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Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
Practice transformation leading to pcmh designation
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Practice transformation leading to pcmh designation

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URAC’s …

URAC’s
Patient Centered Health Care Home (PCHCH)
Practice Achievement Program

Published in: Health & Medicine
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  • 1. URAC’s Patient Centered Health Care Home (PCHCH) Practice Achievement Program This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions.
  • 2. Agenda  URAC’s Patient Centered Health Care Home (PCHCH) • Definition of PCHCH • IOM’s Quality Aims • Focus of the PCHCH Program  URAC PCHCH Practice Achievement Program • The URAC Difference • Practice Achievement Levels • Modules and Standards • Eligibility Requirements • How To Get Started • Onsite Review Process • A URAC PCHCH Success Story This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 2
  • 3. PCHCH Definition URAC Patient Centered Health Care Home (PCHCH) • A quality driven, interdisciplinary clinician-led team approach to delivering and coordinating care that puts patients, family members, and personal caregivers at the center of all decisions concerning the patient’s health and wellness. • A PCHCH provides comprehensive and individualized access to physical health, behavioral health, and supportive community and social services, ensuring patients receive the right care in the right setting at the right time. This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 3
  • 4. Central to the PCHCH Approach Quality Aims How URAC PCHCH Standards Promote IOM Quality Aims Registry, Medication Reconciliation, Transitions of Care, Privacy and 1. Safe Security Evidence Based Guidelines, Wellness Promotion and Quality Management 2. Effective Programs Individualized Focus, Informed Decision-Making, Patient Satisfaction, 3. Patient-centered Consumer Education, Health Literacy Lab Values, Requests for Health Information and Enhanced Coordination 4. Timely of Care Organizational Structure, Policies and Procedures, Electronic Health 5. Efficient Record and Total Quality Management Disparity, Cultural Sensitivity, Complaint Process and Coordination with 6. Equitable the Payor This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 4
  • 5. Focus On Health Care Not Limited to Disease Focus on whole Care coordination person, not just is enhanced illness Accommodating Wellness modules health literacy Formation of Respect for Patient-Provider cultural Agreement differences/needs This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 5
  • 6. URAC PCHCH Practice Achievement Program This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 6
  • 7. Focus  URAC’s PCHCH Practice Achievement focuses on evaluating practices on the Joint Principles of the Patient Centered Medical Home* including: • Access • Coordination • Quality • Patient Centeredness *American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP) American Osteopathic Association (AOA) This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 7
  • 8. The URAC Difference  Flexible stepwise process for supporting the transformation of practices to patient centered health care homes  Recognizes different levels of functioning as practices evolve  Educational, non-prescriptive  Patient-centric  Two levels of achievement  Multiple resources and programs available to support practices  Two year certificate awarded to practice  Onsite review verification This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 8
  • 9. Defining the Practice Achievement Levels Achievement Attain an overall score of 65% (or higher) Meet all of the 7 mandatory standards at least “partially in place” Compliance with medical record review Achievement with Electronic Health Record (EHR) Attain an overall score of 65% (or higher) Meet all of the 7 mandatory standards at least “partially in place” Compliance with medical record review “Fully” meet all elements aligned to Meaningful Use requirements (15 Core and 10 Menu) This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 9
  • 10. Modules and Standard Categories  The URAC PCHCH Practice Achievement program is grouped into modules and standard categories which represent various health care functions. Each of the standard categories have PCHCH standards that correspond with elements (tasks) to complete. This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 10
  • 11. Program Description - Modules  7 modules represents various healthcare functions essential to primary care • Core Quality Care Management • Patient-Centered Operations Management • Access and Communication • Testing and Referrals • Care Management and Coordination • Advanced Electronic Capability • Quality Performance Reporting and Improvement This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 11
  • 12. Core Quality Care Management  Standard Category is Organizational Core (COR) Goal is to establish basic organizational, cultural training and systems, and operational requirements which support a successful PCHCH model of patient engagement and care delivery and follow-up. This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 12
  • 13. Patient-Centered Operations Management  Standard Category is Patient Registry (PR) Goal is to establish a comprehensive patient registry to optimally manage a population of patients, improve health status, and ultimately lower health care cost. Registry allows Practice to identify care gaps and needed preventive, wellness, and follow-up services. This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 13
