Patient Centered Medical Home & Meaningful Use Criteria Crosswalk. Peter Cucchiara, MBA Managing Director PCDC

Patient Centered Medical Home & Meaningful Use Criteria Crosswalk Peter Cucchiara, MBA Managing Director PCDC

3 2 Deep Dive on Standards & The Work 4 What It Looks Like A Journey of BIG ideas 1 5 Examples Q&A

PCMH/MU What Does it Look Like? Begin with the end in mind Stephen R. Covey The 7 Habits of Highly Effective People

IHI

ARRA Patient Centered Medical Home Health Care Reform Pt. Self Mgt. Care Coord. CareTeams Access Accountable Care Organizations Payer Disease/Care Management State Regional Chronic Disease Management Health Home Systems Of Care HIT? RHIO HIE Meaningful Use REC PHR Platforms Google etc

What Does it Look Like? A health care setting that provides patients with: well-organized & on-time visits enhanced access with their own provider & care team for continuity (same day appointment availability, 24/7 telephone access, alternatives to the 1:1 visit) proactive care management (evidence base clinical care, panel management, reminder systems, registries) care coordination across settings (assistance with referrals, tracking for tests & referrals; care during transitions) patient activation, engagement & participation in decisions on care (patient centered customer driven) connections to community resources to extend resources for care focus on health outcomes & goals for improvement data driven use of Health IT as tool to support the achievement of advanced primary care practice

What Makes It Work? Well-trained workforce organized as multi-disciplinary care teams Mutual accountability among the team and between team and patients System designed to support care management & coordination through enhanced access, continuity and information availability Cross boundary cooperation & partnership among all provider types Technology infrastructure for information management & exchange Payment reform to support the work

A Medical Home in a Community Provider Leadership Care Coordination Patient Engagement and Self Management Continuity Teams Access Care Teams and Change Teams Data Driven

The Big Idea PCMH/MU Overlap

What WAS this big idea? PCMH MU

Is it just a matter of Apples and Oranges MU PCMH Certification/Attestation Paid Per Provider Medicaid, Medicare Federal 5 care goals, 20 objectives. 6 quality measures (options and choices)? Recognition/Documentation Paid Per Patient or Visit (in NYS) M caid, M care & Payers State and Federal (increasing demos) 6 standards 27 elements 149 factors

PCMH MU NCQA PCMH 2008 NCQA PCMH 2011 Meaningful Use Stage I URAC TJC PCH AAAHC Minn. Mass. Meaningful Use Stage II

Comparison Factors Eligibility: Goals: Elements: Levels of Recognition: Application Process: Recognition Length: Renewal Process: EMR Requirement: Collaboration w/ other standards/certifications: Cost: Benefits to Certification:

Principle # NCQA TJC URAC AAAHC Minn. Mass. Increasing Patient Centeredness Plan & Manage Care Population Management Clinical Organizational Structure 14 10 11 10 9 12 11 16 15 13 15 14 15 15 8 7 5 6 6 6 5 13 8 10 9 9 6 10 Use of EMR & SW 14 14 4 14 5 8 14 Performance Improvement Comparison Factors 13 8 9 7 9 8 11 Total 78 62 52 61 52 55 66

Implementation s Job - Translation The Principles Whole person orientation Safety and quality Care Coordination and Integration Personal Provider Enhanced Access Continuity of Care Capacity and Accountability 2011 PCMH Standards PPC1: Enhance Access & Continuity PPC2: ID & Manage Patient Populations PPC3: Plan and Manage Care PPC4: Provide Self Care Support & Community Resources PPC5: Electronic Prescribing PPC6: Test Tracking

A Simple Comparison Meaningful Use Goal A: Improve quality, safety, efficiency, & reduce health disparities 2011 PCMH PPC1: Enhance Access & Continuity Goal B: Engage Patients and Families PPC2: ID & Manage Patient Populations PPC3: Plan and Manage Care Goal C: Improve Care Coordination Goal D: Improve Population and Public Health PPC4: Provide Self Care Support & Community Resources PPC5: Electronic Prescribing Goal E: Ensure Adequate Privacy & Security Protection for PHI PPC6: Test Tracking

