HITEQ Tools for NCQA Patient Centered Medical Home

1. HITEQ Highlights: Tools and Tips to Prepare for NCQA Patient Centered Medical Home 2017 January 24, 2019

2. The HITEQ Center is a HRSA-funded National Cooperative Agreement that collaborates with HRSA partners including Health Center Controlled Networks, Primary Care Associations and other National Cooperative Agreements to support health centers in full optimization of their EHR/Health IT systems. • HITEQ identifies and disseminates resources for using health information technology (IT) to improve quality and health outcomes. HITEQ includes: • A searchable web-based health IT knowledgebase with resources, toolkits, training, and a calendar of related events • Workshops and webinars on health IT and QI topics • Technical assistance and responsive teams of experts to work with health centers on specific challenges or needs Intro to HITEQ email us at hiteqinfo@jsi.com!

3. Jillian Maccini, MBA, PMP, PCMH CCEHITEQ Knowledge Base LeadHITEQ Quality Improvement LeadHealth Center Supporter | Overall Data Lover

4. Agenda • Introduction • Review of NCQA PCMH2017 Standards • Demonstration of PCMH management tools • Review of health center assets and practices that support PCMH recognition • Management of PCMH Project We’re going to use PollEverywhere today: https://tinyurl.com/WYpoll

6. Learning Objectives • Describe the general structure of PCMH 2017 and the basic requirements • Understand how to access and begin to use AirTable PCMH tool • Identify 1-2 project management approaches for PCMH

7. Patient Centered Medical HomeUpdated in 2017 • As you likely know, the PCMH program was revamped in 2017. • Continuous practice transformation • Flexible and personalized with new virtual review process • Emphasizes comprehensive, integrated care • New evidence options • Increased alignment with existing initiatives

8. Why does this matter? • As focus on value based payment increases, so does the impetus for structured processes that facilitate whole person care and population health management, as well as quality improvement. Good news: You’re already doing much of this, and this is what is needed for PCMH!

9. First Steps • Contact HRSA, submit NOI through EHBs • Expectation is that you will start within the quarter, and complete within the fiscal year. • Contact EHR/ health IT vendor for pre-validation auto/ transfer credit and ONC certification. • Create Q-PASS account • Complete NCQA Eligibility/ Readiness Survey • Claim/ create/ add organization • Use education and self-assessment tools.

10. HRSA’s Accreditation and Patient-Centered Medical Home (PCMH) Initiative National Patient-Centered Medical Home (PCMH) Recognition in Health Centers(75% as of July 1, 2018) Source: HRSA Accreditation and Patient-Centered Medical Home Report, 2018 Interested health centers must notify HRSA of their intent to participate by submitting a Notice of Intent (NOI) in the HRSA EHB. In the EHB, go to the Grant Folder and click the ‘HRSA Accreditation/PCMH Initiative’ link.

12. Accessing Q-PASS • Q-PASS: Quality Performance Assessment Support System- qpass.ncqa.org You’ll need this! Start Here!

13. Q-PASS Continued New Organizations • Search for your org., just to be sure! • Create organization in Q-PASS • Provide address, phone, Tax ID, etc. • Save organization • Need the following: Site information, including NPI; Each clinician’s information including NPI & boards/ specialties; Authorized signatory for agreements; Payment information

14. Q-PASS Continued • Existing Organizations • Must be an authorized user, then go to ‘My Organizations’ tab • If you need to ‘claim’ your organization, contact NQCA

15. When does the clock start? Once you sign agreements and pay your fees in QPASS, the 12 month clock starts.

16. Don’t be shy about emailing your NCQA representative through Q-PASS! This is helpful for having documentation in case any issues or questions arise. Key to Success

17. Let EHR do (some of) the work! • You may get auto-credit for a number of criteria based on your EHR or Health IT tools. • Pre-Validation- Up to 75 criteria may be fully met or partially met by pre-validation • Obtain the NCQA-issued Prevalidation Summary Approval Table, NCQA Letter of Product Autocredit Approval as well as a Letter of Product Implementation from the vendor • ONC Certified EHR  Criteria TC05

18. Pre-Validation (EHR and Health IT) • Once Prevalidation Summary Approval Table, NCQA Letter of Product Autocredit Approval,as well as a Letter of Product Implementation are received from the vendor, it should be submitted through Q-PASS; NCQA Representative will confirm and then all auto-credit criteria documented will be counted as “Met”.

