DEVELOPING HIGH PERFORMING COMMUNITY PRACTICES April 25, 2014 JEFF LASKER, MD, MMM, FAAP, CPE LISA REED, MBA Treating the FutureSM AGENDA Background on Organization “Secret Sauce” and Approach Exercise Learning Objectives Identify the challenges that community practices face related to population health management and quality reporting Describe the alignment of population health, quality metrics and P4P requirements in a small physician practice Explain the approach taken by the New England Quality Care Alliance (NEQCA) with small practices to achieve Patient Centered Medical Home (PCMH) recognition 4/25/2014 3 New England Quality Care Alliance (NEQCA) Geographic Presence A physician led network of over 1,700 independent community and academic physicians throughout eastern Massachusetts organized into 16 Local Care Organizations (LCOs) Affiliated with Tufts Medical Center, academic medical center in Boston Outside of Tufts Medical Center, the majority of practices have less than 3 providers. 4/25/2014 4 Overall Network Performance 4/25/2014 5 Challenges of Community Practices and Solutions Challenges of Small Practices Solution Increasing federal, state and local requirements Develop consistent workflow across all requirements Increased focus on patient experience measurement Increase patient satisfaction through PCMH Limited resources in the practices Add Practice Consultant and Practice Quality Coordinators to PCMH team Not optimized, limited EHR use despite Meaningful Use Incorporate workflows that apply to all payers and initiatives Workflow non existent in many cases Develop role based training for practice staff Physicians want to see all patients the same way regardless of payer and not “think” about requirements 4/25/2014 6 What is the “secret sauce” to help small physician practices? Crosswalk of Measures Phased Approach to PCMH Implementation Role Based Training Build the Team 4/25/2014 7 Crosswalk of Measures: PCMH: A Foundation for Quality All payers Efficiency Quality P4P/HEDIS Medicare Only Commercial payers Patient Experience Medicare Shared Savings Program/ Accountable Care Organization Physician PCMH System of Care Quality Reporting System Meaningful Use Stage 1 & 2 4/25/2014 8 Crosswalk of Measures: What are the overlaps? Commercial Risk P4P Requirements MU Stage 1 MSSP/ ACO MU Stage 2 Quality Measures PCMH/ NCQA Measures 15 Core 17 Core Find the Overlap Across Programs 10 Menu 6 Menu 6 Elements 30+ Measures 4/25/2014 6 Clinical Quality Measures 9 Clinical Quality Measures 33 Quality Measures 100 Points Total 2013 PQRS 100+ Measures 9 Crosswalk of Measures: Program Level Example Measure Commercial Description P4P MU Stage 1 MU MSSP Stage 2 Measure PCMH/ NCQA Measure 2013 PQRS Measure Diabetic patients between the ages of 18 - 75 who have had a blood pressure less than 140/90 within the last 12 months Clinical Quality Measure NQF 0061 Clinical Quality Measure NQF 0061 • 2.D.2 one of 3 chronic care services • 3.A important condition • 6.A.2 one of 3 chronic care measures Measure #3 Diabetes Mellitus: High Blood Pressure Control Included in multiple contracts Measure #24 Continue same process to map all Meaningful Use, Medicare Shared Savings Program, PQRS, Risk Contract P4P, and PCMH/NCQA Metrics 4/25/2014 10 Phased Approach: How to break into small bites? 4/25/2014 11 Phased Approach: PCMH Practice Level Implementation Month Month Month Month Month Month Month Month Month Month Month Month 1 2 3 4 5 6 7 8 9 10 11 12 •Assess Provider office against PCMH Standards •Observe office workflow •Introduce PCMH to office •Introduce Policies and Procedures required for PCMH Communication 4/25/2014 Technology •Configure Electronic Health Record •Builds the foundation for change, i.e. policy and procedure development •Same day appointments •Patients’ access to clinical advice during/after business hours Access Care Management •Develop care plans for chronically ill patients •Manage patient medications •Provide education and tools for care at home •Provide resources outside of office for their care •Monitor and follow up on diagnostic tests and referrals ordered from office •Contact specialists to obtain patient’s visit note Test/Referral Tracking QI Cycle •Identify quality measures at practice, i.e. mammograms, colonoscopy •Create and implement a quality improvement plan for the selected measures •Monitor practice’s quality improvement plan 12 Build the Team: Practice Consultant Practice Consultant – Project Manager Practice Quality Coordinator (PQC) – Point of contact throughout the entire implementation process – Focused on improved performance on quality measures – Trains/coordinates PCMH workflows – Facilitates outreach for preventive and chronic care services – Facilitates project timelines and identifies and informs Practice Team of any barriers – Active EHR alerts – Collects documentation for NCQA submission 4/25/2014 13 Build the Team: Practice Quality Coordinator (PQC) PQC ½ day per 2 weeks Practice Quality Coordinator Works onsite at practice and has remote access to EHR if available 4/25/2014 14 Role Based Training: Practice Role Based Quick Guides • Each Quick Guide Combines Role Based Tasks for MU, MSSP/ACO, and PCMH Front Office Medical Assistant /Nurse Provider 4/25/2014 • Most tasks are broken into: • “To Complete Daily” • “To Complete for Every Visit” • “To Complete at each Physical Exam” • Other specific tasks around referrals, lab, diagnostic imaging, and hospital admissions 15 Key Takeaways Identify Population Health and Quality Metrics that overlap across programs Develop standardized approach for implementation, but do not always standardize Provide additional resources to practices especially while participating in PCMH Implementation Simplify requirements by role in the practice 4/25/2014 16 Exercise Form a group Each group choose a facilitator – Facilitator is the person who travelled the farthest 15 min - Each group share what resonates with you in your organization regarding the concepts 5 min – Group report out Crosswalk of Measures Phased Approach to PCMH Implementation Role Based Training Build the Team 4/25/2014 17 Discussion What is the most valuable thing you learned in your group? What was the most important takeaway identified at your table? 4/25/2014 18 “There is a recipe, but all recipes can be modified” 4/25/2014 19 Questions? Thank You! Jeffrey I. Lasker, MD, MMM, FAAP, CPE President and Chief Executive Officer New England Quality Care Alliance 325 Wood Road, Suite 210 Braintree, MA 02184 781-356-3336 [email protected] Lisa Reed, MBA Senior Director Healthcare Information Services New England Quality Care Alliance 325 Wood Road, Suite 210 Braintree, MA 02184 781-356-3336 [email protected]
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