Get the Inside Track With URAC

Posted on May 3, 2013 by Danyell Jones

URAC is Hosting a Pre-Conference Informational Session, Reception, and Business Track Session at the 2013 Armada Specialty Pharmacy Summit

If you are looking to get the inside track on the increased importance of accreditation programs in the specialty pharmacy marketplace, attending URAC’s pre-conference informational session should be added to the top of your list. Not only is the session open to everyone but it will be followed with an open reception where you can meet URAC experts who can address your specific questions and needs.

The Armada Summit is the largest gathering of Specialty Pharmacy professionals in the nation and is taking place in 2013 at the Wynn Resort in Las Vegas, May 7th through May 10th. The Summit has historically delivered dynamic networking, educational and exhibiting opportunities.

URAC Pre-conference Informational Session: The Importance of Accreditation in Today’s Marketplace

URAC will kick off its Armada Summit activities with a pre-conference informational session on May 6th from 4pm to 5pmin the Lafleur Room at the Wynn Resort, Las Vegas. The informational session is entitled “The Importance of Accreditation in Today’s Marketplace” and will explore not only how the evolution of the field of Specialty Pharmacy has changed over the years, but also how URAC Accreditation plays an important part in today’s expanding Specialty Pharmacy Marketplace.

URAC Hosted Cocktail Reception

URAC will be following up its pre-conference information session with a Cocktail Reception allowing for networking and discussion around URAC and the Specialty Pharmacy Industry. Attendees will gather from 5pm to 6pm at the Lafleur Patio of the Wynn Resort, May 6th. For additional information, or to RSVP for this reception, attendees should contact Rebecca Sheehan at rsheehan@urac.org.

Armada Specialty Pharmacy Summit Conference – Business Track Session: Proving Value in the Era of Health Care Reform

In addition to the pre-conference informational session and cocktail reception, URAC Senior Vice-President, Vernon Rowen will be presenting a business track session during the specialty pharmacy summit entitled “Proving Value in the Era of Health Care Reform: The Advantage of Accreditation.” The business track session is open to attendees and will occur Thursday, May 9th from 3pm to 3:45pm in Mouton 2 of the Wynn Resort. Attendees can expect to gain further insight and perspective on URAC Accreditation for Specialty Pharmacy, as well as how Accreditation is valuable from a business perspective in the era of healthcare reform.

Additional Information on the 2013 Armada Specialty Pharmacy Summit:

Full agenda of 2013 Armada Specialty Pharmacy Summit Activities : http://www.armadasummit.com/

Top 5 Healthcare Consulting Issues as a Result of the ACA

Posted on April 29, 2013 by Linda Ringquist

Summary: The Affordable Care Act and all of its complexities have given rise to several areas in which healthcare providers may need additional assistance.

Healthcare is changing faster than the blink of an eye. Healthcare providers are finding it more and more cumbersome and in some instances impossible to keep up with all the new legislation. The Patient Protection Affordable Care Act (PPACA) alone is enough to drive a provider mad. The PPACA is a 900+ page document filled with provisions becoming effective from 2010 to 2015. It is difficult to understand all of the provisions let alone know how to properly comply with them. The PPACA touches many different subjects in the healthcare realm.

In order to properly adhere to the PPACA, healthcare providers must have expertise in:

Financial Aspects

Reducing health insurance claim denials to offset some of the reductions in Medicare reimbursement
Reducing hospital readmissions to a level to avoid penalties and further reduction in Medicare reimbursement
Value based payment programs for physicians as opposed to the traditional volume based payment
Bundled payments for groups of services as opposed to the traditional pay for each individual service
Tax credits for small businesses
Additional fraud and abuse penalties

Have you had your healthcare financial analysis lately?

