August 8, 2013 12:00pm to 1:00pm Pamela Lester, Molly Layton and Janeen Boswell 1) NCQA PCMH Recognition, what it means and its process. 2) Understand the rationale and benefits of becoming recognized as a PCMH 3) Learn what has changed in the journey of PCMH. 1&
Disparities in terms of access to care and quality of care largely disappear when adults have a medical home (CMWF, 2006, Closing the Divide) Key features of Medical Home in this study Not difficult to contact provider by phone Not difficult to get care or medical advice after hours or on weekends Office visits available, well-organized and on-time Key Findings when adults have a medical home, their access to needed care, receipt of routine preventive screenings and management of chronic conditions improve substantially It is about: Closing the gap in disparities Changing from a provider centered clinic to a patient centered clinic (transformation) Improving outcomes Decreasing overall patient cost 2&
Recognition is only the beginning of a journey for continuous improvement and cultural transformation. NCQA s rigorous standards challenge a practice to examine nearly every aspect of its operations. The evolution to a PCMH is a serious undertaking one that rewards patients with more coordinated, focused and safer care, and rewards providers with greater satisfaction in practicing medicine. - Marjie Harbrecht, MD CEO, HealthTeamWorks, Colorado PCMH focus is a continuation of the purpose-driven journey Opportunity: continue our work to transform practice to the highest levels of performance and to obtain recognition for this achievement Recognition as a medical home is increasingly associated with opportunities for enhanced payment for the value created. 3&
Investments to redesign the delivery of care around a primary care patient-centered medical home yield an excellent return on investment: demonstrably better quality of care patient experiences care coordination access reductions that produce savings in total costs: emergency department visits inpatient hospitalizations savings at minimum offset new investments in primary care in a cost-neutral manner; in many cases appear to produce a reduction in total costs per patient. Grumach(K,(Bodenheimer(T(&(Grundy(P.((2009.((The(Outcomes(of(Implemen@ng(Pa@entBCentered(Medical(Home(Interven@ons:(A( Review(of(the(Evidence(on(Quality,(Access(and(Costs(from(Recent(Prospec@ve(Evalua@on(Studies.( Review(of(data(&(key(findings(from(PCMH(evalua@on(studies((from(eight(systems( hpp://test.pcpcc.net/files/pcmh_evidence.pdf( Source: Table 1 in NCQA s Standards for PCMH 2011 Standards available at: http://ncqa.org/tabid/1302/default.aspx 4&
PCMH 1C: Electronic Access PCMH 1C1 & MU C12 PCMH 1C2 & MU M5 PCMH 1C3 & MU C13 PCMH 2A: Patient Information PCMH 2A1-5 & MU C7 PCMH 2B: Clinical Data PCMH 2B1 & MU C3 PCMH 2B2 & MU C6 PCMH 2B3-7 & MU C8 PCMH 2B8 & MU C9 PCMH 2B9 & MU C5 PCMH 2D: Use Data for Pop Management PCMH 2D1 & MU M4 PCMH 2D2 & MU M3 PCMH 3A: Implement Evidence-Based Guidelines PCMH 3A1 & MU C11 PCMH 3D: Manage Medications PCMH 3D1 & MU M7 PCMH 3E: Use Electronic Prescribing PCMH 3E1 & MU C4 PCMH 3E2 & MU C1 PCMH 3E4 & MU C2 PCMH 3E6 & MU M1 PCMH 4A: Support Self-Care Processes PCMH 4A2 & MU M6 PCMH 5A: Test Tracking and Follow-Up PCMH 5A9 & MU M2 PCMH 5B: Referral Tracking and Follow-Up PCMH 5B6 & MU C14 PCMH 5B7 & MU M8 PCMH 5C: Coordinate w/ Facilities/Care Transitions PCMH 5C7 & MU C14 PCMH 5C8 & MU M8 PCMH 6F: Report Data Externally PCMH 6F1 & MU C10 PCMH 6F2 & MU M9 PCMH 6F3 & MU M10 Source: PCDC, Feb 2011 Documented process, e.g., policy, checklists, work flows Reports, from either electronic or manual processes Record or files, aka chart review Other Materials, e.g., brochures, pamphlets, Screen shots 5&
Just thinking of where you are at now, what do you think those goals would be if you had your assessment completed now? Where is your greatest weakness? What barriers do you think you might have? What is your greatest strength? Could there be processes that could be further strengthened? Use relevant PCMH reference tools when conducting assessments NCQA standards and guidelines: http://ncqa.org/tabid/1302/default.aspx If you don t know, investigate Spot checks (e.g. mini-chart review, coach, sample your data, regulations etc) Reports Policy and procedure review TO DO: Conduct baseline assessments 6&
