presentation title: starting your pcmh 2017 journey date: … · business hours to meet identified...

www.centerpriseinc.com

Presentation Title: Starting your PCMH 2017 JourneyDate: 4.12.18

Prepared by: Centerprise, Inc.Prepared for: OACHC HCCN

www.centerpriseinc.comConfidentiality Notice: This document is confidential and contains proprietary information and intellectual property of Centerprise, Inc. Neither this document norany of the information contained herein may be reproduced or disclosed under any circumstances without the express written permission of Centerprise, Inc. Pleasebe aware that disclosure, copying, distribution or use of this document and the information contained therein is strictly prohibited.

The Decision Process


Who Are You? How will you Proceed?

New Recognition

• Full Transformation• Evidence for all 40

core criteria and 25 electives

• All documentation and 3 check-ins

• Annual check-in (30 days prior to expiration)

2014 Level 1 or Level 22011 Level 1,2 or 3

• Accelerated Renewal• Must meet all 40 core

criteria and 25 electives • Attestation and

Evidence at Check-ins

2014 Level 3

• Sustainability/Annual Reporting• Annual upload (beg.

Year of current expiration)


Practices with 3 or more sites: following the same policies and procedures and utilizing same EMR

PCMH-Multi-Site Status

All Sites: New Recognition

• Full Transformation• All documentation

and check-in• Annual check-in (30

days prior to expiration)

2014 Multi Site Application: Adding

new sites in 2017• Attestation of select

shared criteria• Evidence should

be available• Documentation of

other criteria

2014 Level 3: Renewal of all sites

• Annual Reporting


Concept. Competency. Criteria. (Standard. Element. Factor.)

https://www.ncqa.org/Portals/0/Programs/Recognition/Intro_to_PCMH_2017.pdf?ver=2017-06-09-202905-513


Concept :(2014 equivalent = Standard)• 6 Concepts:

• Team Based Care• Knowing and Managing your Populations• Access• Care Management• Care Coordination and Care Transitions• Quality Improvement

Competencies: (2014 equivalent= Element)• Must Pass competencies do not exist in 2017 (See Criteria below)• Not scored by Element like in 2014

Criteria: (2014 Equivalent= Factor)• Core- Required for Recognition (40)• Elective- Practice may select for recognition (25 credits required)

PCMH 2017 Glossary


Core: Required Criteria for recognition. (2014 comparison- while a Critical Factor was required to pass an element, each CORE criteria is required for recognition). 40 totalElective: Transformation Criteria that is available for selection by the practice. Must pass 25 credits for recognitionEvidence: (2014 equivalent= Documentation Required)

• 2017 proof of transformation • Report• Source• Workbook• Worksheet• List• Evidence of Implementation: demonstrated proof of transformation (live or static)

PCMH 2017 Glossary


Concept # Competencies # Core Criteria # Elective Criteria # Criteria New to 2017

Team Based Care (TC) 3 5 4 (7 credits) 4

Knowing and Managing your Populations (KM)

6 10 18 (20 credits) 13

Patient-Centered Access and Continuity (AC)

2 7 7 (8 credits) 4

Care Management and Support (CM)

2 4 5 (6 credits) 2

Care Coordination and Care Transitions (CC)

3 5 16 (24 credits) 5

Performance Measurement and Quality Improvement (QI)

3 9 10 (16 credits) 3

Core vs. Elective by Competency


Check in (Virtual Review): Interactive review to gauge progress and discuss next steps in evaluation.Annual Sustainability Reporting: Required demonstration that your practice has continued to align with recognition requirements-post recognitionQ-Pass: NCQA online platform through which you will conduct all transformation and recognition activitiesPre-validation: Letter from your EMR vendor establishing pre-validation criteria for which you can get auto-credit

Fully Meets Criteria: Full credit with attestation

Partially Meets Criteria: Must show partial evidence

Practice Support: Show utilization of provided support

PCMH 2017 Glossary

www.centerpriseinc.comCo

nfide

ntia

lity

Not

ice:

This

docu

men

tis

confi

dent

ial

and

cont

ains

prop

rieta

ryin

form

atio

nan

din

telle

ctua

lpro

pert

yof

Cent

erpr

ise,I

nc.N

eith

erth

isdo

cum

ent

nor

any

ofth

ein

form

atio

nco

ntai

ned

here

inm

aybe

repr

oduc

edor

disc

lose

dun

der

any

circ

umst

ance

sw

ithou

tth

eex

pres

sw

ritte

npe

rmiss

ion

ofCe

nter

prise

,Inc

.Pl

ease

beaw

are

that

disc

losu

re,

copy

ing,

dist

ribut

ion

orus

eof

this

docu

men

tand

the

info

rmat

ion

cont

aine

dth

erei

nis

stric

tlypr

ohib

ited.

