Getting OnBoard Part 1
Before: Learn It
The Recognition Process
All materials © 2014, National Committee for Quality Assurance
Start-to-Finish (S2F) Pathway
Your Roadmap to Recognition
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3 PHASES
• BEFORE: LEARN IT – Am I eligible? Can I make
the commitment? Why would I want to do this?
• DURING: EARN IT – I am committed what do I
need to do submit? What is required?
• AFTER: KEEP IT – I made it!
How do I keep my recognition?
What do I do if my practice changes?
How do I promote my achievement?
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HOW WE ARE USING IT
• Provides clients with a pathway to follow
• Locate where customers are in their
process
• Incorporated into brochures,
meeting materials, presentations,
trainings
• Integrated into our Website
• Distribute to other stakeholders to utilize
and adapt to their own materials
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National Committee for Quality Assurance
(NCQA)
Private, independent non-profit health care quality oversight
organization founded in 1990
_________________________________________________
MISSION
To improve the quality of health care.
VISION
To transform health care through
quality measurement, transparency, and accountability.
________________________________________________
ILLUSTRATIVE PROGRAMS
* Patient-Centered Medical Home * Patient-Centered Specialty Practice
* HEDIS® – Healthcare Effectiveness Data and Information Set
* Health Plan Accreditation * Clinician Recognition
* Disease Management Accreditation * Wellness & Health Promotion Accreditation
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NCQA Recognition Programs
• >53,403 Clinician Recognitions nationally across all Recognition programs.
• Clinical programs.
– Diabetes Recognition Program (DRP)
– Heart/Stroke Recognition Program (HSRP)
*As of 5/31/14
– Back Pain Recognition Program (BPRP) - Retired
• Medical practice process and structural measures.
– Physician Practice Connections - Retired
– Physician Practice Connections-Patient-Centered Medical Home (PPCPCMH) 2008 - Retired
– Patient-Centered Medical Home (PCMH) 2011
– Patient-Centered Medical Home (PCMH) 2014
– Patient centered Specialty Practice (PCSP)
10,843 clinicians
4,108 clinicians
21 Clinicians
387 Clinicians
80 Practices
37,757 Clinicians
7,525 Practices
287 Clinicians
23 Practice
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NCQA Provider-Based Quality Programs
Improve health care quality through
transparency, measurement and accountability.
DRP & HSRP RecognitionACO Accreditation PCMH & PCSP Recognition
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NUMBER OF PCMH CLINICIAN
RECOGNITIONS BY STATE
*As of 5/31/14
WA
ND
MT
VT
NH
MN
OR
WI
SD
ID
MI
IA
PA
NE
UT
CA
IL
CO
KS
OH
IN
MA
NY
WY
NV
ME
RI
CT
NJ
DE
MD
WV
MO
VA
KY
NC
TN
AZ
NM
OK
0 Recognitions
AR
SC
MS
AL
1-20 Recognitions
GA
LA
21-60 Recognitions
TX
FL
AK
61-200 Recognitions
201+ Recognitions
HI
37,757 PCMH
CLINICIAN RECOGNITIONS
PR
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Federal Initiatives with NCQA’s PCMH
Defense Health Agency - Military Treatment
Facilities (MTF)
– Initially a PCMH self-assessment; then
Recognition
– 50 MTFs per year over 3 years
• 254 MTFs achieved Recognition to date*
– Includes: Internal Medicine, Family Practice,
Pediatrics
*As of 5/6/14
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Federal Initiatives with NCQA’s PCMH
HRSA Patient-Centered
Medical Health Home
Initiative
• Community Health Centers –
for rural, underserved, often
nurse-led practices
• Recognition costs and
technical assistance
• Up to 500 Community Health
Centers per year; 5 year
contract
• 2,512 sites currently enrolled
• 902 CHCs Recognized
CMS Advanced Primary
Care Practice Demo
• Federally Qualified Health
Centers (FQHCs)
• 3-year contract for 500 FQHCs
• Track progress toward being a
Medical Home with
reassessments every 6 mo.
