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Goals - Today participants will: Understand how PCMH is consistent with the

Missions of CHCs

Become familiar with the framework for PCMH Become familiar with PCMH standards and

scoring Understand rationale for seeking PCMH

recognition Recognize how PCMH connects to other

initiatives

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What is a PCMH? A PCMH puts patients at the

,center of the health care system and provides primary care that is

, , ,accessible continuous comprehensive- , ,family centered coordinated

,compassionate and culturally.effective

( ) American Academy of Pediatrics

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Nothing about me without me

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PCMH and the Mission of CommunityHealth CentersWe believe our community is best served by doing more

than just treating illness. Our holistic approach tohealth care includes prevention, early screening,counseling and education as well. (Our) Community Health Center promises you affordable, convenient,individualized health care provided by a qualified and caring staff. We use our talents and resources to see youthrough a lifetime of health care .

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PCMH and the Mission of CHCsOur CHC is Committed To:

Being the health care provider of choice for people of all ages

Providing high-quality care in a patient focused manner Equipping our patients with the knowledge, ability, and motivation to make healthy choices and live healthy lives

Eliminating the barriers caused by financial circumstances or social situations that may prevent people from having

access to health care Continually improving the quality of care and service we

provid e.

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PCMH and the Mission of CHCsThe mission of (Our Community Health Center)is to provide comprehensive, high qualitycompassionate medical care in the spirit of theGood Samaritan. The Center is a federallyqualified, community-based, comprehensivemedical safety net that provides access to primary healthcare services for a traditionallyunderserved population .

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Framework for PCMH

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PCMH A Historical Perspective

American Academy of Pediatrics- late 1960s Institute of Medicine- late 1990s and early 2000 Various demonstration projects- from early 2000 to

date National Committee on Quality Assurance (NCQA)Recognition - 2007

Physician Practice Connections- PatientCentered Medical Home

Development of Joint Principles- AAP, AAFP, ACP,AOA- 2007

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Joint Principles of the PCMH Personal Physician Physician Directed Medical Practice Whole Person Orientation Care is Coordinated and Integrated Quality and Safety are Hallmarks

Enhanced Access Payment Reform

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NCQA PCMH 2011 What is New? Robust patient centeredness

Strong focus on integrating behavioral healthand care management

Patient survey results drive quality improvement

Patients and families involved in quality improvement.

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PCMH -Theoretical Frameworks Chronic Care ModelClinical information systems; decision support; patient self-

management; delivery system redesign; community linkages; healthsystems

Patient Centered CareRespect patient values; accessible; family-centered; continuous;

coordinated; community linkages; compassionate; culturally appropriate; emotional support; information and education; physicalcomfort; quality improvement

Cultural CompetenceCulturally competent interactions; language services; reducing

disparities

Medical HomePersonal physician; physician directed team; whole person

orientation; care is coordinated and integrated; quality and safety;enhanced access

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NCQA PCMH Recognition Standards andScoring

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NCQA and the PCMH -NCQA developed a set of standards and a 3 tiered

. -recognition process Patient Centered Medical Home 2011 assess the extent to which health care

organizations are functioning as medical home

-Obtaining recognition via the PPC PCMH programs requires completing an application and providing adequate documentation to show evidence that specific processes and policies are in place

:Recognition is offered at three levels evel 1 Basic

evel 2 Intermedia te evel 3 Advanced

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NCQA PCMH 2011:The Standards

Six standards align with core componentsof primary care. PCMH 1 : Enhance Access and Continuity PCMH 2 : Identify and Manage Patient

Populations PCMH 3 : Plan and Manage Care PCMH 4 : Provide Self-Care and Community

Support PCMH 5 : Track and Coordinate Care PCMH 6 : Measure and Improve Performance

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NCQA PCMH Must Pass

PCMH 1 , Element A: Access During Office Hours

PCMH 2 , Element D: Use Data for Population Management

PCMH 3 , Element C: Care Management PCMH 4 , Element A: Support Self-Care ProcessPCMH 5 , Element B: Track Referrals and Follow-Up

PCMH 6 , Element C: Implement ContinuousQuality Improvement

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NCQA PCMH Scoring

Level 1: 3559 points and all 6 must-pass elements

Level 2: 5084 points and all 6 must-pass elementsLevel 3: 85100 points and all 6

must-pass elements

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Building Blocks

Level 1

Level 2

Level 3

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Building Blocks of a PCMH Personal physician

Each patient has a personal physician whoprovides first-contact, continuous, andcomprehensive care.

