PCMH : A WINDOW TO 2014

Transcription

1 Colorado Community Health Network Spring Conference PCMH : A WINDOW TO 2014 Presented by: Bonni Brownlee, MHA CPHQ CPEHR NCQA PCMH Certified Content Expert Senior Clinical Consultant

2 Audience Poll: Where are you now? Value of PCMH unclear Leadership not on board Key positions for transformation are vacant Fear of change Currently reviewing standards Assembling PCMH team MAYBE ACTIVE PCMH Team meets regularly Actively collecting supporting documents Already hit submit button Awaiting score PCMH Team continues to meet Areas recognized as problematic during application phase are brought forward to the QI Plan Reviewing 2014 PCMH Standards SUSTAINING

3 Why Attain Formal PCMH Recognition? Drives improvement in patient care and operating framework Alignment with Meaningful Use External validation of PCMH transformation and commitment to high quality care Pride Market advantage Potential for increased reimbursement and other incentives

4 2014 NCQA PCMH Standards 1. Patient-Centered Access 2. Team-Based Care 3. Population Health Management 4. Care Management & Support 5. Care Coordination and Care Transitions 6. Performance Measurement and Quality Improvement

5 2014 NCQA PCMH STANDARDS 1 Patient-Centered Access (10) 4 Care Mgmt and Support (20) A Pt-Centered Appointment Access A Identify Patients for Care Management B 24/7 Access to Clinical Advice B Care Planning and Self-Care Support C Electronic Access C Medication Management D Use Electronic Prescribing 2 Team-Based Care (12) E Support Self-Care & Shared Decision Making A Continuity 5 Care Coordination and Care Transitions (18) B Medical Home Responsibilities A Test Tracking and Follow-up C Culturally-Ling Appropriate Services B Referral Tracking and Follow-up D The Practice Team C Coordinate Care Transitions 6 Perf Measurement & Qual Improvement (20) 3 Population Health Management (20) A Measure Clinical Quality Performance A Patient Information B Measure Resource Use B Clinical Data C Measure Patient/Family Experience C Comprehensive Health Assessment D Implement Continuous Quality Improvement D Use Data for Population Management E Demonstrate Continuous Quality Improvement E Implement Evid-Based Decision Support F Report Performance G Use Certified EHR Technology

6 PCMH 1: Patient-Centered Access 1A: Patient-Centered Appointment Access 1. Same-Day appointment availability 2. Appointments outside of regular business hours 3. Availability of alternative visit types 4. Availability of appointments: Time to Third Next Available Appointment 5. Monitoring of No Show Rates 6. Acting on opportunities to improve access

7 PCMH 1. Patient-Centered Access 1C. Electronic Access (use of patient portal) 1. More than 50% of patients have online access to health information 2. More than 5% of patients view, are able to download, or transmit their health information 3. Clinical summaries provided within 1 day for more than 50% of office visits 4. Secure message sent to more than 5% of patients 5. Patients have 2-way communication with the practice 6. Patients can request appointments, prescription refills, referrals and test results

8 PCMH 2: Team-Based Care 2B. Medical Home Responsibilities 1. Practice responsible for coordinating care 2. Instructions for obtaining care and advice when office is closed 3. Patients to provide a complete medical history and info about care obtained outside the practice 4. Access to evidence-based care, patient education and self management support 5. Scope of services available, including how behavioral health needs are addressed 6. Equal access to all patients regardless of source of payment 7. Gives uninsured patients information about obtaining coverage 8. Instructions on transferring records to the practice

9 PCMH 3: Population Health Management 3D: Use of Data for Population Management 1. 2 preventive care services 2. 2 immunizations 3. 3 chronic/acute care services 4. Patients not recently seen by practice 5. Medication monitoring or alert

10 PCMH 3: Population Health Management 3E. Implement Evidence-Based Decision Support 1. Mental health or substance abuse disorder 2. Chronic medical condition 3. Acute condition 4. Condition related to unhealthy behaviors 5. Well child or adult care 6. Overuse/appropriateness issues

