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Wrestling The BeastOf PCMH
Your Partner in Practice
OP User’s ConferenceApril 23-25, 2014
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Getting Started
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Getting Started – Understand Requirements
First, understand the requirements and concepts
1. Understand the purpose• http://www.youtube.com/embed/ZC4YCLG4h5k
2. Read the Standards thoroughly. Then read them again!
• http://ow.ly/uX6zZ
3. Take the trainings (online or in-person)
• http://ow.ly/uX6KJ
4. Visit practices who are already medical homes and network to learn best practices
• http://recognition.ncqa.org/
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Getting Started – Where Are You Today?
Second, figure out where you are in the process and what points you may already have:
➢ Scan through the Standards and check off -
• What you are you already doing
• What processes you need to adjust
• What you need to build
AND / OR you can take the PCS free survey and we will help you determine your ‘gaps’ . . .
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Take the PCS Online Survey
▪ Complete to the best of your ability – keep it simple▪ We will provide feedback to show you where you are
today▪ It will help to set up your project plan by identifying
the areas in which you need to do the least work (quick hits) and the most work
▪ Yes, it is FREE for OP Clients!
https://www.theverdengroup.com/application-process/
PCS Survey
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Example of the Survey
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Getting Started – Have Points Already?
Third, what points can you get through OP?
➢ OP has applied for ‘pre-validation’ points for 2014
• This means that you will receive credit for certain factors simply by having OP’s EMR . . .
You may be able to get up to 6.375 points just for being an OP Client!
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Example of How Pre-Validation Points Work
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Getting Started – MU Points?
Fourth, what points do you already have from MU1?
➢ If you are already doing MU, identify all MU related factors for which you already have the data collected
MU1-MU2 PCMH Crosswalk:
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Fifth, Build & Train Your Team
➢ Form a PCMH team comprised of at least:
• A physician ‘champion’ for each location
• A nurse / clinical manager
• An office manager
➢ Train the members of your PCMH team
➢ Share information across the practice and keep EVERYONE informed
Get Buy In
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• Who should you have on your team?▪ Clinical▪ Administrative▪ Physician Champion
• How frequently should you meet?• How will you stay on track with the project?• Who should receive training?• What training is necessary?
▪ NCQA online webinars▪ NCQA in-person training
The Team and The Plan
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Tools & Support
➢ OP has a PMCH module that includes the following features:
➢ PCMH Reports bundle via QIC
➢ Access to the PCMH user roadmap
➢ PCMH reports webinar to review the OP generated reports
➢ OP has great information, including a Roadmap, available here:
PCMH User Roadmap
Utilize Your Resources!
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Setting Up Your Project
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Put in place basic project management controls:
• Break down the work that needs to be done
• Start with the most important tasks first (not chronologically!)
• Set a timeline to accomplish each item
• Create an organized process for compiling the data and documentation that will be submitted to NCQA
• Have standing meetings on a weekly basis
• Share regular updates with staff in the form of memos
Apply Project Management Principles
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• Walk through every task, in front and behind the scenes, and follow the patient flow through the office
• Look for these key items:▪ Are there formalized policies and procedures ? ▪ Technology utilization beside an EMR, what else does
your practice have that you can leverage for recognitiono Website? o Patient Portal? o Recall system?
Catalogue What You’ve Got
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• Keep detailed notes during your assessment▪ Enter it right into your plan. This is your
roadmap to tracking the changes needed to transform
• Keep it simple▪ If you are not sure about something, note
that and keep moving through the ‘assessment’
Catalogue What You’ve Got
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Tackle the major pieces first:
➢ Figure out what ‘conditions’ you want to focus on first and set up visit templates for those
• While you work through the rest of the project, those most important pieces of data will already be in the process of being gathered
➢ Figure out the best ways to identify and stratify your ‘high-need’ patients (vulnerable and high risk populations)
➢ Determine what data you can get at readily for items like recalling, tracking preventive care and immunizations and improving quality
Focus On The Important Work First
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Zero in on Red first and make decisions about important conditions. Implement Green early – these are the processes that are easiest to adapt. Understand what you need to do for Black and plan accordingly as you work through the project.
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Tackle the Conditions and ‘Must Pass’
Elements First
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Recap - How the Scoring Works
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Focus on Must Pass & High Scores
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Processes & Procedures
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Set Up Protocols
• Create visit templates for your important conditions
▪ The longer you are collecting data, the more likely you will reach your percentage targets when it comes time to compete the workbook.
• Set up Standing Orders and utilize them▪ Example (2D4): testing protocols, defined triggers
for prescription orders, medication refills, vaccinations, routine preventive services
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Processes Preformed But Not Written?
• First, use what you’ve got▪ Job descriptions, meeting notes, training handouts etc.
• Start drafting! ▪ Don’t do an individual policy or procedure for each
factor - group them together, and keep it simple ▪ Have everyone pitch in
• Ask staff to draft what they do and those can be edited / refined from there
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No Process At All?
• Start by adding the easy ones first▪ Example – collecting race & ethnicity, PCP
➢ Have your staff begin doing that right away. ➢ The longer you have them collecting data, the
more likely you will reach your percentage targets when it comes time to submit your supporting data and documentation
OR▪ Take a short cut and purchase MGMA’s fully
customizable Policies and Procedures templates if you do not have any of your own- http://www.mgma.com/store/books/electronic/patient-centered-specialty-practice-medical-home-p
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Manage Your Documentation
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Capture As You Go▪ Create a ‘Master Copy’ binder / electronic file folder and
have one person manage it▪ Keep working versions and final versions separate to
avoid version control issues▪ Tag documents with the specific factors that each
section is addressing using Word notes, PDF markers, etc.
▪ Consistently name your files specific to the Element and Factor(s) addressed
Use a tool like Basecamp!
Compiling the Material
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There Are Resources Available to Help You!
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AAP Resources: www.pediatricmedhome.org
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PCS PCMH Program Project Management and PCMH Consulting Packages in Conjunction with OP
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Contact Information
The Verden Group, IncYour Partner in Practice
www.TheVerdenGroup.com
Susanne Madden, MBA, NCQA [email protected]
Julie Wood, MSc, NCQA [email protected]
Q & A