Transcript Document

Your Partner in Practice
Is PCMH Right For You?
OP User’s Conference
April 23-25, 2015
© 2015 The Verden Group
Why become a recognized
medical home?
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Why Become a Medical Home?
▪ Improve patient care coordination
▪ Take advantage of incentive payments
▪ Help lower overall healthcare costs
▪ Ensure continued viability in Payer networks
▪ Compete with / prepare for ACO models
▪ Realize ROI on technology investments
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As of 2/2014
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First and Foremost
▪ Do you fully understand the concept?
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Research the guidelines, the benefits and the statistics
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Visit practices who are already medical homes and talk to colleagues
about the practicalities of it
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A medical home is not just a reimbursement model!
Read the Joint Principles of a Medical Home Visit
http://medicalhomeinfo.org/downloads/pdfs/JointStatement.pdf
▪
Will it be financially worthwhile?
• Maybe! Depends upon region and Payer mix
•
Biggest benefit is streamlined practice operations and continued
viability in this new ‘era’
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PCMH Payment Models
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Relationship Between Payment Methods
and Organizational Models
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About the 2014 Standards
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Key Components of PCMH*
▪ Personal Clinician
➢ First contact, continuous, comprehensive, care team
▪ Whole Person Orientation
➢ All patient health care needs; all stages of life; acute;
chronic; preventive; end of life
▪ Coordinated
➢ When and where needed/wanted; culturally and
linguistically appropriate; use information technology
* Based on The Joint Principles
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Focus of 2014 PCMH Standards
▪ More emphasis on team-based patient care
▪ Care management focus on high-need
populations
▪ Alignment of quality improvement activities
▪ Reinforces incentives for meaningful use (HIT)
▪ Further integration of behavioral health
▪ Sustained transformation
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PCMH & MU
▪ NCQA emphasizes HIT because highly effective
primary care is information-intensive
▪ PCMH 2014 reinforces incentives to use HIT to
improve quality
▪ Stage 2 Meaningful Use language is embedded in
PCMH 2014 standards
▪ Synergy: PCMH 2014 Recognized medical
practices are well-positioned to qualify for
meaningful use, and vice versa
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PCMH 2014 / MU
✓
Only 3 Objectives are new in MU2 versus
MU1 for PCMH
✓
10 MU2 Objectives for PCMH have increased
the percentages required over MU1
✓
PCC MU1 reports can be used for MU2
requirements – just
meet the increased
percentages
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PCMH 2014 Content and Scoring
Must Pass Elements require a >50% performance level to pass
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MUST PASS ELEMENTS
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1A: Patient Centered Appointment Access
2D: The Practice Team
3D: Use of Data for Population Management
4B: Care Planning and Self-Care Support
5B: Referral Tracking and Follow-Up
6D: Implement Continuous Quality Improvement
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CRITICAL FACTORS
▪ Required to receive more than minimal or, for some
factors, any points
▪ Identified in the scoring section of the element
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DOCUMENTATION TYPES
▪ Documented process
➢ Written procedures, protocols, processes, workflow forms (not
explanations); these should show the practice name and date of
implementation
▪ Reports
➢ Aggregated data showing evidence
▪ Records or files
➢ Patient files or registry entries documenting action taken; data
from medical records for important conditions
▪ Materials
➢ Information for patients or clinicians, e.g. clinical guidelines,
self-management and educational resources
NOTE: Screen shots or electronic “copy” may be used as examples (EHR capability), materials (Web site
resources), reports (logs) or records (advice documentation)
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DOCUMENTATION TIME PERIODS
▪ Report Data, Files, Examples and Materials
➢ Should display information that is current within the last 12
months
▪ Documented Process
➢ Policies, procedures and processes should be in place for at
least 3 months prior to survey submission
▪ Reporting Period (Meaningful Use)
➢ 12 months, or 3 months if 12 months is not available
▪ Reporting Period (Log or Report)
➢ Refer to documentation guidelines for other references to
minimum data for logs and reports (one week, one month, etc.)
