PCC PCMH Resources: Difference between revisions

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This wiki serves as an informal repository of PCMH documentation related to the 2011 PCMH Standards.  Much of the content here comes from PCC clients who have generously allowed us to use their material.  Nothing in this wiki is official PCC documentation and should be used at your own risk.
This wiki serves as an informal repository of PCMH documentation related to NCQA's 2017 Standards.  Some of the content here comes from PCC clients who have generously allowed us to use their material.  Nothing in this wiki is official PCC documentation and should be used at your own risk.


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[http://pcmh.pcc.com/index.php/2017_Main PCC's Resources for 2017 PCMH Standards]
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==PCMH 1: Enhance Access and Continuity (20 points)==
[http://pcmh.pcc.com/index.php/2014_Main PCC's Resources for 2014 PCMH Standards] <span style="color:red">(Outdated as of October, 2017)</span>


The intent of this standard is:
= Why Get PCMH Recognition? =
* Patients have access to routine/urgent care and clinical advice during/after hours that is culturally and linguistically appropriate.
* Patients have electronic access
* Clinician selected by patient
* Team based Care - trained staff


===[[PCMH1A|PCMH1A - Access During Office Hours (4 points) ('''Must Pass''')]]===
NCQA PCMH Recognition is the most widely-used way to transform primary care practices into medical homes. More than 12,000 practices (with more than 60,000 clinicians) are recognized - about 18 percent of all primary care clinicians.
===[[PCMH1B|PCMH1B - After-hours access (4 points)]]===
===[[PCMH1C|PCMH1C - Electronic Access (2 points)]]===
===[[PCMH1D|PCMH1D - Continuity (2 points)]]===
===[[PCMH1E|PCMH1E - Medical Home Responsibilities (2 points)]]===
===[[PCMH1F|PCMH1F - Culturally and Linguistically Appropriate Services (2 points)]]===
===[[PCMH1G|PCMH1G - The Practice Team (4 points)]]===


==PCMH 2: Identify and Manage Patient Populations (16 points)==
Benefits for clinicians include:
*Earn higher reimbursement. More than 50 payers nationwide offer enhanced reimbursement for recognized clinicians or support for practices to become recognized.
*Earn Maintenance of Certification (MOC) credits. Several medical boards award clinicians in NCQA-recognized practices Maintenance of Certification (MOC) credits, reducing the burden on clinicians to take on additional activities.
*Focus on patient care. The PCMH model ensures that team members operate at the highest level of their knowledge, skills, abilities and license, within their assigned roles and responsibilities.


The intent of this standard is:
NCQA Resources
*[http://www.ncqa.org/Portals/0/qpass/NCQA1074-0317_Getting_Started_Toolkit_Web.pdf Toolkit: Getting Started with NCQA PCMH Recognition]
*[http://www.ncqa.org/Portals/0/Programs/Recognition/PCMH/NCQA1005-1016_PCMH%20Evidence_Web.pdf Evidence Report]
*[http://www.ncqa.org/education-training/pcmh-pcsp Training On-site or On-demand]
*[http://www.ncqa.org/Portals/0/Programs/Recognition/Resources/02012018_Resource_Directory_of_Incentives_for_NCQA_Recognition.pdf Resource Directory of Incentives for NCQA Recognition]


* Electronic systems have searchable fields for demographic and clinical data
= PCC Collaboration with The Verden Group's Patient Centered Solutions =
* Patients receive documented comprehensive health assessments
* Electronic systems used to identify patients who need services


===[[PCMH2A|PCMH2A - Patient Information (3 points)]]===
[http://www.theverdengroup.com/our-services/patient-centered-solutions-services The Verden Group’s Patient Centered Solutions (PCS)] has collaborated with PCC to provide a comprehensive program assisting PCC clients in achieving NCQA's PCMH 2014 Recognition.  Contact PCC for more details on this offering.
===[[PCMH2B|PCMH2B - Clinical Data (4 points)]]===
===[[PCMH2C|PCMH2C - Comprehensive Health Assessment (4 points)]]===
===[[PCMH2D|PCMH2D - Use Data for Population Management ('''Must Pass''') (5 points)]]===


==PCMH 3: Plan and Manage Care (17 points)==
= 2017 PCMH Standards =


The practice systematically identifies individual patients and plans, manages and coordinates their care based on their condition and needs and on evidence-based guidelines.
NCQA has redesigned PCMH Recognition. The redesigned program includes ongoing, sustained recognition status with Annual Reporting instead of a 3-year recognition cycle. NCQA based the redesign on feedback from practices, policy makers, payers and other stakeholders. The program is more manageable, while continuing to concentrate on performance and quality improvement. It also reduces paperwork and increases practice interaction with NCQA.  With the redesigned process came [http://www.ncqa.org/programs/recognition/practices/patient-centered-medical-home-pcmh/getting-recognized/documents new 2017 standards] that were released in April, 2017.


