PCMH : A WINDOW TO 2014

Presented by:Bonni Brownlee, MHA CPHQ CPEHR

NCQA PCMH Certified Content ExpertSenior Clinical Consultant

Colorado Community Health NetworkSpring Conference

Audience Poll: Where are you now?

• Value of PCMH unclear• Leadership not on

board• Key positions for

transformation are vacant

• Fear of change

• Currently reviewing standards

• Assembling PCMH team

MAYBE…

• PCMH Team meets regularly

• Actively collecting supporting documents

• Already hit “submit” button

• Awaiting score

ACTIVE

• PCMH Team continues to meet

• Areas recognized as problematic during application phase are brought forward to the QI Plan

• Reviewing 2014 PCMH Standards

SUSTAINING

Why Attain Formal PCMH Recognition?

• Drives improvement in patient care and operating framework

• Alignment with Meaningful Use • External validation of PCMH transformation and

commitment to high quality care• Pride• Market advantage• Potential for increased reimbursement and other

incentives

2014 NCQA PCMH Standards

1. Patient-Centered Access2. Team-Based Care3. Population Health Management4. Care Management & Support5. Care Coordination and Care Transitions6. Performance Measurement and Quality

Improvement

2014 NCQA PCMH STANDARDS1 Patient-Centered Access (10) 4 Care Mgmt and Support (20)

A Pt-Centered Appointment Access A Identify Patients for Care Management

B 24/7 Access to Clinical Advice B Care Planning and Self-Care Support

C Electronic Access C Medication Management

D Use Electronic Prescribing

2 Team-Based Care (12) E Support Self-Care & Shared Decision Making

A Continuity 5 Care Coordination and Care Transitions (18)

B Medical Home Responsibilities A Test Tracking and Follow-up

C Culturally-Ling Appropriate Services B Referral Tracking and Follow-up

D The Practice Team C Coordinate Care Transitions

6 Perf Measurement & Qual Improvement (20)

3 Population Health Management (20) A Measure Clinical Quality Performance

A Patient Information B Measure Resource Use

B Clinical Data C Measure Patient/Family Experience

C Comprehensive Health Assessment D Implement Continuous Quality Improvement

D Use Data for Population Management E Demonstrate Continuous Quality Improvement

E Implement Evid-Based Decision Support F Report Performance

G Use Certified EHR Technology

PCMH 1: Patient-Centered Access

1A: Patient-Centered Appointment Access1. Same-Day appointment availability2. Appointments outside of regular business hours3. Availability of alternative visit types 4. Availability of appointments: Time to Third

Next Available Appointment5. Monitoring of No Show Rates6. Acting on opportunities to improve access

PCMH 1. Patient-Centered Access

1C. Electronic Access (use of patient portal)1. More than 50% of patients have online access to health

information2. More than 5% of patients view, are able to download,

or transmit their health information3. Clinical summaries provided within 1 day for more than

50% of office visits4. Secure message sent to more than 5% of patients5. Patients have 2-way communication with the practice6. Patients can request appointments, prescription refills,

referrals and test results

PCMH 2: Team-Based Care

2B. Medical Home Responsibilities1. Practice responsible for coordinating care2. Instructions for obtaining care and advice when office is closed3. Patients to provide a complete medical history and info about

care obtained outside the practice4. Access to evidence-based care, patient education and self

management support5. Scope of services available, including how behavioral health

needs are addressed6. Equal access to all patients regardless of source of payment7. Gives uninsured patients information about obtaining coverage8. Instructions on transferring records to the practice

PCMH 3: Population Health Management

3D: Use of Data for Population Management1. 2 preventive care services2. 2 immunizations3. 3 chronic/acute care services4. Patients not recently seen by practice5. Medication monitoring or alert

PCMH 3: Population Health Management

3E. Implement Evidence-Based Decision Support1. Mental health or substance abuse disorder2. Chronic medical condition3. Acute condition4. Condition related to unhealthy behaviors5. Well child or adult care6. Overuse/appropriateness issues

