patient-centered medical home & multi-payer demo training webinar # 2 david halpern, md, mph...
TRANSCRIPT
Patient-Centered Medical Home & Multi-Payer Demo
Training Webinar # 2
David Halpern, MD, MPHJune 8th, 2011
Acknowledgements
Let’s Review
• What is a Patient-Centered Medical Home?
• What is the Multi-Payer Demo Project?
• What are the Benefits for Me and My Practice?
“Homework” From Last Time
• Have you:– Built your PCMH Team?
– Started discussing where the time/manpower for practice transformation will come from?
– Signed up for AHEC’s REC services at www.ncahecrec.net?
Today’s Agenda
• What is the National Committee for Quality Assurance (NCQA)?
• How Does NCQA Evaluate a Practice?
• How Does My Practice Apply for PCMH Recognition?
Warning
What Is the National Committee for Quality Assurance (NCQA)?
NCQA• National Committee on Quality Assurance (NCQA)
– 501(c)(3) dedicated to improving health care quality
– NCQA offers “recognition” programs for various aspects of clinical care: diabetes, cardiovascular disease, back pain
– One of the recognition programs is for PCMH– 3 levels of accreditation: Level 1 (lowest),
Level 2, and Level 3 (highest)
Value of PCMH Recognition
• Encourages practices to adopt proven systems for improving care
• Provides mechanism for incentivizing investment in quality infrastructure and processes
• Complements evaluation of clinical effectiveness, patient experiences, and efficiency
How Does NCQA Evaluate A Practice?
NCQA Lingo
• The metrics that NCQA uses to assess your practice are called “standards”
• There are two sets of standards, one released in 2008, called PPC-PCMH & one released in 2011, called PCMH
• 2008 PPC-PCMH has 9 standards & 2011 PCMH has 6 standards
PPC-PCMH (2008) OverviewStandard 1: Access and CommunicationA. Access and communication processesB. Access and communication results
Standard 2: Patient Tracking and Registry Functions
A. Basic system for managing patient data B. Electronic system for clinical dataC. Use of electronic clinical dataD. Organizing clinical dataE. Identifying important conditionsF. Use of system for population management
Standard 3: Care ManagementA. Guidelines for important conditionsB. Preventive service clinician remindersC. Practice organizationD. Care management for important conditions E. Continuity of care
Standard 4: Patient Self-Management SupportA. Documenting communication needsB. Self-management support
Standard 5: Electronic Prescribing A. Electronic prescription writing B. Prescribing decision support - safetyC. Prescribing decision support – efficiency
Standard 6: Test Tracking A. Test tracking and follow upB. Electronic system for managing tests
Standard 7: Referral Tracking A. Referral tracking
Standard 8: Performance Reporting and Improvement
A. Measures of performanceB. Patient experience dataC. Reporting to physiciansD. Setting goals and taking action E. Reporting standardized measures F. Electronic reporting to external entities
Standard 9: Advanced Electronic Communications
A. Availability of interactive website B. Electronic patient identification C. Electronic care management support
PCMH (2011) Overview1. Enhance Access and Continuity
A. Access During Office Hours
B. Access After Hours
C. Electronic Access
D. Continuity (with provider)
E. Medical Home Responsibilities
F. Culturally/Linguistically Appropriate Services
G. Practice Organization
2. Identify/Manage Patient PopulationsA. Patient Information
B. Clinical Data
C. Comprehensive Health Assessment
D. Use Data for Population Management
3. Plan/Manage CareA. Implement Evidence-Based Guidelines
B. Identify High-Risk Patients
C. Manage Care
3. Plan/Manage Care (continued)D. Manage Medications
E. Electronic Prescribing
4. Provide Self-Care and Community Resources
A. Self-Care Process
B. Referrals to Community Resources
5. Track/Coordinate CareA. Test Tracking and Follow-Up
B. Referral Tracking and Follow-Up
C. Coordinate with Facilities/Care Transitions
6. Measure and Improve Performance A. Measures of Performance
B. Patient/Family Feedback
C. Implements Continuous Quality Improvement
D. Demonstrates Continuous Quality Improvement
E. Report Performance
F. Report Data Externally
2008/2011 Comparison 2008 Standards 2011 Standards
PPC-PCMH 1: Access & Communication PCMH 1: Enhance Access & Continuity
PPC-PCMH 2: Patient Tracking and Registry Function
PCMH 2: Identify and Manage Patient Populations
PPC-PCMH 3: Care Management PCMH 3: Plan and Manage Care
PPC-PCMH 4: Self Management Support PCMH 4: Provide Self-Care & Community Support
PPC-PCMH 5: Electronic Prescribing PCMH 5: Track and Coordinate Care
PPC-PCMH 6: Test Tracking
PPC-PCMH 7: Referral Tracking
PPC-PCMH 8: Performance Reporting and Improvement
PCMH 6: Measure and Improve Performance
PPC-PCMH 9: Electronic Communication
NCQA Lingo
each “standard” is composed of
several “elements”
each “element” is composed of several “factors”
“Must Pass” Elements• Some elements are “Must Pass”• **To “Pass” one of these elements, you
must receive a 50% score or higher**• In 2008 Standards, you must pass 5/10 of
these “Must Pass” elements to achieve a level 1, and 10/10 to achieve level 2 or 3
• In 2011 Standards, you must pass 6/6 of the “Must Pass” elements to achieve any level of recognition.
