Objectives Overview of the Medical Home model of care and its benefits Introducing the National Committee for Quality Assurance (NCQA) recognition process Overview of the Medical Home JumpStart approach to NCQA recognition Defining practice responsibilities and coaching team functions Assignments for Unit 1 The Medical Home Background of the Medical Home Concept The American Academy of Pediatrics (AAP) introduced the medical home concept in 1967, initially referring to a central location for archiving a child s medical record. In its 2002 policy statement, the AAP expanded the medical home concept to include care that is: accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. In 2007 the primary care associations came together and formulated the Joint Principles of the Patient-Centered Medical Home as follows: The Patient Centered Medical home model of primary care is quickly becoming foundational to federal and local efforts to improve care and contain the costs of health care in the U.S., and the Centers for Medicare and Medicaid Service (CMS) is currently harmonizing its various initiatives into one unified set of measures and requirements, most of which are embedded in the Medical Home care model. www.bizmedsolutions.com Page 1 of 24
Medical Home Benefits There are currently over 5000 primary care practices recognized as Medical Homes across the US by various local and national organizations. Preliminary research indicates that the following benefits can be expected when transitioning to a Medical Home practice model: Overall cost reductions Decrease in hospital admissions/readmissions Decrease in ER visits Increase in preventive care screenings Improvement in quality measures (e.g. medication use) Decrease staff burnout Decrease appointment wait time Improved patient satisfaction Increased reimbursement/incentives Medical Home benefits are accruing to patients, health care purchasers (public and commercial payers and employers), and also to primary care practices that adopted this model of care or significant portions of it. In most markets, health care purchasers are providing financial incentives to primary care practices to adopt a Patient Centered Medical Home model of care. Most commonly, these incentives are paid as a risk adjusted Per-Member-Per-Month (PMPM) fees in addition to regular fee for service or capitation contracts. Some payers also provide upfront assistance to practices to implement the Medical Home, and shared savings opportunities may also be available in some regions. www.bizmedsolutions.com Page 2 of 24
NCQA Patient Centered Medical Home Recognition In 2008 the National Committee for Quality Assurance (NCQA) created a formal process by which primary care practices that incorporated the first six joint principles in their practice could be recognized as Patient Centered Medical Homes providing recognized practices with a vehicle for obtaining the appropriate payment listed in the seventh principle. The NCQA recognition program operationalizes the Joint Principles of the Patient Centered Medical Home through the definition of six standards (PCMH 2011): These standards, or concepts, consist of 28 Elements and 152 individual Factors, or measures that a primary care practice should satisfy in order to be recognized as a 2011 PCMH by NCQA. NCQA allows three levels of recognition, based on the number of points a practice accumulates for the various Factors and Elements, six of which are required for recognition at any level. www.bizmedsolutions.com Page 3 of 24
The process for obtaining NCQA recognition at any level consists of series of steps as follows: 1. Practice must reach an internal decision to commit itself to change 2. The practice should then review NCQA standards and materials and gain an understanding of the nature of change and the effort involved 3. Changes to process and policy should then be implemented based on the NCQA roadmap 4. Practice staff should follow the new workflows in daily practice 5. Documentation must be generated to reflect the new operations model and to support the assertion that policies and procedures are continuously executed 6. Once the practice has sufficient supporting documentation, an application to NCQA is submitted inclusive of attestation to various factors and documentation to support the attestation NCQA will review the application and make its decision based on the documentation provided. As evident, the change to a Medical Home model of care is not trivial and the administrative complexity is quite significant. It may take an average practice anywhere between one to two years to accomplish the highest level of recognition with or without assistance from consulting entities. The BizMed Medical Home JumpStart Program The Medical Home JumpStart program is design to simplify and accelerate the PCMH recognition process, while removing administrative burdens from the practice as much as possible. www.bizmedsolutions.com Page 4 of 24
The Medical Home JumpStart program provides the following interventions: 1. It breaks down the requirements into small units and presents those in an order that is conducive to quick and logical progress 2. It assists practices with implementing change by providing out of the box guidance that can be customized by the practice with very little effort 3. It provides tools and web applications to assist with the required monitoring, tracking and documentation tasks 4. It provides an experience safety net to ensure that materials are up to the high NCQA standards 5. It submits to NCQA the application and materials on behalf of the practice 6. It provides timely individualized support to practices enrolled in the program on all Medical Home activities, including technology related issues The Medical Home JumpStart Roadmap The JumpStart program is divided into three sequential phases, each concentrating on achieving NCQA recognition at higher proficiency levels. Other than specifying the 6 Must Pass Elements, NCQA is not imposing any requirements regarding the order of elements and factors inclusion in any of its recognition levels, leaving the practice to select its goals and the order in which those are achieved. Sometimes, choices can be daunting. The JumpStart program divides the 152 NCQA Factors into 3 logical