Overview of Patient-Centered Medical Home Eileen Goode, RN BSN Clinical Programs Director 1 HRSA Expectations Quality as Recognized by: – Accreditation – Patient-Centered Medical Home Recognition 2 The Joint Commission (TJC) Accreditation Association for Ambulatory Health Care (AAAHC) National Committee for Quality Assurance (NCQA) TJC – only available with full accreditation AAAHC - only available with full accreditation CHCs and Patient Centered Medical/ Health Home Initiative PAL 2011-01: “HRSA encourages and supports health centers as they strive to continuously improve quality and tailor their care to the needs of the patients and communities that they serve. The PCMHH Initiative will allow health centers to demonstrate their leadership as providers of high-quality care”. Health Centers are encouraged to undertake & document practice changes that enable recognition from NCQA PCMH program 3 PAL 2011-01 Fee for NCQA PCMH recognition is waived Recognition as PCMH is distinct from accreditation & distinct from TJC Primary Care Home Initiative At least six months of planning is recommended – 4 Includes self-assessment to compare HC processes and practices with the standards Core Components of PCMH 1) 2) 3) 4) 5) 6) 5 Enhance access and continuity; Identify and manage patient populations; Plan and manage care; Provide self-care and community support; Track and coordinate care; and Measure and improve performance. NCQA Specifics: 6 Recognition is by site – not by Health Center organization Multi-site applications are an option but eligibility must be determined Five percent of applications are audited Recognition is granted by NCQA for a period of three (3) years Health Centers maintain recognition through the renewal survey process May increase recognition level through Add-On Process Clinical Performance Measurements Three preventive care measures Three chronic or acute care measures – 7 One condition must be related to unhealthy behavior, mental health or substance abuse (e.g. obesity, depression, smoking, alcoholism) Two utilization measures Vulnerable Population Data (AHRQ definition) – includes those at high risk for frequent hospitalizations or ED visits The Joint Commission (TJC) Primary Care Home Initiative - scheduled to launch July 2011 AHRQ Definition of Medical Home Focus – – – – 8 Access Coordinated Care Patient Centered Care Quality & Safety Bureau Expectation Reminder NCQA Patient Centered Medical Home Recognition OR Accreditation through The Joint Commission or AAAHC (w/ or w/o Medical Home designation) 9 REALITY 10 Both accreditation & NCQA recognition symbolize organization-wide quality NCQA is most recognized by payer & may be required by Medicaid in some states Some FQHCs will seek both accreditation & NCQA recognition – BPHC will pay for both Meaningful Use probably needs to come first Accountable Care Organizations are on the horizon Key to Success: Engaged Leadership 11 PCMH transformation requires the visible and sustained engagement and tangible support of a wide range of leaders within the practice. To drive and sustain PCMH transformation, leaders must provide the vision for change, help identify changes to test, and build and sustain the will within the practice for transformation. Where to Start? 12 Ask your CEO/Executive Director what your Health Center is doing about PCMH Utilize the NM Primary Care Association in providing training & technical support Learn what New Mexico Medicaid & other payers are doing Where to start? 13 Be sure your Health Center completed the Baseline NCQA Self-assessment Tool (free from the Primary Care Development Corporation) http://pcdcny.org/index.cfm?organization_id= 128§ion_id=2047&page_id=9512 Review the Self-assessment results Get involved!