2011 NCQA PCMH & Stage 1 MU: Key Areas of Overlap I. PATIENT COMMUNICATION Providing patients with electronic access to health related info [PCMH 1C] Providing patients with ability to make electronic health requests (e.g., erx refill, test results) [PCMH 1C] II. CARE MANAGEMENT Electronically storing patient info (demo and clinical) [PCMH 2A & 2B] Use of evidence-based guidelines [PCMH 3A] Self-management support [PCMH 4A] III. CARE COORDINATION ------INTERNAL & EXTERNAL Medication management [PCMH 3D] Electronic prescribing [PCMH 3E] Test and referral tracking and follow-up [PCMH 5A & 5B] Coordination with facilities/care transitions [PCMH 5C] IV. POPULATION & PUBLIC ---------- ----HEALTH Population management [PCMH 2D] Reporting data externally [PCMH 6F]

PCMH/MU Overlap Summary 1 2 100% of MU is incorporated into PCMH but Only 44% of PCMH is met by MU and You only get 1 must pass element out of 6 MU objectives fall in All 6 standards 12 of the 27 elements 34 of the 149 factors 3 In several cases, multiple PCMH factors relate to 1 MU objective E.g., MU C8 incorporates 5 PCMH factors When choosing 6 MU clinical measures align them with the 3 diagnostic conditions you selected for PCMH and your UDS clinical measures

2011 NCQA & Stage 1 MU Comparisons Standard Standard Element (total points Points possible) Element (total points possible) Points **A: Access During Office Hours (4) 0 B: After-Hours Access (4) 0 PCMH 1: C: Electronic Access (2) 0.5 Enhance Access D: Continuity (2) & Continuity E: Medical Home Responsibilities (2) 0 0 F: Culturally & Linguistically Appropriate Services (2) 0 G: The Practice Team (4) 0 PCMH 2: Identify & Manage Patient Populations PCMH 3: Plan & Manage Care A: Patient Information (3) 1.5 B: Clinical Data (4) 4 C: Comprehensive Health Assessment (4) 0 **D: Use of Data for Population Management (5) 2.5 A: Implement Evidence-Based Guidelines (4) 1 B: Identify High Risk Patients (3) 0 **C: Care Management (4) 0 D: Medication Management (3) 0.75 E: Use Electronic Prescribing (3) 2.25 Standard PCMH 4: Provide Self-Care Support & Community Resources Element (total points possible) **A: Support Self-Care Process (6) B: Provide Referrals to Community Resources (3) A: Test Tracking and Follow-Up PCMH 5: (6) Track & Coordinate **B: Referral Tracking and Follow- Care Up (6) C: Coordinate with Facilities and Care Transitions (6) 1.5 0 0 1.5 A: Measure Performance (4) 0 B: Measure Patient/Family Experience (4) PCMH 6: **C: Implement Continuous Measure & Improve Quality Improvement (4) Performance D: Demonstrate Continuous Quality Improvement (3) Points E: Report Perforamance (3) 0 F: Report Data Externally (2) 2 3 0 0 0 Total Points: 20.5, 1 MPE @ 50%, No Recognition

MPE & Stage 1 MU Comparison Standard Must Pass Elements Points PCMH 1: Enhance Access & Continuity PCMH 2: Identify and Manage Patient Populations PCMH 3: Plan and Manage Care PCMH 4: Provide Self- Care Support and Community Resources PCMH 5: Track and Coordinate Care **A: Access During Office Hours **D: Use of Data for Population Management Pts needed to pass @ 50% Passed at 50%? (Yes/No) 0 2 NO 2.5 2.5 YES **C: Care Management 0 2 NO **A: Support Self-Care Process **B: Referral Tracking and Follow-Up 1.5 3 NO 1.5 3 NO PCMH 6: Measure and Improve Performance **C: Implement Continuous Quality Improvement 0 2 NO Total Points: 20.5, 1 MPE @ 50%, No Recognition

