Presentation Title: PCMH Summit 2017 Date: 9.12.17-9.13.17 ... · Presentation Title: PCMH Summit...
Transcript of Presentation Title: PCMH Summit 2017 Date: 9.12.17-9.13.17 ... · Presentation Title: PCMH Summit...
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Presentation Title: PCMH Summit 2017Date: 9.12.17-9.13.17
Prepared by: Centerprise, Inc.Prepared for: Wyoming Primary Care Association
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• Objectives• Understand the current PCMH environment and cultural changes• Understand 2017 PCMH terminology• Understand the 2017 NCQA Application Process based on your current PCMH
status• Understand key competency changes
Session 1: Review of Key Changes in PCMH Process- 2014-2017
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PCMH: The Evolution
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Why PCMHNCQA 2014: a way of organizing primary care that emphasizes care coordination and communication to transform primary care into “what patients want it to be”. Medical homes can lead to higher quality and lower costs, and can improve patients’ and providers’ experience of care.
CTP 2014: A way of organizing primary care that practices accessibility, coordination, effective processes that transform primary care into what the population needs. Medical homes will lead to higher quality and lower costs, and will improve a population’s health and provider’s experience of care (as defined by Centerprise, Inc)
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Why PCMH 2017NCQA 2017: “The new patient-centered medical home promotes flexibility and incremental achievements in patient access to care, health IT use, population health management, and other key quality initiatives to provide healthcare organizations with a measured, standardized framework leading to comprehensive practice transformation.”…”This improved process makes the PCMH program more manageable for practices and concentrates on performance and quality improvement.” (https://healthitanalytics.com/news/ncqa-revamps-patient-centered-medical-home-to-ease-adoption)
CTP: “Your PCMH recognition demonstrates you have the core capability to put into effect efficient and effective processes that will result in a specifiedimpact on the health of a population when in practice and sustainable”.
Transformation of Capability to Sustainable Practice
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Welcome to 2017• They brought the PATIENT to the PCMH model
And….
• Terminology• Process• Evidence
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PCMH 2017 GlossaryConcept :(2014 equivalent = Standard)
• 6 Concepts:• Team Based Care• Knowing and Managing your Populations• Access• Care Management• Care Coordination and Care Transitions• Quality Improvement
Competencies: (2014 equivalent= Element)• Must Pass competencies do not exist in 2017 (See Criteria below)• Not scored by Element like in 2014
Criteria: (2014 Equivalent= Factor)• Core- Required for Recognition (40)• Elective- Practice may select for recognition (25 credits required across at least 5/6 Concepts)
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Concept. Competency. Criteria. (Standard. Element. Factor.)
https://www.ncqa.org/Portals/0/Programs/Recognition/Intro_to_PCMH_2017.pdf?ver=2017-06-09-202905-513
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Core: Required Criteria for recognition. (2014 comparison- while a Critical Factor was required to pass an element, each CORE criteria is required for recognition). 40 totalElective: Transformation Criteria that is available for selection by the practice. Must pass 25 credits for recognition (Must spread 5/6 concepts)Evidence: (2014 equivalent= Documentation Required)
• 2017 proof of transformation • Report• Source• Workbook• Worksheet• List• Evidence of Implementation: demonstrated proof of transformation (live or static)
PCMH 2017 Glossary
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Concept # Competencies # Core Criteria # Elective Criteria # Criteria New to 2017
Team Based Care (TC) 3 5 4 (7 credits) 4
Knowing and Managing your Populations (KM)
6 10 18 (20 credits) 13
Patient-Centered Access and Continuity (AC)
2 7 7 (8 credits) 4
Care Management and Support (CM)
2 4 5 (6 credits) 2
Care Coordination and Care Transitions (CC)
3 5 16 (24 credits) 5
Performance Measurement and Quality Improvement (QI)
3 9 10 (16 credits) 3
Core vs. Elective by Competency
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The Application Process
Commit Transform SustainSucceed
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1. Enroll sites in Q-pass www.qpass.ncqa.org2. Complete Guided Assessment3. Develop recognition schedule with NCQA4. Identify support and resources:
1. TC 01 and TC 02 are core criteria requiring you to select a Clinician lead for PCMH and a staff lead to manage the PCMH Transformation
COMMIT. Transform. Succeed.
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How do I Proceed Based on my Current Status?
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Who Are You? How will you Proceed?
