PowerPoint Presentation · Example #2: Barriers to care – Are you asking patients why they...
23
p. 1 BizMed © 2014
Transcript of PowerPoint Presentation · Example #2: Barriers to care – Are you asking patients why they...
p. 1 Biz
Me
d ©
20
14
p. 2 Biz
Me
d ©
20
14
Overview
NCQA PCMH 2014 Standards
Strategy to create a PCMH work plan
Quality improvement planning
A word about renewals
Summary
Consider the materials presented in this webinar during your initial PCMH planning sessions
** Links to recordings will be emailed to participants following this session
p. 3 Biz
Me
d ©
20
14
NCQA PCMH 2014 Standards
Recognition Levels Required Points Must-Pass Elements
Level 1 35–59 points
Level 2 60–84 points
Level 3 85–100 points
Elements marked in red font are MUST PASS
6 of 6 elements are required for each level
Score for each Must-Pass element must be ≥ 50%
Points Standard/Element Points Standard/Element
10 PMCH 1: Patient-Centered Access 20 PCMH 4: Care Management and Support
4.5 Element A Patient-Centered Appointment Access 4 Element A Identify Patients for Care Management
3.5 Element B 24/7 Access to Clinical Advice 4 Element B Care Planning and Self-Care Support
2 Element C Electronic Access 4 Element C Medication Management
12 PMCH 2: Team-Based Care 3 Element D Use Electronic Prescribing
3 Element A Continuity 5 Element E Support Self-Care and Shared Decision Making
2.5 Element B Medical Home Responsibilities 18 PCMH 5: Care Coordination and Care Transitions
2.5 Element C Culturally and Linguistically Appropriate Services (CLAS) 6 Element A Test Tracking and Follow-Up
4 Element D The Practice Team 6 Element B Referral Tracking and Follow-Up
20 PCMH 3: Population Health Management 6 Element C Coordinate Care Transitions
3 Element A Patient Information 20 PMCH 6: Performance Measurement and Quality Improvement
4 Element B Clinical Data 3 Element A Measure Clinical Quality Performance
4 Element C Comprehensive Health Assessment 3 Element B Measure Resource Use and Care Coordination
5 Element D Use Data for Population Management 4 Element C Measure Patient/Family Experience
4 Element E Implement Evidence-Based Decision Support 4 Element D Implement Continuous Quality Improvement
3 Element E Demonstrate Continuous Quality Improvement
3 Element F Report Performance
0 Element G Use Certified EHR Technology
p. 4 Biz
Me
d ©
20
14
Building a Roadmap to Recognition
Three recognition levels – Level 1 – 35 points
– Level 2 – 60 points
– Level 3 – 85 points
– (Perfection)
Four types of activities – Things you MUST do
– Things you already do
– Things you want to do
– Things you can do
p. 5 Biz
Me
d ©
20
14
Doing vs. Documenting vs. Reporting
Example #1: Patient phone calls – Are you taking calls?
– Are you noting response time for each call?
– Can you run a report listing response times?
Example #2: Barriers to care – Are you asking patients why they don’t take their meds?
– Are you noting their response in the chart?
– Can you run a report listing percent of times you did that?
Example #3: Health insurance – Are you asking patients if they have insurance?
– Are you recording patients’ insurance details?
– Can you run a report showing percent of recorded insurances?
p. 6 Biz
Me
d ©
20
14
The Things You MUST Do
The bad news:
If you can’t (or won’t) do, document & report at least 50% of each MUST PASS Element, you will not be recognized by NCQA as a PCMH
The good news:
It is not difficult for a typical practice (including small ones on paper) to do, document & report at least 50% of each MUST PASS Element
Points Standard - Element
4.5 PCMH 1 - A Patient-Centered Appointment Access
4 PCMH 2 - D The Practice Team
5 PCMH 3 - D Use Data for Population Management
4 PCMH 4 - B Care Planning and Self-Care Support
6 PCMH 5 - B Referral Tracking and Follow-Up
4 PCMH 6 - D Implement Continuous Quality Improvement
27.5 Total
Must-Pass Elements
p. 7 Biz
Me
d ©
20
14
A Closer Look at MUST PASS Elements
PCMH 1A Patient-Centered Appointment Access
1. Same day appointments
2. After hours appointments
3. Alternative type encounters
4. Analyze schedules
5. Act to improve schedules
PCMH 4B Care Planning and Self-Care Support
1. Preferences and functional/lifestyle goals
2. Treatment goals
3. Barriers
4. Self-management plan
5. Care plan provided to patient/caregiver
PCMH 2D The Practice Team
1. Formal organizational structure
2. Regular meetings (huddles, practice staff)
3. Standing orders
4. Training
5. Involve staff in quality improvements
6. Involve patients in quality improvements
