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NYS PCMH Collaborative
Central New York Care Collaborative
(CNYCC)
April 18, 2018
Welcome and Introductions
Understand NYS PCMH Expectations, Pathways
Understand Practice Transformation Technical Assistance Available
Understand changes to NYS Medicaid Incentive Plan –Current and proposed
Review Annual Reporting documentation and 12 new Core Criteria
Review CNYCC support including Health Literacy training
Partner recommended next steps
Partner sharing for meeting NYS PCMH requirements
Learning Objectives
Comparison of NCQA PCMH 2017 and NYS PCMH
As of April 1, 2018:
Any new (not previously recognized ) practices will need to pursue NYS PCMH
NCQA PCMH 2017 not available to NYS practices
All APC practices will shift to NYS PCMH
No requirement to seek NYS PCMH ahead of your current expiration date
Consider pursuing ahead of expiration due to available funding and future incentive opportunities
Begin planning for NYS PCMH well ahead of your recognition expiration.
Practices will have 18 months or less to achieve recognition depending on your current status.
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NYS PCMH
NCQA PCMH 2017/NYS PCMH Comparison
Key Components NCQA PCMH 2017 NYS PCMHCore Standards 40 52
Requirements for Recognition
40 Core plus 25/83 Elective Credits across 5/6 competencies
52 core criteria- 40 original plus 12 specific elective criteria moved to core; Additional elective credits required from any of the 6 competencies. Number dependent on what is needed to meet 25 additional points in conjunction with value of 12 new core point value. Dependent on type of practice and type of VBP contract for example.
Phases of Transformation-Replaces APC Gates
1. Commit - commit, self-assess, plan 2. Transform-develop and document PCMH capabilities 3. Succeed-Annual re-certification
1. Commit-Same plus a commitment to adopt VBP 2. Transform- develop and document PCMH Capabilities including 12 additional electives as core 3. Succeed- Annual re-certification
Platform to submit validation NCQA Q Pass NCQA Q Pass
RecognitionNCQA PCMH 2017 recognition NCQA and NYS recognition as NYS PCMH
State -Funded Technical Assistance None
Support to achieve NYS PCMH recognition through February 2020
NYS PCMH New Core RequirementsCategory Criteria Description Points
Behavioral Health CC 09
Behavioral Health Referral Expectations: Works with Behavioral Healthcare providers
2 Elective Credits-1 Core
KM 04 Behavioral Health Screenings1 Elective Credit-1 Core
Care Management and Care Coordination
CM 03 Comprehensive Risk-Stratification Process2 Elective Credits-1 Core
CC 08Specialist Referral Expectations: Works with non-behavioral healthcare specialists
1 Elective Credit-1 Core
CM 09 Care Plan Integration1 Elective Credit-1 Core
CC 19 Patient Discharge Summaries1 Elective Credit-1 Core
KM 11
Population Needs: Identifies and addresses population-level needs based on the diversity of practice and community (demonstrate at least 2)
1 Elective Credit-1 Core
NYS PCMH New Core Requirements- (Continued)
Category Criteria Description Points
Health Information Technology
AC 08 2 Way Electronic Communication 1 Elective Credit-1 Core
AC 12 Continuity of Medical Record Information 2 Elective Credits-1 Core
CC 21
External Electronic Exchange of Information: Demonstrates electronic exchange of information with external entities, agencies and registries
3 Elective Credits-1 CORE (RHIO), 1 Potential Elective Credit ( Immunization Registry), 1 Potential Elective Credit (Summary of Care).
TC 05 Certified EHR System 2 Elective Credits-1 Core
Value-Based Contracts QI 19 Value-Based Contract Agreement (s)
Up to 2 Elective Credits-1 Core (upside) OR, 2 Core Credits for Two-sided risk (downside)
NYS DOH Support for Practice Transformation
Covers all NCQA PCMH Recognition Pricing costs regardless of the number of clinicians (for up to three NCQA check-ins)
Use the appropriate code in Q PASS to have the State pay NCQA fees. “GNYDOC” except for APC practices (See your TA)
Contracting with a TA Vendor will provide support for transformation and submission, including preparation for NCQA check-ins, where applicable.
TA Services could include gap analyses, work plan development, staff training, development and review of required documentation, etc. Review their model with each TA you are considering.
Funding for Recognition pricing submission fees and technical assistance expires no later than February 2020.
