practice transformation leading to pcmh designation

©Practice Transformation Institute 2012 This material is the property of URAC. Any use of this material is subject to

copyright and trademark laws, terms of use and other restrictions.

URAC’s Patient Centered Health Care Home

(PCHCH) Practice Achievement Program



URAC’s Patient Centered Health Care Home (PCHCH)• Definition of PCHCH• IOM’s Quality Aims• Focus of the PCHCH Program

URAC PCHCH Practice Achievement Program• The URAC Difference• Practice Achievement Levels• Modules and Standards• Eligibility Requirements• How To Get Started• Onsite Review Process• A URAC PCHCH Success Story

Agenda

2



URAC Patient Centered Health Care Home (PCHCH)

• A quality driven, interdisciplinary clinician-led team approach todelivering and coordinating care that puts patients, family members,and personal caregivers at the center of all decisions concerning thepatient’s health and wellness.

• A PCHCH provides comprehensive and individualized access to physicalhealth, behavioral health, and supportive community and socialservices, ensuring patients receive the right care in the right setting atthe right time.

PCHCH Definition

3



Central to the PCHCH Approach

Quality Aims How URAC PCHCH Standards Promote IOM Quality Aims

1. SafeRegistry, Medication Reconciliation, Transitions of Care, Privacy and Security

2. EffectiveEvidence Based Guidelines, Wellness Promotion and Quality Management Programs

3. Patient-centeredIndividualized Focus, Informed Decision-Making, Patient Satisfaction, Consumer Education, Health Literacy

4. TimelyLab Values, Requests for Health Information and Enhanced Coordination of Care

5. EfficientOrganizational Structure, Policies and Procedures, Electronic Health Record and Total Quality Management

6. EquitableDisparity, Cultural Sensitivity, Complaint Process and Coordination with the Payor

4



Focus On Health Care Not Limited to Disease

Focus on whole person, not just

illness

Wellness modules

Formation of Patient-Provider

Agreement

Respect for cultural

differences/needs

Accommodating health literacy

Care coordination is enhanced

5



URAC PCHCH Practice Achievement Program

6



Focus

URAC’s PCHCH Practice Achievement focuses on evaluating

practices on the Joint Principles of the Patient Centered

Medical Home* including:

• Access

• Coordination

• Quality

• Patient Centeredness

*American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP)

American Osteopathic Association (AOA)

7



The URAC Difference

Flexible stepwise process for supporting the transformation of

practices to patient centered health care homes

Recognizes different levels of functioning as practices evolve

Educational, non-prescriptive

Patient-centric

Two levels of achievement

Multiple resources and programs available to support practices

Two year certificate awarded to practice

Onsite review verification

8



Defining the Practice Achievement Levels

Achievement

Attain an overall score of 65% (or higher)

Meet all of the 7 mandatory standards at least “partially in place”

Compliance with medical record review

Achievement with Electronic Health Record (EHR)

Attain an overall score of 65% (or higher)

Meet all of the 7 mandatory standards at least “partially in place”

Compliance with medical record review

“Fully” meet all elements aligned to Meaningful Use requirements

(15 Core and 10 Menu)

9


copyright and trademark laws, terms of use and other restrictions. 10

Modules and Standard Categories

The URAC PCHCH Practice Achievement program isgrouped into modules and standard categories whichrepresent various health care functions. Each of thestandard categories have PCHCH standards thatcorrespond with elements (tasks) to complete.



Program Description - Modules

7 modules represents various healthcare functions essential to primary care

• Core Quality Care Management• Patient-Centered Operations Management• Access and Communication• Testing and Referrals• Care Management and Coordination• Advanced Electronic Capability• Quality Performance Reporting and Improvement

11



Standard Category is Organizational Core (COR)

Goal is to establish basic organizational, cultural training and systems, and operational requirements which support a successful PCHCH model of patient engagement and care delivery and follow-up.

12

Core Quality Care Management



Patient-Centered Operations Management

Standard Category is Patient Registry (PR)

Goal is to establish a comprehensive patient registry to optimally manage a population of patients, improve health status, and ultimately lower health care cost.Registry allows Practice to identify care gaps and needed preventive, wellness, and follow-up services.



