HRSA’s Quality Initiatives – Many Paths to a Patient Centered Medical Home

1. HRSA’s Quality Initiatives – Many Paths to a Patient Centered Medical Home May 31, 2012 Alyson Roby - AAAHC Lon Berkeley – The Joint Commission William Tulloch – National Committee for Quality Assurance Harriet McCombs – HRSA/BPHC/OQD Nina Brown - HRSA/BPHC/OQD

2. Learning Objectives • Identify the difference between the Accreditation and the PCMHH Initiatives; • Identify the difference between the Patient Centered Medical Home recognition conducted by the three recognizing organizations; • Identify resources on the HRSA webpage that are available to help grantees select the recognition organization that best meets their health center needs; and • Understand the process for enrolling in the initiative and the timelines involved with medical home recognition.

3. Session Outline • Introduction – 5 minutes • Purpose of PCMH Recognition – 10 minutes • Contractor Presentations – 45 minutes • Summary – 5 minutes • Question & Answer – 25 minutes

4. The Patient Centered Medical Home • An approach to providing comprehensive, patient centered, and coordinated primary care for health center patients. • HHS Priority Recognition Goal • Goal: 25% of grantees recognized by 9/30/2013 • Goal: 13% of grantees recognized by 12/31/2012 • HRSA investments in quality • Patient-Centered Medical Health Home Initiative • Covers survey costs and fees • Accreditation Initiative • Covers survey costs and fees • PCMH Supplemental funds • Partnership with the CMS Primary Care Demonstration

5. Why PCMH? • Demonstrates the quality of care provided in health centers. • Positions health centers at an advantage for the changing health care landscape. • Transforms patient care to help health centers achieve the three part aim of: Better Care, Healthy People and Communities, and Affordable Care.

6. Many Paths to PCMH • Many entities across the country are embracing the PCMH model: • Private Payers: Blue Cross Blue Shield, United Health Care, etc. • States: Oregon & Minnesota • Initiatives the provide TA and lead to 3rd party recognizing organization, i.e. NCQA, AAAHC, TJC • HRSA supports 2 initiatives to assist grantees with the survey costs and assistance in achieving PCMH recognition. • The Accreditation Initiative: Accreditation Association for Ambulatory Health Care (AAAHC) & The Joint Commission • The Patient Centered Medical Health Home Initiative: NCQA

7. Agenda Brief History of Organization Organization Surveyors The Handbook of Standards Education Opportunities & Pre-Survey Activities Overview of the Survey Certification/ Recognition Post-Survey Activities and Resources Organization Contacts

8. Contractor Presentations • Alyson Roby – Accreditation Association for Ambulatory Health Care • Lon Berkeley – The Joint Commission • William Tulloch – National Committee for Quality Assurance (NCQA)

9. Accreditation Association for Ambulatory Health Care (AAAHC)Accreditation Initiative Alyson Roby, MD AAAHC Surveyor Family Practice Physician

10. AAAHC Mission AAAHC is committed to maintaining its position as the preeminent leader in developing standards to advance and promote patient safety, quality, value and measurement of performance for ambulatory health care through peer based accreditation processes, education, and research.

11. Brief History of the AAAHC • AAAHC has been conducting surveys since 1979. • Not-for-profit and governed by 18 member organizations. • AAAHC is recognized by many third-party payors including Medicare, Medicare Advantage plans, HRSA, Indian Health Services, and Department of Energy. • In 1983, AAAHC began accrediting managed care organizations. • CMS granted AAAHC deemed status for Medicare certification for ambulatory surgery centers. • AAAHC currently accredits more than 5,100 organizations, and is the largest accreditor of ambulatory settings.

