Introduction to PCMH 2017 - wypca.org

1 Introduction to PCMH 2017 PCMH 2017 Eligibility RequirementsOutpatient primary care practices Practice defined: a clinician or clinicians practicing together at a single geographic location Includesnurse-led practices in states as permitted under state licensing laws Does not include: Urgent care clinics Clinics open on a seasonal basis3 Eligibility Requirements Recognition is achieved at thegeographic 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 Cliniciansshould be listed at eachsite where they routinely see a panel of their patients Non-primary care clinicians should not be includedEligibility Requirements4 Eligibility RequirementsAt least 75% of each clinician s patients come for.

2 First contact for care Selected as personal PCP Continuous care Comprehensive primary care servicesAll eligible clinicians at a site must apply togetherPhysicians in training (residents) should not be listed5 Practices should have staff skilled to use and a computer system that includes the following: Email & Internet access Microsoft Word Microsoft Excel Adobe Acrobat Reader (available free online) Document scanning & screen shots Access to the electronic systems used by the practice, billing system, registry, practice management system, electronic prescription system, EHR, Web portal, Requirements6 Eligibility RequirementsTransformation may take 3-12 months Your roadmap: PCMH 2017 Standards and Guidelines everything coveredImplement changes.

3 Practice-wide commitment New policies and procedures for staff Staff training and reassignments Medical record systems Reporting capabilities improvement Develop and organize documentation7 PCMH 2017 Standards Overview & Scoring9 Changes to PCMHH ighlights Reduced total criteria to 100 from 167 factors in 2014 Core/elective approach allows practices to tailor program to their population Eliminated structure in favor of outcome Improvefocus and flexibility Includes activities necessary to achieve stated aims and drive improvement Focuses on whether the intent was achieved and care was improvedSupport continuous practice transformation Accommodates a spectrum of practices (basic-complex, small-large) Allows a variety of response options that demonstrate a requirement is met Introduces virtual reviewUpdate documentation methods Understanding behavioral needs and social determinants included in core Deeper integration and community connections included in electivesEmphasize comprehensive, integrated care2017 Standards FormatConcepts:Over-arching components of PCMH Competencies: Ways to think about and/or bucket criteriaCriteria.

4 Theindividual things/tasks you do that make you a PCMH10 Structure Concepts, Competencies, Criteria 2017 StandardsConcepts11 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)2017 StandardsStructure -Example122017 Standards RecognitionChanges to LevelsLevel 1 Level 2 Level 313 Changes to Points40 Core Criteria 60 ElectiveCriteriaMust complete all 40 coreMust achieve 25 Credits2017 Standards Scoring142017 StandardsScoringCore CriteriaElective Criteria15162017 Standards ScoringExample of Elective Criteria Selection: Must represent 5 of 6 ConceptsTCKMACCMCCQI21221112112112111111 1112112111122121221121111-31122121221-2 Each row represents a Concept which is laid out with the number of electives included and the credits identified in the middle of each circle.

5 The bluecircles are an example of the electives chosen by a practice to equal 25 credits. Redcircles are the electives leftover that the practice will notdemonstrate performance on. 111 Prevalidation ProgramNCQA prevalidatedHealth IT solutions have successfully demonstrated that their technology solution has functionality that supports or meets one or more criteria in the PCMH standardsEvaluation can result in approved fully met criteria and partially met criteria that are transferable to eligible client practices submitting for recognition and acknowledgment of practice support functionalityOverview17 PCMH 2017 Commit, Transform, SucceedPCMH Redesign3 Parts19 SucceedPractice completes an online guided works with an NCQA representative to develop an evaluation schedule.

6 Practice works with NCQA representative to identify support and education for NCQA PCMH online education resources support the transformation submits initial documentation and checks in with its evaluatorPractice submits additional documentation and checks in with its submits final documentation to complete submission and begin NCQA evaluation earns NCQA is prepared for new payment environment (value-based payment, MACRA MIPS/APMs).Practice demonstrates continued readiness and high quality performance through annual check-ins with RedesignImpactFlexibilityPersonalizedser viceUser-friendlyapproachContinuous improvementAligns with 2017 Standards ContentDocumentation Key22 Presentation documentation key:-Report-Evidence-Process-List-Source -Agreement-Protocol-RRWB-Worksheet-2 Credit ElectivesThe practice provides continuity of care, communicates roles and responsibilities of the medical home to patients/families/caregivers, and organizes and trains staff to work to the top of their license and provide effective team-based care 23 Team-based Care & Practice OrganizationCOMPETENCY AThe practice is committed to transforming the practice into a sustainable medical home.

