Patient Centered Medical Home Overview · What is a patient-centered medical home (PCMH)? •A...

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PCMH Overview


Objectives

At the end of this session, you will be able to:

• Define Patient Centered Medical Home.

• Outline the processes and organization of the National Committee on Quality Assurance as they relate to PCMH.

• Describe the PCMH standards and guidelines.

• Utilize workflows within SuccessEHS to meet some of the more complex standards and guidelines for PCMH.


What is a PCMH?

PCMH Overview


What is a patient-centered medical home (PCMH)?

• A healthcare setting that facilitates partnerships between patients and their personal physicians – as well as the patient's family, when appropriate.

• Developed by ACP, AAFP, AAP and AOA with the publication of 2007 Joint Principles of the PCMH

“The patient-centered medical home is a model of 21st century primary care that combines access, teamwork and technology to deliver quality care and improve health” – Margaret O’Keane, President, National Committee for Quality Assurance (NCQA)


Accreditation programs

• National Committee for Quality Assurance (NCQA)

• Joint Commission

• Utilization Review Accreditation Commission (URAC)

• Accreditation Association for Ambulatory Health Care (AAAHC)


What is the NCQA?

PCMH Overview


National Committee for Quality Assurance (NCQA)

• Private, independent, nonprofit healthcare quality

oversight organization founded in 1990

• More than 41,955 clinician recognitions nationally

across all recognition programs

• 7,066 PPC-PCMH and PCMH-recognized sites as of

February 2014


PCMH recognition by state


Recognition process

1. Complete online application– Are you a multi-site or single-site?

2. Obtain standards and guidelines– Take advantage of available resources– Know your deadline!– It takes a village – get others involved

3. Purchase survey tool ($)– Download workbooks– Upload documents as you complete them

4. Submit Survey Tool ($$)


Recognition based on level of ability

•35 – 59 PointsLevel 1

•60 – 84 Points Level 2

•85 – 100 PointsLevel 3

Required to pass all six “Must Pass” elements for all 3 levels


Eligible applicants

• Recognition is at practice site level

• Practice site is defined as a clinician or clinicians practicing together at a single geographic location, includes nurse-led practices in states where state licensing designates NPs as independent practitioners

• Eligible Providers: MDs, DOs, NPs and PAs with panels of patients

• At least 75 percent of each clinician’s patients come for:

– First contact

– Continuous care

– Comprehensive PCP services

• Unique practice types can still be eligible:

– Walk-in clinic, mobile clinics, workplace and school clinics, home-visit practices, HIV clinics


Review process

• Recognition decision will appear on Survey Tool 30-60 days after submission

• Review process is three-step:1. Reviewer – Initial evaluation

2. Executive Reviewer – NCQA PCMH managers

3. Peer Review – Recognition Program Review Oversight Committee

• Recognition is for three years

• NCQA will post results on their website and report results to payers


Add-on survey

• Offered to move practice site up recognition levels

• Denied practices should submit with 12 months of their decision date

• Can complete add-on anytime during 3-year period

• Does not extend recognition period

• Add-on fee is 50 percent of initial fee for recognized practices


Renewal

• At the end of 3-year recognition period, can submit for renewal to maintain level of recognition

• If you have achieved Level 2 or 3, eligible to use Streamlined Renewal Process– Required to provide documentation for 12 elements

– Attest for all other elements that response matches current operations

• Level 1 recognized sites must submit documentation for same factors to maintain Level 1


Incentives

PCMH Overview


Incentives

• Vary by state and by payer

• Map demonstrates what is happening in different states

• Blue – 22 States with active Medicaid payments to health homes under way

• Gray - 29 states with no Medicaid payment activity

http://www.nashp.org/med-home-map


NCQA Partners in Quality & Organizations Support Practices

• Find Local Recognition Resources such as financial incentives for recognition, learning collaborative support and onsite transformation coaches

• States with No Active Initiatives at this time: Alaska, Arizona, Hawaii, Idaho, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota.