New Recognition 2014 Level 1 or Level 2

2014 Level 3 NOTES

1. Select ClinicalPCMH Champion (Provider)

X X X Required

2. Select Non-Clinical PCMH Champion

X X X Required

3. Create PCMH Core Team

X X X RecommendedProvider, clinical and non clinical

staff, Operations, IT/EMR/Analytics,

QI, (finance)

4. Perform Self Assessment on Core Criteria

X X X Recommended

Where do I start and Where do I go?


nfide

ntia

lity

Not

ice:

This

docu

men

tis

confi

dent

ial

and

cont

ains

prop

rieta

ryin

form

atio

nan

din

telle

ctua

lpro

pert

yof

Cent

erpr

ise,I

nc.N

eith

erth

isdo

cum

ent

nor

any

ofth

ein

form

atio

nco

ntai

ned

here

inm

aybe

repr

oduc

edor

disc

lose

dun

der

any

circ

umst

ance

sw

ithou

tth

eex

pres

sw

ritte

npe

rmiss

ion

ofCe

nter

prise

,Inc

.Pl

ease

beaw

are

that

disc

losu

re,

copy

ing,

dist

ribut

ion

orus

eof

this

docu

men

tand

the

info

rmat

ion

cont

aine

dth

erei

nis

stric

tlypr

ohib

ited.Self Assessment

Patient- Centered Access and Continuity

AC Competency A - enhance access by providing appointment and clinical advice based on patients' needs INTENT

Intent Self Assessment 0-5 Gaps in Practice Plan

CORE AAC 01

Assesses the access needs and preferences of the patient population.

The practice evaluates patient access from collected data (i.e., survey, patient interviews, comment box) to determine if existing access methods are sufficient for its population. Alternative methods for access may include evening/weekend hours, types of appointments or telephone advice.

The practice understands the needs and demands of the patient population and is able to provide appropriate access methodologies for those patients 2

Have not surveyed on alternative appt. types with the exception of evening hours. Do now know why patients do not utilize e-visits

Survey on if patients are interested in alternate appt. types (telephone, e-visits). Based on results see if able to provide appropriate suppy of visits.

CORE AAC 02

Provides same-day appointments for routine and urgent care to meet identified patient needs.

The practice reserves time on the daily appointment schedule to accommodate patient requests for a same-day appointment for routine or for urgent care needs. The time frames allocated for these appointment types are determined by the practice and based on the needs of the patient population, as defined in AC 01. The report may include a 5-day schedule to demonstrate the appointments are available or a report demonstrating which same-day appointments were used. The report may be significant patient-reported access satisfaction, based on AC 01 data.-at least 1 same day apt available per day

The practice understands the quantitative and qualitative demand for convenient access. The practice is able to provide the appropriate supply of access to meet those demands 4

Only 30% of same day appointments are utilized

Monitor demand over next 3 months and adjust schedules for appropriate Same Day templating to maximize utilization and allow for other appointment access

CORE AAC 03

Provides routine and urgent appointments outside regular business hours to meet identified patient needs.

Providing extended access does not include:• Offering appointments when the practice would otherwise be closed for lunch.• Offering daytime appointments when the practice would otherwise close early (e.g., a Friday afternoon or holiday).• Utilizing an ER or urgent care facility that is unaffiliated with the practice.

The practice understands the demand for appointments to improve appropriate utilization outside of normal business hours. The practice provides extended hours that are applicable to the demand of patients and experiences appropriate utilization of those appointments 5

NA--at 80% utilization; 75% kept consistently continue to monitor quarterly


New Recognition 2014 Level 1 or Level 2 (or 2011

recognized practices)

2014 Level 3 NOTES

5. Perform Self Assessment on Elective Criteria

X X X Recommended

6. Select 25 elective Criteria

X X Required

7. Prioritize WorkPlan

X X Recommended

8. Enrollment- EnterOrganization Information into Q-Pass within 12 months recognition

X X (w/in 4-6 months of expiration of

recognition)

X (within 3 months of expiration)

Recommended



nfide

ntia

lity

Not

ice:

This

docu

men

tis

confi

dent

ial

and

cont

ains

prop

rieta

ryin

form

atio

nan

din

telle

ctua

lpro

pert

yof

Cent

erpr

ise,I

nc.N

eith

erth

isdo

cum

ent

nor

any

ofth

ein

form

atio

nco

ntai

ned

here

inm

aybe

repr

oduc

edor

disc

lose

dun

der

any

circ

umst

ance

sw

ithou

tth

eex

pres

sw

ritte

npe

rmiss

ion

ofCe

nter

prise

,Inc

.Pl

ease

beaw

are

that

disc

losu

re,

copy

ing,

dist

ribut

ion

orus

eof

this

docu

men

tand

the

info

rmat

ion

cont

aine

dth

erei

nis

stric

tlypr

ohib

ited.

