Introduction to NCQA s Patient Centered Medical Home

1. Introduction to NCQA’s Patient Centered Medical Home February 4, 2011 Julianne Krulewitz, PhD I’m Juli, PE from VCHIP working on the Blueprint, helped over 25 practices go through the NCQA scoring process. I’m going to briefly describe Blueprint and NCQA definitions of APCPs and PCMHs, discuss the NCQA recognition process here in VT, go over the standards themselves as well as the types of documentation that practices need to submit to be recognized as patient centered medical homes, and share some of my insights and experiences. Then Margaret and Simone will talk about how community mental health and substance abuse clinics have begun to get involved, how the current NCQA standards can be viewed through a behavioral/mental health lens, and talk through some specific examples I’m Juli, PE from VCHIP working on the Blueprint, helped over 25 practices go through the NCQA scoring process. I’m going to briefly describe Blueprint and NCQA definitions of APCPs and PCMHs, discuss the NCQA recognition process here in VT, go over the standards themselves as well as the types of documentation that practices need to submit to be recognized as patient centered medical homes, and share some of my insights and experiences. Then Margaret and Simone will talk about how community mental health and substance abuse clinics have begun to get involved, how the current NCQA standards can be viewed through a behavioral/mental health lens, and talk through some specific examples

2. Advance Primary Care Practices (medical homes) NCQA definition (from www.ncqa.org): “The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.” Advanced Primary Care Practices in Vermont Internal quality improvement team Access to Community Health Team NCQA recognition score & enhanced payments Use available health information technology and participate in Vermont’s Health Information Exchange Why practices are going through NCQA recognition in VT: as part of transition to becoming APCPs. Lisa spoke this morning about the other components of APCPs—community health teams, use of improved health information technology and Vermont’s Health Information Exchange. Practices also receive enhanced payments based on the NCQA medical home score. Talk is underway to enable other practices that act as Vermonter’s medical homes, like the practices many of you work at, to join this process.Why practices are going through NCQA recognition in VT: as part of transition to becoming APCPs. Lisa spoke this morning about the other components of APCPs—community health teams, use of improved health information technology and Vermont’s Health Information Exchange. Practices also receive enhanced payments based on the NCQA medical home score. Talk is underway to enable other practices that act as Vermonter’s medical homes, like the practices many of you work at, to join this process.

3. Recognition (scoring) Process

4. 2008 PPC-PCMH Content & Scoring Currently 9 standards, broken down into 30 elements, 10 of which are considered “must pass.” Raw points and # of must pass elements is used to determine practice level and score—and in VT, a pppm reimbursement rate New standards were released last week and will be available for use soon. New version has 6 standards, 27 elements, and 6 must pass elements—NCQA describes their new survey as having more emphasis on healthcare consumers’ needs and perspective and care coordination—in particular, more integration of behavioral health coordinationCurrently 9 standards, broken down into 30 elements, 10 of which are considered “must pass.” Raw points and # of must pass elements is used to determine practice level and score—and in VT, a pppm reimbursement rate New standards were released last week and will be available for use soon. New version has 6 standards, 27 elements, and 6 must pass elements—NCQA describes their new survey as having more emphasis on healthcare consumers’ needs and perspective and care coordination—in particular, more integration of behavioral health coordination

7. 2008 PPC-PCMH Standards Reminders: Always reflect on the intent & type of documentation required Unit of analysis is the practice Measure of current processes In use for at least 3 months Not more than 1 year old A practice can often get 100% of the points without being able to say yes to 100% of the factors Focus on your strengths If it feels like you’re forcing it, stop Discuss possible types of documentation: Procedures and documented processes: policies, workflow diagrams, job descriptions Numbers, usage, reports: percentages of patients who have met a standard or who have data documented in an electronic field, lists of patients who need a certain service or require some sort of action Screenshots and examples: templates from EHRs showing use of evidence based treatment guidelines, flow sheets from paper charts, examples of patients records showing dialogue between practice, patients, families, and other organizations Worksheets: chart review, QI Discuss possible types of documentation: Procedures and documented processes: policies, workflow diagrams, job descriptions Numbers, usage, reports: percentages of patients who have met a standard or who have data documented in an electronic field, lists of patients who need a certain service or require some sort of action Screenshots and examples: templates from EHRs showing use of evidence based treatment guidelines, flow sheets from paper charts, examples of patients records showing dialogue between practice, patients, families, and other organizations Worksheets: chart review, QI

8. 2008 PPC-PCMH Standards Access & Communication Tracking & Registry Functions Care Management Patient Self Management Electronic Prescribing Test Tracking Referral Tracking Performance Reporting and Improvement Advanced Electronic Communication PPC1: 2 elements, both must pass 1st asks practice to show that it has processes in place, 2nd asks practice to show how it measures it performance and reports on patient access PPC2: Do you use an electronic system or systems to track demographic info, track and organize clinical info, identify important conditions in your population, and manage your population PPC3: Do you use some sort of workflow organizer to provide evidence-based care for specific conditions as well as for preventive care. Also asked to demonstrate how your care team works internally and with others to meet your patients’ needs. Really the who what where how of care management PPC4:They want to know if you identify your patients’ special needs and if you support the self-management PPC5: You need to show you use your eprescriber consistently and that you’re using it to make safe and efficient decisions when prescribing medications PPC6: First they want to know if you track tests from the time they’ve been ordered until you have a result, then they want to know how you follow-up with patient. They’re also interested in how use electronic systems to order, retrieve, and manage tests PPC7: Similar to 6, they’re interested in how you track your referrals and what information you send to consultants PPC8: Do you measure, report, and conduct QI in your practice in areas like clinical processes, outcomes, safety, service and patient experience? Do you measure and report standardized measures? PPC9: Are you using websites and emails to provide patients additional access, to communicate, and to share informationPPC1: 2 elements, both must pass 1st asks practice to show that it has processes in place, 2nd asks practice to show how it measures it performance and reports on patient access PPC2: Do you use an electronic system or systems to track demographic info, track and organize clinical info, identify important conditions in your population, and manage your population PPC3: Do you use some sort of workflow organizer to provide evidence-based care for specific conditions as well as for preventive care. Also asked to demonstrate how your care team works internally and with others to meet your patients’ needs. Really the who what where how of care management PPC4:They want to know if you identify your patients’ special needs and if you support the self-management PPC5: You need to show you use your eprescriber consistently and that you’re using it to make safe and efficient decisions when prescribing medications PPC6: First they want to know if you track tests from the time they’ve been ordered until you have a result, then they want to know how you follow-up with patient. They’re also interested in how use electronic systems to order, retrieve, and manage tests PPC7: Similar to 6, they’re interested in how you track your referrals and what information you send to consultants PPC8: Do you measure, report, and conduct QI in your practice in areas like clinical processes, outcomes, safety, service and patient experience? Do you measure and report standardized measures? PPC9: Are you using websites and emails to provide patients additional access, to communicate, and to share information