QUALITY IMPROVEMENT ROUNDTABLE 2014 NCQA PCMH STANDARDS TRAINING FOLLOW UP SEPTEMBER 29, 2015 OLYMPIA, WA Advancing Healthcare Improving Health
HOUSEKEEPING
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WELCOME & INTRODUCTION Community Health Assoc. of Spokane Family Health Centers N.E.W. Health Programs Interfaith Community Health Center Public Health King County WELCOME Yakima Valley Farm Worker s Clinic Moses Lake Community Health Center Columbia Valley Community Health Peninsula Community Health Services International Community Health Services Cowlitz Family Health Center Lake Roosevelt Community Health Services Community Health Care HealthPoint
WEBINAR Your Webinar TEAMTeam Moderators Technical Assistant Ashley Grant, MPH Practice Transformation Coordinator, WACMHC Heidi Tittle, MPH Practice Transformation Coordinator, WACMHC Adriana Avelar WHIN Project Coordinator
Agenda Welcome Introduce Heather Russo, PCMH CCE Presentation with Qualis Health Discussion & Questions Evaluation
GUEST SPEAKER HEATHER RUSSO, PCMH CCE Qualis Health PCMH practice coach and NCQA PCMH Certified Content Expert (CCE). Utilizes an operational approach and experience to overcoming the challenges of transformation while keeping the focus on the patient. Experience and expertise in utilizing and optimizing health information technology.
NCQA PCMH 2014 Standards Training and Workshop Follow-Up Heather Russo, CCE PCMH Consultant September 29, 2015 Advancing Healthcare Improving Health
Objectives Review Incentives for NCQA PCMH Recognition Review and Answer Follow-Up Questions from the September 15 th Training and Workshop Strategize around Action Steps for NCQA PCMH Recognition 9 9
Your Questions If we have one site at Level 3, but are a multisite organization, how do we move forward with 2014 Recognition? Move forward with Multi-site Streamlined Renewal (request a Multi-site Survey). From NCQA: The organization as a whole may attest to the corporate elements for the streamlined renewal. The previously recognized site would only benefit from the streamlined renewal documentation requirements for the site-specific Elements. 10
Your Questions On Factor 4E-7 Assesses usefulness of identified community resources can these be surveys from another organization? Yes, From the NCQA: As long as the survey covers your practice's patient population and you review the information to guide your listings of community resources for patients, it is okay that the survey is from another organization. 11
Your Questions On Factor 5B-1 Considers available performance information on consultants/ specialists when making referral recommendations can we look at GROUP-level performance rather than the individual specialist? Yes. From the Standards: The practice uses available data on the performance of clinicians and practices it refers its patients to. 12
Incentives - Private Payers Talk to them! (speed dial, know your rep.) Several initiatives in recent years (2008-2015) PMPM (Per Member Per Month) P4P (Pay for Performance) 13
Incentives Federal Pay close attention to announcements Rely on your resources at WACMHC Sign up for email updates! Network with your colleagues Know your Managed Care reps. Ongoing legislation and funding available 14
Incentives PCMH ROI Calculator 15
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PCMH ROI Calculator Recognition and Payment: http://www.coachmedicalhome.org/coachingcurricula/module-2 ROI Calculator: http://www.coachmedicalhome.org/sites/default/file s/coachmedicalhome.org/pcmh-roi-calculator.xls 17
Other Incentives PCMHs improve: Quality Patient experience Continuity Prevention Disease management http://www.pcpcc.org/resource/medical-homes-impact-cost-quality http://www.ncqa.org/portals/0/public%20policy/2014%20comment%20letters/ The_Future_of_PCMH.pdf 18
Select a Project Team Develop the multidisciplinary project team: Clinician, nursing, admin, IT/analytics, QI Project team characteristics: Champions/leaders to bring about change and lead decision making Organizational and departmental knowledge Detail-oriented Policy knowledge Reporting skills Ability to obtain screen shots 19
The team must be trained and empowered to get the job done! Select a Project Team 20
Poll Question Do you have a PCMH project team? 21
Set Goals and Engage Staff Set goals with leadership Level of Recognition Timeline for Recognition Engage Project Team Share and discuss results of Initial Self Assessment Schedule and hold regular project team meetings Develop communication plan and action plan with assigned responsibilities to engage staff Understanding of goals and buy-in by teams is crucial for success! 22
Monitor Progress and Set Priorities Use tools to monitor progress against goals Update self-assessment tool periodically (set intervals) Utilize Renewal Planning Tool if submitting streamlined renewal survey Application Timeline Tool Prioritize Elements and Factors Must Pass Elements and Critical Factors Length of Time to Prepare Factors that require documented processes Care Plans for Record Review Workbook Continuous Quality Improvement activities Review scores on Self-Assessment Tool to see which requirements may require more time to implement 23
Must Pass Elements Element 1A: Patient-Centered Appointment Access Element 2D: The Practice Team Element 3D: Use Data for Population Management Element 4B: Care Planning and Self-Care Support Element 5B: Referral Tracking and Follow-Up Element 6D: Implement Continuous Quality Improvement 24
