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

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Presentation on theme: "NCQA PCMH 2014 Linda J. Pepper, Ph.D., PCMH CCE Executive Director Transformational Healthcare Decisions about Recognition and Renewal June 18, 2014."— Presentation transcript:

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

4 NCQA is Raising the Bar! 2011 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  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? Your Practice Small Medium Large Single SiteMulti-SiteFQHCSingle SiteMulti-Site Your Practice PaperEHRNo MUMU 1 Advanced EHR MU 1MU 2 Your Practice 2011 PCMH 2008 PCMH Exp.< 3/31/2015 No PCMHGot ISSStartedNot StartedNothing Your PracticeHave SupportGrantPayer Startup + PMPM Startup onlyPMPM Only PMPM+Shared Savings All TypesUnknownState Private Payers No SupportVerified Type Tech Status Funds

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 Less work in less time… More work in with more time…

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 PCMH Library of Materials 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 /visualutions /visualutionsCHC /visualutionsCPS Questions?


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