Medical Home Recognition

Erin DormaierTransformation Support Services Manager, CHTS-IM, PCMH-CCE

© 2015 CORHIO – All Rights Reserved – CORHIO Proprietary – Not For Redistribution 1

Agenda

• History of Medical Home• What is a Medical Home• Why be a Medical Home• NCQA Patient Centered Medical Home Breakdown• TSS Can Help

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History of Medical Home

• Introduced in 1967 by American Academy of Pediatrics• 1978 the WHO supports the idea • 2002 seven national family medicine organizations recommend supporting the medical home

concept• 2003 NCQA launched Physician Practice Connections • 2007 Joint PCMH principles released • 2008 NCQA, URAC, Joint Commission, & AAAHC launched 1st PCMH recognition• 2010 ACA signed including investments in medical home pilots• 2015 MACRA passed including Merit Based Incentive Payment System (MIPS)

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What is a Medical Home

PCPCC describes the medical home as an approach to the delivery of primary care that is:• Patient-centered: A partnership among practitioners, patients, and their families ensures that decisions

respect patients’ wants, needs, and preferences, and that patients have the education and support they need to make decisions and participate in their own care.

• Comprehensive: A team of care providers is wholly accountable for a patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care.

• Coordinated: Care is organized across all elements of the broader health care system, including specialty care, hospitals, home health care, community services and supports.

• Accessible: Patients are able to access services with shorter waiting times, "after hours" care, 24/7 electronic or telephone access, and strong communication through health IT innovations.

• Committed to quality and safety: Clinicians and staff enhance quality improvement to ensure that patients and families make informed decisions about their health.

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Versions of Medical Home

• Primary Care Medical Homes• NCQA Patient Centered Medical Home (PCMH)- largest• Joint Commission Primary Care Medical Home • URAC Patient Centered Healthcare Homes (PCHCH)• Accreditation Association for Ambulatory Healthcare (AAAHC)• Medical Home through Colorado Medicaid (HCPF)

• Specialty Care Medical Neighborhoods• NCQA Patient Centered Specialty Practice (PCSP)• NCQA Patient Centered Connected Care (PCCC)

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Why Medical Home?

• Better quality, patient experience, continuity, lower costs related to reduced hospital admissions/ED visits

• Reduce income based disparities in care• Whole person care• Lower rates of provider burnout• Payer reimbursement• Maintenance of Certificate Credit• MIPS- Clinical Practice Improvement

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National Committee Quality Assurance (NCQA)

Patient Centered Medical Hom (PCMH)

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The Basics

• Primary Care, Pediatricians, Internal Medicine, Geriatrics• MDs, DOs, APRNs, and PAs that have a panel of patients• The practice is recognized by site and lists the providers associated with the practice• 3 levels of recognition

• Good for 3 years

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What does it take?

• 6-12 months to achieve recognition• NCQA estimates 100 hours• Compose internal team (4-6 people average)• Have buy in from leadership

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The Standards

PCMH 1: Patient Centered Access• Appointment access• 24/7 clinical advice• Patient electronic access

PCMH 4: Care Management and Support• Identify patients who would benefit from care management• Implement evidence based guidelines for those patients

PCMH 2: Team Based Care• Culturally & linguistically appropriate services• Care team• Medical home responsibilities

PCMH 5: Care Coordination and Care Transitions• Test tracking & follow up• Referral tracking and follow up

PCMH 3: Population Health Management• Collect patient data• Utilize data for population management

PCMH 6: Performance Measurement and Quality Improvement• Clinical Quality Measurement & improvement• Patient experience surveys

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Anatomy of a Standard

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Elements and Factors

• 27 Elements and 178 Factors• Must Pass Elements and Critical Factors • Weighted scoring

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CORHIO Project Management Tool

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- Michael Garcia, Metro Community Provider Network (MCPN)

“The interactive tool is invaluable – I can’t say enough about the value it’s brought to us and our ability to manage the application using it. It tells us what the standards are, gives us an opportunity to input feedback on where we are at in the process and scores us based on the assessment so we know where we stand. If we think we’ll have trouble meeting a certain factor, we can see our score without it and determine if we can proceed with the other elements. I can’t imagine pursuing PCMH recognition without having CORHIO’s tool.”

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Costs

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HIE & PCMH

• Access to hospital ADT• Event notification• Newborn screening results

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PCMH Relates to Federal Initiatives

• Meaningful Use (MU)• PQRS/Value Based Payment Modifier• Evidence Now Southwest (ENSW)• State Innovation Model (SIM)• Transforming Clinical Practice Initiative (TCPi)• Merit Based Incentive Payment (MIPs) in 2019

• Clinical Practice Improvement from data in 2017

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NCQA Partners in Quality

• CORHIO is a NCQA Partner in Quality

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Transformation Support Services (TSS)

• CORHIO has 4 NCQA PCMH Certified Content Experts• Variety of services to assist with achieving recognition

• Project management • Assistance with selection of factors• Document review & labeling• ISS Tool assistance for submission

• CORHIO- NCQA Partner in Quality• Free gap analysis• Practice receives 20% discount on application fee

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Contact Info

© 2015 CORHIO – All Rights Reserved – CORHIO Proprietary – Not For Redistribution 20

Erin DormaierTransformation Support Services Manageredormaier@corhio.org