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

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

5. 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

6. 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

7. 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

9. 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)

10. 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
submit (all dated prior )
Fully operational at the clinic
3 documents per element (not factor!)

12. 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

13. 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

16. 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.

18. 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 address.
Update your providers in the provider directory.
Patients – do they know about PCMH, do you involve them? Include them!

19. 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!

21. More NCQA Resources
NCQA PCMH 2014 FAQhttp:// _Standards_FAQ.pdf NCQA PCMH 2014 training slideshttps:// H%202014%20Intro.%20Training%20Slides%20Part%201%20- %20Standards%201-3%20-% pdf %20Intro.%20Training%20Slides%20Part%202%20-%20Standards%204- 6%20-% pdf

22. 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

24. 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
Crosswalk.pdf

28. 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)

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

30. Let’s Connect!
Dawn Gentsch, MPH, MCHES, PCMH CCE KPCA PCMH Consultant PCMH Consultant & Practice Facilitator |