2014 PCMH STANDARDS. Renewals & Annual Data Requirements

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1 2014 PCMH STANDARDS Renewals & Annual Data Requirements

2 PCMH Renewal Process Streamlined process for renewal through reduced documentation requirements. Even though some elements do not require documentation, the must be able to produce documentation if requested or selected for audit.

3 PCMH Renewal Process Standards requiring documentation: 1A (must pass) 2D (must pass) 3C 3D (must pass) 4A, 4B (must pass), 4C 5B (must pass) 6B 6D (must pass), 6E

4 PCMH Renewal Process remaining elements for answered yes, must attest that you are eligible using the language: Our achieved Level 2 or Level 3 Recognition as a patient centered medical home and attests that the responses to the of this element reflect the current operation of the organization/ sites. Documentation to support these responses can be provided upon request.

5 Points PCMH 2014 Standards and Elements Documentation or Attestation? 10 PCMH 1: Patient-Centered Access 4.5 PCMH 1A: Patient-Centered Appointment Access MUST-PASS Documentation 3.5 PCMH 1B: 24/7 Access to Clinical Advice Attestation 2 PCMH 1C: Electronic Access Attestation 12 PCMH 2: Team-Based Care 3 PCMH 2A: Continuity Attestation 2.5 PCMH 2B: Medical Home Responsibilities Attestation 2.5 PCMH 2C: Culturally and Linguistically Appropriate Services (CLAS) Attestation 4 PCMH 2D: Practice Team MUST-PASS Documentation 20 PCMH 3: Population Health Management 3 PCMH 3A: Patient Information Attestation 4 PCMH 3B: Clinical Data Attestation 4 PCMH 3C: Comprehensive Health Assessment Documentation 5 PCMH 3D: Use Data for Population Management MUST-PASS Documentation 4 PCMH 3E: Implement Evidence-Based Decision-Support Attestation

6 Points PCMH 2014 Standards and Elements 20 PCMH 4: Care Management and Support Documentation or Attestation? 4 PCMH 4A: Identify Patients for Care Management Documentation 4 PCMH 4B: Care Planning and Self-Care Support MUST-PASS Documentation 4 PCMH 4C: Medication Management Documentation 3 PCMH 4D: Use Electronic Prescribing Attestation 5 4E: Support Self-Care and Shared Decision-Making Attestation 18 PCMH 5: Care Coordination and Care Transitions 6 5A: Test Tracking and Follow-Up Attestation 6 5B: Referral Tracking and Follow-Up MUST- PASS Documentation 6 5C: Coordinate Care Transitions Attestation 20 PCMH 6: Performance Measurement and Quality Improvement 3 6A: Measure Clinical Quality Performance Attestation 3 6B: Measure Resource Use and Care Coordination Documentation 4 6C: Measure Patient/Family Experience Attestation 4 6D: Implement Continuous Quality Improvement MUST-PASS Documentation 3 6E: Demonstrate Continuous Quality Improvement Documentation 3 6F: Report Performance Attestation 0 6G: Use Certified EHR Technology N/A Attestation 15 Elements Documentation 11 Elements N/A 1

7 PCMH Annual Documentation Requirements NCQA requires annual documentation to ensure that s are continuously identifying populations and measuring quality data, through the duration of their recognition period. Standards requiring annual documentation: 3D Population Management 6A 6C Performance Measurement

8 PCMH 3D: Use Data for Population Management At least annually the proactively identified populations of patients and reminds them, or their families/caregivers, of needed care based on patient information, clinical data, health assessments and evidence based guidelines including: 1. At least 2 different preventive care services. 2. At least 2 different immunizations. 3. At least 3 different chronic or acute care services. 4. Patients not recently seen by the. 5. Medication monitoring or alert.

9 PCMH 3D: Use Data for Population Management 100% 75% 50% 25% 0% meets 4 5 meets 3 meets 2 meets 1 factor meets 0 Renewing s: is required to meet the in this element at least annually, renewing s can show at least 2 have been met during each year of recognition, prior to their renewal.

10 PCMH 3D: Use Data for Population Management WHAT YOU NEED TO DO NOW: 1. For renewal you need to submit lists of patients and an example of the outreach for each factor you meet. 2. If you have done any reminders this year that meet these standards keep copies of lists and reminder example. a. Medicare pts with no visit this year b. Pts without flu shot this season c. Mammogram or Colorectal Cancer Screening reminders 3. If you have no reminders for this year run lists (look to 4 &5) and send reminders.