Critical Factors in Must Pass Elements Factor 1A-1: Providing same-day appointments for routine and urgent care. Factor 2D-3: Hold care team meetings or a structured communication process to focus on individual patient care Factor 5B-8: Tracking referrals until the results are available, flagging and following up on overdue results 25
Factors Requiring Documented Processes Factors within Elements 1A, 1B, 2A, 2B, 2C, 2D, 4A, 5A, 5B, 5C Processes need to be reviewed against NCQA requirements Processes may need to be edited and reapproved Staff need to be trained on new processes for full implementation 26
Identify Patients to Benefit from Care Planning Consider populations now to plan for processes around care planning: 4A-1: Behavioral health 4A-2: High cost/high utilization 4A-3: Poorly controlled or complex conditions 4A-4: Social determinants of health 4A-5: Referrals by outside organizations, practice staff or patient/family/caregiver Care Plan to include patient preferences and lifestyle goals, treatment goals, assessment of barriers to meeting goals and self-management plan 27
Continuous Quality Improvement 3 Clinical Measures 1 Measure representing a Disparity in Care for a Vulnerable Group 1 Utilization or Care Coordination Measure 1 Patient Experience Measure 28
Timeline for Submission See QH Tool: Suggested Action Steps and Timeline for 2014 NCQA PCMH Preparation for Survey Submission Contains steps and team assignments for: Project Set-Up Gap Analysis, Action Plan Submitting the Application Sustaining PCMH Concepts 29
Your Questions Has anyone developed a project management timeline? 30
Qualis Health Tool 31
Prepare Documentation Format the documents to communicate clearly to the NCQA Reviewers Sequence your documents to tell a story Carefully label each document with: Practice Name and Document Name on top of page PCMH standard and element as footer Annotate with call outs/highlighting/text boxes, etc. to identify sections that meet specific factors Apply page numbers Do not use the same file name more than once Avoid symbols in the file name De-Identify! 32
Where to Begin? Review existing documents that might be used to meet the standards Store these in an organized folder system Tweak these as needed Reports must not be older than 1 year Compile a list of new documents that need to be created Need to be in place for at least 3 months prior to submission 33
Policies Are For You, Not NCQA When you are asked for policies or examples of written communication documents you use in your practice, remember: This is an inside out process: what do you want as a practice? How do you specify it clearly? How do you monitor your own performance against your own standards? There is no specific format that NCQA expects. What do you consider to be a good policy or a good communication? What needs to be included? Policy/Procedure/Standard/Guideline/Workflow 34
Tips for Producing Screen Shots Use real patient information, not information from a test system (unless specified) Look for PHI in unexpected places! Use textboxes to explain what the screen shot is displaying 35
Tips for Producing Reports Create clear summary reports of key information Clearly label all column and row headers Include a brief descriptions as required of: Methodology for how the data was gathered (time period, # of patients, how selected ) Analysis of the results Annotations to help the reviewer know what to look at and what the report demonstrates 36
Explanatory Text Narrative PCMH 2: Team-Based Care Element 2A: Continuity Factor 2A.1. Assisting patients in the selection process for their assigned PCP and care team Our clinic assigns each patient to a PCP through an empanelment process. We provide education and resources to the patient to assist in selection of the PCP. We ensure their selection is documented in the EHR and use the information to ensure continuity of care. The attached policy statement demonstrates our procedures. 37
Documentation Templates 38
Organize Documents for Upload to ISS Network Files Create a folder on a shared drive for the Document Library, subfolders for each Standard and Element Example: NCQA Documentation PCMH 1 PCMH 1A PCMH 1B 39
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Poll Question Does your PCMH Team meet regularly? 41
Change Concepts for Practice Transformation Qualis Health, 2015 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; 39:241-259. 42
Other Resources NCQA s Start to Finish Pathway (Road to Recognition) http://www.ncqa.org/programs/recognition/practices/patientcent eredmedicalhomepcmh.aspx NCQA s Crosswalk 2011 and 2014 Standards http://www.ncqa.org/programs/recognition/practices/patientcent eredmedicalhomepcmh/pcmh2011pcmh2014crosswalk.aspx NCQA s Training for 2014 Standards http://www.ncqa.org/programs/recognition/relevanttoallrecogniti on/recognitiontraining/pcmh2014standards.aspx Qualis Health, 2015 43
OPEN DISCUSSION Q&A
WHAT S NEXT? QI ROUNDTABLE: Patient Engagement vs. Patient Education; What s the Difference? Presented by Jamie VerKamp October 27, 2015, Othello, WA
QUESTIONS & CONTACT INFO Practice Transformation Team qualityimprove@wacmhc.org (360) 786-9722 ext: 233 or 238 www.wacmhc.org Heather Russo, CCE hrusso@qualishealth.org 800-949-7536 x2059 For more information: http://www.qualishealth.org/