NCQA PCMH 2014 – Tips for the Final Weeks Kentucky Primary Care Association August 17, 2017

Summary of Tips – For Today NCQA PMCH 2014 Recognition Updated 11.21.2016 Submit by 9.30.17 Common mistakes Tips to be successful A few details about 2017 standards

Completion-Check Steps Do you have the application and ISS purchased from NCQA? If not, you cannot proceed with 2014 Application (submit now) Via NCQA Recognition Portal Interactive Survey System Providers Evaluation box checked Document Library (3 documents/element) Support Text Notes Print/save Final Due Date: September 30, 2017

Must Pass Elements & Critical Factors 6 Must Pass Elements (50%+ to pass at all) 1A Patient Centered Appointment Access 2D The Practice Team 3D Use Data for Population Management 4B Care Planning and Self-Care Support 5B Referral Tracking and Follow-Up 6D Implement Continuous Quality Improvement Critical Factors (9) Impact scoring 1A1, 4A6, 5A12, 5B8 you have to pass to get any points for that element

HIT Prevalidation Program Are your vendors prevalidated - approved for 2014 auto-credit, giving you points (credit)? Process to get approval and use Your practice has to use the functionality and do it! E.g., Campaigns for population health 3D Use the Prevalidation tab under Organizational Background

Documentation – Your Evidence Within last 12 months Reports Time frame Run date Numerator/denominator (% or #) Definition of the measure Screen shots Examples PII (no personal patient information)

Documents – Your Evidence Policies, Procedures, Workflows (descriptions of what you do, how you do it, when done, by whom …) Date of implementation A minimum of 90 days before you submit 9.30.17 submit (all dated prior 6.30.17) Fully operational at the clinic 3 documents per element (not factor!)

Reviewer – another set of eyes External to your practice Review documents for accuracy All documents that are required Check that the MPE are all met at 50%+ Review ISS Reviewer at your practice NCQA Reviewer – literal May ask for clarification

NCQA Tools Record Review Workbook (RRWB) 4A6 universe, follow instructions for 30 patient selection Audit 30 patient records for factors in 3C, 4B, 4C Screenshots of each factor Quality Measurement Improvement Worksheet (QMI) 1A6: show improvement, PDSA, no-shows common 6D & 6E; based on: 3 6A measures – show improvement on at least 2 1 6B measure 1 6C measure A vulnerable population measure

Renewal vs. Conversion 2011 to 2014 or renewing 2014 11 Elements require Documentation for Streamlined Renewal: 1A, 2D, 3C, 3D, 4A, 4B*, 4C, 5B, 6B, 6D, 6E 15 Elements require Attestation for Streamlined Renewal Streamlined Renewal Recognition is for 3 years. When the 3 year recognition expires a practice is eligible to submit for recognition under NCQA's new sustaining model. Conversion: PCMH 2011 practices that have achieved Level 3 can use the conversion process prior to your expiration date and no later than 9/30/2017.

Other Reminders Three documents/element Outstanding issues form (OIF) status – NCQA goes back to practice for more info If renewal old P/P included if change P/P for new submission Audits: any factors that were scored as yes in the individual practice site survey tool is subject to being reviewed in real time. Any element and factor you attested to will be subject to being audited as well. Lost ID & password: provide the full practice site, 5 digit license number (if you have it), mailing address, previous contact name, and new contact email address. Update your providers in the provider directory. Patients – do they know about PCMH, do you involve them? Include them!

Tips to be Successful Don’t wait until the last day Tell your story 6 weeks left Tell your story Label well, be clear Give them what they ask for (more is okay, but not needed) Details are important Let’s take a look at the ISS!

More NCQA Resources NCQA PCMH 2014 FAQhttp://www.ncqa.org/Portals/0/Programs/Recognition/PCSP/PCMH_2014 _Standards_FAQ.pdf NCQA PCMH 2014 training slideshttps://www.ncqa.org/Portals/0/Programs/Recognition/RPtraining/PCM H%202014%20Intro.%20Training%20Slides%20Part%201%20- %20Standards%201-3%20-%2011.26.pdf https://www.ncqa.org/Portals/0/Programs/Recognition/RPtraining/PCMH%20 2014%20Intro.%20Training%20Slides%20Part%202%20-%20Standards%204- 6%20-%2011.26.pdf

2017 PCMH Standards & Process 40 core criteria & 60 elective All 40 core must be met 25 of 60 elective must be met Concepts = Elements Must meet criteria in all six concept areas 2017 Distinction Modules Practice opportunities to show excellence Patience experience reporting Behavioral health integration Electronic Measure Reporting Q-PASS

2017 PCMH eCQMs Beginning with PCMH 2017 program, option to submit electronic clinical quality measures (eCQMs) to NCQA in support of their recognition process. Submit via E.H.R., HIE, QCDRs & data analytics companies (defined by CMS for ambulatory quality reporting) Measure categories: Acute Behavioral Health/Chronic Care Chronic Disease Care Overuse Immunization Preventative Care Admin QMS http://www.ncqa.org/portals/0/Programs/Recognition/PCMH/Quality_Measures_ Crosswalk.pdf

http://www.ncqa.org/Portals/0/Programs/Recognition/PCMH/PCMH%202014-PCMH%202017%20Crosswalk%206.19.17_Final_web.pdf?ver=2017-06-23-142418-887

Practical Approaches for Your PCMH Journey Begin with an assessment Identify practice champions Pick low-hanging fruit Align transformation with payment Make the time and honor it Work on cross cutting elements Start with areas that are easy to enhance Incorporate staff training Align quality metrics across payers and programs Intake process: practice made slight changes and this impacted 3A-D Referral tracking: update and fine tune the process (workflow) and form (policy)

Your PCMH Action Plan and Questions Will you submit by 9.30.17? What are you wanting more information about? What are your next steps? Where do you want to start? Do you need support, a reviewer?

Let’s Connect! Dawn Gentsch, MPH, MCHES, PCMH CCE KPCA PCMH Consultant PCMH Consultant & Practice Facilitator 515.360.1731 | ddgentsch@msn.com