11 PCMH 4: Care Management and Support 4A. Identify patients for care management 1. Behavioral health conditions 2. High cost/high utilization 3. Poorly controlled or complex conditions 4. Social determinants of health 5. Referrals by outside organizations 6. Monitoring the percentage of total patient population identified for care management and support

12 PCMH 6: Performance Measurement and Quality Improvement 6A: Measure Clinical Quality Performance 1. 2 immunization measures 2. 2 other preventive measures 3. 3 chronic or acute care clinical measures 4. Data stratified for vulnerable populations to assess disparities in care 6B: Measure Resource Use and Care Coordination 1. 2 measures related to care coordination 2. 2 measures affecting health care costs

13 PCMH 6: Performance Measurement and Quality Improvement 6E: Demonstrate Continuous Quality Improvement 1. Measuring effectiveness of actions 2. Achieving improved performance on at least two clinical quality measures 3. Achieving improved performance on 1 utilization or care coordination measure 4. Achieving improved performance on at least one patient experience measure

14 Comparison of Must Pass Elements A Access During Office Hours 1A Patient-Centered Access 2D Use Data for Population Mgmt 2D The Practice Team 3C Care Management 3D Use Data for Population Mgmt 4A Support Self Care Process 4B Care Planning and Self Care Support 5B Referral Tracking and Follow-Up 5B Referral Tracking and Follow-up 6C Implement Continuous Quality Improvement 6D Implement Continuous Quality Improvement

15 PLANNING FOR THE SURVEY Getting Started Understanding the NCQA PCMH Application Process Transitioning / Renewal Applications

16 Getting Started Build your project team Set a goal/date for completion Communicate with staff Conduct a scored self-assessment Develop action plan with short term goals and timelines Build the Document Library Use a tracking sheet to monitor progress

17 Access and Utilize NCQA s Resources Tools, Resources, Materials PCMH Standards and Guidelines (most current version) Self-Assessment tool (for baseline scoring) NCQA Training available on-line NCQA On-line Application & Web-based ISS Survey Tool

18 If you are NCQA Recognized under the 2008 standards Upgrade to the 2011 standards Purchase your ISS tool and application tool NOW Deadline for submission under 2011 standards is March 31, NCQA s Advice: Avoid the rush submit by December 31, 2014 Some grant programs require recognition by November Review the 2011 standards. If you have held the gains achieved through the preparation of the 2008 application, you should be able to start preparing your 2011 application.

19 Transitioning from 2011 to 2014 Standards March Standards Released March 31, 2015 Last day to submit a 2011 Survey Tool June 30, 2014 Last day to purchase 2011 Survey Tool

20 For Renewal Practices Streamlined approach for practices recognized under 2008 standards with Level 2 and 3 status Can attest to 16 of the 39 elements! Score each factor/element, and write an attestation statement: XYZ Clinic previously achieved Level 3 recognition as a PCMH and attests that the responses to the factors for this element reflect the current operations of the practice site and the documentation to support these responses can be provided upon request.

21 16 Elements for Attestations 2011 NCQA PCMH Standards 1A. Access During Office Hours 4B. Referrals to Community Resources 1B. After-hours Access 5A. Test Tracking and Follow-up 1D. Continuity 5B. Referral Tracking and Follow-up 1E. Medical Home Responsibilities 6A. Measure Performance 1F. Culturally & Linguistically 6B. Measure Patient Experience Appropriate Services 2A. Patient Information 6D. Demonstrate Continuous Quality Improvement 2B. Clinical Data 6E. Report Performance 3E. E-Prescribing 6F. Report Data Externally

