Standard 6 Measure and Improve Performance NCQA Recognition for Patient-Centered Medical Home 2011 Standards © Qualidigm

Measure and Improve Performance Elements PCMH 6A:Measure Performance PCMH 6B:Measure Patient/Family Experience PCMH 6C:Implement Continuous Quality Improvement – MUST PASS PCMH 6D:Demonstrate Continuous Quality Improvement PCMH 6E:Report Performance PCMH 6F:Report Data Externally

6A Measure PerformanceScoring and Documentation The practice measures or receives the following data: 1.Three (3) preventive care measures 2.Three (3) chronic or acute care measures 3.Two (2) utilization measures affecting healthcare costs 4.Vulnerable population data 4 Points Scoring  4 factors = 100%  2-3 factors = 75%  1 factor = 25%  0 factors = 0% Documentation  Reports showing performance

NCQA Clinical Program Recognition Where Can It Be Used to Meet Elements? NCQA Clinical Recognition Programs  Diabetes Recognition Program (DRP)  Heart/Stroke Recognition Program (HSRP)  Back Pain Recognition Program (BPRP) Credit for Clinical Program Recognition may be used for meeting some requirements in 6 elements if the majority of clinicians are recognized  PCMH 3A, 3C (for selected conditions used for survey)  PCMH 6A, 6C, 6E, 6F

6B Measure Patient/Family Experience Scoring and Documentation The practice obtains feedback on patient experience with the practice and their care: 1.The practice conducts survey measuring experience on at least three (3) of the following: access, communication, coordination, and whole-person care 2.The practice uses PCMH CAHPS- CG survey tool 3.The practice obtains feedback from vulnerable populations 4.The practice obtains feedback through qualitative means 4 Points Scoring  4 factors = 100%  3 factors = 75%  2 factors = 50%  1 factor = 25%  0 factors = 0% Documentation  Reports showing results of patient feedback

6C Implement Continuous Quality Improvement Scoring and Documentation The practice uses an ongoing quality improvement process: 1.Set goals and act to improve performance on three (3) measures from Element 6A 2.Set goals and act to improve performance on one (1) measure from Element 6B 3.Set goals and address at least one (1) identified disparity in care for vulnerable populations 4.Involve patients in QI teams or on the practice’s advisory council Must Pass 4 Points Scoring  3-4 factors = 100%  2 factors = 50%  1 factor = 25%  0 factors = 0% Documentation  Report or completed PCMH Quality Measurement and Improvement Template  Process demonstrating how it involves patients/families in QI teams or advisory council

6D Demonstrate Continuous Quality Improvement Scoring and Documentation The practice demonstrates ongoing monitoring of the effectiveness of its improvement process: 1.Tracks results over time 2.Assesses the effect of its actions 3.Achieves improved performance on one measure 4.Achieves improved performance on a second measure 3 Points Scoring  4 factors = 100%  3 factors = 75%  2 factors = 50%  1 factor = 25%  0 factors = 0% Documentation  Reports showing measures over time, recognition results, or completed Quality Improvement Measurement and Improvement Template

6E Report PerformanceScoring and Documentation The practice shares data from Elements A and B: 1.Individual clinician results within the practice 2.Practice results within the practice 3.Individual clinician or practice results to patients or public 3 Points Scoring  3 factors = 100%  2 factors = 75%  1 factor = 50%  0 factors = 0% Documentation  Reports (blinded) showing summary data and how it provides results within the practice  Example of patient/public report

6F Report Data ExternallyScoring and Documentation The practice reports electronically: 1.Ambulatory clinical quality measures to CMS or states* 2.Ambulatory clinical quality measures to other external entities 3.Data to immunization registries or systems** 4.Syndromic surveillance data to public health agencies** *Core Meaningful Use Requirement ** Menu Meaningful Use Requirement 2 Points Scoring  3 factors = 100%  2 factors = 75%  1 factor = 50%  0 factors = 0% Documentation  Reports demonstrating data submission