PCMH 5B Referral Tracking and Follow-Up
1. Tracking to completion
2. Co-management agreements
3. Integrated behavioral health
4. Monitor self referrals
5. Evaluate specialists performance
6. Electronic summary exchange
PCMH 3D Use Data for Population Management
1. Outreach for preventive care
2. Outreach for vaccines
3. Outreach for chronic care
4. Outreach for patients not seen recently
5. Outreach for medications monitoring
PCMH 6D Continuous Quality Improvement
1. Analyze, set goals and act to improve
2. 3 clinical quality measures
3. 1 cost/utilization measure
4. 1 patient experience measure
5. 1 disparity for vulnerable patients
p. 8 Biz
Me
d ©
20
14
The Things You Already Do
Points Standard/Element Points Standard/Element
10 PMCH 1: Patient-Centered Access 20 PCMH 4: Care Management and Support
4.5 Element A Patient-Centered Appointment Access 4 Element A Identify Patients for Care Management
3.5 Element B 24/7 Access to Clinical Advice 4 Element B Care Planning and Self-Care Support
2 Element C Electronic Access 4 Element C Medication Management
12 PMCH 2: Team-Based Care 3 Element D Use Electronic Prescribing
3 Element A Continuity 5 Element E Support Self-Care and Shared Decision Making
2.5 Element B Medical Home Responsibilities 18 PCMH 5: Care Coordination and Care Transitions
2.5 Element C Culturally and Linguistically Appropriate Services (CLAS) 6 Element A Test Tracking and Follow-Up
4 Element D The Practice Team 6 Element B Referral Tracking and Follow-Up
20 PCMH 3: Population Health Management 6 Element C Coordinate Care Transitions
3 Element A Patient Information 20 PMCH 6: Performance Measurement and Quality Improvement
4 Element B Clinical Data 3 Element A Measure Clinical Quality Performance
4 Element C Comprehensive Health Assessment 3 Element B Measure Resource Use and Care Coordination
5 Element D Use Data for Population Management 4 Element C Measure Patient/Family Experience
4 Element E Implement Evidence-Based Decision Support 4 Element D Implement Continuous Quality Improvement
3 Element E Demonstrate Continuous Quality Improvement
3 Element F Report Performance
0 Element G Use Certified EHR Technology
Is there a doctor in the house?
If you practice medicine in traditional primary care settings, you are providing continuity of care and evidence-based care. Documentation is simple.
Are you a “meaningful user”?
If you use a meaningful use certified EHR, even if you did not formally apply for incentives, chances are good that ONE meaningful use report will satisfy most electronic Elements (and some additional Factors as well).
Marked in green font
p. 9 Biz
Me
d ©
20
14
The Things You Want To Do
• Would you like to have a fuller schedule?
• Perhaps less no-show appointments?
• Do you have a good way to train new staff?
• Are there ways to get a couple more minutes with patients?
• How’s your public image stacking up? – PQRS will be made public
– Patient experience ratings
• Are you leaving money on the table? – Medicare – Transition of Care
Management fees
– Medicare – Chronic Care Management fees
– Commercial – Performance bonuses, shared savings
– Commercial – Contract negotiations
• Could you use credits for MOC (FM only)?
Points Standard/Element Points Standard/Element
10 PMCH 1: Patient-Centered Access 20 PCMH 4: Care Management and Support
4.5 Element A Patient-Centered Appointment Access 4 Element A Identify Patients for Care Management
3.5 Element B 24/7 Access to Clinical Advice 4 Element B Care Planning and Self-Care Support
2 Element C Electronic Access 4 Element C Medication Management
12 PMCH 2: Team-Based Care 3 Element D Use Electronic Prescribing
3 Element A Continuity 5 Element E Support Self-Care and Shared Decision Making
2.5 Element B Medical Home Responsibilities 18 PCMH 5: Care Coordination and Care Transitions
2.5 Element C Culturally and Linguistically Appropriate Services (CLAS) 6 Element A Test Tracking and Follow-Up
4 Element D The Practice Team 6 Element B Referral Tracking and Follow-Up
20 PCMH 3: Population Health Management 6 Element C Coordinate Care Transitions
3 Element A Patient Information 20 PMCH 6: Performance Measurement and Quality Improvement
4 Element B Clinical Data 3 Element A Measure Clinical Quality Performance
4 Element C Comprehensive Health Assessment 3 Element B Measure Resource Use and Care Coordination
5 Element D Use Data for Population Management 4 Element C Measure Patient/Family Experience
4 Element E Implement Evidence-Based Decision Support 4 Element D Implement Continuous Quality Improvement
