Region II Annual Conference Wednesday, June 2 nd 3:00 – 4:30

1. Achieving Medical Home Status Neil Calman MD, CEO, Institute for Family Health, NYC Samuel De Leon MD, VP Medical Affairs Urban Health Plan, NYC Paul Kaye MD CMO Hudson River Health Care, NYS Pam Ferrari RN, Director Performance Improvement Open Door FMC, NYS When Medical Home Meets Meaningful Use Peter Cucchiara MBA, Director Performance Improvement PCDC, NYS Lisa Perry, MPP, MBA Primary Care Health Information Consortium CHCANYS Region II Annual Conference Wednesday, June 2nd 3:00 – 4:30

2. From This Presentation You Will Learn… I. PCMH – Standards Elements Factors and the Three levels II. MU – Principles Objectives and Stages III. The Processes for Achieving “recognition” and compliance IV. The Incentives and The Common Areas between PCMH and MU V. Challenges and Success – Experience from the Field

3. I. PCMH – Standards Elements Factors and the Three levels • PCMH – What is it? • Standards Elements and Factors • The Three Levels • The Process • The Incentives

4. What is Patient Centered Medical Home? • Ideal model of care delivery - in other words… Providers get what they need, when they need it, in the manner they want Patients and providers work as partners in managing their health Care is coordinated and the right people are talking to each other

5. What is Patient Centered Medical Home? National Committee for Quality Assurance (NCQA) and the PCMH • Set of standards • 3-tiered “recognition” process • Level 1 • Level 2 • Level 3 • Requires completing an application • Requires providing adequate documentation to show evidence that specific processes and policies are in place

6. Standards Elements and Factors MH Standards PPC1: Access and Communication PPC2: Patient Tracking & Registry PPC3: Care Management PPC4: Pt Self Management Support PPC5: Electronic Prescribing PPC6: Test Tracking PPC7: Referral Tracking PPC8: Performance Rpt/Improvmnt PPC9: Advanced Electronic Comm Fundamentals 9 Standards 7 Standards contain 10must-pass elements 30 Elements 10 of which are must-pass Elements contain a series of 166Factors which determine your score

7. The Three Levels, The Points, The Percentages

8. 1 1 1 1 0 0 2 3 4 1 25% 50% 2 1 YES

9. Home Sweet Medical Home Patient Centered Care

10. II. Meaningful Use – Principles and Objectives • MU – What is it? • Principles and Objectives • Eligibility • The Incentives • The Process

11. What is Meaningful Use? ARRA specifies three requirements for “meaningful use” • 1) Usingcertified EHR technology in a meaningful manner (which includes e-prescribing for EPs [eligible providers]) • Connecting a certified EHR in a manner that provides for the electronic exchange of health information to improve the quality of care; • Using the technology to submit informationto CMS on clinical quality measures and other measures selected by CMS.

12. What is Meaningful Use Stage 1? A Improve quality, safety, efficiency, & reduce health disparities ( 15 ) B Engage Patients and Families ( 3 ) C Improve Care Coordination ( 3 ) D Improve Population and Public Health ( 3 ) E Ensure Adequate Privacy & Security Protection for PHI ( 1 ) 5 Meaningful Use Care Goals & Objectives MU 25 Measures / Reporting Requirements • Must run for 90 consecutive days (year1) • Then for full year thereafter • Attestation for 2011 (year1) • More formalized reporting 2012

13. Draft Clinical Quality Measures Required for 15 Specialties Proceduralist/Surgery (6) Cardiology (10) Pulmonology (8) Endocrinology (9) Oncology (6) Primary Care (29) Pediatrics (9) OB/GYN (9) Neurology (5) Psychiatry (6) Opthamology (3) Podiatry (3) Radiology (7) Gastroenterology (6) Nephrology (6) MU Quality Measures / Reporting Requirements • Must run for 90 consecutive days (year1) • Then for full year thereafter • Summary measures in 2011 (year1) • More detail required in 2012

14. Eligibility Medicare Doctor of Medicine Doctor of Dentistry Dental Surgeon Doctor of Osteopathy Podiatrist Optometrist Chiropractor Medicaid Doctor of Medicine Doctor of Dentistry Nurse Midwives Nurse Practitioners PAs in PA led FQHC PAs in Rural Health Clinic

