New York State Patient-Centered Medical Home (NYS PCMH)

On April 1, 2018 The New York State Department of Health (NYSDOH) released an innovative model for primary care transformation known as the New York State Patient-Centered Medical Home (NYS PCMH). New York State collaborated with the National Committee for Quality Assurance (NCQA), creator of the patient-centered medical home (PCMH) program to develop this exclusive transformation model for all eligible primary care providers in New York State. NYS PCMH will expand access to high-performing primary care which is key to improving value in health care and achieving the Triple Aim goals of improved health, better health care and consumer experience, and lower cost.

This model was designed as the optimal solution to meet the needs of New York State, including verifiable progress over time, transition from a focus on processes to one that centers on outcomes and performance as well consistency of financial and technical support. The complexity generated by multiple active primary care transformation programs in the State has been an ongoing challenge to achieving objectives sought by NYSDOH. NYS PCMH seeks to combine transformation activities under one umbrella with a uniformed approach of improving primary care across New York State.

About PCMH

The Patient-Centered Medical Home is a model of care that puts patients as the primary focus of care. PCMHs build better relationships between people and their clinical care teams. Research shows that they improve quality, the patient experience and staff satisfaction, while reducing health care costs.

NCQA's Patient-Centered Medical Home Recognition Program is the most widely adopted Patient-Centered Medical Home evaluation program in the country. More than 12,000 practices (with more than 60,000 clinicians) are recognized by NCQA. And more than 100 payers support NCQA recognition through financial incentives or coaching.

If your practice earns recognition through NCQA, it means you have made a commitment to providing quality improvement within your practice and a patient-centered approach to care that results in patients that are happier and healthier

About NYS PCMH

The New York State Patient-Centered Medical Home (NYS PCMH) Recognition Program is built upon the NCQA PCMH model. The NYS PCMH Recognition Program is exclusive to New York State. NYS PCMH supports the state's initiative to improve primary care and promote the Triple Aim: better health, lower costs and better patient experience.

NYSDOH provides the following resources:

  • Recognition at no cost to practices. NYSDOH covers the first year NYS PCMH Recognition fee or the first NYS PCMH Annual Reporting at 100%. The practice is responsible for paying their Annual Reporting fee each year after earning NYS PCMH Recognition. There are two discount codes that were created and should be used at the time of enrollment:
    • If your practice participated in the NYSDOH Advanced Primary Care (APC) Program please use code: NYAPCD
    • If your practice did not participate in NYSDOH APC – please use code: GNYDOC
  • Transformation Assistance. New York state contracted with 15 organizations that specialize in NYS PCMH transformation and are available at no cost to participating practices. These entities provide step-by-step assistance in managing the transformation process and support the efforts of improving the patient experience. You can find a list of the Transformation Assistance Contractors on the NYSDOH web site. Transformation assistance is provided for physician-led practices only. Practices can, but are not required to, use these organizations to assist in transformation. Practices that do not use, or are not eligible to use, these contractors are encouraged to engage Certified Content Experts (CCE). If you are a CCE that consults with practices and you do not work for one of the transformation assistance contractors, you should still work with and maintain your relationship with your practices.
  • Enhanced reimbursement opportunities. Practices that participate in NYS PCMH transformation may be eligible to receive supplemental payments through state programs such as the Medicaid PCMH Incentive Program. In addition, NYSDOH is engaged regionally with commercial payers to implement voluntary, multi-payer value-based payment (VBP) arrangements to support practices that have not had these opportunities through previous transformation efforts. Many of these models and eligibility to participate will depend on practices achieving and maintaining NYS PCMH recognition.
  • For more questions on NYS PCMH, please see our frequently asked questions document: NYS PCMH FAQ (PDF) April 2018
  • For more information on how to enroll in NYS PCMH please visit NCQA's website.

Additional Information & Resources for NYS PCMH

Communication & Marketing Materials

NYS PCMH Standards and Guidelines

NYS PCMH Annual Reporting Requirements

Patient Centered Medical Home Quarterly Reports

These reports provide snapshots of the PCMH program by quarter and give an illustration on how the program changes over time. These reports have four sections:

  1. Practice Information: includes the number of PCMH-recognized practices in the state by recognition level
  2. Provider Information: includes the number of PCMH-recognized providers in the state by recognition level
  3. Enrollee Information: includes counts of NYS Medicaid enrollees who see PCMH-recognized primary care providers
  4. Fiscal Information: includes the amount spent on PCMH by NYS Medicaid through increased capitation rates to recognized providers and fee-for-service 'add-ons' for qualifying visits with recognized providers

Medicaid PCMH Statewide Incentive Payment Program

NYS Patient Centered Medical Home Incentive Frequently Asked Questions

The following link includes a list of frequently asked questions regarding the PCMH incentive payment programs operating in NYS: Frequently Asked Questions: Patient Centered Medical Homes.

Patient Centered Medical Home Initiative in New York State Medicaid

This section contains annual reports to the Governor and the Legislature which describe the Adirondack Medical Home Demonstration and Statewide Patient Centered Medical Home programs that New York State Medicaid is participating in, as well as information on program trends, evaluation results, and accomplishments

Patient Centered Medical Home Satisfaction with the Experience of Care

In 2013, a survey was administered to Medicaid Managed Care members to review and evaluate their experiences, and the quality of care they received from PCMH recognized providers, and compared them to the member experiences that received care from non-PCMH recognized providers. The instruments used were the Adult and Child SAHPS Clinician, and Group PCMH surveys. Reports are available below:

Patient Centered Medical Home Medicaid Update Articles

Regional Oversight & Management Committee’s (ROMC)