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Guidance to Achieve NCQA Patient Centered Medical Home RecognitionAyesha Mirza, Melissa Scites, Mobeen H. RathoreUniversity of Florida Center for HIV/AIDS Research, Education & Service (UFCARES)

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LEARNING Objectives At the end of this discussion the participant will be able to:Define the meaning and purpose of a medical homeExpress why practices need to consider medical home recognitionDemonstrate the steps required to achieve medical home recognitionDifferentiate a medical home from a general practiceAnalyze the differences between the two

New Vision for Quality Health CareCare based on continuous healing relationshipsCustomization based on patient needs and valuesThe patient as the source of controlShared knowledge and the free flow of informationEvidence-based decision makingSafety as a system propertyThe need for transparencyAnticipation of needsContinuous decrease in wasteCooperation among clinicians

Crossing the quality Chasm: A New Health System for the 21st Century (IOM, 2001)

Consumer PerspectivePatients value well-organized and coordinated experience with their doctor

Most important factor physicians ability to communicate and show a caring attitude (Robinson & Brodie, 1997)

Performance OpportunitiesStaff/doctor returns calls in a timely mannerStaff/doctor follows up with a phone callThe doctor is familiar with the patients medical historyThe doctor is good at diagnosing and treating any problem

What is a medical home?Based on a concept that facilitates partnerships between individual patients and their personal physicians and when appropriate the patients family

Ensure that patients participate in their care side by side with their medical providers

Ensure that patients get the care they need, where and when they need it, and in a culturally and linguistically appropriate manner

Patient Centered Medical Home (PCMH) Principles Personal PhysicianPhysician directed medical practiceWhole person orientationCare is coordinated or integratedQuality and safety are hallmarksEnhanced access to care

Helping Primary Care Practices Transform Health CareThe Patient-Centered Medical Home is amodel of 21st century primary care thatcombines access, teamwork and technology todeliver quality care and improve health.

Margaret E. OKane, President, NationalCommittee for Quality Assurance (NCQA)

NCQA PCMH RecognitionA nationwide program that recognizes physician practices functioning as medical homesComprehensive & extensive assessment of medical home standards within the practice to demonstrate performanceSurvey tool to assess readiness and document processes, procedures, reporting & tracking capabilities via policies, system screen shots and sample documentation and follow-upLevel 1, 2, or 3 Recognition3 year Recognition Status

Must Pass Elements (2011)Standard 1A: Access During Office HoursStandard 2D: Using Data for Population ManagementStandard 3C: Care ManagementStandard 4A: Self-Care ProcessStandard 5B: Referral Tracking and Follow-UpStandard 6C: Implement Continuous Quality Improvement Process

Why PCMH??Continued Emphasis on Improving Quality and Reducing CostsPotential greater reimbursements and cost savings by health plansMedicaid programs considering implementing some type of PCMH demonstrationImproved Health Outcomes for Patients

UF CARES ExperiencePurchased Survey Tool in December 2010Review of Materials and Standards began in January 2011Incorporated PCMH evaluation into monthly Clinical Effectiveness Group MeetingsFeb-May: Started meeting twice a month, then hit roadblock with accessing EMR reports, and progress slowedJune : Met with organizational leaders and gained support to utilize system resources to provide required reporting. June-present: detailed review of each element uploading hundreds of pages of documentation and screen shots to demonstrate performanceRequired hard look at current processes and need for system changes and improvementsSubmission Goal: July 2011Concurrent challenges: undergoing EMR transition and provider changesDifficult to implement new policies and procedures during period of instabilityStrengths: buy-in and support from senior leadership, participation and interest in process from all staff disciplines

where to start??Go to website: www.ncqa.orgTake time to review &understand conceptDownload Standard & Guidelines (free)Download Application (free)Purchase Survey Tool ($80)

Next steps.Understand what you want to accomplishDo you have capacity and resources?Communicate with your senior leadership and staff get buy in!Identify Project Team5-9 key staff 1-2 champions with 1 being project leaderPatient/Peer Advocates/CAB?Develop Timeline, Set Goals for Completion

Be Prepared forRigorous and Lengthy ProcessTransformation with need to develop, change and improve processesPossible Resistance to ChangeChallenges with Commitment, waning enthusiasm, competing prioritiesOther administrative barriers contractual issues, IT support

Tips for successBe realistic on timeline, dont be too ambitious so team is not overwhelmedBe thorough in your review of guidelines, participate in available trainingsMeet regularly, make it a priorityCommunicate regularly with entire staff focusing on benefit of achievementCelebrate milestones and progress

Pts possiblePts EarnedTarget Completion DateCompletedComments/Linked Documents/Pending InformationSurvey Tool Purchase11/24/201011/24/2010NCQA Application7/11/2011Business Associate Agreement7/11/20116/13/11 - downloaded and submitted to Contract services General Agreement/Contract7/11/2011Standard 1: Access and CommunicationElement A - Access and Communication processes**445/1/11100%Policy Completion of Appointment Requests (Pt Online)Patient Online web screen shot and copy of brochurePolicy Continuity of CareSOP Patient Scheduling & POC Coord (PPC1A_2F_3E)Policy Telephone TriagePolicy After Hours Answering ServicePolicy Interpreter ServicesSOP Health Insurance Resources for PatientsElement B - Access and communication results**53.755/16/11100%Screen shots of Allscripts appt schedules (5 pts)Pt satisfaction survey resultsOn-call scheduleLanguage services brochure and invoice97.75n/aStandard 2: Patient Tracking and Registry FunctionsElement A - Basic system for managing patient data225/25/11100%Basic data/demographic report received from Allscripts/IDXIDX/Allscripts screen shots of demographic fields to show capacity (5)Element B - Electronic system for clinical data338/2/11100%Allscripts screen shots of clinical data (immunizations, allergies, VS, HC and advance directives)Portal Screen shot of radiology imaging, pathology, & labsPortal screen shots of labsElement C - Use of electronic clinical data338/2/11100%*Record Review Worksheet. Rec'd report from Allscripts 6/22 of all pts seen last 3 mo. Identified 1st 36 pts with clinical condition (HIV)EMR Chart review conducted of data elements