Reading Each Element
• Description
• Scoring
• Explanation
• Examples & Documentation/Data Source
Supporting Documentation
• NCQA uses the term “data source” to describe the types of materials that you can use to document your practice’s efforts:– Documented Processes (written policies,
workflow forms, checklists)– Reports (aggregate data)– Records or Files (actual patient chart/data)– Materials (brochures, guidelines)
Scoring a Standard
• Each Element in a Standard is worth a certain number of points. To achieve the points, you must complete some (or all) of the factors in that element.
• Note: The actual details of scoring each element depends on that specific element and is NOT the same across the board.
Scoring a Standard
For example:Element A is worth 4 points and has 6 factors
6/6 4-5/6 3/6 1or2/6 0/6
4 points 3 points 2 points 1 point 0 points
Scoring a Standard
For Example:Element B is worth 4 points and has 8 factors
>4/8 3/8 2/8 1/8 0/8
4 points 3 points 2 points 1 point 0 points
Point Requirements
Level of Recognition
Points Required(2008)
Points Required(2011)
Level I 25-49 (5/10 must pass) 35-59 (6/6 must pass)
Level 2 50-74 (10/10 must pass) 60-84 (6/6 must pass)
Level 3 75-100 (10/10 must pass) 85-100 (6/6 must pass)
NCQA’s PCMH Survey Process1. NCQA receives and evaluates Survey Tool
• Responses, documentation, and explanations
• Practice may be contacted for clarification
2. On-site audit - 5% of practices
3. Final decision and status determined
4. NCQA grants certificate and recognition packet
• Recognition status posted on NCQA Web site
• Practices that don’t pass - not reported publicly
How Does My Practice Apply For PCMH Recognition?
Applying for PCMH Recognition
• Interactive Survey Tool ($80)– Self-directed practice assessment
• Application (free)– Demographic information
• When ready, submit Interactive Survey Tool, Application, and final application fee
NCQA’s Interactive Survey System (ISS)
• ISS is the web-based application program
• The practice uses ISS (also called the “Survey Tool”) for:
– Entering responses to each factor for each element
– Attaching documents and providing text to support the responses
Pricing (including 20% CCNC discount)
Upgrading PCMH Recognition
• Practices achieving Level 1 or 2 can complete an add-on survey to upgrade to a higher level anytime within their 3 year recognition period
Next Steps (Homework)
• Peruse the NCQA “Standards and Guidelines” documents for your version (2008 or 2011)
• These are long, but important documents that are the backbone of the recognition process and familiarity with them is CRUCIAL to your success.
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 and will not have in place in time for submission? (e-prescribing, EMR, interactive website)
Next Steps (Homework)
• Organize Your Documents– Create a place on your computer (server or
hard-drive) for all of your documentation– You should have a folder for each standard– A checklist can help you determine what you
already have created/saved and what you need to prepare from scratch
Next Steps (Homework)
• Go to NCQA’s website and take advantage of the various (free) training presentations they have available:– 2008 Standards– 2011 Standards– Using the ISS Interactive Survey System– Submitting As a Multi-Site Practice
• http://www.ncqa.org/tabid/109/Default.aspx
Next Steps (Homework)
• Begin To Think About 3 Important Conditions (e.g. diabetes, asthma, congestive heart failure, depression, etc) that you can track over time– Does your practice already follow evidence-
based guidelines when caring for patients with these conditions?
– Are these guidelines documented anywhere?
Community Care PCMH Team
• David Halpern, MD, MPHCommunity Care of North Carolina (CCNC)
• R.W. “Chip” Watkins, MD, MPH, FAAFPCommunity Care of North Carolina (CCNC)
• Brent Hazelett, MPANorth Carolina Academy of Family Physicians (NCAFP)
• Elizabeth Walker Kasper, MSPHNorth Carolina Healthcare Quality Alliance (NCHQA)
Partners
NCQA Contact InformationContact NCQA Customer Support to:• Order FREE Copy of requirements• Order FREE Application Information• Purchase ISS Tool• 1-888-275-7585
Visit NCQA Web Site to:• View Frequently Asked Questions• View Recognition Programs Training Schedule• www.ncqa.org/medicalhome.aspx
Send Questions to: [email protected]