** ALL DOCUMENTS NEED TO SHOW DATES **
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Vulnerable & High Risk Populations
“Those who are made vulnerable by their financial circumstances or place of
residence, health, age, personal characteristics, functional or developmental
status, ability to communicate effectively, and presence of chronic illness or
disability.” - AHRQ
High Risk:
High-risk patients with clinical conditions and other factors that could
lead to poor outcomes for those conditions. E.G. premies, downs, etc
Vulnerable:
Characteristics that could lead to different access or quality of care
➢ Look for disparities in care/service. E.G. Lack of transport, money
➢ Vulnerable patients need not have current clinical conditions
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The 2014 Standards
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PCMH 1: Patient-Centered Access
Intent of Standard
The practice provides access
to team-based care for both
routine and urgent needs of
patients/families/care-givers
at all times
• Patient-centered
appointment access
•24/7 Access to clinical advice
• Electronic access
Meaningful Use
Alignment
• Patients receive
electronic:
- On-line access to
their health
information
- Clinical summaries
of office visits
- Secure messages
from the practice
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PCMH 2: Team-Based Care
Intent of Standard
The practice provides continuity of care using
culturally and linguistically appropriate, teambased approaches.
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PCMH 3: Population Health Management
Intent of Standard
The practice uses a
comprehensive health
assessment and evidencebased decision support
based on complete patient
information and clinical
data to manage the health
of its entire patient
population
Meaningful Use Alignment
•Practice has searchable
electronic system:
- Race/ethnicity/preferred
language
-Clinical information
•Practice uses clinical
decision support and
electronic system for
patient reminders
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PCMH 4: Care Management and Support
Intent
Meaningful Use Alignment
The practice systematically
identifies individual patients
and plans, manages and
coordinates care, based on
need.
• Practice implements
evidence-based
guidelines
• Practice reviews and
reconciles medications
with patients
• Practice uses eprescribing system
• Patient-specific
education materials
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PCMH 5: Care Coordination and Care Transitions
Intent of Standard
Meaningful Use Alignment
• Track and follow-up on
all lab and imaging
results
• Incorporate clinical lab
test results into the
medical record
• Track and follow-up on
all important referrals
• Electronically exchange
clinical information with
other clinicians and facilities
• Coordination of care
patients receive from
specialty care, hospitals,
other facilities and
Community organizations
• Provide electronic
summary of care record
for referrals and care transitions
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PCMH 6: Performance Measurement and
Quality Improvement
Intent of Standard
• Uses performance data to
identify opportunities for
improvement
• Acts to improve clinical
quality, efficiency
• Acts to improve patient
experience
Meaningful Use Alignment
Practice uses certified EHR to:
• Protect health information
• Generate preventive and
follow-up care reminders
• Submit electronic data to
registries
• Submit electronic syndromic
surveillance data
• Identify and report cases
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Submission & Beyond
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Standard Pricing – as of June 2014
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Multi-Location
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Multi-Location – cont.
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Multi-Location Fees
+
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What Happens After Submission?
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Payment for Recognition
You’ve got the recognition, now get paid!
▪ Find out what programs are available to you (if you
don’t ask, you don’t get)
▪ If they don’t have an identified path, educate them and
leverage your recognized medical home status
▪ Negotiate new contracts for enhanced fees, permember-per-month payments, and quality performance
bonuses
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Is It Worth It?
Who Is Doing What?
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Aetna = PMPM ($3)
UHC = PBC (1-2%)
Cigna = Peds coming 2015?
Blues = Homegrown
programs for Peds
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NCQA PCMH INFORMATION
NCQA Web Site
NCQA General Information:
http://www.ncqa.org/Home/PatientCenteredMedicalHome.aspx
Standards:
http://store.ncqa.org/index.php/recognition/2014-pcmh-standardsand-guidelines-epub-single-user.html
Purchase Survey Tool ($80)
http://store.ncqa.org/index.php/recognition/2014-pcmh-survey-toolweb-based.html
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Q&A
Contact Information
The Verden Group, Inc
Your Partner in Practice
www.TheVerdenGroup.com
Susanne Madden, MBA, NCQA CEC
[email protected]
Julie Wood, MSc, NCQA CEC
[email protected]
© 2015 The Verden Group