DEEP DIVE OF MU CORE AND RELATED PCMH ELEMENTS

Core Organizational Elements in PCMH/MU Work The Team Knowledge & Skills Trusted Colleague Protected Time Decisions Assessing Scope & Capacity Getting Organizational Backing Communications The Messages The Audience Detailed Assessments Workplan Two assessments 1 for PCMH, 1 for MU Defining gaps Tips & coaching provided Outlining Plan, Resources, Timeline Managing the Plan and by the Plan Making the Adjustments

Deep Dive MU PCMH Objectives Understanding Overlap Documentation Work plan Thinking To gain a thorough understanding of the Meaningful Use Incentive program Core Measures Understanding the overlap between the PCMH and MU measures and the impact on documentation and workflow Strategies to meet both criteria Interpreting the rules to produce supporting documentation Outlining Plan, Resources, Timeline Managing the Plan and by the Plan Making the Adjustments

PCMH/MU Work Approach Example PCMH MU Element 5C: Coordinates with facilities and care transitions Measures Goal C: Improve care Coordination Provides electronic care summary to another care facility (for at least 50% of transitions of care and referrals) Workplan Assessing EMR capabilities Process Redesign & Workflow System configuration & upgrades Addressing overlaps between PCMH &MU Producing reports Writing policies & procedures Producing screen shots & documentation

MU Documentation Numerator Denominator Calculations

Objective C/D Measure A1: CPOE C More than 30% of unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE A3: Prob. List C More than 80% of patients have at least one entry or an indication that no problems are known for the patient recorded as structured data 16 Measures A4: erx C More than 40% are transmitted electronically using certified EHR technology Object A5: Active Meds C More than 80% of all unique patients seen by the EP )have at least one entry (or List an indication that the patient is not currently prescribed any medication) recorded as structured data A6: medication allergy C More than 80% of all unique patients seen by the EP have at least one entry (or an indication of "none" to show that the patient has no known medication allergies) recorded as structured data A7: Demogr. C More than 50% of all unique patients seen by the EP have demographics recorded as structured data A8: Vital Signs C More than 50% of all unique patients age 2 and over seen by the EP height, weight and blood pressure are recorded as structured data A9: Smoking C More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data A10: Lab Tests C More than 40% of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified HR technology as structured data A13 Patient Reminders D More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period

16 Measures Objective C/D Measure B1 Electronic Copy Record B2 Electronic Access to Record B3 Clinical Summaries B4 Patient Education C2 Medication Reconciliation C3 Summary Record C D C D D D More than 50% of all patients of the EP who request an electronic copy of their health information are provided it within 3 business days More than 10% of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the EP s discretion to withhold certain information Clinical summaries provided to patients for more than 50% of all office visits within 3 business days More than 10% of all unique patients seen by the EP are provided patientspecific education resources The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals

Numerators Denominators Unique Patients Patients Prescriptions Lab Test Results Visits Transitions Rx Order Data Entry Transmitted erx Labs Ordered Reminders Rx Reconciliations Summaries of Care Copy of Record Timely Record Access Education

Meaningful Use/ PCMH 2011 Overlap Core Measure # 1 Core Measure # 4 PCMH 3E Factors 1& 2

Meaningful Use/ PCMH 2011 Overlap Certified EHR displaying overall results MU #4?

Meaningful Use/ PCMH 2011 Overlap Core Measure #2 PCMH 3E Factor 4

Meaningful Use/ PCMH 2011 Overlap PCMH 3E # 4 Screen shot of Drug- Drug interaction in our EMR PCMH 3E # 3 Interacts w/ patient record and alerts of Drug- Disease interaction

Meaningful Use/ PCMH 2011 Overlap Core Measure # 3 PCMH 2B Clinical Data Factor 1 PCMH 2 Core Measure # 5 PCMH 2B Clinical Data Factor 9 Core Measure # 6 PCMH 2B Clinical Data Factor 2

Meaningful Use/ PCMH 2011 Overlap Core Measure # 8 PCMH 2B Clinical Data Factor 3-7 Core Measure # 9 Core Measure # 9 PCMH 2B Clinical Data Factor 8

