Person-Centered Medical Home Recognition Program

1. Person-Centered Medical Home Recognition Program

2. Connecticut Department of Social Services Presented by Community Health Network of Connecticut, Inc.

3. 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

4. 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

5. 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.

6. 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

7. 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

8. 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

9. 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. • Review the practice’s NCQA work plan to assess implementation timelines • Conduct gap analysis of the practice’s work plan • Monitor, track and assess progress of work plan to ensure practices are accomplishing PCMH/ Glide Path tasks • Provide resources and tools for NCQA recognition • Provide access to patient utilization data • Evaluate practice performance

10. 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

11. 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

12. 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

13. 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

14. 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

15. DSS PCMH Program Questions?