Gbpca ncqa pcmh overview 02 22 13 v1
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  • 810 applications approved for ’12-’13 supplemental grant
  • The FQHC Advanced Primary Care Practice Demonstration to test doctors’ teamwork in treating low-income patients at CHCs. Up to 500 FQHCs will be involved in the demonstration. Get more info on this
  • Qualis/MacColl team. We recommend that each member of the team complete the survey individually, and that you meet together to discuss the results and produce a consensus version to submit. If you complete the survey as a team exercise, please indicate the names of persons (e.g., team members) who complete the survey with you. Later on in the survey, you will be asked to describe the process by which you complete the survey. This survey is designed to help systems and provider practices move toward the “state-of-the-art” in delivering patient-centered care in the context of a medical home. The results can be used to help your team identify areas for improvement. At the end of the assessment you will immediately receive your health center’s overall and subscale (e.g., care coordination) scores. DIRECTIONS FOR COMPLETINGTHE ASSESSMENT Before you begin, please review the Change Concepts for Practice Transformation on pages 4–5, then complete the PCMH-A Intake Form below. Begin the assessment on page 6. Answer each item from the perspective of one physical health center site, not at the level of the health center organization. The rows in this form present key aspects of patient-centered care. Each aspect is divided into levels (A through D) showing various stages in development toward a patient-centered medical home.The levels are represented by points that range from 1 to 12.The higher point values within a level indicate that the actions described in that box are more fully implemented. For each row, click on the relevant point value. Review your subscale and overall scores on page 15. These subscale and overall scores are automatically calculated based on the responses entered. Average scores by change concept (subscale scores) and an overall average score are provided. Using the scores to guide you, discuss opportunities for improvement.
  • These are the technical process steps. Assumes you have decided to pursue obtaining recognition and are committed to making improvements related to the standards as required in your practiceIn setting goals, consider moving to Level 3 recognition in one or more steps if needed. Important opportunity to work on practice transformation as needed in this processRecognition decision is made 30-60 days after submission to NCQA

Transcript

  • 1. Overview of NCQA PCMH 2011 Standards and Guidelines February 2013 Dawn Gentsch, MPH, MCHES PCHH Practice Transformation Facilitator Great Basin Primary Care Association
  • 2. Objectives for Webinar• Overview of the principles and benefits of NCQA PCMH recognition.• Understand the basic elements of the PCMH standards, self-assessment and survey application process.• Identify the next steps for Community Health Alliance.
  • 3. Principles for the Patient-Centered Medical Home• Personal physician/clinician• Team-based care• Whole person orientation• Enhanced access (with continuity)• Coordinated & integrated care• Quality & safety prioritized• Payment for the value provided
  • 4. Medical Home: What it Looks Like• A health care setting that provides patients with: – well-organized & on-time visits – enhanced access with their own provider & care team for continuity (same day appointment availability, 24/7 telephone access, alternatives to the 1:1 visit) – proactive care management (evidence-based clinical care, panel management, reminder systems, registries) – care coordination across settings (assistance with referrals, tracking for tests & referrals; care during transitions) – patient activation, engagement & participation in decisions on care (patient centered  customer driven) – connections to community resources to extend resources for care – focus on health outcomes & goals for improvement – use of Health IT as tool to support the achievement of advanced primary care practice
  • 5. Medical Home: Aligned with (Chronic) Care Model Health System: Community Health Care Organization Resources Self- Decision Delivery Clinical and Management Support System Information Policies Support Design Systems Informed, Prepared, Activated Productive Proactive Patient Interactions Practice Team Functional and Clinical Outcomes
  • 6. From Purpose To Practice: A Continuing Journey Of Commitment• PCMH focus is a continuation of the purpose- driven journey of FQHCs• Opportunity: continue our work to transform practice to the highest levels of performance and to obtain recognition for this achievement• Recognition as a medical home is increasingly associated with opportunities for enhanced payment for the value created.
  • 7. Suma Nair, MS, RD; Director Office of Quality and Data HRSA BPHC 810 ‘12-’13 grant KyPCA Applied PCMH Webinar #1 01.16.13
  • 8. NCQA 2011 Standards• NCQA released its latest standards, PCMH 2011 in January 2011• The new standards direct practices to organize care according to patients’ preferences and needs, and reinforce federal “meaningful use” incentives for primary care practices to adopt health information technology – Meaningful use criteria (all 25) are in the standards – Creates virtuous cycle for PCMH & MU
  • 9. 2011 NCQA PCMH Standards1. Enhance Access and Continuity2. Identify and Manage Patient Populations3. Plan and Manage Care4. Provide Support for Self-Care5. Track and Coordinate Care6. Measure and Improve Performance
  • 10. 2011 NCQA PCMH Structure & Relationships Reflect core principles of primary care. PCMH Joint Principles Evaluate practice’s ability to function as a PCMHScored component of standardsProvide details for performance expectations 6 Standards Scored items for each 27 Elements (6 MPE) element They reflect specific capabilities for PCMH 147 Factors (8 CF) Documentation is developed to demonstrate the capability as described by Factors
