The 2014 Patient- Centered Primary Care Home (PCPCH) Recognition Criteria

Transcription

1 The 2014 Patient- Centered Primary Care Home (PCPCH) Recognition Criteria Deepti Shinde, MPP and E. Dawn Creach, MS Patient-Centered Primary Care Home Program Oregon Health Authority October 2, 2013

2 Welcome! Type questions into the Questions Pane

3 Patient-Centered Primary Care Institute History and Development Launched in 2012 Public-private partnership Broad array of technical assistance for practices at all stages of transformation Learning Collaboratives Website ( Webinars & Online Learning Ongoing mechanism to support practice transformation and quality improvement in Oregon

4 Agenda Overview of PCPCH Program Updates to the PCPCH Recognition Criteria What the 2014 Criteria Means for Your Clinic 2014 Scoring and Must-Pass Requirements Standards that were part of 2011 criteria New, Optional Standards in the 2014 criteria Technical Assistance and Resources Q&A

5 Oregon s Patient-Centered Primary Care Home Program HB 2009 established the PCPCH Program: Create access to patient-centered, high quality care and reduce costs by supporting practice transformation Key PCPCH Program Functions: PCPCH recognition and verification Refinement and evaluation of the PCPCH Standards over time Communication and provider outreach Coordination across OHA divisions, CCO development and health reform initiatives Work with public and private payers to restructure primary care payment to align with the PCPCH framework Technical assistance development

6 Oregon s Goals for PCPCH Based on the Oregon Health Policy Board s Action Plan: All OHA covered lives (900, 000+) receive care through a Patient-Centered Primary Care Home - Includes Medicaid, public employees, Oregon educators, Oregon high-risk pool, Family Health Insurance Assistance Program, and Healthy Kids 75% of Oregonians have access to quality care through a PCPCH by 2015 Spread to private payers and Qualified Health Plans via the Exchange

7 PCPCH Model of Care Oregon s PCPCH Model is defined by six core attributes, each with specific standards and measures Access to Care Health care team, be there when we need you Accountability Take responsibility for us to receive the best possible health care Comprehensive Whole Person Care Provide/help us get the health care and information we need Continuity Be our partner over time in caring for us Coordination and Integration Help us navigate the system to get the care we need safely and timely manner Person and Family Centered Care Recognize we are the most important part of the care team, and we our responsible for our overall health and wellness

8 Oregon s Early Success Over 425 recognized primary care homes The team working with my doctor knows about me. This saves me a lot of time. -- Bryant Campbell (Providence Medical Group North Portland Family and Community Medicine) If you re not in a patientcentered primary care home and this is available to you grab on to it. The care has been fantastic. Cristy Slawson (Metropolitan Pediatrics in Gresham) "My health seems better. I have more energy. I just feel happier when I wake up each morning. I feel good about my health. Michelle Lee (Community Health Center in White City)

9 Over 425 clinics recognized as of September 2013

10 Updates to the PCPCH Recognition Criteria PCPCH Standards Advisory Committee met in fall 2012 Final report provided recommendations to: Clarify current criteria, and Incorporate new standards to improve the current model Evidence-based Each PCPCH standard supported in literature; full evidence base and sources available in final standards advisory committee report Modified proposed revisions based on public comment Updated criteria now available online and will be effective January 1, 2014

11 Summary of 2014 Criteria Current minimum criteria to become a PCPCH will remain the same (10 must-pass standards will be the same) More options available for clinics to achieve PCPCH recognition and higher Tier levels (Tier scoring will be the same, and there are more points on the table) Application renewal cycle expanded from annually to every two years (effective September 3, 2013) - Clinics can reapply every 6 months if they meet a higher tier or overall score New opportunity for primary care homes to become Tier 3 star performers

12 Things to Keep in Mind Many Standards build on other health system transformation work in Oregon CCO metrics, Meaningful Use, Comprehensive Primary Care Initiative Details - found in the technical specifications (The 2014 TA Guide Available this week!) Clarifications - Even if your clinic attested to something before, it s important to read the 2014 technical specifications carefully

13 What does the 2014 criteria mean for my clinic? January 1, 2014 updated application will launch Clinics with current recognition dates between 9/3/12 12/31/12 = option to reapply now or in January. Must submit application by 1/31/14 NO disadvantage for clinics applying under 2014 criteria Advantages of applying under 2014 criteria: - More options = more points on the table - Eligible to receive new Tier 3 Star designation

14 2014 TA Guide Available on program website this week Combines the Implementation Guide and the Technical Assistance and Reporting Guidelines More examples, better clarification of documentation requirements & data collection/calculation procedures New Best Practice Notes - helpful information and resources for clinics looking to move beyond the checklist and implement best-practice approaches

15 2014 PCPCH Scoring 10 must-pass criteria that all clinics must meet in order to recognized at any Tier level (same as 2011 criteria) Menu of optional standards worth varying amount of points - More optional standards in 2014 model = more opportunities to earn points - More ways for clinics to get credit for the good things they are already doing (or want to start doing)! The total points accumulated determines a clinic s overall Tier of PCPCH recognition

16 Different Levels of Primary Care Home-ness Tier 3 Advanced Primary Care Home Proactive patient and population management Accountable for quality and utilization points and all 10 must-pass criteria Tier 2 Intermediate Primary Care Home Demonstrates performance improvement Additional structure and process improvements points and all 10 must-pass criteria Tier 1 Basic Primary Care Home Foundational structures and processes points and all 10 must-pass criteria

