Joint Commission Designation for Your Primary Care Medical Home

Transcription

1 Joint Commission Designation for Your Primary Care Medical Home Webinar - June 21, 2011 Presented by: Joyce Webb Project Co-Lead, Primary Care Medical Home Initiative Project Director, Standards and Survey Methods Lon M. Berkeley Project Co-Lead, Primary Care Medical Home Initiative Project Director, Community Health Center Accreditation 1

2 Agenda Why is The Joint Commission adding this new Primary Care Medical Home option? Features of the Primary Care Medical Home option Understand the new Primary Care Medical Home requirements The on-site survey process The accreditation process for Primary Care Medical Home Questions? 2

3 Background: Joint Commission Vision & Mission Statements Vision: All people always experience the safest, highest quality, best-value health care across all settings. Mission: To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. 3

4 Background: Joint Commission Overview General customer base Accredits or certifies over 19,000 total organizations (hospitals/critical access hospitals, labs, behavioral health, home care/dme, long term care, ambulatory care/office-based surgery) Accrediting Ambulatory Care since 1975: Wide variety of ambulatory settings Medical/Dental settings, including: Federally Qualified Health Centers Medical Group Practices Ambulatory Care program now accredits over 1,900 organizations with 6,400 sites of care 4

5 Purpose: Commitment to Improving Safety and Quality of Care With 50+ years of experience, The Joint Commission addresses the most serious patient safety and quality issues in health care Seek input from national experts and the field to ensure stateof-the-art standards and accreditation process Accreditation = commitment Expect continuous compliance with standards On-site survey, every 3 years and conduct annual selfassessment during interim Accreditation = partnership Independent, outside evaluation Surveyor shares best practices and experience 5

6 Why The Joint Commission is Involved Response to new model of primary care delivery being tested nationally Opportunity for added reimbursement to provide: better access to care; new care coordination; monitoring patient outcomes; greater patient engagement; expanded use of HIT; more team-based care; pro-active approaches Part of health care reform quality & cost-reduction options Request from accredited ambulatory care organizations to have The Joint Commission qualify them and have the benefit of a 2-for-1 on-site survey. 6

7 Joint Commission Ambulatory Care Accreditation Plus Primary Care Medical Home Option PCMH Option Ambulatory Care Accreditation Increasing Patient-Centeredness, Comprehensiveness, Access, Coordination 7

8 Primary Care Medical Home Timetable 2010: Development of Joint Commission PCMH model, draft standards/eps (Expert Panel/PTAC) Early 2011: Field review, survey process pilot testing, and further input from stakeholders, private/public payers, revisions Late Spring 2011: Release of new requirements via website July, 2011: Implementation for Ambulatory Care accredited customers Spring Fall, 2011: Work with public/private payers in demonstration pilots around reimbursement issues 8

9 Joint Commission Primary Care Medical Home Option Overlap with Ambulatory Care Accreditation Copyright, The Joint Commission Composition of Requirements for Primary Care Medical Home Option 30% New PCMH Requirements added to accreditation standards 70% Ambulatory Care Accreditation Standards that also serve as PCMH requirements 9

10 Features of Primary Care Medical Home Applies to an accredited ambulatory care organization (or seeking accreditation) On-site survey process to evaluate compliance with both existing ambulatory care and requirements No special application requirements Organization-wide designation for up to 3 years Primary Care Medical Home designation publicly available on Quality Check (in 2012) Included as part of HRSA/Bureau of Primary Health Care contract 10

11 QUESTION BREAK 11

12 Primary Care Medical Home Requirements Operational Characteristics 1. Patient-Centeredness 2. Comprehensive Care 3. Coordinated Care 4. Superb Access to Care 5. System-Based Approach to Quality and Safety 12

13 Characteristic #1: Patient-Centeredness Orientation toward the whole person Partnership with patients and their families Understanding and respecting each patient s unique needs, culture, values, and preferences Active support for patient self-management Patients and families as core members of the care team 13

14 What New PCMH Patient-Centeredness Requirements Address Patient-selected primary care clinician (can be an MD/DO, NP, or PA) Providing information on: Mission, vision, and goals, scope of care and types of services Selection of a primary care clinician Patient involvement in care Process for obtaining and tracking referrals Collaboration with other clinicians How to access the primary care medical home for care or information, or seek specialty care 14

15 What New PCMH Patient-Centeredness Requirements Address cont d Patient involvement in the treatment plan Working in partnership with the patient to achieve planned outcomes Consideration of patient's communication, language, and cultural needs and preferences Assessment of health literacy Support for self-management Involvement in performance improvement 15

16 Characteristic #2: Comprehensive Care Addresses both physical and mental health care needs Prevention and wellness, acute care, chronic care, and end-of-life care Interdisciplinary team - may include MD/DOs, NPs, PAs, pharmacists, nutritionists, mental health workers, social workers, and care coordinators 16

17 What New PCMH Comprehensive Care Requirements Address The roles and responsibilities of the primary care clinician and the interdisciplinary team Providing or facilitating patient access to: Acute care Management of chronic care Preventive services that are age and gender-specific Behavioral health needs Oral health care Urgent and emergent care Substance abuse treatment 17

18 What New PCMH Comprehensive Care Requirements Address cont d Addressing various phases of a patient s lifespan, including end-of-life care Disease and chronic care management services Assessment for health risk behaviors Designated group (or panel) of patients 18

19 Characteristic #3: Coordinated Care Across the health care system, including specialty care, hospitals, home health care, and community services Transitions between sites of care, such as upon discharge from the hospital Clear and open communication among patients and families, the medical home, and other clinicians 19

