2014 Patient Centered Medical Home (PCMH) Recognition

Transcription

1 Collaboration Catalyst Community 2014 Patient Centered Medical Home (PCMH) Recognition PRESENTED BY: Oct RuthAnn Craven, MS Transformation Coach

2 AHI is an independent, nonprofit organization that partners with regional health care providers and community-based organizations to improve care, lower costs and realize a healthier future. AHI: Who We Are

3 Overview NCQA Overview What is a PCMH? Industry Trends 2014 Standard Updates PCMH Concepts Questions

4 NCQA Provider-Based Quality Programs ACO Accreditation DRP & HSRP Recognition (diabetes/heart stroke) PCMH & PSCP Recognition NCQA National Committee for Quality Assurance

5 What is a PCMH? Delivers whole person coordinated care to transform primary care into what patients want it to be Prizes clinician-patient relationships (not disjointed visits) to keep patients healthy between visits

6 What is a PCMH? (continued) Supports team-based care that frees providers to work to their highest level of training Aligns use of information technology to help providers support the Triple Aim and improve population health

7 Benefits of a PCMH Improved compliance with obtaining recommended preventative services Better chronic disease management resulting in fewer ER and hospital visits Improved health care quality and patient satisfaction

8 Industry Trends Triple Aim: Improve cost, quality, patient experience Population health management Integrated care Care transitions and self-care support Movement toward a value-based model

9 DSRIP and PCMH The Delivery System Reform Incentive Program (DSRIP) is an opportunity to strengthen and expand primary care, which is central to achieving better health for patients and communities, and lowering costs for everyone. New York State and the DSRIP Performing Provider Systems (PPSs) have committed to this vision, including ensuring every primary care provider in their network is a high-performing Patient Centered Medical Home (PCMH)/Advanced Primary Care (APC) practice.

10 PCMH 2014 (6 standards, 27 elements, 100 points) 1. Patient-Centered Access (10) 2. Team-Based Care (12) 3. Population Health Management (20) 4. Care Management and Support (20) 5. Care Coordination and Care Transitions (18) 6. Performance Measurement and Quality Improvement (20)

11 2014 Update: Major Enhancements Team-based care Behavioral and mental health integration Measuring health care costs Meaningful Use alignment Continuous improvement Care coordination

12 2014 Update: Team-Based Care Now its own standard Patients are part of the care team Development of a strong care team is a mustpass element

13 Patients/families should be: 2014 Update: Team-Based Care o Involved in QI opportunities o Educated in expected care and their role in shared decision-making Care team should demonstrate excellence in: o Care management o Care planning o Self-care support

14 2014 Update: Behavioral Health The PCMH is a model of primary care in which a team of clinicians offers accessible first-contact care that is personalized, coordinated, and comprehensive and meets most or all of a person s health care needs, including behavioral health. - American Academy of Family Physicians, 2014

15 2014 Update: Behavioral Health Additional enhancements: o More specific in comprehensive health assessment requirements o Score for practices that integrate behavioral health within the primary care setting o Use of decision support tools

16 2014 Update: Measuring Costs By identifying and eliminating wasteful practices that do not improve health, physicians can provide the best possible care to their patients while reducing unnecessary costs to the health care system at the same time. Steven E. Weinberger, MD, FACP, Chief Executive Officer and EVP, American College of Physicians

17 2014 Update: Measuring Costs Track overuse and appropriateness High cost/high utilization to be considered in care management Annually measure or receive quantitative data affecting health care costs

18 2014 Update: Meaningful Use

19 2014 Update: Care Coordination Updates on how to work with specialists Greater specificity in agreements between providers Engage patients, families on self-referrals Coordinate reports with referred specialists

20 2014 Update: Team-Based Care Proactive, planned, efficient patient care Coordinated delivery process Defined policies, protocols and procedures, staff roles and responsibilities Structured communication process

21 2014 Update: Care Coordination Track patient testing, notify patients of normal and abnormal results Track patient referrals to specialists, following up to receive reports Coordinate with hospital (emergency department and inpatient units) to ensure follow up after discharge

22 2014 Update: Care Management Planned preventive or chronic illness visits Individualized patient plan of care Patient medication management Ongoing patient follow up

23 Continuous Improvement Plan, do, study, act, repeat to improve: o Workflows o Clinical performance o Patient experience (CAHPS PCMH survey) o Cost measures

24 PCMH Concept: Patient Self Management Problem solving Skill building Lifestyle modification Patient emotional support Patient referral to community programs and services

25 PCMH Concept: Access to Care Patients seen by their primary care provider whenever possible Flexible scheduling system Same-day appointments Availability of timely clinical advice Continuity of clinical information

26 PCMH Concept: Population Health Maintaining the overall health of all patients in the practice The practice uses patient information, clinical data and evidence based guidelines to identify patients in need of services

27 PCMH Concept: Electronic Systems The electronic health record (EHR) is a tool for systematically documenting patient information The EHR provides the capability of generating reports summarizing patient information E-prescribing, and patient portals are components of the EHR utilized by a PCMH

28 PCMH Concept: Improving Performance A PCMH uses an ongoing quality improvement process and monitors the effectiveness of this process over time Performance data is used to identify opportunities for improvement in clinical quality, efficiency and patient experience A PCMH shares performance data with providers, the practice and the public

29 Process Attend free on board and Standards and Guidelines training offered by NCQA Request application from NCQA Transform practice into a PCMH Submit completed ISS survey tool to NCQA Receive results

30 Staff Role for PCMH A patient advocate Essential members of the PCMH team Sharing ideas to improve patient care Dedicated to working at your highest level of education and ability

31 Summary PCMH is a process, not an event 2014 updates reflect evidence-based trends Standards work to achieve the Triple Aim Practices must show they follow PCMH standards over long periods

32 RuthAnn Craven