The National Committee for Quality Assurance (NCQA) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) are two nonprofit review organizations you should be aware of, as they provide the lion share of accreditations within the healthcare industry and provide valuable information about PPO's, HMO's, hospitals and other healthcare providers. Every so often, we update our standards and guidelines to clarify guidance, revise resources and refine expectations. Please use the links below to access tools introduced during the training. Knowing and Managing Your Patients (KM). NCQA Patient-Centered Medical Home (PCMH) Standards and Guidelines (Version 7) EFFECTIVE FOR PRACTICES ENROLLING JANUARY 1, 2022 ONWARD. For full program requirements and specifics, please refer to the NCQA Access and Continuity *A. NCQAs Patient-Centered Medical Home (PCMH) 2011 March 28, 2011 Another of the PCMH programs strengths is that it clearly communicates an action plan for becoming a patient-centered medical home. The APC Milestone Code Locator, at the end of the Crosswalk document identifies where information is located in the APC Technical Specifications document. The Joint Commission and the Centers for Medicare and Medicaid Services followed with requirements for healthcare facilities to collect and report performance data. The program CHARTING A COURSE FOR NCQA 2017 PCMH RECOGNITION This in-depth training focused on transforming your practice using the NCQA PCMH standards and the redesigned 2017 PCMH assessment process and ways to effectively transition from the 2014 standards. The Vermont Blueprint for Health is a state led program which aims to integrate a system of health care for patients, improve the health of the overall population, and improve control over health care costs by promoting health maintenance, prevention, and care coordination and management. Foundational Concepts Team-based Care and Practice Organization (TC) Knowing and Managing Your Patients (KM) PCMH certification and recognition standards (as of January 2015) of the following three organizations: The National Committee for Quality Assurance (NCQA) The Joint Commission URAC There are two parts of the crosswalk. Advises management of changes to continuously improve content and delivery 3. 9 Patient -centered medical home demonstration: a prospective, quasi experimental, before and after evaluation. Approximately 13,000 practices (with 67,000 clinicians) are recognized by NCQA. 2017 NCQA further advanced its PCMH program through Recognition Redesign. Did you know that nurse practitioners and physician assistants are Evidence-based guidelines:at are known to be effective in improving health outcome. Read and study the guidelines Review the NCQA Toolkit How many practices are included? The redesigned PCMH 2017 requirements focus on assessing a elements:. The PCMH Annual Reporting Requirements table (starting on page 4 of this document) outlines options for recognized PCMH 2014 practices to move to the Sustain phase of NCQA Recognition. Reid RJ, Fishman NCQA PCMH 2014 Guides practices to o Organize care around patients Recognition lasts for 3 years PPC-PCMH Standards and Guidelines are available free at NCQA 2014 PCMH Standards Focus on team-based care, integration of behavioral health, measuring costs, quality improvement, and care coordination NCQA want practices to understand this is a process, not an event Changes reflect evidence-based trends Focus on the Triple Aim Require practices to follow standards over time NCQA PCMH Quality Measurement and Improvement Worksheet September 30, 2017 PURPOSE: This worksheet helps practices organize the measures and quality improvement activities that are outlined in PCMH AC 01-03, AC 06, QI 08-14 and BH 17-18. PCMH 2014 vs. PCMH 2011 Standards The most recent release of the National Committee for Quality Assurances (NCQA) Patient Centered Medical Home (PCMH) standards were released in March, 2014. Example: Factor:e, an elic or. Evaluates existing policies for compliance with the PCMH PCMH standards have focused thus far on improved access to and coordination of medical services. Organizations with a current NCQA PCMH 2014 or PCMH 2017 recognition for their sites are required to renew each sites recognition using the NCQA PCMH 2017 program Standards and Guidelines, on or before their current recognition expiration. Get FREE PCMH standards and Guidelines Attend onboarding training Transform practice using guidelines (3-12 months) Attend Free standards and guidelines training Order online application Attend software training at least a month before submitting tool NCQA reviews