19. Organizations • Recognition is at the geographic site level, one recognition per address. • Practice: One or more clinicians (including all eligible primary care clinicians) who practice together (meaning following the same procedures/ protocols, have access to shared medical record, etc.) and provide patient care at a location. Multi-site group: 3+ primary care sites using the same systems and processes, including shared electronic medical record system/ EHR. Multi-site allows corporate information to be entered once, and for some specified evidence to be shared (such as documented processes and demonstration of capability), submitted once for all sites.

20. Recognition Process 3 Virtual Check-Ins in 12 months with NCQA Rep. Once transformation is well underway, it’s time to begin meeting with your NCQA representative. You’ll submit documentation and note criteria that will be demonstrated. NQCA representative will provide feedback as needed, and determine whether each criteria is met.

21. Documentation/ Evidence • 2017 offers the option of demonstrating evidence during virtual check-in. • Some evidence can be shared across sites, where specified. • All evidence, including shareable evidence, is uploaded to Q-PASS. Then, credits can be shared within Q-PASS. • All PHI should be removed before adding to Q-PASS

22. Documentation/ Evidence Documented Process: Written policies and procedures (e.g., protocols, practice guidelines, agreements or other documents describing actual processes or forms). Must include date of implementation and provide practice staff with instructions for following policies and procedures. Evidence of Implementation: • Reports • Patient Records • Materials • Examples • Screenshots • Virtual demonstration • eCQM • Transfer credit (from pre-validation) • Surveys (patient satisfaction) • Data entered directly into Q-PASS

23. Build in time and effort for internal review of documentation. Have someone review for labels, highlighting, exact alignment with standards, and needed details. Don’t submit anything that hasn’t been reviewed in detail! Key to Success

24. Structure 6 Concepts Each Concept has 2-6 Competencies Each Competency has Core and Elective Criteria Must meet all 40 core criteria. Must achieve 25 credits*, of 60 elective criteria, in 5 of 6 competencies. *Some elective criteria are worth more than one credit.

25. Timing • Approximately 60 criteria required(depending on what elective credits you select). Approximately 20+ criteria per review call. 60 criteria = 5 per month if taking 12 months.

26. Concepts • Team Based Care + Practice Org. • (TC) • Knowing + Managing Your Patients • (KM) • Patient-Centered Access + Continuity (AC) • Care Management + Support • (CM) • Care Coord. + Care Transition • (CC) • Performance Measurement + Quality Improvement • (QI) • Provide continuity of care, communicate roles and responsibilities of the medical home to patients/ families/ caregivers, and organize and trains staff to work to the top of their license and provide effective team-based care. • Capture and analyze information about the patients and community being served and use the information to deliver evidence-based care that supports population needs and provision of culturally and linguistically appropriate services. • Requires continuity of care. Patients/ families/caregivers have round the clock access to clinical advice and care is facilitated by their designated clinician/care team and supported by access to their medical record. The practice considers the needs and preferences of patient population when establishing and updating standards for access. • Identify patient needs at the individual and population levels to effectively plan, manage, and coordinate patient care in partnership with patients/ families/ caregivers. Emphasis is placed on supporting patients at highest risk. • Systematically track tests, referrals, and care transitions to achieve high quality care coordination, lower costs, improve patient safety and ensure effective communication with specialists and other providers in the medical neighborhood. • Establish a culture of data-driven performance improvement on clinical quality, efficiency and patient experience, and engages staff and patients/ families/ caregivers in quality improvement activities.

27. Team Based Care + Practice Org. Are you… participating in Meaningful Use? Convening staff in a cross functional QI team? Sharing Medical Home information with patients (perhaps along with patient portal or consent information)?

28. Knowing +Managing Your Patients Are you… doing depression screening? SBIRT? Oral health risk assessment? Using PRAPARE? Leveraging population health management tools (i2i, Azara) or reports to identify care gaps and disparities?

29. Knowing +Managing Your Patients Are you… consistently doing med rec? Using CDS tools in your EHR? Involved in community collective impact or asset mapping? Providing patients resource lists or referral to community resources?

30. Patient-Centered Access + Continuity Are you… gathering social determinants and monitoring outcomes, or otherwise assessing equity? Effectively leveraging your patient portal? Using telehealth/ telemedicine?

31. Care Management and Support Are you… Risk stratifying? Implementing Care Coordination? Chronic Disease Self Management programs? Using patient engagement tools?

