Person-Centered Medical Home Recognition Program Connecticut Department of Social Services Presented by Community Health Network of Connecticut, Inc. Person-Centered Medical Home Recognition Program What is a Person-Centered Medical Home?  A Person-Centered Medical Home is a Practice that places the patient at the center of the health care system, and provides primary care that is “accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.”  The patient has a personal relationship with the provider/care team. The care team knows the patient and their health care needs.  A method to merge modern technology with traditional primary care What are the benefits of a PCMH?  Financial Incentives  Improved staff morale: Provider champion leads Care Team  Improved patient satisfaction: Patient has a personal relationship with Provider and Care Team  Embraces quality improvement and improves patient outcomes NCQA Chosen for PCMH Recognition  During PCMH program development at the state level, the committee evaluated a number of PCMH Recognition Programs.  It was determined that the National Committee for Quality Assurance (NCQA) PCMH program of recognition would be the one that the Department of DSS would use for their program.  It was decided that only Levels 2 or 3 would be recognized by DSS. Level 1 NCQA PCMH recognition requires participation in the Glide Path Process. Eligibility to Become A PCMH in CT • NCQA recognized, Level 2 or 3 • Not recognized or Level 1 – with completed PCMH & Glide Path Application • Enrolled as CMAP provider (CT Medical Assistance Program) • Active unrestricted CT license as MD, DO, NP or PA. • Function as PCP with panel of patients • Provide primary care services for at least 60% of the time across all payers Eligibility (continued) • Share all medical records within the practice and use the same system support for all clinical and administrative service • Meet State/Federal requirements for EPSDT, Smoking Cessation (R2Q), addressing Racial and Ethnic Disparities, and Adherence to Consumer Protections • Will not require APRN and PA practitioners to have their own panel of patients to qualify as PCMH providers if they are serving to support or extend the panel of a primary care physician Glide Path Process  Submit state PCMH application  Agree to Glide Path milestones/timeframes  Demonstrate progress toward NCQA PCMH recognition  Complete Gap Analysis (practice’s ability to substantiate compliance with standards contained in NCQA PCMH application)  Complete Work Plan (contained in Glide Path Application)  Provide ongoing documentation in accordance with established Work Plan Practice Transformation Supports  The ASO’s Community Practice Transformation team, comprised of RNs, APRNs, JD, MPH and other professionals, are dedicated to support PCMH/Glide Path practices.  The team is specially trained to assist Primary Care Practices to make meaningful changes designed to improve patient outcomes. o Review the practice’s NCQA work plan to assess implementation timelines o Conduct gap analysis of the practice’s work plan o Monitor, track and assess progress of work plan to ensure practices are accomplishing PCMH/ Glide Path tasks o Provide resources and tools for NCQA recognition o Provide access to patient utilization data o Evaluate practice performance How to Start • Form PCMH Core Teams with a clinical lead, administrative personnel, ancillary staff (3-4 people) • NCQA: (888) 275-7586, Monday through Friday from 8:30 a.m. to 5 p.m. • http://www.ncqa.org/tabid/631/Default.aspx • Download NCQA 2011 Standards • Training Calendar – participate in workshops, Web Ex • On-Boarding Guide Multi-Site/Single Site • NCQA Recognition Process, brochure, scoring NCQA  NCQA – Get free online application account  “Free” one for all sites  Submit Multi-Site Eligibility  NCQA will schedule a personal conference call.  They will walk you through Multi-Site Process.  Focus on 6 NCQA Must Pass Elements  NCQA Standard 1G – correlates with 1D of Glide Path NCQA (continued)  Develop Care Teams (MD, APRN, PA, DO, nurse, care coordinator, MA, receptionist)  Need Physician champion  Identify populations you will be managing – Need to have three months worth of data  Policies and procedures, job descriptions need to be in place at least three months prior to NCQA submission CT DSS PCMH/Glide Path  Develop your work plan  When do you plan to submit to NCQA?  Submit PCMH/Glide Path Accordingly  Start to develop job descriptions, policies  Educate staff on PCMH, keep a log of education activities  Determine populations you will manage/track Resources  www.ncqa.org   www.huskyhealth.com  “For Provider” tab  “Pathways to PCMH”  2 Introductory Webinars on PCMH www.chnct.org  www.cms.gov  www.pcpcc.org  www.ahrq.gov DSS PCMH Program Questions?