1
Candace J. Chitty
RN, MBA, CPHQ, PCMH-CCE
Your Key to
Online
Compliance
Management
 The patient-centered medical home (PCMH)
model of patient care is one of the mo...
Your Key to
Online
Compliance
Management
The first step toward making the transition to
the PCMH model is to accept that i...
Your Key to
Online
Compliance
Management
Educate yourself about PCMH. PCMH Standards and Guidelines can be obtained
at no ...
Your Key to
Online
Compliance
Management
Your Key to
Online
Compliance
Management
Conduct a readiness assessment (Be realistic)
 2010 MacColl Institute for Health...
Your Key to
Online
Compliance
Management
Your Key to
Online
Compliance
Management
Set an end date based on established
expectations
Important timeframes:
 Getting...
Your Key to
Online
Compliance
Management
Start early and avoid project stall.
Establish project team.
Establish project te...
Your Key to
Online
Compliance
Management
Your Key to
Online
Compliance
Management
Your Key to
Online
Compliance
Management
NCQA has divided the PCMH model into a set of six standards:
Enhance Access and C...
Your Key to
Online
Compliance
Management
Each of these standards is sub-divided into
elements, some of which are ―must-pas...
Your Key to
Online
Compliance
Management
 Critical Factors: 5 of the 6 standards also include a
element containing 1 or 2...
Your Key to
Online
Compliance
Management
NCQA provides several recognition levels,
enabling practices with a range of capa...
Your Key to
Online
Compliance
Management
Question: How many points would your practice
receive if you respond “Yes” to 1, ...
Your Key to
Online
Compliance
Management
 Institute for Healthcare Improvement (www.ihi.org)
 National Committee For Qua...
Your Key to
Online
Compliance
Management
19
Your Key to
Online
Compliance
Management
20
Your Key to
Online
Compliance
Management
21
Your Key to
Online
Compliance
Management
22
23
Mark your
Calendars.
Tuesday July 9th.
The next session in
the PolicyPLUS PCMH
Webinar Series:
Standard Talk –
From Eas...
PolicyPLUS PCMH Series, Webinar 1 - What Can I Expect
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PolicyPLUS PCMH Series, Webinar 1 - What Can I Expect

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The patient-centered medical home (PCMH) model of patient care is one of the most widely discussed topics in the health care industry.
The term “patient-centered medical home” appears in the Affordable Care Act more than 80 times, an indicator of the federal government’s interest in this model.
There are over 5,000 NCQA recognized practices.

The first step toward making the transition to the PCMH model is to accept that it won’t happen overnight, though it can happen more quickly if a practice has help along the way.
Setting realistic expectations
Timeline setting from Start to Finish
Project Management Strategies
What’s the Point? – Understanding the NCQA PCMH scoring methodology

Our speaker Candace J. Chitty, BSN, MBA, CPHQ, PCMH-CCE is a NCQA PCMH reviewer and an expert in the NCQA patient centered medical home model and recognition process

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PolicyPLUS PCMH Series, Webinar 1 - What Can I Expect