• CMS reimburses for managing
Medicare beneficiaries
• 232 FQHCs in the
demonstration have achieved
Recognition as of 5/6/14
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Key Components of PCMH*
• Personal Clinician: first contact, continuous,
comprehensive, care team
• Whole Person Orientation: all patient health care
needs; all stages of life; acute; chronic; preventive; end of life
• Coordinated: when and where needed/wanted; culturally
and linguistically appropriate; use information technology
*Based on The Joint Principles
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Evolving PCMH and More
• 2003-2004: Physician Practice Connections
(PPC) - developed with Bridges to Excellence)
• 2006: PPC standards updated
• 2008: PPC–PCMH
• 2011: PCMH 2011
• 2011: ACO Accreditation
• 2013: Patient-Centered Specialty Practice
• 2014: PCMH 2014
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Growing Evidence on PCMH
• PCMH Improves Low-Income Access, Reduces Inequities
Berenson, Commonwealth Fund, May 2012
• PCMH Improves Quality/Patient Satisfaction, Lowers Costs
PCPCC, September 2012
• Colorado PCMH Multi-Payer Pilot Reduced Inpatient
Admissions, ER Visits & Demonstrated Plan ROI
Harbrecht September 2012
• The Group Health Medical Home At Year Two: Cost Savings,
Higher Patient Satisfaction And Less Burnout For Providers
Soman Health Affairs, May 2010
• The Patient-Centered Medical Home’s Impact on Cost and
Quality: An Annual Update of the Evidence, 2012-2013.
Nielsen, M. Olayiwola, J.N., Grundy, P., Grumbach, K. (ed.) Shaljian, M. 2014.
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PCMHs Save Money
Better Access and Care Coordination Goes a Long Way
• Reduction in hospital and emergency room use
Harbrecht et al 2012, PCPCC 2012, Patel 2012, Fields et al 2010
• Lower overall per member per month costs
Fields et al 2010, PCPCC 2012, Takach 2011, Patel 2012
• Health plans can have strong return on investment
Raskas et al, 2012 / Harbrecht 2012
• Also see the Patient-Centered Primary Care
Collaborative’s Summary of Patient-Centered Medical
Home Cost and Quality Results, 2010-2013
PCPCC 2014
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What Specialty Practices are Learning About
Coordinated Patient-Centered Care
Enhances
coordination
between
primary care
and specialty
care
Roadmap for
quality
improvement
using clinical
performance
measures
Enables
excellent care
integration
with the
medical home
Aligns with
processes that
improve
quality and
eliminate
waste
Improves the
experience of
patients
accessing
specialty care
Promotes
coordinated
teamwork in an
information rich
environment
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PCMH & PCSP and Meaningful Use
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Meaningful Use of Health
Information Technology (HIT)
• NCQA emphasizes HIT because highly effective
primary care is information-intensive
• Reinforces incentives to use HIT to improve quality
• Meaningful Use language is embedded in PCMH
2014 & PCSP standards
• Synergy: Recognized medical practices are wellpositioned to qualify for meaningful use, and vice
versa
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PCMH Update Timeline
PCMH 2011
• June 30, 2014 last date to purchase PCMH 2011
survey tools
• March 31, 2015 last date to submit PCMH 2011
survey tools
PCMH 2014 Available
• Standards and Guidelines
• Survey tools
March 31, 2014 - March 31, 2015
• May submit PCMH 2011 or
PCMH 2014
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ACO
PCMH-Related Programs
• Patient-centered medical homes are the central
foundation of an ACO.
PCSP
• Improving care coordination with primary care and
other specialties, with a focus on strategies that
effectively manage the referral process to enhance
patient-centered care.
CEC
• Allows those certified to highlight their
comprehensive knowledge of the requirements, the
application process and documentation of the
PCMH program.
