34
www.ehanys.com Nicole Harmon, MBA, PCMH CCE Senior Director, PCMH Advisory Services © 2015 HANYS Solutions Patient-Centered Medical Home Advisory Services
www.ehanys.com
Nicole Harmon, MBA, PCMH CCE Senior Director, PCMH Advisory Services
© 2015 HANYS Solutions Patient-Centered Medical Home Advisory Services
www.ehanys.com
Objectives
• After today’s presentation, you will
–Understand how Patient Centered Medical Home (PCMH) relates to DSRIP
–Have a better understanding of PCMH
• NCQA’s 2014 PCMH Standards
• True practice transformation
• Lessons learned
www.ehanys.com Source: Medicaid Redesign Team
DSRIP Roadmap for PCMH
www.ehanys.com
Eligibility Requirements
Source: Medicaid Redesign Team
www.ehanys.com
DSRIP Projects Requiring PCMH
Note: CNYCC selected 3.g.i not 3.c.i – Integration of Palliative Care in Patient Centered Medical Home
Source: Medicaid Redesign Team
www.ehanys.com
CNYCC DSRIP Projects
www.ehanys.com
www.ehanys.com
A Building, Place, or People?
www.ehanys.com
The “Triple Aim”
www.ehanys.com
Patient-Centered Medical Home (PCMH)
• Empowers the patient to be an active part of his/her health care team
• Physician-led team approach
– Staff works to the highest capability of license/skill
• The right care, at the right place, at the right time
www.ehanys.com
WHY NOW? WHY SHOULD WE?
www.ehanys.com
www.ehanys.com
www.ehanys.com
Benefits for Your Patients
• Engaged, happier, and more satisfied patients
• Better coordinated, more comprehensive and personalized care
• Improved access to medical care and services
• Improved health outcomes, especially for patients who have chronic conditions
Source: http://www.aafp.org/practice-management/transformation/pcmh/benefits.html
www.ehanys.com
Benefits for Your Practice
• Joy in practice: increased physician and staff member satisfaction
• Physicians and staff members who practice at the top of their licenses
• Improved safety and quality of care
Source: http://www.aafp.org/practice-management/transformation/pcmh/benefits.html
www.ehanys.com
Benefits for Your Bottom Line
• A more efficient use of practice resources, resulting in cost savings
• Opportunities to participate in payment incentives
• Better prepared to succeed in a value-based payment arrangements
• Better prepared to participate in accountable care organizations
Source: http://www.aafp.org/practice-management/transformation/pcmh/benefits.html
www.ehanys.com
"As we've redesigned our office to become a Patient Centered Medical Home, patient satisfaction and staff satisfaction have significantly improved.
We've become better at addressing some of the patient care details that in the past might have been overlooked. We do a better job at delivering patient care to a medically underserved patient population.”
- Dr. Steven Blatt Upstate Pediatric & Adolescent Center
www.ehanys.com
2014 PCMH Survey Tool
www.ehanys.com
NCQA PCMH 2014 Standards
• Tell us what you do, show us how you do it
• Team-Based Care • Record Review Workbook • Aligned with Stage 2
Meaningful Use • Quality Improvement (QI)
focus • Patient-experience-with-care
survey
www.ehanys.com
NCQA PCMH 2014 Standards and Must-Pass Elements
• PCMH 1: Patient-Centered Access – Element A: Patient-Centered Appointment Access
• PCMH 2: Team-Based Care – Element D: The Practice Team
• PCMH 3: Population Health Management
– Element D: Use of Data for Population Management
• PCMH 4: Care Management and Support – Element B: Care Planning and Self-Care Support
• PCMH 5: Care Coordination and Care Transitions – Element B: Referral Tracking and Follow-up
• PCMH 6: Performance Measurement and Quality Improvement – Element D: Implement Continuous Quality Improvement
*Must meet all must-pass elements to obtain any recognition; a 50% score equals pass for a must-pass element
www.ehanys.com
Scoring Considerations
• Each standard has elements and factors
• How many and how well they are performed translates into points:
– Level 1: 35-59 points
– Level 2: 60-84 points
– Level 3: 85-100 points
www.ehanys.com
How to Achieve True Practice Transformation
• Practice Culture
• People, Process, and Technology – Ensure awareness, desire
–Knowledge and ability
–Potential obstacles and risks
www.ehanys.com
Health Information Technology
• An important part of the equation, but not the solution
• Engage from project inception
• Start early
• Test capabilities
• Train on redesigned workflows
• Understand the data and reporting
www.ehanys.com
Successful Transformations
“The medical home transformation process requires more than just a health information
technology intervention. At least as critical are establishing a culture of population
management, building a team by defining roles and responsibilities, and becoming accountable
for performance”
L. M. Kern, A. Edwards, and R. Kaushal, “The Patient-Centered Medical Home, Electronic Health Records, and Quality of Care,” Annals of Internal Medicine, June 2014 160(11):741–49
www.ehanys.com
Team Based Care
• Physician led
• Work to the top of license
• Defined roles and responsibilities
• Patient care communication strategy
www.ehanys.com
The “Cares”
• Care coordination
• Care management
–Care planning
–Patient self-management
• Care transitions
www.ehanys.com
Workforce Engagement • Be inclusive
• Communicate
• Identify necessary skills
• Provide training
• Consistently monitor progress and compliance
www.ehanys.com
Change isn’t Easy
• The transformation process can be a long and difficult journey
• Recognize that change doesn't occur overnight
• Don’t assume that all will embrace change - “I’m already overworked…. Now you want me to do what?”
• Teamwork
• Celebrate the small successes
www.ehanys.com
Change isn’t Easy
“Traditional QI processes are only a part of improvement. Transformation requires group effort. Teams should be agile and capable of changing as per patients needs and preferences”
(Ulka Kothari, Winthrop University, Hempstead Pediatrics)
“Constant communication is essential. Communication about the basic standards, how to live the practices and document and how we measure our success.”
(Carol Pisapia, Richmond University Medical Center)
www.ehanys.com
Why Support PCMH?
• Teamwork results in: – Improved communication – Clearly defined roles and expectations – Shared responsibilities
• Ability to comfortably manage panel size
• Improved satisfaction of providers, patients, and staff –Decreased burnout
• Improved reimbursement
www.ehanys.com
Successful Transformations
www.ehanys.com
Tools and Resources PCMH Advisory Services http://pcmh.hanyssolutions.com/
PCMH Advisory Services Site Analysis http://pcmh.hanyssolutions.com/services/#analysis
Patient-Centered Primary Care Collaborative http://www.pcpcc.org/
http://www.pcpcc.org/initiatives/new-york
www.ehanys.com
NCQA Tools and Resources PCMH 2014 Standards http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH.aspx
Recorded Training Sessions http://www.ncqa.org/Programs/Recognition/RelevanttoAllRecognition/RecognitionTraining/RecordedTrainings.aspx