Standard Category is Access to Services (ATS)Goal is to ensure all patients have comprehensive and timely access to health care services that are patient centered, culturally sensitive, and delivered in the least intensive and most appropriate setting based on the patients needs.

Standard Category is Community Services and Resources (CSR)Goal is to help Patients connect with needed community services and resources by implementing processes that coordinate care between the PCHCH, community services agencies, family, care givers, and the patients.

14

Access and Communications



Standard Category is Managing Tests and Results (MTR)Goal is to implement a standardized, reliable system to ensure patients receive needed tests and imaging that results are communicated in a timely manner, appropriate follow-up care is conducted, and each step in the testing and imaging tracking process is properly documented.

Standard Category is Referral Process (RP)Goal is to create a well-coordinated process where PCHCH patients are referred to specialty care in an efficient manner, and both the practice clinicians and specialists receive timely access to the information they need to provide optimal care to the patient.

15

Testing and Referrals



Standard Category is Wellness and Health Promotion (WHP)Goal is to ensure patients receive all appropriate wellness and preventive services, using screening, active counseling, and outreach efforts to inform and educate patients about the value of preventive care.

Standard Category is Individual Care Management (ICM)Goal is to ensure patients with chronic conditions receive organized, planned care from a team of multidisciplinary clinicians, and that patients are empowered to take greater responsibility for their health, leading to improved health status and decreased health care cost.

16

Care Management and Coordination



Standard Category is Coordination of Care (COC)Goal is to improve patient care by implementing processes that will help clinicians coordinate treatment, communicate with one another, manage health care setting transitions, communicate care options to the patients, and track patient activity.

Standard Category is Self Management Support (SMS)Goal is to implement a comprehensive program that will use patient education tools, informative sessions, and life skills training to offer support to chronic care patients, and to help them manage their condition.

17

Care Management and Coordination



Standard Category is Electronic Communications Portal (ECP)Goal is to implement a patient portal system that will allow clinicians to manage and interact with their patients online. Patients will be able to access their health records online, and the clinician will be able to send reminders and health care literature, and conduct e-visits.

18

Advanced Electronic Capability



Standard Category is Electronic Prescribing and Dispensing (EPD)Goal is to automate the prescribing and medication reconciliation process, providing alerts for medication and allergy conflicts, Therapeutic equivalent and generic substitution information, stream lining prescription fills and renewals, and providing clinicians with patient-specific coverage and insurance formulary information.

Standard Category is Electronic Health Records (EHR)Goal is to implement Electronic Health Record which integrates patient information from all care sources, within and outside the practice.

19

Advanced Electronic Capability



Quality Performance Reporting and Improvement

Standard Category is Performance Reporting (PRT)

Goal is to implement reporting technology that will allow clinicians to generate point-of-care reports, population-level reports, and trend analyses to identify opportunities for improving care to patients. Regular performance feedback enables clinicians to decrease gaps in care and improve patient outcomes.

20



PCHCH Practice Achievement Standards and Elements

21



Eligibility Requirements

Applicants for URAC’s PCHCH Practice Achievement must be a

legally organized health care practice

Practice settings may be in offices, outpatient clinics, or

academic affiliated

Practice eligibility requires possession of a health care practice

license (if permitted by state law), legally organized in

accordance with state law and physically located in the United

States

22



URAC PCHCH Standards –Only Publication

The complimentary URAC PCHCH Practice Achievement

Standards-Only publication provides a summary overview of the

program and the 28 standards

• Go to www.urac.org. Click on “Store” in the upper right corner of the URAC homepage.

• Click on the right side – Patient Centered Health Care Home Achievement Standards. Check the box next to the item that you would like to purchase. Scroll to the bottom and add to cart. Proceed to checkout. Follow directions to download the document.

• The fifty “optional” standards are included in the last section of the publication.

23

http://www.urac.org/



Getting Ready

Review the complimentary URAC PCHCH Practice Achievement

Standards-Only publication prior to purchasing the URAC PCHCH

Practice Achievement application

Attend a URAC PCHCH Practice Achievement Workshop

Listen to the eLearning webinars

Participate in conferences and discussion groups

Sign-up for the complimentary Medical Home Today™ Newsletter

Read the PCHCH links on the URAC website at

www.urac.org/pchch

24

http://www.urac.org/pchch



URAC PCHCH Practice Achievement Application

Purchase the URAC PCHCH Practice Achievement application

• Go to www.urac.org/pchch. Click on “Purchase an application”. Scroll to where you see a listing of practices by size. Click on the size that best suits your practice.

