Does Your Clinic have NCQA

PCMH Recognition? Learn

practical tips on how to transition to

Annual Reporting with NCQA.

November 6, 2018 | 3:00 – 4:00 pm ET

KPCA Annual Conference

Objectives

1) Understand and know how to apply the NCQA

PCMH 2017 standards to your practice and move to

Annual Reporting to maintain your recognition.

2) Obtain practical tips on how to sustain and

maintain your PCMH recognition.

3) Identify a minimum of one action step your health

center will take to be deliberate about putting your

patients at the center of care and improve the care

experience.

CONGRATULATIONS!

It is fantastic that your health center has NCQA PCMH 2014 Level 3 Recognition!

This session is for you!

All are welcome.

Poll Question #1

Which describes your practice’s situation regarding PCMH Recognition best?

A. Not recognized and new to learning about PCMH.

B. Not recognized but have had training about PCMH.

C. Have PCMH recognition, not NCQA 2014 Level 3.

D. Have PCMH recognition, 2014 Level 3.

E. Other

Questions for You and Your Health Center!

1. What is your end date (anniversary) for the 3-year recognition period?

2. How many practice sites have recognition?

Are all sites NCQA PCMH 2014 Level 3?

3. Are any sites not recognized and you now want to have them recognized?

4. Are all of your clinicians up to date with NCQA in the Directory?

5. Have you maintained what you said you were doing when you obtained Recognition? Such as:

Clinical quality measures: monitor/report/improve

Patient satisfaction & engagement

Access measures

Reports

Population Health

Proactive Preventive Care Reminders

What P/P are updated,

new workflows, checklists?

Have you trained new staff

on PCMH, retrained

existing?

Source: FY2018 HRSA BPHC QIA Technical Assistance Webinar

09.13.18

Is this your reality?

National Committee for Quality Assurance, PCMH 2017 Standards & Guidelines

https://www.ncqa.org/programs/health-care-providers-practices/patient-centered-medical-home-pcmh/

Make sure you review ALL

Core Criteria. They equate

to a majority of the MPE

and Critical Factors from

2014!

Educate

yourself on

New

Criteria!

New PCMH 2017 Criteria

Core – Need to review, do and have evidence

TC 01, KM 02 (F-G), KM 21, AC 01, QI 01, QI 08 (D)

Elective Criteria

TC 03, 04, 08

KM 04, 05, 06, 07, 08, 11 (A&C), 13, 18, 19, 21, 23, 25, 28

AC 09, 13, 14

CM 03, 09

CC 03, 05, 06, 11, 13, 17

QI 14, 19

Compare your 2014 Level 3

Recognition Results to the

2017 Criteria!

2017 Core Criteria – New: Your Practice Must Meet! TC 01 (Core) PCMH Transformation Leads: Designates a clinician lead of the medical home and a staff

person to manage the PCMH transformation and medical home activities.

KM 02 (Core) Comprehensive Health Assessment: Comprehensive health assessment includes (all items

required):

F. Social functioning.

G. Social determinants of health.

KM 21 (Core) Community Resource Needs: Uses information on the population served by the practice to

prioritize needed community resources.

AC 01 (Core) Access Needs and Preferences: Assesses the access needs and preferences of the patient

population.

QI 01 (Core) Clinical Quality Measures: Monitors at least five clinical quality measures across the four

categories (must monitor at least one measure of each type):

D. Behavioral health measures.

QI 08 (Core) Goals and Actions to Improve Clinical Quality Measures: Sets goals and acts to improve

upon at least three measures across at least three of the four categories:

D. Behavioral health measures.

NCQA PCMH Recognition – The Process

Commit

• Learn It – PCMH Standards & Guidelines; core criteria

• Apply PCMH Concepts to your practice

• Enroll through Q-PASS (pre-validated vendors, shared credit)

Transform

• NCQA representative

• Begin working with Q-PASS (upload documentation, prepare for

check-ins)

• Virtual reviews

Succeed

• Earn recognition

• Annual reporting

• Sustain your Recognition.

• Core Features must be sustained.

• Meet minimum requirements.

• NCQA has 30 days to review annual

reporting submission.

• NCQA will randomly audit practices to

validate attestation.

• Recognition can be revoked or

suspended.

• New requirements 6 mon ahead.

• Complete the Annual Questionnaire in

Q-PASS.

• Requirements may be removed,

modified or added over time.

