1. Overview of NCQA PCMH 2011Standards and GuidelinesFebruary 2013Dawn Gentsch, MPH, MCHESPCHH Practice Transformation Facilitator Great Basin Primary Care Association

2. Objectives for Webinar Overview of the principles and benefits of NCQAPCMH recognition. Understand the basic elements of the PCMHstandards, self-assessment and survey applicationprocess. Identify the next steps for Community HealthAlliance. 3. Principles for the Patient-Centered Medical Home Personal physician/clinician Team-based care Whole person orientation Enhanced access (with continuity) Coordinated & integrated care Quality & safety prioritized Payment for the value provided 4. Medical Home: What it Looks Like A health care setting that provides patients with: well-organized & on-time visits enhanced access with their own provider & care team for continuity (same day appointment availability, 24/7 telephone access, alternatives to the 1:1 visit) proactive care management (evidence-based clinical care, panel management, reminder systems, registries) care coordination across settings (assistance with referrals, tracking for tests & referrals; care during transitions) patient activation, engagement & participation in decisions on care (patient centered customer driven) connections to community resources to extend resources for care focus on health outcomes & goals for improvement use of Health IT as tool to support the achievement of advanced primary care practice 5. Medical Home: Aligned with (Chronic) Care ModelHealth System: CommunityHealth Care OrganizationResources Self-Decision Delivery ClinicalandManagement Support System InformationPoliciesSupport Design Systems Informed,Prepared, ActivatedProductiveProactive Patient Interactions Practice Team Functional and Clinical Outcomes 6. From Purpose To Practice: A Continuing JourneyOf Commitment PCMH focus is a continuation of the purpose-driven journey of FQHCs Opportunity: continue our work to transformpractice to the highest levels of performance andto obtain recognition for this achievement Recognition as a medical home is increasinglyassociated with opportunities for enhancedpayment for the value created. 7. Suma Nair, MS, RD; Director Office of Quality and Data HRSA BPHC810 12-13grant KyPCA Applied PCMH Webinar #1 01.16.13 8. NCQA 2011 Standards NCQA released its latest standards, PCMH 2011in January 2011 The new standards direct practices to organizecare according to patients preferences andneeds, and reinforce federal meaningful useincentives for primary care practices to adopthealth information technology Meaningful use criteria (all 25) are in the standards Creates virtuous cycle for PCMH & MU 9. 2011 NCQA PCMH Standards1. Enhance Access and Continuity2. Identify and Manage Patient Populations3. Plan and Manage Care4. Provide Support for Self-Care5. Track and Coordinate Care6. Measure and Improve Performance 10. 2011 NCQA PCMH Structure & Relationships Reflect core principles of primary care. PCMH Joint PrinciplesEvaluate practices ability tofunction as a PCMHScored component of standardsProvide details for performance expectations 6 StandardsScored items for each 27 Elements (6 MPE)element They reflect specificcapabilities for PCMH147 Factors (8 CF) Documentation is developed to demonstrate the capability as described by Factors 11. NCQA 2011 Standards & Intent Access and Continuity: Provide team-based care with access andadvice during and after hours and patient/family informationabout medical home Identify and Manage Patient Populations: Acquire and use datafor care of the practices population Plan and Manage Care: Use evidence-based guidelines forpreventive, acute and chronic care management forchronic, frequent and behavior-based conditions, includingmedication management Self-Care: Support patient and family in self-care withinformation, tools and community resources Track and Coordinate Care: Track and coordinate tests, referralsand transitions of care Performance Measurement and Quality Improvement: Useperformance and patient experience data for continuous qualityimprovement 12. Important Parts of theStructure Must Pass Elements Critical Factors Meaningful Use Documentation 13. Must Pass Elements Must Pass Elements1. 1A: Access During Office Hours (4 pts)2. 2D: Use Data for Population Management (5 pts)3. 3C: Manage Care (4 pts)4. 4A: Self-Care Process (6 pts)5. 5B: Referral Tracking and Follow-Up (6pts)6. 