The Army’s PCMH

Posted on September 10, 2012 by Linda Ringquist

Original source is www.army.mil

PCMH stands for patient centered medical home. The Medical Home is a patient care model which places the patient at the center of all healthcare decisions related to their care and gives the personal physician the responsibility to coordinate their healthcare needs. The Medical Home concept originated in 1967 and has evolved to inclusion in the Patient Protection and Affordable Care Act, which was introduced in 2010. It seems to be the model of the future and more and more organizations are becoming Medical Homes, including Army Medical Centers.

McDonald Army Health Center is hoping to establish six patient centered medical homes by 2014. McDonald’s Troop Medical Clinic 2 will be the first to pursue Medical Home accreditation through NCQA. NCQA accreditation provides a standard of quality and excellence and gives organizations a competitive edge in the eyes of the consumer. Consumers are extremely focused on quality and are doing more and more research to choose providers who have attained national accreditation.

McDonald staff are excited about becoming a PCMH. The PCMH are easy to access, patient-centered, team based, and quality focused. They increase communication channels through web and telephone enabling patients to follow up on their issues and voice any concerns they may have. PCMH also enables patients to share and update information with their personal physicians and other care givers. The goal is to provide a comprehensive system of care which can include:

Ensuring delivery of preventative care
Managing chronic conditions
Promoting a spirit of health, welfare, and trust

According to McDonald, the PCMH is “healthcare’s total package. It is team driven with the patient and family in the driver’s seat. Their health care needs drive the bus! The healthcare team is responsible for improving outcomes from acute and chronic disease of the patients and their family. Wellness and preventative care are the pillars of our medical home.”

About Us

BHM Healthcare Solutions is a healthcare management consulting firm with one of our many specialties being accreditation. NCQA accreditation as noted above is a highly sought after accreditation and specifically patient centered health care home accreditation is becoming more popular and desirable. Our NCQA consultants can assist you with your accreditation needs. We have a 100% success rate in assisting our clients in attaining accreditation. We also specialize in URAC Medical Home accreditation. Please visit our accreditation page or call us at 1-888-831-1171 to obtain more information.

PCMH and the Evolving Role of Dietitians

Posted on September 7, 2012 by Linda Ringquist

PCMH stands for patient centered medical home. The PCMH is not a physical place like an actual house, hospital or other building. It is a concept in which the patient is the center of care and is actively involved in all decisions surrounding their care. The primary physician is responsible for coordinating all of the patient’s care including engaging specialists, obtaining lab results, and other referral issues when appropriate. The PCMH is designed to improve patient outcomes, increase access to care, and decrease healthcare costs. When many of us think of the medical home clinicians, we tend to think of mostly physicians and nurses. The August edition of Today’s Dietitian places emphasis on the importance of the Dietitian, and the prevention of Diabetes specifically, within the medical home.

One specific area in which Dietitians can enhance the Medical Home is Diabetes Management. Diabetes Educators work with the rest of the patient centered team to promote evidence based care. They facilitate patients’ effective self-management of diabetes and encourage them to adhere to recommended behavior changes. The Affordable Care Act (ACT) addresses the shift in focus from reactive patient care to preventative. One of the issues stated in the ACT is the prevention of diabetes and the reduced healthcare costs which can be obtained with preventative care. The AADE has the following recommendations for Dietitian Educators in order to remain competitive with the evolving needs of their profession:

Learn as much as possible about the Medical Home concept
Understand the link between Dietitians and the Medical Home
Promote the Medical Home concept amongst your peers
Educate patients and families as to the importance of the Medical Home
Educate yourself on Medical Home news and issues
Continue to indoctrinate your skills and specialties into the Medical Home
Remain current on new legislative measures associated with the Medical Home
Obtain any credentials which may give the competitive edge in your profession
Research and evaluate the importance of diabetes education within the context of the medical home

About Us

BHM Healthcare Solutions provides a wealth of services including, but not limited to, PCMH accreditation. Patient centered health care home accreditation (PCHCH) and URAC medical home accreditation are also terms used interchangeably. BHM has attained URAC accreditation and therefore national recognition in both PCHCH accreditation and URAC PCHCH Auditors Certification. These accreditations enable us to assist you in attaining PCHCH accreditation as well as provide an auditor’s view. We know what URAC is focused upon. We know how to become accredited. Please visit our website and peruse our accreditation pages. We have a 100% success rate in our clients attaining accreditation. Call us today 1-888-831-1171.

