1. Overview of NCQA PCMH 2011
Standards and Guidelines
February 2013
Dawn Gentsch, MPH, MCHES
PCHH Practice Transformation Facilitator
Great Basin Primary Care Association
2. Objectives for Webinar
• Overview of the principles and benefits of NCQA
PCMH recognition.
• Understand the basic elements of the PCMH
standards, self-assessment and survey application
process.
• Identify the next steps for Community Health
Alliance.
3. Principles for the Patient-Centered
Medical Home
• Personal physician/clinician
• Team-based care
• Whole person orientation
• Enhanced access (with continuity)
• Coordinated & integrated care
• Quality & safety prioritized
• Payment for the value provided
4. Medical Home: What it Looks Like
• A health care setting that provides patients with:
– well-organized & on-time visits
– enhanced access with their own provider & care team for continuity (same
day appointment availability, 24/7 telephone access, alternatives to the 1:1
visit)
– proactive care management (evidence-based clinical care, panel
management, reminder systems, registries)
– care coordination across settings (assistance with referrals, tracking for
tests & referrals; care during transitions)
– patient activation, engagement & participation in decisions on care
(patient centered customer driven)
– connections to community resources to extend resources for care
– focus on health outcomes & goals for improvement
– use of Health IT as tool to support the achievement of advanced primary
care practice
5.
6. Medical Home: Aligned with (Chronic) Care Model
Health System:
Community Health Care Organization
Resources Self- Decision Delivery Clinical
and Management Support System Information
Policies Support Design Systems
Informed, Prepared,
Activated Productive Proactive
Patient Interactions Practice Team
Functional and Clinical Outcomes
7. From Purpose To Practice: A Continuing Journey
Of Commitment
• PCMH focus is a continuation of the purpose-
driven journey of FQHCs
• Opportunity: continue our work to transform
practice to the highest levels of performance and
to obtain recognition for this achievement
• Recognition as a medical home is increasingly
associated with opportunities for enhanced
payment for the value created.
8. Suma Nair, MS, RD; Director Office of Quality and Data HRSA BPHC
810 ‘12-’13
grant
KyPCA Applied PCMH Webinar #1 01.16.13
9. NCQA 2011 Standards
• NCQA released its latest standards, PCMH 2011
in January 2011
• The new standards direct practices to organize
care according to patients’ preferences and
needs, and reinforce federal “meaningful use”
incentives for primary care practices to adopt
health information technology
– Meaningful use criteria (all 25) are in the standards
– Creates virtuous cycle for PCMH & MU
10. 2011 NCQA PCMH Standards
1. Enhance Access and Continuity
2. Identify and Manage Patient
Populations
3. Plan and Manage Care
4. Provide Support for Self-Care
5. Track and Coordinate Care
6. Measure and Improve Performance
11. 2011 NCQA PCMH Structure & Relationships
Reflect core principles of
primary care.
PCMH Joint Principles Evaluate practice’s ability to
function as a PCMH
Scored component
of standards
Provide details for
performance
expectations
6 Standards
Scored items for each
27 Elements (6 MPE) element
They reflect specific
capabilities for PCMH
147 Factors (8 CF)
Documentation is developed to demonstrate the capability as described by Factors
12. NCQA 2011 – Standards & Intent
• Access and Continuity: Provide team-based care with access and
advice during and after hours and patient/family information
about medical home
• Identify and Manage Patient Populations: Acquire and use data
for care of the practice’s population
• Plan and Manage Care: Use evidence-based guidelines for
preventive, acute and chronic care management for
chronic, frequent and behavior-based conditions, including
medication management
• Self-Care: Support patient and family in self-care with
information, tools and community resources
• Track and Coordinate Care: Track and coordinate tests, referrals
and transitions of care
• Performance Measurement and Quality Improvement: Use
performance and patient experience data for continuous quality
improvement
13.
14. Important Parts of the
Structure
• Must Pass Elements
• Critical Factors
• Meaningful Use
• Documentation
15.
16.
17.
18. Must Pass Elements
• Must Pass Elements
1. 1A: Access During Office Hours (4 pts)
2. 2D: Use Data for Population Management (5 pts)
3. 3C: Manage Care (4 pts)
4. 4A: Self-Care Process (6 pts)
5. 5B: Referral Tracking and Follow-Up (6pts)
6. 6C: Implement Continuous Quality Improvement
(4 pts)
Must Pass Elements = up to 29 points
19. Critical Factors -- central to capability being assessed;
important impact on scoring
• 1A1: Provide same day appointments [MPE]
• 1B3: Provide timely clinical advice by phone after hours
• 1G2: Have regular team meetings and communication processes
• 3A3: 3rd important condition for MH/SA or unhealthy behavior
• 3D1: Review & reconcile medications with patients/families for more
than 50% of care transitions**
• 3E2: Generate at least 75% of eligible prescriptions electronically*
• 4A3: Develop & document self-management plans and goals in
collaboration w/ at least 50% of patients/families** [MPE]
• 5A1: Track labs until results are available, flagging and following-up on
overdue results
• 5A2: Track imaging tests until results are available, flagging and
following-up on overdue results
NOTE: items in blue are must pass elements
* and ** are meaningful use items (3D1, 3E2, 4A3)
20. Anatomy of a Standard
Standard Name, Points &
Intent
Element Name, Points,
Description of Performance
Expectation
Factor: Scored item in an
Element
NOTE: * and ** indicate MU
criteria
Scoring Description
Explanation: Additional info on
what NCQA is looking for
Documentation Examples
Source: NCQA See pg 19 of NCQA Standards & Guidelines,
March 28, 2011 for definitions
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25.