  • 14. Access and Communications Standard Category is Access to Services (ATS) Goal is to ensure all patients have comprehensive and timely access to health care services that are patient centered, culturally sensitive, and delivered in the least intensive and most appropriate setting based on the patients needs. Standard Category is Community Services and Resources (CSR) Goal is to help Patients connect with needed community services and resources by implementing processes that coordinate care between the PCHCH, community services agencies, family, care givers, and the patients. This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 14
  • 15. Testing and Referrals  Standard Category is Managing Tests and Results (MTR) Goal is to implement a standardized, reliable system to ensure patients receive needed tests and imaging that results are communicated in a timely manner, appropriate follow-up care is conducted, and each step in the testing and imaging tracking process is properly documented.  Standard Category is Referral Process (RP) Goal is to create a well-coordinated process where PCHCH patients are referred to specialty care in an efficient manner, and both the practice clinicians and specialists receive timely access to the information they need to provide optimal care to the patient. This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 15
  • 16. Care Management and Coordination Standard Category is Wellness and Health Promotion (WHP) Goal is to ensure patients receive all appropriate wellness and preventive services, using screening, active counseling, and outreach efforts to inform and educate patients about the value of preventive care. Standard Category is Individual Care Management (ICM) Goal is to ensure patients with chronic conditions receive organized, planned care from a team of multidisciplinary clinicians, and that patients are empowered to take greater responsibility for their health, leading to improved health status and decreased health care cost. This material is the property of URAC. Any use of this material is subject to ©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 16
  • 17. Care Management and Coordination  Standard Category is Coordination of Care (COC) Goal is to improve patient care by implementing processes that will help clinicians coordinate treatment, communicate with one another, manage health care setting transitions, communicate care options to the patients, and track patient activity.  Standard Category is Self Management Support (SMS) Goal is to implement a comprehensive program that will use patient education tools, informative sessions, and life skills training to offer support to chronic care patients, and to help them manage their condition. This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 17
  • 18. Advanced Electronic Capability  Standard Category is Electronic Communications Portal (ECP) Goal is to implement a patient portal system that will allow clinicians to manage and interact with their patients online. Patients will be able to access their health records online, and the clinician will be able to send reminders and health care literature, and conduct e-visits. This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 18
  • 19. Advanced Electronic Capability  Standard Category is Electronic Prescribing and Dispensing (EPD) Goal is to automate the prescribing and medication reconciliation process, providing alerts for medication and allergy conflicts, Therapeutic equivalent and generic substitution information, stream lining prescription fills and renewals, and providing clinicians with patient-specific coverage and insurance formulary information.  Standard Category is Electronic Health Records (EHR) Goal is to implement Electronic Health Record which integrates patient information from all care sources, within and outside the practice. This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 19
  • 20. Quality Performance Reporting and Improvement  Standard Category is Performance Reporting (PRT) Goal is to implement reporting technology that will allow clinicians to generate point-of-care reports, population-level reports, and trend analyses to identify opportunities for improving care to patients. Regular performance feedback enables clinicians to decrease gaps in care and improve patient outcomes. This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 20
  • 21. PCHCH Practice Achievement Standards and Elements This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 21
  • 22. Eligibility Requirements Applicants for URAC’s PCHCH Practice Achievement must be a legally organized health care practice Practice settings may be in offices, outpatient clinics, or academic affiliated Practice eligibility requires possession of a health care practice license (if permitted by state law), legally organized in accordance with state law and physically located in the United States This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 22
  • 23. URAC PCHCH Standards – Only Publication  The complimentary URAC PCHCH Practice Achievement Standards-Only publication provides a summary overview of the program and the 28 standards • Go to www.urac.org. Click on “Store” in the upper right corner of the URAC homepage. • Click on the right side – Patient Centered Health Care Home Achievement Standards. Check the box next to the item that you would like to purchase. Scroll to the bottom and add to cart. Proceed to checkout. Follow directions to download the document. • The fifty “optional” standards are included in the last section of the publication. This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 23
