Transcript Patient-Centered Medical Home & Multi

Patient-Centered Medical Home
& Multi-Payer Demo
Training Webinar # 3
David Halpern, MD, MPH
June 22nd, 2011
Acknowledgements
Let’s Review
• What is the National Committee for
Quality Assurance (NCQA)?
• How Does NCQA Evaluate a Practice?
• How Does My Practice Apply for PCMH
Recognition?
“Homework” From Last Time
• Have you:
– Read the “Standards/Guidelines”?
– Started to make a list of things your
practice already-does/will-do/can’t-do?
– Created a place to save/organize your
supporting documentation?
– Looked at NCQA’s training offerings?
NCQA Lingo
each “standard”
is composed of
several
“elements”
each
“element” is
composed
of several
“factors”
PPC-PCMH (2008) Overview
Standard 1: Access and Communication
Standard 5: Electronic Prescribing
A.
B.
A.
B.
C.
Access and communication processes
Access and communication results
Standard 2: Patient Tracking and Registry
Functions
A.
B.
C.
D.
E.
F.
Basic system for managing patient data
Electronic system for clinical data
Use of electronic clinical data
Organizing clinical data
Identifying important conditions
Use of system for population management
Standard 3: Care Management
A.
B.
C.
D.
E.
Guidelines for important conditions
Preventive service clinician reminders
Practice organization
Care management for important conditions
Continuity of care
Standard 4: Patient Self-Management Support
A.
B.
Documenting communication needs
Self-management support
Electronic prescription writing
Prescribing decision support - safety
Prescribing decision support – efficiency
Standard 6: Test Tracking
A.
B.
Test tracking and follow up
Electronic system for managing tests
Standard 7: Referral Tracking
A.
Referral tracking
Standard 8: Performance Reporting and
Improvement
A.
B.
C.
D.
E.
F.
Measures of performance
Patient experience data
Reporting to physicians
Setting goals and taking action
Reporting standardized measures
Electronic reporting to external entities
Standard 9: Advanced Electronic
Communications
A.
B.
C.
Availability of interactive website
Electronic patient identification
Electronic care management support
PPC-PCMH (2008) Scoring
9 standards = 100 points
NOTE: Must Pass elements require a ≥50% performance level to pass
Level of Qualifying
Points
Must Pass Elements
at 50% Performance Level
Level 3
75 - 100
10 of 10
Level 2
50 – 74
10 of 10
Level 1
25 – 49
5 of 10
Not Recognized
0 – 24
<5
Levels: If there is difference in Level between the number of points
achieved and “Must Pass”elements completed, the practice will be
awarded the lesser level; for example, if a practice has 65 points but passes only
7 “Must Pass” Elements, the practice will only achieve a Level 1 recognition.
Today’s Agenda
•
What are the “Must Pass” Elements?
•
Which Ones Should we Focus on First?
–
–
–
–
–
PPC1A: access and communication (4 points)
PPC2D: organizing clinical information (6 points)
PPC2E: important diagnoses/conditions (4 points)
PPC3A: evidence-based guidelines (3 points)
PPC7A: referral-tracking (4 points)
“Must Pass” Elements
• Some elements are “Must Pass”
• **To “Pass” one of these elements, you
must receive a 50% score or higher**
• In 2008 Standards, you must pass 5/10 of
these “Must Pass” elements to achieve a
level 1, and 10/10 to achieve level 2 or 3
PCMH Must Pass Elements
1.
PPC1A: Written standards for patient access and patient communication
2.
PPC1B: Use of data to show meeting standards in 1A
3.
PPC2D: Use of paper or electronic-based charting tools to organize
clinical information
4.
PPC2E: Use of data to identify important diagnoses and conditions in
practice
5.
PPC3A: Adoption and implementation of evidence-based guidelines for
three conditions
6.
PPC4B: Active support of patient self-management
7.
PPC6A: Tracking system for tests and to identify abnormal results
8.
PPC7A: Tracking referrals with paper-based or electronic system
9.
PPC8A: Measurement of clinical and/or service performance
10.
PPC8C: Performance reporting by physician or across the practice
PCMH Must Pass Elements
1.
PPC1A: Written standards for patient access and patient communication
2.
PPC1B: Use of data to show meeting standards in 1A
3.
PPC2D: Use of paper or electronic-based charting tools to organize
clinical information
4.
PPC2E: Use of data to identify important diagnoses and conditions in
practice
5.
PPC3A: Adoption and implementation of evidence-based guidelines for
three conditions
6.
PPC4B: Active support of patient self-management
7.
PPC6A: Tracking system for tests and to identify abnormal results
8.
