2013 Prevalidated PCMH 2011 Factors   NCQA PCMH 2011 Standard          Elements and Factors         Phytel Product Applica...
PCMH 2011 Prevalidation Step-by-Step Guide                  Client Practices & Participating Vendors Outline of Steps    P...
NCQA’s PCMH 2011 Pre-Validation Summary Approval Table                                           Phytel Outreach v.6.1.3; ...
PCMH 2011 Prevalidation Program                                Letter for of Product Autocredit Approval    4/30/2012    K...
Total Autocredit   Factors ApprovedProduct Name                                                      Attestation Statement...
How Phytel Supports Compliance with NCQA PCMH 2011 and ACO Standards                                                   Mar...
3B: Identify High- Risk                To identify high-risk or complex patients the practice:Patients                    ...
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Phytel: NCQA Prevalidation for PCMH 2011 Autocredit

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Phytel: NCQA Prevalidation for PCMH 2011 Autocredit

  1. 1. 2013 Prevalidated PCMH 2011 Factors NCQA PCMH 2011 Standard Elements and Factors Phytel Product Application Prevalidated by NCQAPCMH 1: 1D 2, 1G 2 and 6 Insight, Coordinate, PopulationEnhance Access and Continuity Health ServicesPCMH 2: 2D 1-3* OutreachIdentify and Manage PopulationsPCMH 3: 3A 1-3, 3B 1, 3C 1, 6 & 7* Insight, Coordinate, OutreachPlan and Manage CarePCMH 4: 4A 1*, 4B 4 CoordinateProvide Self-Care Support andAccess to Community ResourcesPCMH 5: 5C 4 TransitionTrack and Coordinate CarePCMH 6: 6A 1 & 2, 6A 4, Insight, CoordinateMeasure and Improve Performance 6C 1 & 3*, 6D 1, 6E 1-3 Autocredit *Must Pass
  2. 2. PCMH 2011 Prevalidation Step-by-Step Guide Client Practices & Participating Vendors Outline of Steps Practices that want to use autocredit for Vendors that want to submit products for for Participation the PCMH 2011 Survey: NCQA PCMH 2011 prevalidation: Step 1: Obtain the NCQA-issued Step 1: Purchase the PCMH 2011 Survey Prevalidation Summary Approval Tool and attend NCQA’s Free ISS Table and NCQA Letter of Product Trainings and/or an onsite Facilitating Autocredit Approval from the PCMH training session. vendor, in addition to a letter of vendor products implemented and the date of implementation. Step 2: Identify factors whose functionality requirement is met by the product, using Documentation Guidelines Step 2: Implement prevalidated products Data Sources as a guide.* for a minimum of 3 months before submitting the Survey Tool. Step 3: Request a program Agreement at PCMH@ncqa.org. Step 3: Complete an application and enter into required agreements for the NCQA Recognition program. Step 4: Submit the executed PCMH 2011 Prevalidation Program Agreement, Program Application and Application Step 4: Upload the vendor Prevalidation Checklist; submit the application fee Summary Approval Table, per the Program Fee Schedule. implementation letter and a copy of the NCQA Letter of Product Autocredit Approval into the Survey Step 5: Pre-submission demo call with Tool’s document library. NCQA. Step 5: Upload specified documentation Step 6: Complete the PCMH Survey Tool; into the document library, and for alert NCQA of the intended each factor awarded autocredit, submission date; send the final enter the Attestation Statement into payment. the factor’s “notes” field. Step 7: NCQA reviews the survey and Step 6: Submit the Survey Tool. reports the scoring decision in 45–60 days. Note: Find attestation language in the Letter of Product Autocredit Approval provided by Step 8: Receive: the vendor.  Prevalidation Summary Approval Table.  Letter of Product Autocredit Approval.  Marketing & Advertising Guidelines. Step 9: Send proposed press release language and other marketing materials to NCQA for approval. * If a product’s functionality does not fully meet the factor’s requirement, NCQA will list all factors submitted, but not approved for autocredit on the Prevalidation Summary Approval Table.1-28-2013
  3. 3. NCQA’s PCMH 2011 Pre-Validation Summary Approval Table Phytel Outreach v.6.1.3; Phytel Insight v.1.4; Phytel Coordinate v.0.9.2 Points Factors Factors Factors Standard and Element Reported Not Approved Scored Not Scored Reported 1 Enhance Access and Continuity A Access During Office Hours (Must Pass) 1-4 B After-Hours Access 1-5 C Electronic Access 1-6 0.50 D Continuity (Insight) 2 1,3 E Medical Home Responsibilities 1-4 F Culturally and Linguistically Appropriate Services (CLAS) 1-4 G The Practice Team (Coordinate; Insight & Pop Health Svcs) 2,6 1, 3-5,7,8 2 Identify and Manage Patient Populations A Patient Information 1-12 B Clinical Data 1-9 C Comprehensive Health Assessment 1-9 3.75 D Use Data for Population Management (Must Pass) (Outreach) 1-3 4 3 Plan and Manage Care 4.00 A Implement