applying ncqa ppc pcmh standards to primary care and behavioral health n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Applying NCQA PPC-PCMH Standards to Primary Care and Behavioral Health PowerPoint Presentation
Download Presentation
Applying NCQA PPC-PCMH Standards to Primary Care and Behavioral Health

Loading in 2 Seconds...

play fullscreen
1 / 35

Applying NCQA PPC-PCMH Standards to Primary Care and Behavioral Health - PowerPoint PPT Presentation


  • 155 Views
  • Uploaded on

Applying NCQA PPC-PCMH Standards to Primary Care and Behavioral Health. Maria Ludwick, MPH Harold Pincus, MD. Agenda. PCASG Quality Improvement Program NCQA Patient Centered Medical Home Basics Adaptation to PC - BH Gaps in Implementation Strategies to Fill the Gap

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Applying NCQA PPC-PCMH Standards to Primary Care and Behavioral Health' - cynara


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
applying ncqa ppc pcmh standards to primary care and behavioral health
Applying NCQA PPC-PCMH Standards to Primary Care and Behavioral Health

Maria Ludwick, MPH

Harold Pincus, MD

agenda
Agenda
  • PCASG Quality Improvement Program
  • NCQA Patient Centered Medical Home Basics
  • Adaptation to PC - BH
  • Gaps in Implementation
  • Strategies to Fill the Gap

Note: This is a participatory session

goals for the primary care access and stabilization grant
Goals for the Primary Care Access and Stabilization Grant

Increase access to care on a population basis

Develop sustainable business entities

Provide evidenced based, quality health care

Develop an organized system of care

pcasg quality improvement program
PCASG Quality Improvement Program
  • Interprets NoA requirement for a quality improvement

program at the grantee level

  • Approved by CMS in June 2008
  • Outlines a uniform set of quality standards
    • Minimum quality requirements
    • Optional incentive payment program
  • Encourages maximum participation
  • Based on National Committee for Quality Assurance (NCQA) Physician Practice Connections – Patient Centered Medical Home
why ncqa ppc pcmh
Why NCQA PPC-PCMH?
  • Widely recognized for health care quality standards
  • Received input from a variety of stakeholders e.g. professional organizations, insurers, and patient advocacy groups
  • Standards emphasize use of systematic, patient-centered, coordinated care management processes
  • Reinforces partnerships between individual patients, and their personal physicians, and when appropriate, the family
  • Uses of registries, care coordination, information technology, and other means to assure patients have the right care when they need it
  • Standardized survey tool & methodology enables equitable distribution of PCASG funds
  • Encourages grantees to seek NCQA recognition
slide6
5% of PCASG grant funds available for QIP ($3.85M)

3 opportunities (March, June and Dec 09)

~$1.283M each payment

Round One Awards Ranged from $67k-$135k

Three Payment Tiers

Based on NCQA levels but less stringent

Graduated tiers/Graduated payments

Half of an organization’s eligible service delivery sites must pass to obtain a specific tier

Optional Quality Incentive Payment (QIP)

ppc patient centered medical home basics
PPC-Patient Centered Medical Home Basics
  • Measures evaluate:
    • Use of systems
    • Effectiveness in prevention
    • Management of chronic illness and patient safety
  • Measures are “actionable” at practice level
  • Measures are validated by relating them to performance

Score is based on:

    • Responses in Web-based Survey Tool
    • Supporting documentation attached to Survey Tool
    • Each element specifies type of documentation: Reports; Documented processes; Records or files
data sources guidance
Data Sources & Guidance
  • Data sources and documentation are required
  • Each element indicate type of HIT required to perform functions
    • Basic – (HIT) Basic
      • Paper-based or administrative electronic system
    • Intermediate – (HIT) Intermediate
      • Electronic system for clinical functions
    • Advanced – (HIT) Advanced
      • Electronic system for connectivity or interoperability

Practices can achieve a passing score on All Must Pass Elements with Basic Health Information Technology

ppc pcmh content and scoring
PPC-PCMH Content and Scoring

**Must Pass Elements

ncqa ppc pcmh requirements must pass criteria
NCQA PPC – PCMH Requirements: Must pass criteria

1A – Written standards for patient access

1B – Data to show it meets access standards

2D – Use charting tools to organize clinical info

2E – Data to identify 3 important conditions

3A – EBG for 3 conditions – 2 to pass

4B – Supports patient self management

6A – Test tracking

7A – Referral tracking

8A – Measure performance

8C – Report performance

slide11

Evidence-Based Chronic (Planned) Care Approaches for Treating Depression Are Effective

