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Goals - Today participants will: Understand how PCMH is consistent with the
Missions of CHCs
Become familiar with the framework for PCMH Become familiar with PCMH standards and
scoring Understand rationale for seeking PCMH
recognition Recognize how PCMH connects to other
initiatives
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What is a PCMH? A PCMH puts patients at the
,center of the health care system and provides primary care that is
, , ,accessible continuous comprehensive- , ,family centered coordinated
,compassionate and culturally.effective
( ) American Academy of Pediatrics
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Nothing about me without me
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PCMH and the Mission of CommunityHealth CentersWe believe our community is best served by doing more
than just treating illness. Our holistic approach tohealth care includes prevention, early screening,counseling and education as well. (Our) Community Health Center promises you affordable, convenient,individualized health care provided by a qualified and caring staff. We use our talents and resources to see youthrough a lifetime of health care .
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PCMH and the Mission of CHCsOur CHC is Committed To:
Being the health care provider of choice for people of all ages
Providing high-quality care in a patient focused manner Equipping our patients with the knowledge, ability, and motivation to make healthy choices and live healthy lives
Eliminating the barriers caused by financial circumstances or social situations that may prevent people from having
access to health care Continually improving the quality of care and service we
provid e.
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PCMH and the Mission of CHCsThe mission of (Our Community Health Center)is to provide comprehensive, high qualitycompassionate medical care in the spirit of theGood Samaritan. The Center is a federallyqualified, community-based, comprehensivemedical safety net that provides access to primary healthcare services for a traditionallyunderserved population .
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Framework for PCMH
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PCMH A Historical Perspective
American Academy of Pediatrics- late 1960s Institute of Medicine- late 1990s and early 2000 Various demonstration projects- from early 2000 to
date National Committee on Quality Assurance (NCQA)Recognition - 2007
Physician Practice Connections- PatientCentered Medical Home
Development of Joint Principles- AAP, AAFP, ACP,AOA- 2007
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Joint Principles of the PCMH Personal Physician Physician Directed Medical Practice Whole Person Orientation Care is Coordinated and Integrated Quality and Safety are Hallmarks
Enhanced Access Payment Reform
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NCQA PCMH 2011 What is New? Robust patient centeredness
Strong focus on integrating behavioral healthand care management
Patient survey results drive quality improvement
Patients and families involved in quality improvement.
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PCMH -Theoretical Frameworks Chronic Care ModelClinical information systems; decision support; patient self-
management; delivery system redesign; community linkages; healthsystems
Patient Centered CareRespect patient values; accessible; family-centered; continuous;
coordinated; community linkages; compassionate; culturally appropriate; emotional support; information and education; physicalcomfort; quality improvement
Cultural CompetenceCulturally competent interactions; language services; reducing
disparities
Medical HomePersonal physician; physician directed team; whole person
orientation; care is coordinated and integrated; quality and safety;enhanced access
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NCQA PCMH Recognition Standards andScoring
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NCQA and the PCMH -NCQA developed a set of standards and a 3 tiered
. -recognition process Patient Centered Medical Home 2011 assess the extent to which health care
organizations are functioning as medical home
-Obtaining recognition via the PPC PCMH programs requires completing an application and providing adequate documentation to show evidence that specific processes and policies are in place
:Recognition is offered at three levels evel 1 Basic
evel 2 Intermedia te evel 3 Advanced
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NCQA PCMH 2011:The Standards
Six standards align with core componentsof primary care. PCMH 1 : Enhance Access and Continuity PCMH 2 : Identify and Manage Patient
Populations PCMH 3 : Plan and Manage Care PCMH 4 : Provide Self-Care and Community
Support PCMH 5 : Track and Coordinate Care PCMH 6 : Measure and Improve Performance
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NCQA PCMH Must Pass
PCMH 1 , Element A: Access During Office Hours
PCMH 2 , Element D: Use Data for Population Management
PCMH 3 , Element C: Care Management PCMH 4 , Element A: Support Self-Care ProcessPCMH 5 , Element B: Track Referrals and Follow-Up
PCMH 6 , Element C: Implement ContinuousQuality Improvement
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NCQA PCMH Scoring
Level 1: 3559 points and all 6 must-pass elements
Level 2: 5084 points and all 6 must-pass elementsLevel 3: 85100 points and all 6
must-pass elements
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Building Blocks
Level 1
Level 2
Level 3
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Building Blocks of a PCMH Personal physician
Each patient has a personal physician whoprovides first-contact, continuous, andcomprehensive care.
