LPHI Regional Care Collaborative June 17, 2014 PCMH and Meaningful Use Alan Mitchell, PCDC Stacey Curry, Coastal Family Health Center

Today’s Presentation Concepts: Patient Centered Medical Home/Meaningful Use PCMH 2011, 2014 MU Stage 1, Stage 2 Overlap & Gaps Change process: buy-in, team, challenges & solutions Reporting and Attesting Similarities Differences

Patient Centered Medical Home Approach to primary care focused on patient Access Population Management Care Management Self-management Care tracking and coordination Quality Improvement NCQA, Joint Commission, URAC, others NCQA 2008, 2011, 2014 Some state incentives, but not a gov’t program

Meaningful Use CMS: Electronic Health Record Incentive Program Phased approach to: Encourage adoption of EHRs Make “Meaningful Use” of EHRs: use to improve quality of care Measure health trends and quality of care nationwide Stages 1, 2, 3 Adopt/Implement/Upgrade for Medicaid Core vs. Menu (and Clinical Quality Measures) Add graph showing adoptions since Meaningful Use Add info on overlap between MU 1 and MU 2

PCMH Overlap: MU Stage 1 (Core) Medication Orders and Interactions (3D, 3E) Patient Education (4A2) Demographics, Vital Signs, Smoking Status, Problem List (2A, 2B) Clinical Decision Support (3A, others) Clinical Quality Measures (6A) Electronic Copy of Health Info (1C) Clinical Visit Summaries (1C3) Health Information Exchange (5B, 5C) References to NCQA PCMH 2011 Elements

PCMH Overlap: MU Stage 1 (Menu) Drug formulary checks (3E) Lab results (5A) Patient reminders/lists/registries (2D) Patient electronic access (1C) Medication reconciliation (3D) Transition of care summary (5C) Immunization/Syndromic Surveillance (6F) References to NCQA PCMH 2011 Elements

Health Center Experience Requirements Patient information and clinical data (2A, 2B) Med management and ePrescribing (3D, 3E) Test tracking (5A) Successes Challenges & Solutions

PCMH 2A: Patient Information The practice uses an electronic system that records the following as structured (searchable) data for more than 50 percent of its patients. 1. Date of birth 2. Gender 3. Race 4. Ethnicity 5. Preferred language 6. Telephone numbers 7. E-mail address 8. Dates of previous clinical visits 9. Legal guardian/health care proxy 10. Primary caregiver 11. Presence of advance directives (NA for pediatric practices) 12. Health insurance information The First Five Items are MU CORE areas

PCMH 2A: Patient Information Successes We have a registration form/process that ensures that these items are addressed with the patients We have trained our staff to make sure that this information is updated annually All of our providers are well above the MU threshold with the first five factors. Challenges We have had very few challenges with this element Reporting on factors that are not MU Core items has been difficult in our current system

PCMH 2B: Clinical Data All of these areas are MU Core requirements The practice uses an electronic system to record the following as structured (searchable) data. An up-to-date problem list with current and active diagnoses for more than 80 percent of patients Allergies, including medication allergies and adverse reactions, for more than 80 percent of patients Blood pressure, with the date of update for more than 50 percent of patients 2 years and older Height for more than 50 percent of patients 2 years and older Weight for more than 50 percent of patients 2 years and older System calculates and displays BMI (NA for pediatric practices) System plots and displays growth charts (length/height, weight and head circumference (less than 2 years of age) and BMI percentile (2–20 years) (NA for adult practices) Status of tobacco use for patients 13 years and older for more than 50 percent of patients (NA for pediatric practices if all patients <13 years) List of prescription medications with the date of updates for more than 80 percent of patients All of these areas are MU Core requirements

PCMH 2B: Clinical Data Successes Challenges We have trained our clinical staff to make sure that these areas are addressed at each patient visit. All of our providers are well above the MU threshold for the reportable factors. We have been able to show that our system has the capabilities for the factors that require screenshots. Challenges We have had very few challenges with this element