PPC7A: Tracking referrals with paper-based or electronic system
9.
PPC8A: Measurement of clinical and/or service performance
10.
PPC8C: Performance reporting by physician or across the practice
Priority Must Pass Elements
1.
PPC1A: Written standards for patient access and
patient communication (4 points)
2.
PPC2D: Use of paper or electronic-based charting
tools to organize clinical information (6 points)
3.
PPC2E: Use of data to identify important
diagnoses and conditions in practice (4 points)
4.
PPC3A: Adoption and implementation of evidencebased guidelines for three conditions (3 points)
5.
PPC7A: Tracking referrals with paper-based or
electronic system (4 points)
PPC 1A: Access and Communication Processes
PPC 1A: Example of Factors 1 and 4
PPC 1A: Example of Factors 3 – 6
(Your Practice Name)
PPC 1A: Example of Factors 10 & 11
PPC 2D: Organizing Clinical Data
PPC 2D: Example of Med List
PPC 2D: Example of Documentation
PPC 2E: Identifying Important Conditions
PPC 2E: Definitions
PPC 2E: Identifying Important Conditions
• Where does the data come from?
“Practices may use a practice management
system, a billing system or an electronic
health record to identify the conditions.”
PPC 2E: Example of 2E1 – Most
Frequently Seen Diagnoses
PPC 2E: Example of 2E1 – Most
Frequently Seen Diagnoses
PPC 2E: Example of 2E2 – Most
Important Risk Factors
your community
PPC 2E: Choosing 3 Important Conditions
• “To determine the 3 clinically important conditions, the
practice analyzes its entire population. The practice
states the 3 clinically important conditions and explains
or shows the data used to select the conditions. The
clinically important conditions should be chronic or
recurring conditions that the practice sees such as otitis
media, asthma, diabetes or congestive heart failure. In
some cases, the most frequently seen conditions may
be the same as the clinically important conditions.”
• “The practice can also use the following criteria to
identify the three important conditions:
– Ability to successfully treat the conditions (how amenable the
conditions are to care management; whether clinical guidelines
are available, etc)
– Other evidence such as conditions for which the practice is
measuring performance or receiving rewards for performance;
conditions that the practice has selected or targeted to improve
performance.”
PPC 2E: Example of Text Explanations
PPC 3A: Evidence-Based Guidelines
for Important Conditions
PPC 3A: Evidence-Based Guidelines
PPC 3A: Evidence-Based Guidelines
PPC 3A: Evidence-Based Guidelines
PPC 3A: Evidence-Based Guidelines
• You must adopt AND implement the
guidelines
• “Paper-based supporting documentation
includes flow sheets or templates used to
document treatment plans or patient
progress.”
PPC 3A: Evidence-Based Guidelines
Diabetes Management Flow Sheet
PPC 3A: Evidence-Based Guidelines
PPC 3A: Evidence-Based Guidelines
PPC 7A: Referral Tracking
PPC 7A: Referral Tracking
PPC 7A: Referral Tracking
Patient
Name
MRN
Referring
Clinician
Reason for
Referral
Date of
Referral
Referred to
Completed?
Insurance
(Y/N & Date)
Joe Smith
12345
Halpern
Back Pain
6/16/11
Triangle
Ortho
No
BCBS-NC
Mary Jones
54321
Halpern
Colonoscopy
6/16/11
Durham GI
Yes 6/21/11
Duke
Select
Resources
• http://www.aafp.org/online/en/home/public
ations/journals/fpm/fpmtoolbox.html
• more than 150 practice management tools
(templates, flow sheets, etc) that you can
download for free and use in your practice
Next Steps (Homework)
• PPC 1A – Begin compiling/writing your policies
• PPC 2D – Organize your chart data in a
logical/consistent way
• PPC 2E – Choose your 3 “Important Conditions”
• PPC 3A – Find/Implement evidence-based
guidelines for 3 conditions
• PPC 7A – Create a referral tracking system that
works for your practice
Next Steps (Homework)
• Create a place on your computer (server or harddrive) for all of your documentation
• You should have a folder for each standard
• Save/Organize all of your documentation as
you go!
Community Care PCMH Team
• David Halpern, MD, MPH
Community Care of North Carolina (CCNC)
• R.W. “Chip” Watkins, MD, MPH, FAAFP
Community Care of North Carolina (CCNC)
• Brent Hazelett, MPA
North Carolina Academy of Family Physicians (NCAFP)
• Elizabeth Walker Kasper, MSPH
North Carolina Healthcare Quality Alliance (NCHQA)
Partners
Questions?
Feel free to contact me:
David Halpern, MD, MPH
(215) 498-4648
[email protected]