Enhancementsto the NCQAPCMH 2014StandardsBarbara Proffitt RNQuality Initiatives ManagerNCQA PCMHCertified Content Expert

ObjectivesTo provide an overview on the major enhancements to thePCMH NCQA 2014 standardsReview recommendation for preparing forPCMH Recognition renewal

Introduction2004- Physician Practice Connections (PPC)Developed by Bridges for Excellence2006- PPC updated2008 --PPC-PCMH2011-- PCMH 20112013– Patient-Centered Specialty Practice2014 - PCMH 2014

Introduction-PCMH is a model of care that emphasizes carecoordination and communication for primary carepractices to deliver care that the patients wantPatients in medical homes receive the right care, at the righttime, in the right amountPCMH practices leads to safer , better care, empowerspatients, and renews the patient/provider and care teamrelationshipPCMH embraces the full meaning of the triple aim whichis; better outcomes, cost effective care, and satisfiedpatients

The BuildingBlocks for PCMHTransformation

PCMH Recognized Practices NCQA reports 8386 practices have received PCMH recognition(November 2014) Nationally, 58% of FQHCs have at least 1 siterecognized as a PCMH. (October 2014 BPHC) In Massachusetts, 81 % ofhealth centers are PCMHrecognized (MLCHC October 2014)

Recognition Levels and Point Requirements Level 1:35–59 points and all 6 must-pass elementsLevel 2:60–84 points and all 6 must-pass elementsLevel 3:85–100 points and all 6 must-pass elements

PCMH EligibilityPractice defined – Providers practicing together at asingle geographic locationRecognition is at the geographic site- onerecognition per address, one address per surveyProviders are listed at each site where they routinelysee a panel of patients

2014 NCQA PCMH 6 Standards of CarePCMH 1:Patient-Centered AccessPCMH 2:Team Based CarePCMH 3:Population Health ManagementPCMH 4:Care Management & SupportPCMH 5:Care Coordination & Care TransitionsPCMH 6: Performance Measurement & QualityImprovement

PCMH 2014 – 6 Must Pass ElementScore for each Must-Pass element must be 50% PCMH 1A: Patient Centered Appointments & Access PCMH 2D: The Practice Team PCMH 3D :Using Data for Population Management PCMH 4B: Care Planning & Self Care Support PCMH 5B: Referral tracking and follow up PCMH 6D: Implement Continuos Quality Improvement

9 Critical FactorsStandard 11A Factor 11B Factor 2Standard 44A Factor 64C Factor 1Standard 22D Factor 3Standard 33E Factor 1Standard 55A Factor 1 & 25B Factor 8

2014 Standard Updates, Major enhancements Team Based Care Behavioral & Mental Health integration Measuring Health Care Costs Population Management Care Coordination Continuous Improvement Meaningful Use Alignment

PCMH Standard 2- Team Based CareA-ContinuityHaving a process to orient new patients to the practice (2A3)B- Medical Home ResponsibilitiesInform patients how behavioral health needs are metGives uninsured patients information about obtainingcoverageInstructions on transferring records and point of contactC-CLASClarifies for “Interpretation services”- Family or frienddoes not meet the intent of this standardD- The Practice Team

Team Based Care con’t 2D Factors 1 thru 10- the new must pass element Factor 2 is new - “Identify practice organizationalstructure & staff leading & sustaining team basedcare”2D2 -Focus is on the design and operations of thecare teams and training team members Factor 8 is new - “Holding regular team meetingsaddressing practice function”2D8- Focus is on scheduled team meetings toimprove care for all patients, to discuss practice andstaff functions

Further Integration of Behavioral and Mental Health Point of care reminders includes a mental health orsubstance use disorder ( Standard 3E1 ) ID patients that may benefit from Care management forbehavioral health conditions (Standard 4A1) Practices to maintain agreements with BH providers(Standard 5B3) & more specific focus on referrals to BH Services related to BH are communicated to the patient

Measuring Health Care Cost Monitoring “no show” rates (Standard 1A5) Identify patients who may benefit from care management;high cost/ high utilization (Standard 4A) Measure Resource Use and Care Coordination- at leasttwo measures affecting health care costs (Standard 6B2)

Population Management PCMH 3 The comprehensive health assessment which is 3A & 3B- Must providea report for each factor, no longer just showing “the process” New is 3C Factor 10-Assessment of health literacy Annually, must show active outreach to patients (point of carereminders) on a scheduled basis for a specific need (3D- must pass) Increased requirement for evidence based decision support from 2011-Previously 3 conditions, now 5-6 conditions2 different preventative care services 3D12 different immunizations3D2 (new)3 different chronic or acute services 3D3Patients not recently seen3D4Medication monitoring or alert3D5 Renewing practices must show 2 factors have been met during each yearof renewal.

