Practice transformation leading to pcmh designation

URAC’s
Patient Centered Health Care Home
(PCHCH)
Practice Achievement Program

This material is the property of URAC. Any use of this material is subject to
©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions.

Agenda

 URAC’s Patient Centered Health Care Home (PCHCH)
• Definition of PCHCH
• IOM’s Quality Aims
• Focus of the PCHCH Program
 URAC PCHCH Practice Achievement Program
• The URAC Difference
• Practice Achievement Levels
• Modules and Standards
• Eligibility Requirements
• How To Get Started
• Onsite Review Process
• A URAC PCHCH Success Story
©Practice Transformation Institute 2012 copyright and trademark laws, terms of use and other restrictions. 2

PCHCH Definition

URAC Patient Centered Health Care Home (PCHCH)

• A quality driven, interdisciplinary clinician-led team approach to
delivering and coordinating care that puts patients, family members,
and personal caregivers at the center of all decisions concerning the
patient’s health and wellness.
• A PCHCH provides comprehensive and individualized access to physical
health, behavioral health, and supportive community and social
services, ensuring patients receive the right care in the right setting at
the right time.


Central to the PCHCH Approach

Quality Aims How URAC PCHCH Standards Promote IOM Quality Aims

Registry, Medication Reconciliation, Transitions of Care, Privacy and
1. Safe
Security

Evidence Based Guidelines, Wellness Promotion and Quality Management
2. Effective
Programs

Individualized Focus, Informed Decision-Making, Patient Satisfaction,
3. Patient-centered
Consumer Education, Health Literacy
Lab Values, Requests for Health Information and Enhanced Coordination
4. Timely
of Care
Organizational Structure, Policies and Procedures, Electronic Health
5. Efficient
Record and Total Quality Management
Disparity, Cultural Sensitivity, Complaint Process and Coordination with
6. Equitable
the Payor


Focus On Health Care
Not Limited to Disease
Focus on whole
Care coordination
person, not just
is enhanced
illness

Accommodating
Wellness modules
health literacy

Formation of Respect for
Patient-Provider cultural
Agreement differences/needs


URAC PCHCH Practice
Achievement Program


Focus

 URAC’s PCHCH Practice Achievement focuses on evaluating
practices on the Joint Principles of the Patient Centered
Medical Home* including:
• Access
• Coordination
• Quality
• Patient Centeredness

*American Academy of Family Physicians (AAFP), American Academy of
Pediatrics (AAP), American College of Physicians (ACP)
American Osteopathic Association (AOA)


The URAC Difference

 Flexible stepwise process for supporting the transformation of
practices to patient centered health care homes
 Recognizes different levels of functioning as practices evolve
 Educational, non-prescriptive
 Patient-centric
 Two levels of achievement
 Multiple resources and programs available to support practices
 Two year certificate awarded to practice
 Onsite review verification


Defining the Practice
Achievement Levels
Achievement
Attain an overall score of 65% (or higher)
Meet all of the 7 mandatory standards at least “partially in place”
Compliance with medical record review

Achievement with Electronic Health Record (EHR)
Attain an overall score of 65% (or higher)
Meet all of the 7 mandatory standards at least “partially in place”
Compliance with medical record review
“Fully” meet all elements aligned to Meaningful Use requirements
(15 Core and 10 Menu)


Modules and Standard
Categories

 The URAC PCHCH Practice Achievement program is
grouped into modules and standard categories which
represent various health care functions. Each of the
standard categories have PCHCH standards that
correspond with elements (tasks) to complete.


Program Description - Modules

 7 modules represents various healthcare
functions essential to primary care

• Core Quality Care Management
• Patient-Centered Operations Management
• Access and Communication
• Testing and Referrals
• Care Management and Coordination
• Advanced Electronic Capability
• Quality Performance Reporting and Improvement


Core Quality Care Management

 Standard Category is Organizational Core (COR)

Goal is to establish basic organizational, cultural training and
systems, and operational requirements which support a
successful PCHCH model of patient engagement and care
delivery and follow-up.


Patient-Centered Operations
Management

 Standard Category is Patient Registry (PR)

Goal is to establish a comprehensive patient registry to
optimally manage a population of patients, improve health
status, and ultimately lower health care cost.
Registry allows Practice to identify care gaps and needed
preventive, wellness, and follow-up services.


