Patient-Centered Medical Home & Multi-Payer Demo

Training Webinar # 2

David Halpern, MD, MPH June 8th, 2011

Acknowledgements

Let’s Review

• What is a

Patient-Centered Medical Home

?

• What is the

Multi-Payer Demo Project

?

• What are the Benefits for

Me and My

Practice?

“Homework” From Last Time

• Have you:

– Built your

PCMH Team

?

– Started discussing where the

time/manpower

for practice transformation will come from?

– Signed up for

AHEC’s REC services

www.ncahecrec.net

?

at

Today’s Agenda

• What is the

National Committee for Quality Assurance

(NCQA)?

•

How Does NCQA Evaluate

a Practice?

• How Does My Practice

Apply for PCMH

Recognition?

Warning

What Is the National Committee for Quality Assurance (NCQA)?

NCQA

• National Committee on Quality Assurance (NCQA) – 501(c)(3) dedicated to improving health care quality – NCQA offers “recognition” programs for various aspects of clinical care: diabetes, cardiovascular disease, back pain – One of the recognition programs is for PCMH – 3 levels of accreditation: Level 1 (lowest), Level 2, and Level 3 (highest)

Value of PCMH Recognition

• Encourages practices to adopt proven systems for improving care • Provides mechanism for incentivizing investment in quality infrastructure and processes • Complements evaluation of clinical effectiveness, patient experiences, and efficiency

How Does NCQA Evaluate A Practice?

NCQA Lingo

• The metrics that NCQA uses to assess your practice are called

“standards”

• There are

two sets

of standards, one released in

2008

, called

PPC-PCMH

& one released in

2011

, called

PCMH

• 2008 PPC-PCMH has 9 standards & 2011 PCMH has 6 standards

PPC-PCMH (2008) Overview

Standard 1: Access and Communication A.

Access and communication processes B.

Access and communication results Standard 2: Patient Tracking and Registry Functions A.

Basic system for managing patient data B.

C.

D.

E.

F.

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.

Guidelines for important conditions B.

C.

D.

E.

Preventive service clinician reminders Practice organization Care management for important conditions Continuity of care Standard 5: Electronic Prescribing A.

Electronic prescription writing B.

C.

Prescribing decision support - safety Prescribing decision support – efficiency Standard 6: Test Tracking A.

Test tracking and follow up B.

Electronic system for managing tests Standard 7: Referral Tracking A.

Referral tracking Standard 8: Performance Reporting and Improvement A.

Measures of performance B.

C.

D.

E.

F.

Patient experience data Reporting to physicians Setting goals and taking action Reporting standardized measures Electronic reporting to external entities Standard 4: Patient Self-Management Support A.

Documenting communication needs B.

Self-management support Standard 9: Advanced Electronic Communications A.

Availability of interactive website B.

C.

Electronic patient identification Electronic care management support

1.

2.

3.

PCMH (2011) Overview

Enhance Access and Continuity A.

B.

Access During Office Hours Access After Hours C.

D.

E.

F.

G.

Electronic Access Continuity (with provider) Medical Home Responsibilities Culturally/Linguistically Appropriate Services Practice Organization Identify/Manage Patient Populations A.

B.

C.

D.

Patient Information Clinical Data Comprehensive Health Assessment Use Data for Population Management Plan/Manage Care A.

B.

C.

Implement Evidence-Based Guidelines Identify High-Risk Patients Manage Care 3.

4.

5.

6.

Plan/Manage Care (continued) D.

E.

Manage Medications Electronic Prescribing Provide Self-Care and Community Resources A. Self-Care Process B. Referrals to Community Resources Track/Coordinate Care A.

Test Tracking and Follow-Up B.

C.

Referral Tracking and Follow-Up Coordinate with Facilities/Care Transitions Measure and Improve Performance A.

B.

Measures of Performance Patient/Family Feedback C.

D.

E.

F.

Implements Continuous Quality Improvement Demonstrates Continuous Quality Improvement Report Performance Report Data Externally

2008/2011 Comparison

2008 Standards PPC-PCMH 1:

Access & Communication

PPC-PCMH 2:

Patient Tracking and Registry Function

PPC-PCMH 3:

Care Management

PPC-PCMH 4:

Self Management Support

2011 Standards PCMH 1:

Enhance Access & Continuity

PCMH 2:

Identify and Manage Patient Populations

PCMH 3:

Plan and Manage Care

PCMH 4:

Provide Self-Care & Community Support

PCMH 5:

Track and Coordinate Care

PPC-PCMH 5:

Electronic Prescribing

PPC-PCMH 6:

Test Tracking

PPC-PCMH 7:

Referral Tracking

PPC-PCMH 8:

Performance Reporting and Improvement

PPC-PCMH 9:

Electronic Communication

PCMH 6:

Measure and Improve Performance

NCQA Lingo

each “standard” is composed of several “elements” each “element” is composed of several “factors”

“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 • In 2011 Standards, you must pass 6/6 of the “Must Pass” elements to achieve

any

level of recognition.

