Part 1: NCQA PCMH 2014 Standards

Transcription

1 Part 1: NCQA PCMH 2014 Standards Heather Russo, CCE PCMH Consultant September 15, 2015 Advancing Healthcare Improving Health

2 Objectives Examine the requirements for NCQA PCMH 2014 Standards Review project management tools which support preparation for obtaining recognition List three things you can do NOW to prepare Take away at least four must-have resources 2 2

3 Agenda Big Picture, Change Management Overview of Changes and Project Management Tools Preview NCQA PCMH 2014 Standards (lunch break) Table Work, Action Planning Share and Wrap-Up 3

4 Be thinking about Identify the TOP THREE areas of concern for you today What is one action step you can do NOW for each item? Who will do each of those action steps? By when? What do you need to take back and share with your teams? How will this communication take place? 4

5 Big Picture, Change Management 5

6 We ve come this far keep changing? Complying with regulations and guidelines Meeting patient needs, patient-centeredness Taking advantage of new technology PCMHs improve quality, patient experience, continuity, prevention and disease management nt%20letters/the_future_of_pcmh.pdf Recognition and payment tools: ome.org/pcmh-roi-calculator.xls 6

7 Three Elements of Change People: acknowledge and buy into the need for change Processes: process maps, polices and procedures, and business rules that describe how work gets done (evolve over time) Technology: ensures greater organizational efficiency in implementing the changes 7

8 5 Desired Future State Reinforce. Diagnose problems, manage resistance and celebrate successes. 4 Test, Implement What processes will change? What technology will change? Who has accountability? 1 Current State 2 3 Engage Envision the Future Communicate the need for the change and who the change will effect. Get buy in. What are the material differences between where we are now, and where we are going? 8

9 Change Concepts for Practice Transformation Wagner EH, Coleman K, Reid RJ, Phillips K, Abrams MK, Sugarman JR. The Changes Involved in Patient-Centered Medical Home Transformation. Primary Care: Clinics in Office Practice. 2012; 39:

10 What are your burning questions? (Survey Monkey responses, summarized) What are the major differences between the 2014 and 2011 NCQA PCMH standards? Would like a deeper understanding of the 2014 standards and processes for renewal. 10

11 Where do we go from here? 85% of survey respondents have submitted and obtained NCQA PCMH 2011 Recognition 85% want to renew from 2011 to 2014 Stepping it up! 11

12 For today s content Basic understanding of 2011 NCQA PCMH Standards How do we build upon what we have already done? 12

13 Moving from managing to leading, inspiring others How to organize time to meet goals How to motivate people who already give over 100% Inquiring Minds Want to Know Communication & conflict resolution skills How does a high performing team work? 13

14 We Won t Cover Every Issue Today Circle of Concerns Circle of Focus for Today NCQA PCMH 2014 Standards Overview of program Highlight now to renew, make progress 14 14

15 Your Questions Matter 15

16 Overview of Changes in Program Preview Project Management Tools 16

17 NCQA Considerations Safe guard your account; you ll use it again for renewal (every 3 years) Put NCQA renewal on the organizational calendar Recognition lasts 3 years NCQA will send you an 6 months prior to expiration, reminding you of the expiration DO NOT let your recognition expire! Must re-submit BEFORE your expiration date, plan accordingly 17

18 NCQA PCMH Renewals Renewal: submitting NCQA PCMH survey to renew PCMH Recognition status to 2014 Standards Renewals require a limited set of documentation to be provided (streamlined) Submit new documentation for the 11 Elements only; attest to the others New, 3-year recognition period Must demonstrate work/reports over time (3D, 6A, 6B, 6C) For Multi-Site, begin a new, full multi-site process with a corporate tool (How do you merge the recognition cycle when you've got one site recognized initially and will now attempt to add the remaining sites?) If you miss your expiration date to Renew your PCMH Recognition Status, you will have to complete a brand new FULL survey. 18

19 Eligibility Result of Successful Submission Full Survey Add-On Renewal Have Never Submitted for Recognition Denied 2011 Recognition Expired Recognition Level 1 Recognition About to Expire 2014 Recognition Level 1 or Level 2 Recognition (either 2011 or 2014) Denied 2014 Recognition Streamlined Renewal (Renewal) Level 2 or Level 3 Level 1 Recognition Recognition (either under (either under 2011 or 2014) 2011 or 2014) Conversion (new) Level Recognition 2011 Recognition at higher Level than previous 2011 Recognition 2014 Recognition 2014 Recognition 2014 Recognition 2014 Recognition at higher level than previous 2014 Recognition Extends Recognition Period? No, provides an initial one No Yes Yes No Documentation Full Documentation Requirements Required Timeframe Requirements Pricing Allow 1-week for online application to be approved and 3-months for submission to be reviewed prior to Recognition award Recognition lasts 3- years Full Price Only documentation on factors for which you seek to receive a better score (do not rely on previously submitted documents) Level 1 or Level 2 Recognized Practices may submit anytime after Recognition up until 3- months from expiration Denied 2014 Practices must submit within 12- months of denial 50% of initial recognition Do not need to purchase ISS tool Full Documentation Required Must submit 3-months prior to expiration date Full Price Documentation required for 11 Elements (Attestation for 16) as specified by NCQA Must provide documentation showing annual activity for 4 Elements Must submit 3-months prior to expiration date Full Price Documentation required for 6 Elements (Attestation for 21) as specified by NCQA Must submit 1-year prior to expiration date 50% of initial recognition Purchase ISS tool for each site 19

