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Health Home Series:Patient-Centered MedicalHome andMeaningful UsePresenters:Christine Stroebel, MPH, PCIP/NYC REACHNatalie Fuentes, MPH, PCIP/NYC REACHAlan Silver, MD, MPH/IPROMarch 27, 2012, 2:00 – 4:30PMPrimary CareInformation Project1

Learning ObjectivesBy the end of the workshop, participants will be able to:1. Describe the difference between Patient-Centered MedicalHomes (PCMH) and Health Homes (HH) and how they arealigned.2. Identify the main areas of PCMH alignment with MeaningfulUse (MU).3. Describe Stage 1 Meaningful Use and summarize keychanges of Stage 2.4. Access resources for further information and technicalassistance.Primary CareInformation Project2

AgendaAlignment of HH, PCMH and MUPCMHMeaningful UseResourcesPrimary CareInformation Project3

PCMH and Health Homes AlignmentPatient-Centered Medical HomeA model for care that seeks to strengthen the physician-patientrelationship by replacing episodic care with coordinated care. Thephysician-led care team is responsible for coordinating all of theindividual's health care needs, and arranges for appropriate care withother qualified physicians and support services.Health HomeA model of service delivery expands on the PCMH model to buildlinkages to other community and social supports, and to enhancecoordination of medical and behavioral health care, with the mainfocus on the needs of persons with multiple chronic illnesses orsignificant behavioral conditions.Primary CareInformation Project4

PCMH and Health Homes AlignmentHealth Homes and PCMHRequire health information technology to coordinate patient caree.g., patient portal, provider-to-provider portal, RHIOHealth Homes:1. attest to participation in a RHIO/Qualified Entity,2. exchange of interoperable clinical information, certifiedEHRs,3. clinical decision support, and4. follow statewide policy guidance for interoperable HIE by 18months of program initiation.Primary CareInformation Project5

PCMH and Health Homes AlignmentHealth Homes(6 core services)Comprehensive caremanagementPCMH 2011 StandardsMeaningful Use/HIT - selected examplesStandard 1Enhance Access/ContinuityStandard 2Identify and manage patient populationsStandard 3Plan and manage careStandard 6Measure and improve performanceSearchable electronic systemStandard 4Provide self-care and community resourcesStandard 5Track and coordinate careStandard 6Measure and improve performanceProvider-to-provider portalStandard 5Track and coordinate careStandard 6Measure and improve performanceTransition of care summaryPatient and family supportStandard 4Provide self-care and community resourcesStandard 6Measure and improve performanceProvide patients with access to their health informationReferral to community andsocial support servicesStandard 4Provide self-care and community resourcesUsing EHR technology for patient-specific resourcesUse of HIT to link servicesStandards 1 – 6P2P; RHIO; Using EHR technology for patient-specificresourcesCare coordination andhealth promotionTransitional care, includingfollow-up carePrimary CareInformation ProjectCPOE; ePrescribingClinical decision support systems; Active medication list;medication allergy list; up-to-date problem listRHIOElectronic system for patient reminders for preventive orfollow up careMedication reconciliation between care settingsRHIO6

Meaningful Use &NCQA PCMH 2011Core SetMenu SetMeaningfulUse Objectives15 core objectives5 of 10menu set objectivesClinicalQuality Metrics3 core metrics, or3 alternate core metrics3 of 38menu set metrics All fifteen core objectives map to NCQA PCMH 2011 scoring All ten menu objectives map to NCQA PCMH 2011 scoring Depending upon a practice’s choice of NCQA clinicalconditions, preventive & chronic services- many of the MUquality metrics will fulfill NCQA PCMH 2011 requirements7Primary CareInformation Project7

AgendaAlignment of HH, PCMH, and MUPatient-Centered Medical HomeMeaningful UseResourcesPrimary CareInformation Project8

Patient Centered Medical HomePatient Centered NATION OF CARE“There is a clear consensus that primary care needs to be at the center of a reformed US health caresystem. The Patient-centered Medical Home (PCMH) has emerged as the key strategy for the redesign ofprimary care. The PCMH model builds upon the core concepts of primary care that include accessible,accountable, coordinated, comprehensive, and continuous care in a healing physician-patient relationshipover time. Added to these basic primary care concepts are features that improve quality of care, improvepatient centeredness, organize care across teams, and reform the payment system to support thisenhanced model of primary care.” 2010 Annals of Family Medicine, Inc.Primary CareInformation Project9doi: 10.1370/afm.10879

What is the Patient-Centered Medical Home (PCMH)?First described by American Academyof Pediatrics in 1967 in the context ofcoordinating care for children withspecial needsA medical home is a health caredelivery system that: Encourages patients to be activeparticipants in their own health andwell-being Is overseen by a personal physicianwho leads a medical team thatcoordinates all aspects of thepatient’s preventive-, acute-, andchronic-care needsPrimary CareInformation ProjectJoint Principles*Key Elements of a Medical Home Personal clinician Clinician-directed medical practice Whole-person orientation Care is coordinated & integrated Quality & safety are hallmarks Enhanced access Payment reform*Adopted March 2007 by American Academy ofFamily Practice (AAFP), American College ofPhysicians (ACP), American Academy of Pediatrics(AAP), and American Osteopathic Association (AOA)10

PCMH 2011 Goals1.Increase patient-centeredness2.Align the requirements with processes that improvequality and eliminate waste3.Increase the emphasis on patient feedback4.Enhance the use of clinical performance measureresults5.Integrate behaviors affecting health, mental health andsubstance abuse6.Enhance coordination of carePrimary CareInformation Project11