15. How Much is the MU Incentive Payment? • For Medicaid: Potentially as high as $63,750* over 6 years • For Medicaid Eligible Providers, Year 1 can start as early as 2011 or as late as 2016 • For Medicare: Potentially as high as $48,000 • $44,000 if not located in a HPSA • Can start as early as 2011 or as late as 2014 • Last payment year is 2016 • Fiscal penalties for not adopting EHR technologies by Medicare providers start in 2015 (% reduction in fee schedule) * Note: Pediatricians with 20-30% Medicaid patient volume are capped at $42,500 15 Source: CMS, US DHHS

16. Differences Between Medicaid and Medicare Incentive Payments • Medicaid participation is voluntary • No Medicaid financial penalties to Medicaid providers for not adopting • Maximum # of payment years: Medicaid = 6 Medicare = 5 • Medicaid incentive payments are potentially higher than for Medicare • Time period for which incentives are available extends to 2021 (compared to 2016 for Medicare); can start as late as 2016 (2014 for Medicare) • No “meaningful use” required in Year One (either 2010 or 2011, State will decide) – Adopt, Implement or Upgrade Source: CMS, US DHHS

18. The Incentive Structure Stage of Meaningful Use Criteria by Payment Year Etc.

19. The Process: MU Compliance Steps Given the rules are not finalized, specifications are not yet published and official certification of EHRs/modules will not occur until later this year, What should we be doing right now? • Determine who in your practice is an eligible professional • Get knowledgeable about the measures • Assess readiness (systems, workflows, gaps in data capture and financial implications) • Talk with your vendor about plans to support MU • Form a Team to set priorities • Develop Workplanto begin implementation and roll out

20. 3 3 2 16 2% 8% 4 1 33% 3 3 3 3 1 67% 2 4 7 9 1 12% 5% 9% 1%

21. Meaningful Sweet Meaningful Use Patient Centered Care

22. IV. PCMH/MU: Measure Twice Cut Once • What Do They Have in Common • How Much Do They Have in Common • Can I Do Both • Let’s Talk

23. Is it just a matter of Oranges and Apples PCMH MU Recognition/Documentation Paid Per Patient (in NYS) M‘caid, M‘care & Payers State and Federal 9 standards 166 elements Certification/Attestation Paid Per Provider M‘caid, M‘care Federal 5 care goals 25+ objectives ?

24. A Simple Comparison Medical Home Meaningful Use PPC1: Access and Communication Goal A: Improve quality, safety, _______ efficiency, & reduce health _______ disparities PPC2: Patient Tracking & Registry PPC3: Care Management Goal B: Engage Patients and Families PPC4: Pt Self Management Support Goal C: Improve Care Coordination PPC5: Electronic Prescribing PPC6: Test Tracking PPC7: Referral Tracking PPC8: Performance Rpt/Imprvmnt Goal E: Ensure Adequate Privacy & Security Protection for PHI PPC9: Advanced Electronic Comm Goal D: Improve Population and Public Health

25. How Much Overlap? PCMH Elements that relate to HIT (69%) Ginsburg, Maxfield, O’Malley, Piekes, Pham, Making Medical Homes Work Moving from Concept to Practice Center for Studying Health System Change #1 December 2008

26. Findings from Our Own Crosswalk Experience Completely fulfills Does not fulfill No Relationship Partially fulfills

27. Home Sweet Meaningful Medical Home Patient Centered Care

28. Who’s Done PCMH and How Did They Do IT? Can You and Would You do PCMH and MU? How Would You Do IT? Let’s Talk About IT

29. Obtaining PCMH Recognition: A How-To Manual • PCDC recently released a manual to assist practices with the process for obtaining recognition from NCQA as a medical home. • Free and available on the PCDC website using the following URL: • http://www.pcdcny.org/go/medicalhome

31. Resources • ONC: http://healthit.hhs.gov • CMS: www.cms.hhs.gov • HIMSS: www.himss.org/economicstimulus • NPRM: http://www.regulations.gov/search/Regs/home.html #documentDetail?R=0900006480a7c4a8