1. Training Webinar # 2 David Halpern, MD, MPH November 23, 2011 Patient-Centered Medical Home NCQA’s PCMH 2011 Standards

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3. Acknowledgements

4. CCNC’s PCMH Resources www.communitycarenc.org/emerging-initiatives/pcmh-central1/2011-pcmh-resources/

5. Let’s Review What is a Patient-Centered Medical Home (PCMH)? What are the Benefits for Me and My Practice? What is the National Committee for Quality Assurance (NCQA)? How Does My Practice Apply for PCMH Recognition?

6. PCMH (2011) 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 – 35< 6 NOTE: Practices with a numeric score of 0 to 34 points AND practices that achieve less than 6 “Must Pass” Elements will not be Recognized. 6 standards = 100 points NOTE: Must Pass elements require a ≥50% performance level to pass

7. each “standard” is composed of several “elements” each “element” is composed of several “factors” NCQA Lingo

8. Definitions Factor – A scored item in an element. For example, an element may require the practice to demonstrate how the team provides several different patient care services. Each of these services is a factor. Critical Factor – A factor that is required for practices to receive more than minimal points, or in some cases any points for the element. Critical factors are identified in the scoring section of the element. Explanation – Specific requirements that a practice must meet in order to earn points; guidance for demonstrating performance of the factor. Examples/Documentation – Descriptions of the evidence practices must submit to demonstrate performance for a specific factor. Each factor must be documented.

9. Today’s Agenda What is a “Must-Pass” Element? Element 1A (Must-Pass) Element 2D (Must-Pass) Element 5B (Must-Pass)

10. “Must Pass” Elements Some elements are “Must Pass” **To “Pass” one of these elements, you must receive a 50% score or higher** In the 2011 Standards, you must pass all 6/6 of the “Must Pass” elements to achieve any level of recognition.

11. 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”

12. PCMH (2011) Overview 1.Enhance Access and Continuity A.Access During Office Hours B.Access After Hours C.Electronic Access D.Continuity (with provider) E.Medical Home Responsibilities F.Culturally/Linguistically Appropriate Services G.Practice Organization 2.Identify/Manage Patient Populations A.Patient Information B.Clinical Data C.Comprehensive Health Assessment D.Use Data for Population Management 3.Plan/Manage Care A.Implement Evidence-Based Guidelines B.Identify High-Risk Patients C.Manage Care 3.Plan/Manage Care (continued) D.Manage Medications E.Electronic Prescribing 4.Provide Self-Care and Community Resources A. Self-Care Process B. Referrals to Community Resources 5.Track/Coordinate Care A.Test Tracking and Follow-Up B.Referral Tracking and Follow-Up C.Coordinate with Facilities/Care Transitions 6.Measure & Improve Performance A.Measures of Performance B.Patient/Family Feedback C.Implements Continuous Quality Improvement D.Demonstrates Continuous Quality Improvement E.Report Performance F.Report Data Externally

13. Must Pass Elements 1.1A: Access During Office Hours (4 pts) 2.2D: Use Data for Population Management (5 pts) 3.3C: Manage Care (4 pts) 4.4A: Self-Care Process (6 pts) 5.5B: Referral Tracking and Follow-Up (6pts) 6.6C: Implement Continuous Quality Improvement (4 pts) Must Pass Elements = up to 29 points

14. PCMH 1A: Access During Office Hours Practice has written process/standards and demonstrates that it monitors performance against the standards to: 1. Provide same-day appointments – CRITICAL FACTOR 2. Provide timely advice by telephone 3. Provide timely advice by electronic message 4. Document clinical advice

15. MUST PASS 4 Points Scoring –4 factors= 100% –3 factors (including factor 1) = 75% –2 factors (including factor 1)= 50% (must-pass threshold) –Factor 1= 25% (not sufficient for passing element) –0 factors or missing factor 1 = 0% Data Sources: –Documented process for scheduling appointments, providing clinical advice and documenting advice –Report showing same-day access, response times –Screen shots or copies of documented clinical advice PCMH 1A: Access During Office Hours

16. PCMH 1A: Example – Factor 1 This is the practice’s written policy on same-day scheduling

17. (Your Practice Name) PCMH 1A: Example – Factor 1 This is the practice’s written policy on same-day scheduling

