Deborah Johnson Ingram

PCMH Learning Community – Project Structure

• Assessment, Gap Analysis, Work plan

• Webinar Series

• Group Technical Assistance

• Learning Sessions (Face to Face)

Webinar Series

Focus on the PCMH Standards and Guidelines

Tools to prepare for submission

Transformation challenges

Competing Priorities

Value of Motivational Interviewing

Leveraging HIT

Balancing Multiple Initiatives

Today’s to do list

• Grant Opportunities/ Responsibilities

• Regulatory Commitments

• PCMH/HRSA PCMH • Daily Operations

CHC’s experience an array of multiple priorities

Aim

this Journey ConneCts…

I Context

II Decision Making in this Context

III Cross Walking

IV Aligning &

Harmonizing

V Prioritizing

VI Steps/Examples

I Context

PCMH

ACO HH

FTCA HIPAA 5010

Regulatory ICD10

E/M Coding Others

P4P HEDIS

Standards UDS NQF

URAC

TJC

AAAHC

QUALIS 8 Change Concepts

MU

44%

Bridging the gap on all of these commitments is

necessary in order for you to embark on a successful

medical home transformation while maintaining your

obligations to your grantors/regulators

Primary Care of

America

II Decision Making in this Context

This Decision Making Requires “Critical

Thinking”

What is the initiative

What is required of us

Who (in our org) will need to participate

What does it yield our organization

Do we have the capacity to perform the

required tasks

Initiatives Characteristics Needs UDS B2E P4P PQRS TJC MU PCMH ACO HH ICD10 HIPAA 5010 FTCA Healthy People 20/20 RISE TIDES CHCF CPCA Other

2 - Now What are Our Decisions?

3 - Considerations

Which One First? How many can we do at once? Where are the leveragable overlaps/alignments What organizational changes/impacts? (downstream) What is required upstream Cost/benefit to Patient/Organization/Staff

No longer a checklist minimalist compliance mentality Change management and Transformation Locus of Intervention Evidence of sustainable success

Decision making is Iterative - In Change Management Mode It is Continuously Necessary

ACCESS

Schedule

Availability

TNAA

CT REDUX

No Shows

Patient

Experience

CHC Care

Coordination Care Teams Evaluate

Measure

Response

CQI

Visit Types Planned

Group

Outreach

Architectural

Pre-Visit

Risk

Stratification

Panel

Mgt.

Empanelment

Continuity

Transitions

Neighborhood Agreements

Referral Mgt

Data & Communications

Education

PHR

Engagement

Health

Coaching

Develop

Data

System

Pop. Mgt.

III, IV, & V Crosswalking

Aligning Prioritizing

PCMH

MU

NCQA PCMH 2008

Meaningful Use

Stage I

NCQA PCMH 2011

TJC PCH

Meaningful Use

Stage II

URAC AAAHC

Minn. Mass.

CCM/UDS

The Eight Change

Concepts

1. Empanelment

2. Continuous and Team Based

Healing Relationships

3. Patient Centered Interactions

4. Engaged Leadership

5. QI Strategy

6. Enhanced Access

7. Care Coordination

8. Organized Evidenced-Based

Care

2011 PCMH Standards

PCMH 1: Enhance Access &

Continuity

PCMH 2: ID & Manage Patient

Populations

PCMH 3: Plan and Manage Care

PCMH 4: Provide Self Care Support

& Community Resources

PCMH 5: Electronic Prescribing

PCMH 6: Test Tracking

• Eliminate Waste

• Improve Work Flow

• Optimize Inventory

• Change the Work Environment

• Enhance the

Producer/Customer Rels.

• Manage Time

• Manage Variation

• Design Systems to Avoid

Mistakes

• Focus on the Product or

Service

Some Qualitative Overlaps

Langley’s Change Concepts

Categories 1996

2008-2011 PCMH Overlap/Alignment Listing 2008 STANDARDS AND ELEMENTS 2011 STANDARDS AND ELEMENTS

Standards Element/ Process Plan Standards Element/ Process Plan

PPC1: Access and Communication - The practice provides patient access during and after regular business hours, and communicates with patients effectively.

Must pass: PPC 1A: Access and communication processes

PCMH 1: Enhance Access and Continuity - The practice provides access to culturally and linguistically appropriate routine care and urgent team-based care that meets the needs of patients/families.

