Obtaining Medical Home Recognition: A How-to-Manual to Facilitate the Process

8/14/2019 Obtaining Medical Home Recognition: A How-to-Manual to Facilitate the Process

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Obtaining Medical Home

Recognition:A How-To Manual to Facilitate

the ProcessChicago, IL August 25, 2009

Regina M. NealDirector of Performance Improvement

Cari ReinerProgram Manager, PerformanceImprovement

NACHC 2009 Community HealthInstitute & EXPO


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Session Objectives

At the end of this session, you will be able to

2. Describe the NCQA Physician Practice

Connections Patient-Centered Medical Home

(PPC-PCMH) framework3. Use a process and framework to begin or continue

attainment of NCQA PPC-PCMH recognition

4. Apply best practices to ensure the most successful

process for completing your NCQA PPC-PCMHapplication process

has been supported through a grant provided by the New York Community Trust.


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About the Primary Care Development

Corporation (PCDC)

Non-profit formed in 1993

Mission: to ensure excellent health care in everyneighborhood

Work in NYS and throughout US Work with organizations through programs in five areas:

Capital Access

Performance Improvement

Health Information Technology (HIT) Emergency Preparedness

Policy Leadership

Learn more and contact us at: www.pcdcny.org



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Medical Home What is it?

Ideal model of care delivery - in otherwords

you get what you need, when you needit, in a manner you want

patients and providers work as partnersin managing their health

care is coordinated and the right peopleare talking to each other



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Medical Home Why is it Needed?

Current US health care system is fraught

with inefficiencies and subpar outcomes

Cost continues to rise Health outcomes are not improving

We can and ought to do better

We all, as patients, deserve better



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Discussion Questions

Are you familiar with the

Medical Home concept?

Have you begun to thinkabout how you can apply the

principles of a Medical Home

at your organization?



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PCDCs Goal

Through generous support provided by the New YorkCommunity Trust, PCDC sought to reduce barriers

for community health centers seeking PCMH

recognition through the development of a tool

Based on the NCQA PPC-PCMH program, with a

primary focus of aiding in the attainment of at least

Level 1 recognition

Practical, user-friendly, and flexible Builds on and leverages existing best practices, tools,

and resources



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Needs Assessment: Key Questions

What are health centers greatest needs in &barriers preventing them from becoming medical

homes, specifically around the must pass

elements?

What tools already exist to help health centers

become medical homes? Are they accessible to

health centers?

What gaps exist in terms of resources (tools,technical assistance, etc.) to help health centers

become medical homes?



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Needs Assessment: Methodology

Conducted extensive literature review

Interviewed a small, diverse group of NYC

CHCs at varying levels of engaging inNCQA PPC-PCMH recognition process



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Key Findings: Needs & Barriers

Time and dedicated resources

Better understanding of what was required

to pass Clarification of terms in application

Insight into a process/framework to

efficiently and effectively manage theproject



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Key Findings: Existing Resources

Plethora of tools and resources out there

around medical homes but

Often were more academic vs. practical

Not specifically designed for the CHC community

Can be arduous to mine value

Focused on implementation of PPC-PCMH

elements but not on how to manage the process orthe nuts and bolts of completing the application



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Key Findings: Resource Gaps

Project management resources

Additional information on the NCQA

application itself Clarification of terms

What is sufficient for passing?

What is insufficient for passing?



