Patient-Centered Connected Care TM Recognition

Transcription

1 Patient-Centered Connected Care TM Recognition July 2015

2 Introduction to Patient-Centered Connected Care TM Recognition One Day In-Person Seminar Date: December 16, 2015 Location: Washington, DC

3 Celebrating 25 Years of Quality! Quality Talks 11/9/15 PCMH 2014

4 NCQA Provider-Based Quality Programs Improve healthcare quality through transparency, measurement and accountability. Accountable Care Organization Accreditation Diabetes Recognition Program Heart/Stroke Recognition Program Patient-Centered Medical Home Recognition Patient-Centered Specialty Practice Recognition Patient-Centered Connected Care TM Recognition PCMH 2014

5 Programs For Providers PCMH Recognition Patient-Centered Specialty Practice Recognition Patient-Centered Connected Care Recognition Diabetes Recognition Heart/Stroke Recognition For Payers/ Delegated Entities Health Plan Accreditation HEDIS Measurement Quality Improvement tools Other accreditation programs (case management, disease management, etc.) For Government Quality measurement Recognition programs to evaluate practices Accreditation programs for health plans

6 Delivery System Changes PCP SPECIALIST/ SUBSPECIALIST PHARMACY PATIENT CAREGIVER/ FAMILY HOSPITAL OTHER CARE SITE

7 PCMH Recognition Program Principles were developed, but interpretation of what they meant was loose and inconsistent. Direction was needed. NCQA worked with clinicians and associations to develop an evaluation program with sets of standards and processes that put structure around what the medical home model should be. This led to the NCQA PCMH Recognition Program, which evaluates whether a site follows these best practices and standards.

8 Industry trends in PCMH Triple Aim: Improve cost, quality, patient experience Population health management Integrated care: How can fragmentation be reduced? Care transitions and self-care support Movement toward a value-based model PCMH 2014

9 PCMH Standards 1) Enhance Access and Continuity (10) A) *Patient-Centered Appointment Access B) 24/7 Access to Clinical Advice C) Electronic Access 2) Team-Based Care (12) A) Continuity B) Medical Home Responsibilities C) Culturally and Linguistically Appropriate Services D) *The Practice Team 3) Identify and Manage Patient Populations (20) A) Patient Information B) Clinical Data C) Comprehensive Health Assessment D) *Use Data for Population Management E) Implement Evidence-Based Decision Support 4) Plan and Manage Care (20) A) Identify Patients for Care Management B) *Care Planning and Self-Care Support C) Medication Management D) Use Electronic Prescribing E) Support Self-Care and Shared Decision Making 5) Track and Coordinate Care (18) A) Test Tracking and Follow-Up B) *Referral Tracking and Follow-Up C) Coordinate Care Transitions 6) Performance Measurement and Quality Improvement (20) A) Measure Clinical Quality Performance B) Measure Resource Use and Care Coordination C) Measure Patient/Family Experience D) *Implement Continuous Quality Improvement E) Demonstrate Continuous Quality Improvement F) Report Performance G) Use Certified EHR Technology *Indicates Must Pass Element PCMH 2014

10 System-Wide Needs Moving the needle requires a shared commitment For example: Average Medicare beneficiary: Sees 7 physicians per year. Fills 20+ prescriptions per year. Has an average of 2 referrals per year. Integration of care is vital for whole-person care Foy, R., Hempel, S., Rubenstein, L., Suttorp, M., Seelig, M., Shanman, R., Shekelle, P.G. (2010). Meta-analysis: effect of interactive communication between collaborating primary care physicians and specialists. Annals of Internal Medicine, 152 (4),

11 Building From the Patient Centered Medical Home Effective collaborative arrangements may result in significant return on investment 1 Communicating information for shared patient populations results in better care 2 Most states and many payers are leveraging the patient-centered medical home (PCMH) model to improve integration 3 Patients may visit sites other than a primary care office for convenience, because they are seeking care after their primary care physician s office hours because they do not have a primary care provider 4 1 Foy, R., Hempel, S., Rubenstein, L., Suttorp, M., Seelig, M., Shanman, R., Shekelle, P.G. (2010). Metaanalysis: effect of interactive communication between collaborating primary care physicians and specialists. Annals of Internal Medicine, 152 (4), Shih, A., Davis, K., Schoenbaum, S., Hauthier, A., Nuzum, R., McCarthy, D. (2008) Organizing the U.S. health care delivery system for high 3 Nielsen, M., Gibson, L., Buelt, L., Grundy, P., & Grumbach, K. (2015). The patient-centered medical home s impact on cost and quality, reviewof evidence, Tu, H., Cohen, G. (2008). Checking up on retail-based health clinics: Is the Boom Ending? Retrieved April 6, 2015 from