===[[PCMH3A|PMCH3A - Implement Evidence-Based Guidelines (4 points)]]===
PCC has organized [http://pcmh.pcc.com/index.php/2017_Main the 2017 PCMH Standards] in this wiki to provide quick reference to the 2017 standards themselves and, where applicable, documentation showing how PCC functionality applies to individual PCMH factors.  In some cases, PCC clients have also generously allowed us to reference their material.
===[[PCMH3B|PMCH3B - Identify High Risk Patients (3 points)]]===
===[[PCMH3C|PMCH3C - Care Management ('''Must Pass''') (4 points)]]===
===[[PCMH3D|PMCH3D - Medication Management (3 points)]]===
===[[PCMH3E|PMCH3E - Use Electronic Prescribing (3 points)]]===


==PCMH 4: Provide Self-Care Support and Community Resources (9 points)==
= PCC Prevalidation =


Intent of Standard: The practice acts to improve patients' ability to manage their health by providing a selfcare
As of 03/07/2018, practices utilizing PCC can benefit from reduced documentation for criteria designated as “partially met criteria” and have criteria designated as “fully met criteria” marked as “met” in full.  As documented in the [[media:PCC_PrevalidationLOE_6.18.2020_(2).pdf|PCMH 2017 Letter of Credit Approval/Transfer Credit Summary]], each PCC client practice that wishes to apply for NCQA PCMH 2017 Recognition will need to complete the following steps to use PCC's prevalidated status:
plan, tools, educational resources and ongoing support.


===[[PCMH4A|PMCH4A - Support Self-Care Process ('''Must Pass''') (6 points)]]===
#Download the NCQA-issued [[media:PCC_PrevalidationLOE_6.18.2020_(2).pdf|PCMH 2017 Letter of Credit Approval/Transfer Credit Summary]]
===[[PCMH4B|PMCH4B - Provide Referrals to Community Resources (3 points)]]===
#Contact PCC to get a Letter of Product Implementation indicating which prevalidated tool(s)/modules approved for autocredit have been implemented at your practice.
#Log-In to QPASS and complete the following steps:
#*Click “My Evaluations”
#*Hover over Action and select “Organization Dashboard”
#*Select “Transfer Credits” button
#*On the “Select Program” screen, pick “Vendor”
#*Select the applicable practice site(s)
#*Using the evidence component, upload the Letter of Product Implementation
#*Click the “Submit for Review” button
#Receive approval from your NCQA Representative. Once your transfer credit is approved, all eligible criteria with transfer credit will be marked as “met.”


==PCMH 5: Track and Coordinate Care (18 points)==
= Other Resources =


The practice systematically tracks tests and coordinates care across specialty care, facility-based care and community organizations.
[http://pcmh.pcc.com/index.php/2011_Main PCC's Resources for previous 2011 PCMH Standards]


===[[PCMH5A|PMCH5A - Test Tracking and Follow-Up (6 points)]]===
[[media:Chart_Review_Rubrics_for_3C,_3D,_4A.pdf|Chart Review Rubrics for 3C, 3D, and 4A]] courtesy of Plateau Pediatrics in TN
===[[PCMH5B|PMCH5B - Referral Tracking and Follow-Up ('''Must Pass''') (6 points)]]===
===[[PCMH5C|PMCH5C - Coordinate With Facilities and Care Transitions (6 points)]]===


==PCMH 6: Measure and Improve Performance (20 points)==
[[media:MU-Crosswalk-new.pdf|Crosswalk of Meaningful Use components to 2014 PCMH standards]]


The practice uses performance data to identify opportunities for improvement and acts to improve clinical quality, efficiency and patient experience.
[http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH/DuringEarnItPCMH/OtherPCMHResources/FAQsforPediatricPractices.aspx FAQ for pediatric practices related to 2011 PCMH Standards]


===[[PCMH6A|PMCH6A - Measure Performance (4 points)]]===
[http://www.ncqa.org/Programs/Recognition/NCQAPCMHPCSPRecognitionProgramPricing.aspx NCQA's Pricing and Fee Schedule for PCMH Recognition]
===[[PCMH6B|PMCH6B - Measure Patient/Family Experience (4 points)]]===
 
===[[PCMH6C|PMCH6C - Implement Continuous Quality Improvement ('''Must Pass''') (4 points)]]===
[http://www.ncqa.org/Portals/0/Programs/Recognition/PCMH/8_PCMH_Recognition_2014_Appendix_6_Summary_of_Updates_to_PCMH_2014.pdf NCQA Clarifications/Corrections on 2014 PCMH Standards]
===[[PCMH6D|PMCH6D - Demonstrate Continuous Quality Improvement (3 points)]]===
 