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27.
28.
29.
30.
31.
32.
33. Element 1A: Must Pass & Critical Factors
Critical
Factor
Impact of
Critical
Factors on
Scoring
Minimum score Source: NCQA
required for MPEs S&G, p 29-30
34. Element 1C: MU Factors & Reporting a Percent
Meaningful Use
Source: NCQA
S&G p 33-34
35.
36.
37.
38.
39.
40.
41.
42.
43.
44. Element 5A: CFs
What do
you
notice
about the
scoring?
Source: NCQA
50. Recognition & Transformation
“Recognition… is only the beginning of a journey for continuous
improvement and cultural transformation.
NCQA’s rigorous standards challenge a practice to examine nearly
every aspect of its operations. The evolution to a PCMH is a
serious undertaking — one that rewards patients with more
coordinated, focused and safer care, and rewards providers
with greater satisfaction in practicing medicine.”
- Marjie Harbrecht, MD
CEO, HealthTeamWorks, Colorado
51. Multiple Reinforcing Efforts to Support
PCMH Development in FQHCs
• HRSA BPHC QI Supplemental Grant ‘12-’13
– PCMH Cervical Cancer Screening, Apply by June 1
• HRSA PCMHH Initiative to Support FQHCs to
achieve NCQA Recognition
– Education for PCAs and FQHCs around recognition; covers all
fees for survey process
• NACHC Leadership Institute
– National initiative to create design, methods, tools to
facilitate work by PCAs and FQHCs for sustainable system
transformation to PCMHs
52. RRWB is the Supplemental Worksheet
Click here
Click here
KyPCA Applied PCMH Webinar #1 01.16.13
53. The Chart Review Using the
Record Review Workbook
• 2011 Elements PCMH 3C, 3D, 4A
− Require medical record abstraction of data
− Need % of patients for each factor based on
numerator and denominator
• Two methods to collect and submit patient data
– Method #1 - report from the electronic system
– Method #2 – Record Review Workbook
• Excel workbook in the Survey Tool
• Tool to identify sample of patients and abstract data
KyPCA Applied PCMH Webinar #1 01.16.13
54. PCMH 3C: Care Management
Entering NOT USED in row 1
“grays” out the column for all
entries
Response Options
Yes
No
Not Used
Not applicable
KyPCA Applied PCMH Webinar #1 01.16.13
55. Questions - PCMH Standards
Which PCMH standard is of greatest interest to
you, where will your CHC start?
What QI goal do you think you will start with?
58. PCMH-A Background & Context
• Developed to measure a site’s progress
towards achieving the 8 Change Concepts
• Self-administered assessment
• Aids in the identification of improvement
opportunities
• Stimulates conversations with other sites to
learn, share, & transform
• Serves as a standardized measure of progress
KyPCA Applied PCMH Webinar #1 01.16.13
61. Decide/Plan
Assess 3
2
Take Action
4
Understand
1
The setting
for a Support &
BIG Idea
5 Sustain
62. 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 but does not wish to implement in
the near-term?
• Complete the NCQA PCMH Baseline Self
Assessment tool in excel
– Due date February 4, 2013 (Mike and Dawn)
63. Steps in the Process – You have
(will need to) taken!
• Form the Lead Team
• Get Ready
• Assess IT Requirements
• Know Your Deadlines
• Set Your Goals and Timeline for Recognition
• Order Interactive Survey System and On-Line
Application from NCQA
• Determine Eligibility for the Multi-site Survey Option
• Complete Your Survey
• Prepare & Submit Survey (you know when!)
• Receive Recognition Decision from NCQA (TBD)
Notes de l'éditeur
810 applications approved for ’12-’13 supplemental grant
The FQHC Advanced Primary Care Practice Demonstration to test doctors’ teamwork in treating low-income patients at CHCs. Up to 500 FQHCs will be involved in the demonstration. Get more info on this
Qualis/MacColl team. We recommend that each member of the team complete the survey individually, and that you meet together to discuss the results and produce a consensus version to submit. If you complete the survey as a team exercise, please indicate the names of persons (e.g., team members) who complete the survey with you. Later on in the survey, you will be asked to describe the process by which you complete the survey. This survey is designed to help systems and provider practices move toward the “state-of-the-art” in delivering patient-centered care in the context of a medical home. The results can be used to help your team identify areas for improvement. At the end of the assessment you will immediately receive your health center’s overall and subscale (e.g., care coordination) scores. DIRECTIONS FOR COMPLETINGTHE ASSESSMENT Before you begin, please review the Change Concepts for Practice Transformation on pages 4–5, then complete the PCMH-A Intake Form below. Begin the assessment on page 6. Answer each item from the perspective of one physical health center site, not at the level of the health center organization. The rows in this form present key aspects of patient-centered care. Each aspect is divided into levels (A through D) showing various stages in development toward a patient-centered medical home.The levels are represented by points that range from 1 to 12.The higher point values within a level indicate that the actions described in that box are more fully implemented. For each row, click on the relevant point value. Review your subscale and overall scores on page 15. These subscale and overall scores are automatically calculated based on the responses entered. Average scores by change concept (subscale scores) and an overall average score are provided. Using the scores to guide you, discuss opportunities for improvement.
These are the technical process steps. Assumes you have decided to pursue obtaining recognition and are committed to making improvements related to the standards as required in your practiceIn setting goals, consider moving to Level 3 recognition in one or more steps if needed. Important opportunity to work on practice transformation as needed in this processRecognition decision is made 30-60 days after submission to NCQA