7 Members of the care team serve specific roles as defined by the practice s organizational structure and are equipped with the knowledge and training necessary to perform those functions25 Team-Based Care and Practice OrganizationDesignates a clinician lead of medical home, & staff to manage the PCMH transformation and medical home activitiesDefines practice organizational structure& staff responsibilities/skills to support key PMCH functionsTC 01-02: Core Criteria 26 Structure and Staff ResponsibilitiesTC 02: ExampleProvidersOversee management of practice and direct patient careOffice ManagerDaily business managementFront OfficeCoordination of visitCheck inPre-visit planningCheck outFollow-up and schedulingBillingFinancialReferrals CoordinationCodingReimbursementClinical TeamCoordinate care plan.

8 Self-management supportCare CoordinatorCoordinate and manage high risk populationTriage NurseLeader of daily huddle and communicationMedical AssistantSupport clinical team and facilitate patient care27 Team-Based Care and Practice OrganizationThe practice is involved in external collaborative activities* Patient/family is involved in governance structure/ stakeholder committees* Practice uses a certified EHRsystem & security risk analysis TC 03-05: Elective Criteria28 External PCMH CollaborationsTC 03: ExampleTeam-Based Care and Practice OrganizationTC 04: Example29 COMPETENCY BCommunication among staff is organized to ensure that patient care is coordinated, safe and effectiveTeam-Based Care and Practice OrganizationHas regular care team meetings or a structured communication process focused on individual patient care31 Involves care team staff in practice s performance evaluation and quality improvement activitiesTC 06-07: Core CriteriaTeam-Based Care and Practice OrganizationTC 06: Example32 Team-Based Care and Practice OrganizationTC 07: Example33 Date: 01/01/2017 Team-Based Care and Practice Organization34TC 08.

9 Elective Criteria* The practice has at least one care manager qualified to identify and coordinate behavioral health needsCOMPETENCY CThe practice communicates and engages patients on expectations and their role in the medical home model of careTeam-Based Care and Practice OrganizationHas a process for informing patients/ families/caregivers about the role of the medical home and provides materials that contain the information36TC 09: Core CriteriaMedical Home InformationTC 09: Example37 PCMH 2017 Owning Your Transformation ProcessOwning Your Transformation ProcessDocumented Processes -written statements describing the practice s policies and procedures Protocols Practice guidelines Agreements Other documents describing actual processes or forms ( , Referral forms, checklists and flowsheets)39 Types of EvidenceOwning Your Transformation ProcessEvidence of Implementation a means of demonstrating systematic uptake and effective demonstration of required practices including.

10 Reports--Patient records Materials--Examples Screen shots --Virtual demonstration Attestation --eCQMs Transfer credit--Survey Data entered --Not applicable into Q-PASS40 Types of evidenceThe practice captures and analyzes information about the patients and community it serves and uses the information to deliver evidence-based care that supports population needs and provision of culturally and linguistically appropriate services 41 Knowing & Managing Your PatientsCOMPETENCY APractice routinely collects comprehensive data on patients to understand background and health risks of uses information on the population to implement needed interventions, tools and supports for the practice as a whole and for specific individualsKnowing and Managing Your PatientsKM 01-02: Core CriteriaDocuments an up-to-date problem listCompletes a comprehensive health assessment that includes the examination of all 9 itemsMedical history of patient & familyMental health/ substance use history of patient & familyFamily/social/cultural characteristicsCommunication NeedsBehaviors affecting healthSocial functioningSocial determinants of healthDevelopmental screeningAdvanced care planning (NA for pediatrics)4344 Knowing and Managing Your PatientsKM 02: Example45 Knowing and Managing Your PatientsKM 02 A&D.