Transcript Slide 1

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 at
www.ncahecrec.net?
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
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
PCMH (2011) Overview
1.
Enhance Access and Continuity
A.
B.
C.
D.
E.
F.
G.
2.
Identify/Manage Patient Populations
A.
B.
C.
D.
3.
Access During Office Hours
Access After Hours
Electronic Access
Continuity (with provider)
Medical Home Responsibilities
Culturally/Linguistically Appropriate Services
Practice Organization
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.
Plan/Manage Care (continued)
D.
E.
4.
Manage Medications
Electronic Prescribing
Provide Self-Care and Community
Resources
A. Self-Care Process
B. Referrals to Community Resources
5.
Track/Coordinate Care
A.
B.
C.
6.
Test Tracking and Follow-Up
Referral Tracking and Follow-Up
Coordinate with Facilities/Care
Transitions
Measure and Improve Performance
A.
B.
C.
D.
E.
F.
Measures of Performance
Patient/Family Feedback
Implements Continuous Quality
Improvement
Demonstrates Continuous Quality
Improvement
Report Performance
Report Data Externally
2008/2011 Comparison
2008 Standards
2011 Standards
PPC-PCMH 1: Access & Communication
PCMH 1: Enhance Access & Continuity
PPC-PCMH 2: Patient Tracking and
Registry Function
PCMH 2: Identify and Manage Patient
Populations
PPC-PCMH 3: Care Management
PCMH 3: Plan and Manage Care
PPC-PCMH 4: Self Management Support
PCMH 4: Provide Self-Care &
Community Support
PPC-PCMH 5: Electronic Prescribing
PCMH 5: Track and Coordinate Care
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:
Element A is worth 4 points and has 6 factors
6/6
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
Points Required
(2008)
Points Required
(2011)
Level I
25-49 (5/10 must pass)
35-59 (6/6 must pass)
Level 2
50-74 (10/10 must pass)
60-84 (6/6 must pass)
Level 3
75-100 (10/10 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 evidencebased 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]