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NCQA Patient-Centered Medical Home 2011 Recognition Program. PCPCC Consumer Engagement Date. Today. Content and focus of PCMH 2011 standards Criteria related to consumer engagement. PCMH 2011 Advisory Committee. Susan Edgman-Levitan - CHAIR Massachusetts General Hospital - PowerPoint PPT Presentation
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NCQA Patient-Centered Medical Home 2011Recognition Program
PCPCC Consumer Engagement
Date
2February 2011
Today• Content and focus of PCMH 2011
standards• Criteria related to consumer
engagement
3February 2011
PCMH 2011 Advisory Committee
Susan Edgman-Levitan - CHAIRMassachusetts General HospitalMelinda Abrams, MSCommonwealth FundBruce Bagley, MDAmerican Academy of Family PhysiciansMichael Barr, MD, MBA, FACPAmerican College of PhysiciansDuane E. Davis, MDGeisinger Health PlanTom Foels, MD, MMMIndependent HealthAlan Glaseroff, MDHumboldt-Del Norte Foundation for Medical Care/IPAFoster Gesten, MD New York State Department of HealthVeronica GoffNational Business Group on HealthPaul Grundy, MD, MPHIBMMarjie Grazi Harbrecht, MDHealthTeam Works
Edward G. Murphy, MDCarilion ClinicMary Naylor, PhD, RNUniversity of PennsylvaniaAnn O’Malley, MD, MPHCenter for Studying Health System ChangeAmanda H Parsons, MD, MBANYC Department of Health and Mental HygieneLee PartridgeNational Partnership for Women and Families Carol Reynolds-Freeman, MDPotomac PhysiciansMarc Rivo, MD, MPHPrestige Health ChoiceHealth Choice Network Xavier Sevilla, MD, FAAPWhole Child PediatricsJeff SchiffMinnesota Department of Human ServicesAnn TorregrossaGovernor's Office, PennsylvaniaEd Wagner, MD, MPHGroup Health Cooperative
4February 2011
What is different about the PCMH 2011 standards?
• Enhances patient-centeredness• Emphasizes language, culturally sensitive aspects• Integrates behaviors affecting health, substance
abuse, mental health and risk factor assessment and management
• Enhances applicability to pediatric practices• Aligns with CMS Meaningful Use requirements• Emphasizes relationship with/expectations of
subspecialists• Enhances evaluation of patient experience• Underscores the importance of system cost-savings• Enhances use of clinical performance measure
results
5February 2011
PCMH 2011 Overview (6 standards/27 elements)
1. Enhance Access and Continuity A. Access During Office HoursB. Access After HoursC. Electronic AccessD. Continuity (with provider)E. Medical Home ResponsibilitiesF. Culturally/Linguistically Appropriate
ServicesG. Practice Organization
2. Identify and Manage Patient PopulationsA. Patient Information B. Clinical DataC. Comprehensive Health AssessmentD. Use Data for Population Management
3. Plan and Manage CareA. Implement Evidence-Based Guidelines B. Identify High-Risk PatientsC. Care ManagementD. Medication ManagementE. Use Electronic Prescribing
4. Provide Self-Care Support and Community Resources A. Support Self-Care Process B. Provide Referrals to Community
Resources
5. Track/Coordinate CareA. Track Tests and Follow-UpB. Track Referrals and Follow-UpC. Coordinate with Facilities/Care
Transitions
6. Measure and Improve Performance A. Measure PerformanceB. Measure Patient/Family ExperienceC. Implement Continuous Quality
Improvement D. Demonstrate Continuous Quality
ImprovementE. Report PerformanceF. Report Data Externally
Optional Patient Experiences Survey
6February 2011
PCMH Scoring
Level of Qualifying
PointsMust Pass Elementsat 50% Performance
Level
Level 385 - 100
6 of 6
Level 2 60 - 84 6 of 6
Level 1 35 - 59 6 of 6
Not Recognized 0 - 34 < 6Practices with a numeric score of 0 to 34 points and/or achieve less than 6 “Must Pass” Elements are not Recognized.
