Transcript Person-Centered Medical Home Recognition

Person-Centered Medical
Home Recognition Program
Connecticut Department of Social Services
Presented by Community Health Network of Connecticut, Inc.
Person-Centered Medical Home
Recognition Program
What is a Person-Centered Medical Home?
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A Person-Centered Medical Home is a Practice that places the patient at
the center of the health care system, and provides primary care that is
“accessible, continuous, comprehensive, family-centered, coordinated,
compassionate, and culturally effective.”
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The patient has a personal relationship with the provider/care team. The
care team knows the patient and their health care needs.
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A method to merge modern technology with traditional primary care
What are the benefits of a PCMH?
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Financial Incentives
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Improved staff morale: Provider champion leads Care Team
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Improved patient satisfaction: Patient has a personal relationship with
Provider and Care Team
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Embraces quality improvement and improves patient outcomes
NCQA Chosen for PCMH Recognition
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During PCMH program development at the state level, the committee
evaluated a number of PCMH Recognition Programs.
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It was determined that the National Committee for Quality Assurance
(NCQA) PCMH program of recognition would be the one that the
Department of DSS would use for their program.
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It was decided that only Levels 2 or 3 would be recognized by DSS. Level 1
NCQA PCMH recognition requires participation in the Glide Path Process.
Eligibility to Become A PCMH in CT
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NCQA recognized, Level 2 or 3
•
Not recognized or Level 1 – with completed PCMH & Glide Path
Application
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Enrolled as CMAP provider (CT Medical Assistance Program)
• Active unrestricted CT license as MD, DO, NP or PA.
• Function as PCP with panel of patients
• Provide primary care services for at least 60% of the time across all
payers
Eligibility (continued)
•
Share all medical records within the practice and use the same system
support for all clinical and administrative service
•
Meet State/Federal requirements for EPSDT, Smoking Cessation (R2Q),
addressing Racial and Ethnic Disparities, and Adherence to Consumer
Protections
•
Will not require APRN and PA practitioners to have their own panel of
patients to qualify as PCMH providers if they are serving to support or
extend the panel of a primary care physician
Glide Path Process
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Submit state PCMH application
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Agree to Glide Path milestones/timeframes
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Demonstrate progress toward NCQA PCMH recognition
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Complete Gap Analysis (practice’s ability to substantiate compliance with
standards contained in NCQA PCMH application)
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Complete Work Plan (contained in Glide Path Application)
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Provide ongoing documentation in accordance with established Work
Plan
Practice Transformation Supports
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The ASO’s Community Practice Transformation team, comprised of RNs,
APRNs, JD, MPH and other professionals, are dedicated to support
PCMH/Glide Path practices.
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The team is specially trained to assist Primary Care Practices to make
meaningful changes designed to improve patient outcomes.
o Review the practice’s NCQA work plan to assess implementation
timelines
o Conduct gap analysis of the practice’s work plan
o Monitor, track and assess progress of work plan to ensure practices are
accomplishing PCMH/ Glide Path tasks
o Provide resources and tools for NCQA recognition
o Provide access to patient utilization data
o Evaluate practice performance
How to Start
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Form PCMH Core Teams with a clinical lead, administrative personnel,
ancillary staff (3-4 people)
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NCQA: (888) 275-7586, Monday through Friday from 8:30 a.m. to 5 p.m.
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http://www.ncqa.org/tabid/631/Default.aspx
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Download NCQA 2011 Standards
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Training Calendar – participate in workshops, Web Ex
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On-Boarding Guide Multi-Site/Single Site
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NCQA Recognition Process, brochure, scoring
NCQA
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NCQA – Get free online application account
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“Free” one for all sites
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Submit Multi-Site Eligibility
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NCQA will schedule a personal conference call.
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They will walk you through Multi-Site Process.
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Focus on 6 NCQA Must Pass Elements
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NCQA Standard 1G – correlates with 1D of Glide Path
NCQA
(continued)
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Develop Care Teams (MD, APRN, PA, DO, nurse, care coordinator, MA,
receptionist)
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Need Physician champion
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Identify populations you will be managing – Need to have three months
worth of data
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Policies and procedures, job descriptions need to be in place at least
three months prior to NCQA submission
CT DSS PCMH/Glide Path
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Develop your work plan
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When do you plan to submit to NCQA?
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Submit PCMH/Glide Path Accordingly
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Start to develop job descriptions, policies
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Educate staff on PCMH, keep a log of education activities
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Determine populations you will manage/track
Resources
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www.ncqa.org
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www.huskyhealth.com
 “For Provider” tab
 “Pathways to PCMH”
 2 Introductory Webinars on PCMH
www.chnct.org
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www.cms.gov
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www.pcpcc.org
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www.ahrq.gov
DSS PCMH Program
Questions?