7/9/13. PCMH Finally The Power! W H A T. What is PCMH? I S P C M H? THIS MORNING W H A T I S P C M H? Why I LOVE This! It Just Makes Sense

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1 PCM Finally The Power! hy OV This! t Just Makes Sense Presented by: Susan Childs, FACMP voluon ealthcare Consulng Primary and Team Care Based Paent is Responsible Potenal For ncreased ncome And the most obvious: mproving Communicaon is AAYS a +! 2 hat is PCM Key Aspects, Policies And Priories Of PCM Communicaons Of Care ith Your Paents Solid Suggesons That Can Get You Started Resources That Can Give Support To Successful PCM Cerficaon TS MORNNG 3 AAP The American Academy of Pediatrics introduced the medical home concept in 1967 central locaon for archiving a child's medical record xpanded the medical home concept to include these opera'onal characteris/cs: accessible, con/nuous, comprehensive, family centered, coordinated, compassionate, and culturally effec/ve care (AAFP) The American Academy of Family Physicians Medical ome (ACP) American College Of Physicians, advanced medical home 2007 (AOA) SSUD JONT PRNCPS N FB All of the organizaons came together and developed the Joint Principles of the Pa/ent- Centered Medical ome A T S P C M 4 NCQA has developed the naon's most widely adopted medical home standards via: improving care through measurement, transparency, and accountability Major primary care physician groups and the patient centered primary care collaborative believe the most effective way to realign payment incentives to support combination of traditional Fee For Service for office visits within a 3 part payment model. Monthly Performance based factor Care management fee Visit based FFS factor/ allowance. A T S P C M Order free online application (f more than one site, ask about the possibility of a streamlined process) Purchase your license for the SS Survey Tool (electronic) $80 You can download standards etc. from NCQA Submit your online application before you submit the SS survey tool. You will be reviewed and notified within 5 days of linking application to survey tool. TMN 5 6 1

2 After you receive notification, you may submit the Survey Tool when it is complete. Pay for your NCQA Recognition review. 20% Discount offered on full survey to applicants sponsored by health plans employers and other programs. Applies to practices with <15 MD s or sponsors with > 10 in 12 months. Review, scoring and making the recognition decision occurs within 60 days of when fully paid and SS Survey submission. You will receive notification via TMN 7 And Application Fee for Add on Survey No need to purchase another survey tool- the application fee is 50% of the standard applications fees even if paid with discount. COST- (Standard Shown) 8 The orkbook is located in the PPC-PCM Survey Tool and may be used to support 2C, 2D, 3D and 4B. You must purchase a Survey Tool license from NCQA ow to select the patient sample and how to enter in the workbook The Medical Record Review orkbook is an xcel workbook that has two worksheets. One is instructions and the other is where you will enter responses. Selecting the sample for the Medical Record Review Pick date one month prior to date you are prepared to begin chart reviews as your start date. identify the first 36 patients with 1 of the 3 chosen clinically important conditions and had a visit related to the important condition indicated. Represent a mix of the 3 clinically important conditions but you should not select 12 of each one of the clinically important conditions look at frequency...yadayda MDCA RCORD RV ORKBOOK 2013 volu/on ealthcare- Susan Childs FACMP 9 Originally limited to physician- led pracces, (MD, DO) 2010, NCQA - opened the program up to nurse- led prac/ces in states that allow these clinicians to provide the full range of primary care and prac/ce independently. Physician Assistants and Nurse Praconers are also eligible to be listed as part of a recognized prac/ce if they manage their own panel of pa/ents. The clinicians that are iden0fied with the PCM Recognized prac0ce must include all eligible clinicians at the prac0ce site that can be selected by a pa0ent as a personal clinician. O S G B 10 NCQA has had many inquiries from specialty/ subspecialty pracces that may be seen as temporary or subset to the primary care. t can be eligible for PCM recogni/on even if it is not a tradi/onal primary care prac/ce if: The pracce can demonstrate that it provides whole person care and meets the other elements of the joint principles for most of its pa/ents (at least 75%) O S G B 11 The pracce can demonstrate that it provides whole person care and meets the other elements of the joint principles for most of its pa/ents (at least 75%) 2007 JONT PRNCPS Personal physician or clinician nhanced access Physician directed medical prac/ce hole person orienta/on Quality and safety Care is coordinated and integrated Payment O S G B 12 2