  • 11. NCQA 2011 – Standards & Intent• Access and Continuity: Provide team-based care with access and advice during and after hours and patient/family information about medical home• Identify and Manage Patient Populations: Acquire and use data for care of the practice’s population• Plan and Manage Care: Use evidence-based guidelines for preventive, acute and chronic care management for chronic, frequent and behavior-based conditions, including medication management• Self-Care: Support patient and family in self-care with information, tools and community resources• Track and Coordinate Care: Track and coordinate tests, referrals and transitions of care• Performance Measurement and Quality Improvement: Use performance and patient experience data for continuous quality improvement
  • 12. Important Parts of the Structure• Must Pass Elements• Critical Factors• Meaningful Use• Documentation
  • 13. Must Pass Elements• Must Pass Elements1. 1A: Access During Office Hours (4 pts)2. 2D: Use Data for Population Management (5 pts)3. 3C: Manage Care (4 pts)4. 4A: Self-Care Process (6 pts)5. 5B: Referral Tracking and Follow-Up (6pts)6. 6C: Implement Continuous Quality Improvement (4 pts) Must Pass Elements = up to 29 points
  • 14. Critical Factors -- central to capability being assessed; important impact on scoring• 1A1: Provide same day appointments [MPE]• 1B3: Provide timely clinical advice by phone after hours• 1G2: Have regular team meetings and communication processes• 3A3: 3rd important condition for MH/SA or unhealthy behavior• 3D1: Review & reconcile medications with patients/families for more than 50% of care transitions**• 3E2: Generate at least 75% of eligible prescriptions electronically*• 4A3: Develop & document self-management plans and goals in collaboration w/ at least 50% of patients/families** [MPE]• 5A1: Track labs until results are available, flagging and following-up on overdue results• 5A2: Track imaging tests until results are available, flagging and following-up on overdue resultsNOTE: items in blue are must pass elements * and ** are meaningful use items (3D1, 3E2, 4A3)
  • 15. Anatomy of a Standard Standard Name, Points & Intent Element Name, Points, Description of Performance Expectation Factor: Scored item in an Element NOTE: * and ** indicate MU criteria Scoring DescriptionExplanation: Additional info on what NCQA is looking for Documentation Examples Source: NCQA See pg 19 of NCQA Standards & Guidelines, March 28, 2011 for definitions
  • 16. Element 1A: Must Pass & Critical Factors Critical Factor Impact of Critical Factors on Scoring Minimum score Source: NCQA required for MPEs S&G, p 29-30
  • 17. Element 1C: MU Factors & Reporting a Percent Meaningful Use Source: NCQA S&G p 33-34
  • 18. Element 5A: CFs What do you notice about the scoring?Source: NCQA
  • 19. Element 5B: Must PassMeaningful Use Source: NCQA
  • 20. Element 6B: relates to MPE 6CSource: NCQA
  • 21. Recognition & Transformation“Recognition… is only the beginning of a journey for continuous improvement and cultural transformation.NCQA’s rigorous standards challenge a practice to examine nearly every aspect of its operations. The evolution to a PCMH is a serious undertaking — one that rewards patients with more coordinated, focused and safer care, and rewards providers with greater satisfaction in practicing medicine.” - Marjie Harbrecht, MD CEO, HealthTeamWorks, Colorado
  • 22. Multiple Reinforcing Efforts to Support PCMH Development in FQHCs• HRSA BPHC QI Supplemental Grant ‘12-’13 – PCMH Cervical Cancer Screening, Apply by June 1• HRSA PCMHH Initiative to Support FQHCs to achieve NCQA Recognition – Education for PCAs and FQHCs around recognition; covers all fees for survey process• NACHC Leadership Institute – National initiative to create design, methods, tools to facilitate work by PCAs and FQHCs for sustainable system transformation to PCMHs
  • 23. RRWB is the Supplemental Worksheet Click here Click here KyPCA Applied PCMH Webinar #1 01.16.13
  • 24. The Chart Review Using the Record Review Workbook• 2011 Elements PCMH 3C, 3D, 4A − Require medical record abstraction of data − Need % of patients for each factor based on numerator and denominator• Two methods to collect and submit patient data – Method #1 - report from the electronic system – Method #2 – Record Review Workbook • Excel workbook in the Survey Tool • Tool to identify sample of patients and abstract data KyPCA Applied PCMH Webinar #1 01.16.13
  • 25. PCMH 3C: Care Management Entering NOT USED in row 1 “grays” out the column for all entries Response Options  Yes  No  Not Used  Not applicable KyPCA Applied PCMH Webinar #1 01.16.13
  • 26. Questions - PCMH StandardsWhich PCMH standard is of greatest interest toyou, where will your CHC start?What QI goal do you think you will start with?
  • 27. NCQA PCMH 2011 Self-Assessment KyPCA Applied PCMH Webinar #1 01.16.13
  • 28. PCMH-AKyPCA Applied PCMH Webinar #1 01.16.13
  • 29. PCMH-A Background & Context• Developed to measure a site’s progress towards achieving the 8 Change Concepts• Self-administered assessment• Aids in the identification of improvement opportunities• Stimulates conversations with other sites to learn, share, & transform• Serves as a standardized measure of progress KyPCA Applied PCMH Webinar #1 01.16.13
  • 30. PCHH Timeline General Planning KyPCA Applied PCMH Webinar #1 01.16.13
  • 31. KyPCA Applied PCMH Webinar #1 01.16.13
  • 32. Decide/PlanAssess 3 2 Take Action 4 Understand 1The setting for a Support & BIG Idea 5 Sustain
  • 33. 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 but does not wish to implement in the near-term?• Complete the NCQA PCMH Baseline Self Assessment tool in excel – Due date February 4, 2013 (Mike and Dawn)
  • 34. Steps in the Process – You have (will need to) taken!• Form the Lead Team• Get Ready• Assess IT Requirements• Know Your Deadlines• Set Your Goals and Timeline for Recognition• Order Interactive Survey System and On-Line Application from NCQA• Determine Eligibility for the Multi-site Survey Option• Complete Your Survey• Prepare & Submit Survey (you know when!)• Receive Recognition Decision from NCQA (TBD)