• http://www.ncqa.org/Portals/0/Programs/Recognition/PCMH/RP%20Practice%20Resource%20Directory%202.18.pdf?ver=2016-02-26-100452-333


PCMH 2014

PCMH Overview


2014 Standards & Guidelines

6 Standards

1. Patient-centered appointment access

2. Team-based care

3. Population health management

4. Plan and manage

5. Track and coordinate care

6. Measure and improve performance


2014 standards & guidelines

• 27 elements; 6 “Must Pass” elements

– 1A: Patient-centered appointment access

– 2C: The practice team

– 3D: Use data for population management

– 4B: Care planning and self-care support

– 5B: Referral tracking and follow-up

– 6D: Implement continuous quality improvement

• 160 Factors


How to read a standard

• Element: Component of a standard that is scored and provides details about performance expectations

• Factor: Item in an element that is scored

• Scoring: Level of performance organization must demonstrate to receive a specified percentage of element points

Standard

Title &

Statement

Element

Standard

Score

Element

Score

Factors

Scoring


How to read a standard

• Explanation: Guidance for demonstrating performance against an element

• Documentation: Evidence practices can use to demonstrate performance against an element’s requirements

• Types: documented process, reports, materials, patient records


SuccessEHS Workflow Recommendations

PCMH Overview


Standard 3 Element D: Use data for population management (Must Pass element)

At least annually, the practice proactively identifies populations of patients and reminds them of needed care based on patient information, clinical data, health assessments and evidence-based guidelines, including:

• Preventive services

• Immunizations

• Chronic or acute care services

• Patients not recently seen

• Medication monitoring or alert


Standard 3 Element E: Implement evidence-based decision support

The practice implements clinical decision support following evidence-based guidelines for:

• Mental health or substance abuse disorder (critical factor)

• Chronic medical condition

• An acute condition

• Condition related to unhealthy behaviors

• Well child or adult care

• Overuse/appropriateness issues


Clinical Event Manager


Standard 5 Element A Factors 1-4: Test tracking and follow-up

The practice has a documented process for and demonstrates that it:

• Tracks lab tests until results are available, flagging and following up on overdue results (critical)

• Tracks imaging tests until results are available, flagging and following up on overdue results (critical)

• Flags abnormal lab results and alerts clinician

• Flags abnormal imaging results and alerts clinician


Order Tracking


Tracking test results


Tracking test results


PCMH 2014 PREVALIDATION WITH SUCCESSEHS

PCMH Overview


PrevalidationSuccessEHS currently offers 16.75 prevalidation points for 2014 PCMH Practices that want to use autocredit for the PCMH Survey should do the following:

• Step 1: Obtain the NCQA-issued Prevalidation Summary Approval Table, NCQA Letter of Product Autocredit Approval as well as a Letter of Product Implementation from the vendor, indicating which prevalidated tool(s)/modules approved for autocredit have been implemented at the practice.*

• Step 2: Complete an application and enter into required agreements for the NCQA Recognition program.

• Step 3: Upload the vendor Prevalidation Summary Approval Table, the NCQA Letter of Product Autocredit Approval and Product Implementation Letter from the vendor into the “Organizational Background” section of the ISS Survey Tool.

• Step 4: In the Organization Background section under Prevalidation Tab of your ISS Survey tool, complete the site attestation under question 2B by checking the box. By doing so, you attest to the implementation and use of an NCQA Prevalidated health IT solution for associated autocredit points as specified in your attached NCQA Prevalidation Summary Approval Table. You will enter the name of the prevalidated health IT solution you are using in question 1.

• Step 5: Submit the Survey Tool.


Prevalidation


PCMH 2017

PCMH Overview


PCMH 2017

• If you are currently preparing to come through recognition, you can still do so under the 2014 standards. Once your three-year recognition concludes, you will transition to the new process. If a practice wants to be recognized under NCQA PCMH 2014 standards, they must submit their site survey by September 30, 2017.

• Some other key dates include:


2017 PCMH and MACRA/MIPS

• As you may know, MACRA changes how doctors get paid under Medicare—transitioning from volume to value—and takes a big step forward for health care quality. The proposed rule from CMS details how it will implement MACRA’s new payment systems: Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM).

• On the MIPS track, clinicians will get bonuses or penalties based on measures in four areas: Quality Measures (30% of total score); Advancing Care Information (formerly Meaningful Use) (25%); Clinical Practice Improvement Activities (CPIA) (15%); Resource Use Measures (30%).

• Under the proposed rule, physicians in practices that earn NCQA Recognition will automatically get full credit in the CPIA category and will be exempt from reporting in this area. In addition, we have taken into account the reporting and quality improvement requirements of MACRA as part of our PCMH Redesign initiative and expect many of the changes we are making to improve the overall performance scores of recognized practices.

• - See more at: http://www.ncqa.org/programs/recognition/practices/patient-centered-medical-home-pcmh/pcmh-redesign/faq#sthash.R57nB95J.dpuf


2017 PCMH

• See more at: http://www.ncqa.org/programs/recognition/practices/patient-centered-medical-home-pcmh/pcmh-redesign/faq#sthash.1fHSslyC.dpuf


QUESTIONS?THANK YOU!

PCMH Overview


Please take the time to complete the survey for this session – your feedback is important to us!

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2. Click the class

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