Evidence-Based Guidelines (Insight; Coordinate) 1-3 B Identify High-Risk Patients (Insight) 1 2 C Care Management (Must Pass) (Coordinate; Outreach) 1,6-7 2-5 D Medication Management 1-6 E Use Electronic Prescribing 1-6 4 Provide Self-Care Support and Community Resources 1.50 A Support Self-Care Process (Must Pass) (Coordinate) 1 2-6 B Provide Referrals to Community Resources (Coordinate) 4 1-3 5 Track and Coordinate Care A Test Tracking and Follow-Up 1-10 B Referral Tracking and Follow-Up (Must Pass) 1-7 C Coordinate with Facilities/Care Transitions (Transition) 4 1-3,5-8 6 Measure and Improve Performance 3.00 A Measure Performance (Insight) 1-2 4 3 B Measure Patient/Family Experience 1-4 C Implement Continuous Quality Improvement (Insight; 1,3 2,4 Coordinate) D Demonstrate Continuous Quality Improvement (Insight) 1 2-4 E Report Performance (Insight) 1-3 F Report Data Externally 1-4 G Use Certified EHR Technology 1-2 12.75 Points 10 Factors 15 FactorsPractice/Group Name: Implementation Date:Approved Conditions (if applicable): Hypertension, Diabetes, Hypercholesterolemia, CAD, ObesityProduct Validation Date: 4/30/12
  4. 4. PCMH 2011 Prevalidation Program Letter for of Product Autocredit Approval 4/30/2012 Karen Handmaker VP, Population Health Strategies Phytel, Inc. 11511 Luna Rd Dallas, TX 75234 Phytel Outreach v.6.1.3; Phytel Insight v.1.4; Phytel Coordinate v.0.9.2 Dear Ms. Handmaker: NCQA would like to congratulate Phytel, Inc. on developing the Phytel Outreach, Insight and Coordinate solutions which have been awarded a total of 12.75 points in PCMH 2011 Autocredit. As of 4/30/2012, Phytel Inc. client practices utilizing Phytel Outreach, Coordinate and Insight may benefit from reduced documentation and have scoring associated with awarded Autocredit applied to their total PCMH 2011 Survey score. This is contingent upon the eligible practice or practice group and athenahealth, inc. meeting the requirements outlined in the attached PCMH 2011 Prevalidation Step-by-Step Guide for Client Practices and Participating Vendors. The documents accompanying this letter include: NCQA’s PCMH 2011 Prevalidation Summary Approval Table; Program Marketing & Advertising Guidelines; PCMH 2011 Prevalidation Program Step-by-Step Guide. It is essential that you read all documents thoroughly. Phytel Inc. will be listed on NCQA’s PCMH Prevalidation Program webpage. Visitors to the site will be directed to pcmh@phytel.com to receive additional product related information. Below is a summary of the Autocredit awarded by product name(s) and the associated attestation language required for eligible practices to enter into their PCMH ISS Tool in order for awarded Autocredit to be applied to the total score of the practice’s PCMH 2011 Survey. Total Autocredit Factors Approved forProduct Name Attestation Statement Awarded Autocredit Practice attests to the implementation Phytel and use of Phytel Outreach v.6.1.3 for Outreach 3.75 Points PCMH2:D:1-3 associated Autocredit points as specified v.6.1.3 in the attached NCQA Prevalidation Summary Approval Table. 1|P age
  5. 5. Total Autocredit Factors ApprovedProduct Name Attestation Statement Awarded for Autocredit Practice attests to the implementation and PCMH1:D:2Phytel Insight use of Phytel Insight v.1.4 for associated 7.5 Points PCMH3:A:1-3 v.1.4 autocredit points as specified in the attached PCMH6:A:1-2 NCQA Prevalidation Summary Approval Table. Total Autocredit Factors ApprovedProduct Name Attestation Statement Awarded for Autocredit Practice attests to the implementation and Phytel PCMH3:A:1-3 use of Phytel Coordinate v.0.9.2for associated Coordinate 5.5 Points PCMH4:A:1 autocredit points as specified in the attached v.0.9.2 NCQA Prevalidation Summary Approval Table. Sincerely, Mina Harkins Mina L. Harkins, BSMT(ASCP), MBA NCQA AVP, Recognition Programs 2|P age
  6. 6. How Phytel Supports Compliance with NCQA PCMH 2011 and ACO Standards March 2013 The Phytel platform is designed to help build a high performance Patient-Centered Medical Home based on population health management principles and best practices. A number of functions directly support specific elements of the PCMH 2011 standards set forth by NCQA and have been pre-validated for autocredit in the NCQA application process. Many other Phytel-enabled functions, when executed by the care team in the process of care delivery, enable demonstrated compliance with additional elements required to meet standards related to the management and coordination of care, fostering self-management capabilities, and demonstrating ongoing quality improvement. Phytel’s implementation process prepares clients planning to apply for NCQA PCMH recognition by recommending relevant Outreach protocols and Insight measures, focusing on provider attribution and data integrity, and providing sample care management and