CHCACT Collaborative PCMH Element 1 A

1. CHCACT Collaborative PCMH Element 1 A Jaquel Patterson, N.D., Director of Operations Norwalk Community Health Center September 15, 2011

2. PCMH 1: Enhance Access and Continuity • PCMH 1A: Access During Office Hours (MUST PASS, 50%+, 2 of 4 factors met) • The practice must have written process and defined standards, and demonstrates that it monitors performance. • Policy and Reports

3. PCMH 1A: Enhance Access and Continuity PCMH 1A :General Guidelines • The patient can access the clinician and care team for routine and urgent care needs by office visit, by telephone, and through secure electronic messaging. • Patient care needs and preferences when determining urgency of patient requests for same-day access are reviewed. • Polices must be in effect for at least 3 months and demonstrate performance has been monitored.

4. PCMH 1: Enhance Access and ContinuityFactor 1 • PCMH 1A, Factor 1: Providing Same Day Appointments • Critical Factor—must be met to get any score on element • Also known as: “Open Access,” “Advanced Access,” or “Same Day-Scheduling.” • This must be based on practice triage. It does NOT include overbooked appointments. • Example: Third next available appointment (how are you accommodating to patient needs.)

5. PCMH 1: Enhance Access and Continuity: Factor 1 Resource: ProHealth

6. PCMH 1: Enhance Access and Continuity: Factor 1 Resource: ProHealth

7. PCMH 1: Enhance Access and ContinuityFactor 1 Doctor 1 Doctor 2 Doctor 3 Open Access/Same Day slots are available daily; e.g. 40-50% patient slots

8. PCMH 1: Enhance Access and ContinuityFactor 2 • PCMH 1A, Factor 2: Providing Timely Clinical Advice by Telephone During Office Hours • Clinicians return calls in a timely manner. • The practice must define the timeframe for a response and monitor timeliness of response to the practice’s standard.

9. PCMH 1: Enhance Access and ContinuityFactor 2 • Policy example Resource: ProHealth

10. PCMH 1: Enhance Access and ContinuityFactor 2 • Report that shows response times. • For example, ShorTel report that shows when calls are picked up by physician, nursing station, etc. and see how the time corresponds to policy. • Report can be system generated or collected based on minimally 5 days of calls. • Time frame must be defined and measureable.

11. PCMH 1: Enhance Access and Continuity: Factor 2 • Screenshot: Phone reports on clinician support during working hours Resource: VXTracker

12. PCMH 1: Enhance Access and ContinuityFactor 3 • PCMH 1A, Factor 3: Providing timely clinical advice by secure electronic messages during office hours. • Factors 2 and 3 are comparable. • Response time to secure electronic messages must be defined in a policy and measured accordingly to this standards. • E.g. patient portal for secure messages. Not needed to meet this must pass. 2 of 4 factors met achieve a score of 50% which is the “Must Pass” cut-off score.

13. PCMH 1: Enhance Access and ContinuityFactor 4 • PCMH 1A, Factor 4: Documenting Clinical Advice in Medical Record • Must be documented whether its by phone or secure electronic messaging. • Practice must have a documented process and provides three examples of clinical advice documented for phone or electronic messaging. A report can also be used to show how often advice is documented in record (recent 1 month period).

14. PCMH 1: Enhance Access and Continuity: Factor 4 PPC 1A, Factor 4: Documented clinical advice from phone call. Same day access booked.

15. PCMH 1: Enhance Access and Continuity: Factor 4 • Example Report

16. Summary • Make sure policies are completed at least 3 months in advance. • Monitor adherence to these policies as defined by organization. • Make sure everything is measurable and reportable. Check with system capabilities for reports or responsible team member that tracks regularly. • MUST PASS = 50%