PCMH 4: Care Management and Support

4A. Identify patients for care management1. Behavioral health conditions2. High cost/high utilization3. Poorly controlled or complex conditions4. Social determinants of health5. Referrals by outside organizations6. Monitoring the percentage of total patient

population identified for care management and support

PCMH 6: Performance Measurement and Quality Improvement

6A: Measure Clinical Quality Performance1. 2 immunization measures2. 2 other preventive measures3. 3 chronic or acute care clinical measures4. Data stratified for vulnerable populations to assess

disparities in care

6B: Measure Resource Use and Care Coordination1. 2 measures related to care coordination2. 2 measures affecting health care costs

6E: Demonstrate Continuous Quality Improvement1. Measuring effectiveness of actions2. Achieving improved performance on at least two

clinical quality measures3. Achieving improved performance on 1 utilization

or care coordination measure4. Achieving improved performance on at least one

patient experience measure

PCMH 6: Performance Measurement and Quality Improvement

Comparison of Must Pass Elements2011 2014

1A Access During Office Hours 1A Patient-Centered Access

2D Use Data for Population Mgmt 2D The Practice Team

3C Care Management 3D Use Data for Population Mgmt

4A Support Self Care Process 4BCare Planning and Self Care Support

5B Referral Tracking and Follow-Up 5B Referral Tracking and Follow-up

6CImplement Continuous Quality Improvement

6DImplement Continuous Quality Improvement

• Getting Started• Understanding the NCQA PCMH Application

Process• Transitioning / Renewal Applications

PLANNING FOR THE SURVEY

Getting Started

Build your project team Set a goal/date for completion Communicate with staff Conduct a scored self-assessment Develop action plan with short term goals and timelines Build the Document Library Use a tracking sheet to monitor progress

Access and Utilize NCQA’s Resources

Tools, Resources, Materials www.ncqa.org/recognition

PCMH Standards and Guidelines (most current version) Self-Assessment tool (for baseline scoring) NCQA Training available on-line NCQA On-line Application & Web-based ISS Survey Tool

If you are NCQA Recognized under the 2008 standards…

Upgrade to the 2011 standards

Purchase your ISS tool and application tool NOW

Deadline for submission under 2011 standards is March 31, 2015.

NCQA’s Advice: Avoid the rush– submit by December 31, 2014

Some grant programs require recognition by November 2014.

Review the 2011 standards.

If you have held the gains achieved through the preparation of the 2008 application, you should be able to start preparing your 2011 application.

Transitioning from 2011 to 2014 Standards

March 20142014 Standards

Released

June 30, 2014

Last day to purchase

2011 Survey Tool

March 31, 2015Last day to

submit a 2011 Survey Tool

For Renewal Practices

Streamlined approach for practices recognized under 2008 standards with Level 2 and 3 status

Can attest to 16 of the 39 elements! Score each factor/element, and write an attestation

statement: “XYZ Clinic previously achieved Level 3 recognition as a PCMH and attests that the responses to the factors for this element reflect the current operations of the practice site and the documentation to support these responses can be provided upon request.”

16 Elements for Attestations2011 NCQA PCMH Standards

1A. Access During Office Hours 4B. Referrals to Community Resources

1B. After-hours Access 5A. Test Tracking and Follow-up

1D. Continuity 5B. Referral Tracking and Follow-up

1E. Medical Home Responsibilities 6A. Measure Performance

1F. Culturally & LinguisticallyAppropriate Services

6B. Measure Patient Experience

2A. Patient Information 6D. Demonstrate Continuous QualityImprovement

2B. Clinical Data 6E. Report Performance

3E. E-Prescribing 6F. Report Data Externally

Conduct a Scored Self-Assessment

Summary Statistics - Total Score (scores will automatically calculate)