• You must purchase an application for each site you wish to apply for Achievement. You may do this by updating the quantity after you have added the Achievement Product to your cart.

• Click the check box next to the item you would like to purchase. Scroll to the bottom and add to cart. Proceed to checkout and follow directions.

25




Example of a Mandatory Standard

PCH-PA 11: Referral Process (RP) Track and Follow-Up on Referral:The Practice employs the following mechanisms to track and follow-up on referrals to clinicians outside the Practice and: [--]

(a) Provides the patient and/or caregiver and referral clinician with the reason for the consultation and pertinent clinical findings; [4](b) Tracks referrals electronically (preferably) and determines if and when the patient was seen by the specialist; [4](c) Documents the referral dates in the health record; [4](d) Conducts follow-up to obtain a report from the referral clinician; and [4](e) Contacts patient for follow-up if necessary based upon report from specialist. [4]

Once the PCHCH Practice Achievement Application has been purchased, the applicant receives the Practice Achievement Guide:1- Interpretive Information/Points to Remember2- Materials for Review3- Related Interviews3- Agenda4- Checklist and additional information

26



Six Months to Completion

Within the six months the application is purchased

• Practices must submit an executed achievement agreement and practice demographic preliminary background information to URAC via the electronic application prior to the onsite process

• The practice prepares the appropriate documents for the auditor

o Practices should have their policies, procedures, protocols and workflows flagged at important information

• Complete the PCHCH Practice Achievement Standards Checklist

o The practice will check off what they have in place

• An onsite review is scheduled

27



Selecting an Auditor

A practice has a choice for their onsite auditor

URAC PCHCH Certified Auditor

• Organization that met URAC Core Accreditation and Business Associate Requirements and

• Validated by URAC to review practices and submit data • Note: The URAC website directory lists the PCHCH Certified Auditors

https://www.urac.org/pchchDirectory/DirectorySearch.aspx

URAC Reviewer

An auditor code is provided to the practice on the Summary page after the application is submitted. Give that code to your auditor of choice.

28

https://www.urac.org/pchchDirectory/DirectorySearch.aspx



Onsite Review Process

The auditor will need a copy of the completed PCHCH Practice Achievement

Standards Checklist at least 1-3 weeks prior to the onsite visit for review

Review dates are agreed upon between the auditor and the practice

The review will require a 1-2 day visit, but the practice does not need to close

The agenda explains who needs to be with the auditor each hour and what will

be reviewed during each time period

To help things run smoothly, identify a main contact for the review and a staff

member to act as a “driver” for the various review processes

The completed audit tool will be submitted to URAC for review. URAC will

make a decision within 90 days

The URAC PCHCH Practice Achievement is given for 2 years. The practice is

awarded the URAC PCHCH Practice Achievement seal and placed in the URAC

Directory

29



A URAC PCHCH Success Story

Country Creek Pediatrics in Rochester, Michigan became the first

practice to attain URAC PCHCH Practice Achievement.

“Our URAC PCHCH Practice Achievement is a valuable recognition of the work we have put into delivering quality, patient centered health care to our entire population. The URAC onsite auditors were friendly, professional, well-prepared and considerate of our schedule. We look forward to a continued relationship with URAC as we move to the future of patient centered health care.” Dr. Rozmiej

“Working on our URAC PCHCH Practice Achievement helped us to fine tuneour policies and procedures to better address staff training, culturaldiversity and literacy levels of our patient population. Since we werealready operating as a patient centered medical home, we had many ofthe URAC Standards already in place. The URAC PCHCH Practice Achievement Guide was an invaluable tool for preparing us for the actual onsite review.” Patient Care Coordinator

30



Learn more about URAC PCHCH at www.urac.org/pchch

Learn more about Practice Transformation Institute (PTI) at www.transformcoach.org

Contact Mike at [email protected] or 248.475.4867 with your auditor code to schedule an onsite review

31


http://www.transformcoach.org/

mailto:[email protected]

practice transformation leading to pcmh designation

Health & Medicine

terms of use

property of urac

urac pchch standards

trademark laws

meaningful use requirements

behavioral health

health information

thepatients health