quality improvement workflows that tie to specific standards and elements. The following table lists specific NCQA PCMH standards and elements that are supported by functions within the Phytel platform. Factors in red are approved for autocredit; factors in blue are approved as support for the practice’s documented processes and activities for the related elements. In addition, where related NCQA’s ACO 2012 to PCMH 2011 Crosswalk has indicated commonality between the standards, this is noted.Standard 1: Enhance Access and Continuity1D: Continuity The practice provides continuity of care for patients/families by:(multi-site)  Factor 2: Documenting the patient’s/family’s choice of clinician(ACO PC 1 K)1G: The Practice Team The practice provides a range of patient care services by:(multi-site)  Factor 2: Having regular team meetings or a structured communication process (“critical factor”)  Factor 6: Training and assigning care teams for patient population management(ACO PC 1 C)Standard 2: Identify and Manage Populations2D: Use Data for Population The practice uses patient information, clinical data and evidence-based guidelines to generate lists ofManagement patients and to proactively remind patients/families and clinicians of services needed for:MUST PASS  Factor 1: At least three different preventive care services(multi-site)  Factor 2: At least three different chronic or acute care services  Factor 3: Patients not recently seen by the practiceStandard 3: Plan and Manage Care3A: Implement Evidence- The practice implements evidence-based guidelines through point of care reminders for patients with:Based Guidelines  Factor 1: The first important condition  Factor 2: The second important condition(ACO PO 2 A and PC 1 D)  Factor 3: The third condition, related to unhealthy behaviors or mental health or substance abuse 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | f 972.991.9296 | phytel.com ©2013 Phytel, Inc. All rights reserved.
  7. 7. 3B: Identify High- Risk To identify high-risk or complex patients the practice:Patients  Factor 1: Establishes criteria and a systematic process to identify high-risk or complex patients(ACO PC 1 D)3C: Care Management The care team performs the following for at least 75 percent of the patients identified in Elements AMUST PASS and B:  Factor 1: Conducts pre-visit preparations(ACO PC 1 E)  Factor 6: Identifies patients/families who might benefit from additional care management support  Factor 7: Follows up with patients/families who have not kept important appointmentsStandard 4: Provide Self-Care Support and Access to Community Resources4A: Support Self-Care Process The practice conducts activities to support patients/families in self-management:MUST PASS  Factor 1: Provides educational resources or refers at least 50 percent of patients/families to educational resources to assist in self-management(ACO PC 1 G and CM 4 C)4B: Provide Referrals to The practice supports patients/families that need access to community resources:Community Resources  Factor 4: Offers opportunities for health education programs (such as group classes and peer support.)(ACO PC 1 G and CM 4 C)Standard 5: Track and Coordinate Care5C: Coordinate With Facilities On its own or in conjunction with an external organization, the practice systematically:and Care Transitions  Factor 4: Demonstrates its process for contacting patients/families for appropriate follow-up care within an appropriate period following a hospital admission or emergency department visitStandard 6: Measure and Improve Performance6A: Measure Performance The practice measures or receives data on the following:  Factor 1: At least three preventive care measures  Factor 2: At least three chronic or acute care clinical measures  Factor 4: Performance data stratified for vulnerable populations (to assess disparities in care).6C: Implement Continuous The practice uses an ongoing quality improvement process to:Quality Improvement  Factor 1: Set goals and act to improve on at least three measures from Element AMUST PASS  Factor 3: Set goals and address at least one identified disparity in care/ service for vulnerable populations(ACO PC 1 J)6D: Demonstrate Continuous The practice demonstrates ongoing monitoring of the effectiveness of its improvement process by:Quality Improvement  Factor 1: Tracking results over time6E: Report Performance The practice shares performance data from Element A and Element B:  Factor 1: Within the practice, results by individual clinician  Factor 2: Within the practice, results across the practice  Factor 3: Outside the practice to patients or publicly, results across the practice or by clinician. 11511 Luna Road, Suite 600 | Dallas, TX 75234 | 800.559.3057 | f 972.991.9296 | phytel.com ©2013 Phytel, Inc. All rights reserved.

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