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Transforming Healthcare: Achieving Patient-Centered Medical Home Recognition

This guide outlines the fundamental steps and strategies for healthcare practices to attain Patient-Centered Medical Home (PCMH) recognition. It emphasizes the importance of creating partnerships, fostering a systems-oriented perspective, and enhancing team collaboration. Key areas of focus include access to care, continuity of management, and the integration of technology. Careful attention to relationships among patients, practice members, and the community is essential for success. This process also requires thorough documentation, leadership involvement, and a commitment to continuous improvement in practice operations.

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Transforming Healthcare: Achieving Patient-Centered Medical Home Recognition

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  1. Journey to PCMH Recognition Elaine M. Skoch, RN, MN, NEA-BC Director, Systems Transformation Insert Title Here

  2. Revolves around the patient…is “person centered” Creates healthcare “partnerships” Requires a “systems” perspective Elements are inter-related and interdependent Transformation to PCMH

  3. Transformation to a PCMH (cont.) • Calls for leadership, communication & teamwork • with a common language & understanding of the goals at hand • Necessitates flexibility

  4. Focuses on: Access and barriers to care Care management Continuity of care Aided and supported by technology Team based; relationship centered Transformation to a PCMH (cont.)

  5. Requires a team effort Cannot be achieved merely through new technology Takes time Can take unexpected turns Transformation…

  6. Requires attention to relationships: Between the practice and the patient Among members of the practice Between the practice & the community Creating a Patient Centered Medical Home…

  7. Requires review of: Work processes and team structure Organizational structure Utilizing technology to support the delivery of care Practice Redesign…

  8. is a Performance Improvement Process Practice Transformation

  9. First Steps in NCQA Recognition • Define the project team to work on the process • Physician champion • Computer skills • Administrative information (policies & procedures) • Nursing • Purchase the Interactive Survey Tool (ISS Tool) ($80) http://www.ncqa.org/tabid/629/Default.aspx#pcmh • Assign responsibilities and dates for task completion in order to meet the target date for submission

  10. http://www.ncqa.orgNCQA Home Page http://www.ncqa.org/tabid/62/Default.aspx Publications and Products Page http://www.ncqa.org/tabid/629/Default.aspx PPC-PCMH Publications Page-Application Materials To Access NCQA Documents

  11. 9 standards; 100 points total 30 elements 10 Must Pass elements Recognition at three different levels Level I: 25 points and 5 Must Pass Elements Level II: 50 points and 10 Must Pass Elements Level III:75 points and 10 Must Pass Elements NCQA PPC-PCMH Overview

  12. PPC-PCMH Content and Scoring **Must Pass Elements

  13. Reading the Standards Requirements • Standard • Intent • Element A, B, C, etc. • Factors 1, 2, 3, etc. • Scoring

  14. Reading the Standards Requirements • Data Source • Explanation • Examples • Reports, screenshots, procedures, worksheets, etc.

  15. Where to start on Monday…? Review the requirements for each standard, element and factor • What does the practice already do? • What does the practice need to create? • Are there elements the practice clearly does not have in place and that the practice may not have in the submission timeframe? (e-prescribing , Standard 5; or Advanced Electronic Communication, Standard 9)

  16. Next Steps • Work on developing practice access to care and information policies • Identify three important clinical decisions • Same three conditions are identified on the application and for element PPC2E* • Additional elements related to the three important clinical conditions: PPC3A* & D; PPC4B*; PPC9C • Review the standards for what the practice does not have in place and what they may not have in place before submitting

  17. Just a reminder… • Review the elements that require a three month look back to determine what process already exist • Four elements require a 3 month “look back” • PPC2C & D*; PPC3D; PPC4B* • “Must pass” elements require passing at a minimum at the 50% level

  18. Begin gathering supporting documentation • Create a folder (on your server or hard drive) for documents the practice may want to attach to the survey tool, by element • Develop a checklist of documentation already used in the practice and documents that need to be prepared.

  19. Upload documents as you finalize them 1-2 documents at a time to start Permitted file types: .csv, .doc, .gif, .jpg, .mpp, .pdf, .rtf, .tif, .txt, .vsd, .xls Scanned documents are acceptable. Save as .gif, .tif, .jpg Survey Tips

  20. Who is Recognized? • Practices that meet the criteria described in the endorsed principles of the PCMH • A physician or group of physicians practicing together at a single geographic location • Recognition is specific to a practice site.

  21. Recognition is for 3 years. However…. Reapplication to improve score can occur within the 3 year period Up to 2 times. Called an “Add on” survey “Add on” Survey Fee at the 50% level. If Level I is not achieved…. NCQA Tidbits

  22. Must be returned to NCQA prior to submitting the Interactive Survey Tool Minimum of 1 week Survey application is complete when documents have been received by NCQA and ISS tool has been uploaded. Application Materials

  23. Agreement Attestation: Joint Principles Data release NCQA Agreement HIPAA Business Associate Agreement Pricing & payment NCQA Application

  24. NCQA Application Fees

  25. Numbers and names of physicians Determines fees Verify licensure Posting on NCQA website Practice Background Information Worksheet

  26. Three parts to the actual submission of the application • Submission of the application and the appropriate fees • Submission of the Interactive Survey Tool • Uploading of the supporting documentation

  27. Questions?

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