P2 Mobile Logo

Search form


The Potential of Patient-Centered Specialty Practice

The Potential of Patient-Centered Specialty Practice

What is PCSP?

Patient-Centered Specialty Practice (PCSP) is a recognition program from the National Committee for Quality Assurance (NCQA) that went into effect in 2013. The PCSP program was designed in many ways to complement the success of NCQA's Patient-Centered Medical Home (PCMH) program and expand its reach. The goal of the program is to encourage excellent care coordination by specialty practices in the outpatient setting, leading to less duplication of procedures and fewer hospitalizations.

Much like the PCMH program, the PCSP program focuses on proactive coordination of care, information sharing among clinicians involved in a patient's care, and a centering of care around the patient (versus around the care setting).

According to the NCQA, "Specialists who achieve NCQA PCSP Recognition will show purchasers (consumers, health plans, employers and government agencies) that they have undergone a rigorous and independent review to assess their capabilities and commitment to excellence in sharing and using information to coordinate care." What this means practically is that practices that undergo the process will be better placed to meet the challenges of the marketplace.

The value-based era

With the implementation of the Affordable Care Act, the shifting of costs to consumers, and the advent of large deductibles and consumer-based plans, we have moved swiftly into an era of purchasers looking to obtain "value" for their healthcare dollars. Synonymous with value is "quality" and patients are being both incentivized and penalized based on the healthcare provider choices that they make. For example, certain employers and payers will waive all cost sharing (copays, deductibles) for patients in certain networks that choose to receive their care from PCMH-recognized practices. Conversely, patients may face higher copays and cost sharing percentages for not going to PCMH practices where there is availability to do so.

Additionally, just about all physicians in many payer networks are being "graded" based on their ability to meet quality, efficiency, and cost metrics (check out United Healthcare's Premium Designation Program, Aetna's Aexcel Program, or Cigna's Care Designation Program). These grades affect cost-sharing the same way that PCMH-based benefit design does; if a patient chooses to go to a physician who has a low score, that patient may have a greater financial cost share because of it.

However, while the PCSP Program has been in place for a couple of years now, payers have been slow to recognize this program to the same extent as they now recognize PCMH. It took approximately three to five years for most payers to recognize PCMH and I expect it will take the same for PCSP to be as widely recognized.


Loading comments...

By clicking Accept, you agree to become a member of the UBM Medica Community.