Patient Centered Medical Home 2017 Redesign

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2 Patient Centered Medical Home 2017 Redesign

3 Patient-Centered Medical Home Objectives for today: 2017 Redesign Why the redesign? Discussion of the 2017 Redesign Understand core criteria and menu criteria Common best-practices to achieve these factors Strategy for your site(s)

4 PCMH: A Change in Thinking & Definitions Patient Lone physician Ultimate authority Acute, episodic Care Disparities in care Healthcare partner Team based healthcare Shared decision making Planned & proactive whole person care Evidence-based care Terms from NCQA

5 Patient-Centered Medical Home:

6 Purdue Research Foundation

7 Purdue Research Foundation

8 Triple Aim

9 Purdue Research Foundation

10 Purdue Research Foundation

11 Evolution of PCMH Standards 2011 Standards Relationships with specialists Identify cultural and linguistic needs Eval patient experience 2014 Standards More behavioral health More team-based care Management of high need populations

12 2017 Redesign Annual reporting requirements More social determinants More community resources More behavioral health needs Focus on outcomes

13 Why a Redesign? Too much documentation Annual check-ins and reporting and not 3 year cycle More time to concentrate on care and not on collecting data More interaction with NCQA Too challenging for small offices Less emphasis on process and more on performance ISS Tool complicated

14 A living model of care and not a static project Get feedback continuously through process Gradual submission process Demonstrate what the process is instead of screenshots, etc.

15 2017 Steps towards becoming a PCMH

16 Commit Assessment, eligible, work with NCQA to develop a schedule what do you want to work on first Transform Begin to make necessary changes, begin submitting documentation and virtual check-ins with NCQA evaluator Succeed Submit on annual basis to NCQA so they know you re still on track

17 PCMH Eligibility Per site level One recognition per address List of providers at each site A provider can be listed at multiple sites MDs, DOs, PAs, NPs, and APRNs with their own or shared panel

18 Structure of PCMH Concepts Competencies Criteria

19 Purdue Research Foundation

20 Purdue Research Foundation

21 Elective Criteria 39 Criteria = 1 point credit 20 Criteria = 2 credits 1Criterion = 3 credits

22 Scoring All Core Criteria 25 Points of Elective Criteria At least 5 of the 6 Concepts No separate levels of recognition!

23 Structure of PCMH Concepts 6 Concepts Team-Based Care and Practice Organization Knowing and Managing Your Patients Patient-Centered Access and Continuity Care Management and Support Care Coordination and Care Transitions Performance Measurement and Quality Improvement

24 Concept: Team-Based Care & Practice Organization Competency A: The practice is committed to transforming the practice into a sustainable medical home. Members of the care team serve specific roles as defined by the practice s organizational structure and are equipped with the knowledge and training necessary to perform those functions. Core Criteria TC1: Designates a clinical lead of the medical home and a staff person to manage the PCMH transformation and medical home activities TC2: Defines practice organizational structure and staff responsibilities/skills to support key PCMH functions Elective Criteria TC3 (1 credit): The practice is involved in external PCMH-oriented collaborative activities(e.g., federal/state initiatives, health information exchanges) TC4 (2 credits): Patients/families/caregivers are involved in the practice s governance structure or on stakeholder committees TC5 (2 credits): The practice uses an EHR system that has been ONC Certified, conducts a security risk analysis, and implements security updates as necessary correcting identified security deficiencies

25 Concept: Patient-Centered Access and Continuity Competency B: Practices support continuity through empanelment and systematic access to the patient s medical record. Core Criteria (Required) AC10: Helps patient/families/caregiversselect or change a personal clinician AC11: Sets goalsand monitors the percentage of patient visits with selected clinician or team Elective Criteria AC12 (2 credits): Provides continuity of medical record information for care and advice when the office is closed AC13 (1 credit): Reviews and actively manages panel sizes AC14 (1 credit): Reviews and reconciles panel based on health plan or other outside patient assignments

26 How to Become 2017 Recognized

27 Changing Your Current Level to 2017 PCMH 2011 Levels 1, 2, or 3 or PCMH 2014 Levels 1 and 2 Transform to 2017 Some factors will count as criteria Begin 6 months prior to expiration Purchase Q-PASS to begin PCMH 2014 Level 3 Automatically begin annual reviews Purchase Q-PASS to begin

28 Accelerated Process to Transition

29 Did Anyone Here Purchase an Add-On Survey Prior to March 31, 2017?

30 Current Level 1 Options

31 Current Level 2 Options

32 Current Level 3 Options

33 Why Become PCMH Recognized? Benefits shown by pilot programs across the country Improved access to care Lower costs Aligns with the Triple Aim Transitions from physician care supported by clinical staff to patient-centered care directed by the physician Cross training nurses and assistants for other roles Frees physician to focus on more research Transition from episodic care to preventive care

34 PCMH Redesign & MACRA Tailor criteria to your population s needs Supports outcomes Criteria drives improvement Was the intent met or was it improved? Friendly for all size practices

35 PCMH Redesign & MACRA

36 What s Next? Download latest Standards/Guidelines from NCQA Free NCQA.org 2017 Redesign released April 3, 2017 Typically updated quarterly If already a PCMH, plan on your transformation to 2017 Plan on 6 months prior to your expiration Purchase the Q-PASS tool

37 Questions?

38 Contact us: Jennifer Anglin MS, CHES, NCQA PCMH Certified Content Expert Managing Advisor Meaningful Use, PCMH, Healthy Hearts in the Heartland, MACRA Purdue Healthcare Advisors (574) (phone) (765) (fax) Visit us Purdue Healthcare Advisors