3 PCM - Standards PCM - Standards Six Standards ach standard is sub- divided into elements, some of which are must- pass ach element is worth a set number of points, with a maximum of 100 points possible across all elements. Six Standards A prac/ce must score over 50% of the total possible points for each standard Along with achieving the must pass elements, in order to be awarded PCM recogni/on Standard PCM - Standards Max Points 1. nhance Access and Connuity denfy and Manage Paent Populaons Plan and Manage Care Provide Self- Care and Community Support 9 5. Track and Coordinate Care Measure and mprove Performance 20 Max Points = 100 Must pass Must pass Must pass Must pass Must pass Must pass 1A - Access during office hours 4 2D - Use data for popula/on management 5 3C Care management 4 4A - Support self- care process 6 5B - Track referrals and follow up 6 6C mplement Con/nuous Quality mprovement 4 PCM STANDARDS MUST PASS MNTS PCM 2011 Scoring PCM - Standard One Allows a range of capabilies in order to achieve PCM recognion. Recognion evels Required Points Must Pass evel * 6 of 6 elements are required for AC evel level * Score for each Must evel Pass lement must be at least >50% 1. nhance Access and Connuity The prac/ce provides access to culturally and linguis/cally appropriate rou/ne care and urgent team- based care that meets the needs of pa/ents/families. 1A Access During Office ours (MP) 1B Ager ours Access 1C lectronic Access 1D Con/nuity 1 Medical ome Responsibili/es 1F Culturally And inguis/cally Appropriate Services 1G The Prac/ce Team- Organiza/on

4 PCM 1 - Standard One PCM 1 Standard One lement 1.A 1. nhance Access and Connuity xample of submission lement 1.A. Access During Office ours (MP) PCM Standard Two PCM Standard Two PCM2 - denfy and Manage Paent Populaons The prac/ce systema/cally records pa/ent informa/on and uses it for popula/on management to support pa/ent care. 2A Pa/ent nforma/on 2B Clinical Data 2C Comprehensive ealth Assessment 2D Use Data For Popula/on Management (MP) 2. denfy and Manage Paent Populaons lement 2D Use Data For Populaon Management (MP) Pracce uses data and evidence based guidelines to generate and lists and remind paents about needed services volu/on ealthcare- Susan Childs FACMP denfy and Manage Paent Populaons xample of submission PCM Standard Two Pracce uses data and evidence based guidelines to generate and lists and remind paents about needed services PCM3 - Plan and Manage Care The pracce systemacally idenfies individual paents and plans, manages, and coordinates their care based on their condion and needs and on evidence- based guidelines. A. mplement vidence Based Guidelines B. den/fy igh Risk Pa/ents C. Manage Care (MP) D. Manage Medica/ons. lectronic Prescribing lement 2D Use Data For Populaon Management (MP) PCM Standard Three 2013 volu/on ealthcare- Susan Childs FACMP