portions: JumpStart Level I The Basics: This level includes basic infrastructure and workflow adjustments to support advancement to higher levels. JumpStart Level I can be achieved by practices that are still maintaining paper charts, and is intended as a stepping stone for more technology savvy practices. Practices that for unforeseen reasons decide to discontinue, or delay, their Medical Home efforts after this portion, are still able to obtain some form of formal recognition for their efforts. JumpStart Level II Electronic Practice: This level adds the most common Meaningful Use components to the work done in Level I. For practices that utilize a certified EHR and have achieved Meaningful Use, or are very close to achieving it, Level II should require very little effort. Practices engaged in efforts to achieve Meaningful Use can leverage the work done in this JumpStart portion to accelerate attestation for Meaningful Use Stage I. As in JumpStart www.bizmedsolutions.com Page 5 of 24
Level I, practices that are forced to suspend their Medical Home efforts following this portion, will still be able to obtain some NCQA recognition. JumpStart Level III The last JumpStart learning chapter is intended to implement advanced Medical Home features and some advanced Meaningful Use Stage 1 measures. JumpStart Level III includes several advanced topics which are optional to NCQA Level III recognition. Practices that complete all three parts of the JumpStart program will be well positioned to realize the benefits associated with the implementation of a Medical Home model of care. The Medical Home JumpStart Level I Below is an illustration of the JumpStart Level I curriculum. It consists of 20 distinct learning units and 14 webinars, including this one. The estimated level of effort for the practice is approximately 40 hours. The level of effort will vary based on current practice operation workflows. It is worth observing that learning and implementation follow a logical order that builds on practice already implemented workflows and in addition to obtaining Level I recognition, it is intended to accustom the practice to new activities and ease its way into higher levels of Medical Home recognition. It is our assumption that primary care practices are mostly performing many of the tasks associated with Medical Home models, and this program is geared to highlighting and formally documenting existing practice activities, as well as affecting small changes as may be required for formal Medical Home recognition. It should also be noted that practices that have implemented an EHR in the past, and practices that have a good understanding of Meaningful Use, or have attested for meeting the Stage 1 measures, will be able to leverage some of that work for this section as well. Practices that are contemplating EHR implementation will benefit from the JumpStart Level I program in their EHR deployment process. www.bizmedsolutions.com Page 6 of 24
Weekly Learning Process The Medical Home JumpStart program is delivered via a series of webinars followed by assignments, review and coaching. Practice Responsibilities Although the Medical Home JumpStart program will greatly simplify the practice journey to a Patient Centered Medical Home model of care and NCQA recognition of its efforts, there are several commitments that practice staff must make in order to ensure success. Be assured that JumpStart facilitators, coaches and support teams will be there for you every step of the way, and together we can make a difference. www.bizmedsolutions.com Page 7 of 24
The BizMed Toolbox The BizMed Toolbox is a web application designed from the bottom up to simplify administrative burdens for primary care practices. The tool will be used to offload most of the paperwork associated with NCQA recognition from your busy practice to our coaching team, and to provide you with continuous guidance during the process. Below are the main advantages of the BizMed Toolbox for the Medical Home JumpStart program: The BizMed Toolbox and the customized contents are provided to you free of charge and for as long as you choose to use it. If you decide to continue your Medical Home journey to Levels II and III, you will be able to use the BizMed Toolbox and build on your Level I achievements. As the program commences and advances, each learning Unit will contain detailed instructions on how to use the BizMed Toolbox for accomplishing the Unit assignments. In general, these are the two main portions of the software that will be most useful for this project: www.bizmedsolutions.com Page 8 of 24
Feel free to explore the tools and features of the BizMed Toolbox and suggest additional content and functionality that you feel may be helpful to your practice. Unit 1: Assignments Unit 1: Materials Next on JumpStart www.bizmedsolutions.com Page 9 of 24
References 1. To learn more about Medical Homes and the Joint Principles visit http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home 2. Most recent study on Medical Home benefits: Benefits of Implementing the Primary Care Patient-Centered Medical Home: A Review of Cost and Quality Results, 2012, Patient Centered Primary Care Collaborative, https://www.pcpcc.net/files/benefits_of_implementing_the_primary_care_pcmh.pdf 3. For more information on PCMH recognition and registration, go to the NCQA website at http://www.ncqa.org/tabid/631/default.aspx 4. What truly patient centered care is all about: Gawande, A. (2011, January 24). The Hot Spotters. The New Yorker http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande 5. Merck/NCQA PCMH overview video - Brief (22 minute) video outlining the PCMH recognition process. http://www.youtube.com/watch?v=zc4yclg4h5k&feature=player_embedded www.bizmedsolutions.com Page 10 of 24