20 NCQA s Prevalidation Program NCQA identifies HIT systems that have functionality to help meet the PCMH requirements Helps you to: Save time preparing documentation Maintain recognition List of products here: Check version numbers and check with your vendor rep! 20

21 2014 NCQA PCMH Standards Standard 1: Patient-Centered Access Standard 2: Team-Based Care Standard 3: Population Health Management Standard 4: Care Management and Support Standard 5: Care Coordination and Care Transitions Standard 6: Performance Measurement and Quality Improvement 21

22 NCQA PCMH Standards Crosswalk 22

23 Levels of Recognition (Same as 2011) 6 Standards = 100 Points 6 Must Pass Elements Must Pass Elements require a score of 50% to pass Practices with a numeric score of 0-34 points and/or achievement of less than 6 Must Pass Elements will not achieve recognition. 23

24 Primary High-Level Changes Enhanced emphasis on team-based care Focus on care management for high-need patients Quality Improvement bar has been raised (aligns with Triple Aim) Alignment with Stage 2 MU Further integration of behavioral health 24

25 NCQA PCMH 2014 Resources for this Workshop NCQA PCMH 2014 Renewal Planning Tool (printed and available electronically) NCQA PCMH 2014 Self-Assessment Tool (available electronically) NCQA PCMH 2014 Standards and Guidelines, including all appendices (Download and print!) 25

26 Standard Name, Points and Intent Element Name, Points, Description of Performance Expectation Anatomy of a Standard Factors Scoring Description Additional Information on what NCQA is looking for Documentation Examples 26

27 Usually updated in March, July, November each year ISS Tool will notify you Re-download Standards Most recent update, July

28 28

29 29

30 30

31 31

32 32

33 33

34 34

35 How will we know what our potential renewal score will be for each Element? 35

36 NCQA PCMH 2014 Self-Assessment Tool 36

37 37

38 Single Site Streamlined Renewal Standard/Element PCMH 1: Patient-Centered Access Element A: Patient Centered Appointment Access Element B: 24/7 Access to Clinical Advice Element C: Electronic Access PCMH 2: Team-Based Care Element A: Continuity Element B: Medical Home Responsibilities Element C: Culturally and Linguistically Appropriate Services (CLAS) Element D: The Practice Team PCMH 3: Population Health Management Element A: Patient Information Element B: Clinical Data Element C: Comprehensive Health Assessment Element D: Use Data for Population Management Element E: Implement Evidence-Based Decision Support key BOLD + RED = Documentation Required on Must Pass Element BOLD = Documentation Required Standard/Element PCMH 4: Care Management and Support Element A: Identify Patients for Care Management Element B: Care Planning and Self-Care Support Element C: Medication Management Element D: Use Electronic Prescribing Element E: Support Self-Care and Shared Decision Making PCMH 5: Care Coordination and Care Transitions Element A: Test Tracking and Follow-Up Element B: Referral Tracking and Follow-Up Element C: Coordinate Care Transitions PCMH 6: Performance Measurement and Quality Improvement Element A: Measure Clinical Quality Performance Element B: Measure Resource Use and Care Coordination Element C: Measure Patient/Family Experience Element D: Implement Continuous Quality Improvement Element E: Demonstrate Continuous Quality Improvement Element F: Report Performance Element G: Use Certified EHR Technology 38

39 Multi-Site Streamlined Renewal Standard/Element PCMH 1: Patient-Centered Access Element A: Patient Centered Appointment Access Element B: 24/7 Access to Clinical Advice Element C: Electronic Access PCMH 2: Team-Based Care Element A: Continuity Element B: Medical Home Responsibilities Element C: Culturally and Linguistically Appropriate Services (CLAS) Element D: The Practice Team PCMH 3: Population Health Management Element A: Patient Information Element B: Clinical Data Element C: Comprehensive Health Assessment **Element D: Use Data for Population Management Element E: Implement Evidence-Based Decision Support key Standard/Element PCMH 4: Care Management and Support Element A: Identify Patients for Care Management Element B: Care Planning and Self-Care Support Element C: Medication Management Element D: Use Electronic Prescribing Element E: Support Self-Care and Shared Decision Making PCMH 5: Care Coordination and Care Transitions Element A: Test Tracking and Follow-Up **Element B: Referral Tracking and Follow-Up Element C: Coordinate Care Transitions PCMH 6: Performance Measurement and Quality Improvement Element A: Measure Clinical Quality Performance **Element B: Measure Resource Use and Care Coordination Element C: Measure Patient/Family Experience Element D: Implement Continuous Quality Improvement Element E: Demonstrate Continuous Quality Improvement Not Bold = Site Attestation BOLD = Site Documentation Element F: Report Performance Not Bold = Corporate Eligible Elements that Require Attestation Element G: Use Certified EHR Technology BOLD = Corporate Eligible Elements that Require Documentation BOLD + Red = Documentation Required on Must Pass Element ** = Corporate Elements that Require Documentation 39

40 Questions Heather Russo, CCE PCMH Consultant x2059 For more information: 40