and issues decision (30 60 days) Submit survey tool to NCQA Submit online 2014 NCQA PCMH Standards 1. PCMH 2011 Standards and Elements NCQA Patient-Centered Medical Home 2011 February 1, 2011 PCMH 2011 Standards and Elements based guidelines to generate lists of patients and to proactively remind patients/families and clinicians of services needed for: 1. PCMH has no tiers/level of recognition Either you are recognized or not. 2008 NCQA launched the first PCMH Recognition program, 2011/ 2014 NCQA raised the bar with updates to PCMH Recognition. Providers that demonstrate compliance with Stage 1 requirements can receive credit on the applicable PCMH standards. $5 million in savings per year for the ~100,000 patients touched by the pilot) and a 10.3% reduction in ambulatory-care- sensitive inpatient admissions for patients with two or more comorbidities.1 Annual Reporting requirements for reporting year 2019 were also published. NCQA PCMH 2011 6/5/2012 Description Minimum Documentation and Reporting Period PCMH 3: Plan and Manage Care 3A: Implement Evidence-Based Guidelines The practice implements evidence-based guidelines through point of care reminders for patients with: 1. November 16, 2015 NCQA Patient-Centered Medical Home 2014 Element B: 24/7 Access to Clinical Advice 3.50 points The practice has a written process and defined standards for providing access to clinical advice and continuity of medical record information at all times, and regularly assesses its performance on: Yes No NA 1. 2017 NCQA PCMH Webinar Series, Standard Five: Care Coordination and Care Transitions 5/9/2018 1 1 Candace Chitty RN, MBA, CPHQ, PCMH-CCE 6 PCMH Concepts within the standards 1. The ACA indicates that medical/health homes should be supported by community-based interprofessional teams or health teams that include physicians, nurses, and other health professionals. 1) HRSA Accreditation [since 1997] X (includes PCMH certification option) 2) HRSA Medical/Health Home [since 2010] X . 9 guidelines, self-management and educational resources National Committee on Quality Assurance (NCQA) Recognition 6 Standards - Enhance Access and Continuity - Identify and Manage Patient Populations - Plan and Manage Care - Provide Self-Care Support and Community Resources NCQA language 1. Research shows NCQA PCMH Recognition improves patient care and reduces costs. NCQA PCMH practices should utilize the NCQA Patient-Centered Medical Home (PCMH) Standards and Guidelines to ensure that they are choosing the appropriate number of criteria and meeting all the requirements of the program. Factor 4: NCQA reviews a documented process defining the practices standards for timely appointment availability (e.g., One pilot program showed a 9.3% reduction in emergency department utilization (resulting in approx. The work you do for NCQA PCMH recognition can also improve your Performance Scorecard and shared savings payments as a participant in Enhanced Personal Health Care. After consulting with NCQA, OPM issued this Carrier Letter with the clarification, effective for benchmark comparison beginning in 2018 and going forward: 2017-15: 12/14/2017: Federal Employees Health Benefits (FEHB) Plan Performance Assessment Consolidated Methodology The NCQA PCMH Standards and Guidelines lists the evidence that practices must provide for each PCMH criteria NCQA will evaluate practices based on evidence prepared or shared during the virtual review. For PCMH 2017, new practices will have to complete the core criteria plus their selected electives. 0024 NCQA Weight Assessment and Counseling for Children and Adolescents URACs Patient-Centered Medical Home (PCMH) Certification process focuses on development over time, an approach to a more sustainable transformation of primary care practices. This process is also a teaching and learning experience as the organization implements best practices and methods for providing value-based, quality medical services. The PCMH elements referenced in this FAQ are based on the National Committee for Quality Assurance (NCQA) PCMH model. 2014 NCQA Patient Centered Medical Home (PCMH) Standards and Guidelines Anthem designed Enhanced Personal Health Care to align with NCQA PCMH standards and guidelines. Do they share the same policies and procedures? 2 Thus, the purpose of this guide is to provide a framework and practical evidenced-based guidance Title NCQA Standards Questionnaire v 2 Develops new policies and procedures necessary for PCMH implementation. 