12 Atul Gawande on Fragmented Care... pieces of [care] don t fit together because we haven t turned [care] into a system, a team of capabilities, of people with their capabilities. - Atul Gawande at NCQA 2012 Health Quality Awards

13 NCQA Medical Home Neighborhood Programs Patient-Centered Medical Home Recognition is the foundation of effective healthcare delivery emphasizing whole person care Patient-Centered Specialty Practice Recognition emphasizes care coordination Accountable Care Organization Accreditation is based on PCMHs, but PCSPs and Patient-Centered Connected Care sites are also key components of a network or payment strategy Patient-Centered Connected Care Recognition emphasizes communication and connectivity

14 Eligibility

15 Scoring & Recognition Structure PCMH & PCSP 3 YR Recognition 3 Recognition Levels Report patient data at individual clinician and site level Patient-Centered Connected Care TM 3 YR Recognition 1 Recognition Level Report patient data at the site level only

16 Patient-Centered Connected Care: Standards Overview Standard 1 Connecting With Primary Care: The site connects with and shares information with patients primary care practitioners. Element A: Connecting Patients With Primary Care (Must-Pass) Element B: Sharing Information With Primary Care Element C: Demonstrating Information Sharing (Must-Pass) Element D: Working With Primary Care Element E: Coordination With Primary Care 9.00 points 7.50 points 4.50 points 4.50 points 4.50 points

17 Patient-Centered Connected Care: Standards Overview Standard 2 Identifying Patient Needs: The site triages patients to appropriate providers, when necessary.

18 Patient-Centered Connected Care: Standards Overview Standard 3 Patient Care and Support: The site uses evidencebased decision support in care delivery, patient collaboration, and culturally and linguistically appropriate services.

19 Patient-Centered Connected Care: Standards Overview Standard 4 System Capabilities: The site uses electronic systems to collect data and execute specific tasks.

20 Patient-Centered Connected Care: Standards Overview Standard 5 Measure and Improve Performance: The site performs quality improvement activities designed to measure performance

21 Clinical Program Goals Better outcomes. Create healthier patients by working within the medical home neighborhood model of care, which has been shown to reduce healthcare costs and result in better outcomes for patients Happier patients. Provide a better patient experience by connecting patients to the right resources, at the right time Improved operations. Enhance current processes and procedures by evaluating them against best practices and striving for continuous improvement

22 Additional Benefits Demonstrate value. Public and private payers are looking for cost containment and quality improvement activities that reduce fragmentation to be used in value-based benefit design. Increase referrals. Demonstrate to PCP practices that you are ready to be effective partners in caring for shared patients Market to patients. Leverage NCQA seal and validation to demonstrate to patients you are a trusted source for their care (benefits for marketing your business) Elevate your reputation. You ll gain national exposure as a firstmover into an unchartered program devised by a leader in development of nationally endorsed quality programs

23 Patient-Centered Connected Care First-Movers Affinity Health Group, LLC dba Affinity Health Management Center Alcester Chiropractic Arkfeld Advanced Chiropractic, LLC Brookings Chiropractic Center CVFP Immediate Care Division Children s Hospital of Wisconsin Cigna Corporation CityMD Coram-Selden Chiropractic CoxHealth Dr. Roger D. Prill Jr & Dr. Craig A. Pickart Dr. Elizabeth C. McMunn, OD First Chiropractic Center (FCC) Fogel Chiropractic Clinics Foot and Ankle Specialists of the Mid-Atlantic Forest Hill Rehabilitation Center Greater Lawrence Family Health Center SBHCs Immediate Care of Southern New Hampshire Indiana Army National Guard InterMed, P.A. Konstant Chiropractic Clinic Madison Chiropractic Center, PC MEDCare Urgent Care Mitchell Chiropractic & Acupuncture Center, PC Northeast GA Physician Group; PM Pediatrics Prevea Health Sandia National Laboratories Health, Benefits & Employee Services Summit Orthopedic Home Care Urban Health Plan SBHC Watson Clinic WellSpan Medical Group Whittier Street Health Center Yalich Clinic

24 Thank You Questions? Call