NYS DOH Support for Practice Transformation
NYS DOH Technical Support Vendors-Region 6
NYS will provide technical assistance through vendors, timeframe, depending on your
practice’s current recognition status
Region 6: Onondaga and Cayuga Counties
Common Ground Health (CGH)
• Contact – Bill Brien, 585-224-3149 [email protected]
• Contact – Sue Swift, 585-224-3144 [email protected]
Island Peer Review Organization (IPRO)
• Contact – Thomas Lemme, 516-209-5284 [email protected]
• Contact – Susan Hollander, 516-209-5241 [email protected]
https://www.health.ny.gov/technology/innovation_plan_initiative/ta_contact_info.htm#region_1
NYS DOH Technical Support Vendors-Region 7
NYS will provide technical assistance through vendors timeframe, depending on your
practice’s current recognition status
Region 7: Oswego, Madison, Oneida and Lewis Counties
Adirondack Health Institute (AHI)
• Contact – Mary McLaughlin, 518-480-0111 ext. 413 [email protected]
• Contact –Jolene Munger, 518-480-0111 ext. 421 [email protected]
Capital District Physicians Health Plan (CDPHP)
• Contact – Vincent Speenburgh, 518-641-4194 [email protected]
• Contact – Michael Courtney, 518-641-3494 [email protected]
https://www.health.ny.gov/technology/innovation_plan_initiative/ta_contact_info.htm#region_1
NYS DOH Technical Support Vendors-Other
This technical advisor worked with one partner in the PPS to achieve APC Gate 2 and will
continue work towards NYS PCMH. For technical advisors outside of your region, the State
has an established process including approval from the regional vendors.
The Healthcare Association of New York State (HANYS)
• Contact – Lindsay Milchteim, 516-686-6935 [email protected];
• Contact – Nicole Harmon, 716-201-1170 [email protected]
NYS PCMH Pathways and Timeline
As of April 1, 2018:
All NYS practices will need to pursue NYS PCMH
For previously recognized practices, begin planning for NYS PCMH well ahead of your recognition expiration.
Practices will have availability of 18 months or less technical assistance to achieve recognition depending on where you are in the process.
Review NCQA Pathways for NYS PCMH depending on your current status.
NYS PCMH Pathways and Timeline
NYS PCMH Support andTimeline
Current Recognition Level
Stage of NCQA Process
Timeline for NYS PCMH NCQA support TA Support
PCMH Level 3
Succeed (Annual reporting with new NYS PCMH criteria in 1st year.) up to 6 months
Representative only
Available for up to 6 months
PCMH Level 1 or 2Transform (Accelerated renewal) up to 12 months
Representative and 3 check-ins
Available for up to 12 months
APC Gate 2 Commit up to 12 monthsRepresentative and 3 check-ins
Available for up to 12 months
APC Less than Gate 2 or Unrecognized Commit up to 18 months
Representative and 3 check-ins
Available for up to 18 months
NYS PCMH Pathways and Timeline
Different Pathways to NYS PCMH2018 2019 2020
New Practices Enroll in NYS PCMH Achieve NYS PCMH Recognition NYS PCMH Annual Reporting
NCQA PCMH 2014 Level 1, 2
Enroll in NYS PCMH Accelerated Renewal
Achieve NYS PCMH Recognition/NYS PCMH Annual
Reporting
NYS PCMH Annual Reporting
NCQA PCMH 2014 Level 3
Practices expiring 2018: Enroll in "First NYS
PCMH Annual Report*" Practices expiring in
2019/2020: "First NYS PCMH Annual Report
optional."
Practices expiring 2018: NYS PCMH Annual Reporting
Practices expiring in 2019/2020: "First NYS PCMH
Annual Report optional."
Practices expired in 2018/2019: NYS PCMH
Annual Reporting Practices expiring 2020: Enroll in "First NYS PCMH
Annual Report*"
APC Practices Enroll in NYS PCMH Achieve NYS PCMH Recognition
NYS PCMH Annual Reporting
*For practices that are currently NCQA PCMH 2014 Level 3 recognized, the "First NYS PCMH annual report" will include evaluation of NCQA annual reporting requirements for the year and the 12 elective criteria required by New York State.
NYS Medicaid PCMH Incentive Changes
Rate of PCMH incentives need to be adjusted due to:Fiscal constraints of the Medicaid Global Spending Cap
DSRIP success has increased participation in PCMH programs
Due to a payment lag from DOH for this incentive, changes must be made prior to July 2018 for State Fiscal year 2018-2019 and 2019-2020.
