training webinar # 2 david halpern, md, mph november 23, 2011 patient-centered medical home ncqa’s...

Training Webinar # 2

David Halpern, MD, MPHNovember 23, 2011

Patient-Centered Medical Home

NCQA’s PCMH 2011 Standards

Legal Disclaimer

© Copyright 2011 North Carolina Community Care Networks, Inc.  All rights reserved. The content set forth herein is made available on an “as is” basis without representation or warranty of any kind and solely for use and distribution by primary care physicians, without modification and only so long as the content of this footer is reproduced on every copy thereof, in connection with the internal activities of their respective not-for-profit organizations to secure NCQA recognition as patient-centered medical homes.  All other uses of or modifications to the content set forth herein without the prior express written approval of North Carolina Community Care Networks, Inc. are strictly prohibited. Works copyrighted by third parties and included herein are used with the permission of the respective copyright owners in each case.

Acknowledgements

CCNC’s PCMH Resources

www.communitycarenc.org/emerging-initiatives/pcmh-central1/2011-pcmh-resources/

Let’s Review

• What is a Patient-Centered Medical Home (PCMH)?

• What are the Benefits for Me and My Practice?

• What is the National Committee for Quality Assurance (NCQA)?

• How Does My Practice Apply for PCMH Recognition?

PCMH (2011) Scoring

Level of Qualifying PointsMust Pass Elements

at 50% Performance Level

Level 3 85 - 100 6 of 6

Level 2 60 – 84 6 of 6

Level 1 35 – 59 6 of 6

Not Recognized 0 – 35 < 6

NOTE: Practices with a numeric score of 0 to 34 points AND practices that achieve less than 6 “Must Pass” Elements will not be Recognized.

6 standards = 100 pointsNOTE: Must Pass elements require a ≥50% performance level to pass

each “standard” is composed of

several “elements”

each “element” is composed of several “factors”

NCQA Lingo

Definitions• Factor – A scored item in an element. For example, an

element may require the practice to demonstrate how the team provides several different patient care services. Each of these services is a factor.

• Critical Factor – A factor that is required for practices to receive more than minimal points, or in some cases any points for the element. Critical factors are identified in the scoring section of the element.

• Explanation – Specific requirements that a practice must meet in order to earn points; guidance for demonstrating performance of the factor.

• Examples/Documentation – Descriptions of the evidence practices must submit to demonstrate performance for a specific factor. Each factor must be documented.

Today’s Agenda

• What is a “Must-Pass” Element?

• Element 1A (Must-Pass)

• Element 2D (Must-Pass)

• Element 5B (Must-Pass)

“Must Pass” Elements

• Some elements are “Must Pass”

• **To “Pass” one of these elements, you must receive a 50% score or higher**

• In the 2011 Standards, you must pass all 6/6 of the “Must Pass” elements to achieve any level of recognition.

Must Pass Elements

• Rationale for Must Pass Elements

– Identifies critical concepts of PCMH– Helps focus Level 1 practices on most

important aspects of PCMH– Guides practices in PCMH evolution and

continuous quality improvement– Standardizes “Recognition”

PCMH (2011) Overview1. Enhance Access and Continuity

A. Access During Office HoursB. Access After Hours

C. Electronic Access

D. Continuity (with provider)

E. Medical Home Responsibilities

F. Culturally/Linguistically Appropriate Services

G. Practice Organization

2. Identify/Manage Patient PopulationsA. Patient Information

B. Clinical Data

C. Comprehensive Health Assessment

D. Use Data for Population Management

3. Plan/Manage CareA. Implement Evidence-Based Guidelines

B. Identify High-Risk Patients

C. Manage Care

3. Plan/Manage Care (continued)D. Manage Medications

E. Electronic Prescribing

4. Provide Self-Care and Community Resources

A. Self-Care ProcessB. Referrals to Community Resources

5. Track/Coordinate CareA. Test Tracking and Follow-Up

B. Referral Tracking and Follow-UpC. Coordinate with Facilities/Care

Transitions

6. Measure & Improve Performance A. Measures of Performance

B. Patient/Family Feedback

C. Implements Continuous Quality Improvement

D. Demonstrates Continuous Quality Improvement

E. Report Performance

F. Report Data Externally

Must Pass Elements

• Must Pass Elements1. 1A: Access During Office Hours (4 pts)

2. 2D: Use Data for Population Management (5 pts)

3. 3C: Manage Care (4 pts)

4. 4A: Self-Care Process (6 pts)

5. 5B: Referral Tracking and Follow-Up (6pts)

6. 6C: Implement Continuous Quality Improvement (4 pts)

Must Pass Elements = up to 29 points

PCMH 1A: Access During Office Hours

• Practice has written process/standards and demonstrates that it monitors performance against the standards to:

