Patient-Centered Medical Home & Multi-Payer Demo

1. Patient-Centered Medical Home & Multi-Payer Demo Training Webinar # 3 David Halpern, MD, MPH June 22nd, 2011

2. Acknowledgements

3. Let’s Review What is the National Committee for Quality Assurance (NCQA)? How Does NCQA Evaluate a Practice? How Does My Practice Apply for PCMH Recognition?

4. “Homework” From Last Time • Have you: • Read the “Standards/Guidelines”? • Started to make a list of things your practice already-does/will-do/can’t-do? • Created a place to save/organize your supporting documentation? • Looked at NCQA’s training offerings?

5. NCQA Lingo each “standard” is composed of several “elements” each “element” is composed of several “factors”

6. PPC-PCMH (2008) Overview

7. PPC-PCMH (2008) Scoring 9 standards = 100 points NOTE: Must Pass elements requirea≥50% performance level to pass Levels: If there is difference in Level between the number of points achieved and “Must Pass”elements completed, the practice will be awarded the lesser level;for example, if a practice has 65 points but passes only 7 “Must Pass” Elements, the practice will only achieve a Level 1 recognition.

8. Today’s Agenda What are the “Must Pass” Elements? Which Ones Should we Focus on First? PPC1A: access and communication (4 points) PPC2D: organizing clinical information (6 points) PPC2E: important diagnoses/conditions (4 points) PPC3A: evidence-based guidelines (3 points) PPC7A: referral-tracking (4 points)

9. “Must Pass” Elements • Some elements are “Must Pass” • **To “Pass” one of these elements, you must receive a 50% score or higher** • In 2008 Standards, you must pass 5/10 of these “Must Pass” elements to achieve a level 1, and 10/10 to achieve level 2 or 3

10. PCMH Must Pass Elements • PPC1A: Written standards for patient access and patient communication • PPC1B: Use of data to show meeting standards in 1A • PPC2D: Use of paper or electronic-based charting tools to organize clinical information • PPC2E: Use of data to identify important diagnoses and conditions in practice • PPC3A: Adoption and implementation of evidence-based guidelines for three conditions • PPC4B: Active support of patient self-management • PPC6A: Tracking system for tests and to identify abnormal results • PPC7A: Tracking referrals with paper-based or electronic system • PPC8A: Measurement of clinical and/or service performance • PPC8C: Performance reporting by physician or across the practice

11. PCMH Must Pass Elements • PPC1A: Written standards for patient access and patient communication • PPC1B: Use of data to show meeting standards in 1A • PPC2D: Use of paper or electronic-based charting tools to organize clinical information • PPC2E: Use of data to identify important diagnoses and conditions in practice • PPC3A: Adoption and implementation of evidence-based guidelines for three conditions • PPC4B: Active support of patient self-management • PPC6A: Tracking system for tests and to identify abnormal results • PPC7A: Tracking referrals with paper-based or electronic system • PPC8A: Measurement of clinical and/or service performance • PPC8C: Performance reporting by physician or across the practice

12. Priority Must Pass Elements • PPC1A: Written standards for patient access and patient communication (4 points) • PPC2D: Use of paper or electronic-based charting tools to organize clinical information (6 points) • PPC2E: Use of data to identify important diagnoses and conditions in practice (4 points) • PPC3A: Adoption and implementation of evidence-based guidelines for three conditions (3 points) • PPC7A: Tracking referrals with paper-based or electronic system (4 points)

13. PPC 1A: Access and Communication Processes

14. PPC 1A: Example of Factors 1 and 4

15. PPC 1A: Example of Factors 3 – 6 (Your Practice Name)

16. PPC 1A: Example of Factors 10 & 11

17. PPC 2D: Organizing Clinical Data

18. PPC 2D: Example of Med List

19. PPC 2D: Example of Documentation

20. PPC 2E: Identifying Important Conditions

21. PPC 2E: Definitions

22. PPC 2E: Identifying Important Conditions • Where does the data come from? “Practices may use a practice management system, a billing system or an electronic health record to identify the conditions.”

23. PPC 2E: Example of 2E1 – Most Frequently Seen Diagnoses

24. PPC 2E: Example of 2E1 – Most Frequently Seen Diagnoses

25. PPC 2E: Example of 2E2 – Most Important Risk Factors your community

26. PPC 2E: Choosing 3 Important Conditions • “To determine the 3 clinically important conditions, the practice analyzes its entire population. The practice states the 3 clinically important conditions and explains or shows the data used to select the conditions. The clinically important conditions should be chronic or recurring conditions that the practice sees such as otitis media, asthma, diabetes or congestive heart failure. In some cases, the most frequently seen conditions may be the same as the clinically important conditions.” • “The practice can also use the following criteria to identify the three important conditions: • Ability to successfully treat the conditions (how amenable the conditions are to care management; whether clinical guidelines are available, etc) • Other evidence such as conditions for which the practice is measuring performance or receiving rewards for performance; conditions that the practice has selected or targeted to improve performance.”

27. PPC 2E: Example of Text Explanations

28. PPC 3A: Evidence-Based Guidelines for Important Conditions

29. PPC 3A: Evidence-Based Guidelines

30. PPC 3A: Evidence-Based Guidelines

31. PPC 3A: Evidence-Based Guidelines

32. PPC 3A: Evidence-Based Guidelines • You must adoptAND implement the guidelines • “Paper-based supporting documentation includes flow sheets or templates used to document treatment plans or patient progress.”

33. PPC 3A: Evidence-Based Guidelines Diabetes Management Flow Sheet

34. PPC 3A: Evidence-Based Guidelines

35. PPC 3A: Evidence-Based Guidelines

36. PPC 7A: Referral Tracking

37. PPC 7A: Referral Tracking

38. PPC 7A: Referral Tracking

39. Resources • http://www.aafp.org/online/en/home/publications/journals/fpm/fpmtoolbox.html • more than 150 practice management tools (templates, flow sheets, etc) that you can download for free and use in your practice

40. Next Steps (Homework) • PPC 1A – Begin compiling/writing your policies • PPC 2D – Organize your chart data in a logical/consistent way • PPC 2E – Choose your 3 “Important Conditions” • PPC 3A – Find/Implement evidence-based guidelines for 3 conditions • PPC 7A – Create a referral tracking system that works for your practice

41. Next Steps (Homework) • Create a place on your computer (server or hard-drive) for all of your documentation • You should have a folder for each standard • Save/Organize all of your documentation as you go!

42. Community Care PCMH Team • David Halpern, MD, MPH Community Care of North Carolina (CCNC) • R.W. “Chip” Watkins, MD, MPH, FAAFP Community Care of North Carolina (CCNC) • Brent Hazelett, MPA North Carolina Academy of Family Physicians (NCAFP) • Elizabeth Walker Kasper, MSPH North Carolina Healthcare Quality Alliance (NCHQA)

43. Partners

44. Questions? Feel free to contact me: David Halpern, MD, MPH (215) 498-4648 dhalpern@n3cn.org