  1. 1. 1 Candace J. Chitty RN, MBA, CPHQ, PCMH-CCE
  2. 2. Your Key to Online Compliance Management  The patient-centered medical home (PCMH) model of patient care is one of the most widely discussed topics in the health care industry.  The term ―patient-centered medical home‖ appears in the Affordable Care Act more than 80 times, an indicator of the federal government’s interest in this model.  There are over 5,000 NCQA recognized practices.
  3. 3. Your Key to Online Compliance Management The first step toward making the transition to the PCMH model is to accept that it won’t happen overnight, though it can happen more quickly if a practice has help along the way. Setting realistic expectations Timeline setting from Start to Finish Project Management Strategies What’s the Point? – Understanding the NCQA PCMH scoring methodology
  4. 4. Your Key to Online Compliance Management Educate yourself about PCMH. PCMH Standards and Guidelines can be obtained at no charge on the NCQA Website. NCQA trainings are highly recommended. Links to additional resources are available through NCQA’s website, such as: American Academy of Family Physicians (AAFP): • Joint Principles of the Patient-Centered Medical Home • Road to Recognition—Your Guide to the NCQA Medical Home19 American Academy of Pediatrics (AAP): • How to Become a Medical Home • AAP and the Medical Home Model American College of Physicians (ACP)  Understanding and Running a Patient-Centered Medical Home TransforMED, a subsidiary of AAFP, was awarded the initial National Demonstration Project for PCMH in 2006. It offers several tools and services and conducts an annual PCMH Conference with the Medical (www.transformed.com) Group Management Association (MGMA). (www.mgma.com) Safety Net Medical Home Initiative (www.safetynetmedicalhome.org) Patient Centered Primary Care Collaborative (www.pcpcc.net)
  5. 5. Your Key to Online Compliance Management
  6. 6. Your Key to Online Compliance Management Conduct a readiness assessment (Be realistic)  2010 MacColl Institute for Healthcare Innovation, Group Health Cooperative  http://www.commonwealthfund.org/Resources/2010/~/med ia/Files/Resources/2011/PCMHA%20PUBLIC%20110511.pdf What is the organization’s goal and objectives for seeking PCMH Recognition? Are there pre-established or required expectations from outside influencers? What resources are available to support the project? Are any of our software applications NCQA pre- validated?
  7. 7. Your Key to Online Compliance Management
  8. 8. Your Key to Online Compliance Management Set an end date based on established expectations Important timeframes:  Getting Started: 1-2 months (Putting the team in place and establishing roles and responsibilities)  Preparation: 4-8 months  Document Preparation and Submission – 80 hours
  9. 9. Your Key to Online Compliance Management Start early and avoid project stall. Establish project team. Establish project team meeting frequency and keep notes of progress in minutes or in the project plan Identify a project lead who is a content expert. Know the standards and documentation requirements. Create project management tools (Project plan, document tracking system, shared folders) Consider a staged approach. Set priorities for tasks based on expected time to complete or required time periods such as seen below. Recognize important timeframes in PCMH standards and guidelines:  Report Requirements: A minimum of 3 months  Documented Processes: A minimum of 3 months.  Application Process – 1 month  Reach out to others
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  11. 11. Your Key to Online Compliance Management
  12. 12. Your Key to Online Compliance Management NCQA has divided the PCMH model into a set of six standards: Enhance Access and Continuity. (20 pts) The practice provides access to culturally and linguistically appropriate routine care and urgent team-based care that meets the needs of patients/families. Identify and Manage Patient Populations. (16 pts)The practice systematically records patient information and uses it for population management to support patient care. Plan and Manage Care. (17 pts) The practice systematically identifies individual patients and plans, manages, and coordinates their care based on their condition and needs and on evidence-based guidelines. Provide Self-Care and Community Support. (9 pts) The practice acts to improve patients’ ability to manage their health by providing a self-care plan, tools, educational resources, and ongoing support. Track and Coordinate Care. (18 pts)The practice systematically tracks tests and coordinates care across specialty care, facility-based care, and community organizations. Measure and Improve Performance. (20 pts) The practice uses performance data to identify opportunities for improvement and acts to improve clinical quality, efficiency, and patient experience.
  13. 13. Your Key to Online Compliance Management Each of these standards is sub-divided into elements, some of which are ―must-pass.‖ Each element is worth a set number of points, with a maximum of 100 points possible across all elements. A practice must score over 50% of the total possible points for each standard, as well as achieving the ―must pass‖ elements, in order to be awarded PCMH recognition.
  14. 14. Your Key to Online Compliance Management  Critical Factors: 5 of the 6 standards also include a element containing 1 or 2 critical factors. Critical factors. Meeting these factors are required for practices to receive more than minimal or, for some factors, any points.  NA: Many elements include NA options. A NA response counts as a ―Yes‖ when scoring.  Scoring: The level of performance the practice must demonstrate to receive a specified percentage of element points. Each element has up to five possible scoring levels (100%, 75%, 50%, 25%, 0%).
  15. 15. Your Key to Online Compliance Management NCQA provides several recognition levels, enabling practices with a range of capabilities to achieve PCMH recognition. A practice’s PCMH recognition level is determined by the number of points achieved:  Level 1: 35-59 points (and six must-pass elements)  Level 2: 60-84 points (and six must-pass elements)  Level 3: 85-100 points (and six must-pass elements)
  16. 16. Your Key to Online Compliance Management Question: How many points would your practice receive if you respond “Yes” to 1, 4 and 5?
  17. 17. Your Key to Online Compliance Management  Institute for Healthcare Improvement (www.ihi.org)  National Committee For Quality Improvement (www.ncqa.org)  Agency for Healthcare Research and Quality –PCMH Resource Center (http://www.pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483)  Community Health Association of Mountain/Plains States http://www.champsonline.org/ToolsProducts/CrossDiscResources/PCMH.html  Health Team Works (www.healthteamworks.org)  Primary Care Development Association (www.pcdc.org)  The Joint Commission – PCMH (http://www.jointcommission.org/accreditation/pchi.aspx)  AAAHC PCMH  (https://www.aaahc.org/accreditation/primary-care-medical-home/)  URAC PCHCH (https://www.urac.org/pchch/)  AAFP PCMH Videos (http://www.aafp.org/practicemanagement/pcmh/overview/videos.html)
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  22. 22. 23 Mark your Calendars. Tuesday July 9th. The next session in the PolicyPLUS PCMH Webinar Series: Standard Talk – From Easy to Difficult Thank you for participating in the PolicyPLUS PCMH Webinar series. If you have any comments or additional questions please do not hesitate to contact us at: CJChitty@Qfhc.com RChitty@Qfhc.com www.Qfhc.com www.Qfms.org Questions & Answers

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