5 PCM Standard Three Care team performs the following for at least 75% of the patients in elements A and B 1. Conducts pre visit preparations 2. Collaborates with patient to develop care plan including treatment goals 3. Gives patient written care plan 4. Assesses and addresses barriers to treatment goals 5. Gives patient clinical summary at relevant visits 6. dentifies patients who need more care management support 7. Follow up with patients who have not kept important appointments PCM Standard Three Factors Think about it hat could you submit lement 3C Manage Care PCM3 - Plan and Manage Care 1. Conducts pre visit preparations 2. Collaborates with patient to develop care plan including treatment goals 3. Gives patient written care plan 4. Assesses and addresses barriers to treatment goals 5. Gives patient clinical summary at relevant visits 6. dentifies patients who need more care management support 7. Follow up with patients who have not kept important appointments PCM Standard Four PCM4 - Provide Self- Care and Community Support The prac/ce acts to improve pa/ents ability to manage their health by providing a self- care plan, tools, educa/onal resources, and ongoing support. lement A. Support Self Care Process (MP) e.g. 4A Factor 3 is a CF Collaborates with at least 50% of pa'ents to develop and document self management plans and goals Documents: Reports from system or record review workbook og of community resources and checklist to confirm no/fica/on to pa/ents PCM Standard Four 4. Provide Self- Care and Community Support The prac/ce acts to improve pa/ents ability to manage their health by providing a self- care plan, tools, educa/onal resources, and ongoing support. lement B. Referrals to Community Resources Factor One: Prac/ce Supports pa/ents who need access to community resources Documents: 5 community service areas (weight loss, geriatrics - fall preven/on smoking cessa/on, meals, dental).document process PCM Standard Five PCM Standard Five PCM5 - Track and Coordinate Care The prac/ce systema/cally tracks tests and coordinates care across specialty care, facility- based care, and community organiza/ons. A. Test Tracking and Follow Up (10 factors) B. Referral Tracking and Follow Up (MP) (7 factors) C. Coordinate ith Facili/es/Care Transi/ons (8 factors) 5. Track and Coordinate Care Sample Submissions 5B factor 6,7 - Referral tracking / Follow Up tracking log/table or referrals Pa/ent, D.O.S.,.MD, Dx, status, phone log Provides electronic summary of care for more than 50% of referrals (also MU) Reports with numerators and denominators to result in percentages. xamples of screen shots

6 PCM6 - Measure and mprove Performance The prac/ce uses performance data to iden/fy opportuni/es for improvement and acts to improve clinical quality, efficiency, and pa/ent experience. A. Measure of Performance B. Measure Pa/ent/Family xperience Feedback A. mplement Con/nuous Quality mprovement (MP) A. Demonstrate Con/nuous Quality mprovement B. Performance Repor/ng C. Report Data xternally D. Use of Cer/fied R Technology PCM Standard Six 6. Measure and mprove Performance lement 6A Measure of Performance Factors: Prac/ce measures or receives the following data: 1. Three preven/ve care measure 2. Three chronic or acute care measures 3. Two u/liza/on measures affec/ng healthcare costs 4. Vulnerable popula/on PCM Standard Six Measure and mprove Performance lement 6A Measure of Performance Sample Submission demonstrate how you measure and receive data on at least three measures including u/liza/on. Reports on mmuniza/ons already done, where needed, pa/ents iden/fied, more immuniza/on reports three months later,. ipids with Diabe/c pa/ents ospital care management report PCM Standard Six One or more clinicians who prac0ce together and provide pa0ent care at a single geographic loca0on and may include either all eligible specialty clinicians at the site or all eligible clinicians of a single specialty at a single geographic loca0on. NCQA N SPCASTS TOO! PCSP MARC 2013! PCSP SPCASTS TOO! Similar to Primary Three levels Poten/al for increased reimbursement Cer/fica/on for three to five years Cer/fied by prac/ce not provider The Goal is the same- to coordinate care The Targets - Specialists that have good performance hx. But Does NOT require MU or R! Reimbursement Care coordina/on Fee SPCASTS TOO!