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PCDCs Conclusion

Develop a tool which focuses on: Assisting with project management of the initiative (i.e.,

setting goals, forming a project team, developing

realistic work plans)

Providing practical tips and information on successfully

completing the NCQA PPC-PCMH application



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How-To Manual: An Overview

Purpose: Provide a user-friendly tool to walk

through the project planning and management

related to the nuts and bolts of completing the

NCQA PPC-PCMH application and obtainingmedical home recognition

Scope: Focuses on NCQA PPC-PCMH

recognition program but helps CHCs beginjourney toward transforming to a PCMH



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How-To Manual: An Overview

Audience: CHCs and other primary careproviders serving the safety net, PCAs,other organizations providing assistance to

these providers

Medium: multimedia manual available inpaper- and electronic-versions



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An Inside Look at the How-To Manual:

A Process for Obtaining NCQA PPC-PCMH Recognition



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Overview of Process

Step 1: Learn the Lay of the Land

Step 2: Identify goals

Step 3: Identify a Project Team Step 4: Assess Your Internal Resources

Step 5: Develop a Plan



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Step 1:

Learn the Lay of the Land


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STEP 1: Learn the Lay of the Land

Familiarize yourself and staff with PCMH framework& NCQA recognition process

General principles and tenets; NCQA PPC-PCMH

standards and scoring process

Things youre already doing that align with PCMH

principles

Benefits in obtaining NCQA recognition

Resources and time commitment required to obtainNCQA recognition

Resource: ACPs The PCMH: 3-Part Series of

Presentations (www.acponline.org)



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Overview of NCQA Content

9 standards, 7 of which contain must-pass

elements

30 elements, 10 of which are must-pass Each element contains a series of factors

which your score is based upon

Example: PPC1A: Access &Communication Processes



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Overview of Scoring Methodology

The NCQA scoring guidelines for the

PCMH has 3 levels of achievement

There are 10 Must-Pass elements, of whicha practice must pass at a 50% or greater

score.

A practice must pass 5 of the 10 must pass

elements for Level 1 recognition, and 10 of the

10 elements for Level 2 or 3 recognition



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NCQA Score Requirements

Level Points Must-Pass Elements

Level 1 25-495 of 10, with a performance

level of at least 50%

Level 2 50-74 10 of 10, with a performancelevel of at least 50%

Level 3 75-10010 of 10, with a performance

level of at least 50%



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Before going too far in the process,

make sure to

1. Confirm practice/site eligibility for NCQA PPC-PCMH recognition

If a network, decide if want to use multi-site

process Purchase PPC-PCMH application from NCQA

and obtain free copy of standards & guidelines(available at http://www.ncqa.org/tabid/631/Default.aspx)

Review, complete and submit key non-applicationdocuments to NCQA



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How familiar is your healthcenter with the PCMH concept?

NCQA PPC-PCMH program?

Have you taken any steps tobegin the recognition process?

Where did you start? Did you face any challenges?



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Step 2:

Identify Goals


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STEP 2: Identify Goals

Answer the following questions:

Why is our organization seeking PCMH

recognition?

What level of NCQA PPC-PCMH

recognition do we want to obtain?

When do we want to obtain recognition by?



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SMART Framework

Goals should be:

Specific

Measurable Attainable

Relevant

Timely



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Tips for Setting Goals

Best to do as a group and likely to be an iterativeprocess

Key questions to consider:

What are your longer-term strategic goals (i.e.,where do you see your organization in 5 yrs?)

Do you have any major competing priorities?

What HIT capabilities do you currently have (or

are planning to implement in the near future)? What are the benefits of attaining the various

levels of PCMH recognition?



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Have you set yourgoals?

What are they?

What process did youuse to set them?

Who was involved?



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Step 3:

Identify a Project Team


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STEP 3: Identify Project Team

A team is a:

small number of people with complementary

skills who are committed to a common

purpose, set of performance goals, andapproach for which they hold themselves

mutually accountable

Katzenbach & Smith,

The Wisdom of Teams



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Team Composition

Organizational factors to consider:

Size

Number of sites

Culture

Management style

Project goals



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Team Composition

Teams typically consists of 4-6 people (5-memberteams are ideal)

Include representation from clinical,

administrative/operational, and IT areas/departments

Ensure at least one member is computer proficient

(2 members with computer proficiency is ideal)

Team should have a complementary set of skills



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Team Selection & Recruitment

The highest ranking member of the site (e.g., CEO,Executive Director) should select and recruit teammembers