Standard Element (total points possible) Points

PCMH 1: Enhance Access and

Continuity

**A: Access During Office Hours (4) 0

B: After-Hours Access (4) 0

C: Electronic Access (2) 0

D: Continuity (2) 0

E: Medical Home Responsibilities (2) 0

F: Culturally and Linguistically Appropriate Services (2) 0

G: The Practice Team (4) 0

PCMH 2: Identify and Manage Patient

Populations

A: Patient Information (3) 0

B: Clinical Data (4) 0

C: Comprehensive Health Assessment (4) 0

**D: Use Data for Population Management (5) 0

PCMH 3: Plan and Manage Care

A: Implement Evidence-Based Guidelines (4) 0

B: Identify High-Risk Patients (3) 0

**C: Care Management (4) 0

D: Medication Management (3) 0

E: Use Electronic Prescribing (3) 0

PCMH 4: Provide Self-Care Support and Community Resources

**A: Support Self-Care Process (6) 0

B: Provide Referrals to Community Resources (3) 0

PCMH 5: Track and Coordinate Care

A: Test Tracking and Follow-Up (6) 0

**B: Referral Tracking and Follow-Up (6) 0

C: Coordinate With Facilities and Manage Care Transitions (6) 0

PCMH 6: Measure and Improve

Performance

A: Measure Performance (4) 0

B: Measure Patient/Family Experience (4) 0

**C: Implement Continuous Quality Improvement (4) 0

D: Demonstrate Continuous Quality Improvement (3) 0

E: Report Performance (3) 0

F: Report Data Externally (2) 0

G: Use Certified EHR Technology (2) NA

Total Score 0# MPE Passed at 50% 0Level of Recognition None

Summary Statistics - Must Pass Elements Score

Standard Must Pass Elements

Points

Points needed

to pass at

50%

Passed at 50%?(Yes/No)

PCMH 1: Enhance Access and Continuity

**A: Access During Office Hours 0 2 NO

PCMH 2: Identify and Manage Patient Populations

**D: Use Data for Population Management

0 2.5 NO

PCMH 3: Plan and Manage Care **C: Care Management 0 2 NO

PCMH 4: Provide Self-Care Support and Community Resources

**A: Support Self-Care Process 0 3 NO

PCMH 5: Track and Coordinate Care

**B: Referral Tracking and Follow-Up 0 3 NO

PCMH 6: Measure and Improve Performance

**C: ImplementContinuous QualityImprovement

0 2 NO

Set a Goal for Submission and a Realistic Project Timeline

Types of Supporting Documentation

Documented Process Formal organizational documentation that describes what you do, such as

written policy, procedure, protocol, workflow Must be dated and in place for 3 months

Reports Aggregated and site-specific data showing evidence of action Trended data, graphical presentations Data must be less than 1 year old; label all parts of graphics carefully

Records or Files DE-IDENTIFY! Actual patient records, files or registry/log entries Screenshots from EHR, website or other

• Materials Information given to patients, staff or clinicians, such as self-management or

educational resources, guidelines, letters, emails, meeting minutes

Before Submission, revisit the Self-Assessment Tool

What can you reasonably accomplish by your deadline ?

Can you get maximum points for all elements and factors ?

Do we meet all the Critical Factors and Must Pass elements ? If not, why not ?

Understand where you can sacrifice points.

NCQA PCMH 1:  ENHANCE ACCESS AND CONTINUITY

Element (total points possible) Points STRENGTHS WEAKNESSES CAN WE MAXIMIZE THE POINTS?

**A: Access During Office Hours (4) 3

Same Day Appts for each providerAppointment scheduling policy

Triage protocolCall logs to demonstrate response time to clinical advice callsDocumentation of clinical advice in the patient's medical record (use of phone notes)No Patient Portal

No.   Must produce the triage protocol, call logs, and use of phone notes to be solid at 3 points.  

B: After-Hours Access (4) 2 Extended clinic hoursAnswering service availability

Call logs to demonstrate response time to clinical advice calls after hours, and also thorough documentation of advice given after hours.Bonni to complete the logs with a chart review.

Yes, if call logs demonstrate response times and full documentation.

C: Electronic Access (2) 0 None No Patient Portal No.  We do not have an active Patient Portal

D: Continuity (2) 2Empanelment PolicyCentricity data field for PCPContinuity of Care Reports

Empanelment protocols not fully in place, but will not impede application.

Yes.

E: Medical Home Responsibilities (2) 0 None No Patient Brochure which explains the roles 

and responsibilities of a PCMHNo.  There is no time to prepare and print a Patient Brochure.

