PCMH Development and NCQA Recognition Overview

Transcription

1 PCMH Develpment and NCQA Recgnitin Overview May 2015

2 Overview f PCMH PCMH Features Outcmes f Medical Hme Benefits f PCMH Medical Hmes in SC NCQA Recgnitin Requirements Applicatin Prcess Overview Building a PCMH Practice Transfrmatin SCORH Center fr Practice Transfrmatin

3 WHY PCMH? Quality Chasm Healthcare csts Declining physician and staff satisfactin Patient dissatisfactin Health infrmatin technlgy Perfrmance measurement & reprting Changes in payment methdlgies

4 Patient Centered Medical Hme PCMH is an enhanced primary-care mdel that delivers cmprehensive and timely care t patients, emphasizing the central rle f teamwrk and engagement between caregivers and patients PCMH is a radmap fr transfrming primary care

5 Enhancing Health and the Patient Experience Medical Hme Mdel Team-Based Healthcare Delivery Access t Care Ppulatin Health Advanced IT Systems Patient is the center f the Medical Hme Patient-Centered Care Decisin Supprt Tls Patient & Physician Feedback Refcused Medical Training Mdel adapted frm the NNMC Medical Hme

6 Care Crdinatin Better verall care Three- Part Aim Advanced Access Imprved health Lwer per capita csts Team-Based Care Chrnic Care Mdel

7 PCMH Outcmes: Smarter Healthcare Drp in hspital days %* Drp in ER use %* Reductin in ttal csts - 9.6%* Reductin in utpatient specialty care %* Imprvements in chrnic disease and preventive care* Decreased staff burnut Higher patient experience ratings * Outcmes f Implementing Patient Centered Medical Hme Interventins: A Review f the Evidence frm Prspective Evaluatin Studies in the US, K. Grumbach & P. Grundy, Nvember 16 th 2010 Patient-centered medical hme demnstratin: a prspective, quasi-experimental, befre and after evaluatin. Reid RJ, Fishman PA,Yu O, Rss TR, Tufan JT, Sman MP, Larsn EB. Am J Man Care, 2009 Sep 1;15(9):e71-87

8 PCMH in Suth Carlina SC primary care practices are transfrming their practices as medical hmes ~120 practices which include >520 prviders have btained NCQA recgnitin as a PCMH 56 Nurse Practitiners are Recgnized as practicing in a PCMH 24 Physician Assistants are Recgnized as practicing in a PCMH Organizatins are wrking t supprt the develpment f medical hmes in SC Grwing alignment t supprt practice transfrmatin and medical hme develpment Meaningful Use EMR Implementatin SC Healthy Outcmes Plan

9 Payment fr PCMH SC Medicaid currently incentivizes practices t pursue PCMH recgnitin $.50 PMPM fr practices pursuing PCMH recgnitin $1.00 PMPM fr Level I recgnitin $1.50 PMPM fr Level II recgnitin $2.00 PMPM fr Level III recgnitin BCBSSC has a prgram fr recgnized practices Applicatin fr participatin can start 6-mnths befre recgnitin is btained Three-cmpnent payment system Traditinal FFS PMPM Care Management fee Perfrmance-based bnus Fcus n selected chrnic diseases BCBSSC Rewarding Excellence prgram Cigna & Humana have PCMH/Accuntable Care prgrams in SC CMS Health Innvatins Award

10 PCMH EHR PQRS MU Vlume-Based Reimbursement Value-Based Reimbursement

11 Why Nw?

12 NCQA RECOGNITION

13 NCQA PCMH Recgnitin Prcess Set f standards t assess the extent t which health care rganizatins are functining as medical hme Obtaining recgnitin requires cmpleting an applicatin, which dcuments that specific medical hme prcesses and plicies are in place

14 NCQA PCMH 2014 Guides practices t Organize care arund patients Wrk in teams Crdinate and track care ver time Prvides a framewrk fr transfrmatin Used by payers & thers as stamp f apprval Aligns clsely with Meaningful Use Stage 2 3 levels f Recgnitin Recgnitin lasts fr 3 years PPC-PCMH Standards and Guidelines are available free at

15

16 Pint Requirements Level f Recgnitin Level 1 Level 2 Level 3 Pints Required Must Pass 6/6 must pass 6/6 must pass 6/6 must pass NOTE: Must Pass elements require a 50% perfrmance level t pass

17 PCMH Transfrmatin Initial Steps

18 Imprvement Team Frm a team 3-6 members (2-3 if small practice) Rles: Prvider champin Day-t-Day leader System leader IT leader Other (Frnt Desk Staff) Meet 2x per mnth t get started regular meetings Review PCMH materials and develp game plan Accuntable fr deliverables Practice transfrmatin and medical hme develpment CANNOT be dne by ne persn

19 Practice Assessment Assess yur practice Practice prfile Lists strengths and challenges Identify pprtunities fr imprvement If yu culd change ne thing abut yur day what wuld it be Increase yur understanding f yur patients - # f patients with selected chrnic disease; average wait time fr yur patients PCMH Assessment Cmplete PCMH Assessment tl - MH-A_0.pdf Tl will identify strengths and gaps Use PCMH Assessment t set pririties and develp game plan

20 PCMH Assessment Surce: PCMH-A -

21 Why Me? Rural Health Clinics increasingly are expected t measure, reprt and imprve quality measures and demnstrate clinical and peratinal imprvements SCORH Center fr Practice Transfrmatin created t supprt rural practices and prviders in their imprvement effrts and prepare them t perate under perfrmance-based reimbursement mdels Alignment with Meaningful Use Perfrmance reprting EHR Implementatin & Supprt Wrkfrce Management

22 Center fr Practice Transfrmatin Prvides experienced staff and resurces in practice transfrmatin Practice supprt is prvided thrugh Practice caching Practice assessment & planning Learning pprtunities mnthly webinars, SharePint site Recgnitin supprt Practical & tactical Partner with practices and supprt services team as needed

23 APPENDIX

24 PCMH 1: Enhance Access and Cntinuity Same day appintments Patients have access t culturally and linguistically apprpriate rutine/urgent care and clinical advice during and after ffice hurs The practice prvides electrnic access Practice tracks and imprves a measure f access

25 PCMH 2: Team-Based Care Patients prvides ptin t select a persnal clinician Practice reprts cntinuity Practice ntifies patients f medical hme respnsibilities Practice trains staff in team-based care and Implements team-based care structure and activities

26 PCMH 3: Identify and Manage Ppulatins The practice cllects demgraphic and clinical data fr ppulatin management The practice assesses and dcuments patient risk factrs The practice identifies patients fr practive and pint-f-care reminders

27 PCMH 4: Plan and Manage Care The practice identifies patients fr case management Care management emphasizes: Pre-visit planning Assessing patient prgress tward treatment gals Addressing patient barriers t treatment gals The practices uses e-prescribing Assesses patient/family self-management abilities Wrks with patients t develp a self-care plan and prvide tls and resurces Clinicians cunsel patients n healthy behavirs Assesses and prvides r arranges fr mental health/substance abuse treatments

28 PCMH 5: Track & Crdinate Care Tracks, fllw-up n and crdinates tests, referrals and care at ther facilities Fllws up with discharged patients Care crdinatin

29 PCMH 6: Measure & Imprve Perfrmance Uses perfrmance and patient experience data t cntinuusly imprve Identifies vulnerable patient ppulatins Demnstrates imprved perfrmance