PCMH Workshop Transforming your practice

Transcription

1 PCMH Workshop Transforming your practice May 2, 2014 Presented by: Ashley Johnson EHR Training Team Coordinator and Susanne Madden The Verden Group Patient Centered Solutions

2 Welcome! Agenda Setting Up Your PCMH Project Successfully What OP Can Do for You: Pre-Validation Points, Report Bundle, Roadmap Working Through the Standards OPMH Reports Bundle Overview What s coming for PCMH 2014?

3 Why NCQA s PCMH Model? 2014 The Verden Group

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5 Focus of NCQA s PCMH Standards Emphasis on patient-centeredness and patient experience of care Reinforces incentives for meaningful use (HIT) Focuses attention on aspects of primary care that improve quality and reduce cost Based on advances in evidence and changes in practice capability 2014 The Verden Group

6 Before You Begin Your PCMH Project 2014 The Verden Group

7 Determine What Points You Already Have (You May be Halfway there Already!) 1. PCMH Tools What tools or services are available to help you more easily achieve NCQA recognition? 1. NCQA Pre-validated Points? What pre-validated points may be available? Vendors can receive pre-validated points from NCQA to share with their clients. This means that for any points pre-validated, you do not have to submit documentation for those factors. 2. Are You Doing MU? If so, there are many MU areas that also qualify for PCMH points The Verden Group

8 What does OP have to offer? OPMH Reports Bundle OP User PCMH Roadmap (Detailed Overview later in the Workshop!)

9 PCMH Pre- Validation 7.75 Auto- Credits

10 Get Educated! Understand the requirements and concepts: Understand the purpose Read the Standards thoroughly Take the trainings (online or in-person) Visit practices who are already medical homes and network to learn best practices The Verden Group

11 Run Through The Elements and Factors Use the Standards Workbook as checklist. Run through each item and identify: Do we already do this? - If yes, do we have a written process? - If not, add a write up to the to do list If no, what do we need to do to adopt a new process to meet the factor? You will be able to quickly hone in on the areas where you will need create new processes and/or adjust current workflow 2014 The Verden Group

12 PCMH Checklist Have a checklist of PCMH action items Make it a team effort; you can not transform a practice alone

13 Make Sure Everyone Is On-Board Get buy in across the Practice Form a PCMH team comprised of (depending upon size): - A physician champion for each location - A nurse / clinical manager - An office manager Train the members of your PCMH team Share information across the practice and keep EVERYONE informed There is never a good time to do this (only the right time - can you afford to wait?) 2014 The Verden Group

14 Taking a Look at the 2011 Standards 2014 The Verden Group

15 PCMH 2011 Standards 2014 The Verden Group

16 PCMH Standard 1: Enhance Access and Continuity Element Must Pass Element # Factors Critical Factor Report in OP A: Access During Office Hours Yes 4 Factor 1 Yes (Factor 2-3) B: After Hours Access No 5 Factor 3 Yes (Factor 3-4) C: Electronic Access No 6 Yes (Factor 1-3) D: Continuity No 3 Yes (Factor 1) E: Medical Home Responsibilities No 4 No F: Culturally and Linguistically Appropriate Services No 4 Yes (Factor 1-2) G: The Practice Team No 8 No

17 Successful PCMH Projects Hinge Around Choosing & Working With Your Preventive Measures and Important Conditions 2014 The Verden Group

18 PCMH Standard 2: Identify and Manage Patient Populations Element Must Pass Element # Factors Critical Factor Report in OP A: Patient Information No 12 Yes (Factor 1-12, Exclusion for 11) B: Clinical Data No 9 Yes (Factor 1-5 & 8-9) C: Comprehensive Health Assessment No 9 No D: Data for Population Management Yes 4 No

19 PCMH 2D: Using Data for Population Management 2014 The Verden Group

20 Why Choosing the Right Conditions Is So Important In 2D, you are asked to select 3 important conditions and 3 preventive measures in order to proactively recall patients that need services. If you pick well, you can use these same selections to satisfy criteria in PCMH 3, Elements C Care Management PCMH 3, Element D Medication Management PCMH 4, Element A Support Self-Care Process PCMH 6, Element A1 & 2 - Measure Performance (1 & 2) PCMH 6 Element C1 - Implement Continuous Quality Improvement 2014 The Verden Group

21 Choosing Preventive Measures Keep it simple and use what s readily available. Many EMRs allow for tracking of Patients overdue for well visits Asthma patients overdue for seasonal flu vaccine 2-year-olds who are behind on vaccinations 2014 The Verden Group

22 PCMH2D: Use Data for Population Management Documentation required to satisfy: Reports or lists of patients needing services generated within the past 12 months. For factors 1 and 2, documentation must identify at least three different services. And Materials showing how patients are notified of needed services (e.g., letters sent to patients, a script or description of phone reminders, screen shots of electronic notices) The Verden Group

23 Standard 2 PCMH 2D: Preventive Measures Patients overdue for well exams Demographic Analysis and Recall Asthma patients overdue for seasonal flu Demographic analysis and Recall Vaccine recalls 2 Year Olds due for vaccines QIC