Community

Health System

Resources and Policies

Health Care Organization

ClinicalInformationSystems

Self-Management Support

DeliverySystem

Design

Decision

Support

Productive Interactions

Patient-Centered Coordinated

Timely and Evidence- Efficient Based and Safe

Informed, Empowered

Patient and Family

Prepared, Proactive

Practice Team

Improved Outcomes

chronic disease clinical models
Chronic Disease Clinical Models
  • Hypertension
  • Congestive heart failure (CHF)/Coronary artery disease (CAD)
  • Stroke
  • COPD (Chronic Obstructive Pulmonary Disease)
  • DM (Disease Management)
  • Asthma
  • Multiple comorbidities
  • Transitional care management
slide13

Depression Clinical Models

  • Chronic (planned) care model – Wagner
  • Collaborative care – Katon
  • Partners in Care (AHRQ) – Wells
  • PROSPECT – Alexopoulous, Katz, Reynolds
  • Telephone care management – Simon, Hunkeler
  • IMPACT (Hartford) – Unutzer
  • RESPECT (MacArthur) – Dietrich
  • Quality Improvement for Depression (NIMH) – Rost, Ford, Rubenstein
  • Child models – Campo, Asarnow, GLAD-PC
  • Other models for anxiety/PTSD
leadership
Leadership

A Clinical Framework for Depression Treatment in Primary Care; Psychiatric Annals 32:9; September 2002

delivery system design
Delivery System Design

A Clinical Framework for Depression Treatment in Primary Care; Psychiatric Annals 32:9; September 2002

clinical information system
Clinical Information System

A Clinical Framework for Depression Treatment in Primary Care; Psychiatric Annals 32:9; September 2002

decision support
Decision Support

A Clinical Framework for Depression Treatment in Primary Care; Psychiatric Annals 32:9; September 2002

self management support
Self-Management Support

A Clinical Framework for Depression Treatment in Primary Care; Psychiatric Annals 32:9; September 2002

functions of care managers
Functions of Care Managers

A Clinical Framework for Depression Treatment in Primary Care; Psychiatric Annals 32:9; September 2002

functions of care managers1
Functions of Care Managers

A Clinical Framework for Depression Treatment in Primary Care; Psychiatric Annals 32:9; September 2002

slide23

Phases of Depression Treatment

Recovery

Remission

Relapse

Recurrence

No Depression

Response

Symptoms

Syndrome

Treatment Phases

Acute

Continuation

Maintenance

Kupfer DJ. J Clin Psychiatry. 52(5s):28-34,1991.

top ten issues
Top Ten Issues

General Health/Mental Health Relationships

  • Partnerships
  • Formalize
  • Accountability
  • Referral
  • Consultation/Evaluation
  • Information Flow
  • Money
  • Quid Pro Quo
  • Maintenance
  • Generalize
gaps 1
Gaps (1)

Participant comments

NCQA Reports

where qip participants did well
Where QIP Participants Did Well

* PCASG Quality Minimum Requirement

behavioral health organizations challenges successes
Successes

Reporting on Access & Communication

Charting Tools

Care Management

Challenges

Clinical Data

System for Population Management

Self Management Support

Test Tracking

Behavioral Health Organizations Challenges & Successes
primary care organizations challenges successes
Successes

Processes for Access & Communications

Charting Tools

Challenges

Reporting on Access & Communication

Clinical Data Systems

System for Population Management

Care Management

Continuity of Care

Self Management Support

Test Tracking

Primary Care Organizations Challenges & Successes
gaps 2
Gaps (2)

Organizing care management

Tasks/Roles/People

Incorporating self management

Disease registries

Referral tracking

Communication/HIPAA

Test tracking

Guideline-based reminders

Using data for QI

Continuity of care

Anticipation of needs

care management functions
Care Management Functions

Patient engagement/rapport

Screening/Assessment

Education/Planning

Self management support

Clinical monitoring/Tracking

Reminders (patient/provider)

Accessing resources/referrals

Coordination/Continuity

Problem solving/counseling/therapy

top ten issues1
Top Ten Issues

General Health/Mental Health Relationships

  • Partnerships
  • Formalize
  • Accountability
  • Referral
  • Consultation/Evaluation
  • Information Flow
  • Money
  • Quid Pro Quo
  • Maintenance
  • Generalize