20 What New PCMH Coordinated Care Requirements Address Providing comprehensive and coordinated care, and maintaining continuity of care Referral tracking and follow-up Population-based care Use of health information technology to: Document and track care Support disease management, preventive care Create reports Facilitate information exchange Support performance improvement Tracking patient care and progress towards treatment goals 20

21 Characteristic #4: Superb Access to Care Accessible health care services Shorter waiting times for urgent needs Enhanced in-person hours Around-the-clock telephone or electronic access Alternative methods of communication such as and patient portal Responsiveness to patient preferences regarding access 21

22 What New PCMH Superb Access to Care Requirements Address 24 hours a day, 7 days a week access to: Appointment availability/scheduling Requests for prescription renewal Test results Clinical advice for urgent health needs Note: Methods include: telephone, use of flexible hours, and computer websites Flexible scheduling to accommodate patient care needs. Note: Methods include: open scheduling, same day appointments, expanded hours, and arrangements with other organizations Addressing patient s urgent care needs 24/7 22

23 Characteristic #5: Systems-Based Approach to Quality and Safety Commitment to performance measurement and quality improvement Use of evidence-based medicine and clinical decision-support tools Measuring and responding to patient experiences and patient satisfaction 23

24 What New PCMH Systems-Based Approach to Quality and Safety Requirements Address Copyright, The Joint Commission Use of an electronic prescribing process Use of clinical decision support tools to guide decision making The collection of data on: Disease management outcomes Patient perceptions of access to care Patient experience and satisfaction Patient perception of the comprehensiveness, coordination, and continuity of care Use of collected data to improve performance 24

25 Access the Requirements View Primary Care Medical Home requirements on the Joint Commission website or use the links below. Review New PCMH Requirements Prepublication Version Review New PCMH Requirements 5 Operational Characteristics Version Register for Trial Version of E-dition (Free 60-day access to electronic version of Ambulatory Care Standards) 25

26 The On-Site Survey Process On-site survey No change to current survey sessions Trace patient experience (patient tracers) Conduct patient interviews re: Selection of primary care clinician Information rec d about how to access the org to meet their care needs Consideration of language, cultural needs and preferences Discussions with organization leaders and staff Scope of services available- acute, chronic, behavioral health? Infrastructure-clinical decision support tools, use of HIT, e-prescribing, referral tracking Determining the composition of interdisciplinary teams 26

27 The On-Site Survey Process cont d Clinical Record review Patient self-management goals Follow-up on care recommendations, test results HR file review Primary care clinician qualified for the role, working within scope of practice, and in accordance with law & regulation Review of performance improvement data Patient perception of access and care coordination 27

28 QUESTION BREAK 28

29 The Accreditation Process for PCMH: After the Survey Follow-up to findings ( Requirements for Improvement ): Evidence of Standards Compliance for both PCMH and other ambulatory care standards Acceptance of Evidence of Standards Compliance: Special Designation Letter Posting on Quality Check (2012) 3 year Accreditation and Designation period Periodical Performance Review Annual self-assessment of PCMH and ambulatory care standards 29

30 The Accreditation Process for PCMH: Application Application Process Part of web-based extranet platform e-application First time survey: YOU designate ready date Re-survey: part of unannounced triennial survey Extension survey: 4-6 months after notification Earlier triennial survey To Access the Application: If you are currently accredited under the Ambulatory Health Care Accreditation program, please contact: Rex Zordan, , If you are NOT accredited under the Ambulatory Health Care Accreditation program, please contact Isa Rodriguez, , 30

31 The Accreditation Process for PCMH: Joint Commission Fees Fees for First-time and Full Resurveys On-site survey fee: Only higher if number of surveyor days increases Annual fee: No additional costs projected for 11 or 12 Fees for Extension Surveys On-site survey fee: $4,130 for one day ($1,965/day if more days needed) Annual fee: No additional costs projected for 11 or 12 Note: For federal Bureau of Primary Health Care-supported Health Centers any fees will be paid as part of Joint Commission contract. 31

32 The Accreditation Process for PCMH: Estimated time if: Preparation Time Joint Commission accredited with existing Medical Home recognition: 1 6 months Joint Commission accredited without existing Medical Home recognition: 6 9 months Not yet Joint Commission accredited but have Medical Home recognition: 6-12 months Not yet Joint Commission accredited and no Medical Home recognition: 6-15 months 32

33 The Accreditation Process for PCMH: Resources Business Development Team Account Executives Your personal point-of-contact Contact live via phone or Manage application & post-survey steps Standards Interpretation Group Live phone or on-line access 33

34 The Accreditation Process for PCMH: Resources cont d Joint Commission Primary Care Medical Home Website PCMH requirements Register for trial version of E-dition (Free 60-day access to electronic version of Ambulatory Care Standards) Request application News, articles and links to other resources! 34

35 The Accreditation Process for PCMH: Accreditation Support Resources Joint Commission Connect TM (Extranet) Perspectives - Joint Commission s official monthly e-periodical Survey Activity Guide Resources cont d Joint Commission Resources (JCR) Ambulatory Care standards available in print and electronic formats Ambulatory Care 10/3/11 Pre-Conference Session "The Joint Commission Primary Care Medical Home" Review the JCR Education Programs 35

36 The Accreditation Process for PCMH: Contact Us! If you are currently accredited under the Ambulatory Health Care Accreditation program, please contact: Rex Zordan, , If you are NOT accredited under the Ambulatory Health Care Accreditation program, please contact : Isa Rodriguez, , irodriguez@jointcommission.org Other questions? Please contact : Lon Berkeley, , lberkeley@jointcommission.org 36

37 Questions? 37