Meaningful Use/ PCMH 2011 Overlap Meaningful Use Core Measures 3,5,6,8,9 PCMH 2B Factors 1-9 MU # 3 MU # 6 MU # 8 MU # 9 MU # 5

Meaningful Use/ PCMH 2011 Overlap The Johnson Clinic for Primary Care & Adult Medicine PPC PCMH 2B #2B6 Patients seen from 01/01/11 to 3/31/11 = 1282 Num. Den. Percent 1 Up to date problem list 1282 1282 100% Goal is 80% 2 Allergies 1282 1282 100% Goal is 80% 3 Blood Pressure 1282 1282 100% Goal is 50% 4 Height 565 1282 44.1% Goal is 50% 5 Weight 610 1282 48% Goal is 50% 6 BMI 565 1282 44.1% Goal is 50% 7 Length/ height/ head circum.(<2yrs old) BMI % (2-20yrs old)w/ plotted changes 0 1282 0% Goal is 50% 8 Status of Tobacco Use (13 and older) 780 1282 61% Goal is 50% 9 List of Rx meds w/ date of update 1280 1282 100% Goal is 50% Text Note: The Johnson Clinic answered yes to factors 1-3, 8 and 9 (5 factors) NA to # 7. See attached screen shot of report

Meaningful Use/ PCMH 2011 Overlap Core Measure # 7 PCMH 2A Factor 1-5

Meaningful Use/ PCMH 2011 Overlap Watertown Family Health Center PCMH 2A Unique Patients seen from 2/01/11-5/31/11= 3752 Factor Percentage Denominator DOB 100 3752 Gender 100 3752 Race 66 3752 Ethnicity 68 3752 Preferred Language 100 3752 Telephone # 99 3752 E-mail 0 3752 Previous Visit Dates 100 3752 Legal Guardian 96 3752 PCP 100 3752 Advance Directives 98 3752 Health Ins. 99 3752 MU Core #7 Goal is 50%

Meaningful Use/ PCMH 2011 Overlap Clinical Quality Measures Core Measure # 10 PCMH 6F Factor 1 Element F: Report Data Externally 2 points The practice electronically reports: Yes No 1. Ambulatory clinical quality measures to CMS or states+

Meaningful Use/ PCMH 2011 Overlap Core Measure # 11 PCMH 3A Factors 1-3

Meaningful Use/ PCMH 2011 Overlap Documenting use of evidence based guidelines PPC 3A This and the following screen shots show our HIV templates now completely filled in following the recommended guidelines and CDSS

Meaningful Use/ PCMH 2011 Overlap CDSS Panel above displaying alerts for screenings due

Meaningful Use/ PCMH 2011 Overlap Core Measure # 12 PCMH 1C Factors 1 MU menu measure

Meaningful Use/ PCMH 2011 Overlap Core Measure # 13 PCMH 1C Factors 3

Meaningful Use/ PCMH Overlap

Meaningful Use/ PCMH 2011 Overlap Core Measure # 14 PCMH 5B Factor 6

Meaningful Use/ PCMH 2011 Overlap PCMH 5C factor 7 was previously designated as aligning with MU # 14 removed in March 28, 2011 revision Example documentation to meet PCMH 5B Factor 6

Meaningful Use/ PCMH 2011 Overlap Core Measure # 15 Ensure adequate privacy and security protections for personal health information

QUIZ TIME!

A practice is on its way to meet medication reconciliation criteria because its patient portal enables post-op access to a clinical summary of care including a medication reconciliation list. Does this meet meaningful use criteria? NO! WHY NOT? MU criteria specifically addresses transitions of care thus providers have to be trained to use a specific code to identify a post-op visit as a transition of care event. This is an EMR awareness, a workflow issue, and a data flow issue.