24 PCMH Standard 3: Plan and Manage Care Element A: Implement Evidence-Based Guidelines Must Pass Element # Factors Critical Factor No 3 Factor 3 No Report in OP B: Identify High-Risk Patients No 2 Yes (Factor 2) C: Care Management Yes 7 Yes (Factor 5) D: Medication Management No 6 Factor 1 Yes (Factor 1-2) E: Use Electronic Prescribing No 6 Factor 2 Yes (Factor 1-3)

25 Standard 3 PCMH 3A: Implement Evidence Based Guidelines 3A1: Age Specific Well Visits BF guidelines 3A2: PCMH 2011 Custom Report Frequent diagnoses to help identify 3A3: ADD/ADHD,Depression, Obesity, etc...

26 Standard 3 PCMH 3B: Identify High Risk Patients 3B1: Age Specific Well Visits BF guidelines 3B2: Identify Care Coordinator

27 Standard 3 PCMH 3C: Care Management (Must Pass) 3C1-3C4,6 & 7 Practice Protocols Update language in appropriate templates Screenshots as needed NCQA workbook for documentation 3C5:Patient Exit Notes

28 Workbook for Important Conditions

29 Workbook for Important Conditions

30 PCMH Standard 4: Provide Self-Care Support and Community Element Must Pass Element Resources # Factors Critical Factor Report in OP A: Support Self-Care Process Yes 6 Factor 3 Yes (Factor 2) B: Provide Referrals to Community Resources No 4 Factor 3 Yes (Factor 2)

31 Workbook for Important Conditions

32 PCMH Standard 5: Track and Coordinate Care Element Must Pass Element # Factors Critical Factor Report in OP A. Test Tracking and Follow-up No 10 Yes (Factors 6 & 9) B. Referral Tracking and Follow- up Yes 7 Yes (Factors 1 & 7) C. Coordinate with Facilities and Manage Care Transitions No 8 Yes (Factor 8) A. Test Tracking and Follow-up No 10 Yes (Factors 6 & 9)

33 PCMH Standard 6: Plan and Manage Care Element Must Pass Element # Factors Critical Factor Report in OP A: Measure Performance No 4 Yes, partial B: Measure Patient/Family Experience C: Implement Continuous Quality Improvement D: Demonstrate Continuous Quality Improvement No 4 No Yes 4 No No 4 No E. Report Performance No 3 No F. Report Data Externally No 4 No G. Use Certified EHR Technology* No 2 No

34 Standard 6 PCMH 6A: Measure Performance 6A1:Use QIC Adult Weight Screening Tobacco Use Assessment and cessation counseling BMI w/ nutrition and physical activity Immunizations by 2

35 Standard 6 PCMH 6A: Measure Performance 6A2:Use QIC Hypertension and BP measurement Controlling high BP Asthma Assessment Asthma Pharmacological Therapy

36 PCMH6C: Continuous Improvement 1. The practice must have a clear and ongoing quality improvement strategy and process that includes regular review of performance data and evaluation of performance against goals or benchmarks. 2. Review and evaluation offer the practice an opportunity to identify and prioritize areas for improvement, analyze potential barriers to meeting goals and plan methods for addressing the barriers. 3. The practice sets goals and establishes a plan to improve performance on clinical quality and resource measures (Element A) and patient experience measures (Element B). USE the Quality Measurement and Improvement Worksheet for all three criteria 2014 The Verden Group

37 PCMH 6D: Demonstrate Continuous Quality Improvement (3 points) 2014 The Verden Group

38 PCMH6D: Continuous Improvement For all 4 Factors: The practice provides reports, recognition results or a completed PCMH Quality Measurement and Improvement Worksheet showing performance measures over time. USE the Worksheet The Verden Group

39 PCMH6: Worksheet 2014 The Verden Group

40 There is still time to submit under the 2011 Standards, particularly if you have OP s PCMH Reporting Bundle! You can purchase the 2011 Standards by June 30 th, 2014 must be submitted no later than March 31 st, The Verden Group

41 OP s PCMH 2011 Bundle Overview Let s Take a Look

42 A Look At What s Ahead NCQA PCMH 2014 Standards 2014 The Verden Group

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44 Why Choosing Conditions Is So Important In 2D, you are asked to select 3 important conditions and 3 preventive measures in order to proactively recall patients that need services. If you pick well, you can use these same selections to satisfy criteria in PCMH 3, Elements C Care Management PCMH 3, Element D Medication Management PCMH 4, Element A Support Self-Care Process PCMH 6, Element A1 & 2 - Measure Performance (1 & 2) PCMH 6 Element C1 - Implement Continuous Quality Improvement

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49 Q & A Contact Information Susanne Madden The Verden Group, Inc Your Partner in Practice 99 Main St, Suite 303 Nyack, NY x7 madden@theverdengroup.com Ashley Johnson, RHIA EHR Training Team Coordinator Connexin Software 5 Walnut Grove Drive, Suite 240 Horsham, PA 19044www.officepracticum.com