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

2. 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

3. 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

4. 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

5. 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

6. 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

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

8. 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. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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”

20. Questions and Comments
Alan Mitchell Senior Program Manager Primary Care Development Corp. (212)
Stacey Curry, MPH Dir. of Clinical Quality Management Coastal Family Health Center, Inc Ext