patient-centered medical home recognition (pcmh) as a ... · 2. examining differential performance...

Patient-Centered Medical Home Recognition (PCMH) as a Foundation for Transformation

NACHC Community Health Institute

August 27, 2018

Advancing the Quadruple Aim

NACHC’s Quality Center has developed a Value Transformation Framework that translates research, proven solutions, and promising practices into manageable

steps health centers can apply in advancing the Quadruple Aim goals:

PCMH within the Framework

NACHC Quality Center’s

Value Transformation Framework

PCMH as a Foundation for

Transformation

2018 COMMUNITY HEALTH INSTITUTE

NCQA

William F. Tulloch

Director, Government Recognition Initiatives

About NCQA

Measure

7

About

Accredit Recognize

Clinical quality,

consumer

experience,

resource use

Health plans,

ACOs, etc.

Physician

practices

Measurement

8

What we do, and why

Transparency Accountability

We can’t improve

what we don’t

measure

We show how

we measure so

measurement will

be accepted

Once we measure, we

can expect and track

progress

OUR MISSION

To improve the quality of health care

OUR METHOD

Recognition Process

Outpatient primary care practices

Practice defined: a clinician or clinicians

practicing together at a single

geographic location

• Includes nurse-led practices in states

as permitted under state licensing

laws

• Does not include:

− Urgent care clinics

− Clinics open on a seasonal basis

10

Eligibility Requirements

• Recognition is achieved at the geographic

site level -- one Recognition per address, one

address per survey

• MDs, DOs, PAs, and APRNs with their own or

shared panel are listed on the application

• Clinicians should be listed at each site where

they routinely see a panel of their patients

• Non-primary care clinicians should not be

included

2017 StandardsConcepts

11

Team-Based Care and

Practice Organization

(TC)

Knowing and

Managing Your

Patients (KM)

Patient-Centered

Access and Continuity

(AC)

Care Management and

Support (CM)

Care Coordination

and Care Transitions

(CC)

Performance

Measurement &

Quality Improvement

(QI)

12

PCMH Redesign3 Parts

Practice completes an online guided

assessment.

Practice works with an NCQA

representative to develop an

evaluation schedule.

Practice works with NCQA

representative to identify support

and education

for transformation.

New NCQA PCMH online education

resources support the

transformation process.

CommitPractice submits initial

documentation and checks in with

its evaluator

Practice submits additional

documentation and checks in with

its Evaluator.

Practice submits final

documentation to complete

submission

and begin NCQA evaluation

process.

Practice earns

NCQA Recognition.

Transform SucceedPractice is prepared for new

payment environment (value-

based payment, MACRA

MIPS/APMs).

Practice demonstrates

continued readiness and high

quality performance through

annual reporting with NCQA.

Recognition and PCMH Transformation

Improving Health Outcomes

Knowing patient population

• Demographics

• Social Determinants of Health

• Health Assessment

Population Management

Focus on Complex Cases

Quality Culture

• Input from all staff

• Input from patients/family/caregivers

• Reporting & Accountability14

Improving Patient Experience

Patient Experience Monitoring

• Surveys

• Qualitative data

• Access preferences

Patient Education

• Medical Home Model

• Treatment/Cost options

Quality Culture

• Input from patients/family/caregivers

15

Improving Staff Experience

Team-based Care

• Everyone is responsible

• Working at top of license/skill set

• Delegation

Patient Planning and Communication

Quality Culture

• Input from all staff

• Reporting & Accountability

16

Improving Cost and Efficiency

Knowing patient population

• Demographics

• Social Determinants of Health

• Health Assessment

Proactive management

• Reduced ER Use

Coordination

• What happens when care leaves the practice?

Quality Culture

• Measure cost/efficiency issues

• Quality effort focus17

A success story

Contact Information

William F. Tulloch

Director, Government Recognition Initiatives

NCQA

1100 13th ST, NW, 3rd Floor

Washington, DC 20005

[email protected]

202-955-5145

19

mailto:[email protected]

PCMH as a Foundation for TransformationCHI 2018

Presented by:Lynette Mundey, MD

21

© 2018 The Joint Commission. All Rights Reserved.

Organizational Overview

Mission: To continuously improve health care for the public, in

collaboration with other stakeholders, by evaluating health care

organizations and inspiring them to excel in providing safe and effective

care of the highest quality and value.

