The New York State Health Center Controlled Network (NYS-HCCN) A HRSA-Funded Project of the Community Health Care Association of New York State PCMH 2014 Must Pass Elements Qualis Health November 16, 2015
NYS-HCCN Mission To support participating health centers by working together to advance the use of health information and analytics to improve and sustain quality of care and health outcomes of our patients. 11/24/2015
Project summary 3 1/2-year HRSA grant to CHCANYS 35 NYS FQHCs participating ½ upstate, ½ downstate Technical assistance in EHR Implementation & Use Meaningful Use (MU) Quality Improvement (QI) Patient Centered Medical Home (PCMH)
Project goals 100% of health center sites and eligible providers will be live on a MU-certified EHR 100% of eligible providers attested for and received EHR incentive payments for Stage 1 Meaningful Use; prepared for Stage 2 100% of health centers meet or exceed Healthy People 2020 goals for at least 2 measures 100% of health centers achieve PCMH recognition or maintain/increase their level of PCMH recognition
HCCN-Sponsored TA: PCMH Must Pass Elements 4-part webinar series focused on the six (6) must pass elements for PCMH s 2014 application Monday, November 16, 2015: Overview, Patient-Centered Appointments, Access and Empanelment Monday, December 14, 2015: The Practice Team, Care Planning and Self Care Support Monday, January 11, 2016: Referral Tracking Monday, February 8, 2016: Using Data for Population Management and Implementing Continuous Quality Improvement 11/24/2015 www.chcanys.org 5
CHCANYS NCQA PCMH 2014 Webinar Series #1 Patient Centered Access and Empanelment Karen Taubert RN, BSN, MBA, CPHQ NCQA Certified Content Expert November 16, 2015 Advancing Healthcare Improving Health
Objectives Understand the differences between NCQA s 2011 and 2014 PCMH Model Learn what s required for the Must Pass Element around Patient Centered Access Share best practices around empanelment 7 7
Agenda Overview of 2014 Standards and Requirements The Must Pass Elements PCMH 1A: Patient Centered Appointments & Access Discussion on empanelment 8
Working the WebEx Use Chat to ask questions or to post comments to All Participants or to select attendees. This works better than the Q&A for communication on the WebEx. Use the raise hand function to ask a question or to make a comment. We will unmute your line so you can talk. Use this icon to expand the WebEx slide presentation to full screen. 9
Change Concepts for Practice Transformation 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. 10
2014 NCQA PCMH Standards Standard 1: Patient-Centered Access Standard 2: Team-Based Care Standard 3: Population Health Management Standard 4: Care Management and Support Standard 5: Care Coordination and Care Transitions Standard 6: Performance Measurement and Quality Improvement 11
2014 Primary High-Level Changes Enhanced emphasis on team-based care Focus on care management for high-need patients Quality Improvement bar has been raised (aligns with Triple Aim) Alignment with Stage 2 MU Further integration of behavioral health 12
NCQA PCMH Standards Crosswalk 13
NCQA Considerations Safe guard your account; you ll use it again for renewal (every 3 years) Put NCQA renewal on the organizational calendar Recognition lasts 3 years NCQA will send you an email reminder 6 months prior to expiration Do not let your recognition expire! Must submit at least 60 days BEFORE your expiration date, plan accordingly 14
NCQA PCMH Renewals Renewals require a limited set of documentation to be provided (streamlined) Submit new documentation for the 11 Elements only; attest to the others New 3-year recognition period Must demonstrate work/reports over time (3D, 6A, 6B, 6C) If you miss your expiration date to renew your PCMH recognition status, you will have to complete a brand new FULL survey. 15
NCQA s Prevalidation Program NCQA identifies HIT systems that have functionality to help meet the PCMH requirements Helps you to: Save time preparing documentation Maintain recognition List of products here: http://www.ncqa.org/programs/recognition/pract ices/patientcenteredmedicalhomepcmh/pcmh PrevalidationProgram/VendorList.aspx 16
Improve the quality, safety, and efficiency of care http://www.hrsa.gov/healthit/meaningfuluse/mu%20stage1%20cqm/whatis.html 17
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2014 Must Pass Elements Prerequisite PCMH 1, Element A: Patient-Centered Appointment Access PCMH 2, Element D: The Practice Team None None PCMH 3, Element D: Use Data for Population Management None PCMH 4, Element B: Care Planning and Self-Care Support PCMH 5, Element B: Referral Tracking and Follow-up Identify Patients for Care Management Support None PCMH 6, Element D: Implement Continuous Quality Improvement Measure Performance Measure Utilization Measure Patient/Family Experience Qualis Health, 2015 19