Biggest enhancements to 2014- Care coordinationThe lack of coordinatedcare can lead to .Poor ulspendingUnsafepracticesDissatisfiedpatients

PCMH 4: Care Management and Support4A Factors 1 to 6 are all new factors

Care Coordination con’t New record review or electronic reports are from identifiedpatients for care management in 4A. No longer the threeimportant condition from 2011. Documentation from medical records for;-3C Comprehensive health assessment-4B Care planning and self-support- Expanded to includecaregivers, evaluate collaboration to develop & updateindividualized care plans- 4C Medication management Two (2) methods for medical record abstraction of data;Method #1- Report from electronic system, requiresnumerator/denominator for each factorMethod #2- Record Review Workbook- Now 30 recordsAND each factors must have “documentation” example.

PCMH 6- Monitoring & Improving PerformanceContinues to be the “Continuous ImprovementStandard” only sequencing of factors differentPractices make efforts to improve in patientexperience, cost and clinical quality i.e. Triple AimPractices conduct activities at least annually and aresubject to audit (annually is new)

PCMH 6- Monitoring & Improving Performance6A1- Measure Clinical Quality PerformanceMeasure at least annually (new)Renewing practices demonstrate annual measurementfor two (2) years-Must identify at least eight (8) different clinical measures-Two (2) immunization measures (new)-Two (2) preventative care measures (2011 it was 3)-Three (3) chronic or acute care measures (same as 2011)-One (1) immunization, preventative or chronic/acute caremeasure for a vulnerable population (new)

PCMH 6- Monitoring & Improving Performance con’t6B - Measure Resource use and Care Coordination-Measure annually-Renewing practices must demonstrate annual measurementfor two (2) years (new)- Must identify at least four (4) measures-Two (2) measures related to care coordination (new)-Two (2) utilization measures affecting health care costs6C- Measure Patient & Family Experience-(new) Annual Patient Surveys6D- Implement Continuous Quality Improvement-(new) Must improve one patient experience measure

Meaningful Use Alignment Where there are similar requirement,MU stage 2 definitions and thresholdsare embedded in the 2014 standards NCQA treats each of the MUrequirements as a separate factor

Questions on the standards?

RenewalsNCQA emails reminders to practice primary contact 6 monthsbefore expirationKeep NCQA updated on primary contact changes so you don’tmiss out on this notificationPractices should apply for renewal at least two months before theirrecognition expiration dateLevel 1 Practices- Full Survey tool for 2014 Standards

Streamlined Renewals NCQA offers a streamlined process for renewal throughreduced documentation requirements for single & multi-sitepractices with current NCQA Level 2 or Level 3 Recognition Even though some elements do not require a practice tosubmit documentation, practices must be able to producedocumentation if selected for audit Required to “attest” to standard eligibility and meeting therequirements for identified factors, must sign a waiver.

Single Site Streamline Renewal Requirements15 Attestation Elements11 Documentation ElementsThe 11 documentation elements include:*1A -Patient centered appointment access*2D -The Practice Team3C -Comprehensive Health Assessment*3D -Data for population Management4A -Patients identified for Care Management*4B -Care planning & Self-Care Support4C -Medication Management*5B -Referral Tracking & follow-up6B -Measure Resource Use & Care Coordination*6D -Implement CQI6E -Demonstrate QI*The six (6) Must Pass Elements

Multi-site Streamline Renewal Requirements17 elements available for Corporate Survey must be ableto respond to at least 12 elements, 9 site specific elementsSame attestation statement as single site15 Attestation elements & 11 Documentation ElementsMulti-sites with combination of Level 1, 2, 3 RecognitionsCan use the reduced documentation, however, Level 1 ornon-recognized practices, must include responses anddocumentation for all site specific elements in the surveytool

Recommendations for 2014 PCMHGet your 2014 NCQA PCMH Standards-free of chargePurchase the 80 ISS survey tool and use it as your guide/scoring for the 2014 StandardsDecide if pursuing single or multi-site survey start preparingdocuments 9 to 12 months before you plan to renewMulti-site survey process is followed for multi-site renewals

Recommendations for 2014 PCMH con’tPlan adequate time -team approach is recommendedFocus on Must Pass Elements first and secondly the critical factorsPrepare NCQA reviewer friendly documents and pay attention tothe document requirementsAlways submit NOI, application & ISS tool together-one for eachinitial, add-on, or renewal.NOI to HRSA first, application next -5 days before sending ISStool.

Auto CreditNCQA provides auto credit to EMR vendors forscored factors where EMR technology meets thefactor requirementsEMR vendors must go through a NCQA Prevalidationfor auto credit.The need for practices to provide required documentationwithin the PCMH survey is eliminated.

Pre-validated Vendor ListA full list is on the NCQA web-siteEMR vendors familiar to our health centers are:-GE Centricity-e-Clinical Works-Athena-Greenway Intergy

NCQA RESOURCES“Start to Finish” flowchart to plan your path to PCMHrecognition- Learn It, Earn It, Keep es/PatientCenteredMedicalHomePCMH.aspxPCS system - Policy Clarification inars

Thank [email protected]

Get your 2014 NCQA PCMH Standards-free of charge Purchase the 80 ISS survey tool and use it as your guide /scoring for the 2014 Standards Decide if pursuing single or multi-site survey start preparing documents 9 to 12 months before you plan to renew Multi-site survey process is followed for multi-site renewals Recommendations for 2014 PCMH