Compare your assessment score with your goals for recognition Consider the work required to bring you to your goal level; identify the clinically important conditions early Create a work plan and a team to lead the work of improving processes and compiling documentation Set a timeline for the work have an ambitious aim and acknowledge realities Consider obtaining Level 3 in stages if necessary Position work as part of continuous improvement strategy Expect it to take time and effort and resources and plan accordingly NCQA will contact the clinic with Survey Tool and on-line application access information Create draft timeline for survey completion Refer clinics to NCQA web site for information on PCMH process clinics complete readiness evaluation in Survey Tool Applies when ready Source: HRSA Patient Centered Medical/Health Home Initiative ( http://www.bphc.hrsa.gov/policy/pal1101/) 7&
Using a Learning Collaborative to provide a framework, roadmap, tools, technical assistance and coaching to support: Achievement of medical home recognition and MU certification by Iowa FQHCs Process and workflow redesign required to meet PCMH and MU standards (practice transformation) Anchoring of changes and new capabilities to ensure sustainability within each organization Approach: The Collaborative Learning Model P P P P A D A D A D A D S S S S PW LS 1 LS 2 LS 3 LS 4 S&S SUPPORTS FOR LEARNING & CHANGE Coaching, Focus on Results, Leadership, Commitment, and Engagement Source: IHI Breakthrough Series College 8&
The Iowa PCA Team worked with each Iowa FQHC participating in this Learning Collaborative A lead coach was assigned to each FQHC, but the entire team assisted. Assistance and coaching was provided via scheduled webinars, teleconferences and site visits 18 9&
19 -APCP Demo -Supplemental Grant -Improve Patient Care -Decrease patient over all cost 20 10&
Advanced Primary Care Practice -Federally Qualified Health Center (FQHC) APCP demonstration will show how the PCHM model can improve quality of care, promote better health, and in return lower costs. 21 - CMS Selected sites that were eligible to apply -3yr demonstration period 10-2011 to 10-2014 -200 Medicare beneficiaries during a 12 month period -Pursue a level 3 PCMH recognition -Random audits and quarterly reports -Sites receive a quarterly fee for each eligible Medicare beneficiary 22 11&
CHCSI applied for this funding opportunity to improve cervical cancer screenings. Part of the agreement was to reach a Level 3 PCMH recognition. 23 24 12&
Standards and protocols Outline what expectations are for each chronic condition so there is no question what the goals are and what care should be provided. 25 Standing Orders Allow care team to perform labs and other orders before the patient sees their provider. 26 13&
Morning Huddles Care team reviews each patient at the beginning of the day to plan and prepare for the patients visit, i.e. lab draws, request referrals or tests that may not be in the chart. 27 Tracking and Monitoring All referrals, labs, diagnostic orders, hospitalizations, ER visits, and follow up appointments are tracked to ensure comprehensive care coordination. 28 14&
Empowering patients in their own care -Patients are expected to designate a PCP. -Patients are expected to set self management goals. -Patients are asked to report self referrals. -Patients are held accountable in assisting to manage their own care. -Patients are held accountable to come to appointments. 29 Standards and Protocols, Standing orders, Morning Huddles, Tracking and Monitoring, and Empowering Patients complete the circle of care. Setting up systems and protocols ensure patients receive the care they need. 30 15&
Prevention is the key in decreasing over all cost. Our goal is to prevent an illness from progressing, which often leads to ER visits or hospitalization. Educating our patients is a key factor in this model. It is necessary for our patients to participate in their care and disease management. 31 Patient Safety Quality Improvement Better Outcomes! 16&
We didn t know all of the pieces we were missing. EMR implementation allows us to improve processes with the ability to audit, track fallouts, and continue to make changes! We can see which PODs are excelling at a given measure and work to reproduce those results. Yields the same results. good and bad. 17&
Referrals -PCMH -Meaningful Use - FTCA High risk associated with referrals that are not initiated, not completed, or results are not obtained, reviewed, and placed in the chart. Allow POD teams to do as much work for the patient as possible in anticipation for the visit. Allows the provider to maximize the time spent with patient by not wasting the time looking for or waiting for components that could have been done and ready. 18&