3 Element E Demonstrate Continuous Quality Improvement
3 Element F Report Performance
0 Element G Use Certified EHR TechnologyHighlighted in dark grey
p. 10 Biz
Me
d ©
20
14
Example: Phone Calls & Appointments
p. 11 Biz
Me
d ©
20
14
Example: Tools to Analyze Phone Calls
p. 12 Biz
Me
d ©
20
14
Example: Tools to Analyze Schedules
p. 13 Biz
Me
d ©
20
14
Example: Tools to Analyze Schedules
p. 14 Biz
Me
d ©
20
14
The Things You Can Do
Also known as low hanging fruit…
Elements that require little effort and relatively simple documentation
Points Standard/Element Points Standard/Element
10 PMCH 1: Patient-Centered Access 20 PCMH 4: Care Management and Support
4.5 Element A Patient-Centered Appointment Access 4 Element A Identify Patients for Care Management
3.5 Element B 24/7 Access to Clinical Advice 4 Element B Care Planning and Self-Care Support
2 Element C Electronic Access 4 Element C Medication Management
12 PMCH 2: Team-Based Care 3 Element D Use Electronic Prescribing
3 Element A Continuity 5 Element E Support Self-Care and Shared Decision Making
2.5 Element B Medical Home Responsibilities 18 PCMH 5: Care Coordination and Care Transitions
2.5 Element C Culturally and Linguistically Appropriate Services 6 Element A Test Tracking and Follow-Up
4 Element D The Practice Team 6 Element B Referral Tracking and Follow-Up
20 PCMH 3: Population Health Management 6 Element C Coordinate Care Transitions
3 Element A Patient Information 20 PMCH 6: Performance Measurement and Quality Improvement
4 Element B Clinical Data 3 Element A Measure Clinical Quality Performance
4 Element C Comprehensive Health Assessment 3 Element B Measure Resource Use and Care Coordination
5 Element D Use Data for Population Management 4 Element C Measure Patient/Family Experience
4 Element E Implement Evidence-Based Decision Support 4 Element D Implement Continuous Quality Improvement
3 Element E Demonstrate Continuous Quality Improvement
3 Element F Report Performance
0 Element G Use Certified EHR TechnologyMarked in blue font
p. 15 Biz
Me
d ©
20
14
Where are we on the roadmap?
Must-Pass + Meaningful Use + Low Hanging Fruit = PCMH Level 2 (~65 points)
To achieve PCMH Level 3 recognition you MUST measure and act to improve quality metrics
p. 16 Biz
Me
d ©
20
14
Points Standard/Element Points Standard/Element
10 PMCH 1: Patient-Centered Access 20 PCMH 4: Care Management and Support
4.5 Element A Patient-Centered Appointment Access 4 Element A Identify Patients for Care Management
3.5 Element B 24/7 Access to Clinical Advice 4 Element B Care Planning and Self-Care Support
2 Element C Electronic Access 4 Element C Medication Management
12 PMCH 2: Team-Based Care 3 Element D Use Electronic Prescribing
3 Element A Continuity 5 Element E Support Self-Care and Shared Decision Making
2.5 Element B Medical Home Responsibilities 18 PCMH 5: Care Coordination and Care Transitions
2.5 Element C Culturally and Linguistically Appropriate Services 6 Element A Test Tracking and Follow-Up
4 Element D The Practice Team 6 Element B Referral Tracking and Follow-Up
20 PCMH 3: Population Health Management 6 Element C Coordinate Care Transitions
3 Element A Patient Information 20 PMCH 6: Performance Measurement and Quality Improvement
4 Element B Clinical Data 3 Element A Measure Clinical Quality Performance
4 Element C Comprehensive Health Assessment 3 Element B Measure Resource Use and Care Coordination
5 Element D Use Data for Population Management 4 Element C Measure Patient/Family Experience
4 Element E Implement Evidence-Based Decision Support 4 Element D Implement Continuous Quality Improvement
3 Element E Demonstrate Continuous Quality Improvement
3 Element F Report Performance
0 Element G Use Certified EHR Technology
Strategies for Quality Improvement
• You can take the Elements in order and pick ad-hoc measures as you go
• You can select lists and reports based on what your EHR can produce
• You can select reports and results based on your current quality initiatives
• You can select measures based on performance bonuses from insurers
• You can combine everything into an overall strategic plan for your practice
Quality related Elements
p. 17 Biz
Me
d ©
20
14
Planned Quality Improvement
4A – Select
Conditions
3E – Select
Guidelines
2D – Train Team
Members
3D – Outreach for
Services
3C, 4B, 4C, 4E,
Manage Care
6A, 6B – Select
Quality Measures
6D, 6E – Act and
Improve Quality
p. 18 Biz
Me
d ©
20
14
Focused Quality Example: Diabetes Care
4A – Select Conditions