Joint Commission Structure: Private, not-for-profit Over 40 years in ambulatory care Primary Care Medical Home

Certification 2011 2,100 - plus organizations Accreditation/certification options Accredit organization/setting

The Joint Commission’s nationally recognized standards and comprehensive on-site survey process provides the foundation to build sound patient safety and quality care processes.

22


Real-time assessment

Educational opportunity and on-site consultation

Sharing of best practices and implementation strategies

No document submission requirement

Organization-wide certification for 3 years for PCMH eligible sites

Combined survey option for accreditation and PCMH certification

PCMH Program

23


PCMH Program: What Does a Survey Look Like?

On-site, fully integrated, transparent event

Educational, informative and interactive

Patient and systems focused

Direct observation of patient care processes

Patient engagement

Staff/care team engagement

Governing Body/Leadership engagement

Medical record and HR file review

Pertinent document/policy review

24


Transformation

The Joint Commission: Supporting transformation toward value-driven care and the Quadruple Aim

Improved health outcomes

Improved patient experience

Improved staff experience

Reduced costs

25


Improved Health Outcomes Support

Provides the structure and resources to support and guide quality improvement and risk management:

Reduces variation in care delivery

Establishes a consistent approach to care, reducing the risk of error

Demonstrates commitment to a higher standard of clinical service

Organizes teams across the continuum of care

Enhances staff recruitment and development

26


Improved Health Outcomes Support

Survey Team Driven

Focused education on health literacy assessment

Focused evaluation of patient self-management goals

Identification of gaps in care

Sharing best practices/lessons learned in patient and care team engagement

Engagement of leadership in resource support/change management

27


Improved Patient Experience

Patients benefit from this model of care:

Increased access to their primary care clinician and interdisciplinary team

Care is tracked and coordinated

Increased use of health information technology supports their care

Model is focused on education and self-management by the patient

Model is based on the Agency for Healthcare Research and Quality’s (AHRQ) definition of a medical home

28


Improved Patient Experience

Survey Team Driven

Interactive discussion with patients on perception of

Patient-centered care

Comprehensive care

Coordinated care

Access to care

Quality and safety concerns

Review of data collected on patient care experience

29


Improved Staff Experience

Electronic prescribing - for allowable scripts

Computerized order entry - lab, meds, radiology

Use of clinical decision support tools

Referral tracking and follow-up

Collection of data on:

Disease management outcomes

Staff perception of quality and safety of care

Track patient progress toward treatment goals

30


Reduced Costs

What we know now:

Reduction/no appreciable increase in intensive outpatient treatment costs for high risk patient¹

Reduction in emergency department visits and hospital admissions²

and

Overall increased cost of managing the health center’s practice population³

31


Transformation Success Story:Erie Family Health Center, Chicago, Illinois

>90% increase in patient outreach around transitions from inpatient/ ER to Erie

Improved readmissions rate

More same-day appointments based on daily conversion of unused appointments

Access Review Committee to review access measures for every provider monthly

Review potentially misaligned patients 2x/year to ensure correctly assigned to PCP

Created practice teams to ensure continuity of care when provider is out

Better collection of patient feedback: paper surveys quarterly; text surveys weekly

32


References

1. Impact of Primary Care intensive Management on High-Risk Veterans” Cost and Utilization, J Yoon et al, Annals of Internal Medicine, 19 June 2018

2. Examining Differential Performance of 3 Medical Home Recognition Programs, Ammarah Mahmud, MPH et al, American Journal of Managed care, July 2018

3. Community Health Workers Bring Cost Savings to a Patient Centered Medical Home, ML Moffett et al, Journal of Community Health, 10 July 2017

33


Contact Information

Brittnay Hull, Lead Account Executive

630-792-5216

[email protected]

Joyce Webb, RN, Project Lead, PCMH Initiative

630-792-5277

[email protected]

Kristen Witalka, Business Development Manager

630-792-5292

[email protected]

Pam Komperda, Project Manager

630-792-5551

[email protected]





Medical Home Accreditation as a Foundation for Practice Transformation

2018 Community Health Institute & Expo

August 27, 2018

3535

Presenter• Dennis Schultz, MD, MSPH, FACOEM

• Board member

• Vice Chair, Standards and Survey Procedures Committee

• Surveyor since 1995

• Regional Medical Director QuadMed

©2018 Accreditation Association for Ambulatory Health Care, Inc. All rights reserved.