12. Who We Accredit • Community health centers (Internal Medicine, Family Practice, and Pediatrics) • Medical Home • Women’s health • Laboratory and x-ray facilities • Behavioral health • Dental • School-based health centers • Walk-in clinics • Indian Health Centers

13. Why choose AAAHC? • Emphasis on education and consultation to organizations • Not “inspectors” • Peer-based accreditation program • Nationally-recognized standards • 325 surveyors (physicians, dentists, Advanced Practice Registered Nurses and other nurses, pharmacists, health care administrators, etc.) • CHC-specific surveyors who will perform your surveys are selected, trained, and privileged to conduct FQHC surveys

14. How are AAAHC StandardsAssessed? • Substantial Compliance (SC) – Current operations are acceptable and meet the Standards • Partial Compliance (PC) – A portion of the standard is met in an acceptable manner, but area(s) need to be addressed • Non-Compliance (NC) – Current operations do not meet the Standard • Not Applicable (NA) – This Standard does not apply to this organization

15. Handbook of Standards: Core Chapters • Chapter 1 – Rights of Patients • Chapter 2 – Governance • Chapter 3 – Administration • Chapter 4 – Quality of Care Provided • Chapter 5 – Quality Management and Improvement • Chapter 6 – Clinical Records and Health Information • Chapter 7 – Infection Prevention and Control and Safety • Chapter 8 – Facilities and Environment

16. Handbook of Standards:Adjunct Chapters • Medical Home • Pharmaceutical Services • Pathology and Medical Laboratory Services • Diagnostic and Other Imaging Services • Dental Services • Health Education and Health Promotion • Behavioral Health Services • Teaching and Publication Activities • Immediate/Urgent Care Services

17. Medical Home • Transformation to a Medical Home is a journey worthy of the investment of time and resources. • Stronger relationships = higher treatment plan compliance • Fewer hospital days, fewer ER visits • Higher satisfaction levels for patient, providers, staff • Foundation of the Medical Home model of care focuses on: • Patient and provider relationship • Continuity of care • Comprehensiveness of care • Accessibility • Quality

18. Educational Opportunities/Pre-Survey Activities • Technical Assistance • Mock Surveys • Pre-Survey Calls with Surveyors • Achieving Accreditation • Dedicated Staff Availability

19. Pre-Survey Activities:Application Process • Select AAAHC on your NOI (Notice of Interest) and submit it to AccreditInit@hrsa.gov • Once the NOI is approved, AAAHC will be notified and they will send you a welcoming letter containing instructions on the online application for the survey. • Application Supporting Documents: • Brief organization history and current org chart • Statement of Patient Rights and Responsibilities • Governing Body meeting minutes • Patient satisfaction survey results • Quality improvement plan and studies • Emergency preparedness plan

20. Overview: Day of the Survey • Opening conference with senior leaders and Board members • Tour of facility and introduction to staff • Review of select clinical records, policies, and other documentation to support compliance • Review and discussion of QI plan and studies • Interaction with staff and patients • Summation conference, including consultative advice for improving quality of care and safety for patients, staff and others

21. Recognition • Public recognition of National recognized accreditation • Consultative guidance • Quality improvement • Increase consumer awareness

22. Post-Survey Activities and Resources • FQHCs are eligible to sign-up for participation in one complimentary six-month QI study with the Institute for Quality Improvement (IQI) • Information on www.aaahc.org/institute • Primary care/non-surgical studies are designed to examine processes and outcomes at the point of care • A “QI Toolkit” of educational publications provides: • A step-by-step Workbook • Examples of award-winning studies • Basic information and examples of important QI topics • IQI staff available to assist and answer QI questions

23. Questions about Survey Preparation • Commonly-asked questions: • Estimated length of time to prepare for survey • Common areas for improvement • Estimated length of time to complete survey • How long will it take to get the survey report

24. Keep in Mind AAAHC is about: Discovery………………vs. inspection Consultation…………vs. prescription Collaborative……..……vs. dictatorial

25. In Conclusion • Focus - Quality of care at the provider/patient level • Goal - Improve and enhance health care in ambulatory settings • Standards - Designed to promote excellence, professionalism and patient safety • Survey Process - Assure compliance with published standards through education and consultation

26. Visit us: www.aaahc.org

27. AAAHC Contacts • Gina Stepuncik Prus, MHA • gstepuncik@aaahc.org • (847) 324-7700 • Michon Villanueva • mvillanueva@aaahc.org • (847) 853-6063

28. The Joint Commission’s Accreditation & Primary Care Medical Home (PCMH) Certification Option Lon M. Berkeley Project Co-Lead, Primary Care Medical Home Initiative Project Director, Community Health Center Accreditation The Joint Commission May 30 & 31, 2012