Health Insurance

As mentioned above, cutbacks in Medicare reimbursement
Covering children longer
Not being able to use pre-existing conditions as a basis for non-coverage
Expanding Medicaid to cover more consumers
Health Insurance Exchanges/Marketplaces
Preventative care and what that entails
Limits on administrative costs as a percentage of total cost

Health insurance appeals for denied claims

Do you find it difficult to manage the appeals process? Wouldn’t it be great to have a healthcare management consulting firm relieve this burden for you. Wouldn’t it be nice to utilize physician advisor services that is fully automated with medical necessity criteria built in and deadlines automated to comply with accreditation requirements? Visit our physician advisor services pages for more details.

Do you know all of the ins and outs of insurance from private to commercial and from medicare to medicaid?

Care Models

Patient Centered Medical Homes (PCMH) or Patient Centered Health Care Home (PCHCH)
Accountable Care Organizations (ACOs)/integrated health

Do you know all of the advantages of becoming a PCMH? Will you be left behind by not being armed with information as to how to implement? Are you interested in becoming a part of an ACO? Do you know how to start the process?

Accreditation

In order to be recognized as a PCMH, an organization must go through the accreditation process. The following organizations currently offer PCMH/PCHCH accreditation:

URAC accreditation
NCQA accreditation
CARF accreditation
TJC accreditation
AAAHC accreditation

Generally what differentiates these organizations is the type of organizations they accredit as well as the accreditations offered. Additionally, ACOs must be accredited. Currently only NCQA offers ACO accreditation. Look for details in the future to see if any of the other national accreditation organizations begin to offer this type of accreditation as well.

Do you need assistance with your accreditation needs?

Healthcare has become extremely complex and it is difficult for healthcare organizations to be experts on every aspect. Healthcare management consulting has expanded with the enactment of the PPACA especially. You don’t have to do everything on your own. You don’t have to reinvent the wheel. Turn to the experts who have already been through and established protocols for the healthcare issues you are experiencing.

About BHM Healthcare Solutions

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, financial consulting for healthcare, physician advisor/peer review, and organizational development.

What Are the Current Trends in Accountable Care Organizations (ACOs)?

Posted on April 25, 2013 by Linda Ringquist

Summary: What can we expect in 2013 in terms of Accountable Care Organizations (ACOs)? Where are we headed? What considerations need to be taken into account?

ACOs are continuations to the Patient Centered Medical Home (PCMH) model. PCMH places the patient at the center of all decisions regarding his health care and assigns responsibility to the primary care physician to coordinate care with all other care givers involved with the patient. These might include specialists, laboratories, imaging centers, etc. If a PCMH is like a home, an ACO is more like a neighborhood. It is a group of PCMHs working together in an accountable manner which is nationally recognized through organizations such as the Centers for Medicare and Medicaid Services (CMS).

ACOs began formally being recognized in 2012. As of January 2013, there are approximately 300 ACOs. They are really taking off – leaps and bounds.

So what are some of the trends we are seeing?

We would expect the Medicare Shared Savings Plan (MSSP) to nearly double in 2013 and continue the trend of expansion.
We would expect Medicaid ACOs to slow in growth a bit due to the impending healthcare exchanges and Medicaid expansion which are results of the Patient Protection Affordable Care Act (PPACA). We are in a holding pattern waiting to see what is going to happen with these. 2014 will probably provide more growth for Medicaid ACOs. Medicaid also has additional challenges of instability of the population and a large emphasis on long-term care which adds to the slower growth in Medicaid ACOs as compared to Medicare ACOs.
For states that decide to expand Medicaid, ACOs can provide additional monetary incentives which may encourage ACO expansion as well. States that have currently opted to expand Medicaid are: Arkansas, California, Connecticut, Delaware, the District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, Missouri, Nevada, Rhode Island, Vermont, and Washington.
We would expect a growth in the number of patient centered medical homes (PCMH). 2012 was a big year for PCMH and really was the turning point for health care and the focus on the patient.
States will begin to move dual eligible populations toward managed care and toward ACOs.
Beginning in perhaps 2015 or 2016, we may see ACOs as part of the exchanges.
We will begin to see the expansion of commercial ACOs.
Mergers and acquisitions should rise in 2013 with the cutbacks from Medicare and the move to accountable care.
NCQA accreditation in particular will take off in 2013. They will be accrediting ACOs and exchanges. The number of accredited organizations will grow in leaps and bounds this year.
One can hope with all of the emphasis on primary care that more physicians will begin to choose primary care as their profession. This still remains to be seen.

