2014 - PCMH4A - Revision history

Tim: /* 4.A.2 High cost/high utilization. */

2016-09-06T16:04:46Z

4.A.2 High cost/high utilization.

← Older revision		Revision as of 16:04, 6 September 2016
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	=4.A.2 High cost/high utilization.=		=4.A.2 High cost/high utilization.=

	~~Refer to~~ PCC~~'s 'utilize'~~ report ~~which is designed to show~~ patients who ~~utilize your services~~ most in ~~terms~~ of ~~number~~ of ~~visits and cost (charges billed)~~. Contact PCC support ~~for assistance with locating and running~~ this report.		PCC has a custom srs report that will identify patients who had the most visits or charges within a time period. Use this report to identify patients in need of care management based on their high utilization of your services. Contact PCC support to get this report installed on your system.

	NCQA provides other examples of ways to identify patients with high cost/high utilization:		NCQA provides other examples of ways to identify patients with high cost/high utilization:

Tim: /* 4.A.6. The practice monitors the percentage of the total patient population identified through its process and criteria. CRITICAL FACTOR) */

2015-12-01T17:48:53Z

4.A.6. The practice monitors the percentage of the total patient population identified through its process and criteria. CRITICAL FACTOR)

← Older revision		Revision as of 17:48, 1 December 2015
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	Assessment of a combination of factors 1–5 results in a subset of the practice’s entire panel of patients identified as likely to benefit from care management.		Assessment of a combination of factors 1–5 results in a subset of the practice’s entire panel of patients identified as likely to benefit from care management.
	Note: Patients identified in this element will be used to draw a sample for the medical record review required in PCMH 4, Elements B and C.		Note: Patients identified in this element will be used to draw a sample for the medical record review required in PCMH 4, Elements B and C.

			NCQA requires a numerator and denominator to be reported for this factor. Based on the care management criteria you have defined, identify how many patients you are considering in need of care management (numerator). The denominator is the number of total active patients at your practice which you can determine through the patient recaller report. Be sure to exclude patients with inactive, transferred, etc flags and include only patients seen at least once in the past three years.

Tim: /* 4.A.6. The practice monitors the percentage of the total patient population identified through its process and criteria. CRITICAL FACTOR) */

2015-12-01T17:46:26Z

4.A.6. The practice monitors the percentage of the total patient population identified through its process and criteria. CRITICAL FACTOR)

← Older revision		Revision as of 17:46, 1 December 2015
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	=4.A.6. The practice monitors the percentage of the total patient population identified through its process and criteria. CRITICAL FACTOR) =		=4.A.6. The practice monitors the percentage of the total patient population identified through its process and criteria. CRITICAL FACTOR) =

	~~{\| border = "1"~~		Assessment of a combination of factors 1–5 results in a subset of the practice’s entire panel of patients identified as likely to benefit from care management.
	~~! style="background~~:~~#8facd9; width:40%;" \|'''Description'''~~		Note: Patients identified in this element will be used to draw a sample for the medical record review required in PCMH 4, Elements B and C.
	~~! style="background:#8facd9; width:20%;" \|'''Example/Screenshot/Documentation'''~~
	~~! style="background:#8facd9; width:20%;" \|'''Source'''~~
	~~! style="background:#8facd9; width:20%;" \|'''Date Added'''~~
	\|-
	\|}

Tim: /* 4.A.5 Referrals by outside organizations (e.g., insurers, health system, ACO), practice staff or patient/family/caregiver. */

2015-12-01T17:45:42Z

4.A.5 Referrals by outside organizations (e.g., insurers, health system, ACO), practice staff or patient/family/caregiver.

← Older revision		Revision as of 17:45, 1 December 2015
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	=4.A.5 Referrals by outside organizations (e.g., insurers, health system, ACO), practice staff or patient/family/caregiver. =		=4.A.5 Referrals by outside organizations (e.g., insurers, health system, ACO), practice staff or patient/family/caregiver. =

	~~{\| border = "1"~~		NCQA explains: The practice has a process based on these criteria that is intended to allow for referrals by external entities and nominations by those closest to patients/families/caregivers.
	~~! style="background~~:~~#8facd9; width:40%;" \|'''Description'''~~
	~~! style="background:#8facd9; width:20%;" \|'''Example~~/~~Screenshot~~/~~Documentation'''~~
	~~! style="background:#8facd9; width:20%;" \|'''Source'''~~
	~~! style="background:#8facd9; width:20%;" \|'''Date Added'''~~
	\|-
	\|}

	=4.A.6. The practice monitors the percentage of the total patient population identified through its process and criteria. CRITICAL FACTOR) =		=4.A.6. The practice monitors the percentage of the total patient population identified through its process and criteria. CRITICAL FACTOR) =

Tim: /* 4.A.4 Social determinants of health. */

2015-12-01T17:44:45Z

4.A.4 Social determinants of health.

