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Your Partner in Practice

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Presentation on theme: "Your Partner in Practice"— Presentation transcript:

1 Your Partner in Practice
1 1 Your Partner in Practice Is PCMH Right For You? OP User’s Conference April 23-25, 2015 1

2 Why become a recognized medical home?
2 Why become a recognized medical home?

3 Why Become a Medical Home?
3 3 Why Become a Medical Home? Improve patient care coordination Take advantage of incentive payments Help lower overall healthcare costs Ensure continued viability in Payer networks Compete with / prepare for ACO models Realize ROI on technology investments 3


5 As of 2/2014

6 First and Foremost 6 6 Do you fully understand the concept?
Research the guidelines, the benefits and the statistics Visit practices who are already medical homes and talk to colleagues about the practicalities of it A medical home is not just a reimbursement model! Read the Joint Principles of a Medical Home Visit Will it be financially worthwhile? Maybe! Depends upon region and Payer mix Biggest benefit is streamlined practice operations and continued viability in this new ‘era’ 6

7 7 7 PCMH Payment Models 7

8 Relationship Between Payment Methods and Organizational Models

9 9 About the 2014 Standards

10 Key Components of PCMH*
10 1010 Key Components of PCMH* Personal Clinician First contact, continuous, comprehensive, care team Whole Person Orientation All patient health care needs; all stages of life; acute; chronic; preventive; end of life Coordinated When and where needed/wanted; culturally and linguistically appropriate; use information technology * Based on The Joint Principles 10

11 Focus of 2014 PCMH Standards
11 Focus of 2014 PCMH Standards More emphasis on team-based patient care Care management focus on high-need populations Alignment of quality improvement activities Reinforces incentives for meaningful use (HIT) Further integration of behavioral health Sustained transformation

12 12 PCMH & MU NCQA emphasizes HIT because highly effective primary care is information-intensive PCMH 2014 reinforces incentives to use HIT to improve quality Stage 2 Meaningful Use language is embedded in PCMH 2014 standards Synergy: PCMH 2014 Recognized medical practices are well-positioned to qualify for meaningful use, and vice versa

13 PCMH 2014 / MU ✓ Only 3 Objectives are new in MU2 versus MU1 for PCMH
13 PCMH 2014 / MU ✓ Only 3 Objectives are new in MU2 versus MU1 for PCMH ✓ 10 MU2 Objectives for PCMH have increased the percentages required over MU1 ✓ PCC MU1 reports can be used for MU2 requirements – just meet the increased percentages

14 PCMH 2014 Content and Scoring
Must Pass Elements require a >50% performance level to pass

15 MUST PASS ELEMENTS 1A: Patient Centered Appointment Access
2D: The Practice Team 3D: Use of Data for Population Management 4B: Care Planning and Self-Care Support 5B: Referral Tracking and Follow-Up 6D: Implement Continuous Quality Improvement

16 CRITICAL FACTORS Required to receive more than minimal or, for some factors, any points Identified in the scoring section of the element

17 DOCUMENTATION TYPES Documented process Reports Records or files
Written procedures, protocols, processes, workflow forms (not explanations); these should show the practice name and date of implementation Reports Aggregated data showing evidence Records or files Patient files or registry entries documenting action taken; data from medical records for important conditions Materials Information for patients or clinicians, e.g. clinical guidelines, self-management and educational resources NOTE: Screen shots or electronic “copy” may be used as examples (EHR capability), materials (Web site resources), reports (logs) or records (advice documentation)

Report Data, Files, Examples and Materials Should display information that is current within the last 12 months Documented Process Policies, procedures and processes should be in place for at least 3 months prior to survey submission Reporting Period (Meaningful Use) 12 months, or 3 months if 12 months is not available Reporting Period (Log or Report) Refer to documentation guidelines for other references to minimum data for logs and reports (one week, one month, etc.) ** ALL DOCUMENTS NEED TO SHOW DATES **

19 Vulnerable & High Risk Populations
“Those who are made vulnerable by their financial circumstances or place of residence, health, age, personal characteristics, functional or developmental status, ability to communicate effectively, and presence of chronic illness or disability.” - AHRQ High Risk: High-risk patients with clinical conditions and other factors that could lead to poor outcomes for those conditions. E.G. premies, downs, etc Vulnerable: Characteristics that could lead to different access or quality of care Look for disparities in care/service. E.G. Lack of transport, money Vulnerable patients need not have current clinical conditions

20 20 The 2014 Standards


22 PCMH 1: Patient-Centered Access
Intent of Standard Meaningful Use Alignment The practice provides access to team-based care for both routine and urgent needs of patients/families/care-givers at all times • Patients receive electronic: - On-line access to their health • Patient-centered appointment access information - Clinical summaries of office visits •24/7 Access to clinical advice - Secure messages from the practice • Electronic access

23 PCMH 2: Team-Based Care Intent of Standard
The practice provides continuity of care using culturally and linguistically appropriate, team- based approaches.

24 PCMH 3: Population Health Management
Intent of Standard Meaningful Use Alignment The practice uses a comprehensive health assessment and evidence- based decision support based on complete patient information and clinical data to manage the health of its entire patient population •Practice has searchable electronic system: - Race/ethnicity/preferred language -Clinical information •Practice uses clinical decision support and electronic system for patient reminders

25 PCMH 4: Care Management and Support
Intent Meaningful Use Alignment The practice systematically • Practice implements identifies individual patients and plans, manages and coordinates care, based on need. evidence-based guidelines • Practice reviews and reconciles medications with patients • Practice uses e prescribing system • Patient-specific education materials

26 PCMH 5: Care Coordination and Care Transitions
Meaningful Use Alignment Intent of Standard • Incorporate clinical lab • Track and follow-up on all lab and imaging test results into the medical record results • Electronically exchange clinical information with • Track and follow-up on all important referrals other clinicians and facilities • Coordination of care patients receive from • Provide electronic summary of care record specialty care, hospitals, other facilities and for referrals and care transitions Community organizations

27 PCMH 6: Performance Measurement and Quality Improvement
Intent of Standard Meaningful Use Alignment Practice uses certified EHR to: • Protect health information • Uses performance data to identify opportunities for • Generate preventive and follow-up care reminders improvement • Acts to improve clinical quality, efficiency • Submit electronic data to registries • Acts to improve patient experience • Submit electronic syndromic surveillance data • Identify and report cases

28 28 Submission & Beyond


30 Standard Pricing – as of June 2014
30 Standard Pricing – as of June 2014

31 Multi-Location

32 Multi-Location – cont.

33 33 Multi-Location Fees +

34 What Happens After Submission?
34 What Happens After Submission?

35 Payment for Recognition
3535 Payment for Recognition You’ve got the recognition, now get paid! Find out what programs are available to you (if you don’t ask, you don’t get) If they don’t have an identified path, educate them and leverage your recognized medical home status Negotiate new contracts for enhanced fees, per- member-per-month payments, and quality performance bonuses 35

36 Is It Worth It? Who Is Doing What? Aetna = PMPM ($3) UHC = PBC (1-2%)
Cigna = Peds coming 2015? Blues = Homegrown programs for Peds

37 NCQA PCMH INFORMATION 3737 NCQA Web Site 37 NCQA General Information:
Standards: Purchase Survey Tool ($80) 37

38 3838 Q & A Contact Information The Verden Group, Inc Your Partner in Practice Susanne Madden, MBA, NCQA CEC Julie Wood, MSc, NCQA CEC 38

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