What are some particular organizations doing?

Crystal Run is glad that reimbursement has finally become a focal point when using patient centered care models. They have been practicing patient centered strategies since the 1990s and have had an EMR since 1999. They were just waiting for the rest of the country to catch up. Crystal Run just thought it was the right thing to do and didn’t do it for any other reason.
Colorado ACO program saved $20 million in unnecessary care, of which after expenses, they were able to give $3 million back. Colorado ACO program also saw a reduction in emergency room visits and hospital readmissions. A true success story.
North Carolina has had great success with their medical home model within Medicaid which of course is the prelude to any successful ACO.
Aetna is on the move expanding their ACO kingdom both through partnerships with providers as well as a data analytics subsidiary.
Kelsey-Seybold was named the first accredited ACO through NCQA

2013 and going forward are going to be very interesting and an opportunity for tremendous growth. Keeping up with all of the changes is a daunting task. What are your thoughts on ACO? Do you think they are a good concept? Do you think there are flaws? Do you think there are areas of improvement?

About BHM Healthcare Solutions

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development.

Checkout our PCHCH accreditation (patient centered health care home accreditation) services: http://www.bhmpc.com/accreditation/

What Sets PCMH Apart from Other Healthcare Models?

Posted on April 22, 2013 by Linda Ringquist

Summary: What is PCMH? What does it mean to provide patient centered care? What are the foundations of this healthcare model?

Patient Centered Medical Homes are not physical places but a model of healthcare based on the principles of providing care which is accessible, coordinated, comprehensive, patient centered and is committed to quality and safety. Wow, that is a mouthful. Let’s break down each part:

What is accessible care?

Accessible means readily available at the convenience of the patient. Some of the activities surrounding accessible care are: extended office hours, access to care providers on a 24/7 basis, online appointment scheduling, patient access to medical records through electronic mechanisms, shorter wait times, and wave scheduling.

What is coordinated care?

Coordinated care is centered around the primary care physician who is given the responsibility to coordinate care with other health care professionals to make sure everyone is informed about all aspects of the patient’s care. This involves electronic medical records and conversations with specialists, laboratories and radiology just to name a few. Rather than each health care provider only having access to the specific care he/she is providing, care is coordinated through the continuum of care.

What is comprehensive care?

Comprehensive care encompasses treating the whole person and not one individual symptom or issue within a silo. It involves taking into account all issues a patient might be experiencing and coming up with a treatment plan in which a minimal number of side effects are incurred. It involves making sure that treating one issue won’t exacerbate another issue or impede the treatment process.

What is patient centered care?

Patient centered care focuses on the patient. How simple is that? The patient and his/her family are involved in the decisions surrounding building blocks his/her care. The patient is able to provide input and make choices in regard to diagnosis, treatment, and follow-up. Rather than the physician just telling the patient what is going to happen, it becomes a two-way conversation and therefore much more interactive.

What does it mean to be committed to quality and safety?

All healthcare is becoming more focused on providing quality outcomes and keeping the patient safe while under the care of their physician. Measures are being introduced daily to track quality and patient safety, with reimbursement being tied to these outcomes. Additionally, the public is becoming more and more astute as to the quality measures and how particular hospitals fare in the ratings. Consumers have a choice to go to any facility they would like. Many of these decisions are trending toward quality as opposed to just proximity. Wouldn’t you rather drive a little further to find a facility that is dedicated to providing quality care?

So why do we need patient centered medical homes? Providing care which adheres to all of the guidelines above will help reduce healthcare costs, reducing unnecessary hospital re-admissions, and return to focusing upon prevention and wellness. It is more proactive rather than reactive approach. With so many choices and so much available wouldn’t you choose healthcare which is accessible, coordinated, comprehensive, patient-centered, and focused upon quality and patient safety?