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PCMH &PCSP Eligibility & Survey
Components
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Eligibility Basics
• Recognitions are conferred at geographic site level -one Recognition per address, one address per survey
• MDs, DOs, PAs, and APRNs practicing at site with their
own or shared panel of patients are listed with
Recognition
• Clinicians should be listed at each site where they
routinely see a panel of their patients
− Clinicians can be listed at any number of sites
− Site clinician count determines program fee
− Non-primary care clinicians should not be included
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PCMH Eligible Applicants
• Outpatient primary care practices that meet the
scoring criteria for Level 1, 2, or 3 as assessed
against Patient-Centered Medical Home (PCMH)
requirements
• Practice defined: a clinician or clinicians practicing
together at a single geographic location
– Includes nurse-led practices in states where state licensing
designates Advanced Practice Registered Nurses (APRNs)
as independent practitioners
– Does not include urgent care clinics or clinics opened on
a seasonal basis
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PCMH Clinician Eligibility
• At least 75% of each clinician’s patients come for:
− First contact for care
− Continuous care
− Comprehensive primary care services
• Clinicians may be selected as personal PCPs
• All eligible clinicians at a site must apply together
• Physicians in training (residents) should not be
listed
• Practice may add or remove clinicians during the
Recognition period
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Eligible Applicants for PCSP Recognition
• Recognition is at the practice-site level
• Assessment for Recognition must include a
survey for every site the practice expects to
identify as a Recognized PCSP
• PCSP Recognition identifies clinicians
practicing at the site, including nurse
practitioners and physicians’ assistants who
share or have their own panel of patients
• Practice may add and remove clinicians for
the duration of their Recognition
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Eligibility for PCSP Recognition
• May be multi-site and/or multi-specialty
• Eligible clinicians:
– MDs, DOs
– NPs/PAs with their own or shared panel of
patients
– Certified nurse mid-wives
– Behavioral health specialists: Psychologists,
licensed clinical social workers, marriage and
family counselors
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Practice System Needs for
Survey Process
1. Computer system and staff skill with:
−
−
−
−
−
−
Email
Internet access
Microsoft Word
Microsoft Excel
Adobe Acrobat Reader (available free online)
Document scanning and screen shots
2. Access to the electronic systems used by the
practice, e.g. billing system, registry, practice
management system, electronic prescription
system, EHR, Web portal, etc.
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Transformation and Prep Work
• Transformation can easily take 3-12 months
• Your roadmap: Standards and Guidelines –
everything covered
• Implement changes:
–
–
–
–
–
Practice-wide commitment
New policies and procedures for staff
Staff training and reassignments
Medical record systems
Reporting capabilities improvement
• Develop and organize documentation
• Procedures and EMR must be fully implemented
at least 3 months before survey submission
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Start-to-Finish
Before/Learn It
1. Eligibility
2. Order the free electronic version of the
guidelines and download whenever
updates are published
3. “Getting on Board” live and recorded
4. Are you able and ready to proceed?
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Before | Learn It
Start-to-Finish Step 1
Determining Eligibility
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Before | Learn It
Start-to-Finish Step 2
Obtaining the Standards and Guidelines
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Resources Available
The PCMH and PCSP Standards
and Guidelines -- the “rules”
•
Standards, elements, factors
•
Policies and Procedures
•
These are free of charge
from NCQA
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Before | Learn It
Start-to-Finish Step 3
Attend the “On Board” training
Here’s where you are today.
Congratulations for being
on the Start-to-Finish track
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Other Training (Fee)
NCQA Education Dept seminars
for PCMH and PCSP 2011
www.ncqa.org/tabid/1295/Default.aspx
•
Locations across the country – see website
•
Book early – these fill up fast!