32. Care Coordination +Care Transitions Are you… using referral coordinators? integrating BH in primary care? Part of an RHIO or HIE? Systematically receiving ADT information? Using state immunization information systems or registries?

33. Performance Measurement + Quality Improvement Are you… Participating in Learning Collaboratives or ongoing QI projects? Do you use dashboards, data visualizations?

35. Links to Resources • Sign Up for AirTable • https://tinyurl.com/WYsignup • HITEQ PCMH Self-Assessment Tool • https://tinyurl.com/HITEQ-PCMH • PCMH AirTable Tracking Tool • https://tinyurl.com/WYPCMH • PCMH Annual Renewal AirTable Tool • https://tinyurl.com/WYrenewal

36. PCMH Self Assessment Tool • Excel-based tool • Allows you to track core and elective criteria met • Use as planning document

37. PCMH AirTable Tracking Tool https://tinyurl.com/WYPCMH • Allows you to track core and elective criteria met • Use as project management tool • Allows you to upload documentation into the database • Allows multiple views.

38. Demonstration of AirTable

39. Set the foundation Look at what you are currently doing Look at what you need to be doing Use change management principles Managing your PCMH Project

40. Quality Improvement Framework • Check/ reinforce foundations • Select target for improvement; Initiate QI project • Document/ analyze current flows; Identify improvements • Implement and evaluate changes • Spread and sustain results • Understand data-driven quality improvement Osheroff, Jerome A. "Improving Care Processes and Outcomes in Health Centers. HRSA’s Health Information Technology, Evaluation and Quality Center, JSI. 9 Sept. 2016. Web. 21 Nov. 2016

41. Reinforce Foundations • Are consistent systems in place? • Shared EHR • Shared processes/ policies/ procedures • Report inventory • Are we doing quality assurance or validation? • Does the process have buy-in from leadership and staff? • Do we have the capacity and stability to take on an initiative right now?

42. Use existing efforts, existing reports, existing tools– everything you are currently doing BEFORE you create new policies/ procedures! Everything should be moving in the same direction and PCMH should go with the flow. Key to Success

43. Alignment Example Source: PCMH Congress Presentation, Sept. 2018

44. FQHC Alignment Example

45. 1 2 Analyze Current Flows Identify Opportunities for Improvement Improving alignment Formalizing structure Improving documentation Sharing information more effectively Implementing needed partnerships/ agreements • Current QI activities • Current value based payment activities (ACOs, CPC+, etc.) • Current care mgt approaches • Data sharing practices (HIE, MOUs, etc.) • Current reports, dashboards, etc.

46. HITEQ Quality Improvement Tools • Guide to Improving Care Processes and Outcomes in Health Centers • Improving Diabetes Outcomes • Excel-based Data Validation Tools • Five Minutes of QI • Many more! • Visit HITEQCenter.org

47. Kotter’s Theory of Change: Change Management Develop Strategy + Vision Create Urgency Build your Coalition Goal: Form a coalition of leadership, stakeholders, staff that will focus on this initiative specifically on an ongoing basis. Goal: The majority of staff/ stakeholders agree that change is necessary. Goal: Show your full team where this initiative is going to take them and develop strategies for achieving that vision. Communicate for Buy-In/ Share the Vision Remove Barriers + Empower Action Get Short Term Wins Goal: Plan for visible change and improvements to keep everyone committed. Goal: Use many opportunities + modalities to communicate the new vision and strategy, tell everyone what to expect both in day-to-day work and in terms of outcomes. Goal: Establish ground rules and give staff authority to bring ideas, implement change, change systems or structures that undermine the vision.

48. Change Management Continued Sustain/ Accelerate Change, Don’t Let Up Make Changes Stick Goal: Reinvigorate the efforts with new goals, projects, themes, and change agentsto further embed in systems. Goal: Embed the ’new initiative ‘ and its component parts in workflows/ systems through training, monitoring, and accountability. Change Management needed not only for CREATING needed change, but also to SUSTAIN needed change.

49. Comments, Questions, Next Steps? Q&A

50. HITEQ Center • In addition the Health IT QI tools and guide discussed, HITEQ has several other resource sets on health center priority topics. • For additional information see http://hiteqcenter.orgor contact HITEQ at hiteqinfo@jsi.com. Reach out: hiteqinfo@jsi.com