22 Conduct a Scored Self-Assessment Summary Statistics - Total Score (scores will automatically calculate) Standard Element (total points possible) Points **A: Access During Office Hours (4) 0 PCMH 1: Enhance Access and Continuity B: After-Hours Access (4) 0 C: Electronic Access (2) 0 D: Continuity (2) 0 E: Medical Home Responsibilities (2) 0 F: Culturally and Linguistically Appropriate Services (2) 0 G: The Practice Team (4) 0 A: Patient Information (3) 0 PCMH 2: Identify and Manage Patient Populations B: Clinical Data (4) C: Comprehensive Health Assessment (4) 0 0 **D: Use Data for Population Management (5) 0 PCMH 3: Plan and Manage Care A: Implement Evidence-Based Guidelines (4) 0 B: Identify High-Risk Patients (3) 0 **C: Care Management (4) 0 D: Medication Management (3) 0 E: Use Electronic Prescribing (3) 0 PCMH 4: **A: Support Self-Care Process (6) 0 Provide Self-Care Support B: Provide Referrals to Community Resources (3) and Community Resources 0 A: Test Tracking and Follow-Up (6) 0 PCMH 5: **B: Referral Tracking and Follow-Up (6) 0 Track and Coordinate Care C: Coordinate With Facilities and Manage Care Transitions (6) 0 PCMH 6: Measure and Improve Performance A: Measure Performance (4) 0 B: Measure Patient/Family Experience (4) 0 **C: Implement Continuous Quality Improvement (4) 0 D: Demonstrate Continuous Quality Improvement (3) 0 E: Report Performance (3) 0 F: Report Data Externally (2) 0 G: Use Certified EHR Technology (2) NA Total Score 0 # MPE Passed at 50% 0 Level of Recognition None Summary Statistics - Must Pass Elements Score Points needed Must Pass Point to Elements s pass at 50% Standard PCMH 1: Enhance Access and Continuity PCMH 2: Identify and Manage Patient Populations **A: Access During Office Hours **D: Use Data for Population Management Passed at 50%? (Yes/No) 0 2 NO NO PCMH 3: Plan and **C: Care Management Manage Care 0 2 NO PCMH 4: Provide Self-Care Support **A: Support Self-Care and Community Process 0 3 NO Resources PCMH 5: Track and Coordinate Care PCMH 6: Measure and Improve Performance **B: Referral Tracking and Follow-Up **C: Implement Continuous Quality Improvement 0 3 NO 0 2 NO

23 Set a Goal for Submission and a Realistic Project Timeline

24 Types of Supporting Documentation Documented Process Formal organizational documentation that describes what you do, such as written policy, procedure, protocol, workflow Must be dated and in place for 3 months Reports Aggregated and site-specific data showing evidence of action Trended data, graphical presentations Data must be less than 1 year old; label all parts of graphics carefully Records or Files DE-IDENTIFY! Actual patient records, files or registry/log entries Screenshots from EHR, website or other Materials Information given to patients, staff or clinicians, such as self-management or educational resources, guidelines, letters, s, meeting minutes

25 Before Submission, revisit the Self- Assessment Tool What can you reasonably accomplish by your deadline? Can you get maximum points for all elements and factors? Do we meet all the Critical Factors and Must Pass elements? If not, why not? Understand where you can sacrifice points.

26 NCQA PCMH 1: ENHANCE ACCESS AND CONTINUITY Element (total points possible) Points STRENGTHS WEAKNESSES CAN WE MAXIMIZE THE POINTS? **A: Access During Office Hours (4) 3 Same Day Appts for each provider Appointment scheduling policy Triage protocol Call logs to demonstrate response time to clinical advice calls Documentation of clinical advice in the patient's medical record (use of phone notes) No Patient Portal No. Must produce the triage protocol, call logs, and use of phone notes to be solid at 3 points. B: After-Hours Access (4) 2 Extended clinic hours Answering service availability C: Electronic Access (2) 0 None No Patient Portal D: Continuity (2) 2 E: Medical Home Responsibilities (2) F: Culturally and Linguistically Appropriate Services (2) G: The Practice Team (4) 3 0 None 2 Empanelment Policy Centricity data field for PCP Continuity of Care Reports Assessment of Racial and Ethnic breakdown of patient population Assessment of, and language needs of patient population Interpretation services Print materials in other languages Team diagram Huddles documentation Weds clinical team meetings Standing Orders Trainings on communication; population mangement; care coordination Teams involved in QI Call logs to demonstrate response time to clinical advice calls after hours, and also Yes, if call logs demonstrate response thorough documentation of advice given after times and full documentation. hours. Bonni to complete the logs with a chart review. Empanelment protocols not fully in place, but will not impede application. No Patient Brochure which explains the roles and responsibilities of a PCMH None Teams are a bit weak, but starting to gel; will not impact the application. Trainings are weak in that they have not been provided to all team members, but can be further developed; will not impact the application. Involvement in QI weak, but can be represented through BEACON and pap projects. No. We do not have an active Patient Portal Yes. No. There is no time to prepare and print a Patient Brochure. Yes No. There is not time to train staff and implement self management support for all clinical support staff.