About BHM Healthcare Solutions

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development.

Contact Us : results@bhmpc.com, 1-888-831-1171

Checkout our PCMH accreditation services: http://www.bhmpc.com/accreditation/. Our healthcare accreditation consultants can assist you with all of your PCMH/PCHCH accreditation needs.

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Patient Centered Care – the Building Block of PCMH and ACO

Posted on April 8, 2013 by Linda Ringquist

What has caused the emphasis on Patient-Centered Care, Patient-Centered Medical Homes, and Accountable Care Organizations?

In a nutshell, our healthcare system is inefficient. Healthcare costs are continuing to rise at a level higher than inflation, quality is less than optimal, and our coordination of care is fragmented and disjointed. Additionally, hospital admissions/readmissions are increasing and need to be controlled.

What is the solution or at least one solution to try to fix our healthcare system?

One such answer is a concept called patient-centered care. This is not a new concept. It was originally proposed by the American Academy of Family Medicine in 1967. The concept began to gain popularity in the 1990s and started to take off in 2002. Patient-centered care is exactly what the term infers. It is care that is focused upon the patient and involves the patient in all of his healthcare decisions.

Where does the Medical Home Concept come into play?

A medical home (sometimes referred to as patient centered medical home PCMH or patient centered health care home PCHCH) is the term used to denote an organization that has officially adopted the patient centered care concept. It is not really a place but a healthcare model. The model incorporates the focus on patient centered care and takes it a step further to include care coordination between the primary care physician and any others involved in the patient’s care such as specialists, laboratories, and imaging. It seeks to provide continuity of care throughout the full spectrum of healthcare providers. The Medical Home was introduced in 2007 as a collaborative effort between the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians and American Osteopathic Association. The primary goals of the medical home are to provide better access, coordination of care, prevention, quality and safety.

What are the building blocks of a medical home?

The medical home is established based upon the following building blocks or principles:

Comprehensive Care
Patient-Centered Care
Coordinated Care
Accessible Services
Quality and Safety

Challenges to creating a PCMH

PCMHs are not setup overnight. It is a lengthy process in which certain barriers may exist:

This method is still a bit disjointed in terms of providers outside of the primary care physician. There aren’t any direct incentives for these providers and therefore little motivation to join efforts with primary care.
PCMHs can be costly to setup and even cost-prohibitive for smaller practices.

How are some of the challenges to becoming a PCMH overcome? Enter the ACO

What is an Accountable Care Organization (ACO)? An ACO is basically a network or neighborhood of medical homes. It is a collaboration of Patient centered health care home accreditation different organizations and practices working together which may include primary care physicians, specialists, hospitals, providers, payers, etc. The ACOs take medical homes a step further in emphasizing the alignment of incentives and accountability for providers across the continuum of care. There is a need for very strong leadership to address cultural, legal, and resource related barriers when creating an ACO.

Benefits of ACOs

Ability to manage a larger population with a larger budget (combined budget for participating organizations)
Better cost management
Less variation in the population
Ability to track and trend quality better
Receive fee-for-service payment
Share in cost savings through either risk-adjusted projecting spending targets and/or partial or full capitation

Types of ACOs

Currently there are several types of ACOs which might be created:

Large integrated delivery systems
Physician-hospital organizations
Multispecialty practice groups with or without hospital ownership
Independent practice associations
Virtual independent networks of physician practices

So where does accreditation come into play or does it?

