Transcript PRESENTATION TITLE HERE YOUR NAME YOUR TITLE

~ HIT Investment and Quality Outcomes~
The Patient-Centered Medical Home
National Committee for Quality Assurance
NCQA
Our Mission
• To improve the quality of health care
Our Methods
• Measurement
We can’t improve what we don’t measure
• Transparency
We show how we measure, so measurement will be
accepted
• Accountability
Once we measure, we can expect and track progress
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Outcomes and PCMH
• Some Examples:
– $10 PMPM reduction in total costs; total PMPM cost $488 for PCMH patients vs.
$498 for control patients (p=.076).
– 16% reduction in hospital admissions (p<.001); 5.1 admissions per 1,000 patients
per month in PCMH patients vs. 5.4 in controls. $14 PMPM reduction in inpatient
hospital costs relative to controls. 29% reduction in emergency department use
(p<.001); 27 emergency department visits per 1,000 patients per month in PCMH
patients vs. 39 in controls. $4 PMPM reduction in emergency department costs
relative to controls.
– Geisinger has estimated in unpublished reports an ROI of more than 2 to 1 for its
investment in its PCMH model, and is spreading the ProvenHealth Navigator
PCMH model throughout the Geisenger Health System.
• Statistically significant improvements in quality of preventive (74.0% improvement),
coronary artery disease (22.0%) and diabetes care (34.5%) for PCMH pilot practice
sites.
Source: http://www.pcpcc.net/files/evidence_outcomes_in_pcmh_2010.pdf
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PPC-PCMH & PCMH SITES BY STATE
*As of 08/31/12
WA
ND
MT
VT
NH
MN
OR
WI
SD
ID
MI
IA
PA
NE
UT
CA
IL
CO
KS
OH
IN
MA
NY
WY
NV
ME
RI
CT
NJ
DE
MD
WV
MO
VA
KY
NC
TN
AZ
NM
OK
AR
SC
MS
AL
GA
0 Sites
LA
TX
1-20 Sites
FL
AK
21-60 Sites
61-200 Sites
HI
4772 Sites
22565 Clinicians
201+ Sites
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PCMH 2011 Content and Scoring
PCMH 1: Enhance Access and Continuity
Pts
A.
B.
C.
D.
E.
F.
G.
4
4
2
2
2
2
4
Access During Office Hours**
Access After Hours
Electronic Access
Continuity (with provider)
Medical Home Responsibilities
Culturally/Linguistically Appropriate Services
Practice Organization
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PCMH 2: Identify and Manage Patient
Populations
Pts
A.
B.
C.
D.
3
4
4
5
PCMH 4: Provide Self-Care and Community
Resources
Pts
A.
B.
6
3
Support Self-Care Process**
Provide Referrals to Community Resources
9
PCMH 5: Track and Coordinate Care
Pts
A.
B.
C.
6
6
6
Track Tests and Follow-Up
Track Referrals and Follow-Up**
Coordinate with Facilities/Care Transitions
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PCMH 6: Measure and Improve Performance
Pts
4
4
16
A.
B.
C.
PCMH 3: Plan and Manage Care
Pts
D.
A.
B.
C.
D.
E.
4
3
4
3
3
E.
F.
G.
Patient Information
Clinical Data
Comprehensive Health Assessment
Use Data for Population Management**
Implement Evidence-Based Guidelines
Identify High-Risk Patients
Care Management**
Medication Management
Use Electronic Prescribing
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Measure Performance
Measure Patient/Family Experience
Implement Continuous Quality
Improvement**
Demonstrate Continuous Quality
Improvement
Report Performance
Report Data Externally
Use Certified EHR Technology
4
3
3
2
20
Optional Patient Experiences Survey
**Must Pass Elements
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Meaningful Use of Health
Information Technology (HIT)
• NCQA emphasizes HIT because good primary
care is information-intensive
• PCMH 2011 reinforces incentives to use HIT to
improve quality
• Meaningful Use language is embedded, often
verbatim, in PCMH 2011 evaluation standards
• Synergy/virtuous cycle: PCMH 2011 medical
practices will be well prepared to qualify for
meaningful use, and vice versa
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NCQA’s PCMH* and Meaningful Use
~ Powerful Synergy ~
Patient-Centered Medical Homes
Build on Meaningful Use
Foundation
* Based on Stage 1 Meaningful Use Requirements
Update to Stage 2 planned
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NCQA’s PCMH 2011 and Meaningful Use
PCMH closely aligned with Stage 1 MU
• Electronic prescribing
• Drug formulary, drug-drug, drug allergy checks
• Maintaining an up-to date problem list of current and active
diagnoses and medications
• Recording demographics on preferred language gender
(sex), race, ethnicity and date of birth
• Recording and charting changes in vital signs
• Recording smoking status
• Reporting ambulatory quality measures
• Implementing clinical decision support rules…
Plan similar alignment with Stage 2 MU
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PCMH 1: Enhance Access and Continuity
Intent of Standard
•
•
•
•
Patient access to routine/urgent
care and clinical advice
during/after hours that are
culturally and linguistically
appropriate
Electronic access
Clinician selected by patient
Team-based care; trained staff
Meaningful Use Criteria
Patients provided electronic:
• Copy of health information
• Clinical summary of visit
• Access to health information
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PCMH 2: Identify/Manage Patient Populations
Intent of Standard
Meaningful Use Criteria
•
• Language, gender (sex), race,
ethnicity, DOB
• Problem list
• Medication list
• Medication allergy list
• Vital signs
• Growth chart (peds.)
