongoing care.

Whole person orientation — The personal physician is responsible for providing all of the patient's health care needs and when needed, arranges for appropriate care with other qualified professionals. This includes care for all stages of life, acute and chronic care, preventative services, and end of life care.

Care is coordinated or integrated across all elements of the complex health care system and the patient's community. Care is facilitated by registries, information technology, health information exchange, and other means to assure that patients receive the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

Enhanced access to care is available through systems such as open scheduling, expanded hours, and new options for communication between the patient and the practice.

Payment for services appropriately recognizes the added value provided to patients who have a patient-centered medical home.

Quality and safety are hallmarks in which:

• Evidence-based medicine and clinical decision-support tools guide decision-making;
• Physicians accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement
• Patients actively participate in decision-making and feedback is sought to ensure patients' expectations are being met
• Information technology is utilized to support optimal patient care, performance measurement, patient education, and enhanced communication
• Patients and families participate in quality improvement activities

The patient-centered medical home has nine standards with one overall score. Each standard consists of several specific elements. The nine standards include:

• Access and Communication
• Patient Tracking and Registry Functions
• Care Management
• Patient Self Management Support
• Electronic Prescribing
• Test Tracking
• Referral Tracking
• Performance Reporting and Improvement
• Advanced Electronic Communications

The cost to purchase the survey tool license is $80 for all practice sizes. Application fees for NCQA review and recognition depend on the size of the practice. These range from $450 for a one physician practice to $2,700 for practices from 6 to 100 physicians. Practices with over 100 physicians pay $2,700 plus $10 for each additional physician. NCQA offers a 20% discount for applicants sponsored by health plans, employers, and other programs.

Some payors, such as Highmark, currently provide financial rewards to eligible practices that have met the NCQA performance criteria. It is expected that more payors will follow suit in the future.

For additional information on the NCQA medical home, go to www.ncqa.org. To learn more about Highmark's current initiatives, go to www.highmark.com.