Reading Each Element

• Description • Scoring • Explanation • Examples & Documentation/Data Source

Supporting Documentation

• NCQA uses the term “data source” to describe the types of materials that you can use to document your practice’s efforts: – Documented Processes (written policies, workflow forms, checklists) – Reports (aggregate data) – Records or Files (actual patient chart/data) – Materials (brochures, guidelines)

Scoring a Standard

• • Each Element in a Standard is worth a certain number of points. To achieve the points, you must complete some (or all) of the factors in that element.

Note:

The actual details of scoring each element depends on that specific element and is

NOT

the same across the board.

Scoring a Standard

For example: 6/6 Element A is worth 4 points and has 6 factors 4-5/6 3/6 1or2/6 0/6 4 points 3 points 2 points 1 point 0 points

Scoring a Standard

For Example: Element B is worth 4 points and has 8 factors >4/8 3/8 2/8 1/8 0/8 4 points 3 points 2 points 1 point 0 points

Point Requirements

Level of Recognition Level I Points Required (2008)

25-49 (5/10 must pass)

Level 2 Level 3

50-74 (10/10 must pass) 75-100 (10/10 must pass)

Points Required (2011)

35-59 (6/6 must pass) 60-84 (6/6 must pass) 85-100 (6/6 must pass)

NCQA’s PCMH Survey Process

1. NCQA receives and evaluates Survey Tool • • Responses, documentation, and explanations Practice may be contacted for clarification 2. On-site audit - 5% of practices 3. Final decision and status determined 4. NCQA grants certificate and recognition packet • • Recognition status posted on NCQA Web site Practices that don’t pass - not reported publicly

How Does My Practice Apply For PCMH Recognition?

Applying for PCMH Recognition

• Interactive Survey Tool ($80) – Self-directed practice assessment • Application (free) – Demographic information • When ready, submit Interactive Survey Tool, Application, and final application fee

NCQA’s Interactive Survey System (ISS)

• ISS is the web-based

application program

• The practice uses ISS (also called the “Survey Tool”) for: – Entering responses to each factor for each element – Attaching documents and providing text to support the responses

Pricing

(including 20% CCNC discount)

Upgrading PCMH Recognition

• Practices achieving Level 1 or 2 can complete an add-on survey to upgrade to a higher level anytime within their 3 year recognition period

Next Steps (Homework)

• Peruse the NCQA “Standards and Guidelines” documents for your version (2008 or 2011) • These are long, but important documents that are the backbone of the recognition process and familiarity with them is CRUCIAL to your success.

Next Steps (Homework)

• Review the requirements for each standard, element and factor – What does the practice already do?

– What does the practice need to create?

– Are there elements the practice clearly does not have in place and will not have in place in time for submission? (e-prescribing, EMR, interactive website)

Next Steps (Homework)

• Organize Your Documents – Create a place on your computer (server or hard-drive) for all of your documentation – You should have a folder for each standard – A checklist can help you determine what you already have created/saved and what you need to prepare from scratch

Next Steps (Homework)

• • Go to NCQA’s website and take advantage of the various (free) training presentations they have available: – 2008 Standards – 2011 Standards – Using the ISS Interactive Survey System – Submitting As a Multi-Site Practice http://www.ncqa.org/tabid/109/Default.aspx

Next Steps (Homework)

• Begin To Think About 3 Important Conditions (e.g. diabetes, asthma, congestive heart failure, depression, etc) that you can track over time – Does your practice already follow evidence based guidelines when caring for patients with these conditions?

– Are these guidelines documented anywhere?

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

NCQA Contact Information

Contact NCQA Customer Support to:

• Order FREE Copy of requirements • Order FREE Application Information • Purchase ISS Tool • 1-888-275-7585 •

Visit NCQA Web Site to:

• View Frequently Asked Questions • View Recognition Programs Training Schedule www.ncqa.org/medicalhome.aspx

Send Questions to:

[email protected]

Questions?

Feel free to contact me: David Halpern, MD, MPH (215) 498-4648 [email protected]