← Older revision		Revision as of 17:44, 1 December 2015
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	=4.A.4 Social determinants of health. =		=4.A.4 Social determinants of health. =

	~~{\| border = "1"~~		NCQA explains: Social determinants of health are conditions in the environment that affect a wide range of health, functioning and quality-of-life outcomes and risks. Examples include: availability of resources to meet daily needs; access to educational; economic and job opportunities; public safety, social support; social norms and attitudes; exposure to crime, violence and social disorder; socioeconomic conditions; residential segregation and others (Healthy People 2020).
	~~! style="background~~:~~#8facd9; width~~:~~40%~~;~~" \|'''Description'''~~
	~~! style="background:#8facd9~~; ~~width:20%~~;~~" \|'''Example/Screenshot/Documentation'''~~
	~~! style="background:#8facd9~~; ~~width:20%~~;~~" \|'''Source'''~~
	~~! style="background:#8facd9~~; ~~width:20%~~;~~" \|'''Date Added'''~~
	\|-
	\|}

	=4.A.5 Referrals by outside organizations (e.g., insurers, health system, ACO), practice staff or patient/family/caregiver. =		=4.A.5 Referrals by outside organizations (e.g., insurers, health system, ACO), practice staff or patient/family/caregiver. =

Tim: /* 4.A.3 Poorly controlled or complex conditions. */

2015-12-01T17:44:05Z

4.A.3 Poorly controlled or complex conditions.

← Older revision		Revision as of 17:44, 1 December 2015
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	=4.A.3 Poorly controlled or complex conditions. =		=4.A.3 Poorly controlled or complex conditions. =

	~~{\| border = "1"~~		To meet this factor, consider using PCC EHR Patient Lists to identify patients with high Blood Pressure, BMI, or particular lab test results.
	~~! style="background:#8facd9; width:40%;" \|'''Description'''~~
	~~! style="background:#8facd9; width:20%;" \|'''Example/Screenshot/Documentation'''~~
	~~! style="background:#8facd9; width:20%;" \|'''Source'''~~
	~~! style="background:#8facd9; width:20%;" \|'''Date Added'''~~
	\|-
	\|}

	=4.A.4 Social determinants of health. =		=4.A.4 Social determinants of health. =

Tim: /* 4.A.2 High cost/high utilization. */

2015-12-01T17:42:26Z

4.A.2 High cost/high utilization.

← Older revision		Revision as of 17:42, 1 December 2015
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	* Hospital readmissions.		* Hospital readmissions.
	* Unusually high numbers of imaging or lab tests ordered.		* Unusually high numbers of imaging or lab tests ordered.
	* Unusually high number of prescriptions.		* Unusually high number of prescriptions.
	* High-cost medications.		* High-cost medications.
	* Number of secondary specialist referrals.		* Number of secondary specialist referrals.

Tim: /* 4.A.2 High cost/high utilization. */

2015-12-01T17:42:12Z

4.A.2 High cost/high utilization.

← Older revision		Revision as of 17:42, 1 December 2015
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	Refer to PCC's 'utilize' report which is designed to show patients who utilize your services most in terms of number of visits and cost (charges billed). Contact PCC support for assistance with locating and running this report.		Refer to PCC's 'utilize' report which is designed to show patients who utilize your services most in terms of number of visits and cost (charges billed). Contact PCC support for assistance with locating and running this report.

			NCQA provides other examples of ways to identify patients with high cost/high utilization:

			* ER visits.
			* Hospital readmissions.
			* Unusually high numbers of imaging or lab tests ordered.
			* Unusually high number of prescriptions.
			* High-cost medications.
			* Number of secondary specialist referrals.
			* Reports, alerts or other notifications from health plans indicating high cost or high utilization.

	=4.A.3 Poorly controlled or complex conditions. =		=4.A.3 Poorly controlled or complex conditions. =

Tim: /* 4.A.1 Behavioral health conditions. */

2015-12-01T17:40:36Z

4.A.1 Behavioral health conditions.

← Older revision		Revision as of 17:40, 1 December 2015
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	PCC's [http://learn.pcc.com/help/quickstart-recalling-patients/ recaller] or [http://learn.pcc.com/help/patient-lists/ EHR Patient List] functionality can be used to identify patients based on billed diagnosis (recaller) or active problem list, lab result, or medication (EHR Patient Lists).		PCC's [http://learn.pcc.com/help/quickstart-recalling-patients/ recaller] or [http://learn.pcc.com/help/patient-lists/ EHR Patient List] functionality can be used to identify patients based on billed diagnosis (recaller) or active problem list, lab result, or medication (EHR Patient Lists).

			NCQA further explains how pediatric practices can go about identifying patients in need of care management:

			Practices may identify children and adolescents with special health care needs, defined by the U.S. Department of Health and Human Services Maternal and Child Health Bureau (MCHB) as children “who have or are at risk for chronic physical, developmental, behavioral or emotional conditions and who require health and related services of a type or amount beyond that required generally.” (Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, American Academy of Pediatrics, 3rd Edition, 2008, p. 18.)

	=4.A.2 High cost/high utilization.=		=4.A.2 High cost/high utilization.=

Tim: /* 4.A.1 Behavioral health conditions. */

2015-12-01T17:39:27Z

4.A.1 Behavioral health conditions.

← Older revision		Revision as of 17:39, 1 December 2015
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	* A positive screening result from a standardized behavioral health screener (including substance use).		* A positive screening result from a standardized behavioral health screener (including substance use).

	PCC's recaller or EHR Patient List functionality can be used to identify patients based on billed diagnosis (recaller) or active problem list, lab result, or medication (EHR Patient Lists).		PCC's [http://learn.pcc.com/help/quickstart-recalling-patients/ recaller] or [http://learn.pcc.com/help/patient-lists/ EHR Patient List] functionality can be used to identify patients based on billed diagnosis (recaller) or active problem list, lab result, or medication (EHR Patient Lists).

	=4.A.2 High cost/high utilization.=		=4.A.2 High cost/high utilization.=