1. Provide same-day appointments –

CRITICAL FACTOR

2. Provide timely advice by telephone

3. Provide timely advice by electronic message

4. Document clinical advice

• MUST PASS• 4 Points• Scoring

– 4 factors= 100%– 3 factors (including factor 1) = 75%– 2 factors (including factor 1)= 50% (must-pass threshold)– Factor 1= 25% (not sufficient for passing element)– 0 factors or missing factor 1 = 0%

• Data Sources:– Documented process for scheduling appointments, providing

clinical advice and documenting advice– Report showing same-day access, response times– Screen shots or copies of documented clinical advice

PCMH 1A: Access During Office Hours

PCMH 1A: Example – Factor 1

This is the practice’swritten policy on

same-day scheduling

(Your Practice Name)

PCMH 1A: Example – Factor 1

This is the practice’swritten policy on

same-day scheduling

PCMH 1A: Example – Factor 1

Brown Smith Jones

PCMH 1A: Example – Factor 2Element 1A,

Factor 2

PCMH 1A: Example – Factor 2

Percent of calls returned on the same day

PCMH 2D: Use Data For Population Management

• Practices uses patient data and evidence-based guidelines to generate lists and remind patients about needed services:1. At least three different preventive care services**2. At least three different chronic care services**3. Patients not recently seen by the practice4. Specific medications

** Meaningful Use Requirement

PCMH 2D: Use Data For Population Management

• MUST PASS• 5 Points• Scoring

– 4 factors = 100%– 3 factors = 75%– 2 factors = 50% (must-pass threshold)– 1 factors = 25% (not sufficient for passing element)– 0 factors = 0%

• Data Sources:– Lists or summary reports of patients who need services

• Reports must contain at least three different immunizations or screenings and three different acute/chronic care services

• A registry is not specifically required but will facilitate the process– Materials demonstrating patient notification

PCMH 2D: Example – Factor 1

Patient list is blinded to

protect confidentiality

List of patients who havenot received pneumovax

PCMH 2D: Example – Factor 2

patientnames

andMRNs havebeen

blinded

List of patients who havenot received appropriate

hypertensive care

PCMH 2D: Example – Factor 3

List of diabetics who have not been seen

in past 6 months

PCMH 2D: Example – Factor 4

(names of patients blinded for HIPAA)

List of patients in the practice taking Toprol XL

PCMH 5B: Referral Tracking and Follow-Up

• Practice coordinates referrals:1. Provides specialist with reason and key information for the

referral2. Tracks referral status3. Follows up to obtain specialist reports4. Has agreements with specialists documented in the record5. Asks patients about self-referrals and requests specialist

reports6. Demonstrates electronic exchange of key clinical

information**7. Provides electronic summary of care for more than 50% of

referrals**** Meaningful Use Requirement

• MUST PASS• 6 Points• Scoring

– 5-7 factors= 100% – 4 factors = 75%– 3 factors = 50% (must-pass threshold)– 1-2 factors= 25% (not sufficient for passing element)– 0 factors = 0%

• Data Sources:– Reports or logs demonstrating tracking system data collection – Documented processes with three examples– Reports from electronic system showing frequency of

information exchange and summary of care records

PCMH 5B: Referral Tracking and Follow-Up

PCMH 5B: Example – Factor 2

PCMH 5B: Example – Factor 2

PCMH 5B: Example – Factor 2Patient Name

MRN Referring Clinician

Reason for Referral

Date of Referral

Referred to Completed? Insurance

(Y/N & Date)

Joe Smith 12345 Halpern Back Pain 6/16/11 Triangle Ortho

No BCBS-NC

Mary Jones 54321 Halpern Colonoscopy 6/16/11 Durham GI Yes 6/21/11 Duke Select

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 but does not wish to implement in the near-term?

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

Next Steps (Homework)

• Go to NCQA’s website and take advantage of the various (free) training presentations they have available:– 2011 Standards– Using the ISS Interactive Survey System– Submitting As a Multi-Site Practice

• http://www.ncqa.org/tabid/109/Default.aspx

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?

Community Care PCMH Team

• David Halpern, MD, MPHCommunity Care of North Carolina (CCNC)

• R.W. “Chip” Watkins, MD, MPH, FAAFPCommunity Care of North Carolina (CCNC)

• Brent Hazelett, MPANorth Carolina Academy of Family Physicians (NCAFP)

• Elizabeth Walker Kasper, MSPHNorth Carolina Healthcare Quality Alliance (NCHQA)

NCQA Contact InformationContact 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

Happy Thanksgiving!

Questions?

Feel free to contact me:

David Halpern, MD, MPH

(215) 498-4648

dhalpern@n3cn.org