27 TIPS AND TRAPS from a Reviewer s perspective

28 1A: Access during Office Hours Factor 3: Providing timely clinical advice by secure electronic messages during office hours 1B: After Hours Access Factor 4: Providing timely clinical advice during secure electronic messages when the office is not open Interactive electronic system means that someone will monitor incoming messages and respond in real time. A turnaround time for response to messages of 24 or 72 hours does not meet the definition of interactive.

29 1E: Medical Home Responsibilities The practice has a process and materials that it provides patients/families on the role of the medical home Factors 1-4: coordinating care, obtaining care and advice during office hours and when the office is closed, patients must provide a complete medical history and information about care obtained outside the practice, care team provides evidence-based care and selfmanagement support You must submit a documented process for how you provide printed materials to patients about the medical home as well as the brochure/materials that are given to patients.

30 1G Team Structure and Roles Job Descriptions should reflect a team approach to care delivery. Example: Each team member plays an integral role in providing patient-centered healthcare. Our model uses the parallel workflow design where workload is distributed throughout the team, thus improving efficiency resulting in better workflow and improved patient an staff satisfaction.

31 Care Team Diagram

32 2C: Comprehensive Health Assessment Factors 1-9: age/gender appropriate immunizations and screenings; family social and cultural characteristics, communication needs, medical history, advance care planning, behaviors affecting health, mental health/substance abuse, developmental screening (peds), depression screening tool Submit a documented process and a completed health assessment Must use screenshots from the SAME patient for all factors Rationale: Using screenshots from different patients does not demonstrate a PROCESS

33 2D: Use Data for Population Mgmt Factor 4- Specific Medications Intent: Ability to pull lists of patients on specific medications for purposes of clinical care and/or patient safety. Submit list of patients on the medication of your choice, and also an example of an outreach letter about the medication. Can t just say We ve never had a recall situation. Be proactive and prepare a letter to be used in case of a recall or notice of newly known adverse side effects

34 3: Plan and Manage Care Element A: Implement Evidence-Based Guidelines Factors 1-3: First important condition; second important condition; third condition related to unhealthy behaviors or mental health or substance abuse. Important conditions do not have to be the most frequently seen, but they are diagnoses, not treatment protocols or screening Must provide BOTH source of guidelines and evidence of implementation Do not use one guideline to cover two conditions (such as DM and HTN) EHR templates for chronic disease care are acceptable as evidence of implementing EBG Screenshots must be of real patients All screenshots illustrating implementation of EBG should come from the same patient

35 6E Report Performance Factor 1- within the practice, results by individual clinician Factor 2- Within the practice, results across the practice These factors REQUIRE reporting examples from the measures provided in both: 6A (clinical measures) and 6B (patient satisfaction survey data)

36 Is your EMR Vendor Pre-Validated? Athena Health Cerner : Power Chart Connexin : Office Practicum eclinicalworks SOURCE: GE Centricity Greenway : Prime /PatientCenteredMedicalHomePCMH/PCMH HealthFusion : MediTouch PrevalidationProgram.aspx i2isystems : i2itracks Website accessed May M3 Information MDLand : iclinic MDDatacor : MDInsight PatientPoint Phytel : Insight, Outreach, Coordinate Physician Hub: Electronic Medical Office Vitera Healthcare Solutions: Vitera Intergy

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38 Questions and Thank You!!!