does your clinic have ncqa pcmh recognition? · learn practical tips on how to maintain and sustain...

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Does Your Clinic have NCQA PCMH Recognition? Learn

practical tips on how to transition to Annual Reporting with NCQA.

November 6, 2018 | 3:00 – 4:00 pm ET

KPCA Annual Conference

Objectives

1) Understand and know how to apply the NCQA PCMH 2017 standards to your practice and move to Annual Reporting to maintain your recognition.2) Obtain practical tips on how to sustain and maintain your PCMH recognition. 3) Identify a minimum of one action step your health center will take to be deliberate about putting your patients at the center of care and improve the care experience.

Presenter

Presentation Notes

Learn practical tips on how to maintain and sustain your PCMH recognition and successfully complete the Annual Reporting requirements. Evidence continues to demonstrate that PCMH activities can cut growth in emergency department use, lower health costs, support team-based practice for integrated behavioral health, impact your efficiency, support higher medication adherence rates, reduce socio-economic disparities in cancer screening, among others. It is grounded by the Triple AIM, now many have expanded to the Quadruple Aim, with patients at the center of care. PCMH encourages you to create a culture and environment where you strive to eliminate gaps in the health of the populations you serve and utilize all opportunities to improve the care experience. Has your health center improved health care quality while reducing costs in numerous ways? Take a look at the NCQA PCMH 2017 standards, recognition process, annual reporting process, and then identify ways that your health center will act immediately to improve the health of, quality of and value of health care provided to the populations and communities you serve.

CONGRATULATIONS!

It is fantastic that your health center has NCQA PCMH 2014 Level 3 Recognition!

This session is for you!All are welcome.

Poll Question #1

Which describes your practice’s situation regarding PCMH Recognition best?

A. Not recognized and new to learning about PCMH.

B. Not recognized but have had training about PCMH.

C. Have PCMH recognition, not NCQA 2014 Level 3.

D. Have PCMH recognition, 2014 Level 3.

E. Other

Questions for You and Your Health Center!1. What is your end date (anniversary) for the 3-year recognition period? 2. How many practice sites have recognition?

Are all sites NCQA PCMH 2014 Level 3?3. Are any sites not recognized and you now want to have them recognized?4. Are all of your clinicians up to date with NCQA in the Directory?5. Have you maintained what you said you were doing when you obtained

Recognition? Such as: Clinical quality measures: monitor/report/improve Patient satisfaction & engagement Access measures Reports Population Health Proactive Preventive Care Reminders

What P/P are updated, new workflows, checklists? Have you trained new staff

on PCMH, retrained existing?

Source: FY2018 HRSA BPHC QIA Technical Assistance Webinar

Is this your reality?

Presenter

Presentation Notes

222 practices in KY with NCQA PCMH recognition 1097 clinicians listed

National Committee for Quality Assurance, PCMH 2017 Standards & Guidelines https://www.ncqa.org/programs/health-care-providers-practices/patient-centered-medical-home-pcmh/

Make sure you review ALL Core Criteria. They equate to a majority of the MPE and Critical Factors from

2014!

Presenter

Presentation Notes

Now in order to achieve recognition under PCMH 2017 practices must Meet all 40 core criteria in the program, and Earn 25 credits in elective criteria across 5 of 6 concepts

Educate yourself on

New Criteria!

New PCMH 2017 Criteria Core – Need to review, do and have evidence

TC 01, KM 02 (F-G), KM 21, AC 01, QI 01, QI 08 (D)

Elective Criteria

TC 03, 04, 08

KM 04, 05, 06, 07, 08, 11 (A&C), 13, 18, 19, 21, 23, 25, 28

AC 09, 13, 14

CM 03, 09

CC 03, 05, 06, 11, 13, 17

QI 14, 19

Compare your 2014 Level 3 Recognition Results to the

2017 Criteria!

2017 Core Criteria – New: Your Practice Must Meet! TC 01 (Core) PCMH Transformation Leads: Designates a clinician lead of the medical home and a staff

person to manage the PCMH transformation and medical home activities.

KM 02 (Core) Comprehensive Health Assessment: Comprehensive health assessment includes (all items required):

F. Social functioning.

G. Social determinants of health.

KM 21 (Core) Community Resource Needs: Uses information on the population served by the practice to prioritize needed community resources.

AC 01 (Core) Access Needs and Preferences: Assesses the access needs and preferences of the patient population.

QI 01 (Core) Clinical Quality Measures: Monitors at least five clinical quality measures across the four categories (must monitor at least one measure of each type):

D. Behavioral health measures.

QI 08 (Core) Goals and Actions to Improve Clinical Quality Measures: Sets goals and acts to improve upon at least three measures across at least three of the four categories:

D. Behavioral health measures.

Presenter

Presentation Notes

TC01: details on clinician lead & PCMH Manager KM02: documented process & evidence of implementation; F: assess pt ability to interact with other people in everyday social tasks: isolation, declining cognition, relationships, independent living; G: SDOH food housing, crime KM21: list of key patient needs and concerns, collect pop info prioritize comm resources AC01: process & evidence of implementation; survey, interviews, comment box, weekend hours, phone appointments QI01: report, like A-C Ix, preventive care and chronic/acute QI08: R or QIW on BH measure

NCQA PCMH Recognition – The ProcessCommit• Learn It – PCMH Standards & Guidelines; core criteria• Apply PCMH Concepts to your practice• Enroll through Q-PASS (pre-validated vendors, shared credit)Transform• NCQA representative• Begin working with Q-PASS (upload documentation, prepare for

check-ins)• Virtual reviewsSucceed• Earn recognition• Annual reporting

• Sustain your Recognition.• Core Features must be sustained.• Meet minimum requirements.• NCQA has 30 days to review annual

reporting submission.• NCQA will randomly audit practices to

validate attestation.• Recognition can be revoked or

suspended.• New requirements 6 mon ahead.