Standards & elements2008 PPC-PCMH9 Standards30 Elements161 scored items/factors

2011 PCMH6 Standards28 Elements152 scored items/factors

ScoringBoth have Must Pass Elements (receive a 50% score or higher2008 Standards had 10 Must Pass Elements Level 1: 25-49 pts and 5 of 10 Must PassLevel 2: 50-74 pts and 10 of 10 Must PassLevel 3: 75-100 pts and 10 of 10 Must Pass2011 Standards Level 1: 35-59 ptsLevel 2: 60-84 ptsLevel 3: 85-100 ptsAll require 6 of 6 Must Pass elements

22PCMH1: Enhance Access and Continuity

Access During Office Hours**After-Hours AccessElectronic AccessContinuityMedical Home ResponsibilitiesCulturally and Linguistically Appropriate ServicesPractice TeamPts

442222

420PCMH2: Identify and Manage Patient Populations

Patient InformationClinical DataComprehensive Health AssessmentUse Data for Population Management**Pts

344516PCMH3: Plan and Manage Care

Implement Evidence-Based GuidelinesIdentify High-Risk PatientsCare Management**Manage MedicationsUse Electronic Prescribing Pts

4343317PCMH4: Provide Self-Care Support and Community Resources

Support Self-Care Process**Provide Referrals to Community ResourcesPts

639PCMH5: Track and Coordinate Care

Test Tracking and Follow-UpReferral Tracking and Follow-Up**Coordinate with Facilities/Care TransitionsPts

66618PCMH6: Measure and Improve Performance

Measure Performance Measure Patient/Family ExperienceImplement Continuously Quality Improvement**Demonstrate Continuous Quality ImprovementReport PerformanceReport Data ExternallyPts

444

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322023PCMH 2011 Standards and Scoring**Must Pass Elements2323lets look at some examplesUsing worksheet handout, review factors and check yes for the items you are currently able to demonstrateIndicate your data source: P&P, SOP, ReportsTally score to see if you passed standardDiscuss responses from groupWhat did UF CARES provide?

Standard 1: access & communicationHas written standards for pt access & communication:Scheduling each pt with a personal clinicianCoordinating visits during 1 tripDetermining through triage how soon a pt needs to be seenCapacity to schedule pts same day they callScheduling same day appointments based on triageScheduling same day appointment base on pt requestProviding telephone advice during office hrsProviding urgent phone response 24/7Providing email consultationsInteractive practice websiteLanguage servicesHealth insurance resources

Standard 2: Patient tracking & registryThe practice systematically manages pt information & uses information for population mgmt to support patient careBasic System for Managing Patient DataElectronic System for Clinical DataUse of Electronic Clinical DataOrganizing Clinical DataIdentifying Important ConditionsUse of System for Population Management

Standard 3: Care managementPractice maintains continuous relationships with pts by implementing evidence-based guidelines and applying them to the identified needs of individual pts over time Guidelines for Important ConditionsPreventive Service Clinician RemindersPractice OrganizationCare Management for Important ConditionsContinuity of Care

Standard 4: pt self- management supportThe practice collaborates with pts & families to pursue goals for optimal achievable healthDocumenting Communication NeedsProviding Self-Management Support

Standard 5: electronic prescribingThe practice seeks to reduce medical errors and improve efficiency by eliminating handwritten prescriptions and by using drug safety checks and cost information when prescribingElectronic Prescription WritingPrescribing Decision SupportSafetyEfficiency

Standard 6: test trackingThe practice works to improve effectiveness of care, pt safety & effciency by using timely information on all tests and resultsTest tracking & follow-upElectronic system for managing tests

Standard 7: referral trackingThe practice seeks to improve effectiveness, efficiency, timeliness & coordination of care by following through on consultationsReferral tracking

Standard 8: performance reporting & improvementThe practice regularly measures its performance and takes actions to continuously improveMeasures of PerformancePatient Experience DataReporting to PhysiciansSetting Goals and Taking ActionReporting Standardized MeasuresElectronic Reporting External Entities

Standard 9: advance electronic communicationThe practice uses electronic communication to improve timeliness, effectiveness, efficiency & coordination of careAvailability of Interactive Web SiteElectronic Patient IdentificationElectronic Care Management Support

Ready or notTake the next step to receive recognition for the hard work your programs are already doing!Receive the distinction for your commitment to excellence in quality care and patient safety!Good Luck!!

AcknowledgementsSyed BukhariGlen EdwardsBonita DraytonNaoma WoodsSaniyyah Mahmoudiand the entire UFCARES team

UF CARES team

Obtaining CME/ce creditIf you would like to receive continuingeducation credits for this activity, please visit:

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