New Recognition 2014 Level 1 or Level 2 (or 2011

recognized practices)

2014 Level 3 NOTES

9. Have initial call with NCQA Rep

X X X Required

10. Conduct 3 check-ins with NCQA Rep

X (As needed based on call)

Required

11. Submit all additional documentation

X X (attestation vs. evidence as

needed)

Required

12. Ensure payment has been received/HRSA code entered

X X X Required

13.Recognition Received

X X X HOPEFULLY!!!



nfide

ntia

lity

Not

ice:

This

docu

men

tis

confi

dent

ial

and

cont

ains

prop

rieta

ryin

form

atio

nan

din

telle

ctua

lpro

pert

yof

Cent

erpr

ise,I

nc.N

eith

erth

isdo

cum

ent

nor

any

ofth

ein

form

atio

nco

ntai

ned

here

inm

aybe

repr

oduc

edor

disc

lose

dun

der

any

circ

umst

ance

sw

ithou

tth

eex

pres

sw

ritte

npe

rmiss

ion

ofCe

nter

prise

,Inc

.Pl

ease

beaw

are

that

disc

losu

re,

copy

ing,

dist

ribut

ion

orus

eof

this

docu

men

tand

the

info

rmat

ion

cont

aine

dth

erei

nis

stric

tlypr

ohib

ited.

New Recognition 2014 Level 1 or Level 2 (or 2011 recognized

practices)

2014 Level 3 NOTES

14. Download Annual Reporting Phase (Annual Assessment)

X X X Required

15. Collect documentation and evidence for required annual reporting

X X X Required

16. Collectdocumentation and evidence for optional reporting requirements

X X X Required

17. Complete annual reporting 30 days prior to expiration

X X X RequiredCan be submitted any

time during year

18. COMPLETE SUSTAINABILITYASSESSMENT/REPORTING INTERNALLY

X X X Recommended.Ensures compliance

and outcomes

How do I Sustain?


• The PCMH process is intended to create a medical home that is convenient, efficient and effective for you and the patient

• 2017 provides less restrictive guidelines on “how to demonstrate” allowing you to be innovative, efficient and effective

• 2017 provides you the ability to determine what is important to you and your patients

• This means understanding your population

Why all the changes?


• Evidence:• R (Report): a manual or electronically generated report showing numerator,

denominator and percentage• L (list): a repository of information in list form• S (source): siting of information or evidence source• E (evidence): demonstration of process (live or static)• P (Process): documented process; workflow, policy, procedure, training

manual, Visio, etc…• W (Workbook): Worksheet to documentation audited evidence• WS (Worksheet): NCQA worksheet developed for QI initiatives

What are the ways to prove I do something?


nfide

ntia

lity

Not

ice:

This

docu

men

tis

confi

dent

ial

and

cont

ains

prop

rieta

ryin

form

atio

nan

din

telle

ctua

lpro

pert

yof

Cent

erpr

ise,I

nc.N

eith

erth

isdo

cum

ent

nor

any

ofth

ein

form

atio

nco

ntai

ned

here

inm

aybe

repr

oduc

edor

disc

lose

dun

der

any

circ

umst

ance

sw

ithou

tth

eex

pres

sw

ritte

npe

rmiss

ion

ofCe

nter

prise

,Inc

.Pl

ease

beaw

are

that

disc

losu

re,

copy

ing,

dist

ribut

ion

orus

eof

this

docu

men

tand

the

info

rmat

ion

cont

aine

dth

erei

nis

stric

tlypr

ohib

ited.

2017 PCMH Tracker

Drop down list

Totals points, based on

dropdown choosen


• Red-Do not have evidence required; progress not being made• Yellow-Progress being made; evidence not finalized• Green-Progress complete; evidence meets requirements• Blue – Progress completed and approved by Reviewer• Communicate revisions and concerns• Use for self assessment

How to Use the Tracker/Tips and Tricks


nfide

ntia

lity

Not

ice:

This

docu

men

tis

confi

dent

ial

and

cont

ains

prop

rieta

ryin

form

atio

nan

din

telle

ctua

lpro

pert

yof

Cent

erpr

ise,I

nc.N

eith

erth

isdo

cum

ent

nor

any

ofth

ein

form

atio

nco

ntai

ned

here

inm

aybe

repr

oduc

edor

disc

lose

dun

der

any

circ

umst

ance

sw

ithou

tth

eex

pres

sw

ritte

npe

rmiss

ion

ofCe

nter

prise

,Inc

.Pl

ease

beaw

are

that

disc

losu

re,

copy

ing,

dist

ribut

ion

orus

eof

this

docu

men

tand

the

info

rmat

ion

cont

aine

dth

erei

nis

stric

tlypr

ohib

ited. If recognized

under 2014 how to assess? (Crosswalk)


nfide

ntia

lity

Not

ice:

This

docu

men

tis

confi

dent

ial

and

cont

ains

prop

rieta

ryin

form

atio

nan

din

telle

ctua

lpro

pert

yof

Cent

erpr

ise,I

nc.N

eith

erth

isdo

cum

ent

nor

any

ofth

ein

form

atio

nco

ntai

ned

here

inm

aybe

repr

oduc

edor

disc

lose

dun

der

any

circ

umst

ance

sw

ithou

tth

eex

pres

sw

ritte

npe

rmiss

ion

ofCe

nter

prise

,Inc

.Pl

ease

beaw

are

that

disc

losu

re,

copy

ing,

dist

ribut

ion

orus

eof

this

docu

men

tand

the

info

rmat

ion

cont

aine

dth

erei

nis

stric

tlypr

ohib

ited.

If recognized under 2014 how to assess? (Crosswalk)


“Prove it!”“Show me what you do when the response is ‘no’”Live vs. Static evidenceFlexible recognition planAnnual reporting requirements will change

What You Need to Know About the Recognition Process


• Demonstrate process to individuals who are not familiar with the process prior to check in

• Can you answer all the questions associated with the intent?• Can you answer the expected outcome that led to the current

process?• Ask reviewer for other ways a criteria can be met• Provide reason and justification proactively• Consistency—if you cannot demonstrate reliability 8/10 times then

don’t show it!• Anti-validation

How to Make the Most of the Check In


• GET THE TEAM TOGETHER, AND….

From here….before the Bootcamp


TC 01 (Core)


• Things to consider:• Clinician Lead:

• CMO is not always the best choice• Don’t chose based on availability• Integrated with QI

• PCMH Manager• Can be embedded within a current Job Description• Must provide details on role of manager• Detail communication methods• Detail role on QI• Detail role in communicating with NCQA

TC01:


• Step 1: Data driven assessment leads to a plan that is Actionable and Sustainable

• Who are is our team?• Who are our patients?• What does the team want to do?• When does the team want to do it?• Who does the team want to be?• How will the team do it?• What is the team supposed to do?• Why is the team supposed to do it?

Step 1: Assess: Data to Engage

4 Steps to Transformation

Engagement Activation

Transformation Sustaianability


• Using your Assessment to ACTIVATE your transformation plan• What do you need to meet the intent?• What does your current data tell you?• What is your plan?• What is your next step?

Step 2: Study: Create your Activation Plan from Assessment Information



Transformation Sustainability

Example: Study: Risk Stratify Your Transformation

Requirement What is your goal?

Current Data What does it tell you? Why does this matter?

Risk Score Data based Message

PCMH Factor 3

Visits by the PCP

85% 1 week-75%30 days-75%

Patients not able to see PCP regularly. Provider data shows 2 providers not able to see patients. Established visits are 30 days out. Data shows we are likely over capacity with 2 providers. Current empanelment data 90% for additional providers—we have access with these providers

2. Quality3. Access4. Provider Satisfaction5. Patient Satisfaction

3 Patients are not able to see the provider they have chosen. This leads to discontinuous care, and potential room for mixed-treatmentplanning. Patient satisfaction scores at risk and QI incentives dependent on patient panels. What are strategies to mitigate risk?

www.centerpriseinc com

Confidentiality Notice: This document is confidential and contains proprietary information and intellectual property of Centerprise, Inc. Neither this document nor any of the information contained hereinmay be reproduced or disclosed under any circumstances without the express written permission of Centerprise, Inc. Please be aware that disclosure, copying, distribution or use of this document and theinformation contained therein is strictly prohibited.


• Transformational success is dependent on your ability to engage internal teams and the patient

• Did the team successfully engage in transformative process?• Did we meet the goals set forth in Steps 1 and Step 2?• Why do we have a variance?

Step 3: Determine: Using your information based plan to determine effective Transformation and Engagement



Transformation Sustainability


Step 4: Prepare: Proactive use of Data to Create Sustainable Transformation


Enough with the PDSA• A PDSA without data is NOT A PLAN• A PDSA without data is Simon Says• A PDSA without data is Water Cooler Gossip• A PDSA without data is Ground Hogs Day

presentation title: starting your pcmh 2017 journey date: … · business hours to meet identified...

Documents