Patient-Centered Medical Home Recognition (PCMH) as a ... · 2. Examining Differential Performance...
Transcript of Patient-Centered Medical Home Recognition (PCMH) as a ... · 2. Examining Differential Performance...
Patient-Centered Medical Home Recognition (PCMH) as a Foundation for Transformation
NACHC Community Health Institute
August 27, 2018
Advancing the Quadruple Aim
NACHC’s Quality Center has developed a Value Transformation Framework that translates research, proven solutions, and promising practices into manageable
steps health centers can apply in advancing the Quadruple Aim goals:
PCMH within the Framework
NACHC Quality Center’s
Value Transformation Framework
PCMH as a Foundation for
Transformation
2018 COMMUNITY HEALTH INSTITUTE
NCQA
William F. Tulloch
Director, Government Recognition Initiatives
About NCQA
Measure
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About
Accredit Recognize
Clinical quality,
consumer
experience,
resource use
Health plans,
ACOs, etc.
Physician
practices
Measurement
8
What we do, and why
Transparency Accountability
We can’t improve
what we don’t
measure
We show how
we measure so
measurement will
be accepted
Once we measure, we
can expect and track
progress
OUR MISSION
To improve the quality of health care
OUR METHOD
Recognition Process
Outpatient primary care practices
Practice defined: a clinician or clinicians
practicing together at a single
geographic location
• Includes nurse-led practices in states
as permitted under state licensing
laws
• Does not include:
− Urgent care clinics
− Clinics open on a seasonal basis
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Eligibility Requirements
• Recognition is achieved at the geographic
site level -- one Recognition per address, one
address per survey
• MDs, DOs, PAs, and APRNs with their own or
shared panel are listed on the application
• Clinicians should be listed at each site where
they routinely see a panel of their patients
• Non-primary care clinicians should not be
included
2017 StandardsConcepts
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Team-Based Care and
Practice Organization
(TC)
Knowing and
Managing Your
Patients (KM)
Patient-Centered
Access and Continuity
(AC)
Care Management and
Support (CM)
Care Coordination
and Care Transitions
(CC)
Performance
Measurement &
Quality Improvement
(QI)
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PCMH Redesign3 Parts
Practice completes an online guided
assessment.
Practice works with an NCQA
representative to develop an
evaluation schedule.
Practice works with NCQA
representative to identify support
and education
for transformation.
New NCQA PCMH online education
resources support the
transformation process.
CommitPractice submits initial
documentation and checks in with
its evaluator
Practice submits additional
documentation and checks in with
its Evaluator.
Practice submits final
documentation to complete
submission
and begin NCQA evaluation
process.
Practice earns
NCQA Recognition.
Transform SucceedPractice is prepared for new
payment environment (value-
based payment, MACRA
MIPS/APMs).
Practice demonstrates
continued readiness and high
quality performance through
annual reporting with NCQA.
Recognition and PCMH Transformation
Improving Health Outcomes
Knowing patient population
• Demographics
• Social Determinants of Health
• Health Assessment
Population Management
Focus on Complex Cases
Quality Culture
• Input from all staff
• Input from patients/family/caregivers
• Reporting & Accountability14
Improving Patient Experience
Patient Experience Monitoring
• Surveys
• Qualitative data
• Access preferences
Patient Education
• Medical Home Model
• Treatment/Cost options
Quality Culture
• Input from patients/family/caregivers
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Improving Staff Experience
Team-based Care
• Everyone is responsible
• Working at top of license/skill set
• Delegation
Patient Planning and Communication
Quality Culture
• Input from all staff
• Reporting & Accountability
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Improving Cost and Efficiency
Knowing patient population
• Demographics
• Social Determinants of Health
• Health Assessment
Proactive management
• Reduced ER Use
Coordination
• What happens when care leaves the practice?
Quality Culture
• Measure cost/efficiency issues
• Quality effort focus17
A success story
Contact Information
William F. Tulloch
Director, Government Recognition Initiatives
NCQA
1100 13th ST, NW, 3rd Floor
Washington, DC 20005
202-955-5145
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PCMH as a Foundation for TransformationCHI 2018
Presented by:Lynette Mundey, MD
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© 2018 The Joint Commission. All Rights Reserved.
Organizational Overview
Mission: To continuously improve health care for the public, in
collaboration with other stakeholders, by evaluating health care
organizations and inspiring them to excel in providing safe and effective
care of the highest quality and value.
Joint Commission Structure: Private, not-for-profit Over 40 years in ambulatory care Primary Care Medical Home
Certification 2011 2,100 - plus organizations Accreditation/certification options Accredit organization/setting
The Joint Commission’s nationally recognized standards and comprehensive on-site survey process provides the foundation to build sound patient safety and quality care processes.
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© 2018 The Joint Commission. All Rights Reserved.