PCHCH Versus PCMH

Posted on September 4, 2012 by Linda Ringquist

PCHCH stands for patient centered health care home and is the term URAC uses.

PCMH stands for patient centered medical home and is the term TJC and NCQA use.

Medical Home is also the term used in the Affordable Care Act. They all basically have the same meaning – healthcare is centered around the patient and enables patient to have input into all of their healthcare decisions. The Medical Home is generally the primary care provider who is the person who coordinates all of the care for the patient. They act as the nucleus or glue which provides a central contact for patient healthcare.

Patient Centered Care seems to be the trend for the foreseeable future as it is one of the focal points for the Patient Protection and Affordable Care Act (PPACA).

URAC Medical Home Accreditation, otherwise known as Patient Centered Health Care Home Accreditation, offers an opportunity for organizations to become recognized as a leader in quality and a provide a commitment to excellence. URAC accreditation is a prestigious award which helps organizations to be held accountable to nationally recognized standards and therefore be regarded as organizations of choice.

Consumers are becoming more and more astute when it comes to healthcare decisions. They desire to be included in all of the decisions affecting their healthcare needs and services and are savvy in their research to select care from nationally accredited organizations. Quality care is essential and national accreditation is becoming the new standard, rather than a designation that only few organizations attain.

BHM Healthcare Solutions is a healthcare management consulting company who has achieved URAC accreditation for both PCHCH Practice Achievement as well as URAC PCHCH Auditors Certification. Our organization has already been through the accreditation process, therefore, we are well versed in all aspects of URAC PCHCH accreditation. Our experts have a process already in place to assist organizations who are pursuing either accreditation for the first time or re-accreditation. We have a 100% accreditation success rate with the clients we have assisted. Our accreditation expertise goes beyond URAC PCHCH accreditation and extends to areas including: URAC, NCQA, TJC, COA, and CARF accreditation. Please visit the accreditation pages of our website for more information as to how BHM can assist your organization or call 1-888-831-1171.

The Affordable Care Act and CMS Quality Framework Presentation

Posted on August 22, 2012 by Linda Ringquist

Original source is CMS website.

The Affordable Care Act is such an ominous piece of government regulations and encompasses just about every aspect of healthcare. The CMS Quality Framework is no exception. Section 3014 of the Affordable Care Act establishes a federal pre-rulemaking process for the selection of quality and efficiency measures for use in certain specific programs for use in performance reporting within the Department of Health and Human Services (HHS). This pre-rule making process includes:

Making publicly available by December 1^st annually, a list of measures currently under consideration by HHS for qualifying programs within the Department, including measures suggested by the public
Providing the opportunity for multi-stakeholder groups to review and provide input by February 1^st annually to HHES on the measures under consideration, and for HHS to consider this input
Publishing the rationale for the selection of any quality and efficiency measures that are not endorsed by the National Quality Forum
Assessing the impact of endorsed quality and efficiency measures at least every three years (the first report due to the public by March 1, 2012) (CMS Quality Framework Presentation)

The priorities set forth by CMS are as follows:

Making care safer by reducing harm caused in the delivery of care (Safety)
Ensuring that each person and family is engaged as partners in their care (Person and Family Centered Care) which can lead to URAC Medical Home Accreditation
Promoting effective communication and coordination of care (Communication and Care Coordination)
Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease (Effective Prevention and Treatment of Illness)
Working with communities to promote wide use of best practices to enable health living (Best Practices for Healthy Living)
Making quality care more affordable for individuals, families, employers and governments by developing and spreading new health care delivery models (Affordable Care)

According to the March 1, 2012 report, following are the programs which have been implemented and are currently being tracked and monitored for improvement:

Hospital Inpatient Quality Reporting (Hospital IQR)
Hospital Outpatient Quality Reporting (Hospital OQR)
Physician Quality Reporting System (PQRS)
Nursing Home (NH)
Home Health (HH)
End-Stage Renal Disease (ERSD)
Medicare Part C (Part C)
Medicare Part D (Part D)

The full report can be viewed at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/NationalImpactAssessmentofQualityMeasuresFINAL.pdf

The report also indicates quality measures which are either in the development or early implementation phases and will more than likely be included in the March 2015 report in terms of trending and results:

Hospice Quality Reporting
Ambulatory Surgery Center Quality Reporting
Prospective Payment System – Exempt Cancer Hospital Quality Reporting
Inpatient Rehabilitation Facility Quality Reporting
Long-Term Care Hospital Quality Reporting
Hospital Value-Based Purchasing
Inpatient Psychiatric Facility Quality Reporting
Electronic Prescribing Quality Reporting
Medicare and Medicaid Electronic Health Record Incentive Program for Eligible Professionals
Medicare and Medicaid Electronic Health Record Incentive Program for Hospitals and Critical Access Hospitals
Medicare Shared Savings Program
Medicare Physician Feedback/Value-Based Modifier Program
Children’s Health Insurance Program Reauthorization Act Quality Reporting
Health Insurance Exchange Quality Reporting
Initial Core Set of Health Care Quality Measures for Medicaid-Eligible Audit

Part 4 – What is PCHCH? NCQA’s PCHCH Accreditation

Posted on August 20, 2012 by Linda Ringquist

From Part 1 of our series, PCHCH stands for Patient Centered Health Care Home Accreditation. It is also sometimes referred to as Medical Home Accreditation. It is one of the latest health care models that places the consumer/patient at the center of health care decisions. It provides a collaborative effort between health care providers, patients, and patient’s families to discuss the pros and cons associated with potential procedures and outcomes.

Part 2 of our series provided enlightenment on URAC’s PCHCH program, including PCHCH as well as URAC PCHCH Auditors Certification (sometimes referred to as URAC Medical Home Accreditation).

In part 3, we reviewed the PCHCH certification program which is specific to The Joint Commission.

Part 4 we focus on NCQA’s PCHCH program. The official title is NCQA’s Patient-Centered Medical Home (PCMH 2011). This program is aimed toward the primary care setting. The plan gives practice information about organizing care around the patients, working in teams and coordinating and tracking care over time. There are 6 main elements to NCQA’s PCHCH recognition:

Access and continuity – provide team-based care with access and advice during and after hours and patient/family information about medical home
Identify and manage patient populations – acquire and use data for care of the practice’s population
Plan and manage care – use evidence-based guidelines for preventative, acute and chronic care management for chronic, frequent and behavior-based conditions
Self-care – support patient and family in self-care with information, tools and community resources
Track and coordinate care – track and coordinate tests, referrals and transitions of care

In order to become PCMH recognized, all six elements must be passed with a score of at least 50% on each element.

BHM Healthcare Solutions is a healthcare management consulting company with a broad range of services. One of those services is accreditation. NCQA accreditation can be difficult to obtain. Our NCQA consultants are experts on all of the nuances of accreditation. We have a 100% success rate for all of our clients whom we have assisted in the quest to obtain accreditation. For more information, please visit our accreditation webpage or call 1-888-831-1171.

Part 3 – What is PCHCH? TJC’s PCHCH Accreditation

Posted on August 17, 2012 by Linda Ringquist

Part 2 of our series provided enlightenment on URAC’s PCHCH program, including PCHCH as well as URAC PCHCH Auditors Certification (sometimes referred to as URAC Medical Home Accreditation).

In part 3, we will review the PCHCH certification program which is specific to The Joint Commission. The official title is The Joint Commission’s Primary Care Medical Home Model and consists of five parts:

Patient-centered care
Comprehensive care
Coordinated care
Superb access to care
A system’s based approach to quality and safety

Patient-centered care encompasses the following elements of performance:

Patient-selected primary care clinician (PPC)
PCC and interdisciplinary team work in partnership with the patient
Consideration of the patient’s cultural, linguistic, language, and educational needs and preferences
Patient involvement in establishing the treatment plan
Support for patient self-management

Comprehensive care includes the following elements of performance:

The provision of acute, preventative, and chronic care
Provision of continuous and comprehensive care
Team-based approach and the use of a multidisciplinary team to provide care
Use of internal and external resources to meet patient needs
The individual serving in the role of PCC had the educational background and broadbased knowledge and experience necessary to handle most medical needs of the patient and resolve conflicting recommendations for care
PCC works collaboratively with an interdisciplinary team
Care that addresses various phases of a patient’s lifespan, including end-of-life care
Disease management

Coordinated care has the following elements of performance:

Use of internal and external resources to meet patient needs
Responsibility for care coordination
Team-based approach

Superb access to care incorporates the following elements of performance:

Enhanced access
Availability of information regarding scheduled appointments 24 hours a day, 7 days a week
Access for non-visit related patient needs
Access for patients with special communication needs

Quality and safety includes the following elements of performance:

Population-based care
Use of health information technology
PCC and team members function within their scope of practice and in accordance with law and regulation and privileges granted
Use of evidence-based medicine and decision support tools
The provision of care to a panel of patients
Patient involvement in performance monitoring and improvement efforts

BHM Healthcare Solutions is a healthcare management consulting company with a wide range of services, including accreditation such as TJC accreditation, URAC accreditation, NCQA accreditation, COA accreditation and CARF accreditation. For more information, please refer to our BHM accreditation webpage.

