Patient Centered Medical Home: Transforming Your Health Center

Patient Centered

Medical Home: Transforming Your Health Center

A Guide to Obtaining PCMH Recognition

www.healthhiv.org

What is a Patient Centered Medical Home?

The Patient Centered Medical Home (PCMH) is a healthcare deliver y model that improves the quality of care for patients through increased access, planning, management, and monitoring of care. It is an approach to providing comprehensive primary care for community members of all ages, which facilitates partnerships between individual patients, their providers, and when appropriate, the patient’s family. PCMH is defined by several care principles, outlined on page 7.

HIV in the Patient Centered Medical Home HIV impacts many populations across the United States that have historically lacked access to the health care system, including support and

The PCMH model offers many benefits including increased

prevention services. These com-

patient, staff, and provider satisfaction, reduced hospitaliza-

munities include low-income

tion and emergency room visits, reduction in overall health

and medically underserved

costs to health centers and patients, and reduced strain on the healthcare system. PCMH benefits have been acknowledged by national organizations as well as state legislation.

Twenty-two states define, test, implement, or promote PCMH in their laws.

communities, ethnic and racial minorities, the homeless, and substance abusers. Within the last decade, there have been major advances in treatment,

The AIDS Education and Training Centers (AETC) National

which have significantly in-

Center for HIV Care in Minority Communities (NCHCMC),

creased the length and quality

led by HealthHIV, is the Health Resources and Services

of life for people living with HIV.

Administration (HRSA), HIV/AIDS Bureau’s (HAB’s) major effort

However, disparities in access to

to expand HIV/AIDS care and treatment within highly impact-

HIV treatment and quality care

ed communities of color served by community health cen-

persist. As people living with HIV

ters. The AETC NCHCMC increases access to comprehensive

age, and lead longer lives, they

HIV care by developing the organizational capacity of health

face additional health chal-

centers, and includes both clinical and practice transformation training, as well as capacity building.

lenges for which a PCMH is well equipped to provide care. By integrating services across specialties, PCMHs provide comprehensive HIV care in high-risk and severely impacted communities, thus promoting health equity.

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Frequently Asked Questions: What types of facilities become PCMHs? Almost every type of health facility can be a PCMH. Many Federally Qualified Health Centers and look-alikes have been recognized. The majority of accredited PCMH facilities are family medical practices. An increasing percentage of PCMH facilities offer primary and specialty care.

How long does it take to be recognized?

Time periods vary. Recognition timeframes depend on the practice’s starting point, financial situation, health plan, and choice of accrediting body.

What are the challenges?

The top five challenges cited by a Medical Group Management Association (MGMA) survey were: ■ Establishing care coordination agreements with referral physicians, ■ Financing the transformation, ■ Coordinating care for high-risk patients, ■ Projecting financial effects (e.g. practice revenue and costs), ■ Modifying or adapting an EHR system to support PCMH related functions.

How long will my health center be recognized for?

All recognizing bodies, except for URAC, provide PCMH recognition for three years. URAC recognizes PCMH for two years before reaccreditation must take place. Health centers can reapply for recognition before the previous recognition expires in order to remain continuously recognized.

Where can I get more information on PCMH? For more information on PCMH recognition, go directly to the websites of the recognizing bodies (found on pages 4 and 5). For more information on the benefits of PCMH, visit the website of the American College of Physicians (www.acponline.org/running_practice/pcmh/). For a more extensive checklist of requirements and guidelines, visit the American Academy of Family physicians (www.aafp.org). Visit the HRSA Bureau of Primary Health Care (www.hrsa.gov) for information on funding for PCMH recognition.

How can I apply to participate in the AETC National Center for HIV Care in Minority Communities?

For applications, news, updates and information, please visit www.nchcmc.org.

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Key Features of PCMH Recognition National Committee for Quality Assurance (NCQA) Joint Commission

Patient Centered Health Care Home Program

Utilization Review Accreditation Commission (URAC)

Medical Home On-Site Certification/ Medical Home Accreditation

Accreditation Association for Ambulatory Health Care (AAAHC)

■ S ite visit by AAAHC surveyors Medical Home Accreditation

■C ertification handbook with specific standards

Medical Home On-Site Certification

Primary Care Medical Home Option, as part of the Ambulatory Care Accreditation

■ Accreditation handbook ■ Access to the Joint Commission Business Development Staff and Standards Interpretation Group ■ Online survey activity guide

■ Two workshops explaining the URAC accreditation process

Physician Practice Connections Patient-Centered Medical Home Program

Four national organizations offer recognition for health centers to become PCMHs. Each offers a unique recognition process.