29. Joint Commission Background • General customer base • Accredits or certifies over 19,000 total organizations (hospitals/critical access hospitals, labs, behavioral health, home care/Durable Medical Equipment, long term care, ambulatory care/office-based surgery) • Accrediting Ambulatory Caresince 1975: • Ambulatory Care program accredits over 2,000 organizations with 6,400 sites of care • Wide variety of ambulatory settings, including Medical/Dental settings such as: • Federally Qualified Health Centers (almost 300) • Medical Group Practices

30. Primary Care Medical Home Distinguishing Features • Applies to an accredited ambulatory care organization (or one seeking accreditation) • On-site survey process to evaluate compliance with both existing ambulatory care and PCMH requirements • No special application requirements • No additional on-site survey time • No jeopardy to accreditation • Organization-widecertificationfor up to 3 years • Primary Care Medical Home certification publicly available on Quality Check at http://www.qualitycheck.org/

31. Joint Commission Accreditation Plus Primary Care Medical Home Option PCMH Certification Option (52 additional requirements) Ambulatory Care Accreditation (~ 900 applicable standards pertaining to medical settings, including 123 applicable to PCMH) Increasing Patient-Centeredness, Comprehensiveness, Access, Coordination

32. The Joint Commission’sPCMH Requirements* • 5 Operational Characteristics • Patient-Centeredness • Comprehensive Care • Coordinated Care • Superb Access to Care • System-Based Approach to Quality and Safety *from the Agency for Health Care Research and Quality

33. Accreditation + PCMH On-Site Survey Process • On-site survey: No change to ambulatory survey sessions • Trace patient experience (patient tracers) • Observe care provided • Conduct patient interviews re: • Selection of primary care clinician • Information offered on how to access the center • Consideration of language, cultural needs and preferences • Discussions with organization leaders and staff re: • Scope of services available- acute, chronic, behavioral health • Determining the composition of interdisciplinary teams • Observe use of infrastructure elements • Clinical decision support tools, HIT, e-prescribing, referral tracking

34. Accreditation + PCMH On-Site Survey Process • Clinical Record review • Patient self-management goals • Follow-up on care recommendations, test results • Building Tours • HR file review • Primary care clinician qualified for the role, working within scope of practice, and in accordance with laws & regulation • Review of performance improvement data • Patient perception of access and care coordination • Daily Briefings and Exit Conference • Written report with both accreditation & PCMH requirements for improvement

35. Accreditation + PCMH: Post-Survey Process • Follow-up to findings (“Requirements for Improvement”): Evidence of Standards Compliance for both PCMH and other ambulatory care standards • Acceptance of Evidence of Standards Compliance: • Special Certification Letter • Posting on Quality Check • 3 year Accreditation and Certification period • Periodical Performance Review • Annual self-assessment of PCMH and ambulatory care standards

36. Joint Commission PCMHDecision & Scoring Impacts • Failure to comply with all PCMH “Requirement for Improvements” will not jeopardize accreditation status • Scoring for PCMH requirements during a resurvey is similar to expectations for an initial survey, minimally: • Implement in at least one location, for at least one population • Have supporting written policies/procedures • Plan to implement organization-wide prior to next triennial survey (18-36 months)

37. “Readiness” Steps for PCMH Certification Option If already accredited: • Complete self-assessment relative to additional PCMH Requirements • Mock Tracers • Technical assistance • Determine best timetable for survey: • Include as part of next triennial unannounced survey • Special extension survey • Communicate to Joint Commission (part of new application)

38. “Readiness” Steps for PCMH Certification Option If not yet accredited: • Complete self-assessment of ambulatory care accreditation standards & additional PCMH Requirements • Use resources available: • Mock Tracers - Educational programs • Technical assistance - Publications • Determine best timetable for survey • Include as part of scheduled survey • Communicate to Joint Commission (part of new application)

39. PCMH Certification Option Preparation Time • Estimated time if: • Joint Commission accredited with existing Medical Home recognition: 1 – 6 months • Joint Commission accredited without existing Medical Home recognition: 6 – 9 months • Not yet Joint Commission accredited but have Medical Home recognition: 6 - 12 months • Not yet Joint Commission accredited and no Medical Home recognition: 6 - 15 months

