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The Path to PCMH with
athenahealth
Emily Gurvis
athenaClinicals Quality Associate
Agenda
• Why PCMH?
• Becoming a PCMH
• PCMH with athenahealth
• Next Steps
• Resources
• Q&A
2
Why PCMH?
PCMH improves care coordination
4
EHR Connectivity
& Interoperability
Data Registries
Patient &
Provider Portals
Data Warehousing
& Mining
Acute Care
PHARMACY SPECIALTY CARE
PATIENT/FAMILY SUPPORTS
HOME CARE
ACUTE CARE
EMERGENCY CARE
SUPPORTIVE/PALLIATIVE
CARE
TELEHEALTH LONG TERM
CARE
Medical Home
What the Patient-Consumer Wants
5
SOURCE: 2014 Primary Care Consumer Choice Survey, Marketing and Planning Leadership Council interviews and analysis.
For patients,
access
comes first.
Service
• Provider education
on illness and
wellness
• Provider continuity
Affordability
• In-network status
• Eliminated out of
pocket charges
Access and Convenience
• Walk-in availability,
less than 30
minutes wait
• Lab tests, X-rays,
pharmacy onsite
• 24/7 access
• Same day
appointment
availability
• Geographic
proximity
6
Benefits of Becoming a PCMH
58% increase in clinician satisfaction
66% increase in staff satisfaction
11% increase in practice revenue
14% increase in clinician salaries
SOURCE: http://primarycareprogress.org/pcmh
L. M. Kern, R. V. Dhopeshwarkar, A. Edwards et al., "Patient Experience Over Time in Patient-Centered Medical Homes," American Journal of Managed Care, May 2013 19(5):403–10.
Nationwide Payer PCMH Programs
7 Source: http://www.theverdengroup.com/payer-pcmh-programs-nationwide/
8
Becoming a
PCMH
PCMH Recognition Programs
9 Source: The Urban Institute, "Patient-Centered Medical Home Recognition Tools: A Comparison of Ten Surveys' Content and Operational Details”, May 2011
NCQA PCMH Growth 2008-2013
10
SOURCE: http://www.ncqa.org/Portals/0/Events/BehindtheEnhancements_FINAL.pdf
214 1,976
7,676
16,191
24,544
34,492
28 383
1,506
3,302
5,198
6,762
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
12/31/08 12/31/09 12/31/10 12/31/11 12/31/12 12/31/13
Clinicians Sites
The ideal candidate for PCMH
11
Passionate about improving patient care
Ready to undergo change
Eligible for financial incentives
Becoming a PCMH is a 12 to 18 month
process of transformation
12
Project Management and Change Management
Documenting and implementing policies and procedures
Possible external consulting Tracking and improving on
quality measures for at least 1 year (supported in
athenaClinicals)
A variety of PCMH specific workflows and reports
(supported in athenaClinicals and athenaCommunicator)
Submitting application to NCQA
13
PCMH Recognition Through NCQA
14
Six Standards
✔
✔
✔
✔
✔
✔
1. Patient-centered Access
5. Care Coordination and Care Transitions
6. Performance Measurement and Quality Improvement
4. Care Management and Support
3. Population Health Management
2. Team-based Care
PCMH Recognition Through NCQA
15
Six “Must-Pass” Elements
✔
✔
✔
✔
✔
✔
1. Patient-Centered Appointment Access
5. Referral Tracking and Follow-Up
6. Implement Continuous Quality Improvement
4. Care Planning and Self-Care Support
3. Use Data for Population Management
2. The Practice Team (Team-Based Care)
PCMH Recognition Through NCQA
16
Three Levels of Recognition
✔
✔
✔
Level 1: 35-59 points
Level 3: 85-100 points
Level 2: 60-84 points
“The patient-centered medical home has the potential to
change the interaction between patients and physicians.
Patients can no longer be silent partners in their care— they are
active participants in managing their health with a shared goal
of staying as healthy as possible.”
-Margaret E. O’Kane, NCQA President
Scoring Breakdown
17
PCMH 2011 vs. PCMH 2014
18
Team-based care
• New standard for 2014
• Focus of the standard is about incorporating patients as a part of their own care team
Behavioral and mental health integration • Practices to maintain agreements with behavioral health
providers (Standard 5B.3) • Services related to behavioral health are communicated to the
patient
“Meaningful Use” Stage 2 alignment • 2011 PCMH had factors based on Stage 1 requirements. • The 2014 PCMH standards require adherence to and reports
under MU Stage 2 measures, which are modeled into the program built in athenaClinicals
Continuous improvement
• Practices make efforts to improve in patient experience, cost and clinical quality (the Triple Aim)
• Practices conduct activities at least annually and are subject to audit (annually is new)
Measuring Health Care Costs
• Track overuse and appropriateness
• High cost/high utilization to be considered in care management
• Annually measure or receive quantitative data affecting health-care costs
Population Management
• Increased requirement for evidence based decision support from 2011
• New is 3C Factor 10-Assessment of health literacy
• Annually, must show active outreach to patients (point of care reminders) on a scheduled basis for a specific need (3D- must pass)
Care Coordination
• Updates on how to work with specialists:
• Greater specificity in agreements between providers
• Engage patients, families on self-referrals
• Coordinate reports with referred specialists
PCMH with
athenahealth
athenahealth was first to undergo
NCQA PCMH Corporate Review
19
With our auto-credits and “practice support” points,
athenaOne clients are only 4.25 points away from
Level 3 recognition
85
35.25
45.5
0
20
40
60
80
100
Minimum amount of points
for NCQA Level 3
Practice Responsibility
4.25
athena-Enabled
Auto Credits*
NCQA
Level 1
NCQA
Level 2
*pre-validated NCQA points
*practice support
points
athenahealth PCMH
Accelerator Program
NCQA
Level 3
We also offer guidance and training
PCMH Resource Center:
o PCMH 2014 self-assessment
o Guidance materials
o Quality Management team
o athenaNet support
o Quality Management tools
Next Steps
Getting Started
22
1. Review the PCMH requirements to recognition on the NCQA website and take the PCDC Self-Assessment Tool on
their website.
2. Review the athenahealth PCMH Guide to Success document in the QMRC. Plan auto-credit eligible factor workflows and settings, accordingly.
3. Request to enroll your practice in the NCQA PCMH
Accelerator 2014 Standards Program in athenaClinicals.
4. Plan your approach to each of the standards – and auto-
credit eligible factors - that require action and explore all
options to optimize the PCMH experience.
Applying for PCMH Recognition
23
1. Work with your staff and providers on the standards and
any behavior or workflow changes required.
2. Monitor your performance using the Quality Management
Tools available in athenaClinicals.
3. Gather your results and documentation and submit a case
to the CSC to obtain the auto-credit documentation you
will need from athenahealth to apply for NCQA PCMH
Recognition with athenahealth sponsorship auto-credits.
4. Apply by sending your PCMH application, together with
your results, documentation, and athenahealth auto-credit
documentation to NCQA.
Additional
Resources
25
26
Additional Resources
27
Questions
Thank You