17 10 Must-Pass Requirements 1.C.0 PCPCH provides continuous access to clinical advice by telephone. 2.A.0 PCPCH tracks one quality metric from the core or menu set of PCPCH Quality Measures. 3.B.0 PCPCH reports that it routinely offers all of the following categories of services: Acute care for minor illnesses and injuries; Ongoing management of chronic diseases including coordination of care; Office-based procedures and diagnostic tests; Patient education and self-management support. 3.C.0 PCPCH has a screening strategy for mental health, substance use, or developmental conditions and documents onsite and local referral resources. 4.A.0 PCPCH reports the percentage of active patients assigned to a personal clinician or team. (D) 4.B.0 PCPCH reports the percent of patient visits with assigned clinician or team. (D) 4.C.0 PCPCH maintains a health record for each patient that contains at least the following elements: problem list, medication list, allergies, basic demographic information, preferred language, BMI/BMI percentile/growth chart as appropriate, and immunization record; and updates this record as needed at each visit. 4.E.0 PCPCH has a written agreement with its usual hospital providers or directly provides routine hospital care. 5.F.O PCPCH has a process to offer or coordinate hospice and palliative care and counseling for patients and families who may benefit from these services. 6.A.0 PCPCH offers and/or uses either providers who speak a patient and family s language at time of service in-person or telephonic trained interpreters to communicate with patients and families in their language of choice.

18 Standards that were part of 2011 criteria Many standards & measures will be the same: e.g., 1.B.1 PCPCH offers access to in-person care at least 4 hours weekly outside traditional business hours. Many standards have new measures (more points) available: e.g., 5.F.O PCPCH has a process to offer or coordinate hospice and palliative care and counseling for patients and families who may benefit from these services. (Must-Pass, Same as 2011 criteria) 5.F.1 PCPCH has a process to engage patients in end-of-life planning conversations and completes advance directive and other forms such as POLST that reflect patients wishes for end-of-life care; forms are submitted to available registries (unless patients opt out). (New optional measure available for 5 points) Some measures are clarified but intent has not changed: e.g., 3.C.2: 2011 = PCPCH documents direct collaboration or co-management of patients with specialty mental health, substance abuse, or developmental providers = PCPCH has a cooperative referral process with specialty mental health, substance abuse, or developmental providers including a mechanism for co-management as needed.

19 Standard 2.A Performance & Clinical Quality Updated Core and Menu Set of quality measures to choose from More quality measures have benchmarks Easier process to access most recent specifications e.g.: 1) Visit the National Quality Forum website. Go to 2) Print out the specifications for the quality measures you are planning to report on. 3) Calculate your clinic s data according to the specifications. 4) Keep the specifications you are using and your raw data summaries along with your other PCPCH application documentation.

20 About the new optional 2014 standards Provides a road map for transformation Enhanced focus on continuous quality improvement structure and culture Enhanced focus on demonstrating improvement Encourages greater involvement of patients/families/caregivers/advisors Encourages clinics to move beyond checking the box

21 New Optional 2014 Standards Standard 1.D) Same Day Access Standard 1.E) Electronic Access Standard 1.F) Prescription Refills Standard 2.B) Public Reporting Standard 2.C) Patient and Family Involvement in Quality Improvement Standard 2.D) Quality Improvement Standard 2.E) Ambulatory Sensitive Utilization Standard 3.E) Preventive Services Reminders Standard 4.F) Planning for Continuity Standard 4.G) Medication Reconciliation Standard 6.D) Communication of Rights, Roles, and Responsibilities

22 Standards/Measures Aligned with Meaningful Use 1.E.3 - Using a method that satisfies either Stage 1 or Stage 2 meaningful use measures, the PCPCH provides patients with an electronic copy of their health information upon request. 3.E.3 - Using a method that satisfies either Stage 1 or Stage 2 meaningful use measures, the PCPCH sends reminders to patients for preventive/follow-up care. 4.D.3 - PCPCH shares clinical information electronically in real time with other providers and care entities (electronic health information exchange). 4.G.3 - Using a method that satisfies either Stage 1 or Stage 2 meaningful use measures, the PCPCH performs medication reconciliation for patients in transition of care. 5.B.3 - PCPCH has a certified electronic health record and the PCPCH practitioners must meet the standards to be meaningful users of certified electronic health record technology established by the Centers for Medicare and Medicaid Services Standard 6.B - Education & Self-Management Support

23 Resources and Technical Assistance 2014 TA Guide available this week Online learning modules based on 2014 criteria coming later this fall Updated self-assessment tool coming soon PCPCI website Search for resources by 2014 PCPCH Standards ( PCPCI webinars live and recorded PCPCH Program staff

24 In Closing PCPCH Road Map - LOTS of options to continue improving care on your clinic s transformation journey Flexibility Work on areas that are important to your patient population and/or identified areas for improvement Health Care Neighborhood How are you working outside the walls of your clinic to improve your patients and your community s health?

25 Questions?

26 Visit: Contact us: E. Dawn Creach, MS PCPCH Program lead for Recognition, Technical Assistance, and Communications Deepti Shinde, MPP PCPCH Policy Analyst Nicole Merrithew, MPH PCPCH Program Director Evan Saulino, MD, PhD PCPCH Program Clinical Advisor