Patient-Centered Medical Home (PCMH)
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This document provides an overview of the Patient-Centered Medical Home (PCMH) model of healthcare delivery. It describes key aspects of the PCMH including its team-based and patient-centered approach, emphasis on continuous quality improvement, and transformation from a traditional doctor-centered model. It also outlines the recognition process through the National Committee for Quality Assurance, including their standards, elements, factors and requirements for different levels of recognition. Challenges of becoming a PCMH and common myths are also addressed.
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Patient-Centered Medical Home (PCMH)
- 1. Pa$ent-‐Centered Medical Home (PCMH) Wednesday, January 22, 2014 Disclaimer: Nothing that we are sharing is intended as legally binding or prescrip7ve advice. This presenta7on is a synthesis of publically available informa7on and best prac7ces.
- 2. PCMH -‐ Overview • Transforma*ve model for delivery of care • Espouses team-‐based approach – Comprehensive and con*nuous pa*ent-‐driven care – Evidence based healthcare and best prac*ces – Consistent high quality care • Rela*onship-‐based • Whole person • Team-‐based
- 3. Transforma*ve Care Model • Change from tradi*onal doctor-‐centered medical prac*ce • Care coordina*on – Health Informa*on Technology – Data-‐driven decision-‐making – Appropriate staff development • Con*nuous quality improvement • Policies and procedures
- 4. What Transforma*on Looks Like • Constant innova*on • Key data measurement and improvement targets • Capitalizing the benefits of EHRs • Regular pa*ent communica*on • Proac*vely scheduled pa*ent follow up • Expanded access to care • Pa*ent care plan coordina*on
- 5. Why Consider Becoming a PCMH? • Improved outcomes • Improved pa*ent sa*sfac*on • Improved pa*ent accessibility – Informa*on – Same day appointments – APer hours – Remote – Culturally and Linguis*cally Appropriate Service (CLAS) – Follow up • Improved professional sa*sfac*on
- 7. Seeking Recogni*on • Na*onal CommiUee for Quality Assurance (NCQA) • The Joint Commission • Accredita*on Associa*on for Ambulatory Health Care (AAAHC) • Others – Private Insurers – Employers – State en**es
- 8. NCQA Recogni*on Program • Third genera*on of qualifica*on standards – 2008 – 2011 – 2014 • Pilo*ng Pa*ent-‐Centered Specialty Program – 2013 • High volume – 20-‐30 applica*on submissions per week to approximately 100 per week
- 9. NCQA Recogni*on Criteria • Points-‐based recogni*on Points Recogni$on < 35 None 35 – 59 Level 1 60 – 84 Level 2 > 85 Level 3
- 10. NCQA Recogni*on Criteria • Six Standards – Access and con*nuity – Iden*fy and manage pa*ent popula*ons – Plan and manage care – Provide self care support and community resources – Track and coordinate care – Measure and improve performance
- 11. NCQA Recogni*on Criteria • 28 Elements – Six “must-‐pass” • PCMH 1: Element A: Access During Office Hours • PCMH 2: Element D: Use Data for Popula*on Management Element • PCMH 3: Element C: Care Management • PCMH 4: Element A: Support Self-‐Care Process • PCMH 5: Element B: Referral Tracking and Follow-‐Up • PCMH 6: Element C: Implement Con*nuous Quality Improvement
- 12. NCQA Recogni*on Criteria • 152 Factors – Nine cri*cal factors • • • • • • • • • PCMH1A, Factor 1: Same-‐day appointments PCMH 1B, Factor 3: Clinical advice by phone PCMH 1G, Factor 2: Regular team mee*ngs PCMH 3A, Factor 3: Evidence-‐based guidelines for unhealthy behaviors PCMH 3D, Factor 1: Medica*on reconcilia*on PCMH 3E, Factor 2: ePrescribing PCMH 4A, Factor 3: Self-‐management goals PCMH 5A, Factor 1: Track lab results PCMH 5A, Factor 2: Track imaging results
- 13. NCQA Recogni*on Process • Complete self-‐assessment to iden*fy gaps • Ensure all P&Ps were in effect for at least 90 days • Run reports • Collate all suppor*ng documents • Submit applica*on
- 14. Challenges of Becoming a PCMH • Transforming the prac*ce’s leadership • Teamwork – ShiP from “doctor as the hero” • Knowing when to seek help
- 15. Common Myths About Becoming a PCMH • • • • • Transform as you go You must have an EHR You must have a pa*ent portal Once you’re recognized, your done You need special repor*ng tools for PCMH
- 16. The Future of PCMH • Pa*ent-‐Centered Medical Neighborhood – Bidirec*onal communica*on, coordina*on, and integra*on – Consulta*ons and referrals – Flow of pa*ent care informa*on – Responsibility in co-‐management – Support pa*ent-‐centered care, enhanced access, and care quality – Support whole-‐person primary care
- 17. What’s Next? January 29, 2014 – Accountable Care Organiza*ons (ACOs) February 5, 2014 – Physician Quality Repor*ng System (PQRS)
- 18. Q&A dan.holleran@quirkhealthcare.com tamina.vahidy@quirkhealthcare.com