Unit 1: BizMed Toolbox Registration Instructions The BizMed Toolbox contains a web-based suite of applications to assist primary care practices with management of their NCQA Patient Centered Medical Home process. These tools are available for Free to individual practices. Below are the steps necessary to facilitate the utilization of these tools for your organization. Medical Practice Sign-up To sign up for a BizMed account for your practice, please follow these steps: Step 1 In your preferred browser*, navigate to www.bizmedtoolbox.com. A login screen will display. Click on the Sign Up tab at the top right to create your new account *Please note that BizMed does not support IE 7 or older versions. If you are using Internet Explorer, please upgrade to version 8 or higher. Make sure you fill in ALL boxes, read the License Agreement and Privacy Policy and then check the box next to these documents. The Sign Up button will become active. Click on the button to create your Practice account. You will be able to change this information once you are logged in. For security reasons, you cannot create two Practices with the same email address. Email addresses are unique for all users across the software. If you get a message stating that this email is already in use, please click on the support@bizmedsolutions.com link provided at the bottom of this page and we will locate any other accounts you may have created in the past. Step 2 An email with your assigned User Name and Password will be sent to the email you provided. Once you receive this email, please log into the application (if you are not already logged in) and change www.bizmedsolutions.com Page 11 of 24
your password to something that you can easily remember. User Names have the following structure <first initial><last name><random number>. User Names cannot be changed and you should keep yours in a handy place. If you forget your credentials, click on the Forgot password link on the login page and your credentials will be sent to your registered email address. Step 3 When you log into the application for the first time, we highly recommend that you edit the auto generated practice name, and enter all the pertinent information for your practice, sites and users. The Practice Setup page shown below is where you edit the default practice name and add other practice details. www.bizmedsolutions.com Page 12 of 24
Next, you should add all your sites (if you have multiple practice locations) and edit the auto generated names. Next you should add your other users. Please make sure all your providers are listed, and if they have any other NCQA program recognitions, those are selected on the user page. www.bizmedsolutions.com Page 13 of 24
Step 4 You are now ready to use your PCMH Project tools Step 5 Make sure you check out the resources and materials under the Toolbox tab We highly recommend that you read the instruction sheet for the tools, available from the Home page, before you start. We hope you find the BizMed Toolbox useful and enjoyable and we would love to hear your suggestions and impressions as you use it in your daily work. www.bizmedsolutions.com Page 14 of 24
Unit 1: Instructions for Taking an Express Assessment Once you log into your BizMed Toolbox account, navigate to My Projects by clicking on the tab To open the Tools for your Site, click on the grey triangle to the left on your Site name If your practice has multiple Sites, each site should complete an assessment, or you can just complete one assessment for the Main site, if all Sites are centrally managed. www.bizmedsolutions.com Page 15 of 24
Next click on the grey triangle to the left of the Tools menu item Next click on the Express Assessment item The right side of your screen will now display a list of 15 simple questions. Select the answer that best matches your situation. Note that for questions #10 and #11 you may select multiple answers. www.bizmedsolutions.com Page 16 of 24
Important: All 15 questions must be completed before the system can calculate the assessment results Remember that there is no right or wrong answer and each practice is different. Once you answered all 15 questions, click the Calculate Result button at the bottom of the page. The application will display your results and tips regarding answers that would increase the burden of a Medical Home transition. www.bizmedsolutions.com Page 17 of 24
You can save a copy of your results in the Utility folder, and you can also print a copy for your records. You can retake the Express Assessment as many times as you need and continue to save or print copies. www.bizmedsolutions.com Page 18 of 24
Unit 1: Instructions for Taking the JumpStart Survey Once you log into your BizMed Toolbox account, navigate to Toolbox by clicking on the tab To access the JumpStart Survey click on Assessment under the Patient Centered Medical Home and double click on the Medical Home JumpStart Survey file name on the top right pane Depending on your browser, a download dialog will display similar to the one below. Select Open. (Note: you can choose the Save as option and Save the file to your Desktop or other handy location on your computer) www.bizmedsolutions.com Page 19 of 24
Depending on your browser security setting, you may need to Enable Editing on the opened Survey file. Click on the Enable Editing button on top of the document. You can now answer the 16 Survey questions. When you are done, please save the completed Survey to your Desktop. www.bizmedsolutions.com Page 20 of 24
Next log into your BizMed Toolbox and click on the My Projects tab Open the Utility Folder by clicking on the grey triangle to its left and click on the Uploaded Documents folder (Note: Your folder may be empty or contain a copy of your Express Assessment) To upload your JumpStart Survey click on the yellow Upload button on your top right www.bizmedsolutions.com Page 21 of 24
A dialog box will open. Click on the Browse button to locate your completed survey copy On the file explorer popup navigate to your Desktop (or the folder where you saved your Survey), click on the Survey file and click on the Open button at the bottom www.bizmedsolutions.com Page 22 of 24
The file explorer will close and in the Upload dialog the file you chose will be selected. You MUST type a name for your file (any name is fine we suggest JumpStart Survey). Finally click the UPLOAD button to upload your survey to the BizMed Toolbox A confirmation green ribbon will display if your upload was successful. Close the popup by clicking on the X in the top right corner www.bizmedsolutions.com Page 23 of 24
Your BizMed Toolbox will refresh and show your uploaded Survey in the current folder This completes your task. Thank you for answering the Medical Home JumpStart Survey. www.bizmedsolutions.com Page 24 of 24