Team practice Personal physician leads a team of individuals at
the practice level for ongoing care andprevention.
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Building Blocks of a PCMH Coordinated care
Care is coordinated across medicalsubspecialties, hospitals, home healthagencies, and nursing homes
Care is coordinated with the patient, thepatients family, and public and private
community-based services.
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Building Blocks of a PCMH Expanded access to practitioners
Open scheduling and after-hours access topersonal physicians
After-hours access to personal physician andstaff by telephone and through secure e-mail.
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Building Blocks of a PCMH Payment Reform
Targeted financial incentives reward physiciansand providers for supporting medical homefeatures, including additional payments forachieving cost savings and measureable andcontinuous quality improvement
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Rationale
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Rationale for Obtaining PCMHRecognition Address the Burden of Chronic Disease
50% of Americans live with one or more chronic
conditions and only 54% of chronically ill adultpatients receive recommended care Over 60% of patients are non-compliant Experts estimate 20-50% of U.S. health care spending
produces no benefit to patients and potential
harm Health costs in the United States are growing fasterthan employee wages and the economy at large.
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Rationale for Obtaining PCMHRecognition
Blueprint for transforming health care delivery
Allows CHCs to assess strengths andachievements Allows CHCs to recognize areas for
improvement
q
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q Rationale for Obtaining PCMHRecognition Address High Health Care Costs
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P 4 P
CMeaningful Use
H DS
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PCMH as the Key
Access and Continuity Manage PatientPopulations
Plan and Manage Care Self-Care and
Community Support Track and Coordinate
Care Measure and Improve
Performance
Becoming leadersin Health Quality
M/U
HITECHIncentives
UDS
P4P
ACO
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PCMH and UDS UDS and PCMH
Identify and track patient populations
Collect and report demographics Identify patients with specific conditions Identify patients for proactive reminders
(preventive or follow-up care).
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Recommendations of Special Commission onthe Health Care Payment System
Development of Accountable Care Organizations (ACOs)composed of hospitals, CHCs, physicians and/or otherproviders that accept responsibility for all of most of
the care that enrollees need Patient-Centered Medicaid Home (PCMH) ACOs toundergo the necessary practice redesign to becomeeffective PCMHs
Patients selection of a primary care provider will directinsurer payments to the ACO with which the patientsprimary care physician is affiliated
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Recommendations of Special Commission onthe Health Care Payment System Use of Pay-For-Performance (P4P)
incentives to ensure appropriate access tocare, and encourage quality improvementand care coordination among providers
Global payments will be adjusted to reflect
patient demographics and healthconditions
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Potential Reimbursement for PCMH Private Insurance
Blue Cross/Blue Shield SC PCMH initiative
Medicare Demonstration pilots
Medicaid Managed care reimbursement based on
performance and outcomes
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PCMH: Return on Investment Improvement in quality and equity Improved patient
/satisfaction compliance /Provider staff satisfaction Helps attract new business
Recognized leader among peers Eligibility for P4P
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PCMH Building Blocks
Patient Experience
Quality
Health Information Technology Practice Organization
PCMH
CommunityHealthCen
ters
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Transformation to a Medical Home
Patient ExperienceQuality
Health Information TechnologyPractice Organization
PCMH
Community Health Centers
Adapted from American Academy of Family Practice PCMH web page
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Next Steps Webinar Series Presentation to Board of Directors, CHC
Management and Others Pre-conference for Medical Directors at June2011 Clinical Network Retreat
CHCs conduct self-assessment
Identify cohort of CHCs ready to move forward Utilize a collaborative model for training Participate in the HRSA Bureau of Primary
Health Care PCMH Initiative
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Are you ready? Are you able to pull together a team of 4-5 staff
including management, a provider, other
clinical team member, an administrative staff member and others appropriate for your CHC? Do you have electronic health records? Do you have support from the top down and the
bottom up willing to work to meet thestandards?