  • 24. Getting Ready  Review the complimentary URAC PCHCH Practice Achievement Standards-Only publication prior to purchasing the URAC PCHCH Practice Achievement application  Attend a URAC PCHCH Practice Achievement Workshop  Listen to the eLearning webinars  Participate in conferences and discussion groups  Sign-up for the complimentary Medical Home Today™ Newsletter  Read the PCHCH links on the URAC website at www.urac.org/pchch This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 24
  • 25. URAC PCHCH Practice Achievement Application  Purchase the URAC PCHCH Practice Achievement application • Go to www.urac.org/pchch. Click on “Purchase an application”. Scroll to where you see a listing of practices by size. Click on the size that best suits your practice. • You must purchase an application for each site you wish to apply for Achievement. You may do this by updating the quantity after you have added the Achievement Product to your cart. • Click the check box next to the item you would like to purchase. Scroll to the bottom and add to cart. Proceed to checkout and follow directions. This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 25
  • 26. Example of a Mandatory StandardPCH-PA 11: Referral Process (RP) Track and Follow-Up on Referral:The Practice employs the following mechanisms to track and follow-up on referrals to clinicians outside thePractice and: [--](a) Provides the patient and/or caregiver and referral clinician with the reason for the consultation andpertinent clinical findings; [4](b) Tracks referrals electronically (preferably) and determines if and when the patient was seen by thespecialist; [4](c) Documents the referral dates in the health record; [4](d) Conducts follow-up to obtain a report from the referral clinician; and [4](e) Contacts patient for follow-up if necessary based upon report from specialist. [4]Once the PCHCH Practice Achievement Application has beenpurchased, the applicant receives the Practice Achievement Guide:1- Interpretive Information/Points to Remember2- Materials for Review3- Related Interviews3- Agenda4- Checklist and additional information This material is the property of URAC. Any use of this material is subject to ©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 26
  • 27. Six Months to Completion  Within the six months the application is purchased • Practices must submit an executed achievement agreement and practice demographic preliminary background information to URAC via the electronic application prior to the onsite process • The practice prepares the appropriate documents for the auditor o Practices should have their policies, procedures, protocols and workflows flagged at important information • Complete the PCHCH Practice Achievement Standards Checklist o The practice will check off what they have in place • An onsite review is scheduled This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 27
  • 28. Selecting an Auditor A practice has a choice for their onsite auditor  URAC PCHCH Certified Auditor • Organization that met URAC Core Accreditation and Business Associate Requirements and • Validated by URAC to review practices and submit data • Note: The URAC website directory lists the PCHCH Certified Auditors https://www.urac.org/pchchDirectory/DirectorySearch.aspx  URAC Reviewer An auditor code is provided to the practice on the Summary page after the application is submitted. Give that code to your auditor of choice. This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 28
  • 29. Onsite Review Process  The auditor will need a copy of the completed PCHCH Practice Achievement Standards Checklist at least 1-3 weeks prior to the onsite visit for review  Review dates are agreed upon between the auditor and the practice  The review will require a 1-2 day visit, but the practice does not need to close  The agenda explains who needs to be with the auditor each hour and what will be reviewed during each time period  To help things run smoothly, identify a main contact for the review and a staff member to act as a “driver” for the various review processes  The completed audit tool will be submitted to URAC for review. URAC will make a decision within 90 days  The URAC PCHCH Practice Achievement is given for 2 years. The practice is awarded the URAC PCHCH Practice Achievement seal and placed in the URAC Directory This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 29
  • 30. A URAC PCHCH Success Story Country Creek Pediatrics in Rochester, Michigan became the first practice to attain URAC PCHCH Practice Achievement. “Our URAC PCHCH Practice Achievement is a valuable recognition of the work we have put into delivering quality, patient centered health care to our entire population. The URAC onsite auditors were friendly, professional, well-prepared and considerate of our schedule. We look forward to a continued relationship with URAC as we move to the future of patient centered health care.” Dr. Rozmiej “Working on our URAC PCHCH Practice Achievement helped us to fine tune our policies and procedures to better address staff training, cultural diversity and literacy levels of our patient population. Since we were already operating as a patient centered medical home, we had many of the URAC Standards already in place. The URAC PCHCH Practice Achievement Guide was an invaluable tool for preparing us for the actual onsite review.” Patient Care Coordinator This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 30
  • 31. Learn more about URAC PCHCH at www.urac.org/pchch Learn more about Practice Transformation Institute (PTI) at www.transformcoach.org Contact Mike at mmellor@transformcoach.org or 248.475.4867 with your auditor code to schedule an onsite review This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 31
  • 32. This material is the property of URAC. Any use of this material is subject to©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 32

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