3. The second important condition 3. The columns show where National CLAS Standards and NCQA PCMH criteria align and where they differ. Foundational Concepts Team-based Care and Practice Organization (TC) Knowing and Managing Your Patients (KM) PCMHs build better relationships between people and their clinical care teams. NCQA plans to align the PCMH program with Stage 2 PCMH 6 PCMH 6 PCMH 6 Elements A-B Elements C-E Elements F-G Todays Agenda. 3. 5) CMS FQHC Advanced Primary Care Practice Level 3 is the highest level. As defined by the NCQA, the patient-centered medical home is a way of organizing primary care that emphasizes care coordination and communication to transform primary care into "what patients want it to be.". MEASURE PERFORMANCE Standard 6 A . PCMH Participation Incentives and Outcome Incentive Awards (OIAs) are based on the performance of Panel s. To form a Panel, PCPs must organize into a group of five to 15 PCPs. However, the survey tool must be submitted online (instructions follow). Team-Based Care 3. On July 24, the National Committee for Quality Assurance (NCQA) updated the 2017 editions of the Patient-Centered Medical Home (PCMH) Standards and Guidelines and New York State (NYS) NYS PCMH Standards and Guidelines. 2. ALLIANCE FAQ PATIENT-CENTERED MEDICAL HOME (PCMH) 2018 CONTENT Overview: This FAQ is to inform you of new and revised Alliance Clinical Content for use in implementing PCMH 2017 Standards & Guidelines. Population management:to identify groups of patients who require specific services. PCMH 3: Plan and Manage Care, Element A: Implement Evidence-Based Guidelines The practice systematically identifies individual patients and plans, View Table of Contents for this Publication R4 1 in the NCQA PCMH Standards and Guidelines (2017 Edition, Version 2). Getting started with a Patient-Centered Medical Home A Resource for Primary Care Practices The Patient-Centered Medical Home (PCMH) is a model of primary care delivery that emphasizes the relationship between a patient and their health care provider for accessible, coordinated, comprehensive, and continuous quality health care. (The Interactive Survey System, or ISS, PCMH tool, $80@) for PCMH submissions. Th e information contained within is based on the NCQA -published PCMH Standards and Guidelines, 2014. My Account. Patient Centered Medical Home 2011 Standards 2 . METHODS: Thirty parents at each of 6 Boston-area community health centers (CHCs) were administered the 19-question medical home measure of the 2011 National Survey of Childrens Health (NSCH). NOTE: Practices are not required to submit the worksheet as evidence; it is provided as an option. The first part gives you an at-a-glance table From NCAQ Standards and Guidelines for Physician Practice Connections - Patient-Centered Medical Home (PPC-PCMH ) 2008. The report or examples will Do they share the same EHR? The effectiveness is ofessional ELINES. 32 PCMH 1: Patient-Centered Access 2014 PCMH Recognition November 21, 2016 Ad hoc telephone or e-mail exchanges do not meet the requirement. Only enter the numerator, denominator, reporting period and requested information, as dictated by the annual reporting requirements, into Q-PASS. The first important condition 2. Patient-Centered Medical Home (PPC-PCMH) To do this, we must empower patients to work with their doctors and make health care decisions that are best for them. Physician Practice Connections . NCQA PCMH Recognition is fully aligned with the Medicare and Medicaid EHR Incentive Programs Stage 1 Core and Menu Meaningful Use requirements. PCMHs build better relationships between people and their clinical care teams. PCMH 6A Measure Performance . The medical home, also known as the patient-centered medical home (PCMH), is a team-based health care delivery model led by a health care provider to provide comprehensive and continuous medical care to patients with a goal to obtain maximal health outcomes. The goal of the medical home is simple: to obtain the best possible outcomes for patients by coordinating the medical teams care with available community resources. The ABCs of Accreditation NCQA standards for primary care practices offer best practices Variances are implemented as needed as defined in chapter 0050 in the HCH rule. The Survey Tool also includes all the information and the electronic data collection tool needed to prepare and submit materials to apply for recognition. This chapter describes recent changes in the structure of health insurance and health-care delivery in the United States and how the changes have altered how people who have chronic diseases and disabling conditions receive health care. Attains expert knowledge of NCQA PCMH standards, policies, processes and application requirements.