NCQA PCMH 2017 ANNUAL REPORTING

PERIOD: JANUARY 1 – DECEMBER 31, 2019 (Updated 07.24.18)

Report the following:

Team-Based Care and Practice Organization

(AR-TC)

AR-TC 01 Patient Care Team Meetings

Knowing and Managing Your Patients (AR-KM)

AR-KM 01 Proactive Care Reminders

Patient-Centered Access and Continuity (AR-

AC)Choose to report one of the following: (AC 01, 02 or

03)

AR-AC 01 Patient Experience Feedback—Access

AR-AC 02 Third Next Available Appointment

AR-AC 03 Monitoring Access—Other Method

Care Management and Support (AR-CM)

AR-CM 01 Identifying and Monitoring Patients for

Care Management

Care Coordination and Care Transitions (AR-CC)

AR-CC 01 Care Coordination ProcessChoose to report one of the following: (CC 02, 03, 04 or

05)

AR-CC 02 Patient Experience Feedback—Care

Coordination

AR-CC 03 Lab and Imaging Test Tracking

AR-CC 04 Referral Tracking

AR-CC 05 Care Transitions

Performance Measurement and Quality

Improvement (AR-QI)Report all of the following:

AR-QI 01 Clinical Quality Measures

AR-QI 02 Resource Stewardship Measures

AR-QI 03 Patient Experience Feedback7 criteria to report

+ 2 of 7 criteria to report

9 Total

Behavioral Health Criteria (must report)

Behavioral Health (AR-BH)

Report ALL of the following (Required, Not Scored):

AR-BH 01 Behavioral Health eCQMs

AR-BH 02 Behavioral Health Staffing

AR-BH 03 Behavioral Health Referral Monitoring

AR-BH 04 Depression Screening

AR-BH 05 Anxiety Screening

AR-BH 06 Behavioral Health Referral Monitoring

Not Penalized if

you do not do. But

you must report!

AR 2018 NCQA Requirement Slides

Poll Question #2

Which Annual Reporting (AR) Concept have you been maintaining or

addressing the least?

A. Team Based Care and Practice Organization (AR-TC)

B. Knowing and Managing Your Patients (AR-KM)

C. Care Management and Support (AR-CM)

D. Care Coordination and Care Transitions (AR-CC)

E. Performance Measurement and Quality Improvement (AR-

QI)

Are you still tracking

& reporting on the

same measures from

the point in time you

obtained Recognition?

Improvements?

Has this changed

since you obtained

Recognition?

Review your

2014 Level 3

Recognition

Results to 2017

Criteria.

Review now so you can plan accordingly:

• EHR/HIT changes

• P/P changes

• Back-up your timeline for AR

PCMH Annual Reporting– Your Timeframe

1. Education on PCMH 2017

Criteria

2. Patients (& Community)

3. Gap Analysis

2011 or 2014 Recognition

Results – Crosswalk to 2017

4. Review Annual Reporting

Criteria

5. Core Criteria – must meet

all

6. Auto-Credit Pre Validation

7. Action Plan

8. P/P = 90 day rule

9. Reporting & HIT Functionality

10. Training

11. Gather Evidence

12. Embrace Change

13. Q-PASS starts 12 mon. clock

14. Annual Reporting Submit 30

days prior to Anniversary Date

Enroll in Q-PASS for NCQA PCMH Annual Reporting

https://player.vimeo.com/video/209613949 To enroll you need:

• Claim your organization from

before

• Site information, including NPI

• Clinician information (NPI &

boards/specialties)

• Authorized signatory for

agreements

• Payment method

After enrollment:

• NCQA representative assigned

• Transfer credit – pre-validated

vendors

• Shared credit – multiple sites

Q-PASS ExamplesFor AR, start Q-PASS in year you

will complete AR Requirements.

Poll Question #3

Write down on your PCMH AR Activity Worksheet responses to the questions

below:

What is one action you will take as a result of today’s webinar?

What one PCMH Concept do you want to consider and learn more about?

What Annual Reporting (AR) questions do you have?

What aligns with an activity, decision, need at your Practice now?

What one thing do you want to explore, change or do differently?

For use by practices with

Recognition under NCQA PCMH

2011 Levels 1-3 or 2014 Levels 1-2.

Note: The evaluator may ask practices to verify a selection of attestation responses during a virtual review.

“Review,” practices should follow the current PCMH Standards & Guidelines and submit evidence in Q-PASS, as

indicated ..

“attestation,” all you have to do is attest that your practice is still performing PCMH activities in these criteria.

Documentation to support these responses will be provided upon request.”

Use if full

Process

= sites not

recognized

Keeping Connected and Supporting You!

Dawn Gentsch, MPH, MCHES, PCMH CCE

KPCA PCMH Consultant

PCMH Consultant/Practice Transformation Facilitator

515.360.1731 M | ddgentsch@msn.com

What was helpful today?

What will you use?

What would you like more information about?

How can I support you and your practice?