URAC Patient Centered Health Care Home (PCHCH) Education, Evaluation, and Recognition
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1 URAC Patient Centered Health Care Home (PCHCH) Education, Evaluation, and Recognition PRESENTER: Michelle Phipps, RN, PhD Sr. Director of Clinical Education and Conferences DATE: March 13, 2013
2 Focus On URAC Overview and PCHCH Overview Who is URAC? Nonprofit, independent organization founded in 1990 originally chartered to accredit utilization review services URAC offers more than 30 accreditation and certification programs across the entire continuum of care URAC currently accredits more than 600 programs operating in all 50 states Government references to URAC accreditation appear in statutes, regulations, agency publications, Requests for Proposals, and contract language URAC is now recognized by 48 states, District of Columbia, and five federal agencies (OPM, DOD, VA, CMS, and DOL) 3/13/ URAC 2
3 About URAC Providers MCO s Purchasers Regulators Labor Consumers Expert Advisory Panels (Volunteer) Consumer Protection and Empowerment Improving and Innovating Healthcare Management 3/13/ URAC 3
4 URAC Board Member Organizations The URAC Board maintains at-large representatives from consumer groups, public organizations and other industry experts. 3/13/ URAC 4
5 URAC Offers a Full Range of Accreditation and Certification Programs 3/13/ URAC 5
6 Why URAC? Industry was looking for an alternative Core philosophy of URAC is educational with non prescriptive approach URAC PCHCH Program is patient centric vs. emphasis on EHR and meaningful use Design supports a stepwise approach for transformation of a practice to a patient centered health care home Option to apply for achievement or achievement with EHR recognition (phase in option) Standards focus on access and coordination of care Resources available for practices to use tools such as selfassessment checklist and Primer for tracking progress Review by professional clinician-consultative interaction Tiered pricing based on # of clinicians in practice 3/13/ URAC 6
7 URAC Patient Centered Health Care Home Overview 3/13/ URAC 7
8 URAC Patient-Centered Health Care Home (PCHCH) Program Toolkit and Information Resources Auditor Certification Practice Achievement Details PCHCH Assessment Standards Survey Information Resource Performance Measures Information Resource Practice Assessment or Achievement Validation Clinical Training Required 3 Year Auditor Certification 3 Year Core Accreditation of Auditor Organization Primer Licensed Subscription Web Based Technology Customized Self Assessment Verified via office onsite that practices successfully meet the PCHCH Assessment Standards Standards from PCHCH Program Toolkit 2 Year 3/13/ URAC 8
9 Central to the PCHCH Standards: Institute of Medicine Quality Aims 1. Safe 2. Effective 3. Patientcentered 4. Timely 5. Efficient 6. Equitable How URAC PCHCH Standards Promote IOM Quality Aims Registry, Medication Reconciliation, Transitions of Care, Privacy and Security Evidence Based Guidelines, Wellness Promotion and Quality Management Programs Individualized Focus, Informed Decision Making, Patient Satisfaction, Consumer Education, Health Literacy Lab Values, Requests for Health Information and Enhanced Coordination of Care Organizational Structure, Policies and Procedures, Electronic Health Record and Total Quality Management Disparity, Cultural Sensitivity, Complaint Process and Coordination with the Payor 3/13/ URAC 9
10 Defining a URAC Patient Centered Health Care Home 3/13/ URAC 10
11 10 Principles Foundation of PCHCH Program 3/13/ URAC 11
12 Health Care Accreditation Continuum Accreditation Building Blocks Health Care Delivery Convergence Point Health Care Financing & Management Medical Home Primary Care Practitioners Medical Home Neighborhood Specialty Providers Clinically Integrated Networks/ Systems Accountable Care Organizations Care Management Accreditation Traditional Case Management Care Coordination Evolution of the Delivery System Transitions of Care Patient Engagement 3/13/ URAC 12
13 Focus On Standards and Recognition Process URAC Patient Centered Health Care Home Practice Achievement Program 3/13/ URAC 13
14 URAC PCHCH Practice Achievement PCHCH Practice Achievement Program 28 Comprehensive URAC PCHCH Standards Mandatory and essential standards Standards are aligned with the meaningful use requirements Interactive educational review Achievement awarded to the practice 3/13/ URAC 14
15 3/13/ URAC 15
16 PCHCH Practice Achievement Modules/Standards 3/13/ URAC 16
17 PCHCH Practice Achievement Modules/Standards 3/13/ URAC 17
18 PCHCH Practice Achievement Modules/Standards 3/13/ URAC 18
19 Focus On Tools and Resources 3/13/ URAC 19
20 URAC PCHCH Practice Assessment Checklist URAC PCHCH Practice Standards In Place (Y/N) Access to Services (ATS) Goal is to ensure all patients have comprehensive and timely access to health care services that are patient centered, culturally sensitive, and delivered in the least intensive and most appropriate setting based on the patient s needs. PCH PA 6 (ATS): Patient Access to Services and Information The Practice has a process to ensure that patients: a)have access to timely appointments with appropriate clinician(s); b)have access to referrals with appropriate specialist(s), if applicable; c)receive clearly specified hours of office operation and location(s); d)receive instructions about what to do in an emergency; and e)how to access after hour services non emergency and urgent care needs. Yes No Referral Process (RP) Goal is to create a well coordinated process where PCHCH patients are referred to specialty care in an efficient manner, and both the practice clinicians and specialists receive timely access to the information they need to provide optimal care to the patient. PCH PA 10 (RP): Referrals Process The Practice has an established process to: a)identify patients who need a referral; b)coordinate referrals; c)ensure referrals are made to specialists and/or appropriate programs; and d)involve patients in selecting the clinician(s). Yes No 3/13/ URAC 20
21 3/13/ URAC 21
22 Bi weekly Newsletter Register Now for Your Complimentary Copy Welcome to the Medical Home Today, the knowledge source for today's enlightened practitioners operating (or seeking to operate) in a patient-centered health care home. This biweekly source for news and analysis on the emerging trend of the medical home is brought to you by URAC, a quality-driven accreditation body and Dorland Health. Sign up - View newsletters - 3/13/ URAC 22
23 Summary PCHCH Practice Achievement 3/13/ URAC 23
24 Thank You! URAC 1220 L Street, NW, Suite 400 Washington, D.C Phone: (202) Fax: (202) or BusinessDevelopment@urac.org 3/13/ URAC 24
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