In order to be considered either a PCMH or an ACO, the organization(s) must be accredited. Accreditation offers national recognition to ACO 2 organizations for achieving levels of excellence in areas such as quality, patient satisfaction, and safety. Accreditation provides piece of mind to those wishing to do business with an organization, which in turn provides a competitive advantage. Accreditation for PCMH is offered through the following organizations:

NCQA accreditation
URAC accreditation
TJC accreditation
AAAHC accreditation
CARF accreditation (new for 2013)

Accreditation for ACOs

Currently, the only organization authorized to provide accreditation for ACOs is NCQA. NCQA was on the cutting edge of medical home accreditation and standards became effective in 2008. Note this was before the Patient Protection and Affordable Care Act became effective in 2010. In 2011, NCQA revised their standards and these are still the most current regulations for NCQA. In January, 2012, NCQA launched their Consumer Assessment of Healthcare Providers and Systems as a part of their medical home accreditation. This takes patient centered care to the level of accountability and provides a mechanism for tracking and trending quality and safety initiatives for organizations while providing a means of comparing organizations to one another.

NCQA was again ahead of the curve in launching their ACO accreditation effective November 2011. To follow suit with their PCMH product, NCQA launched their Healthcare Effectiveness Data and Information Set (HEDIS) tool. This tool is used to measure quality for organizations and allow organizations to be compared. It is similar to HCAPS but specific to ACOs.

If you require any assistance in becoming a Medical Home or becoming accredited/re-accredited, please contact us.

BHM Healthcare Solutions – www.bhmpc.com We have URAC PCHCH consultants, TJC consultants, NCQA consultants, and CARF accreditation consultants ready to assist you with your accreditation needs.

Call us: 1-888-831-1171

Email us: results@bhmpc.com

A Step-By-Step Guide to Establishing a Patient Centered Medical Home Part 7

Posted on March 28, 2013 by Patrick Christopher

Part seven of the seven-part series

Payment & Finance

Matching quality care and NCQA recognition with payment and value.

Optimally you have been able to benefit from the tools, resources and guidance in Sections 1, 2, 3, 4 & 5 and begin to build the capacity of your medical home. Once you successfully gain recognition for the level of “medical home-ness” at your practice (meeting the PCMH NCQA Accreditation standards) you are better positioned to advocate and negotiate for improved and appropriate primary care payment. As a “work in progress” these contract and other negotiations will be specific to the unique nature of your practice – whether you are a small/large independent group, a community health center or an integrated delivery network.

The tool in this section – Building Your Medical Home and Getting Paid Appropriately – helps you to understand routes to enhanced payment for the medical home and shows you some of the work already accomplished to help you achieve this goal.

Step 1:

The following link, Building Your Medical Home and Getting Paid Appropriately, contains information on:

Pediatric Councils
Medical Home payment reform
Coding resources to help you negotiate contracts with payers
Please review the Resources above before continuing to Step 2.

Step 2:

After reviewing the resources, honestly assess your familiarity with medical home payment and financing issues, note areas for development, NCQA Accreditation and take necessary action steps.

Congratulations! You have successfully completed the six Building Blocks of the Building Your Medical Home toolkit.

If you build it they will come.

A step-by-step guide to establishing a Patient Centered Medical Home

Do you have questions or comments about Medical Homes? We invite you to contact the NCQA Consultants at BHM Healthcare Solutions today.

About us

BHM Healthcare Solutions is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of healthcare management consulting services including accreditation (URAC, TJC, NCQA, CARF, and COA), healthcare financial analysis, clinical operations, physician advisor services, quality improvement, and reducing claim denials.

Contact us

Call us 1-888-831-1171

Email us: results@bhmpc.com

Visit us: www.bhmpc.com

Follow us on Linkedin: http://www.linkedin.com/company/bhm-healthcare-solutions?trk=hb_tab_compy_id_386984

Patient Centered Medical Homes: What it Takes for PCMH Accreditation Part 13

Posted on March 26, 2013 by Danyell Jones

Patient centered medical homes have become a very hot healthcare topic recently, and while there are multiple recognition, or PCMH Patient Centered Health Care Home Accreditation accreditation, programs to choose from there are commonalities in the guidelines of what must be met by any medical home seeking accreditation. So whether your organization is pursuing URAC PCHCH accreditation, TJC accreditation, NCQA Accreditation, or the recently launched CARF accreditation for medical homes, keep these general standards in mind:

Evaluations should be conducted by the Accrediting Agency to ensure that the effectiveness of its program is measured, and that improvements are made to the accrediting program over time

It is important for Medical Homes to understand that Accreditation standards and requirements are continuously evolving so that programs can improve over time based on industry recognized best practices. This is similar to the Medical Homes goal of continuing Quality Improvement, but from the perspective of the accrediting body. Changes in a rapidly evolving healthcare environment necessitate accreditation requirement changes, and these changes are made taking into account evidence, field testing, the experience of the stakeholders utilizing the program, public comment, and the general changes in the healthcare environment.

As such, organizations who have become accredited may be surprised to learn that when applying for re-accreditation some of the requirements have changed. This is why accreditation maintenance should be part of any ongoing accreditation implementation undertook by a Medical Home. Accreditation maintenance serves to ensure that your organization will be prepared for reaccreditation when the time comes, it will keep the organization on track with the latest in accreditation standards, and allow providers and administrative staff of the Medical Home to continuously work toward accreditation preparation in between accreditations, allowing for a smoother more efficient process.

Those who have begun an accreditation maintenance program have been pleased to find that they are able to actively prepare for re-accreditation over a period of years, rather than trying to cram accreditation prep work in over a few months. Furthermore, continuous maintenance of your accreditation means that your organization will remain in compliance with accreditation standards throughout the term.

For more information on Accreditation Maintenance packages offered by BHM please visit: http://www.bhmpc.com/accreditation/

BHM Healthcare Solutions Assists Eastpointe in the Transition to MCO

Posted on March 20, 2013 by Linda Ringquist

Summary: Eastpointe, a local management entity (LME) officially transitioned to a live and operational Managed Care Organization on Jan. 1^st 2013. At this time the organization became responsible for the authorization and management of services for mental health, substance use, and intellectual and developmental disabilities for Medicaid recipients in a 12 county region of North Carolina.

The state of North Carolina has been leading the way in healthcare delivery redesign with the transition of care provided for Medicaid enrollees being designated by newly formed Managed Care Organizations (formerly Local Management Entities). The goal of these organizations, as stated on the NC Department of Health and Human Services website “is to create community health networks to achieve long-term quality, cost, access, and utilization objectives.” This is achieved through the provision of services by a network of providers who are contracted with the Managed Care Organization.

BHM consultants began working with Eastpointe on the transition to managed care back in 2010 when they assisted the organization in submitting an application to be chosen as one of the Managed Care Organizations. This work continued after selection, when BHM consultants worked with individuals at Eastpointe in a consultative and supportive role to ensure that the organization was able to be operational as an MCO by Jan. 1^st 2013. This work included assistance with IT architecture, provider relations, quality management, clinical operations, URAC Accreditation, and financial advisory and analysis.

Eastpointe was one of five organizations who were selected to “go-live” Jan. 1^stand successfully met the standards to become an MCO. “We believe that this is a fantastic success for our clients” stated Mark Rosenberg, CEO of BHM Healthcare Solutions. “Eastpointe is led by a phenomenal team of people, and it has been our pleasure working with them. We are excited to see their success in achieving this important milestone.”

About BHM Healthcare Solutions

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including accreditation, healthcare financial analysis, clinical operations, physician advisor services, quality improvement, and denial management.

10 Myths of Health Care Reform Infographic

Posted on March 13, 2013 by Linda Ringquist

The Patient Protection and Affordable Care Act (PPACA) is sometimes referred to as the Affordable Care Act (ACA) or Healthcare Reform. This legislation was enacted in 2010 and provides effective dates for specific provision through 2014. 2014 is slated as the year of most significance as healthcare exchanges, for example, become effective. The past few years have been interesting including such events as the debt ceiling being reached, the fiscal cliff of 2012, and most recently the sequestration (across the board spending cuts). What are the conversations floating around the water cooler in terms of Health Care Reform?