11 PCMH 6A: Measuring Clinical Quality Performance At least annually, the measures or receives data on: 1. At least 2 different immunizations. 2. At least 2 different preventive care services. 3. At least 3 different chronic or acute care services. 4. Performance data stratified for vulnerable populations (to assess disparities in care).

12 PCMH 6A: Measuring Clinical Quality Performance 100% 75% 50% 25% 0% meets all 4 meets 3 meets 2 meets 1 factor meets 0 Renewing s: NCQA reviews reports showing that the has measured at least annually for 2 years.

13 PCMH 6A 2011 Standards

14 PCMH 6A: Measuring Clinical Quality Performance WHAT YOU NEED TO DO NOW: 1. This element is an attestation for renewal (i.e., you do not have to submit documentation). 2. You do have to have documentation of these measurements at least annually in case of an audit. 3. Review the measures you submitted for the 2011 standards and ensure you have annual measurement for all. Focus on Factors 1 & You will likely need either another immunization measure or a preventive care measure

15 PCMH 6B: Measuring Resource Use and Care Coordination At least annually, the measures or receives quantitative data on: 1. At least 2 measures related to care coordination. 2. At least 2 utilization measures affecting health care costs. 100% 75% 50% 25% 0% meets all 2 meets 1 meets 0 Renewing s: For Factor 2 NCQA reviews reports showing that the has measured at least annually for 2 years.

16 PCMH 6A 2011 Standards

17 PCMH 6B: Measuring Resource Use and Care Coordination WHAT YOU NEED TO DO NOW: 1. This element requires documentation for renewals. 2. Continue to download & review in/out of network reports provided by CMP. 3. Identify 2 care coordination measures for tracking/ improvement. Some examples: 1. Reconciled medications for discharged patients 2. Receipt of discharge summary 3. Follow up call within 2 days of discharge 4. Follow up appointment within 7 days of discharge

18 PCMH 6C: Measuring Patient/Family Experience At least annually, the obtains feedback from patients/families on their experience with the and their care: 1. conducts a survey (using any instrument) to evaluate patient/family experiences on at least three of the following categories: Access. Communication. Coordination. Whole person care/self management support. 2. uses the PCMH version of the CAHPS Clinician & Group Survey Tool. 3. obtains feedback on experiences of vulnerable patient groups. 4. obtains feedback from patients/families through qualitative means.

19 PCMH 6C: Measuring Patient/Family Experience 100% 75% 50% 25% 0% meets all 4 meets 3 meets 2 meets 1 factor meets 0 Renewing s: NCQA reviews reports showing that the has measured at least annually for 2 years.

20 PCMH 6C: Measuring Patient/Family Experience WHAT YOU NEED TO DO NOW: 1. This element is an attestation for renewal (i.e., you do not have to submit documentation). 2. You do have to have documentation of these measurements at least annually in case of an audit. 3. CMP does complete the surveys annually using the CG CAHPS tool. Review results online via Catalyst. Identify at least 1 area for improvement. Stratify data by vulnerable population.

21 PCMH 6D: Implement Continuous Quality Improvement (MUST PASS) uses an ongoing quality improvement process to: 1. Set goals and analyze at least three clinical quality measures from Element A. 2. Act to improve at least three clinical quality measures from Element A. 3. Set goals and analyze at least one measure from Element B. 4. Act to improve at least one measure from Element B. 5. Set goals and analyze at least one patient experience measure from Element C. 6. Act to improve at least one patient experience measure from Element C. 7. Set goals and address at least one identified disparity in care/service for identified vulnerable populations. 100% 75% 50% 25% 0% meets all 7 meets 6 meets 5 meets 1 4 meets 0

22 PCMH 6E: Demonstrate Continuous Quality Improvement demonstrates continuous quality improvement by: 1. Measuring the effectiveness of the actions it takes to improve the measures selected in Element D. 2. Achieving improved performance on at least two clinical quality measures. 3. Achieving improved performance on one utilization or care coordination measure. 4. Achieving improved performance on at least one patient experience measure. 100% 75% 50% 25% 0% meets all 4 meets 3 meets 2 meets 1 factor meets 0

23 PCMH RENEWAL QUESTIONS?

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