1. All materials © 2011, National Committee for Quality Assurance NCQA’s Patient-Centered Medical Home (PCMH) Program February 15 and 28, 2012 Florida CHIPRA Pediatric Medical Home Demonstration Project

2. 2 NCQA PCMH Overview February 2012 Goals for Today’s Meeting Understand rationale for NCQA’s PCMH recognition program and requirements for practices to demonstrate the patient- centered medical home model Identify resources for NCQA’s PCMH 2011 program Review information about quality, cost savings and pay-for-recognition initiatives Identify PCMH components specific to pediatric practices

3. 3 NCQA PCMH Overview February 2012 Support for NCQA’s PCMH Most widely used tool in PCMH demonstrations with payment reform (Bitton et al 2010) Endorsed for Recognition by American Academy of Pediatrics, National Quality Forum, et al. Federal initiatives (CMS, HRSA, Military) State initiatives (NYS Medicaid, multi- payor efforts that include Medicaid in VT, RI, CO, ME, and more )

4. 4 NCQA PCMH Overview February 2012 Positive Impact on Practices Better care management programs Greater attention to patient compliance Improved patient outreach (patient reminders, increased screenings, educational materials) Increased data collection and reporting Significant adoption of patient registries

5. 5 NCQA PCMH Overview February 2012 Of the >3500 Recognized Practices 15% are pediatrics only, >30% serve children 38% have only 1-2 physicians 60% are Level 3 48 states & DC have recognized practices (91 in FL, 85 Level 3) EMR is not required to achieve recognition – Level 1 recognition is achievable without EMR – Higher levels require more health IT

6. 6 NCQA PCMH Overview February 2012 NUMBER OF PPC-PCMH & PCMH SITES BY STATE ME VT RI NJ MD MA DE NY WA OR AZ NV WI NM NE MN KS FL CO IA NC MI PA OH VA MO HI OK GA SC TN MT KY WV AR LA AL IN IL SD ND TX ID WY UT AK CA CT NH 61-200 Sites *As of 1/31/12 MS 21-60 Sites 0 Sites 1-20 Sites 201+ Sites 3571 PPC-PCMH SITES

7. 7 NCQA PCMH Overview February 2012 Initiatives Supporting NCQA Recognition Programs National/Multi-state – CMS, HRSA, MHS, Anthem, Aetna, Maine – Patient Centered Medical Home Pilot Vermont - Vermont “Blueprint for Health” North Carolina – Community Care of North Carolina (N3CN), BCBSNC Pennsylvania – Chronic Care Commission, PAFP Rhode Island – Rhode Island Quality Institute Minnesota – Primary Care Coordination Program – Facilitated by Office of the Commissioner of Securities and Insurance Maryland – Maryland Health Care Collaborative (MHCC) Michigan – Priority Health, Health Plan of Michigan and Medicaid Health Plan Massachusetts – State Medicaid PCMH Initiative New York – Adirondack Medical Home Demonstration, State Medicaid Ohio – Cincinnati Health Improvement Collaborative Colorado – Colorado Clinical Guidelines Collaborative Louisiana – Through DHH the Louisiana Health Care Quality Forum Florida– BCBSFL Care Management and P4P Quality Initiative Connecticut - Connecticut Department of Social Services– Medicaid Initiative

8. 8 NCQA PCMH Overview February 2012 2011 PCMH Content and Scoring Standard 1: Enhance Access and Continuity A.Access During Office Hours** B.After-Hours Access C.Electronic Access D.Continuity E.Medical Home Responsibilities F.Culturally and Linguistically Appropriate Services G.Practice Team Pts 4 2 4 20 Standard 2: Identify and Manage Patient Populations A.Patient Information B.Clinical Data C.Comprehensive Health Assessment D.Use Data for Population Management** Pts 3 4 5 16 Standard 3: Plan and Manage Care A.Implement Evidence-Based Guidelines B.Identify High-Risk Patients C.Care Management** D.Medication Management E.Use Electronic Prescribing Pts 4 3 4 3 17 Standard 4: Provide Self-Care Support and Community Resources A.Support Self-Care Process** B.Provide Referrals to Community Resources Pts 6 3 9 Standard 5: Track and Coordinate Care A.Test Tracking and Follow-Up B.Referral Tracking and Follow-Up** C.Coordinate with Facilities/Care Transitions Pts 6 18 Standard 6: Measure and Improve Performance A.Measure Performance B.Measure Patient/Family Experience C.Implement Continuously Quality Improvement** D.Demonstrate Continuous Quality Improvement E.Report Performance F.Report Data Externally G.Use of Certified EHR Technology Pts 4 3 2 0 20 ** Must Pass Elements