Part 2 – What is PCHCH? URAC’s PCHCH Accreditation

Posted on August 16, 2012 by Linda Ringquist

URAC is one of at least four regulatory agencies who offer PCHCH accreditation. According to the URAC website, there are four subcategories associated with PCHCH: URAC PCHCH Auditors Certification (sometimes referred to as URAC Medical Home Accreditation), PCHCH Practice Achievement, PCHCH Practice Achievement with Electronic Health Record (HER) and PCHCH Program Toolkit and Information Resources.

URAC PCHCH Auditors Certificate is an extension of the PCHCH program which provides independent auditing of organizations to determine if the organization is meeting the standards set forth in the PCHCH program. The certification enables the independent organization to perform these auditing functions and is valid for three years. In order to become URAC PCHCH Certified Auditors, the additional requirements beyond the core standards are: business associate requirements, attending specific auditor training, and passing the certification. Additionally, annually, the auditors must attend annual training, undergo mid-year monitoring audits, and perform requirements to remain in good standing. Organizations eligible for PCHCH Auditors Certification include: health management organizations such as medical home pilots, health plans and consulting companies. More specifically, the occupations eligible may include: physicians, pharmacists, nurse practitioners, physician assistants, and social workers.

PCHCH Practice Achievement is the certification associated with complying with the core standards. There are two levels associated: Achievement – obtaining at least 65% or higher and score at least partially ratings for all seven mandatory standards and Achievement with HER – At least partially meeting all seven mandatory standards and fully meeting all of the elements aligned to meet all elements aligned to meaningful use requirements and attain an overall score of 65% of higher.

The seven mandatory standards include:

Patient rights and responsibilities
Access to service and information
Enhancing patient access to services
Track and follow-up on referral
Ongoing care management protocols for all patients
Coordination of care
Performance reporting

The last element of PCHCH is the URAC PCHCH Program Toolkit. This is more of a self guided program in which organizations can begin working toward achieving accreditation in one of the categories listed. It provides the standards and the building blocks to begin the accreditation journey. The toolkit provides benchmarks and measurable steps to assist with the accreditation process.

BHM Healthcare Solutions is a healthcare management consulting company with one of our areas of expertise as URAC accreditation which extends to patient centered health care home accreditation. We recently received URAC accreditation for PCHCH and PCHCH auditors certification. Please visit our webpage for more details. For a free consultation, please call 1-888-831-1171. Our URAC accreditation consultants are standing by to help you achieve your accreditation goals.

URAC’s Health Website Accreditation Helps Ensure Consumer Safety

Posted on July 17, 2012 by Linda Ringquist

Original source is the URAC website – website has a list of URAC accredited websites and those in process

The URAC Website Accreditation program is a mechanism to provide feedback to health website owners on how to improve their online operations. This provides additional credibility in trust in a company’s online market. There is an abundance of information available on the internet, especially in regard to healthcare. It is difficult to discern which sites provide factual information and which do not. Which information can you depend upon? URAC developed this program to address the concerns of the consumers and provide a tool to help identify websites that meet the high standards of quality and accountability.

Accreditation by URAC ensures the health information presented is peer-reviewed, research-validated and minimizes risky decision-making by consumers. These standards focus upon:

Privacy and security
Health content editorial processes
Disclosure of financial relationships
Linking policies
Consumer complaints
Emerging best practices
Evidence-based health information

URAC accredited websites are required to disclose information to consumers including:

Site’s sponsors and financial backers
Site’s privacy policies
How the site develops health information
Site’s advertising policy

The standards apply to a large variety of health-related websites, including health care financing organizations. Health delivery organizations, health management organizations, organizations offering health resources primarily through the Internet or other electronic media, application service providers, content providers or different combination of the organizations listed above. URAC conducts periodic reviews of the accredited site on an on-going basis and a full review. The standards provide strong protections regarding the use and protection of personal information consumers may provide to a health website.

URAC is an independent, nonprofit organization, promotes health care quality through its accreditation, education and measurement programs. It offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system and provides a symbol of excellence for organizations to validate their commitment to quality and accountability.