===[[PCMH6E|PMCH6E - Report Performance (3 points)]]===
[http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH/PCMH2011PCMH2014Crosswalk.aspx NCQA's PCMH 2011–PCMH 2014 Crosswalk]
===[[PCMH6F|PMCH6F - Report Data Externally (2 points)]]===
 
[http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH/PCMH2014ContentandScoringSummary.aspx NCQA's 2014 PCMH Content and Scoring Summary]
 
[http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH/PCMH2014ContentandScoringSummary.aspx NCQA PCMH 2014: Behind the Enhancements] free webinar download
 
[http://www.ncqa.org/education-training/pcmh-pcsp NCQA's recorded PCMH recognition training]

Latest revision as of 16:59, 8 January 2021

This wiki serves as an informal repository of PCMH documentation related to NCQA's 2017 Standards. Some of the content here comes from PCC clients who have generously allowed us to use their material. Nothing in this wiki is official PCC documentation and should be used at your own risk.

PCC's Resources for 2017 PCMH Standards

PCC's Resources for 2014 PCMH Standards (Outdated as of October, 2017)

Why Get PCMH Recognition?

NCQA PCMH Recognition is the most widely-used way to transform primary care practices into medical homes. More than 12,000 practices (with more than 60,000 clinicians) are recognized - about 18 percent of all primary care clinicians.

Benefits for clinicians include:

  • Earn higher reimbursement. More than 50 payers nationwide offer enhanced reimbursement for recognized clinicians or support for practices to become recognized.
  • Earn Maintenance of Certification (MOC) credits. Several medical boards award clinicians in NCQA-recognized practices Maintenance of Certification (MOC) credits, reducing the burden on clinicians to take on additional activities.
  • Focus on patient care. The PCMH model ensures that team members operate at the highest level of their knowledge, skills, abilities and license, within their assigned roles and responsibilities.

NCQA Resources

PCC Collaboration with The Verden Group's Patient Centered Solutions

The Verden Group’s Patient Centered Solutions (PCS) has collaborated with PCC to provide a comprehensive program assisting PCC clients in achieving NCQA's PCMH 2014 Recognition. Contact PCC for more details on this offering.

2017 PCMH Standards

NCQA has redesigned PCMH Recognition. The redesigned program includes ongoing, sustained recognition status with Annual Reporting instead of a 3-year recognition cycle. NCQA based the redesign on feedback from practices, policy makers, payers and other stakeholders. The program is more manageable, while continuing to concentrate on performance and quality improvement. It also reduces paperwork and increases practice interaction with NCQA. With the redesigned process came new 2017 standards that were released in April, 2017.

PCC has organized the 2017 PCMH Standards in this wiki to provide quick reference to the 2017 standards themselves and, where applicable, documentation showing how PCC functionality applies to individual PCMH factors. In some cases, PCC clients have also generously allowed us to reference their material.

PCC Prevalidation

As of 03/07/2018, practices utilizing PCC can benefit from reduced documentation for criteria designated as “partially met criteria” and have criteria designated as “fully met criteria” marked as “met” in full. As documented in the PCMH 2017 Letter of Credit Approval/Transfer Credit Summary, each PCC client practice that wishes to apply for NCQA PCMH 2017 Recognition will need to complete the following steps to use PCC's prevalidated status:

  1. Download the NCQA-issued PCMH 2017 Letter of Credit Approval/Transfer Credit Summary
  2. Contact PCC to get a Letter of Product Implementation indicating which prevalidated tool(s)/modules approved for autocredit have been implemented at your practice.
  3. Log-In to QPASS and complete the following steps:
    • Click “My Evaluations”
    • Hover over Action and select “Organization Dashboard”
    • Select “Transfer Credits” button
    • On the “Select Program” screen, pick “Vendor”
    • Select the applicable practice site(s)
    • Using the evidence component, upload the Letter of Product Implementation
    • Click the “Submit for Review” button
  4. Receive approval from your NCQA Representative. Once your transfer credit is approved, all eligible criteria with transfer credit will be marked as “met.”

Other Resources

PCC's Resources for previous 2011 PCMH Standards

Chart Review Rubrics for 3C, 3D, and 4A courtesy of Plateau Pediatrics in TN

Crosswalk of Meaningful Use components to 2014 PCMH standards

FAQ for pediatric practices related to 2011 PCMH Standards

NCQA's Pricing and Fee Schedule for PCMH Recognition

NCQA Clarifications/Corrections on 2014 PCMH Standards

NCQA's PCMH 2011–PCMH 2014 Crosswalk

NCQA's 2014 PCMH Content and Scoring Summary

NCQA PCMH 2014: Behind the Enhancements free webinar download

NCQA's recorded PCMH recognition training

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