Source: hitconsultant.net via HIT on Pinterest

If you need assistance with complying with the ACA, such as URAC accreditation assistance, becoming an accountable care organization, transitioning to managed care, or seeking PCHCH accreditation, please contact us.

BHM Healthcare Solutions – a healthcare management consulting firm

Visit our site: http://www.bhmpc.com/

A Step-by-Step Guide to Establishing a Patient Centered Medical Home Part 6

Posted on February 28, 2013 by Patrick Christopher

Part six of the seven-part series

Practice Performance Measurement

Addresses the organization and promotion of safe and high quality care

The purpose of this section is to provide tools and strategies to help you evaluate the performance of your practice; this includes both the URAC Medical Home Accreditation physician performance and the patient/family perspective regarding the quality of their care. Collecting data on performance, sharing these data with clinicians, staff and families and being transparent with consumers will help drive improvement and prepare your practice for successful completion of the NCQA recognition application process. Use the following ‘Practice Performance Guide’ tool and checklist to assess how well your practice tracks performance.

This tool may help prepare you to meet the PCMH elements 8A, 8B, & 8C for NCQA accreditation.

Step 1:

Check the following planned, proactive and comprehensive management strategies that your practice currently uses for each patient.

Complete a practice performance assessment

The following tools are available to measure the performance of your overall practice. tools

Medical Home Index
Assessment measuring Medical Home activities in the practice- short version

Measuring Medical Homes: Tools to Evaluate the Pediatric Patient- and Family-Centered Medical Home

EQIPP: Medical Home for Pediatric Primary Care
This course helps a practice improve its medical home, and includes a practice survey to assess organizational capacity

Obtain feedback from families; share this data with all staff

There are a variety of ways to learn from families about their experience of care. Methods range from simple face-to-face inquiries or focus groups, to more formal survey approaches. Patients and families will need help becoming comfortable providing critical feedback. Making a commitment to use their feedback builds trust.

Consider using the following resources to obtain feedback:

CAHPS (Clinician/Group Pediatric Care Survey)
Survey for providers to assess patient-centeredness

Medical Home Family Index and Survey (short version)
Survey for families to assess their satisfaction with the provide

Family Focus Group
Fact Sheet on the benefits of Family Focus Groups

Family ‘Exit’ Survey
Survey for families on their post-visit experience with the practice

Family Advisory Group
Fact Sheet on how to create Family Advisory Groups in the practice

Measuring Medical Homes: Tools to Evaluate the Pediatric Patient- and Family-Centered Medical Home

Report practice performance and family feedback data back to all clinical staff
Presentation of practice performance data and family feedback to all partners fosters improvement. It benefits the practice to share these data building blocks with partners and discuss implications for improvement. Together you can select changes and use the Model for Improvement to test and implement improvements.

Prepare for completion of the NCQA PPC®-PCMH™ Recognition application
Achieving Level 1, 2 or even 3 using the NCQA positions your practice for potential enhanced payments and/or inclusion in medical home pilot demonstrations projects.

Step 2:

Assess the performance strategies from Step 1 to determine whether they are currently in place and note areas necessary for development.

To read the previous articles in this series, please click on the links below.

If you build it they will come.

A step-by-step guide to establishing a Patient Centered Medical Home

Part 1 http://www.bhmpc.com/2013/02/a-step-by-step-guide-to-establishing-a-patient-centered-medical-home-part-1/

Part 2 http://www.bhmpc.com/2013/02/a-step-by-step-guide-to-establishing-a-patient-centered-medical-home-part-2/

Part 3 http://www.bhmpc.com/2013/02/a-step-by-step-guide-to-establishing-a-patient-centered-medical-home-part-3/

Part 4 http://www.bhmpc.com/2013/02/a-step-by-step-guide-to-establishing-a-patient-centered-medical-home-part-4/

Part 5 http://www.bhmpc.com/2013/02/a-step-by-step-guide-to-establishing-a-patient-centered-medical-home-part-5/

Please check back with us for the final article in this series.