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Patient-Centered Medical Home (PCMH) and Healthix

Five Key Steps for New York State
PCMH Recognition & HIE Integration

1- What is PCMH?

The Patient-Centered Medical Home (PCMH) is 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.

Connecting to the Health Information Exchange (HIE): A core requirement for practices seeking NYS PCMH recognition

2- PCMH Core Criteria and NYS Required Criteria

The NYS PCMH recognition program features 6 concepts, developed from evidence-based guidelines and best practices that make up a medical home. These are the criteria which a practice must satisfactorily demonstrate in order to earn NYS PCMH Recognition.

To earn NYS PCMH Recognition, a practice must meet all 40 core criteria and 12 NYS-required criteria.
Practices must earn a total of 25 credits in elective criteria across 5 of 6 concepts (16–19 credits are earned by meeting required NYS criteria, which cross all 6 concepts). Practices decide which of the remaining 6-9 credits of elective criteria to complete.

3- How does Healthix relate to PCMH?

Healthix is a public health information exchange (HIE), also known as a RHIO or Qualified Entity of the Statewide Health Information Network of NY (SHIN-NY). PCMH requirement CC21A is a core requirement for practices seeking NYS PCMH Recognition is for the organization to connect to the HIE. As an HIE, Healthix connectivity can:

  • Enhance the organization’s ability to manage complex patients (a core requirement of NCQA for practices pursuing NYS PCMH recognition).
  • Improve clinical outcomes
  • Better facilitate care coordination
  • Lower duplicate testing and lab costs and facilitate efficiency
  • Improve patient and clinician experience

4 – HIE Integration: Timing

It is the responsibility of the practice to give Healthix advance notice regarding their PCMH deadline. Typically, Healthix will need 3 months to complete an integration with the practice EHR. This does not include time to complete any required documentation with Healthix or your EHR vendor. It may be possible for some projects to be completed in less than 3 months, however it is not guaranteed. Please contact us with ample time to meet your PCMH deadline. Please contact your Healthix Relationship Manager or Customer Support if you have PCMH requirements that require our assistance, allowing ample time to meet your PCMH deadline. To find your Relationship Manager click here  or contact Customer Support click here.

5 – Checklist for Successful Bi-Directional Healthix Integration

    • Completion of Healthix Participant Agreement and Business Associate Agreement
    • Completion of EHR Vendor HIE Integration Contract
    • Completion of Compliance Requirements Workplan
    • Healthix must receive OID (Organization Identification Number) from the EHR vendor or practice
    • Successful data transmission from EHR to Healthix
    • Successful collection of Healthix consent from patient(s)
    • Healthix users must complete mandated Policy Training to query Healthix data

PLEASE NOTE: Healthix is not able to provide guidance on meeting PCMH requirements, nor is Healthix NCQA certified in any way.  Healthix can only assist with, and support, the steps required for HIE connectivity.