• Smoking status
• Lists of patients with specific
conditions for QI, decrease
disparities
• Follow-up reminders for care
•
•
Collects demographic and
clinical data for population
management
Assess/document risks
Create lists; use for point of
care reminders
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PCMH 3: Plan and Manage Care
Intent of Standard
Meaningful Use Criteria
•
• Clinical decision support
• Medication reconciliation with
transitions of care
• E-prescribing
• Drug-drug, drug-allergy
checks
• Transmit prescriptions using
EHR
• Drug-formulary checks
Identify patients with specific
conditions including high-risk
or complex, behavioral
health
• Care management
– Manage care using pointof-care reminders
– Pre-visit planning
– Progress toward goals
– Barriers to treatment goals
• Reconcile medications
• E-prescribing
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PCMH 4: Provide Self-Care/Community Resources
Intent of Standard
Meaningful Use Criteria
• Assess self-management
abilities
• Document self-care plan
• Provide educational tools and
resources
• Counsel on healthy behaviors
• Assess/provide/arrange for
mental health/substance
abuse treatment
• Provide community resources
Patient-specific education
materials
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PCMH 5: Track and Coordinate Care
Intent of Standard
•
•
•
•
•
•
Tracks, follows-up on and
coordinates tests, referrals and
patient care in other facilities
Orders, retrieves and
incorporates into patient
records lab and imaging
results
Establish information exchange
with facilities
Follows up with discharged
patients
E-information exchange
E-summary of care
Meaningful Use Criteria
• Incorporate lab/test results
• Exchange patient information
with other providers (meds/
allergies, tests)
• Provide summary care record
for transitions and referrals
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PCMH 6: Measure and Improve Performance
Intent of Standard
•
•
•
•
Practice uses performance
and patient experience data
to continuously improve
Track utilization measures
Identifies vulnerable
populations
Report data to CMS,
immunization registries, public
health agencies
Meaningful Use Criteria
Report:
• Ambulatory clinical quality
measures to CMS/state
• Immunization data to registries
• Syndromic surveillance data to
public health agencies
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Alignment: Health IT Meaningful Use & NCQA’s PCMH 2011
Domain
MU-only
Family History as
structured data
(Stage 2)
Record and chart vital signs
Record smoking status
Imaging results/ info accessible through EHR
Clinical lab-test results in EHR as structured data
Generate lists of patients by conditions Surveillance data to public health
agencies
Patient Education/
Self Care
Clinical summaries to patients for each visit
Let patients view online, download, transmit health information w/in 4
business days
ID patients for preventive/follow-up reminders
Use EHR to ID/provide patient-specific education
Care Coordination
Summary record for each transition or referral
Med reconciliation from other provider/setting
Medication
Management
Decision Support
Electronic Rx & CPOE for meds, lab & radiology
Use clinical decision support to improve performance on high-priority
health condition
Record demographics as structured data
Disparities
Reporting
Enhance Access and
Continuity
PCMH-only
Protect EHRs/secure electronic messaging
Protecting Privacy
Using Patient
Information
MU-PCMH Alignment
Report to Registries
(Stage 2)
Report clinical quality measures to CMS
Electronic data to immunization registries
Comprehensive Health Assessment
(including family history)
Use Data for Population Management
Plan and Manage Care
Identify High-Risk Patients
Care Management
Measure Patient/Family Experience
Support self-management/behavior change
Care teams coordinate care
Population management
Support self-mgmt/behavior change
Referrals to Community Resources
Referral tracking & follow-up
Performance evaluation & QI
Assess patients; racial/ethnic diversity
Assess language needs
Provide interpretation/bilingual services
Printed materials patients’ languages
Measure and Improve Performance
Same day appointments
Phone/electronic advice
After-hours access
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