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Pa$ent-‐Centered Medical Home (PCMH) Wednesday, January 22, 2014
Disclaimer: Nothing that we are sharing is intended as legally binding or prescrip7ve advice. This presenta7on is a
synthesis of publically available informa7on and best prac7ces.
• Transforma*ve model for delivery of care • Espouses team-‐based approach – Comprehensive and con*nuous pa*ent-‐driven care
– Evidence based healthcare and best prac*ces – Consistent high quality care
• Rela*onship-‐based • Whole person • Team-‐based
PCMH -‐ Overview
Transforma*ve Care Model
• Change from tradi*onal doctor-‐centered medical prac*ce
• Care coordina*on – Health Informa*on Technology – Data-‐driven decision-‐making – Appropriate staff development
• Con*nuous quality improvement • Policies and procedures
What Transforma*on Looks Like
• Constant innova*on • Key data measurement and improvement targets
• Capitalizing the benefits of EHRs • Regular pa*ent communica*on • Proac*vely scheduled pa*ent follow up • Expanded access to care • Pa*ent care plan coordina*on
Why Consider Becoming a PCMH? • Improved outcomes • Improved pa*ent sa*sfac*on • Improved pa*ent accessibility – Informa*on – Same day appointments – APer hours – Remote – Culturally and Linguis*cally Appropriate Service (CLAS)
– Follow up • Improved professional sa*sfac*on
Financial Incen*ves
Seeking Recogni*on
• Na*onal CommiUee for Quality Assurance (NCQA)
• The Joint Commission • Accredita*on Associa*on for Ambulatory Health Care (AAAHC)
• Others – Private Insurers – Employers – State en**es
NCQA Recogni*on Program
• Third genera*on of qualifica*on standards – 2008 – 2011 – 2014
• Pilo*ng Pa*ent-‐Centered Specialty Program – 2013
• High volume – 20-‐30 applica*on submissions per week to approximately 100 per week
NCQA Recogni*on Criteria
• Points-‐based recogni*on Points Recogni$on
< 35 None
35 – 59 Level 1
60 – 84 Level 2
> 85 Level 3
NCQA Recogni*on Criteria
• Six Standards – Access and con*nuity – Iden*fy and manage pa*ent popula*ons – Plan and manage care – Provide self care support and community resources
– Track and coordinate care – Measure and improve performance
NCQA Recogni*on Criteria
• 28 Elements – Six “must-‐pass”
• PCMH 1: Element A: Access During Office Hours • PCMH 2: Element D: Use Data for Popula*on Management Element • PCMH 3: Element C: Care Management • PCMH 4: Element A: Support Self-‐Care Process • PCMH 5: Element B: Referral Tracking and Follow-‐Up • PCMH 6: Element C: Implement Con*nuous Quality Improvement
NCQA Recogni*on Criteria • 152 Factors – Nine cri*cal factors
• PCMH1A, Factor 1: Same-‐day appointments • PCMH 1B, Factor 3: Clinical advice by phone • PCMH 1G, Factor 2: Regular team mee*ngs • PCMH 3A, Factor 3: Evidence-‐based guidelines for unhealthy behaviors
• PCMH 3D, Factor 1: Medica*on reconcilia*on • PCMH 3E, Factor 2: ePrescribing • PCMH 4A, Factor 3: Self-‐management goals • PCMH 5A, Factor 1: Track lab results • PCMH 5A, Factor 2: Track imaging results
NCQA Recogni*on Process
• Complete self-‐assessment to iden*fy gaps • Ensure all P&Ps were in effect for at least 90 days
• Run reports • Collate all suppor*ng documents • Submit applica*on
Challenges of Becoming a PCMH
• Transforming the prac*ce’s leadership • Teamwork – ShiP from “doctor as the hero”
• Knowing when to seek help
Common Myths About Becoming a PCMH
• Transform as you go • You must have an EHR • You must have a pa*ent portal • Once you’re recognized, your done • You need special repor*ng tools for PCMH
The Future of PCMH
• Pa*ent-‐Centered Medical Neighborhood – Bidirec*onal communica*on, coordina*on, and integra*on
– Consulta*ons and referrals – Flow of pa*ent care informa*on – Responsibility in co-‐management – Support pa*ent-‐centered care, enhanced access, and care quality
– Support whole-‐person primary care
What’s Next?
January 29, 2014 – Accountable
Care Organiza*ons
(ACOs)
February 5, 2014 – Physician Quality
Repor*ng System (PQRS)