Real-time assessment
Educational opportunity and on-site consultation
Sharing of best practices and implementation strategies
No document submission requirement
Organization-wide certification for 3 years for PCMH eligible sites
Combined survey option for accreditation and PCMH certification
PCMH Program
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© 2018 The Joint Commission. All Rights Reserved.
PCMH Program: What Does a Survey Look Like?
On-site, fully integrated, transparent event
Educational, informative and interactive
Patient and systems focused
Direct observation of patient care processes
Patient engagement
Staff/care team engagement
Governing Body/Leadership engagement
Medical record and HR file review
Pertinent document/policy review
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© 2018 The Joint Commission. All Rights Reserved.
Transformation
The Joint Commission: Supporting transformation toward value-driven care and the Quadruple Aim
Improved health outcomes
Improved patient experience
Improved staff experience
Reduced costs
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© 2018 The Joint Commission. All Rights Reserved.
Improved Health Outcomes Support
Provides the structure and resources to support and guide quality improvement and risk management:
Reduces variation in care delivery
Establishes a consistent approach to care, reducing the risk of error
Demonstrates commitment to a higher standard of clinical service
Organizes teams across the continuum of care
Enhances staff recruitment and development
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© 2018 The Joint Commission. All Rights Reserved.
Improved Health Outcomes Support
Survey Team Driven
Focused education on health literacy assessment
Focused evaluation of patient self-management goals
Identification of gaps in care
Sharing best practices/lessons learned in patient and care team engagement
Engagement of leadership in resource support/change management
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© 2018 The Joint Commission. All Rights Reserved.
Improved Patient Experience
Patients benefit from this model of care:
Increased access to their primary care clinician and interdisciplinary team
Care is tracked and coordinated
Increased use of health information technology supports their care
Model is focused on education and self-management by the patient
Model is based on the Agency for Healthcare Research and Quality’s (AHRQ) definition of a medical home
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© 2018 The Joint Commission. All Rights Reserved.
Improved Patient Experience
Survey Team Driven
Interactive discussion with patients on perception of
Patient-centered care
Comprehensive care
Coordinated care
Access to care
Quality and safety concerns
Review of data collected on patient care experience
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© 2018 The Joint Commission. All Rights Reserved.
Improved Staff Experience
Electronic prescribing - for allowable scripts
Computerized order entry - lab, meds, radiology
Use of clinical decision support tools
Referral tracking and follow-up
Collection of data on:
Disease management outcomes
Staff perception of quality and safety of care
Track patient progress toward treatment goals
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© 2018 The Joint Commission. All Rights Reserved.
Reduced Costs
What we know now:
Reduction/no appreciable increase in intensive outpatient treatment costs for high risk patient¹
Reduction in emergency department visits and hospital admissions²
and
Overall increased cost of managing the health center’s practice population³
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© 2018 The Joint Commission. All Rights Reserved.
Transformation Success Story:Erie Family Health Center, Chicago, Illinois
>90% increase in patient outreach around transitions from inpatient/ ER to Erie
Improved readmissions rate
More same-day appointments based on daily conversion of unused appointments
Access Review Committee to review access measures for every provider monthly
Review potentially misaligned patients 2x/year to ensure correctly assigned to PCP
Created practice teams to ensure continuity of care when provider is out
Better collection of patient feedback: paper surveys quarterly; text surveys weekly
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© 2018 The Joint Commission. All Rights Reserved.
References
1. Impact of Primary Care intensive Management on High-Risk Veterans” Cost and Utilization, J Yoon et al, Annals of Internal Medicine, 19 June 2018
2. Examining Differential Performance of 3 Medical Home Recognition Programs, Ammarah Mahmud, MPH et al, American Journal of Managed care, July 2018
3. Community Health Workers Bring Cost Savings to a Patient Centered Medical Home, ML Moffett et al, Journal of Community Health, 10 July 2017
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© 2018 The Joint Commission. All Rights Reserved.
Contact Information
Brittnay Hull, Lead Account Executive
630-792-5216
Joyce Webb, RN, Project Lead, PCMH Initiative
630-792-5277
Kristen Witalka, Business Development Manager
630-792-5292
Pam Komperda, Project Manager
630-792-5551
Medical Home Accreditation as a Foundation for Practice Transformation
2018 Community Health Institute & Expo
August 27, 2018
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Presenter• Dennis Schultz, MD, MSPH, FACOEM
• Board member
• Vice Chair, Standards and Survey Procedures Committee
• Surveyor since 1995
• Regional Medical Director QuadMed
©2018 Accreditation Association for Ambulatory Health Care, Inc. All rights reserved.
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AAAHC Since 1979
©2018 Accreditation Association for Ambulatory Health Care, Inc. All rights reserved.