Team practice Personal physician leads a team of individuals at

the practice level for ongoing care andprevention.

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Building Blocks of a PCMH Coordinated care

Care is coordinated across medicalsubspecialties, hospitals, home healthagencies, and nursing homes

Care is coordinated with the patient, thepatients family, and public and private

community-based services.

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Building Blocks of a PCMH Expanded access to practitioners

Open scheduling and after-hours access topersonal physicians

After-hours access to personal physician andstaff by telephone and through secure e-mail.

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Building Blocks of a PCMH Payment Reform

Targeted financial incentives reward physiciansand providers for supporting medical homefeatures, including additional payments forachieving cost savings and measureable andcontinuous quality improvement

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Rationale

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Rationale for Obtaining PCMHRecognition Address the Burden of Chronic Disease

50% of Americans live with one or more chronic

conditions and only 54% of chronically ill adultpatients receive recommended care Over 60% of patients are non-compliant Experts estimate 20-50% of U.S. health care spending

produces no benefit to patients and potential

harm Health costs in the United States are growing fasterthan employee wages and the economy at large.

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Rationale for Obtaining PCMHRecognition

Blueprint for transforming health care delivery

Allows CHCs to assess strengths andachievements Allows CHCs to recognize areas for

improvement

q

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q Rationale for Obtaining PCMHRecognition Address High Health Care Costs

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P 4 P

CMeaningful Use

H DS

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PCMH as the Key

Access and Continuity Manage PatientPopulations

Plan and Manage Care Self-Care and

Community Support Track and Coordinate

Care Measure and Improve

Performance

Becoming leadersin Health Quality

M/U

HITECHIncentives

UDS

P4P

ACO

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PCMH and UDS UDS and PCMH

Identify and track patient populations

Collect and report demographics Identify patients with specific conditions Identify patients for proactive reminders

(preventive or follow-up care).

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Recommendations of Special Commission onthe Health Care Payment System

Development of Accountable Care Organizations (ACOs)composed of hospitals, CHCs, physicians and/or otherproviders that accept responsibility for all of most of

the care that enrollees need Patient-Centered Medicaid Home (PCMH) ACOs toundergo the necessary practice redesign to becomeeffective PCMHs

Patients selection of a primary care provider will directinsurer payments to the ACO with which the patientsprimary care physician is affiliated

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Recommendations of Special Commission onthe Health Care Payment System Use of Pay-For-Performance (P4P)

incentives to ensure appropriate access tocare, and encourage quality improvementand care coordination among providers

Global payments will be adjusted to reflect

patient demographics and healthconditions

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Potential Reimbursement for PCMH Private Insurance

Blue Cross/Blue Shield SC PCMH initiative

Medicare Demonstration pilots

Medicaid Managed care reimbursement based on

performance and outcomes

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PCMH: Return on Investment Improvement in quality and equity Improved patient

/satisfaction compliance /Provider staff satisfaction Helps attract new business

Recognized leader among peers Eligibility for P4P

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PCMH Building Blocks

Patient Experience

Quality

Health Information Technology Practice Organization

PCMH

CommunityHealthCen

ters

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Transformation to a Medical Home

Patient ExperienceQuality

Health Information TechnologyPractice Organization

PCMH

Community Health Centers

Adapted from American Academy of Family Practice PCMH web page

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Next Steps Webinar Series Presentation to Board of Directors, CHC

Management and Others Pre-conference for Medical Directors at June2011 Clinical Network Retreat

CHCs conduct self-assessment

Identify cohort of CHCs ready to move forward Utilize a collaborative model for training Participate in the HRSA Bureau of Primary

Health Care PCMH Initiative

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Are you ready? Are you able to pull together a team of 4-5 staff

including management, a provider, other

clinical team member, an administrative staff member and others appropriate for your CHC? Do you have electronic health records? Do you have support from the top down and the

bottom up willing to work to meet thestandards?