Person-Centered Medical Home Recognition Program

Connecticut Department of Social Services Presented by Community Health Network of Connecticut, Inc.

Person-Centered Medical Home Recognition Program What is a Person-Centered Medical Home? A Person-Centered Medical Home is a Practice that places the patient at the center of the health care system, and provides primary care that is “accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.” The patient has a personal relationship with the provider/care team. The care team knows the patient and their health care needs. A method to merge modern technology with traditional primary care

What are the benefits of a PCMH? Financial Incentives Improved staff morale: Provider champion leads Care Team Improved patient satisfaction: Patient has a personal relationship with Provider and Care Team Embraces quality improvement and improves patient outcomes

NCQA Chosen for PCMH Recognition During PCMH program development at the state level, the committee evaluated a number of PCMH Recognition Programs. It was determined that the National Committee for Quality Assurance (NCQA) PCMH program of recognition would be the one that the Department of DSS would use for their program. It was decided that only Levels 2 or 3 would be recognized by DSS. Level 1 NCQA PCMH recognition requires participation in the Glide Path Process.

Eligibility to Become A PCMH in CT NCQA recognized, Level 2 or 3 Not recognized or Level 1 – with completed PCMH & Glide Path Application Enrolled as CMAP provider (CT Medical Assistance Program) Active unrestricted CT license as MD, DO, NP or PA. Function as PCP with panel of patients Provide primary care services for at least 60% of the time across all payers

Eligibility (continued) Share all medical records within the practice and use the same system support for all clinical and administrative service Meet State/Federal requirements for EPSDT, Smoking Cessation (R2Q), addressing Racial and Ethnic Disparities, and Adherence to Consumer Protections Will not require APRN and PA practitioners to have their own panel of patients to qualify as PCMH providers if they are serving to support or extend the panel of a primary care physician

Glide Path Process Submit state PCMH application Agree to Glide Path milestones/timeframes Demonstrate progress toward NCQA PCMH recognition Complete Gap Analysis (practice’s ability to substantiate compliance with standards contained in NCQA PCMH application) Complete Work Plan (contained in Glide Path Application) Provide ongoing documentation in accordance with established Work Plan

Practice Transformation Supports The ASO’s Community Practice Transformation team, comprised of RNs, APRNs, JD, MPH and other professionals, are dedicated to support PCMH/Glide Path practices. The team is specially trained to assist Primary Care Practices to make meaningful changes designed to improve patient outcomes. o Review the practice’s NCQA work plan to assess implementation timelines o Conduct gap analysis of the practice’s work plan o Monitor, track and assess progress of work plan to ensure practices are accomplishing PCMH/ Glide Path tasks o Provide resources and tools for NCQA recognition o Provide access to patient utilization data o Evaluate practice performance

How to Start Form PCMH Core Teams with a clinical lead, administrative personnel, ancillary staff (3-4 people) NCQA: (888) , Monday through Friday from 8:30 a.m. to 5 p.m. Download NCQA 2011 Standards Training Calendar – participate in workshops, Web Ex On-Boarding Guide Multi-Site/Single Site NCQA Recognition Process, brochure, scoring

NCQA  NCQA – Get free online application account  “Free” one for all sites  Submit Multi-Site Eligibility  NCQA will schedule a personal conference call.  They will walk you through Multi-Site Process.  Focus on 6 NCQA Must Pass Elements  NCQA Standard 1G – correlates with 1D of Glide Path

NCQA (continued)  Develop Care Teams (MD, APRN, PA, DO, nurse, care coordinator, MA, receptionist)  Need Physician champion  Identify populations you will be managing – Need to have three months worth of data  Policies and procedures, job descriptions need to be in place at least three months prior to NCQA submission

CT DSS PCMH/Glide Path Develop your work plan When do you plan to submit to NCQA? Submit PCMH/Glide Path Accordingly Start to develop job descriptions, policies Educate staff on PCMH, keep a log of education activities Determine populations you will manage/track

Resources  “For Provider” tab  “Pathways to PCMH”  2 Introductory Webinars on PCMH

DSS PCMH Program Questions?