7 Q: Does the PCSP program replace PPC recognition A: Yes. f you are eligible for PPC recognition, consider applying for PCSP recognition instead. PPC is being retired on the following timeline: ast day to purchase a PPC Survey Tool: March 31, ast day to submit a PPC Survey Tool: September 30, Q: Are the PCSP standards related to the CMS Meaningful Use standards The PCSP program seeks to align with Meaningful Use criteria for Stage 1 and Stage 2. Stage 2 data collection will not begin until October 2014, with January 1, 2015, as the first date when data may be submitted to CMS. Stage 1 criteria will be used to evaluate the practice until that date. SPCASTS TOO! (FROM NCQA) Q: s there a streamlined documentation process for specialty providers who are on the same MR and in the same medical group as primary care providers who are PCM recognized A: Refer to the PCM-PCSP crosswalk on the Resources page of the application. You may repurpose documentation, but it may be no more than 12 months old. Q: ill there be an NCQA Distinction in Patient xperience Reporting component to the PCSP program, as there is with the PCM survey A: No. There is currently no distinction component to the PCSP program. SPCASTS TOO! FROM NCQA ligible Providers MD and DO Nurse prac//oners Physician assistants Cer/fied nurse midwives Doctoral or master s- level psychologists Doctoral or master s level clinical social workers Doctoral or master s level marriage and family counselors All eligible clinicians in one defined specialty prac/ce All eligible clinicians in mul/ple special/es prac/cing together ospital based and residency clinics SPCASTS TOO! hat Payers ave To Say North Carolina Aetna, UC, Medcost ooking at now Cigna - Collabora/ve Accountable Care program which is for large prac/ces that have greater than 2500 aligned Cigna pa/ents hat Payers ave To Say North Carolina BCBSNC /M s evel 1 140% of 2008 evel 2 155% evel 3 182% /M Procedures - All evels - 120% and orking on Specialist now hat Payers ave To Say CGNA Collabora/ve Accountable Care program which is for large prac/ces that have greater than 2500 aligned Cigna pa/ents. 17 States 28 Pa/ent Centered ni/a/ves BCBSNC Many states with ini/a/ves Aetna Began PCM in NJ and Conn., UC and Coventry aing but. N A T O N A Y

8 7/9/13 Challenges Not nough Primary Care Communicaon Of Care - The Paent s Perspecve Cost - incenves don t always align with what your pracce needs to get there They feel they have help to navigate through a system they do not understand Provider Acceptance Change Adherence MR/Portal Technology is essenal (PC) 2013 volu/on ealthcare- Susan Childs FACMP s ealthcare ocal As paents choose their physician PCM status adds credibility to the level of care they will be receiving. and Just sayin Pa/ent sa/sfac/on standard 6B- Measure pa/ent/family experience 43 Remember PCM Can Also elp 2013 volu/on ealthcare- Susan Childs FACMP Remember PCM Can Also elp A key principle of the medical home is that providers should pracce at the top of their license. More qualified, beser staff ill PCM prac0ces draw healthier pa0ents Resul0ng in beser outcomes qualing higher reimbursement.thus - Finally the POR! 2013 volu/on ealthcare- Susan Childs FACMP 45 Tips - Put To Acon hat do do first BeSer career sa0sfac0on = beser performance Resul0ng in beser outcomes qualing higher reimbursement.thus - Finally the POR! 2013 volu/on ealthcare- Susan Childs FACMP 46 Resources For Successful PCM Cerficaon Your PMS/MR Vendor ASK TM! Q: ow do you support PCM American Academy of Family Physicians (AAFP): Joint Principles of the Pa/ent- Centered Medical ome American Academy of Pediatrics (AAP): ow to Become a Medical ome American College of Physicians (ACP) Understanding and Running a Pa/ent- Centered Medical ome - ACP Medical ome Builder 2.0 Develop a system to gather and report stablish a /meline ook for ways to measure that you are using the best ideas and resources to deliver. hrps:// Consultants ( know) Medical Society DS - Agency For ealthcare Research and Quality Resource Center: hrp:// pcmh home/1483 Don t be afraid to change! Go for it! Update and Submit!!! 2013 volu/on ealthcare- Susan Childs FACMP volu/on ealthcare- Susan Childs FACMP

9 Thank You! Quesons Susan Childs, FACMP