PCMH 3D: Med management The practice manages medications in the following ways: Reviews and reconciles medications with patients/families for more than 50% of care transitions Reviews and reconciles medications with patients/families for more than 80% of care transitions Provides information about new prescriptions to more than 80 percent of patients/families Assesses patient/family understanding of medications for more than 50 percent of patients with date of assessment Assesses patient response to medications and barriers to adherence for more than 50 percent of patients with date of assessment Documents over-the-counter medications, herbal therapies and supplements for more than 50 percent of patients/families, with the date of updates

PCMH 3E: ePrescribing The practice uses an electronic prescription system with the following capabilities. Generates and transmits at least 40 percent of eligible prescriptions to pharmacies Generates at least 75 percent of eligible prescriptions Enters electronic medication orders into the medical record for more than 30 percent of patients with at least one medication in their medication list Performs patient-specific checks for drug-drug and drug-allergy interactions Alerts prescribers to generic alternatives Alerts prescribers to formulary status

PCMH 3D and 3E: Med management and ePrescribing Successes Most of our providers are doing very well with the MU components of ePrescribing Our current system is able to generate the needed alerts Our providers do very well in documenting over-the-counter medications Challenges Providers who are on the mobile units and use a wireless card have ePrescribing limitations Although providers do address barriers to medication adherence and make sure their patient understand their medication their medications, they do not always adequately document it. Medication reconciliation in the current system has posed some challenges. Solutions Better training in weaker areas Implementation of new system

PCMH 5A: Test Tracking The practice has a documented process for and demonstrates that it: Tracks lab tests until results are available, flagging and following up on overdue results Tracks imaging tests until results are available, flagging and following up on overdue results Flags abnormal lab & imaging results, bringing them to the attention of the clinician Notifies patients/families of normal and abnormal lab and imaging test results Follows up with inpatient facilities on newborn hearing and blood-spot screening Electronically communicates with labs to order lab & imaging tests and retrieve results Electronically incorporates at least lab & imaging test results into structured fields in medical records

PCMH 5A: Test Tracking Successes Challenges Solutions We have a policy in place for test/imaging tracking Our system allows us to track these areas Challenges Current system is limited as to what NCQA requires for this element We do not have consistency with tracking these elements Solutions We are in the process of implementing a new HIT system We will better standardize our processes and our training so that all providers follow up in the same way

Gaps: MU vs PCMH 2011 Policies and procedures (all) Access to care (1A-G) Comprehensive Health Assessment (2C) Care Teams, Care Plans (1G, 3C) Referral tracking (specialists and community) (4B, 5B) Evidence-based guidelines in use (3A) Transitions of care to hospital (beyond HIE) (3C) Patient experience (6B) QI program (6C-E) MU: HIT privacy & security audit and plan

Approach to PCMH and MU Change Management Seek areas of overlap / identify gaps Self-assess Plan Act Change Management Leadership buy-in Identify a project lead and a clinical champion Organize a multidisciplinary, cross-hierarchical team Clinical, Operational, HIT Plan, communicate, train Health center experience in managing change

Reporting/Attestation PCMH Gather evidence Purchase “survey tools” (by June 30 for PCMH 2011!) Upload files and submit Recognition is per practice Meaningful Use Register with CMS and/or state Medicaid Work with vendors to customize & ensure you’re documenting in the right place Run reports to make sure you’re passing all measures Manually enter data in CMS or state system (90 days or 1 year, depending) Attestation is per provider Get ready for the next phase! Sustainability PCMH 2014, MU Stage 2 or 3, etc. Policies/procedures, reports, chart review worksheet, screenshots, examples Annotate, “tell the story”

Questions and Comments Alan Mitchell Senior Program Manager Primary Care Development Corp. (212) 437-3952 amitchell@pcdc.org Stacey Curry, MPH Dir. of Clinical Quality Management Coastal Family Health Center, Inc. 228-374-2494 Ext. 1119 scurry@coastalfamilyhealth.org