Download Patient Centered Medical Homes and Meaningful Use Two Birds

LPHI Regional Care Collaborative
June 17, 2014
PCMH and Meaningful Use
Alan Mitchell, PCDC
Stacey Curry, Coastal Family Health Center
Slide 1
Today’s Presentation
• Concepts: Patient Centered Medical Home/Meaningful Use
– PCMH 2011, 2014
– MU Stage 1, Stage 2
• Overlap & Gaps
• Change process: buy-in, team, challenges & solutions
• Reporting and Attesting
– Similarities
– Differences
Slide 2
Patient Centered Medical Home
• Approach to primary care focused on patient
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Access
Population Management
Care Management
Self-management
Care tracking and coordination
Quality Improvement
• NCQA, Joint Commission, URAC, others
– NCQA 2008, 2011, 2014
• Some state incentives, but not a gov’t program
Slide 3
Meaningful Use
• CMS: Electronic Health Record Incentive Program
• Phased approach to:
– Encourage adoption of EHRs
– Make “Meaningful Use” of EHRs: use to improve quality of care
– Measure health trends and quality of care nationwide
• Stages 1, 2, 3
– Adopt/Implement/Upgrade for Medicaid
– Core vs. Menu (and Clinical Quality Measures)
Slide 4
PCMH Overlap: MU Stage 1 (Core)
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Medication Orders and Interactions (3D, 3E)
Patient Education (4A2)
Demographics, Vital Signs, Smoking Status, Problem List (2A, 2B)
Clinical Decision Support (3A, others)
Clinical Quality Measures (6A)
Electronic Copy of Health Info (1C)
Clinical Visit Summaries (1C3)
Health Information Exchange (5B, 5C)
References to NCQA PCMH 2011 Elements
Slide 5
PCMH Overlap: MU Stage 1 (Menu)
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Drug formulary checks (3E)
Lab results (5A)
Patient reminders/lists/registries (2D)
Patient electronic access (1C)
Medication reconciliation (3D)
Transition of care summary (5C)
Immunization/Syndromic Surveillance (6F)
References to NCQA PCMH 2011 Elements
Slide 6
Health Center Experience
• Requirements
– Patient information and clinical data (2A, 2B)
– Med management and ePrescribing (3D, 3E)
– Test tracking (5A)
• Successes
• Challenges & Solutions
Slide 7
PCMH 2A: Patient Information
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The practice uses an electronic system that records the following as structured
(searchable) data for more than 50 percent of its patients.
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1. Date of birth
2. Gender
3. Race
4. Ethnicity
5. Preferred language
6. Telephone numbers
7. E-mail address
8. Dates of previous clinical visits
9. Legal guardian/health care proxy
10. Primary caregiver
11. Presence of advance directives (NA for pediatric practices)
12. Health insurance information
The First Five Items are MU CORE areas
Slide 8
PCMH 2A: Patient Information
• Successes
– We have a registration form/process that ensures that these items are
addressed with the patients
– We have trained our staff to make sure that this information is updated
annually
– All of our providers are well above the MU threshold with the first five factors.
• Challenges
– We have had very few challenges with this element
– Reporting on factors that are not MU Core items has been difficult in our
current system
Slide 9
PCMH 2B: Clinical Data
• The practice uses an electronic system to record the following as structured
(searchable) data.
– An up-to-date problem list with current and active diagnoses for more than 80 percent of
patients
– Allergies, including medication allergies and adverse reactions, for more than 80 percent of
patients
– Blood pressure, with the date of update for more than 50 percent of patients 2 years and older
– Height for more than 50 percent of patients 2 years and older
– Weight for more than 50 percent of patients 2 years and older
– System calculates and displays BMI (NA for pediatric practices)
– System plots and displays growth charts (length/height, weight and head circumference (less
than 2 years of age) and BMI percentile (2–20 years) (NA for adult practices)
– Status of tobacco use for patients 13 years and older for more than 50 percent of patients (NA for
pediatric practices if all patients <13 years)
– List of prescription medications with the date of updates for more than 80 percent of patients
• All of these areas are MU Core requirements
Slide 10
PCMH 2B: Clinical Data
• Successes
– We have trained our clinical staff to make sure that these areas are addressed
at each patient visit.
– All of our providers are well above the MU threshold for the reportable
factors.
– We have been able to show that our system has the capabilities for the
factors that require screenshots.