40. Accreditation + PCMH: Application Process • Application Process • Part of web-based ‘extranet’ platform “e-application” • First time survey: YOU designate ready date • Already accredited options: • Request as part of unannounced triennial survey • Extension survey: 4-6 months after notification • Earlier triennial survey • To Access the Application: • If you are currently accredited, contact: Rex Zordan, 630.792.5509, rzordan@jointcommission.org • If you are NOT accredited, contactIsa Rodriguez, 630.792.5286, irodriguez@jointcommission.org

41. Joint Commission PCMH Resources • Joint Commission Primary Care Medical Home Website http://www.jointcommission.org/PCMH • PCMH requirements • Self-Assessment Tool • Register for trial version of E-dition(Free 60-day access to electronic version of Ambulatory Care Standards) • Request application • News, articles and links to other resources! • Comparisons to other evaluative models.

42. Joint Commission Accreditation • + PCMH Resources • Accreditation Support Resources • Joint Commission ConnectTM (Extranet) • Perspectives - Joint Commission’s official monthly e-periodical • Survey Activity Guide • Joint Commission Resources (JCR) • Ambulatory Care standards available in print and electronic formats • Ambulatory Care conferences and webinars on accreditation and Primary Care Medical Home certification

43. Distinguishing Features of Joint Commission Accreditation • Staff & Service • Dedicated Account Executive & Project Director • Certified and salaried surveyors: ongoing training & evaluation • Standards Interpretation Staff • Electronic Manual (“E-dition”) • Short report turn-around time • Education & Training Resources • Publications - Webinars & Teleconferences • Mock surveys - Training Conferences

44. Distinguishing Features of Joint Commission Accreditation • Accreditation Process • On-site survey tracers, consultative, leading practices & written report • First survey scheduled then re-surveys unannounced • Periodical Performance Review • Certifies and accredits your entire organization for a 3 year period, and • Provides assistance to attain/maintain accreditation & PCMH throughout the process. • Name Recognition • All Settings (Lab/Behavioral Health) • Accreditation for 3 year period • State of the Art Standards • National Patient Safety Goals • Levels of Criticality

45. Request The Joint Commission for your Quality Initiative • If you want: Both Primary Care Medical Home certification and accreditation that’s integrated into one on-site survey… …by surveyors who are familiar with Health Centers and who provide suggestions for how to meet any non-compliant requirements… …using an tracer-based evaluative approach that doesn’t require any additional application time or resources… - Certifies and accredits your entire organization for a 3 year period, and… - Provides assistance to attain/maintain accreditation & PCMH throughout the process.

46. FOR MORE INFORMATION • Michael Kulczycki, Executive Director Ambulatory Health Care Accreditation: 630-792-5290 mkulczycki@jointcommission.org • Lon Berkeley, • Co-Project Lead, PCMH Initiative • Project Director, Community Health Center Accreditation 630-792-5787 lberkeley@jointcommission.org

47. NCQA’sPatient-Centered Medical Home (PCMH) Program William Tulloch Director, Government Recognition Initiatives

48. NCQA Private, independent non-profit health care quality oversight organization founded in 1990 ________________________________________________ MISSION To improve the quality of health care. VISION To transform health care throughquality measurement, transparency, and accountability. ______________________________________________ ILLUSTRATIVE PROGRAMS HEDIS® – Healthcare Effectiveness Data and Information Set * Health Plan Accreditation * Clinician Recognition * Disease Management Accreditation * Wellness & Health Promotion Accreditation • * Quality Compass™

49. > 30,910 Clinician Recognitions nationally across all Recognition programs (as of 12/31/11) Clinical programs Diabetes Recognition Program (DRP) Heart/Stroke Recognition Program (HSRP) Back Pain Recognition Program (BPRP) Practice process and structural measures Physician Practice Connections (PPC) – includes specialty practices Physician Practice Connections-Patient-Centered Medical Home (PPC-PCMH) 2008 NCQA Patient-Centered Medical Home (PCMH) 2011 NCQA Recognition Program

50. PCMH 2011 Standards and Scoring **Must Pass Elements