Medical Home Recognition

Transcription

1 Medical Home Recognition Erin Dormaier Transformation Support Services Manager, CHTS-IM, PCMH-CCE 2015 CORHIO All Rights Reserved CORHIO Proprietary Not For Redistribution 1

2 Agenda History of Medical Home What is a Medical Home Why be a Medical Home NCQA Patient Centered Medical Home Breakdown TSS Can Help 2

3 History of Medical Home Introduced in 1967 by American Academy of Pediatrics 1978 the WHO supports the idea 2002 seven national family medicine organizations recommend supporting the medical home concept 2003 NCQA launched Physician Practice Connections 2007 Joint PCMH principles released 2008 NCQA, URAC, Joint Commission, & AAAHC launched 1 st PCMH recognition 2010 ACA signed including investments in medical home pilots 2015 MACRA passed including Merit Based Incentive Payment System (MIPS) 3

4 What is a Medical Home PCPCC describes the medical home as an approach to the delivery of primary care that is: Patient-centered: A partnership among practitioners, patients, and their families ensures that decisions respect patients wants, needs, and preferences, and that patients have the education and support they need to make decisions and participate in their own care. Comprehensive: A team of care providers is wholly accountable for a patient s physical and mental health care needs, including prevention and wellness, acute care, and chronic care. Coordinated: Care is organized across all elements of the broader health care system, including specialty care, hospitals, home health care, community services and supports. Accessible: Patients are able to access services with shorter waiting times, "after hours" care, 24/7 electronic or telephone access, and strong communication through health IT innovations. Committed to quality and safety: Clinicians and staff enhance quality improvement to ensure that patients and families make informed decisions about their health. 4

5 Versions of Medical Home Primary Care Medical Homes NCQA Patient Centered Medical Home (PCMH)- largest Joint Commission Primary Care Medical Home URAC Patient Centered Healthcare Homes (PCHCH) Accreditation Association for Ambulatory Healthcare (AAAHC) Medical Home through Colorado Medicaid (HCPF) Specialty Care Medical Neighborhoods NCQA Patient Centered Specialty Practice (PCSP) NCQA Patient Centered Connected Care (PCCC) 6

6 Why Medical Home? Better quality, patient experience, continuity, lower costs related to reduced hospital admissions/ed visits Reduce income based disparities in care Whole person care Lower rates of provider burnout Payer reimbursement Maintenance of Certificate Credit MIPS- Clinical Practice Improvement 5

7 National Committee Quality Assurance (NCQA) Patient Centered Medical Hom (PCMH) 7

8 The Basics Primary Care, Pediatricians, Internal Medicine, Geriatrics MDs, DOs, APRNs, and PAs that have a panel of patients The practice is recognized by site and lists the providers associated with the practice 3 levels of recognition Good for 3 years 8

9 What does it take? 6-12 months to achieve recognition NCQA estimates 100 hours Compose internal team (4-6 people average) Have buy in from leadership 9

10 The Standards PCMH 1: Patient Centered Access Appointment access 24/7 clinical advice Patient electronic access PCMH 2: Team Based Care Culturally & linguistically appropriate services Care team Medical home responsibilities PCMH 3: Population Health Management Collect patient data Utilize data for population management PCMH 4: Care Management and Support Identify patients who would benefit from care management Implement evidence based guidelines for those patients PCMH 5: Care Coordination and Care Transitions Test tracking & follow up Referral tracking and follow up PCMH 6: Performance Measurement and Quality Improvement Clinical Quality Measurement & improvement Patient experience surveys 10

11 Anatomy of a Standard 11

12 Elements and Factors 27 Elements and 178 Factors Must Pass Elements and Critical Factors Weighted scoring 12

13 CORHIO Project Management Tool 13

14 The interactive tool is invaluable I can t say enough about the value it s brought to us and our ability to manage the application using it. It tells us what the standards are, gives us an opportunity to input feedback on where we are at in the process and scores us based on the assessment so we know where we stand. If we think we ll have trouble meeting a certain factor, we can see our score without it and determine if we can proceed with the other elements. I can t imagine pursuing PCMH recognition without having CORHIO s tool. - Michael Garcia, Metro Community Provider Network (MCPN) 14

15 Costs 15

16 HIE & PCMH Access to hospital ADT Event notification Newborn screening results 16

17 PCMH Relates to Federal Initiatives Meaningful Use (MU) PQRS/Value Based Payment Modifier Evidence Now Southwest (ENSW) State Innovation Model (SIM) Transforming Clinical Practice Initiative (TCPi) Merit Based Incentive Payment (MIPs) in 2019 Clinical Practice Improvement from data in

18 NCQA Partners in Quality CORHIO is a NCQA Partner in Quality 18

19 Transformation Support Services (TSS) CORHIO has 4 NCQA PCMH Certified Content Experts Variety of services to assist with achieving recognition Project management Assistance with selection of factors Document review & labeling ISS Tool assistance for submission CORHIO- NCQA Partner in Quality Free gap analysis Practice receives 20% discount on application fee 19

20 Contact Info Erin Dormaier Transformation Support Services Manager 2015 CORHIO All Rights Reserved CORHIO Proprietary Not For Redistribution 20