Peer-based Accreditation Program focused on Quality
Integrated Onsite Survey
Over 6000 accredited organizations
Consultative and Collaborative
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AAAHC Primary Care Standards and the Transformation Process
©2018 Accreditation Association for Ambulatory Health Care, Inc. All rights reserved.
Core Chapters Adjunct Chapters
• Patient Rights
• Governance
• Administration
• Quality of Care
• Quality Management & Improvement
• Clinical Records
• Infection Prevention & Control & Safety
• Facilities & Environment
• Anesthesia & Surgery
• Pharmaceutical Services
• Imaging
• Pathology & Laboratory
• Dental & Dental Home
• Health Education
• Behavioral Health
• Medical Home
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Tenants of Medical Home Chapter
©2018 Accreditation Association for Ambulatory Health Care, Inc. All rights reserved.
Relationship and Engagement
Accessibility
Continuity
Comprehensiveness
Quality
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Survey Process, HRSA PCMH Accreditation Initiative & Transformation
©2018 Accreditation Association for Ambulatory Health Care, Inc. All rights reserved.
Survey Process Support Additional HRSA Support
• Self assessment & improvement
• Presurvey planning and calls
• Comprehensive onsite survey
• Consultative comments & suggestions
• Summation conference
• Extensive written report
• Virtual survey-Two hour pre survey assessment call
• Mock survey
• Current & Archived webinars
• Builds upon current metrics and recognition programs
• Ongoing AAAHC team contact providing education and resources
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Medical Home Accreditation Supports Transformation
©2018 Accreditation Association for Ambulatory Health Care, Inc. All rights reserved.
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• Continuous quality improvement
• Framework for program design
• Appropriate goal setting
• Tools provide practical tips and guidance
• Emphasis on team based care
• Improved treatment plans, referrals, tests ordered and completed
• Improved ability to address expanded scope of patient centered care
Medical Home Accreditation Supports Improved Outcomes
©2018 Accreditation Association for Ambulatory Health Care, Inc. All rights reserved.
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• Improved patient experience of care
• Increased access
• Improved ability to address expanded scope of patient centered care
Medical Home Accreditation Supports Improved Patient Experience
©2018 Accreditation Association for Ambulatory Health Care, Inc. All rights reserved.
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• Increased care team satisfaction
• Supports staff development
• Provide different perspectives, knowledge base and skill set
• Promotes a culture of continuous improvement
• Work at the top of your license
• Distribution of work and support; clearly defined roles
• Continuity of staffing
Medical Home Accreditation Supports Improved Staff Experience
©2018 Accreditation Association for Ambulatory Health Care, Inc. All rights reserved.
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• Improves efficiency
• Improves business operations through a consultative approach
• Identifies risk management issues
• Tracked PCMH elements (structured data in the EHR) allow for improved work flow and compliance evaluation by QI staff
Medical Home Accreditation Supports Reduced Costs
©2018 Accreditation Association for Ambulatory Health Care, Inc. All rights reserved.
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Topic Ara % Answered Yes
Patient Safety/Quality of care
Implementation of a new risk assessment/prevention activities, policies, or procedures 88%
Reduced adverse events or near misses 63%
Care Coordination
Improved management of care for patients with high health care needs 72%
Improved delivery of preventative care (Note: Only primary care organizations answered this question) 68%
Increased patient and caregiver engagement 65%
Improved coordination of care across providers in the community 51%
Satisfaction
Increased patient satisfaction 63%
Increased provider satisfaction 59%
Increased staff satisfaction 58%
Personnel (Staff/Providers)
Improved provider credentialing/privileging process 79%
Organizational Audit Performance
Improved Performance on clinical records audit 83%
Improved Performance on operational audit 65%
2017 ROI Survey Results
©2018 Accreditation Association for Ambulatory Health Care, Inc. All rights reserved.
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• Healing community garden
• Universal clinical quality metric incentives
• Proper opioid prescribing initiative
• Interdisciplinary care team & A1C reduction
• PCHM Clinic effect on total cost of care
• Integrating oral health as part of pre-natal care
• Stress identification & self management bingo
• Home wound management program
• Behavioral & community health aid training programs
• Native healers & residential treatment programs
©2018 Accreditation Association for Ambulatory Health Care, Inc. All rights reserved.
Medical Home Accreditation Transformation Success Stories
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Mona Sweeney, RN BSN
Assistant Director Business Development -Primary Care/ Medical Home
Phone: 847-324-7487
Email: [email protected]
Deborah Edelman, MPH
Senior Account Executive
Phone: 847-324-7737
Email: [email protected]
Know your team!
©2018 Accreditation Association for Ambulatory Health Care, Inc. All rights reserved.
Questions?
PCMH as a Foundation for Transformation
Thank you!
Sarah Roberto, MPP
Deputy Director, Quality Center
National Association of Community Health Centers