Training at your site
www.ncqa.org/tabid/63/Default.aspx
•
•
Equivalent training at your location
Speakers Bureau
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Resources Available -- Training
Red Nodes
FREE Customer Training
Each Month
http://www.ncqa.org/tabid/109/Default.aspx
• Getting on Board PCMH/PCSP: Learn It, Earn It,
Keep It (3 part program)
• PCMH 2014 Standards (2 part program)
• PCSP 2013 Standards (2 part program)
• Using the ISS System (Recorded)
• The Online Application (Recorded)
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Resources Available -- Website
FREE Customer Resources
• NCQA Website contains a wealth of resources
– Check frequently for new and updated materials
• Website is configured with “Start-to-Finish” and
pertinent information is associated with each node
• FAQs to help answer your questions –
http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHo
mePCMH/DuringEarnItPCMH/OtherPCMHResources.aspx
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Before |Learn It
Start-to-Finish Step 4
Determine commitment to Recognition
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What Are Multi-Site Surveys?
(PCMH & PCSP)
• Option for organizations or medical practices with 3 or
more sites that share policies and procedures and
electronic systems across all of their practice sites.
• NCQA does not give organization-wide Recognition
• A specified number of corporate (shared)
elements are completed once for
multiple practice sites in an additional
survey tool
• All other elements require responses at the site level
• Any possible multi-site should attend the “Getting on
Board” training for complete details
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What are Multi-Specialty Surveys?
(PSCP ONLY)
• Multi-Specialty organizations can be a single site
or Multi-site practice
• Both require NCQA approval
• Request approval teleconference through Online
Application
• Multi-specialty eligible practices will submit
examples from 3 or more specialties, including a
mental health specialty, if present for specified
elements
• Conference call will discuss submission of
individual specialty surveys versus multi-specialty
surveys
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NCQA Support
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Submitting Questions to NCQA
• Submit questions to Policy Clarification Support (PCS)
System: http://ncqa.force.com/pcs/login
• Do not submit questions to pcmh@ncqa.org
– Only submit payment or practice changes to the mailbox
• Check for existing FAQs
http://www.ncqa.org/Programs/Recognition/PatientCenteredMe
dicalHomePCMH/DuringEarnItPCMH/OtherPCMHResources.aspx
• Do you already have an assigned manager? Continue
to submit questions to them
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Why YOU Will Like It
• Categorizes YOUR important questions
• Let’s YOU track responses to YOUR ???s
• NCQA will be able to develop more useful FAQs
and additional documentation for YOU
• A place to for YOU to access developed FAQs
• There is a Step by Step Users Guide to help YOU
navigate.
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How to Submit a Question
1. Log into our PCS System:
http://ncqa.force.com/pcs/login
2. Register if you are a new user
3. Click “Ask a New Question”
4. Select “Recognition Programs” in the first drop
down selection
5. Select program and category in the other drop
downs that best fits your question
6. Type in question and submit
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Login/Register
http://ncqa.force.com/pcs/login
New User
Registration
Returning User
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Track & Manage Questions
See what questions you have
asked, responses to questions,
and track your questions
Step by Step Guide for
navigating through the
PCS system
Click to Ask a New Question
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Ask a Question
Select “Recognition Programs”
in the first drop down
Check our FAQs first to
see if your question
has already been
answered
Select the Program, Category
and Publication Year that best
fits your question
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After Submitting a Question
• You will receive a confirmation email with
your case #
• Any correspondence is sent directly to
your email registered
• Might be asked for further clarification
• Track your question and the response
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NCQA Contact Information
Contact NCQA Customer Support at 1-888-275-7585
M-F, 8:30 a.m. - 5:00 p.m. ET to:
 Acquire standards documents, application account, survey
tools
 Questions about your user ID, password, access
Visit NCQA Web Site at www.ncqa.org to:
 Follow the Start-to-Finish Pathway
 View Frequently Asked Questions
 View Recognition Programs Training Schedule
• For questions about interpretation of
standards or elements to
submit a question to PCS
(Policy/Program Clarification Support)
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Final Questions?
Thanks so much for attending and
best wishes for your upcoming
Recognition!
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