Patient Centered Medical Home 2017 Redesign
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)
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
Patient-Centered Medical Home:
Purdue Research Foundation
Purdue Research Foundation
Triple Aim
Purdue Research Foundation
Purdue Research Foundation
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
2017 Redesign Annual reporting requirements More social determinants More community resources More behavioral health needs Focus on outcomes
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
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.
2017 Steps towards becoming a PCMH
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
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
Structure of PCMH Concepts Competencies Criteria
Purdue Research Foundation
Purdue Research Foundation
Elective Criteria 39 Criteria = 1 point credit 20 Criteria = 2 credits 1Criterion = 3 credits
Scoring All Core Criteria 25 Points of Elective Criteria At least 5 of the 6 Concepts No separate levels of recognition!
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
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
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
How to Become 2017 Recognized
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
Accelerated Process to Transition
Did Anyone Here Purchase an Add-On Survey Prior to March 31, 2017?
Current Level 1 Options
Current Level 2 Options
Current Level 3 Options
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
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
PCMH Redesign & MACRA
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
Questions?
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) 773-5870 (phone) (765) 496-6990 (fax) www.pha.purdue.edu anglinj@purdue.edu healthcareadvisors@purdue.edu Visit us on @ Purdue Healthcare Advisors