3636

AAAHC Since 1979


Peer-based Accreditation Program focused on Quality

Integrated Onsite Survey

Over 6000 accredited organizations

Consultative and Collaborative

3737

AAAHC Primary Care Standards and the Transformation Process


Core Chapters Adjunct Chapters

• Patient Rights

• Governance

• Administration

• Quality of Care

• Quality Management & Improvement

• Clinical Records

• Infection Prevention & Control & Safety

• Facilities & Environment

• Anesthesia & Surgery

• Pharmaceutical Services

• Imaging

• Pathology & Laboratory

• Dental & Dental Home

• Health Education

• Behavioral Health

• Medical Home

3838

Tenants of Medical Home Chapter


Relationship and Engagement

Accessibility

Continuity

Comprehensiveness

Quality

3939

Survey Process, HRSA PCMH Accreditation Initiative & Transformation


Survey Process Support Additional HRSA Support

• Self assessment & improvement

• Presurvey planning and calls

• Comprehensive onsite survey

• Consultative comments & suggestions

• Summation conference

• Extensive written report

• Virtual survey-Two hour pre survey assessment call

• Mock survey

• Current & Archived webinars

• Builds upon current metrics and recognition programs

• Ongoing AAAHC team contact providing education and resources

40

Medical Home Accreditation Supports Transformation


4141

• Continuous quality improvement

• Framework for program design

• Appropriate goal setting

• Tools provide practical tips and guidance

• Emphasis on team based care

• Improved treatment plans, referrals, tests ordered and completed

• Improved ability to address expanded scope of patient centered care

Medical Home Accreditation Supports Improved Outcomes


4242

• Improved patient experience of care

• Increased access

• Improved ability to address expanded scope of patient centered care

Medical Home Accreditation Supports Improved Patient Experience


4343

• Increased care team satisfaction

• Supports staff development

• Provide different perspectives, knowledge base and skill set

• Promotes a culture of continuous improvement

• Work at the top of your license

• Distribution of work and support; clearly defined roles

• Continuity of staffing

Medical Home Accreditation Supports Improved Staff Experience


4444

• Improves efficiency

• Improves business operations through a consultative approach

• Identifies risk management issues

• Tracked PCMH elements (structured data in the EHR) allow for improved work flow and compliance evaluation by QI staff

Medical Home Accreditation Supports Reduced Costs


4545

Topic Ara % Answered Yes

Patient Safety/Quality of care

Implementation of a new risk assessment/prevention activities, policies, or procedures 88%

Reduced adverse events or near misses 63%

Care Coordination

Improved management of care for patients with high health care needs 72%

Improved delivery of preventative care (Note: Only primary care organizations answered this question) 68%

Increased patient and caregiver engagement 65%

Improved coordination of care across providers in the community 51%

Satisfaction

Increased patient satisfaction 63%

Increased provider satisfaction 59%

Increased staff satisfaction 58%

Personnel (Staff/Providers)

Improved provider credentialing/privileging process 79%

Organizational Audit Performance

Improved Performance on clinical records audit 83%

Improved Performance on operational audit 65%

2017 ROI Survey Results


4646

• Healing community garden

• Universal clinical quality metric incentives

• Proper opioid prescribing initiative

• Interdisciplinary care team & A1C reduction

• PCHM Clinic effect on total cost of care

• Integrating oral health as part of pre-natal care

• Stress identification & self management bingo

• Home wound management program

• Behavioral & community health aid training programs

• Native healers & residential treatment programs


Medical Home Accreditation Transformation Success Stories

4747

Mona Sweeney, RN BSN

Assistant Director Business Development -Primary Care/ Medical Home

Phone: 847-324-7487

Email: [email protected]

Deborah Edelman, MPH

Senior Account Executive

Phone: 847-324-7737

Email: [email protected]

Know your team!


Questions?

PCMH as a Foundation for Transformation

Thank you!

Sarah Roberto, MPP

Deputy Director, Quality Center

National Association of Community Health Centers

[email protected]


patient-centered medical home recognition (pcmh) as a ... · 2. examining differential performance...

Documents