Must pass: PCMH 1A: Access during office hours

Must pass: PPC 1B: Access and communication results

PCMH 1B: After-hours access

PCMH 1C: Electronic access

PCMH 1D: Continuity

PCMH 1E Medical home responsibilities

PCMH 1F: Culturally and linguistically appropriate services

PCMH 1G: The practice team

Total points available 9 Total points available 20

PPC3: Care Management - The practice maintains continuous relationships with patients by implementing evidence-based guidelines and applying them to the identified needs of individual patients over time and with the intensity needed by the patients.

Must Pass: PPC 3A: Guidelines for important conditions

PCMH3: Plan and Manage Care - The practice systematically identifies individual patients and plans, manages and coordinates their care, based on their condition and needs and on evidence-based guidelines.

PCMH 3A: Implement evidence-based guidelines

PPC 3B: Preventive service clinician reminders

PCMH 3B: Identify high-risk patients

PPC 3C: Practice organization

Must pass: PCMH 3C: Care management

PPC 3D: Care management for important conditions

PCMH 3D: Medication management

PPC 3E: Continuity of care PCMH 3E: Use electronic prescribing

Total points available 20 Total points available 17

2008 STANDARDS AND ELEMENTS 2011 STANDARDS AND ELEMENTS

Standards Element/ Process Plan Standards Element/ Process Plan

UDS/MU/PCMH Overlap/Alignment Listing

VI Steps & Examples

#1. Organize All Current Activities

Steps to aligning

organizational activities

& goals

PRIMARY CARE OF AMERICA REPORTING PROGRAMS 2012

Programs/ Initiatives Customers Reporting Required Task Manager

UDS HRSA/ CMS Annual Table Dr. Nash (CMO)

BS - Population Stanford Hospital

HEALTHY People 2020 HHS/CMS No

WE CARE San Mateo

County DOH

On going claims Richard/ Billing

PCMH/PCHH NCQA

Payers

6 standards/ 3yrs

Meaningful Use The Fed 20 Measures (15

Core, 5 menu)

#1. Organize All Current Activities

Steps to aligning

organizational activities

& goals

#2. Detail the Initiatives & Activities

#2. Detail the Initiatives & Activities

PRIMARY CARE OF AMERICA REPORTING PROGRAMS 2012

Programs/ Initiatives

Customers Reporting Required

Manager

UDS HRSA Annual Clinical

Director

What is required for you

to report annually?

PRIMARY CARE OF AMERICA REPORTING PROGRAMS 2012

UDS Description

UDS-Table 3A

Patients by

Age & Gender

Unique patients by age group & gender that have had at least 1 encounter

UDS- Table 3B

Patients by

race/ ethnicity/

language

Unique patients by race/ ethnicity/ language that have had at least one encounter

UDS- Table 4 Socioeconomic

Characteristics

1.Income as a percent of Poverty Level 2.Principal third party med Ins

What is required for you

to report annually? #2. Detail the Initiatives & Activities

Steps to aligning

organizational activities

& goals

#3. Assess their successes…

#3. Assess their successes…

Steps to aligning

organizational activities

& goals

#4. Prioritize the activities (categorize)

#4. Prioritize the activities (categorize)

• Not Important / Voluntary

• Important/Voluntary

• Mandatory/ As per Board leadership

• Mandatory (related to funding)

I

UDS

II

DRP

IV

Healthy People 2020

III

WE Care

Now look at that new

project…

PCMH

Time for some “Critical Thinking…”

What is PCMH

What is required of us

Who (in our org.) will need to

participate

What does it yield our organization

Do we have the capacity to perform

the required tasks

Now… Refer back the aligning priorities steps

Go to step #2

Detail the Initiative

Crosswalking the initiative can help you draw upon similarities in

varying programs

Deborah Johnson Ingram Primary Care Development Corp 22 Cortlandt Street New York, New York 10007 Phone 212-437-3935 Mobile 917-270-4033 djingram@pcdc.org

Deborah Johnson Ingram is a Health Care Quality Improvement Specialist and Senior Program Manager with Primary Care Development Corporation (PCDC) in NYC. As a subject matter expert in practice transformation and patient centered medical home, she’s been able to share her expertise and consult with a variety of health care organizations to achieve NCQA PCMH Recognition across the country. In addition, with the finalization of the Stage 1 CMS’s EMR Meaningful Use (MU) rules, Deborah also consults on achieving both MU and PCMH 2011 simultaneously. She has more than fifteen years’ experience in Health Care Quality Improvement and six years experience in EMR implementation in both small and large private practice settings. Deborah was recently published in HIMSS’ recent book Medical Informatics, An Executive Primer: Second Edition.