BHM Healthcare Solutions is a behavioral health consulting firm with one of our many areas of expertise being URAC accreditation. Our URAC Accreditation Consulting can assist with URAC accreditation, URAC PCHCH Auditors Certification, and URAC Medical Home Accreditation. For more information or to schedule a free consultation, please call 1-888-831-1171.

BHM Healthcare Solutions Services Spotlight – Patient Centered Health Care Home Accreditation

Posted on June 27, 2012 by Linda Ringquist

BHM Healthcare Solutions (BHM) specializes in healthcare management consulting. Our services are designed to help our clients achieve their goals by aligning and optimizing their growth, operational, financial and quality strategies. Our health care consultants bring a collaborative, knowledge based, and broad building style to every project resulting in measurable outcomes.

BHM clients have a 100% success rate in gaining the accreditation that their organizations sought. Need we say more? Our success rate speaks for itself.

Our last services spotlight focused on URAC accreditation in general. Today, we are focusing on Patient Centered Health Care Home Accreditation. According to the URAC website, “A Patient Centered Health Care Home (PCHCH) is a quality-driven, interdisciplinary clinician-driven approach to coordinating and delivering care that puts patients, family members, and personal caregivers at the center of all decisions concerning the patient’s health and wellness.” This basically means that any decisions made about a patient’s condition will be a collaborative effort between the patient, the patient’s family and the caregiver to arrive at the optimal method of treatment. Why shouldn’t the patient have input into their own care plan? Previous health care models centered around the caregiver’s recommendations without the input of the patient.

BHM understands how complex the accreditation process can be for healthcare organizations who are pursuing accreditation or re-accreditation, and our valuable guidance can serve to breakdown and simplify the complex and ever-changing components of URAC PCHCH accreditation into more management tasks in order to optimize your organization’s achievements.

Achieving URAC PCHCH Accreditation (sometimes called URAC Medical Home Accreditation) is an essential step for patient centered health care homes who wish to show they are nationally recognized for quality of care and meeting applicable standards. Accreditation also adds value to programs by providing an external seal of approval, and by promoting quality improvement within the organization as part of the accreditation process. The essential accreditation steps include:

Assessment of documentation compliance to URAC standards provided through analysis
Expert assistance and guidance toward URAC PCHCH compliance
Assembly of application and assistance with Accredinet
Content development and policy and procedure construction in an approved URAC format
Mock surveys
Specialized assistance with program design, orientation, and training

BHM can continue to work with your organization after accreditation is achieved. Accreditation is an ongoing process and our consultants can help keep your organization current with changing standards and procedures in your field. In the fast changing filed of healthcare, we can assist you now and in the future to ensure that your organization meets and stays within compliance. For a free consultation, please call 1-888-831-1171.

The History of URAC

Posted on June 22, 2012 by Linda Ringquist

Original source is the URAC website

URAC is an independent, nonprofit organization designed to promote health care quality through mediums such as accreditation, education and measurement programs. URAC provides benchmarking services which provide a symbol of excellence for organizations to validate their commitment to quality and accountability.

URAC’s mission statement is very simple and straight-forward.” To promote continuous improvement in the quality and efficiency of health care management through processes of accreditation and education.”

In the 1980’s, there was an awareness and concern looming over the lack of uniform standards for utilization review services. Utilization review is defined as the process of organizations making a determination of whether or not a health care service is medically necessary. As a result of this growing concern, URAC set out to improve the quality and accountability of health care organizations using utilization review programs. Many years later, the goal of URAC expanded to cover a larger range of service functions found in health care settings, including the accreditation of integrated systems such as health plans to smaller organizations offering specialty services. Today, URAC accreditation and certification includes over 25 programs.

URAC was setup as an organization independent of any particular stakeholder group. The governing Board of Directors was established with representatives from affected groups such as consumers, providers, employers, regulators, and industry experts. Today URAC consists of more than 300 volunteers and 30 paid staff.

URAC is considered one of the fastest growing health care accreditation agencies world-wide. URAC is constantly reviewing and developing new standards to ensure that all stakeholders are protected.

With the importance and notoriety of URAC accreditation, BHM Healthcare Solutions provides URAC consulting services. A few our areas of expertise are: URAC PCHCH certified auditors, patient centered health care home accreditation, and URAC medical home accreditation. For additional information, please contact BHM Health Care Solutions at 1-888-831-1171 for a free consultation.