ConnectedCareOverview_FinalJuly23

Patient-Centered Connected
CareTM Recognition
July 2015
©Copyright National Committee for Quality Assurance. Do not alter.
Introduction to Patient-Centered Connected
CareTM Recognition
One Day In-Person Seminar
Date: December 16, 2015
Location: Washington, DC
http://pages.ncqa.org/edupccc
©Copyright National Committee for Quality Assurance. Do not alter.
Celebrating 25 Years of Quality!
Quality Talks 11/9/15
©Copyright National Committee for Quality Assurance. Do not alter.
PCMH 2014
NCQA Provider-Based Quality Programs
Improve healthcare quality through transparency,
measurement and accountability.
Accountable Care Organization
Accreditation
Diabetes Recognition Program
Heart/Stroke Recognition Program
Patient-Centered Medical Home Recognition
Patient-Centered Specialty Practice Recognition
Patient-Centered Connected CareTM Recognition
©Copyright National Committee for Quality Assurance. Do not alter.
PCMH 2014
Programs
For Providers
For Payers/
Delegated Entities
For Government
• PCMH Recognition
• Patient-Centered
Specialty Practice
Recognition
• Patient-Centered
Connected Care
Recognition
• Diabetes Recognition
• Heart/Stroke
Recognition
• Health Plan
Accreditation
• HEDIS®
Measurement
• Quality
Improvement tools
• Other accreditation
programs (case
management,
disease
management, etc.)
• Quality
measurement
• Recognition
programs to
evaluate practices
• Accreditation
programs for
health plans
©Copyright National Committee for Quality Assurance. Do not alter.
Delivery System Changes
PCP
SPECIALIST/
SUBSPECIALIST
PHARMACY
PATIENT
HOSPITAL
OTHER
CARE SITE
©Copyright National Committee for Quality Assurance. Do not alter.
CAREGIVER/
FAMILY
PCMH Recognition Program
Principles were developed,
but interpretation of what
they meant was loose and
inconsistent.
Direction was needed.
NCQA worked with
clinicians and associations
to develop an evaluation
program with sets of
standards and processes
that put structure around
what the medical home
model should be.
This led to the NCQA
PCMH Recognition
Program, which evaluates
whether a site follows
these best practices and
standards.
©Copyright National Committee for Quality Assurance. Do not alter.
Industry trends in PCMH
• Triple Aim: Improve cost, quality, patient
experience
• Population health management
• Integrated care: How can fragmentation be
reduced?
• Care transitions and self-care support
• Movement toward a value-based model
©Copyright National Committee for Quality Assurance. Do not alter.
PCMH 2014
PCMH Standards
1)
Enhance Access and Continuity (10)
A) *Patient-Centered Appointment Access
B) 24/7 Access to Clinical Advice
C) Electronic Access
2) Team-Based Care (12)
A) Continuity
B) Medical Home Responsibilities
C) Culturally and Linguistically Appropriate Services
D) *The Practice Team
3) Identify and Manage Patient Populations (20)
A) Patient Information
B) Clinical Data
C) Comprehensive Health Assessment
D) *Use Data for Population Management
E) Implement Evidence-Based Decision Support
4) Plan and Manage Care (20)
A) Identify Patients for Care Management
B) *Care Planning and Self-Care Support
C) Medication Management
D) Use Electronic Prescribing
E) Support Self-Care and Shared Decision Making
5)
6)
Track and Coordinate Care (18)
A) Test Tracking and Follow-Up
B) *Referral Tracking and Follow-Up
C) Coordinate Care Transitions
Performance Measurement and
Quality Improvement (20)
A) Measure Clinical Quality
Performance
B) Measure Resource Use and Care
Coordination
C) Measure Patient/Family Experience
D) *Implement Continuous Quality
Improvement
E) Demonstrate Continuous Quality
Improvement
F) Report Performance
G) Use Certified EHR Technology
*Indicates Must Pass Element
©Copyright National Committee for Quality Assurance. Do not alter.
PCMH 2014
System-Wide Needs
• Moving the needle requires a shared
commitment
• For example:
• Average Medicare beneficiary:
– Sees 7 physicians per year.
– Fills 20+ prescriptions per
year.
– Has an average of 2 referrals
per year.
Integration of care is vital for
whole-person care
Foy, R., Hempel, S., Rubenstein, L., Suttorp, M., Seelig, M., Shanman, R., Shekelle, P.G. (2010).
Meta-analysis: effect of interactive communication between collaborating primary care
physicians and specialists. Annals of Internal Medicine, 152 (4), 247-258.
©Copyright National Committee for Quality Assurance. Do not alter.
Building From the
Patient Centered Medical Home
• Effective collaborative arrangements may result in significant return
on investment1
• Communicating information for shared patient populations results in
better care2
• Most states and many payers are leveraging the patient-centered
medical home (PCMH) model to improve integration3
• Patients may visit sites other than a primary care office for
convenience, because they are seeking care after their primary care
physician’s office hours because they do not have a primary care
provider4
1Foy,
2Shih,
R., Hempel, S., Rubenstein, L., Suttorp, M., Seelig, M., Shanman, R., Shekelle, P.G. (2010). Metaanalysis: effect of interactive communication between collaborating primary care physicians and specialists. Annals of Internal Medicine, 152 (4), 247-258.