Is a practice that offers a HI for patients to download from a portal, and the patients download the HI themselves, complying with the MU menu measure of providing a HI on request? No, (says Health Data Management Magazine) Because the practices do not get requests and cannot attest to providing HI on request because patients download the HI themselves

Did you know If your e-pms feeds data to your EMR, then it must be Certified

MU #10 Clinical Quality Measures MU & PCMH Overlap PCMH 6F Factor 1

06/10/2011 134/84 134/84 134/84

06/10/2011 400

06/11/2011 150/80 right a 150/80 right arm 150/80 right arm 134/84

Meaningful Use/ PCMH 2011 Overlap Certified EHR displaying overall results MU #4?

PCMH 5A Factor 1 Tracks Labs We track labs from our EMR by using this screen. We set all of the filters to All to see global view of all labs

PCMH5A Factor 2 Tracks Images We track Images (X-ray) from our EMR by using this screen. We set all of the filters to All to see global view of Images (X-ray)

PCMH 5A Factor 3 Flag Abnormal Our lab interface will give us an alert when results are abnormal by appearing in red Abnormal Lab

PCMH Factor 5 A5 Notifies patients/ Family If a lab is abnormal, the providers will attach a note to the lab, along with a task for the nurse to notify the patient/family and any necessary action needed. Patient chart showing abnormal lab results The provider tasked the nurse to contact the patient and review results

Conclusions/Recommendations Planning to accomplish both initiatives involves carving a pathway that practically applies the overlaps to gain time and multiple goals. Interpreting standards and requirements into policies and procedures; documentation, and a narrative that proves the points These two initiatives, especially MU Stage 1 are foundational. This means that it is essential to recognize building the initiatives correctly. They lay in the method, effort, and the way of operating In a way these are quality improvement, process improvement and outcomes improvement projects that are HIT enabled & enhanced

Home Sweet Meaningful Medical Home Patient Centered Care

References & Research Accreditation Association for Ambulatory Health Care, Inc. (2011) Medical Home On-site Certification Handbook. Skokie, IL. Corsello, Therese. (2011, June 20) Telephone conversation with Catherine Harrison, Executive Office of Health and Human Services, The Commonwealth of Massachusetts. Corsello, Therese. (2011, June 23) Telephone conversation with Susan Stern, URAC. Minnesota Department of Health. (2009). Minnesota s Vision: Health Care Homes, Information for Providers. Retrieved from: http://www.health.state.mn.us/healthreform/homes/education/index.html Minnesota Department of Health. (2009). Minnesota s Vision: Health Care Homes, An Overview. Retrieved from: http://www.health.state.mn.us/healthreform/homes/education/index.html Minnesota Department of Health. (2010) Health Care Homes Certification Application Process Checklist. Retrieved from: http://www.health.state.mn.us/healthreform/homes/certification/index.html Minnesota Department of Health.(2010) Health Care Homes Certification Tool with Examples. Retrieved from: http://www.health.state.mn.us/healthreform/homes/certification/index.html Minnesota Rules Chapter 4764. National Committee on Quality Assurance. (2011). Standards and Guidelines for NCQA s Patient-Centered Medical Home (PCMH) 2011. Washington, DC.

References & Research The Commonwealth of Massachusetts, Executive Office of Health and Human Services. (2011). The Massachusetts Patient-Centered Medical Home Initiative [PowerPoint slides]. Boston, MA. The Commonwealth of Massachusetts, Executive Office of Health and Human Services. (2011) Patient-Centered Medical Home Initiative Draft Provider Contract Addendum Technical Assistance-Plus Practices. Boston, MA. The Commonwealth of Massachusetts, Executive Office of Health and Human Services. (2011) Patient-Centered Medical Home Initiative Draft Provider Contract Addendum Technical Assistance-Only Practices. Boston, MA. The Joint Commission (2011, June 21). Webinar: Joint Commission Designation for your Primary Care Medical Home. The Joint Commission. (2011). Primary Care Medical Home Pre-publication Standards Ambulatory Care Program. Retrieved from: http://www.jointcommission.org/primary_care_medical_home_prepublication_standards/. URAC (2011). URAC Patient Centered Health Care Home Practice Achievement, v1.0. Washington, D.C. URAC. (2010). URAC s Patient Centered Health Care Home Program Toolkit Version 1.0. Washington, D.C.