6 standards = 100 points6 Must Pass elements
NOTE: Must Pass elements require a ≥ 50% performance level to pass
7February 2011
Must Pass ElementsRationale for Must Pass Elements • Identifies critical concepts of PCMH• Helps focus Level 1 practices on most important
aspects of PCMH• Guides practices in PCMH evolution and continuous
quality improvement• Standardizes “Recognition”
Must Pass Elements• 1A: Access During Office Hours• 2D: Use Data for Population Management• 3C: Manage Care• 4A: Self-Care Process• 5B: Referral Tracking and Follow-Up• 6C: Implement Continuous Quality Improvement
8February 2011
PCMH 1: Enhance Access and Continuity
Intent of Standard• Patients have access to
routine/urgent care and clinical advice during/after hours that are culturally and linguistically appropriate
• Electronic access• Clinician selected by patient• Team-based care; trained staff
Elements
A. Access During Office HoursB. After-Hours AccessC. Electronic AccessD. ContinuityE. Medical Home
ResponsibilitiesF. Culturally and Linguistically
Appropriate ServicesG. The Practice Team
Meaningful Use CriteriaPatients provided electronic: • Copy of health information• Clinical summary of visit• Access to health information
9February 2011
PCMH 2: Identify/Manage Patient Populations
Intent of Standard• Collects demographic and
clinical data for population management
• Assess/document risks• Create lists; use for point of
care reminders
ElementsA. Patient InformationB. Clinical DataC. Comprehensive Health
AssessmentD. Use Data for Population
Management
Meaningful Use Criteria• Language, gender, race,
ethnicity, DOB• Problem list• Medication list• Medication allergy list• Vital signs• Growth chart (peds.)• Smoking status• Lists of patients with specific
conditions for QI, decrease disparities
• Follow-up reminders for care
10February 2011
PCMH 3: Plan and Manage Care
Intent of Standard• Identify patients with
specific conditions including high-risk or complex, behavioral health
• Care management – Pre-visit planning – Progress toward goals – Barriers to treatment goals
• Reconcile medications• E-prescribing
ElementsA. Implement Evidence-Based
GuidelinesB. Identify High-Risk PatientsC. Care ManagementD. Medication ManagementE. Electronic Prescribing
Meaningful Use Criteria• Clinical decision support• Medication reconciliation
with transitions of care• E-prescribing• Drug-drug, drug-allergy
checks• Transmit prescriptions using
EHR• Drug-formulary checks
11February 2011
PCMH 4: Provide Self-Care/Community Resources
Intent of Standard• Assess self-management
abilities• Document self-care plan;
provide tools and resources• Counsel on healthy behaviors• Assess/provide/arrange for
mental health/substance abuse treatment
• Provide community resources
ElementsA. Supports Self-Care
ProcessB. Provides Referrals to
Community Resources
Meaningful Use CriteriaPatient-specific education
materials
12February 2011
PCMH 5: Track and Coordinate CareIntent of Standard• Tracks, follows-up on and coordinates tests, referrals
and patient care in other
facilities. • Establish information
exchange with facilities• Follows up with discharged
patients
ElementsA. Track Tests and Follow-
UpB. Track Referrals and
Follow-UpC. Coordinate with Facilities/
Care Transitions
Meaningful Use Criteria• Incorporate lab/test results• Exchange patient information
with other providers (meds/allergies, tests)
• Provide summary care record for transitions and referrals
13February 2011
PCMH 6: Measure and Improve Performance
Intent of Standard• Practice uses performance
and patient experience data to continuously improve
• Track utilization measures• Identifies vulnerable
populations
ElementsA. Measure PerformanceB. Measure Patient/Family
ExperienceC. Implements Continuous
Quality ImprovementD. Demonstrates Continuous
Quality ImprovementE. Report PerformanceF. Report Data Externally
Meaningful Use CriteriaReport:• Ambulatory clinical quality
measures to CMS/ state• Immunization data to
registries• Syndromic surveillance data
to public health agencies
14February 2011
Proposed Plan for Optional Patient Experience Survey
1. PCMH 2011 standards will allow practices to provide reports of patient experience results as documentation for meeting relevant elements
2. Voluntary standardized survey will allow practices to obtain additional distinction for reporting results
15February 2011
Optional Patient Experience Survey• Provide practices with distinction• Require Patient-Centered Medical Home version of
the CAHPS Clinician & Group survey tool on: – Access– Communication– Coordination– Whole person care
• Require standardized sampling approach• Require use of approved data collection
methodologies• Require reporting data to NCQA beginning January
2012• Over time, increase requirements for
standardization to allow results to be scored against benchmarks
16February 2011
Enhance Patient-Centeredness• Goal for PCMH 2011 to Increase patient-centeredness• PCMH 1: Enhance Access and Continuity
– Provide continuity of care with the same provider– Provide information to the patient about medical home– Provide access to care during and after office hours– Provide patient materials and services to meet the language
needs of patients
• PCMH 4: Provide Self-Care and Community Support – Provide resources to support patient/family self-
management
• PCMH 6: Measure and Improve Performance– Involve patients/families in quality improvement– Obtain performance data for key vulnerable populations
17February 2011
Focus on Behavioral Health• Goal for PCMH 2011 to integrate behaviors affecting health,
mental health and substance abuse• PCMH 1: Enhance Access and Continuity
– Comprehensive assessment includes depression screening, behaviors affecting health and patient and family mental health and substance abuse
• PCMH 3: Plan and Manage Care– One of three clinically important conditions identified by the
practice must be a condition related to unhealthy behaviors (e.g. obesity) or a mental health or substance abuse condition
– Practice must plan and manage care for the selected condition
• PCMH 4: Provide Self-Care and Community Resources– Self-care support includes educational and community resources
and adopting healthy behaviors
• PCMH 5: Track and Coordinate Care– Tracks referrals and coordinates care with mental health and
substance abuse services
• PCMH 6: Measure and Improve Performance– Preventive measures include depression screening
18February 2011
Questions?
19February 2011
Where to Find PCMH 2011• Standards
– No charge to view or download– Go to www.ncqa.org/view-pcmh2011
• PCMH 2011 Survey Tool – Available March 28– Preorders are accepted now– Go to
http://www.ncqa.org/tabid/629/Default.aspx • NCQA Customer Support
– 1-888-275-7585• Questions