A., Davis, K., Schoenbaum, S., Hauthier, A., Nuzum, R., McCarthy, D. (2008) Organizing the U.S. health care delivery system for high
M., Gibson, L., Buelt, L., Grundy, P., & Grumbach, K. (2015). The patient-centered medical home’s impact on cost and quality, reviewof evidence, 2013-2014
4Tu, H., Cohen, G. (2008). Checking up on retail-based health clinics: Is the Boom Ending? Retrieved April 6, 2015 from
http://www.commonwealthfund.org/usr_doc/Tu_checkinguponretail-basedhltclinics_1199_ib.pdf
3Nielsen,
©Copyright National Committee for Quality Assurance. Do not alter.
Atul Gawande
on Fragmented Care…..
….”pieces of [care]
don’t fit together”
because we haven’t
turned [care] into a
system, a team of
capabilities, of people
with their capabilities….”
- Atul Gawande at NCQA 2012
Health Quality Awards
©Copyright National Committee for Quality Assurance. Do not alter.
NCQA Medical Home
Neighborhood Programs
• Patient-Centered Medical Home Recognition is the
foundation of effective healthcare delivery emphasizing
“whole person” care
• Patient-Centered Specialty Practice Recognition
emphasizes care coordination
• Accountable Care Organization Accreditation is
based on PCMHs, but PCSPs and Patient-Centered
Connected Care sites are also key components of
a network or payment strategy
• Patient-Centered Connected Care Recognition
emphasizes communication and connectivity
©Copyright National Committee for Quality Assurance. Do not alter.
Eligibility
©Copyright National Committee for Quality Assurance. Do not alter.
Scoring & Recognition Structure
PCMH & PCSP
• 3 YR Recognition
• 3 Recognition Levels
• Report patient data at individual clinician and
site level
Patient-Centered Connected CareTM
• 3 YR Recognition
• 1 Recognition Level
• Report patient data at the site level only
©Copyright National Committee for Quality Assurance. Do not alter.
Patient-Centered Connected Care:
Standards Overview
• Standard 1 Connecting With Primary Care: The site
connects with and shares information with patients’ primary
care practitioners.
Element A: Connecting Patients With Primary Care (Must-Pass)
9.00
points
Element B: Sharing Information With Primary Care
7.50
points
Element C: Demonstrating Information Sharing (Must-Pass)
4.50
points
Element D: Working With Primary Care
4.50
points
Element E: Coordination With Primary Care
4.50
points
©Copyright National Committee for Quality Assurance. Do not alter.
Patient-Centered Connected Care:
Standards Overview
• Standard 2 Identifying Patient Needs: The site triages
patients to appropriate providers, when necessary.
©Copyright National Committee for Quality Assurance. Do not alter.
Patient-Centered Connected Care:
Standards Overview
• Standard 3 Patient Care and
Support: The site uses evidencebased decision support in care
delivery, patient collaboration, and
culturally and linguistically appropriate
services.
©Copyright National Committee for Quality Assurance. Do not alter.
Patient-Centered Connected Care:
Standards Overview
• Standard 4 System Capabilities: The site uses electronic
systems to collect data and execute specific tasks.
©Copyright National Committee for Quality Assurance. Do not alter.
Patient-Centered Connected Care:
Standards Overview
• Standard 5 Measure and Improve Performance: The site
performs quality improvement activities designed to measure
performance
©Copyright National Committee for Quality Assurance. Do not alter.
Clinical Program Goals
• Better outcomes. Create healthier patients by working within
the medical home neighborhood model of care, which has been
shown to reduce healthcare costs and result in better outcomes
for patients
• Happier patients. Provide a better patient experience by
connecting patients to the right resources, at the right time
• Improved operations. Enhance current processes and
procedures by evaluating them against best practices and
striving for continuous improvement
©Copyright National Committee for Quality Assurance. Do not alter.
Additional Benefits
• Demonstrate value. Public and private payers are looking for cost
containment and quality improvement activities that reduce
fragmentation to be used in value-based benefit design.
• Increase referrals. Demonstrate to PCP practices that you are
ready to be effective partners in caring for shared patients
• Market to patients. Leverage NCQA seal and validation to
demonstrate to patients you are a trusted source for their care
(benefits for marketing your business)
• Elevate your reputation. You’ll gain national exposure as a firstmover into an unchartered program devised by a leader in
development of nationally endorsed quality programs
©Copyright National Committee for Quality Assurance. Do not alter.
Patient-Centered Connected Care
First-Movers
Affinity Health Group, LLC dba Affinity Health Management
Center
Greater Lawrence Family Health Center SBHCs
Immediate Care of Southern New Hampshire
Alcester Chiropractic
Indiana Army National Guard
Arkfeld Advanced Chiropractic, LLC
InterMed, P.A.
Brookings Chiropractic Center
Konstant Chiropractic Clinic
CVFP Immediate Care Division
Madison Chiropractic Center, PC
Children’s Hospital of Wisconsin
MEDCare Urgent Care
Cigna Corporation
Mitchell Chiropractic & Acupuncture Center, PC
CityMD
Northeast GA Physician Group; PM Pediatrics
Coram-Selden Chiropractic
Prevea Health
CoxHealth
Dr. Roger D. Prill Jr & Dr. Craig A. Pickart
Sandia National Laboratories Health, Benefits & Employee
Services
Dr. Elizabeth C. McMunn, OD
Summit Orthopedic Home Care
First Chiropractic Center (FCC)
Urban Health Plan SBHC
Fogel Chiropractic Clinics
Watson Clinic
Foot and Ankle Specialists of the Mid-Atlantic
WellSpan Medical Group
Forest Hill Rehabilitation Center
Whittier Street Health Center
Yalich Clinic
©Copyright National Committee for Quality Assurance. Do not alter.
Thank You
Questions?
Call 202-719-0447
©Copyright National Committee for Quality Assurance. Do not alter.