1. NCQA PCMH 2014 Decisions about Recognition and Renewal June 18, 2014
Linda J. Pepper, Ph.D., PCMH CCE
Executive Director
Transformational Healthcare
June 18, 2014

2. Discussion Timeframe for Transitions
Comparison of PCMH 2011 to PCMH 2014
What’s Best for Your Practice?
Differences in PCMH 2014
What are your PCMH Options?
Decisions and Considerations
How Visualutions Can Help
Recommendations
Q&A

3. 2011 & 2014 Timelines Only 10 months left! 3/24/2014 6/30/2014
NCQA PCMH 2014 Standards released
6/30/2014
Last day to purchase 2011 ISS tool and online application
12/31/2014
Last Day to submit PCMH 2011 ISS tool
3/31/2015
Last day to submit PCMH 2011
Only 10 months left!

4. NCQA is Raising the Bar! 2011 PCMH Standards 2014 PCMH Standards
MU Stage 1
28 Elements
152 Factors (2 not scored)
2014 PCMH Standards
MU 2
27 Elements
178 Factors (10 Not Scored)
Increased emphasis on:
Team Care
Mental/behavioral health
Processes
Analytics
Quality Improvement
High-Need Populations
Transformation
More Documentation

5. Increased Emphasis on Team-Based Care

6. Care Management Focuses on High-Need Populations

7. Enhanced Alignment with Triple Aim

8. Increased Emphasis on Behavioral Health

9. Enhanced Focus on Sustained Transformation

10. PCMH 2014 Change Summary New Factors
37 new requirements
6 new MU2 measures
Higher thresholds on most MU factors
Increased emphasis in several areas
Technology
For 30% of factors you MUST have an eHR!
An additional 20% of factors are extremely difficult without an “advanced” EHR (registry)

11. What is an “Advanced EHR?”
2014 Edition – Complete product with CQM
Flexible, customizable “registry” with ability to run complex clinical and demographic queries
For Example: Obtain list of patients that…
Are over 65
Are dual eligible (Medicare/Medicaid)
Have 10 or more active meds
Have a Dx of Depression
And CHF and COPD
Or DM with A1c > 9
Have been discharged from hospital 2 times or more in last year
Or have been to the ED 2 times or more in last year
Or have 6 or more specialty referrals in last year

12. PCMH 2014 (6 Standards/27 Elements/100 Points)

13. Deeper Dive Into PCMH 2014 PCMH 2011 Must Pass PCMH 2014 Must Pass
Access during office hours
Same Day Appointments
Clinical advice by phone
Outreach
Care Management
Self-Mgt Care Support
Referral Tracking
Quality Improvement
PCMH 2014 Must Pass
Access during and after hours
Same Day Appointments
Access analysis
Advanced Team Care
Outreach
Case/Care Management
Referral Management
Quality Improvement

14. Access to Care

15. The Care Team

16. Outreach Notables: No big change in MUST PASS
One extra mental/behavioral health
Overuse/appropriate use
A few new items you may not be recording:
Occupations
Contact info for specialists
Health literacy level

17. Care Management

18. Care Coordination

19. Quality Improvement

20. Decisions, Decisions? Type Funds Status Tech Paper EHR No MU MU 1 MU 2
Your Practice
Have Support
Grant
Payer
Startup + PMPM
Startup only
PMPM Only
PMPM+Shared Savings
All Types
Unknown
State
Private Payers
No Support
Verified
Type
Funds
Your Practice
Small
Medium Large
Single Site
Multi-Site
FQHC
Status
Your Practice
2011 PCMH
2008 PCMH
Exp.< 3/31/2015
Exp. < 3/31/2015
No PCMH
Got ISS
Started
Not Started
Nothing
Your Practice
Paper
EHR
No MU
MU 1
Advanced EHR
MU 2
Tech

21. The Easy Decisions
Your practice already has PCMH 2011 recognition – you do nothing until renewal.
You decide not to pursue PCMH recognition.
Your practice is working on your PCMH 2011 application – no time to lose!
You are submitting a multi-site 2011 – your corporate tool must be in by December 31, 2014 and all sites completed by March 31, 2015.

22. Do you go for 2011 or do 2014? If you are…
In a Medium to Large Practice
With standardized & documented processes
An emphasis on integrated behavioral health
With an advanced HER and state of the art Registry
Able and willing to do Meaningful Use Stage 2
Less work in less time…
More work in with more time…
2011
2014

23. When is 2014 the only choice? If you are…
A health system with a large number of physicians and dozens of sites under one Corporate application.
and/or you are…
Starting now with little to no prior experience or knowledge of PCMH.

24. Everyone else should be going for 2011!
PCMH 2011 Advantages for Small Practices
With smart work & ingenuity, practices on paper can obtain Level I recognition
Level III recognition is straightforward even for small practices with MU 1 (or equivalent)
Contrary to mythology, lean small practices can become 2011 PCMH recognized
The increased 2014 emphasis on Team Care, Mental/behavioral health, Processes and Analytics is particularly challenging for small practices

25. Scenarios

26. What if I try but can’t finish in time…?

27. What can Visualutions do to help?
Use these slides to see if the new or expanded factors present a challenge for your practice.
If you go for 2011 or 2014, sign up for our Visualutions PCMH reports and dashboard with a consulting package.
Either way, Visualutions has the reports, training, consulting and technology that can help you reach Level III recognition.

28. Visualutions’ PCMH Program
PCMH Reports Module & Dashboard
PCMH Manual
Coaching
Pre-Assessment
Library of Materials
PCMH
Workflow Assessments
On-going Monitoring

29. A Quick Look at Some of Our Materials

30. Recommendations
Make an informed PCMH decision…even if it is to do nothing!
Find out if there are any incentives – current or planned.
Learn and better understand what PCMH means and the effort involved
Ignore the myths
Your medical home is yours to build
With a few exceptions, go for 2011 recognition
Your current preparedness and EHR capabilities
Raising the bar on your future
Let us help you
Talk to us
Take a look at our reports, services and tools
Let us do a quick assessment to help you plan

31. Some Resources

32. Visualutions Resources
Your sales executive! Contact them at
Schedule a demo with your sales executive to see how our system works.
Linda J. Pepper, PhD, PCMH CCE at

33. Presentation Resources
Margalit Gu-Arie, M.Sc., NCQA PCMH CCE, Founding Partner for BizMed Solutions
NCQA PCMH 2014 Guidelines,

34. Questions?
/visualutions
/visualutionsCHC
/visualutionsCPS