Each team member should have enough protected

time dedicated to the project Tips for recruitment

Best when done face-to-face

Discuss goals for PCMH recognition initiative be as

specific as possible Discuss expectations to ensure individual is committed

to AND interested in the initiative and its goals



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Team Charter Elements

Team members with clearly defined roles andresponsibilities

Team purpose and project goal

Project timeline and key assumptions

Frequency, date, and time of project meetings

Project team expectations meeting deadlines,attending meetings, time commitment,accountability for deliverables

Method for resolving team conflicts

Communication with key stakeholders, includingsenior leaders



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Have you established a

project team?

Who is on it?

How are you organized?



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Step 4:

Assess Your Internal Resources


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STEP 4: Assess Internal Resources

Assess your internal resources

Entire project team reviews application andassesses baseline score

Resource: NCQA PPC-PCMH Self-Assessment Tool Conduct technology gap analysis: compare what

HIT you have in place against what is required tocomplete the elements

Based on your baseline and HIT capabilities,reconsider your organizational goals for seekingrecognition and modify accordingly

http://c/Documents%20and%20Settings/data/Performance%20Improvement/Patient-Centered%20Medical%20Homes/NYCT-Medical%20Homes%20Program%20Dev/NACHC%20Presentation/jump%20drive%20materials/How-To%20Manual/appendices/4_NCQA%20PPC-PCMH%20Self%20Assessment.xlshttp://c/Documents%20and%20Settings/data/Performance%20Improvement/Patient-Centered%20Medical%20Homes/NYCT-Medical%20Homes%20Program%20Dev/NACHC%20Presentation/jump%20drive%20materials/How-To%20Manual/appendices/4_NCQA%20PPC-PCMH%20Self%20Assessment.xls


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Step 5:

Develop a Plan


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STEP 5: Develop a Plan

Conduct gap analysis between yourbaseline and organizational goals this willserve as the basis for your workplan

Define timeframe for submittingapplication

Develop an action plan describing whatneeds to be done, who will do what and bywhen



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Gap Analysis Key Questions

How does your current level of recognition(based on self-assessment) compare withyour goal?

How many additional points do you need toreach your goal? How many additional mustpass elements do you need to pass at the 50%level?

How easily (or difficult) will it be todocument the elements you currently have inplace?



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Defining a Timeframe

Your timeline should include Regular and PCMH project team meetings

frequency will depend on organizational

goals Deadlines for completion of:

Project management tasks

PCMH application elements

Communication to key stakeholders,including all staff updates



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A Good Workplan

Identifies key deliverables and completiondates that are ambitious yet attainable

Is action-oriented (use the active verbtense)

Assigns tasks/activities to specificindividuals

Identifies required resources

Is used throughout the project and keepsyou on track



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Action Plan Activities

Make plans to: Identify documentation needs by

element

Identify additional HIT needs What modifications are needed?

Who is responsible for making themodification?

How much will it cost?

How long will it take?



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Action Plan Activities

Identify additional elements toimplement Impact on patient population?

Ease of implementation? Alignment with organizational culture?

Alignment with organizational mission,vision, and strategic goals?

Complete and submit the PPC-PCMHapplication


T f i PCMH


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Transforming to a PCMH:

Best Practices

Learn to be a learning organization

Develop leadership and communicationskills

Monitor change fatigue

Take a step back

Keep your eye on the prize: stay focused on

key deadlines and deliverables but dont letsmall issues derail your entire workplan



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What are 2-3 things you can

do when you get back toyour organization to move

forward?



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Q&A

Group Discussion



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For more information contact:

Regina M. Neal(212) 437-3934

[email protected]

www.pcdcny.org

Cari Reiner(212) 437-3912

[email protected]

NCQA Customer Support

(888) 275-7585

[email protected]

www.ncqa.org/medicalhome.aspx

Obtaining Medical Home Recognition: A How-to-Manual to Facilitate the Process

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