Access and Communications

Standard Category is Access to Services (ATS)
Goal is to ensure all patients have comprehensive and timely access
to health care services that are patient centered, culturally sensitive,
and delivered in the least intensive and most appropriate setting
based on the patients needs.

Standard Category is Community Services and Resources
(CSR)
Goal is to help Patients connect with needed community services and
resources by implementing processes that coordinate care between
the PCHCH, community services agencies, family, care givers, and the
patients.

Testing and Referrals

 Standard Category is Managing Tests and Results (MTR)
Goal is to implement a standardized, reliable system to ensure
patients receive needed tests and imaging that results are
communicated in a timely manner, appropriate follow-up care is
conducted, and each step in the testing and imaging tracking
process is properly documented.

 Standard Category is Referral Process (RP)
Goal is to create a well-coordinated process where PCHCH patients
are referred to specialty care in an efficient manner, and both the
practice clinicians and specialists receive timely access to the
information they need to provide optimal care to the patient.


Care Management and
Coordination
 Standard Category is Wellness and Health Promotion
(WHP)
Goal is to ensure patients receive all appropriate wellness and
preventive services, using screening, active counseling, and outreach
efforts to inform and educate patients about the value of preventive
care.

 Standard Category is Individual Care Management (ICM)
Goal is to ensure patients with chronic conditions receive organized,
planned care from a team of multidisciplinary clinicians, and that
patients are empowered to take greater responsibility for their
health, leading to improved health status and decreased health care
cost.

Care Management and
Coordination
 Standard Category is Coordination of Care (COC)
Goal is to improve patient care by implementing processes that
will help clinicians coordinate treatment, communicate with one
another, manage health care setting transitions, communicate
care options to the patients, and track patient activity.

 Standard Category is Self Management Support (SMS)
Goal is to implement a comprehensive program that will use
patient education tools, informative sessions, and life skills
training to offer support to chronic care patients, and to help
them manage their condition.


Advanced Electronic Capability

 Standard Category is Electronic Communications
Portal (ECP)
Goal is to implement a patient portal system that will allow
clinicians to manage and interact with their patients online.
Patients will be able to access their health records online, and
the clinician will be able to send reminders and health care
literature, and conduct e-visits.


Advanced Electronic Capability

 Standard Category is Electronic Prescribing and
Dispensing (EPD)
Goal is to automate the prescribing and medication reconciliation
process, providing alerts for medication and allergy conflicts,
Therapeutic equivalent and generic substitution information,
stream lining prescription fills and renewals, and providing
clinicians with patient-specific coverage and insurance formulary
information.
 Standard Category is Electronic Health Records (EHR)
Goal is to implement Electronic Health Record which integrates
patient information from all care sources, within and outside
the practice.


Quality Performance
Reporting and Improvement

 Standard Category is Performance Reporting (PRT)

Goal is to implement reporting technology that will allow
clinicians to generate point-of-care reports, population-level
reports, and trend analyses to identify opportunities for
improving care to patients. Regular performance feedback
enables clinicians to decrease gaps in care and improve
patient outcomes.


PCHCH Practice Achievement
Standards and Elements


Eligibility Requirements

 Applicants for URAC’s PCHCH Practice Achievement must be a
legally organized health care practice
 Practice settings may be in offices, outpatient clinics, or
academic affiliated
 Practice eligibility requires possession of a health care practice
license (if permitted by state law), legally organized in
accordance with state law and physically located in the United
States


URAC PCHCH Standards –
Only Publication
 The complimentary URAC PCHCH Practice Achievement
Standards-Only publication provides a summary overview of the
program and the 28 standards
• Go to www.urac.org. Click on “Store” in the upper right corner of
the URAC homepage.
• Click on the right side – Patient Centered Health Care Home
Achievement Standards. Check the box next to the item that you
would like to purchase. Scroll to the bottom and add to cart.
Proceed to checkout. Follow directions to download the document.
• The fifty “optional” standards are included in the last section of the
publication.


