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 [email protected]
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.
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