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6/5/2012

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Learning Session 2

June 6, 2012

Welcome

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Learning Community Structure

Assessments

Gap Analysis

Workplans


• Webinars• Monthly, 1 hour long• Detailed explanation of each of the standards• Tutorial for use of NCQA submission tools• Practice transformation for certain standards

• Group Technical Assistance• Bi‐Weekly, 90 mins• PCMH content experts available to answer specific questions

• Regular check‐ins on progress of the work

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Learning Sessions• Collaborative learning on PCMH, practice

transformation• Over half of the day is action• Impart training around content areas• Share best practices from various centers• Encourage unity amongst centers around healthcare

initiatives• A chance to meet other committed community

health staff

AgendaAM (1 break)

• PCMH Ice Breaker

• Sustainability

• PCMH Standard 6 ‐ Quality

LUNCH (60 minutes)

PM (1 break)

• PCMH: Before and After

• PCMH 2D – Population Management

• The Patient Experience

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Patient Centered Soul Scramble

• Let’s stand up and meet colleagues with the same letter at the respective easel

• At your easel is an envelope with letters

• The letters make up a word(s) related to PCMH

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• Unscramble the letters to identify the medical home concept

• List what comes to mind when you hear that word/concept

• Think of a dance that would best represent that word/concept

7 mins

Patient Centered Soul Scramble

You CAN Use

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6 Principles of Sustainability

1. Management Prioritizes Goal

All principles adapted from: 5 Million Lives Campaign. Getting Started Kit: Rapid Response Teams. Cambridge, MA: Institute for Healthcare Improvement; 2008. (Available at www.ihi.org)


2. Foolproof Change


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3. Transparent Feedback Systems



4. Clinic‐Wide Understanding of Improvement Process


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5. Staff Engaged in a Culture of Improvement



6. Capacity Building Programs


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You CAN Use

MEASURE PERFORMANCE

Standard 6 A

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PCMH 6A – Measure Performance

PCMH 6A – Measure Performance

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PCMH 6A – Factor 1 – Sample Documentation


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Our clinic receives data from our local hospital on both Admissions and ED visits for 4 chronic conditions affecting our rural community.

Our clinic goals are to reduce both ED and hospital admissions for CAD, COPD, DM and HTN patients. Our data reflects significant decreases when compared to Q1 2011


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Community Health Center, Section 330 (e) Migrant Health Center, Section 330 (g) Health Care for the Homeless, Section 330 (h) Public Housing Primary Care, Section 330 (i)All new grantees that receive Health Center grant awards and are operational by October of the reporting year are required to submit UDS reports.

Uniformed Data Set/ HRSA

PCMH 6A – Factor 3 – Sample DocumentationPCMH 6A –Factor 4 –Sample Documentation

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Element 6A – Activity – Measures Race

• “Measures Race” Sheet• List 3 preventative care measures reviewed by QI committee or clinical committee

• List 3 acute or chronic care measures reviewed by QI committee or clinical committee

• List either 2 utilization measures or one measure that you stratify vulnerable patient populations for

7 mins

When sheet is completed, send a representative to the front for review


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What measures are we tracking?

Element 6A – Activity – Vulnerable Patients

• Understanding interventions closely relates to understanding populations

• Think about quality measures that may be heavier on a “vulnerable population”

• Looking at our current QI measures for a specific population

• Having UDS Measures makes this easier

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1 Choose a clinical measure 2 Subset Vulnerable Population

3 Re‐write out new measure & brainstorm intervention


4 Ideas of how to engage staff

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BREAK

PCMH Element 6C: Implement Continous

QI

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PCMH 6C – Implement Continuous QI

What are the performance measures from A&B?


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NCQA Supplemental Worksheet: Documentation for Factors 1‐3


Example documentation for factor 4

Meeting Notes for QI Reporting

PCMH 6C – Sample Documentation

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Activity Time

Element 6C – Activity – Setting Goals & Actions To Improve

• NCQA wants to see you set goals and act to improve

• Think about a reasonable goal for QI measure you selected from the previous activity

• Plan at least one intervention to address this goal and measure

• Sustainability: Transparent feedback and management priority

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Element 6C – Activity – Setting Goals & Actions To Improve

1 Identify a Goal

2 Think of intervention

3 Staff feedback

4 Management Priority

PCMH Elements 6D & 6E: Demonstrate

Improvement and Report Performance

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PCMH 6D – Demonstrate Continuous QI


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PCMH 6E – Report Performance

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Core Measures for all EP's Medicaid and Medicare

Measure Recommended Measure Title Recommended Measure Description

0013 AMA Hypertension: Blood Pressure Measurement

Percentage of patient visits for patients aged 18 years and older with a diagnosis of hypertension who have been seen for at least 2 office visits, with blood pressure (BP) recorded.

0028a AMAPreventive Care and Screening Measure Pair: a.Tobacco Use

Assessment

Percentage of patients aged 18 years or older who have been seen for at least 2 office visits, who were queried about tobacco use one or more times within 24 months.

0028b AMAPreventive Care and Screening Measure Pair: b.Tobacco

Cessation Intervention

Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months who received cessation intervention.

0421 QIP Adult Weight Screening and Follow‐Up

Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside parameters, a follow‐up plan is documented.

Alternate Core for all EP's Medicaid and Medicare

0024 NCQAWeight Assessment and Counseling for Children and

Adolescents

The percentage of patients 2‐17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year.

0038 NCQA Childhood immunization Status

The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); two H influenza type B (HiB); three hepatitis B (Hep B), one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and two separate combination rates.

0041 AMAPreventive Care and Screening: Influenza Immunization for

Patients ≥ 50 Years Old

Percentage of patients aged 50 years and older who received an influenza immunization during the flu season (September through February).

