Patient-Centered Medical Home & Multi-Payer Demo

1. Patient-Centered Medical Home & Multi-Payer Demo Training Webinar # 2 David Halpern, MD, MPH June 8th, 2011

2. Acknowledgements

3. Let’s Review What is a Patient-Centered Medical Home? What is the Multi-Payer Demo Project? What are the Benefits for Me and My Practice?

4. “Homework” From Last Time • Have you: • Built your PCMH Team? • Started discussing where the time/manpower for practice transformation will come from? • Signed up for AHEC’s REC services at www.ncahecrec.net?

5. Today’s Agenda What is the National Committee for Quality Assurance (NCQA)? How Does NCQA Evaluate a Practice? How Does My Practice Apply for PCMH Recognition?

6. Warning

7. What Is the National Committee for Quality Assurance (NCQA)?

8. NCQA • National Committee on Quality Assurance (NCQA) • 501(c)(3) dedicated to improving health care quality • NCQA offers “recognition” programs for various aspects of clinical care: diabetes, cardiovascular disease, back pain • One of the recognition programs is for PCMH • 3 levels of accreditation: Level 1 (lowest), Level 2, and Level 3 (highest)

9. Value of PCMH Recognition • Encourages practices to adopt proven systems for improving care • Provides mechanism for incentivizing investment in quality infrastructure and processes • Complements evaluation of clinical effectiveness, patient experiences, and efficiency

10. How Does NCQA Evaluate A Practice?

11. NCQA Lingo • The metrics that NCQA uses to assess your practice are called “standards” • There are two sets of standards, one released in 2008, called PPC-PCMH & one released in 2011, called PCMH • 2008 PPC-PCMH has 9 standards & 2011 PCMH has 6 standards

12. PPC-PCMH (2008) Overview

13. PCMH (2011) Overview • Enhance Access and Continuity • Access During Office Hours • Access After Hours • Electronic Access • Continuity (with provider) • Medical Home Responsibilities • Culturally/Linguistically Appropriate Services • Practice Organization • Identify/Manage Patient Populations • Patient Information • Clinical Data • Comprehensive Health Assessment • Use Data for Population Management • Plan/Manage Care • Implement Evidence-Based Guidelines • Identify High-Risk Patients • Manage Care • Plan/Manage Care (continued) • Manage Medications • Electronic Prescribing • Provide Self-Care and Community Resources A. Self-Care Process B. Referrals to Community Resources • Track/Coordinate Care • Test Tracking and Follow-Up • Referral Tracking and Follow-Up • Coordinate with Facilities/Care Transitions • Measure and Improve Performance • Measures of Performance • Patient/Family Feedback • Implements Continuous Quality Improvement • Demonstrates Continuous Quality Improvement • Report Performance • Report Data Externally

14. 2008/2011 Comparison

15. NCQA Lingo each “standard” is composed of several “elements” each “element” is composed of several “factors”

16. “Must Pass” Elements • Some elements are “Must Pass” • **To “Pass” one of these elements, you must receive a 50% score or higher** • In 2008 Standards, you must pass 5/10 of these “Must Pass” elements to achieve a level 1, and 10/10 to achieve level 2 or 3 • In 2011 Standards, you must pass 6/6 of the “Must Pass” elements to achieve any level of recognition.

17. Reading Each Element • Description • Scoring • Explanation • Examples & Documentation/Data Source

18. Supporting Documentation • NCQA uses the term “data source” to describe the types of materials that you can use to document your practice’s efforts: • Documented Processes (written policies, workflow forms, checklists) • Reports (aggregate data) • Records or Files (actual patient chart/data) • Materials (brochures, guidelines)

19. Scoring a Standard • Each Element in a Standard is worth a certain number of points. To achieve the points, you must complete some (or all) of the factors in that element. • Note: The actual details of scoring each element depends on that specific element and is NOT the same across the board.

20. Scoring a Standard For example: Element A is worth 4 points and has 6 factors 6/6 4-5/6 3/6 1or2/6 0/6 4 points 3 points 2 points 1 point 0 points

21. Scoring a Standard For Example: Element B is worth 4 points and has 8 factors >4/8 3/8 2/8 1/8 0/8 4 points 3 points 2 points 1 point 0 points

22. Point Requirements

23. NCQA’s PCMH Survey Process • NCQA receives and evaluates Survey Tool • Responses, documentation, and explanations • Practice may be contacted for clarification • On-site audit - 5% of practices • Final decision and status determined • NCQA grants certificate and recognition packet • Recognition status posted on NCQA Web site • Practices that don’t pass - not reported publicly

24. How Does My Practice Apply For PCMH Recognition?

25. Applying for PCMH Recognition • Interactive Survey Tool ($80) • Self-directed practice assessment • Application (free) • Demographic information • When ready, submit Interactive Survey Tool, Application, and final application fee

26. NCQA’s Interactive Survey System (ISS) • ISS is the web-based application program • The practice uses ISS (also called the “Survey Tool”) for: • Entering responses to each factor for each element • Attaching documents and providing text to support the responses

27. Pricing (including 20% CCNC discount)

28. Upgrading PCMH Recognition • Practices achieving Level 1 or 2 can complete an add-on survey to upgrade to a higher level anytime within their 3 year recognition period

29. Next Steps (Homework) • Peruse the NCQA “Standards and Guidelines” documents for your version (2008 or 2011) • These are long, but important documents that are the backbone of the recognition process and familiarity with them is CRUCIAL to your success.

30. Next Steps (Homework) • Review the requirements for each standard, element and factor • What does the practice already do? • What does the practice need to create? • Are there elements the practice clearly does not have in place and will not have in place in time for submission? (e-prescribing, EMR, interactive website)

31. Next Steps (Homework) • Organize Your Documents • Create a place on your computer (server or hard-drive) for all of your documentation • You should have a folder for each standard • A checklist can help you determine what you already have created/saved and what you need to prepare from scratch

32. Next Steps (Homework) • Go to NCQA’s website and take advantage of the various (free) training presentations they have available: • 2008 Standards • 2011 Standards • Using the ISS Interactive Survey System • Submitting As a Multi-Site Practice • http://www.ncqa.org/tabid/109/Default.aspx

33. Next Steps (Homework) • Begin To Think About 3 Important Conditions (e.g. diabetes, asthma, congestive heart failure, depression, etc) that you can track over time • Does your practice already follow evidence-based guidelines when caring for patients with these conditions? • Are these guidelines documented anywhere?

34. Community Care PCMH Team • David Halpern, MD, MPH Community Care of North Carolina (CCNC) • R.W. “Chip” Watkins, MD, MPH, FAAFP Community Care of North Carolina (CCNC) • Brent Hazelett, MPA North Carolina Academy of Family Physicians (NCAFP) • Elizabeth Walker Kasper, MSPH North Carolina Healthcare Quality Alliance (NCHQA)

35. Partners

36. NCQA Contact Information Contact NCQA Customer Support to: Order FREE Copy of requirements Order FREE Application Information Purchase ISS Tool 1-888-275-7585 Visit NCQA Web Site to: View Frequently Asked Questions View Recognition Programs Training Schedule www.ncqa.org/medicalhome.aspx Send Questions to:ppc-pcmh@ncqa.org

37. Questions? Feel free to contact me: David Halpern, MD, MPH (215) 498-4648 dhalpern@n3cn.org