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Concept: Patient-Centered Access and Continuity (AC)

• The PCMH model expects continuity of care. Patients/families/caregivers have 24/7 access to clinical advice and appropriate care facilitated by their designated clinician/care team and supported by access to their medical record. The practice considers the needs and preferences of the patient population when establishing and updating standards for access.

• 2 Competencies• 14 Criteria:

• 7 Core• 7 Elective (8 credits)

• 4 New to 2017 criteria

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• Competency A: The practice seeks to enhance access by providing appointments and clinical advice based on patients’ needs.

Patient-Centered Access and Continuity (AC)

Criteria Core Elective # Credits

AC01: Assesses the access needs and preferences of the patient population X

AC02: Provides same day appointments for routine and urgent care to meet identified patient needs X

AC03: Provides routine and urgent appointments outside regular business hours to meet identified patient needs

X

AC04: Provides timely clinical advice by telephone X

AC05: Documents clinical advice in patient records and confirms clinical advice and care provided after-hours does not conflict with patient medical record

X

AC06: Provides scheduled routine or urgent appointments by telephone or other technology-supported mechanisms

X 1

AC07: Has a secure electronic system for patient to request appointments, prescription refills, referrals and test results

X 1

AC08: Has a secure electronic system for two way communication to provide timely clinical advice X 1

AC09: Uses information about the population served by the practice to assess equity of access that considers health disparities

X 1

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AC 01 (Core)

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AC01: • Patient Portal Survey• ED Utilization Survey• Pt. Sat survey• Customer Focus Group• Payer data• Hospital data

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AC01: The foundation of your PCMH• Five Dimensions of Access:

1. Availability: The relationship between volume/supply and demand

2. Accessibility: The relationship between location of supply and the location of the patient

3. Accommodation: The relationship between organization of services and patient needs

4. Affordability: The relationship between prices and the patient’s ability to pay

5. Acceptability: The relationship between the patient’s personal preferences/expectations and the provider’s actual delivery

Access

Availability

Accessibility

AccommodationAffordability

Acceptability

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AC 02 (Core)

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AC02: (2014 equivalent = 1A1)

• Min. 1/day/site –> efficient• Alternative methodology to Appt.:

• Open access provider• Teamlet model• E-visits

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AC 03(Core)

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AC03: (2014 equivalent = 1A2) • Reg hours = 8-5 (per NCQA)• Utilization of appointments:

• Pt. Satisfaction of appointments• HC Efficiencies• Appropriateness

Routine & Urgent?

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AC 04 (Core)

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AC04: (2014 equivalent = 1B2)• If care team is answering for clinician-note that clinician gave

advice for communication• Consider tiering “timeliness”

• Rx refills: 72 hours• Urgent clinical advice: 2 hours• Routine clinical advice: 4 hours

• Why don’t patients call after hours? (AC01)

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AC 05 (Core)

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AC05: (2014 equivalent = 1B4)• If care team is answering for clinician-note that

clinician gave advice for communication

• If documented after call, must be next business day

• This is BIGGER THAN PCMH….IF it’s NOT documented, then….?

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AC 06 (1 Credit)

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AC06: (2014 equivalent = 1A3)• What does AC01 say?

• Is your staffing appropriate?

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AC 07 (1 Credit)

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AC07: (2014 equivalent = 1C6)

• (Your portal doesn’t work because you didn’t listen!!!)

• You can’t pretend anymore!!!

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AC 08 (1 Credit)

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AC08: • 2014 Equivalent ≠1C5

• Accountability

• Utilization

• Consider roles and responsibilities for timeliness 1.1.2017-

1.7.2017Time received

Time responded

Time to response

Compliant?

Message #1 1.1.2017 12:00 PM

1.1.2017 4:00 PM

4.0 Y

Message #2 1.2.2017 6:45 PM

1.3.2017 4:45 PM

22.0 N

Message #3 1.4.2017 8:00 AM

1.4.2017 8:30 AM

.5 Y

TOTAL COMPLIANCE

2/3 = 66%

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AC 09 (1 Credit)

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AC09: • Consider the UDS Mapper• Payer attribution vs. visit lists

• Can you stratify AC01?• Geographic location

• 330 Grant Needs Assessment

Characteristics of your population drive utilization of appropriate access

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• Competency B: Practices support continuity through empanelment and systematic access to the patient’s medical record.

Patient-Centered Access and Continuity (AC)

Criteria Core Elective # Credits

AC10: Helps patients/families/caregivers select or change a personal clinician X

AC11: Sets goals and monitors the percentage of patient visits with the selected clinician or team X

AC12: Provides continuity of medical record information for care and advice when the office is closed

X

AC13: Reviews and actively manages panel sizes X 1

AC14: Reviews and reconciles panels based on health plan or other outside patient assignments X 1

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AC 10 (Core)

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AC10: (2014 equivalent = 2A1)

• Account for patient preference----you are a PCMH, afterall!• Consider who should be a PCP and who should not

• NOT THE SAME THING AS PCP for MCO• What about dental? BH?

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AC 11 (Core)

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AC11: (2014 equivalent = 2A2)

• This is the MOST important measure you will EVER look at!

• 30 days; every month, every year

• > 75% is the recommended goal

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Jan Feb Mar Apr May June Jul Aug Sept Oct Nov Dec

Cont

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Continuity of Care

Goal

PCP Continuity

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AC11: More, because it is the MOST important measure you will EVER look at!

What percentage of patients are seeing their PCP?What percentage of a providers visits are with their patients?Is their a site or provider issues?

Empanelment or scheduling related?Productivity related?

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AC 12 (2 Credits)

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AC12: (2014 equivalent = 1B1) • Just, duh!• At least 1 person at your practice will need to have access to record

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AC 13 (1 Credit)

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AC13

?

Your Value Based Driver-You are not a

PCMH without this!!!!

• Why are you under/over empaneled?• Do your avg visits/pt align with Evidence Based Guidelines?• Are your panel sizes appropriate to the patient panel needs?• How do the panel sizes align with productivity performance?

• How does this align with your 3NA and continuity of Care report?• Are you panel sizes contributing to low continuity?• Are your panel sizes contributing to scheduling issues?• Do you need to create a new care team model?

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AC13: Access to Value: Right Sizing Panels

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AC 14 (1 Credit)

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AC14:• Attribution• HEDIS• ACO/CPC• Panel managers• If you haven’t done it….DO IT!

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AC14: Your Transformation Application

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BREAK