Overvie w Megan A. Housley, MBA Business Development Director - PowerPoint PPT Presentation

Practice Transformation: Patient Centered Medical Home Overvie w Megan A. Housley, MBA Business Development Director Kentucky Regional Extension Center

The Triple Aim Population Health TRIPLE AIM Per Capita Experience Cost of Care

Policy Framework For Achieving Triple Quality & Efficiency Aim Care Delivery & Innovation Provider Feedback & Measurement Payment Reform HIT Foundation: Meaningful Use of EHRs and HIE

A journey of a thousand miles begins with a single step… Payment Innovation Care Delivery Innovation Meaningful Use (PCMH) Health IT & HIE + Quality Improvement

What is Patient-Centered Medical Home? What is Patient-Centered Medical Home? PCMH is a model that provides specific standards for transforming the organization and delivery of primary care to be more:  Comprehensive  Patient-Centered  Coordinated  Accessible  Safe

Other Common PCMH Descriptors Other Common PCMH Descriptors: …a vision of healthcare as it should be …a framework for organizing systems of care at both the micro (practice) and macro (society) level …a model to test, improve, and validate …part of the healthcare reform agenda political construct that includes new ways of organizing and financing care , while attempting to remain true to the proven value of primary care

Patient Centered Medical Home PCMH: Extreme Makeover Extreme Makeover • Uncoordinated care • Team-based approach • Over-loaded schedule • Open access • Physician & practice-centric • Patient engagement & empanelment • Data directed quality improvement • Arbitrary quality improvement efforts projects • Engaged leadership • Lack of clear leadership & support

5 Functions of PCMH Five Functions of a PCMH 1. Comprehensive Care 2. Patient-Centered 3. Coordinated Care 4. Accessible Services 5. Quality and Safety

PCMH Benefits PCMH Benefits • Long-term partnerships, not hurried visits • Care that is coordinated among providers • Better access • Shared decision-making • Lower costs • Fewer EH visits/hospitalizations • Practices get paid for doing the right things • More satisfied providers and patients

Even Bigger Picture: Medical Neighborhood • Primary Care • Specialty Care • Inpatient Care • Emergency Care • Urgent Care • Laboratory Services • Physical Therapy / Rehabilitation • Mental Health • Home Health Services • Pharmacy • Durable Medical Equipment • Social Work • Community Support Agencies

Patient Centered Medical Neighborhood Patient-Centered Medical Neighborhood HIT Hospital HIT Pharmacy Sub-Specialty PCMH/ Medical Home Neighbor HIT HIT HIT HIT PCMH HIT Sub-Specialty Lab Procedural Practice

So How Do We Get There? How Do We Get There? • Meaningful Use • Primary Care-PCMH Recognition • Care Coordination Agreements – Define type of interaction – Responsibility for elements of care • Expectations for HIE • Population Health Management focus (work with ACO/Medical System with this focus)

How To Achieve PCMH Recognition • Many PCMH recognition programs • National Committee for Quality Assurance (NCQA) – Private, non-profit health care quality organization offering clinical & practice process programs – “Gold Standard” for Primary Care Transformation – By far the most widely used method for Medical Home Recognition (Each month 150+ practices apply) – Partnering with Department of Defense, Department of Health & Human Services, state programs and insurance companies

NCQA PCMH Recognition NCQA PCMH Recognition • For outpatient primary • Recognizes PCPs at the care site, including NPs and Pas who can be designated as a personal • Practice-site level clinical with their own panel of patients • NCQA defines practice as a clinician or clinicians • 3-year Recognition period practicing together at a single geographic location • Practice may add/remove clinicians

Who Is Eligible? Who Is Eligible? • Clinicians with intention of serving as the personal, primary care clinician • Physicians, NPs and Pas who practice in Internal Medicine, Family Medicine, or Pediatrics • Must have license as MD, DO, NP or PA

6 NCQA PCMH Standards 6 NCQA PCMH Standards Standard 1: Enhance Access and Continuity of Care Standard 2: Identify and Manage Patient Populations Standard 3: Plan and Manage Care Standard 4: Self-Care Support & Community Resources Standard 5: Track and Coordinate Care Standard 6: Measure and Improve Performance

NCQA PCSP Recognition NCQA PCSP Recognition • For non-primary care • 3-year Recognition specialists period • Practice-site level • May be multi-site and/or multi-specialty • Recognizes clinicians at the site, including NPs • May add/remove and PAs with clinicians own/shared patient panel

Who Is Eligible? Who Is Eligible? • Clinicians who typically receive referrals from PCPs and other non- primary care specialists including : – MDs, DOs, – NPs/PAs with own/shared patient panel – CNMs – Behavioral health specialists: Psychologists, licensed clinical social workers, marriage and family counselors

6 NCQA PCSP Standards 6 NCQA PCSP Standards Standard 1: Track and Coordinate Referrals Standard 2: Provide Access and Communication Standard 3: Identify and Coordinate Patient Populations Standard 4: Plan and Manage Care Standard 5: Track and Coordinate Care Standard 6: Measure and Improve Performance

Meaningful Use Overlap Meaningful Use Overlap • PCMH reinforces the use of HIT through the involvement of an EHR, registries, and HIEs • MU practices well- prepared for PCMH • MU language embedded in PCMH Standards

Connect with Kentucky REC! Phone: (859) 323-3090 Email: Kyrec@uky.edu Follow us on Twitter: @KentuckyREC Like us on Facebook: facebook.com/EHRResource Follow us on LinkedIn: linkedin.com/company/kentucky-rec Check out our website: www.kentuckyrec.com

Andrew C. Bledsoe, MBA, CHPA, PCMH CCE Executive Director Northeast KY Regional Health Information Organization www.nekyrhio.org

NCQA Program Setup Standards • Six Standards Outline Program Elements • Six Must Pass • Must meet 50% AND Factors ALL Critical Factors

2014 NCQA Standards PCMH 1 • Patient – Centered Access PCMH 2 • Team – Based Care PCMH 3 • Population Health Management PCMH 4 • Care Management and Support PCMH 5 • Care Coordination and Care Transition PCMH 6 • Performance Measurement and Quality Improvement

Sample Element P C M H 3 : P o p u l a t i o n H e a l t h M a n a g e m e n t Element D: Use Data for Population Management At least annually the practice proactively identifies populations of patients and reminds them, or their families/caregivers, of needed care based on patient information, clinical data, health assessments and evidence-based guidelines including: 1) At least two different preventive care services 2) At least two different immunizations 3) At least three different chronic or acute care services 4) Patient not recently seen by the practice 5) Medication monitoring or alert 100% 75% 50% 25% 0% The practice The practice The practice The practice The practice meets 4-5 meets 3 meets 2 meets 1 meets 0 factors factors factors factor factors 5 Points 3.75 Points 2.5 Points 0 Points 0 Points

1) CPOE Stage 2 Core MU Measures 2) eRX 3) Demographics 4) Vital Signs 5) Smoking Status 6) Clinical Decision Support 7) View, Download and Transmit 8) Clinical Summaries 9) Privacy and Security 10) Lab-test Results 11) List of Patients 12) Patient Reminders 13) Patient Education 14) Medication Reconciliation 15) Summary of Care/Transitions of Care 16) Immunization Registry 17) Secure Electronic Messaging