The Path to PCMH with

athenahealth

Emily Gurvis

athenaClinicals Quality Associate

Agenda

• Why PCMH?

• Becoming a PCMH

• PCMH with athenahealth

• Next Steps

• Resources

• Q&A

2

Why PCMH?

PCMH improves care coordination

4

EHR Connectivity

& Interoperability

Data Registries

Patient &

Provider Portals

Data Warehousing

& Mining

Acute Care

PHARMACY SPECIALTY CARE

PATIENT/FAMILY SUPPORTS

HOME CARE

ACUTE CARE

EMERGENCY CARE

SUPPORTIVE/PALLIATIVE

CARE

TELEHEALTH LONG TERM

CARE

Medical Home

What the Patient-Consumer Wants

5

SOURCE: 2014 Primary Care Consumer Choice Survey, Marketing and Planning Leadership Council interviews and analysis.

For patients,

access

comes first.

Service

• Provider education

on illness and

wellness

• Provider continuity

Affordability

• In-network status

• Eliminated out of

pocket charges

Access and Convenience

• Walk-in availability,

less than 30

minutes wait

• Lab tests, X-rays,

pharmacy onsite

• 24/7 access

• Same day

appointment

availability

• Geographic

proximity

6

Benefits of Becoming a PCMH

58% increase in clinician satisfaction

66% increase in staff satisfaction

11% increase in practice revenue

14% increase in clinician salaries

SOURCE: http://primarycareprogress.org/pcmh

L. M. Kern, R. V. Dhopeshwarkar, A. Edwards et al., "Patient Experience Over Time in Patient-Centered Medical Homes," American Journal of Managed Care, May 2013 19(5):403–10.

Nationwide Payer PCMH Programs

7 Source: http://www.theverdengroup.com/payer-pcmh-programs-nationwide/

8

Becoming a

PCMH

PCMH Recognition Programs

9 Source: The Urban Institute, "Patient-Centered Medical Home Recognition Tools: A Comparison of Ten Surveys' Content and Operational Details”, May 2011

NCQA PCMH Growth 2008-2013

10

SOURCE: http://www.ncqa.org/Portals/0/Events/BehindtheEnhancements_FINAL.pdf

214 1,976

7,676

16,191

24,544

34,492

28 383

1,506

3,302

5,198

6,762

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

12/31/08 12/31/09 12/31/10 12/31/11 12/31/12 12/31/13

Clinicians Sites

The ideal candidate for PCMH

11

Passionate about improving patient care

Ready to undergo change

Eligible for financial incentives

Becoming a PCMH is a 12 to 18 month

process of transformation

12

Project Management and Change Management

Documenting and implementing policies and procedures

Possible external consulting Tracking and improving on

quality measures for at least 1 year (supported in

athenaClinicals)

A variety of PCMH specific workflows and reports

(supported in athenaClinicals and athenaCommunicator)

Submitting application to NCQA

13

PCMH Recognition Through NCQA

14

Six Standards

✔

✔

✔

✔

✔

✔

1. Patient-centered Access

5. Care Coordination and Care Transitions

6. Performance Measurement and Quality Improvement

4. Care Management and Support

3. Population Health Management

2. Team-based Care

PCMH Recognition Through NCQA

15

Six “Must-Pass” Elements

✔

✔

✔

✔

✔

✔

1. Patient-Centered Appointment Access

5. Referral Tracking and Follow-Up

6. Implement Continuous Quality Improvement

4. Care Planning and Self-Care Support

3. Use Data for Population Management

2. The Practice Team (Team-Based Care)

PCMH Recognition Through NCQA

16

Three Levels of Recognition

✔

✔

✔

Level 1: 35-59 points

Level 3: 85-100 points

Level 2: 60-84 points

“The patient-centered medical home has the potential to

change the interaction between patients and physicians.

Patients can no longer be silent partners in their care— they are

active participants in managing their health with a shared goal

of staying as healthy as possible.”

-Margaret E. O’Kane, NCQA President

Scoring Breakdown

17

PCMH 2011 vs. PCMH 2014

18

Team-based care

• New standard for 2014

• Focus of the standard is about incorporating patients as a part of their own care team

Behavioral and mental health integration • Practices to maintain agreements with behavioral health

providers (Standard 5B.3) • Services related to behavioral health are communicated to the

patient

“Meaningful Use” Stage 2 alignment • 2011 PCMH had factors based on Stage 1 requirements. • The 2014 PCMH standards require adherence to and reports

under MU Stage 2 measures, which are modeled into the program built in athenaClinicals

Continuous improvement

• Practices make efforts to improve in patient experience, cost and clinical quality (the Triple Aim)

• Practices conduct activities at least annually and are subject to audit (annually is new)

Measuring Health Care Costs

• Track overuse and appropriateness

• High cost/high utilization to be considered in care management

• Annually measure or receive quantitative data affecting health-care costs

Population Management

• Increased requirement for evidence based decision support from 2011

• New is 3C Factor 10-Assessment of health literacy

• Annually, must show active outreach to patients (point of care reminders) on a scheduled basis for a specific need (3D- must pass)

Care Coordination

• Updates on how to work with specialists:

• Greater specificity in agreements between providers

• Engage patients, families on self-referrals

• Coordinate reports with referred specialists

PCMH with

athenahealth

athenahealth was first to undergo

NCQA PCMH Corporate Review

19

With our auto-credits and “practice support” points,

athenaOne clients are only 4.25 points away from

Level 3 recognition

85

35.25

45.5

0

20

40

60

80

100

Minimum amount of points

for NCQA Level 3

Practice Responsibility

4.25

athena-Enabled

Auto Credits*

NCQA

Level 1

NCQA

Level 2

*pre-validated NCQA points

*practice support

points

athenahealth PCMH

Accelerator Program

NCQA

Level 3

We also offer guidance and training

PCMH Resource Center:

o PCMH 2014 self-assessment

o Guidance materials

o Quality Management team

o athenaNet support

o Quality Management tools

Next Steps

Getting Started

22

1. Review the PCMH requirements to recognition on the NCQA website and take the PCDC Self-Assessment Tool on

their website.

2. Review the athenahealth PCMH Guide to Success document in the QMRC. Plan auto-credit eligible factor workflows and settings, accordingly.

3. Request to enroll your practice in the NCQA PCMH

Accelerator 2014 Standards Program in athenaClinicals.

4. Plan your approach to each of the standards – and auto-

credit eligible factors - that require action and explore all

options to optimize the PCMH experience.

Applying for PCMH Recognition

23

1. Work with your staff and providers on the standards and

any behavior or workflow changes required.

2. Monitor your performance using the Quality Management

Tools available in athenaClinicals.

3. Gather your results and documentation and submit a case

to the CSC to obtain the auto-credit documentation you

will need from athenahealth to apply for NCQA PCMH

Recognition with athenahealth sponsorship auto-credits.

4. Apply by sending your PCMH application, together with

your results, documentation, and athenahealth auto-credit

documentation to NCQA.

Additional

Resources

25

26

Additional Resources

27

Questions

Thank You