9. 9 NCQA PCMH Overview February 2012 PCMH Scoring Level of QualifyingPoints Must Pass Elements at 50% Performance Level Level 385 - 1006 of 6 Level 260 - 846 of 6 Level 135 - 596 of 6 Not Recognized0 - 34< 6 Practices with a numeric score of 0 to 34 points and/or achieve less than 6 “Must Pass” Elements are not Recognized. 6 standards = 100 points 6 Must Pass elements NOTE: Must Pass elements require a ≥ 50% performance level to pass

10. 10 NCQA PCMH Overview February 2012 Must Pass Elements Rationale for Must Pass Elements Identifies critical concepts of PCMH Helps focus Level 1 practices on most important aspects of PCMH Guides practices in PCMH evolution and continuous quality improvement Standardizes “Recognition” Must Pass Elements 1A: Access During Office Hours 2D: Use Data for Population Management 3C: Manage Care 4A: Self-Care Process 5B: Referral Tracking and Follow-Up 6C: Implement Continuous Quality Improvement

11. 11 NCQA PCMH Overview February 2012 NCQA Survey Process Components Standards and Elements – basis for scoring, each described with type of documentation required and level of health information technology required Important conditions – basis for data responses in multiple elements Survey Tool – software to record and score practice responses and file documentation Record Review Workbook - requires data from selected medical records Documentation –identify and organize documents needed for evidence of compliance with each element Readiness – practice uses the Survey Tool to assess readiness to meet the standards and submit

12. 12 NCQA PCMH Overview February 2012 Training NCQA provides free web-based training www.ncqa.org/rptraining.aspx www.ncqa.org/rptraining.aspx – Twice a month Getting On Board Instruction for the online application system and multi-site submission process – Once per month Overview of standards and requirements given in 2 sessions Overview of the Survey Tool and the Interactive Survey System (ISS) – Recorded Getting On Board Record Review Workbook

13. 13 NCQA PCMH Overview February 2012 Focus on Pediatrics Goal for PCMH 2011 to enhance applicability to pediatric practices AAP participated on the PCMH Advisory Committee Throughout the Standards – “Patients/Families” has been incorporated where appropriate – “NA for pediatric practices” has been used where appropriate – Pediatric examples and explanations have been added – References to Bright Futures have been included PCMH 1: Enhance Access and Continuity – Explanation addresses unique pediatric issues, such as teen privacy and guardianship PCMH 2: Identify and Manage Patient Populations – Includes pediatric clinical data, health assessment requirements and age appropriate immunizations and screenings – Includes age appropriate screenings, e.g. developmental and adolescent depression screening

14. 14 NCQA PCMH Overview February 2012 Focus on Pediatrics (cont.) PCMH 3: Plan and Manage Care – Explanation specifies relevant pediatric clinical conditions, including well-child care and children/youth with special health care needs PCMH 4: Provide Self-Care and Community Resources – Population specific referrals includes parenting and respite care PCMH 5: Track and Coordinate Care – Communicate with facilities for newborn lab test results – Collaborate to develop a written care plan for patients transitioning from pediatric care to adult care PCMH 6: Measure and Improve Performance – Preventive measures include developmental screening, immunizations and depression screening

15. 15 NCQA PCMH Overview February 2012 Using NCQA’s PCMH: Steps for the Practice 1.Review PCMH program information 2.Participate in a free standards webinar 3.Obtain a web-based Survey Tool 4.Participate in a free WebEx ISS demonstration of the Survey Tool 5.Use Survey Tool to self-assess current performance 6.To apply for recognition (optional), submit completed application, agreements, discounted application fee, and survey with documentation to NCQA when ready

16. 16 November 30, 2010 Overview of NCQA Recognition Process Review requires Survey Tool, application information: NCQA Agreement and Business Associate Addendum (BAA), Application, Clinician Information Licensure check of all clinicians Evaluation includes Survey Tool responses, documentation, and explanations by trained reviewers 5% audit by email, teleconference, or on site visit Executive review by NCQA for consistency Peer review by trained Review Oversight Committee (ROC) member Final decision and status to the practice within 30 – 60 days Results reported - Recognition posted on NCQA Web site and distributed on monthly data feeds Recognition packet provided - Certificate, press release and advertising guidelines

17. 17 NCQA PCMH Overview February 2012 Best Practices: What We Have Learned Roadmap for quality improvement Recognizes roles of every care team member, physicians and mid-level practitioners Coordinated teamwork Patient/family engagement Enables practice system change Share benefits with patients and payors Connection to community resources

18. 18 NCQA PCMH Overview February 2012 NCQA Contact Information Contact NCQA Customer Support to: Acquire standards documents, application materials, and survey tools Questions about your user ID, password, access 1-888-275-7585 Visit NCQA Web Site to: View Frequently Asked Questions View Recognition Programs Training Schedule Submit to questions to pcmh@ncqa.orgpcmh@ncqa.org Or direct questions to your assigned team contacts: Ask about interpretation of standards or elements Request technical assistance with the application process

19. 19 NCQA PCMH Overview February 2012 Questions?