1. Depression
2. LT/ST DM Complications Admit
3. Low SES
4. Uncontrolled DM
5. Plan referrals (care gaps)
6A, 6B –Quality Measures
1. Pneumovax & flu shots
2. DM & Obesity screening
3. DM composite (5 services*)
4. Ophthalmology referrals
5. LT/ST complications admit
6. Stratify by SES
3E – Guidelines
1. Depression
2. Diabetes
3. UTI
4. Obesity
5. Annual visits
6. Generics - DM & Depression
3C, 4B, 4C, 4E
Manage Care
3D – Outreach
1. Diabetes & Obesity screening
2. Pneumovax & flu shots
3. DM composite (5 services)
4. A1c > 8 & not recently seen
5. Insulin for low SES
2D – Train Team Members
1. Diabetes standing orders
2. DM population management
3. DM self-care education
4. Diet & exercise education
5. DM QI activities
6D, 6E
Act and Improve Quality
1
2
4
3
5
6
* Comprehensive Diabetes Care Composite – 5 services:
(HbA1c testing, LDL C screening, BP measure, neuropathy attention: urine or ACE/ARB or referral, eye exam )
p. 19 Biz
Me
d ©
20
14
A Word About Renewals
• Only 11 Elements require full documentation to be submitted
• 16 Elements require attestation only, but you MUST be able to produce proper documentation if requested (audited) by NCQA
Points Standard/Element Points Standard/Element
10 PMCH 1: Patient-Centered Access 20 PCMH 4: Care Management and Support
4.5 Element A Patient-Centered Appointment Access 4 Element A Identify Patients for Care Management
3.5 Element B 24/7 Access to Clinical Advice 4 Element B Care Planning and Self-Care Support
2 Element C Electronic Access 4 Element C Medication Management
12 PMCH 2: Team-Based Care 3 Element D Use Electronic Prescribing
3 Element A Continuity 5 Element E Support Self-Care and Shared Decision Making
2.5 Element B Medical Home Responsibilities 18 PCMH 5: Care Coordination and Care Transitions
2.5 Element C Culturally and Linguistically Appropriate Services (CLAS) 6 Element A Test Tracking and Follow-Up
4 Element D The Practice Team 6 Element B Referral Tracking and Follow-Up
20 PCMH 3: Population Health Management 6 Element C Coordinate Care Transitions
3 Element A Patient Information 20 PMCH 6: Performance Measurement and Quality Improvement
4 Element B Clinical Data 3 Element A Measure Clinical Quality Performance
4 Element C Comprehensive Health Assessment 3 Element B Measure Resource Use and Care Coordination
5 Element D Use Data for Population Management 4 Element C Measure Patient/Family Experience
4 Element E Implement Evidence-Based Decision Support 4 Element D Implement Continuous Quality Improvement
3 Element E Demonstrate Continuous Quality Improvement
3 Element F Report Performance
0 Element G Use Certified EHR TechnologyRequire documentation
Element Renewal Requirement
PCMH 2D At least two Factors met annually
PCMH 6A All Factors met annually
PCMH 6B Only Factor #2 met annually
PCMH 6C All Factors met annually
+
p. 20 Biz
Me
d ©
20
14
Where to go from here?
Research Your Options • Study the PCMH Standards and Guidelines – BizMed is a safe and free
sandbox to do just that
• Understand your performance bonuses (HEDIS, Star, PCMH, State, PQRS, custom)
• Consider using the PCMH framework for quality/business improvements even without formal recognition
• Objectively assess your practice and the effort required from your practice to achieve your goals – DO NOT mindlessly go through all 172 NCQA Factors answering Yes/No to all
questions
– DO NOT assume that doing something is enough without documenting, measuring and reporting
– DO decide on your personalized practice roadmap to PCMH recognition
Make a Plan • Define your goals
• Use these materials to draw your roadmap to achieving those goals
• Assign resources and understand that physicians MUST be involved
• Estimate time frame to completion and pick meaningful milestones to guide you
• Stay the course – there will be good days and plenty of bad days
• And yes, it is worth the effort…
p. 21 Biz
Me
d ©
20
14
PCMH – A Practice Management Framework
PC
MH
Financial Management
Operations Management
Care Management
Quality Management
Included in
NCQA PCMH
Missing from
NCQA PCMH
What are your
practice goals?
Step 2:
Refine & expand the framework to address your goals
Step1:
Define your goals
An opportunity….
p. 22 Biz
Me
d ©
20
14
Summary – PCMH is just a framework
p. 23 Biz
Me
d ©
20
14
Contact info: Margalit Gur-Arie
Mobile: 314.651.9137
For more information and assistance:
On the web: www.bizmedsolutions.com
Email: [email protected]
Phone: 1-866-861-0160
** Links to recording will be emailed to participants following this session
