Your SlideShare is downloading. ×
Patient-Centered Medical Home (PCMH)
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Introducing the official SlideShare app

Stunning, full-screen experience for iPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Patient-Centered Medical Home (PCMH)

103
views

Published on

Published in: Health & Medicine

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
103
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
3
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1.         Pa$ent-­‐Centered  Medical  Home  (PCMH)   Wednesday,  January  22,  2014     Disclaimer:  Nothing  that  we  are  sharing  is  intended  as  legally  binding  or  prescrip7ve  advice.  This  presenta7on  is  a   synthesis  of  publically  available  informa7on  and  best  prac7ces.  
  • 2. PCMH  -­‐  Overview   •  Transforma*ve  model  for  delivery  of  care   •  Espouses  team-­‐based  approach   –  Comprehensive  and  con*nuous  pa*ent-­‐driven   care   –  Evidence  based  healthcare  and  best  prac*ces   –  Consistent  high  quality  care   •  Rela*onship-­‐based   •  Whole  person   •  Team-­‐based    
  • 3. Transforma*ve  Care  Model   •  Change  from  tradi*onal  doctor-­‐centered   medical  prac*ce   •  Care  coordina*on   –  Health  Informa*on  Technology   –  Data-­‐driven  decision-­‐making   –  Appropriate  staff  development   •  Con*nuous  quality  improvement   •  Policies  and  procedures  
  • 4. What  Transforma*on  Looks  Like   •  Constant  innova*on   •  Key  data  measurement  and  improvement   targets   •  Capitalizing  the  benefits  of  EHRs   •  Regular  pa*ent  communica*on   •  Proac*vely  scheduled  pa*ent  follow  up   •  Expanded  access  to  care   •  Pa*ent  care  plan  coordina*on  
  • 5. Why  Consider  Becoming  a  PCMH?   •  Improved  outcomes   •  Improved  pa*ent  sa*sfac*on   •  Improved  pa*ent  accessibility   –  Informa*on   –  Same  day  appointments   –  APer  hours   –  Remote   –  Culturally  and  Linguis*cally  Appropriate  Service   (CLAS)   –  Follow  up   •  Improved  professional  sa*sfac*on  
  • 6. Financial  Incen*ves  
  • 7. Seeking  Recogni*on   •  Na*onal  CommiUee  for  Quality  Assurance   (NCQA)   •  The  Joint  Commission   •  Accredita*on  Associa*on  for  Ambulatory   Health  Care  (AAAHC)   •  Others   –  Private  Insurers   –  Employers   –  State  en**es  
  • 8. NCQA  Recogni*on  Program   •  Third  genera*on  of  qualifica*on  standards   –  2008   –  2011     –  2014   •  Pilo*ng  Pa*ent-­‐Centered  Specialty  Program   –  2013   •  High  volume   –  20-­‐30  applica*on  submissions  per  week  to   approximately  100  per  week    
  • 9. NCQA  Recogni*on  Criteria   •  Points-­‐based  recogni*on   Points   Recogni$on   <  35   None   35  –  59     Level  1   60  –  84     Level  2   >  85   Level  3  
  • 10. NCQA  Recogni*on  Criteria   •  Six  Standards   –  Access  and  con*nuity   –  Iden*fy  and  manage  pa*ent  popula*ons   –  Plan  and  manage  care   –  Provide  self  care  support  and  community   resources   –  Track  and  coordinate  care   –  Measure  and  improve  performance  
  • 11. NCQA  Recogni*on  Criteria   •  28  Elements   –  Six  “must-­‐pass”     •  PCMH  1:  Element  A:  Access  During  Office  Hours   •  PCMH  2:  Element  D:  Use  Data  for  Popula*on   Management  Element     •  PCMH  3:  Element  C:  Care  Management   •  PCMH  4:  Element  A:  Support  Self-­‐Care  Process   •  PCMH  5:  Element  B:  Referral  Tracking  and  Follow-­‐Up   •  PCMH  6:  Element  C:  Implement  Con*nuous  Quality   Improvement      
  • 12. NCQA  Recogni*on  Criteria   •  152  Factors   –  Nine  cri*cal  factors   •  •  •  •  •  •  •  •  •  PCMH1A,  Factor  1:  Same-­‐day  appointments   PCMH  1B,  Factor  3:  Clinical  advice  by  phone   PCMH  1G,  Factor  2:  Regular  team  mee*ngs   PCMH  3A,  Factor  3:  Evidence-­‐based  guidelines  for  unhealthy   behaviors   PCMH  3D,  Factor  1:  Medica*on  reconcilia*on   PCMH  3E,  Factor  2:  ePrescribing   PCMH  4A,  Factor  3:  Self-­‐management  goals   PCMH  5A,  Factor  1:  Track  lab  results   PCMH  5A,  Factor  2:  Track  imaging  results  
  • 13. NCQA  Recogni*on  Process   •  Complete  self-­‐assessment  to  iden*fy  gaps   •  Ensure  all  P&Ps  were  in  effect  for  at  least  90   days   •  Run  reports   •  Collate  all  suppor*ng  documents   •  Submit  applica*on  
  • 14. Challenges  of  Becoming  a  PCMH   •  Transforming  the  prac*ce’s  leadership   •  Teamwork   –  ShiP  from  “doctor  as  the  hero”   •  Knowing  when  to  seek  help    
  • 15. Common  Myths  About  Becoming  a   PCMH   •  •  •  •  •    Transform  as  you  go   You  must  have  an  EHR   You  must  have  a  pa*ent  portal   Once  you’re  recognized,  your  done   You  need  special  repor*ng  tools  for  PCMH  
  • 16. The  Future  of  PCMH   •  Pa*ent-­‐Centered  Medical  Neighborhood   –  Bidirec*onal  communica*on,  coordina*on,  and   integra*on   –  Consulta*ons  and  referrals   –  Flow  of  pa*ent  care  informa*on   –  Responsibility  in  co-­‐management   –  Support  pa*ent-­‐centered  care,  enhanced  access,   and  care  quality   –  Support  whole-­‐person  primary  care    
  • 17. What’s  Next?       January  29,  2014   –  Accountable   Care   Organiza*ons   (ACOs)   February  5,  2014   –  Physician   Quality   Repor*ng   System  (PQRS)  
  • 18. Q&A       dan.holleran@quirkhealthcare.com     tamina.vahidy@quirkhealthcare.com