18. PCMH 1A: Example – Factor 1 Brown SmithJones

19. PCMH 1A: Example – Factor 2 Element 1A, Factor 2

20. PCMH 1A: Example – Factor 2 Percent of calls returned on the same day

21. PCMH 2D: Use Data For Population Management Practices uses patient data and evidence- based guidelines to generate lists and remind patients about needed services: 1. At least three different preventive care services** 2. At least three different chronic care services** 3. Patients not recently seen by the practice 4. Specific medications ** Meaningful Use Requirement

22. PCMH 2D: Use Data For Population Management MUST PASS 5 Points Scoring –4 factors = 100% –3 factors = 75% –2 factors = 50% (must-pass threshold) –1 factors = 25% (not sufficient for passing element) –0 factors = 0% Data Sources: –Lists or summary reports of patients who need services Reports must contain at least three different immunizations or screenings and three different acute/chronic care services A registry is not specifically required but will facilitate the process –Materials demonstrating patient notification

23. PCMH 2D: Example – Factor 1 Patient list is blinded to protect confidentiality List of patients who have not received pneumovax

24. PCMH 2D: Example – Factor 2 patient names and MRNs have been blinded List of patients who have not received appropriate hypertensive care

25. PCMH 2D: Example – Factor 3 List of diabetics who have not been seen in past 6 months

26. PCMH 2D: Example – Factor 4 (names of patients blinded for HIPAA) List of patients in the practice taking Toprol XL

27. PCMH 5B: Referral Tracking and Follow-Up Practice coordinates referrals: 1.Provides specialist with reason and key information for the referral 2.Tracks referral status 3.Follows up to obtain specialist reports 4.Has agreements with specialists documented in the record 5.Asks patients about self-referrals and requests specialist reports 6.Demonstrates electronic exchange of key clinical information** 7.Provides electronic summary of care for more than 50% of referrals** ** Meaningful Use Requirement

28. MUST PASS 6 Points Scoring –5-7 factors= 100% –4 factors = 75% –3 factors = 50% (must-pass threshold) –1-2 factors= 25% (not sufficient for passing element) –0 factors = 0% Data Sources: –Reports or logs demonstrating tracking system data collection –Documented processes with three examples –Reports from electronic system showing frequency of information exchange and summary of care records PCMH 5B: Referral Tracking and Follow-Up

29. PCMH 5B: Example – Factor 2

31. Patient Name MRNReferring Clinician Reason for Referral Date of Referral Referred toCompleted?Insurance (Y/N & Date) Joe Smith12345HalpernBack Pain6/16/11Triangle Ortho NoBCBS-NC Mary Jones54321HalpernColonoscopy6/16/11Durham GIYes 6/21/11Duke Select

32. Next Steps (Homework) Review the requirements for each standard, element and factor –What does the practice already do? –What does the practice need to create? –Are there elements the practice clearly does not have in place but does not wish to implement in the near-term?

33. Next Steps (Homework) Organize Your Documents –Create a place on your computer (server or hard-drive) for all of your documentation –You should have a folder for each standard –A checklist can help you determine what you already have created/saved and what you need to prepare from scratch

34. Next Steps (Homework) Go to NCQA’s website and take advantage of the various (free) training presentations they have available: –2011 Standards –Using the ISS Interactive Survey System –Submitting As a Multi-Site Practice http://www.ncqa.org/tabid/109/Default.aspx

35. Next Steps (Homework) Begin To Think About 3 Important Conditions (e.g. diabetes, asthma, congestive heart failure, depression, etc) that you can track over time –Does your practice already follow evidence- based guidelines when caring for patients with these conditions? –Are these guidelines documented anywhere?

36. Community Care PCMH Team David Halpern, MD, MPH Community Care of North Carolina (CCNC) R.W. “Chip” Watkins, MD, MPH, FAAFP Community Care of North Carolina (CCNC) Brent Hazelett, MPA North Carolina Academy of Family Physicians (NCAFP) Elizabeth Walker Kasper, MSPH North Carolina Healthcare Quality Alliance (NCHQA)

37. NCQA Contact Information Contact NCQA Customer Support to: Order FREE Copy of requirements Order FREE Application Information Purchase ISS Tool 1-888-275-7585 Visit NCQA Web Site to: View Frequently Asked Questions View Recognition Programs Training Schedule www.ncqa.org/medicalhome.aspx Send Questions to: ppc-pcmh@ncqa.orgppc-pcmh@ncqa.org

38. Happy Thanksgiving!

39. Questions? Feel free to contact me: David Halpern, MD, MPH (215) 498-4648 dhalpern@n3cn.org