• Challenges
– We have had very few challenges with this element
Slide 11
PCMH 3D: Med management
• The practice manages medications in the following ways:
– Reviews and reconciles medications with patients/families for more than 50%
of care transitions
– Reviews and reconciles medications with patients/families for more than 80%
of care transitions
– Provides information about new prescriptions to more than 80 percent of
patients/families
– Assesses patient/family understanding of medications for more than 50
percent of patients with date of assessment
– Assesses patient response to medications and barriers to adherence for more
than 50 percent of patients with date of assessment
– Documents over-the-counter medications, herbal therapies and supplements
for more than 50 percent of patients/families, with the date of updates
Slide 12
PCMH 3E: ePrescribing
• The practice uses an electronic prescription system with the
following capabilities.
– Generates and transmits at least 40 percent of eligible prescriptions to
pharmacies
– Generates at least 75 percent of eligible prescriptions
– Enters electronic medication orders into the medical record for more than 30
percent of patients with at least one medication in their medication list
– Performs patient-specific checks for drug-drug and drug-allergy interactions
– Alerts prescribers to generic alternatives
– Alerts prescribers to formulary status
Slide 13
PCMH 3D and 3E: Med management and ePrescribing
• Successes
– Most of our providers are doing very well with the MU components of
ePrescribing
– Our current system is able to generate the needed alerts
– Our providers do very well in documenting over-the-counter medications
• Challenges
– Providers who are on the mobile units and use a wireless card have
ePrescribing limitations
– Although providers do address barriers to medication adherence and make
sure their patient understand their medication their medications, they do not
always adequately document it.
– Medication reconciliation in the current system has posed some challenges.
• Solutions
– Better training in weaker areas
– Implementation of new system
Slide 14
PCMH 5A: Test Tracking
• The practice has a documented process for and demonstrates that it:
– Tracks lab tests until results are available, flagging and following up on overdue results
– Tracks imaging tests until results are available, flagging and following up on overdue
results
– Flags abnormal lab & imaging results, bringing them to the attention of the clinician
– Notifies patients/families of normal and abnormal lab and imaging test results
– Follows up with inpatient facilities on newborn hearing and blood-spot screening
– Electronically communicates with labs to order lab & imaging tests and retrieve
results
– Electronically incorporates at least lab & imaging test results into structured fields in
medical records
Slide 15
PCMH 5A: Test Tracking
• Successes
– We have a policy in place for test/imaging tracking
– Our system allows us to track these areas
• Challenges
– Current system is limited as to what NCQA requires for this element
– We do not have consistency with tracking these elements
• Solutions
– We are in the process of implementing a new HIT system
– We will better standardize our processes and our training so that all providers
follow up in the same way
Slide 16
Gaps: MU vs PCMH 2011
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Policies and procedures (all)
Access to care (1A-G)
Comprehensive Health Assessment (2C)
Care Teams, Care Plans (1G, 3C)
Referral tracking (specialists and community) (4B, 5B)
Evidence-based guidelines in use (3A)
Transitions of care to hospital (beyond HIE) (3C)
Patient experience (6B)
QI program (6C-E)
MU: HIT privacy & security audit and plan
Slide 17
Approach to PCMH and MU
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Seek areas of overlap / identify gaps
Self-assess
Plan
Act
Change Management
• Leadership buy-in
• Identify a project lead and a clinical champion
• Organize a multidisciplinary, cross-hierarchical team
– Clinical, Operational, HIT
• Plan, communicate, train
Slide 18
Reporting/Attestation
• PCMH
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Gather evidence
Purchase “survey tools” (by June 30 for PCMH 2011!)
Upload files and submit
Recognition is per practice
• Meaningful Use
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Register with CMS and/or state Medicaid
Work with vendors to customize & ensure you’re documenting in the right place
Run reports to make sure you’re passing all measures
Manually enter data in CMS or state system (90 days or 1 year, depending)
Attestation is per provider
• Get ready for the next phase!
– Sustainability
– PCMH 2014, MU Stage 2 or 3, etc.
Slide 19
Questions and Comments
Alan Mitchell
Senior Program Manager
Primary Care Development Corp.
(212) 437-3952
[email protected]
Stacey Curry, MPH
Dir. of Clinical Quality Management
Coastal Family Health Center, Inc.
228-374-2494 Ext. 1119
[email protected]
Slide 20