Getting Ready

 Review the complimentary URAC PCHCH Practice Achievement
Standards-Only publication prior to purchasing the URAC PCHCH
Practice Achievement application
 Attend a URAC PCHCH Practice Achievement Workshop
 Listen to the eLearning webinars
 Participate in conferences and discussion groups
 Sign-up for the complimentary Medical Home Today™ Newsletter
 Read the PCHCH links on the URAC website at
www.urac.org/pchch


URAC PCHCH Practice
Achievement Application
 Purchase the URAC PCHCH Practice Achievement application

• Go to www.urac.org/pchch. Click on “Purchase an application”.
Scroll to where you see a listing of practices by size.
Click on the size that best suits your practice.

• You must purchase an application for each site you wish to apply
for Achievement. You may do this by updating the quantity after
you have added the Achievement Product to your cart.

• Click the check box next to the item you would like to purchase.
Scroll to the bottom and add to cart. Proceed to checkout and
follow directions.


Example of a Mandatory
Standard
PCH-PA 11: Referral Process (RP) Track and Follow-Up on Referral:
The Practice employs the following mechanisms to track and follow-up on referrals to clinicians outside the
Practice and: [--]

(a) Provides the patient and/or caregiver and referral clinician with the reason for the consultation and
pertinent clinical findings; [4]
(b) Tracks referrals electronically (preferably) and determines if and when the patient was seen by the
specialist; [4]
(c) Documents the referral dates in the health record; [4]
(d) Conducts follow-up to obtain a report from the referral clinician; and [4]
(e) Contacts patient for follow-up if necessary based upon report from specialist. [4]

Once the PCHCH Practice Achievement Application has been
purchased, the applicant receives the Practice Achievement Guide:
1- Interpretive Information/Points to Remember
2- Materials for Review
3- Related Interviews
3- Agenda
4- Checklist and additional information

Six Months to Completion

 Within the six months the application is purchased
• Practices must submit an executed achievement agreement and
practice demographic preliminary background information to URAC
via the electronic application prior to the onsite process
• The practice prepares the appropriate documents for the auditor
o Practices should have their policies, procedures, protocols and
workflows flagged at important information
• Complete the PCHCH Practice Achievement Standards Checklist
o The practice will check off what they have in place
• An onsite review is scheduled


Selecting an Auditor

A practice has a choice for their onsite auditor
 URAC PCHCH Certified Auditor
• Organization that met URAC Core Accreditation and Business
Associate Requirements and
• Validated by URAC to review practices and submit data
• Note: The URAC website directory lists the PCHCH Certified Auditors
https://www.urac.org/pchchDirectory/DirectorySearch.aspx

 URAC Reviewer

An auditor code is provided to the practice on the Summary page after the
application is submitted. Give that code to your auditor of choice.


Onsite Review Process
 The auditor will need a copy of the completed PCHCH Practice Achievement
Standards Checklist at least 1-3 weeks prior to the onsite visit for review
 Review dates are agreed upon between the auditor and the practice
 The review will require a 1-2 day visit, but the practice does not need to close
 The agenda explains who needs to be with the auditor each hour and what will
be reviewed during each time period
 To help things run smoothly, identify a main contact for the review and a staff
member to act as a “driver” for the various review processes
 The completed audit tool will be submitted to URAC for review. URAC will
make a decision within 90 days
 The URAC PCHCH Practice Achievement is given for 2 years. The practice is
awarded the URAC PCHCH Practice Achievement seal and placed in the URAC
Directory


A URAC PCHCH Success Story

Country Creek Pediatrics in Rochester, Michigan became the first
practice to attain URAC PCHCH Practice Achievement.
“Our URAC PCHCH Practice Achievement is a valuable recognition of the work we have put
into delivering quality, patient centered health care to our entire population. The URAC
onsite auditors were friendly, professional, well-prepared and considerate of our
schedule. We look forward to a continued relationship with URAC as we move to the
future of patient centered health care.” Dr. Rozmiej

“Working on our URAC PCHCH Practice Achievement helped us to fine tune
our policies and procedures to better address staff training, cultural
diversity and literacy levels of our patient population. Since we were
already operating as a patient centered medical home, we had many of
the URAC Standards already in place. The URAC PCHCH Practice
Achievement Guide was an invaluable tool for preparing us for the
actual onsite review.” Patient Care Coordinator


Learn more about URAC PCHCH at www.urac.org/pchch

Learn more about Practice Transformation Institute (PTI) at
www.transformcoach.org

Contact Mike at mmellor@transformcoach.org or 248.475.4867
with your auditor code to schedule an onsite review


Practice transformation leading to pcmh designation

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