6C: Implement Continuous Quality Improvement (4 pts) Must Pass Elements = up to 29 points 14. Critical Factors -- central to capability being assessed;important impact on scoring 1A1: Provide same day appointments [MPE] 1B3: Provide timely clinical advice by phone after hours 1G2: Have regular team meetings and communication processes 3A3: 3rd important condition for MH/SA or unhealthy behavior 3D1: Review & reconcile medications with patients/families for morethan 50% of care transitions** 3E2: Generate at least 75% of eligible prescriptions electronically* 4A3: Develop & document self-management plans and goals incollaboration w/ at least 50% of patients/families** [MPE] 5A1: Track labs until results are available, flagging and following-up onoverdue results 5A2: Track imaging tests until results are available, flagging andfollowing-up on overdue resultsNOTE: items in blue are must pass elements * and ** are meaningful use items (3D1, 3E2, 4A3) 15. Anatomy of a StandardStandard Name, Points & Intent Element Name, Points, Description of PerformanceExpectation Factor: Scored item in anElement NOTE: * and ** indicate MU criteria Scoring DescriptionExplanation: Additional info on what NCQA is looking forDocumentation Examples Source: NCQA See pg 19 of NCQA Standards & Guidelines,March 28, 2011 for definitions 16. Element 1A: Must Pass & Critical FactorsCriticalFactorImpact ofCriticalFactors on Scoring Minimum score Source: NCQArequired for MPEsS&G, p 29-30 17. Element 1C: MU Factors & Reporting a Percent Meaningful UseSource: NCQAS&G p 33-34 18. Element 5A: CFsWhat doyou notice about thescoring?Source: NCQA 19. Element 5B: Must PassMeaningful UseSource: NCQA 20. Element 6B: relates to MPE 6CSource: NCQA 21. Recognition & TransformationRecognition is only the beginning of a journey for continuous improvement and cultural transformation.NCQAs rigorous standards challenge a practice to examine nearly every aspect of its operations. The evolution to a PCMH is a serious undertaking one that rewards patients with more coordinated, focused and safer care, and rewards providerswith greater satisfaction in practicing medicine.- Marjie Harbrecht, MD CEO, HealthTeamWorks, Colorado 22. Multiple Reinforcing Efforts to SupportPCMH Development in FQHCs HRSA BPHC QI Supplemental Grant 12-13 PCMH Cervical Cancer Screening, Apply by June 1 HRSA PCMHH Initiative to Support FQHCs toachieve NCQA Recognition Education for PCAs and FQHCs around recognition; covers allfees for survey process NACHC Leadership Institute National initiative to create design, methods, tools tofacilitate work by PCAs and FQHCs for sustainable systemtransformation to PCMHs 23. RRWB is the Supplemental WorksheetClick hereClick here KyPCA Applied PCMH Webinar #1 01.16.13 24. The Chart Review Using the Record Review Workbook 2011 Elements PCMH 3C, 3D, 4A Require medical record abstraction of data Need % of patients for each factor based onnumerator and denominator Two methods to collect and submit patient data Method #1 - report from the electronic system Method #2 Record Review Workbook Excel workbook in the Survey Tool Tool to identify sample of patients and abstract dataKyPCA Applied PCMH Webinar #1 01.16.13 25. PCMH 3C: Care Management Entering NOT USED in row 1 grays out the column for all entries Response Options Yes No Not Used Not applicable KyPCA Applied PCMH Webinar #1 01.16.13 26. Questions - PCMH StandardsWhich PCMH standard is of greatest interest toyou, where will your CHC start?What QI goal do you think you will start with? 27. NCQA PCMH 2011 Self-Assessment KyPCA Applied PCMH Webinar #1 01.16.13 28. PCMH-AKyPCA Applied PCMH Webinar #1 01.16.13 29. PCMH-A Background & Context Developed to measure a sites progresstowards achieving the 8 Change Concepts Self-administered assessment Aids in the identification of improvementopportunities Stimulates conversations with other sites tolearn, share, & transform Serves as a standardized measure of progress KyPCA Applied PCMH Webinar #1 01.16.13 30. PCHH Timeline General Planning KyPCA Applied PCMH Webinar #1 01.16.13 31. KyPCA Applied PCMH Webinar #1 01.16.13 32. Decide/PlanAssess32Take Action4Understand1The setting for a Support & BIG Idea5Sustain 33. Next Steps (Homework) Review the requirements for eachstandard, element and factor What does the practice already do? What does the practice need to create? Are there elements the practice clearly does nothave in place but does not wish to implement inthe near-term? Complete the NCQA PCMH Baseline SelfAssessment tool in excel Due date February 4, 2013 (Mike and Dawn) 34. Steps in the Process You have(will need to) taken! Form the Lead Team Get Ready Assess IT Requirements Know Your Deadlines Set Your Goals and Timeline for Recognition Order Interactive Survey System and On-LineApplication from NCQA Determine Eligibility for the Multi-site Survey Option Complete Your Survey Prepare & Submit Survey (you know when!) Receive Recognition Decision from NCQA (TBD)