PCMH 1A: Patient-Centered Appointment Access What s New: Providing alternative types of clinical encounters Availability of appointments (wait times) Monitoring no-show rates Acting on identified opportunities to improve access 20
Factor 1A1-Same Day Access Reserving same day appointments for routine and urgent care based on patient preference and need Add-ons do not count Walk-in hours as well as same-day appointments Provide a documented process and a 5-day report showing availability and use 21
Patient Centered Medical Home (PCMH 2014) Standards Training material is reproduced with permission from the National Committee for Quality Assurance (NCQA) website. Source: http://www.ncqa.org/programs/recognition/relevanttoallrecognition/recognitiontraining/pcmh2014standards.aspx. Last accessed: October 2015. 22
Factor 1A1-Example Source: Turner House Children s Clinic, 2015, used with permission. 23
Factor 1A1-Example Source: Turner House Children s Clinic, 2015, used with permission. 24
Factor 1A2-Providing Appointments Outside Regular Hours Providing appointment access outside regular hours for routine and urgent care If practice is unable to provide access, makes arrangements for patients to schedule with other facilities for after-hours care Provide a documented process and/or 5-day report showing availability and use 25
Source: Turner House Children s Clinic, 2015, used with permission. 26
Factor 1A2-Example 27
Source: Turner House Children s Clinic, 2015, used with permission. 28
Factor 1A3-Providing Alternative Types of Clinical Encounters Provide a documented process for arranging alternative visit types Provide a 30 calendar-day report showing frequency of alternative encounter types 29
Factor 1A3-Examples A scheduled telephone clinical visit A scheduled clinical home visit A scheduled clinical group visit A scheduled video chat visit Tele-health visitscontracted, with provider Tele-psychiatry visits Pediatric visits where the provider sees more than one sibling at a time 30
Factor 1A4-Availability of Appointments A documented process for defining the practices standards for appointment availability by type (e.g., third next available appointment is X far out, or, 14 calendar days for routine care) A report showing at least 5 days monitoring against the defined standard 31
Factor 1A4-Example Source: Turner House Children s Clinic, 2015, used with permission. 32
Source: Turner House Children s Clinic, 2015, used with permission. 33
Factor 1A5-Monitoring No-Show Rates Provide a documented process for monitoring scheduled visits Report from a recent 30 calendar-day period showing no-show rates 34
Factor 1A5-Example Source: Turner House Children s Clinic, 2015, used with permission. 35
Source: Turner House Children s Clinic, 2015, used with permission. 36
Factor 1A6-Acting on Identified Opportunities to Improve Access Use the information from factor 1-5 to demonstrate improvement efforts 37
Factor 1A6-Example Source: Turner House Children s Clinic, 2015, used with permission. 38
Questions? 39
Let s Talk About Empanelment Assign all patients to a provider panel and confirm Assess practice supply and demand, and balance Use panel data and registries to proactively contact, educate, and track patients by disease status, risk status 40
Empanelment is the Driver of the PCMH Continuity of Care Access to Care Team- Based Care Provider Panels Planning & Control Capacity Analysis 41
Empanelment is an Administrative Leadership Function Provide necessary staffing and equipment to support panel management Provide support to identify the correct panel size Set expectations for assigning new patients when panels are open Have a process to ensure that one single provider is not assigned all of the most chronically ill patients Clarify the coverage expectations at the time of employment 42
Where Are You With Respect to Empanelment Processes? 43
Questions to Consider What is your PCP assignment process? What are your practice panel size and individual provider panel sizes? Do you use PCP assignment in appointing patients? Do you use empanelment data for practice management? Do you have a registry by condition and PCP? Do you have teams assigned to a PCP/panel? Do the teams outreach to patients? 44
Qualis Health, 2015 45
Resources Panel Size: How Many Patients Can One Doctor Manage? - Family Practice Management Safety Net Medical Home Empanelment Guide Enhanced Access Safety Net Medical Home Initiative Qualis Health, 2015 46
For More Information Contact Karen Taubert RN karenv@qualishealth.org Qualis Health, 2015 47
Any questions? Amy Grandov, MS PMP Managing Director, NY Statewide-Health Center Controlled Network (NYS-HCCN) CHCANYS Direct line: 212-710-4185 Main Line: 212-279-9686 ext. 132 Fax: 212-279-3851 agrandov@chcanys.org Barbara Salcedo, MPH Clinical Quality Improvement Project Manager CHCANYS Direct line:212-710-3818 Main Line: 212-279-9686 ext. 126 Cell: 929-244-3988 Fax: 212-279-3851 bsalcedo@chcanys.org