• Complete the Annual Questionnaire in Q-PASS.

• Requirements may be removed, modified or added over time.

NCQA PCMH 2017 ANNUAL REPORTING PERIOD: JANUARY 1 – DECEMBER 31, 2019 (Updated 07.24.18)

Report the following:Team-Based Care and Practice Organization (AR-TC)AR-TC 01 Patient Care Team MeetingsKnowing and Managing Your Patients (AR-KM)AR-KM 01 Proactive Care RemindersPatient-Centered Access and Continuity (AR-AC)Choose to report one of the following: (AC 01, 02 or 03)AR-AC 01 Patient Experience Feedback—AccessAR-AC 02 Third Next Available AppointmentAR-AC 03 Monitoring Access—Other MethodCare Management and Support (AR-CM)AR-CM 01 Identifying and Monitoring Patients for Care Management

Care Coordination and Care Transitions (AR-CC)

AR-CC 01 Care Coordination ProcessChoose to report one of the following: (CC 02, 03, 04 or 05)AR-CC 02 Patient Experience Feedback—Care CoordinationAR-CC 03 Lab and Imaging Test TrackingAR-CC 04 Referral TrackingAR-CC 05 Care TransitionsPerformance Measurement and Quality Improvement (AR-QI)Report all of the following:AR-QI 01 Clinical Quality MeasuresAR-QI 02 Resource Stewardship MeasuresAR-QI 03 Patient Experience Feedback7 criteria to report

+ 2 of 7 criteria to report9 Total

Behavioral Health Criteria (must report)Behavioral Health (AR-BH)

Report ALL of the following (Required, Not Scored):

AR-BH 01 Behavioral Health eCQMs

AR-BH 02 Behavioral Health Staffing

AR-BH 03 Behavioral Health Referral Monitoring

AR-BH 04 Depression Screening

AR-BH 05 Anxiety Screening

AR-BH 06 Behavioral Health Referral Monitoring

Not Penalized if you do not do. But you must report!

AR 2018 NCQA Requirement Slides

Poll Question #2

Which Annual Reporting (AR) Concept have you been maintaining or addressing the least?A. Team Based Care and Practice Organization (AR-TC)B. Knowing and Managing Your Patients (AR-KM)C. Care Management and Support (AR-CM)D. Care Coordination and Care Transitions (AR-CC)E. Performance Measurement and Quality Improvement (AR-

QI)

Are you still tracking & reporting on the same measures from the point in time you obtained Recognition? Improvements?

Has this changed since you obtained

Recognition?

Review your 2014 Level 3 Recognition

Results to 2017 Criteria.

Review now so you can plan accordingly:• EHR/HIT changes• P/P changes• Back-up your timeline for AR

PCMH Annual Reporting– Your Timeframe1. Education on PCMH 2017

Criteria2. Patients (& Community)3. Gap Analysis

2011 or 2014 Recognition Results – Crosswalk to 2017

4. Review Annual Reporting Criteria

5. Core Criteria – must meet all

6. Auto-Credit Pre Validation

7. Action Plan8. P/P = 90 day rule9. Reporting & HIT Functionality10. Training11. Gather Evidence12. Embrace Change13. Q-PASS starts 12 mon. clock14. Annual Reporting Submit 30 days prior to Anniversary Date

Enroll in Q-PASS for NCQA PCMH Annual Reporting

https://player.vimeo.com/video/209613949 To enroll you need:• Claim your organization from

before• Site information, including NPI• Clinician information (NPI &

boards/specialties)• Authorized signatory for

agreements• Payment methodAfter enrollment:• NCQA representative assigned• Transfer credit – pre-validated

vendors• Shared credit – multiple sites

https://player.video.com/video/209613949

Q-PASS ExamplesFor AR, start Q-PASS in year youwill complete AR Requirements.

Poll Question #3

Write down on your PCMH AR Activity Worksheet responses to the questions below:

What is one action you will take as a result of today’s webinar?

What one PCMH Concept do you want to consider and learn more about?

What Annual Reporting (AR) questions do you have?

What aligns with an activity, decision, need at your Practice now?

What one thing do you want to explore, change or do differently?

For use by practices with Recognition under NCQA PCMH 2011 Levels 1-3 or 2014 Levels 1-2.

Note: The evaluator may ask practices to verify a selection of attestation responses during a virtual review.“Review,” practices should follow the current PCMH Standards & Guidelines and submit evidence in Q-PASS, as indicated ..“attestation,” all you have to do is attest that your practice is still performing PCMH activities in these criteria. Documentation to support these responses will be provided upon request.”

Use if full Process

= sites not recognized

Keeping Connected and Supporting You!

Dawn Gentsch, MPH, MCHES, PCMH CCE

KPCA PCMH Consultant

PCMH Consultant/Practice Transformation Facilitator

515.360.1731 M | [email protected]

What was helpful today?What will you use?

What would you like more information about?How can I support you and your practice?

does your clinic have ncqa pcmh recognition? · learn practical tips on how to maintain and sustain...

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