Variations on Description and Measurement*Assessment entitiesinclude:AAAHCAAFPCMSJoint CommissionNCQAURACVarious state departmentsof health Other NCQA is the mostrelevant to New York Focus mainly on structure(policies, procedures,technical capability) andprocess Tell us what you do, showus how you do it Clinical focus on three selfselected conditions &practice-defined group ofhigh-risk patients*Burton, RA, Devers KJ, Berensen RA, Patient-Centered Medical HomeRecognition Tools: A Comparison of Ten Surveys’ Content & OperationalDetails. Urban Institute, May 2011Primary CareInformation Project12

NCQA PCMH 2011 StructureAchievement levelsLevel 1: 35-59 points; Must-pass elements 6 of 6, with performance of at least 50%Level 2: 60-84 points; Must-pass elements 6 of 6, with performance of at least 50%Level 3: 85-100; Must-pass elements 6 of 6, with performance of at least 50%IT requirementsSteps for evaluation Basic: Requires electronic practice managementIntermediate: Requires EHR or e-prescribingAdvanced: Requires interoperable IT capabilities1.Practice conducts self-scoring assessment2.Practice completes on-line Survey Tool3.NCQA evaluates all data and documents & provides score4.At least 5% of practices receive additional, onsite audit by NCQA5.NCQA provides final information to the practice6.NCQA reports information on the practice, the providers and level of performance to NCQA & data users(health plans & physician directories) for practices that pass a levelPricing charged byNCQAInitial fee Survey Tool license - 80Initial Application fee Primary CareInformation Project 450- 2700 for 1-6 non-sponsored provider 360- 2700 for 1-6 sponsored providers13

Standard 1:Enhance Access and ContinuityIntent of StandardCorresponding Meaningful Use Measures Access during Office Hours (must pass)Core 12: Electronic Copy of Health Information Requires availability of advice afterCore 13: Clinical Visit Summaryhours*Menu 5: Timely Electronic Access to Health Electronic access to health information Culturally and Linguistically AppropriateInformationServices Team-based care; trained staffPrimary CareInformation Project14

Standard 2:Identify and Manage Patient PopulationsIntent of StandardCorresponding Meaningful Use Measures Practice has searchable electronic system:Electronic systems have searchablefields for demographic and clinicaldata; (not chart review) Patients receive comprehensive healthassessments Use data for population management(must pass) Identify patients who needservicesPrimary CareInformation ProjectCore 4:Core 5:Core 6:Core 7:Core 8:Core 9:Menu 3:Race/ethnicity/preferred languageMaintain up to date problem listActive medication listActive medication allergy listRecord vital signsRecord Smoking StatusGenerate lists of patients by specificconditionMenu 4: Send reminders for preventive/follow-upcare15

Standard 3:Plan and Manage CareIntent of StandardPracticeimplements evidence-based Correspondingguidelines Meaningful Use Measures Practice implements evidence-basedguidelines High-risk patients identified Care team performs care managementthrough pre-visit planning, developingplan and treatment goalsPrimary CareInformation ProjectCore 1: CPOECore 2: drug-drug, drug-allergy interactionchecksCore 3: eRxCore 6: Maintain active medication listCore 10: Use clinical decision supportMenu 1: Drug formulary checksMenu 7: Perform medication reconciliationbetween care settings16

Standard 4:Provide Self-Care Support and Community ResourcesIntent of StandardCorresponding Meaningful Use Measures Develop and document self-managementplans/goalsMenu 6: Use EHR to identify patient-specificeducation resources Provide self-care tools and support topatients Practice identifies and refers patients tocommunity resourcesPrimary CareInformation Project17

Standard 5:Track and Coordinate CareOverview of 2011 Standards Track, flag and follow up on labs andimaging results Track and follow-up on referrals Coordinate care received at hospitalsand other facilities/care transitionsMeaningful Use MeasuresCore 14: Capability to exchange key clinicalinformationMenu 2: Incorporate clinical lab test results intoEHR as structured dataMenu 7: Medication reconciliation performedfor patients coming from other caresettings or providerMenu 8: Provide summary of care record forpatients referred or transitioned toanother provider or settingPrimary CareInformation Project18

Standard 6:Measure and Improve PerformanceIntent of StandardCorresponding Meaningful Use Measures Core 11: Report clinical quality measures to CMS Measure preventive, chronic, andacute care; utilization affecting costs;patient experience and reportperformanceUse and monitor effectiveness ofquality improvement processMenu 9: Capability to submit electronic data toimmunization registriesMenu 10: Submit electronic syndromic surveillancedata to public health agenciesReport performancePrimary CareInformation Project19

New York State Medicaid Incentives for NCQA PCMH titutional providers) (Professionalproviders)Managed Care1* 5.50per visit 7.00per visit 2.00pmpm2 11.25per visit 14.25per visit 4.00pmpm3 16.75per visit 21.25per visit 6.00pmpmAlso Medicare and a number of NYS commercial insurance pilots**provide additional dollars to clinicians who attain NCQA PCMHrecognition. Current range is 2 to 7 per member, per month.*Medicaid payments for level 1 will end December 2012** Burke G. The Patient-Centered Medical Home: Taking a Model to Scale in New York State. 2011. United HospitalFundPrimary CareInformation Project20

Patient Centered Medical HomesPCIP practices258 sites recognizedLevel 1: 194Level 2: 1Level 3: 63PCMH Status4Pending NCQAEvaluation63Recognition Level 1 4 pending NCQA evaluation(anticipated level 3)1Recognition Level 2Recognition Level 3 194Approximately 1 million cared forat these sitesPrimary CareInformation Project212

AgendaAlignment of HH, PCMH, and MUPatient-Centered Medical HomeMeaningful UseResourcesPrimary CareInformation Project22