Presentation on theme: "NCQA PCMH 2014 Decisions about Recognition and Renewal June 18, 2014"— Presentation transcript:
1NCQA PCMH 2014 Decisions about Recognition and Renewal June 18, 2014 Linda J. Pepper, Ph.D., PCMH CCEExecutive DirectorTransformational HealthcareJune 18, 2014
2Discussion Timeframe for Transitions Comparison of PCMH 2011 to PCMH 2014What’s Best for Your Practice?Differences in PCMH 2014What are your PCMH Options?Decisions and ConsiderationsHow Visualutions Can HelpRecommendationsQ&A
32011 & 2014 Timelines Only 10 months left! 3/24/2014 6/30/2014 NCQA PCMH 2014 Standards released6/30/2014Last day to purchase 2011 ISS tool and online application12/31/2014Last Day to submit PCMH 2011 ISS tool3/31/2015Last day to submit PCMH 2011Only 10 months left!
4NCQA is Raising the Bar! 2011 PCMH Standards 2014 PCMH Standards MU Stage 128 Elements152 Factors (2 not scored)2014 PCMH StandardsMU 227 Elements178 Factors (10 Not Scored)Increased emphasis on:Team CareMental/behavioral healthProcessesAnalyticsQuality ImprovementHigh-Need PopulationsTransformationMore Documentation
10PCMH 2014 Change Summary New Factors 37 new requirements6 new MU2 measuresHigher thresholds on most MU factorsIncreased emphasis in several areasTechnologyFor 30% of factors you MUST have an eHR!An additional 20% of factors are extremely difficult without an “advanced” EHR (registry)
11What is an “Advanced EHR?” 2014 Edition – Complete product with CQMFlexible, customizable “registry” with ability to run complex clinical and demographic queriesFor Example: Obtain list of patients that…Are over 65Are dual eligible (Medicare/Medicaid)Have 10 or more active medsHave a Dx of DepressionAnd CHF and COPDOr DM with A1c > 9Have been discharged from hospital 2 times or more in last yearOr have been to the ED 2 times or more in last yearOr have 6 or more specialty referrals in last year
13Deeper Dive Into PCMH 2014 PCMH 2011 Must Pass PCMH 2014 Must Pass Access during office hoursSame Day AppointmentsClinical advice by phoneOutreachCare ManagementSelf-Mgt Care SupportReferral TrackingQuality ImprovementPCMH 2014 Must PassAccess during and after hoursSame Day AppointmentsAccess analysisAdvanced Team CareOutreachCase/Care ManagementReferral ManagementQuality Improvement
16Outreach Notables: No big change in MUST PASS One extra mental/behavioral healthOveruse/appropriate useA few new items you may not be recording:OccupationsContact info for specialistsHealth literacy level
20Decisions, Decisions? Type Funds Status Tech Paper EHR No MU MU 1 MU 2 Your PracticeHave SupportGrantPayerStartup + PMPMStartup onlyPMPM OnlyPMPM+Shared SavingsAll TypesUnknownStatePrivate PayersNo SupportVerifiedTypeFundsYour PracticeSmallMedium LargeSingle SiteMulti-SiteFQHCStatusYour Practice2011 PCMH2008 PCMHExp.< 3/31/2015Exp. < 3/31/2015No PCMHGot ISSStartedNot StartedNothingYour PracticePaperEHRNo MUMU 1Advanced EHRMU 2Tech
21The Easy DecisionsYour 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.
22Do you go for 2011 or do 2014? If you are… In a Medium to Large PracticeWith standardized & documented processesAn emphasis on integrated behavioral healthWith an advanced HER and state of the art RegistryAble and willing to do Meaningful Use Stage 2Less work in less time…More work in with more time…20112014
23When 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.
24Everyone else should be going for 2011! PCMH 2011 Advantages for Small PracticesWith smart work & ingenuity, practices on paper can obtain Level I recognitionLevel III recognition is straightforward even for small practices with MU 1 (or equivalent)Contrary to mythology, lean small practices can become 2011 PCMH recognizedThe increased 2014 emphasis on Team Care, Mental/behavioral health, Processes and Analytics is particularly challenging for small practices
27What 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.
28Visualutions’ PCMH Program PCMH Reports Module & DashboardPCMH ManualCoachingPre-AssessmentLibrary of MaterialsPCMHWorkflow AssessmentsOn-going Monitoring
30RecommendationsMake 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 involvedIgnore the mythsYour medical home is yours to buildWith a few exceptions, go for 2011 recognitionYour current preparedness and EHR capabilitiesRaising the bar on your futureLet us help youTalk to usTake a look at our reports, services and toolsLet us do a quick assessment to help you plan