PCMH 6E – Report Performance – CMS


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…taken from the CMS Attestation User Guide


US Preventive Service Task Force Recommendationshttp://www.ahrq.gov/clinic/pocketgd1011/

Recommendations of the Advisory Committee on Immunization Practices (ACIP)http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm?s_cid=rr6002a1_e

Using Standing Orders to Increase Vaccination Rateshttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr4901a2.htm

CDC: Increasing Adult Vaccinations Rates: What Workshttp://www2a.cdc.gov/vaccines/ed/whatworks/index.html

Resources

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Questions

Spread The Word

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PCMH 6 – Activity – Quality Improvement Worksheet

• Talked through 3 of 4 elements for PCMH Standard 6

• NCQA Quality Worksheet helps compile this information

• A nice format to share with entire staff: DASHBOARD

• Sustainability: Clinic‐wide understanding of QI process

PCMH 6 – Activity – Quality Improvement Worksheet

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Spread The Word

Quiz

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Quiz – Question 1

Name a sustainability principle and give an example of what it looks like in a health center.

1) management prioritizes goals; 2) foolproof change; 3) transparent feedback systems; 4) clinic‐wide understanding of improvement process; 5) staff engaged in a culture of

improvement; 6) capacity building programs

Quiz – Question 2

True or False: the chronic or acute care clinical measures can be associated with the three important conditions tracked by the practice?

True

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Quiz – Question 3

What is a component of a clear and on‐going quality improvement strategy as defined by NCQA?

a. Guaranteed Success

b. Evaluation of performance against goals

c. Only the QI committee knows what QI initiatives are going on

d. Performance data is only reviewed once a year

LUNCH

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PCMH Before & After

Managing Patient

Populations

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PCMH Element 2D: Identify and Manage Patient Population

PCMH 2D – Population Management

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PCMH 2D # 1

PCMH 2D – Factor 1 – Preventative Services

PCMH 2D – Factor 1 – Preventative Services

Patients needing reminder for preventive services and specific test (Mammography Reminder list)

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PCMH 2D – Factor 2 – Chronic Care Services

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Sample of proactive reminders of a patient


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PCMH 2D – Factor 3 – Not Recently Seen

• Who do you need to see on a regular basis?• i.e. Diabetic patients with HbA1c > 9 need to be seen monthly

• Who needs to be seen by Care Manager or Clinical Pharmacists?

• i.e. Hypertensive patients who have had a hospital admission but have not been seen in 6 months

• Who is missing a specific follow‐up?

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PCMH 2D – Factor 4 – Specific Medications

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Questions

PCMH Element 2D: Activity

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PCMH 2D Activity

Step 1: Using Part 1 worksheet, work as a team to select ONE preventive care service and ONE chronic care service

PCMH 2D Activity

Step 2: Using Part 2 worksheet work as a team to identify what registry you could create and what action you could take to address these gaps in services

Step 3: Who will be responsible? When will you start?

Step 4: What other resources will you need? How will you get them?

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PCMH Element 6B: Measure

Patient/Family Experience

Close Your Eyes

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PCMH 6B: Activity 1Goal: Experiencing what the patient experiences

1. Close your eyes and imagine you are a patient in the exam room waiting to see your doctor

2. When you feel like you’ve waited an appropriate amount of time for your doctor, open your eyes and stand up

Is this how long patients wait to see a provider at your health center?

Objectives

• Understand how patient experience relates to the medical home being “patient centered”

• Review of PCMH Standard 6, Element B

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New Focus on the Patient

PCMH 6B, Factor 1

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Patient Experience: Access

Sample questions:

– When you called to schedule this appointment, did you get an appointment as soon as you thought you needed one?

– In general, how often do you feel that you are able to get an appointment as soon as you think you need one?

Patient Experience: Communication

Sample questions:

– Did you have all of your concerns addressed and questions answered today?

– Did the nurse/provider communicate information about your health, medications and next steps in a way that was easy for you to understand?

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Patient Experience: Coordination of Care

Sample questions:– How often does your primary care physician seem informed and up‐to‐date about the care you got from a specialist?

– In the past year, did you and anyone in this provider’s office talk at each visit about all the prescription medicines you were taking?

Patient Experience: Self‐Management Support

Sample Questions:– In the past year, did you and anyone in this provider’s office talk about things in your life that worry you or cause stress?

– In the past year, did anyone in this provider’s office ask you if there are things that make it hard for you to take care of your health?

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PCMH 6B, Factor 2

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

• Developed by the Agency for Healthcare Research and Quality (AHRQ)

• Practices can receive special acknowledgement from NCQA for administering the PCMH version of the CAHPS Clinical Group Survey Tool:

• Use specific method or vendor for collecting the data

• Report results to NCQA• Practices can compare benchmarks

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More Info on CAHPS

Please visit:

http://www.cahps.ahrq.gov/Surveys‐Guidance/CG/PCMH.aspx

Building Your Own Survey

• Written at a basic reading level

• Refer to specific activities

• Ensure responses can be tracked, analyzed, and compared

• Can include questions from CAHPS

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Example

PCMH 6B, Factor 3

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PCMH 6B, Factor 4

Questions

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BREAK

PCMH 6B: Activity 2

Let’s Move Around

Co‐Consulting Around Patient Experience

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PCMH 6B: Activity 2Goal: Think about patient experience from the patient’s perspective

1. Remember a time when you, as a patient, experienced something positive or negative related to one or more of the four patient experience categories (access, communication, coordination, self‐management).

2. Write down what questions you could ask on a patient experience survey that will let the health center staff know that they are doing well or poorly in that area.

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