New Recognition
• Full Transformation• All documentation
and check-in• Annual check-in (30
days prior to expiration)
2014 Level 1 or Level 2
• Accelerated Renewal• Attestation and
Evidence/Check-in
2014 Level 3
• Sustainability/Annual Reporting• Annual Check in
(beg. Year of current expiration)
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Check in (Virtual Review): Interactive review to gauge progress and discuss next steps in evaluation.Annual Assessment: Required demonstration that your practice has continued to align with recognition requirements-post recognitionQ-Pass: NCQA online platform through which you will conduct all transformation and recognition activitiesPre-validation: Letter from your EMR vendor establishing pre-validation criteria for which you can get auto-credit
PCMH 2017 Glossary
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New Recognition 2014 Level 1 or Level 2
2014 Level 3 NOTES
1. Select ClinicalPCMH Champion (Provider)
X X X Required
2. Select Non-Clinical PCMH Champion
X X X Required
3. Create PCMH Core Team
X X X RecommendedProvider, clinical and non clinical
staff, Operations, IT/EMR/Analytics,
QI, (finance)
4. Perform Self Assessment on Core Criteria
X X X Recommended
Where do I start and Where do I go?
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New Recognition 2014 Level 1 or Level 2 (or 2011
recognized practices)
2014 Level 3 NOTES
5. Perform Self Assessment on Elective Criteria
X X X Recommended
6. Select 25 elective Criteria
X X Required
7. Prioritize WorkPlan
X X Recommended
8. Enrollment- EnterOrganization Information into Q-Pass within 12 months recognition
X X (w/in 4-6 months of expiration of
recognition)
X (within 3 months of expiration)
Recommended
Where do I Start and Where do I Go?
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New Recognition 2014 Level 1 or Level 2 (or 2011
recognized practices)
2014 Level 3 NOTES
9. Have initial call with NCQA Rep
X X X Required
10. Conduct 3 check-ins with NCQA Rep
X (As needed based on call)
Required
11. Submit all additional documentation
X X (attestation vs. evidence as
needed)
Required
12. Ensure payment has been received/HRSA code entered
X X X Required
13.Recognition Received
X X X HOPEFULLY!!!
Where do I start and Where do I go?
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New Recognition 2014 Level 1 or Level 2 (or 2011 recognized
practices)
2014 Level 3 NOTES
14. Download Annual Reporting Phase (Annual Assessment)
X X X Required
15. Collect documentation and evidence for required annual reporting
X X X Required
16. Collectdocumentation and evidence for optional reporting requirements
X X X Required
17. Complete annual reporting 30 days prior to expiration
X X X RequiredCan be submitted any
time during year
18. COMPLETE SUSTAINABILITYASSESSMENT/REPORTING INTERNALLY
X X X Recommended.Ensures compliance
and outcomes
How do I Sustain?
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• The PCMH process is intended to create a medical home that is convenient, efficient and effective for you and the patient
• 2017 provides less restrictive guidelines on “how to demonstrate” allowing you to be innovative, efficient and effective
• 2017 provides you the ability to determine what is important to you and your patients
• This means understanding your population
Why all the Changes?
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How will I Manage the Process Over Time?2017 PCMH Centerprise Tracker
Drop down list
Totals points, based on
dropdown chosen
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2017 PCMH Centerprise Tracker
www.centerpriseinc.comCo
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Drop Down Options
• Yes• No• NA• Approved
Will Calculate based on Yes, NA and Approved drop down selections below
www.centerpriseinc.comConfidentiality Notice: This document is confidential and contains proprietary information and intellectual property of Centerprise, Inc. Neither this document norany of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of Centerprise, Inc. Pleasebe aware that disclosure, copying, distribution or use of this document and the information contained therein is strictly prohibited.
• Red-Do not have evidence required; progress not being made• Yellow-Progress being made; evidence not finalized• Green-Progress complete; evidence meets requirements• Blue – Progress completed and approved by Reviewer• Communicate revisions and concerns• Use for self assessment
How to Use the Tracker/Tips and Tricks
www.centerpriseinc.comConfidentiality Notice: This document is confidential and contains proprietary information and intellectual property of Centerprise, Inc. Neither this document norany of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of Centerprise, Inc. Pleasebe aware that disclosure, copying, distribution or use of this document and the information contained therein is strictly prohibited.
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