F: Culturally and Linguistically Appropriate Services (2)

2

Assessment of Racial and Ethnic breakdown of patient populationAssessment of , and language needs of patient populationInterpretation servicesPrint materials in other languages

None Yes

G: The Practice Team (4) 3

Team diagramHuddles documentationWeds clinical team meetingsStanding OrdersTrainings on communication; population mangement; care coordinationTeams involved in QI

Teams are a bit weak, but starting to gel; will not impact the application.  Trainings are weak in that they have not been provided to all team members, but can be further developed; will not impact the application.   Involvement in QI weak, but can be represented through BEACON and pap projects. 

No.   There is not time to train staff and implement self management support for all clinical support staff.

• …from a Reviewer’s perspective

TIPS AND TRAPS

1A: Access during Office HoursFactor 3: Providing timely clinical advice by secure electronic messages during office hours

1B: After Hours AccessFactor 4: Providing timely clinical advice during secure electronic messages when the office is not open

• “Interactive electronic system” means that someone will monitor incoming messages and respond in real time.

• A turnaround time for response to messages of 24 or 72 hours does not meet the definition of “interactive”.

1E: Medical Home Responsibilities

The practice has a process and materials that it provides patients/families on the role of the medical home

Factors 1-4: …coordinating care, obtaining care and advice during office hours and when the office is closed, patients must provide a complete medical history and information about care obtained outside the practice, care team provides evidence-based care and self-management support

• You must submit a documented process for how you provide printed materials to patients about the medical home as well as the brochure/materials that are given to patients.

1G – Team Structure and Roles

• Job Descriptions should reflect a team approach to care delivery.

• Example: “Each team member plays an integral role in providing patient-centered healthcare. Our model uses the parallel workflow design where workload is distributed throughout the team, thus improving efficiency resulting in better workflow and improved patient an staff satisfaction.”

Care Team Diagram

2C: Comprehensive Health Assessment

Factors 1-9: age/gender appropriate immunizations and screenings; family social and cultural characteristics, communication needs, medical history, advance care planning, behaviors affecting health, mental health/substance abuse, developmental screening (peds), depression screening tool

• Submit a documented process and a completed health assessment

• Must use screenshots from the SAME patient for all factors

• Rationale: Using screenshots from different patients does not demonstrate a PROCESS

2D: Use Data for Population MgmtFactor 4- Specific Medications

• Intent: Ability to pull lists of patients on specific medications for purposes of clinical care and/or patient safety.

• Submit list of patients on the medication of your choice, and also an example of an outreach letter about the medication.

• Can’t just say “We’ve never had a recall situation.”• Be proactive and prepare a letter to be used in

case of a recall or notice of newly known adverse side effects

3: Plan and Manage CareElement A: Implement Evidence-Based Guidelines

Factors 1-3: First important condition; second important condition; third condition related to unhealthy behaviors or mental health or substance abuse.

• Important conditions do not have to be the most frequently seen, but they are diagnoses, not treatment protocols or screening

• Must provide BOTH source of guidelines and evidence of implementation

• Do not use one guideline to cover two conditions (such as DM and HTN)• EHR templates for chronic disease care are acceptable as evidence

of implementing EBG• Screenshots must be of real patients• All screenshots illustrating implementation of EBG should come from

the same patient

6E – Report Performance

Factor 1- within the practice, results by individual clinicianFactor 2- Within the practice, results across the practice

• These factors REQUIRE reporting examples from the measures provided in both: 6A (clinical measures) and 6B (patient satisfaction survey data)

Is your EMR Vendor Pre-Validated?

Athena Health Cerner : Power Chart Connexin : Office Practicum eClinicalWorks GE Centricity Greenway : Prime HealthFusion : MediTouch i2iSystems : i2iTracks M3 Information MDLand : iClinic MDDatacor : MDInsight PatientPoint Phytel : Insight, Outreach, Coordinate Physician Hub: Electronic Medical Office Vitera Healthcare Solutions: Vitera Intergy

Website accessed May 7 2014

SOURCE: http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH/PCMHPrevalidationProgram.aspx

Questions

…and Thank You!!!