NYS DOH conducting a current push on commercial payers to support continuing transformation
Medicaid PCMH Incentive Changes: Background
Medicaid PCMH Incentive Changes
NYS PCMH Medicaid Incentives
PCMH Incentive (PCMH Standard Year and LevelThrough April 30,
2018May-June 2018
MMC PMPM (2014 Level 2) $3.00 0
MMC PMPM (2014 Level 3, APC* or 2017) $7.50 $2.00
FFS claim add-on Professional (2014 Level 2) $20.50 0
FFS claim add-on Institutional (2014 Level 2) $23.25 0FFS claim add-on Professional (2014 Level 3, APC* or 2017**) $29.00 $29.00 FFS claim add-on Institutional (2014 Level 3, APC* or 2017**) $25.25 $25.25
*NYS Medicaid is planning to add APC providers, who are Gates 2 and 3 certified, into the PCMH incentive program once federal approval is obtained.
** Starting April 1, 2018, the NCQA "NYS PCMH" model will take the place of PCMH 2017 in New York.
2018/2019 Budget: In development (Additional guidance will be published once the final policy is published)
*Effective July 1, 2018 the Department of Health is proposing that MedicaidManaged Care (MMC) and Fee-for-Service (FFS) PCMH incentive be tied to bothPCMH recognition and VBP contracting.
Proposal components include:Providers have at minimum PCMH recognition at NCQA PCMH 2014 Level 3Providers have a Medicaid VBP contract at Level 1 or higher with at least one MMC
PlanThe FFS incentive will be tied to VBP contracting for those providers who
participate in both FFS and MMC.
Medicaid PCMH Incentive from July 2018 Onward
CNYCC Support for NYS PCMH and Next
Steps
Proposed components include:
NYS PCMH Learning Collaborative for interested partners-TBDPurpose: Share best practices- Agenda to be determined by partners
Continued support through training opportunities, such as Value Based Payment
Ongoing workforce efforts to support primary care
Population Health Management platform – IBM Watson
Health Literacy training and screening implementation support
CNYCC Support for NYS PCMH
TrainingCultural Competency and Health Literacy 101 Future trainings planned on teach back methods etc.
Performance Activity Funding Support-Due 6/30/18
PA 133 Provide "Intro to Cultural Competency/Health Literacy (CCHL)" training to at least 75% of all staff by June 30, 2018.
PA 93 Adopt and implement an evidence-based health literacy screening tool
Health Literacy Screening Tools- CNYCC Clinical Governance approved
CNYCC Support for Health Literacy/Cultural Competency
Cultural Competency & Health Literacy 101 Course
CCHL 101 course provides general awareness and identify ways partner organizations (and their employees) can deliver more culturally competent and health literate services. https://cnycares.org/training/cc-hl_101/
20 min video presentation and a post-test questionnaire
Provided to partners via CNYCC’s LMS, HWapps (login required):• https://www.hwapps.org/dsrip/new-york/cnycc/training-center/courses/
• Define and describe cultural competency.• Define and describe health literacy.• Recognize the potential consequences of limited understanding of cultural
diversity and impact of low literacy.• Identify appropriate resources to address cultural, linguistic, and health
literacy gaps.
Health Literacy Screening Tools
CNYCC provided health literacy screening tools that partners can use and implement:Rapid Estimate of Adult Literacy in Medicine – Short Form (REALM-SF)Short Assessment of Health Literacy - English and Spanish (SAHL-E&S)Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50)Pfizer’s Newest Vital Sign in English & SpanishShort Test of Functional Health Literacy in Adults (STOFHLA)
Screening Tools Review webinar: by CNYCC CMO Dr. Joseph Maldonadohttps://attendee.gotowebinar.com/recording/5525782991794486530
Resources for building a Health Literate organizationAgency for Healthcare Research and QualityAlliance for Health
Review NYS PCMH Standards and Guidelines, Annual reporting requirements andpathways regardless of whether you are currently recognized or when your recognitionexpires. http://www.ncqa.org/programs/recognition/practices/patient-centered-medical-home-pcmh/new-york-state-pcmh
APC practices will continue to work with their technical advisors on NYS PCMH.
Continue all PCMH initiatives begun as part of your recognition, including populationoutreach, patient satisfaction and quality monitoring.
Consider contracting with a technical advisor for NYS PCMH assistance.
Each recognized practice site should have a clinical and business lead.
Consider your organization’s time-line for achieving NYS PCMH.
Consider work with the RHIO to identify ways to share care plans across settings.
Continue your efforts toward value-based payment contracts to maximize incentives.
Partner Recommended next steps
Questions & Answers