Program Name

■ Survey tool ■ Training on PCMH standards and guidelines ■ A state-wide program manager that provides individual guidance

■E xcerpts of the Handbook for Ambulatory Health Care on Medical Home

Accreditation consists of an on-site survey of staff, facility, equipment, medical protocols, and the coordination of care procedures.

Key Components

■ A toolkit that includes practice assessment standards, interpretive guidance, and checklist

■ Three day site visit by an accredited Ambulatory Care Surveyor

After sending preliminary background information via an application, an URAC Certified Auditor or Reviewer performs an on-site practice audit. The process includes review by a licensed health professional who evaluates the processes and documentation on-site.

For on-site certification, including application and survey fee, cost is $3,500 per site. For full accreditation, contact AAAHC. Costs vary greatly according to size, range and type of services provided by the organization.

■ Access to the Targeted Solutions Tool online

■ Site visit available (additional cost: $3,000)

An on-site, three day survey to validate the information provided in the application and to further educate the health center staff.

Recognition is based on the application and site visit results.

$1,155 for toolkit. Total cost ranges from $720 to $2,400. On-site visits cost $1,500 per day and vary according to length of stay and level of achievement requested.

This program offers an on-site certification program, which allows for rapid completion when compared to the others. The handbooks for both programs are very extensive.

■C omprehensive medical home survey process conducted by AAAHC surveyors

Recognition Process

NCQA recognition is based solely on the application and self assessment. The self assessment is very specific and is guided through a survey tool.

For health center sites with an average daily patient census of under 30 individuals the cost is $5,150 for the first year, and $1,100 every year after - for a total of 3 years of accreditation. For sites with higher average daily censuses and multiple sites or providers, costs can reach to $15,000.

The on-site audit is low-cost and offers basic requirements for full accreditation.

URAC released their toolkit in 2010.

■ Site visit by a URAC Certified Auditor or Reviewer

Costs

Application price varies by number of providers, starting at $500, and the survey tool is $80 per site. Seminars cost $1,000 on average, ranging from $850 to $1,250.

This program is connected to ambulatory care accreditation and was initiated in 2011. The recent creation of the program limits its recognition from other organizations and states.

■ Webinars and seminars available (additional cost: $990)

Unique Aspects

NCQA is endorsed by HRSA, and offers a 20% discount for applicants working with health plans, employers, and other programs. NCQA PCMH awards are recognized by many states for monetary and legislative benefits. Check your state’s Association of Family Physicians or department of health for details.

www.urac.org

Call: 847.853.6060 Email: mwallander@aaahc.org

www.aaahc.org www.jointcommission.org

Call: 202.216.9010

Call: 202.955.1700 Email: pcmh@ncqa.org

www.ncqa.org

Call: 630.792.5252

Getting Started

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Questions to ask if your health center is considering becoming a PCMH*

PCMH Checklist: PCMH Principles

Yes

In Progress

No

Do patients have a designated primary care provider?

Does your health center allow patients to select their primary care provider?

Are health services delivered by a provider-directed care team? [Check to see if NPs, PAs are allowed to lead the team with each accrediting body.)

Does your health center foster collaboration among providers, staff, patients, and their families to ensure that decisions respect patients’ wants, needs, and preferences?

Does your health center provide resources to ensure that patients have the education and support needed to make decisions and participate in their care?

Does your health center offer support for patient self-management?

Does your health center offer coordinated or integrated care with other organizations, including local hospitals, community services, and specialty care practices?

Does your health center use internal and external resources to meet patients’ needs?

Do the partnerships with other organizations allow transfer of patient information and ensure quality follow-up?

Are all providers and staff trained in the cultural, linguistic, and educational needs and preferences of the patient population?

Have patients been informed on how to obtain medical care 24 hours a day, 7 days a week?

Does your health center use advanced health information technology, including electronic prescribing and patient registries? * I n order to be recognized, these principles need to be formally adopted and implemented.

Each component varies by recognizing organization. This checklist is intended to be representative of the components and principles of PCMH.

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About HealthHIV Mission HealthHIV advances effective prevention, care, and support for people living with, or at risk for, HIV/AIDS through education, technical assistance, and health services research to organizations, communities and professionals.

Programs The AIDS Education and Training Centers (AETC) National Center for HIV Care in Minority Communities (NCHCMC) works to increase access for ethnic and racial minority communities to culturally competent HIV care through the nation’s community health centers. The AETC NCHCMC is a three year effort supported by HRSA-HAB and the Minority AIDS Initiative (MAI), to develop the clinical and organizational capacity of health centers not directly funded through the Ryan White HIV/AIDS Program to offer comprehensive HIV/AIDS care and treatment within highly impacted communities of color.

The Fiscal Health: Systems to Sustainability program helps ensure the fiscal sustainability of Ryan White funded grantees by delivering trainings that builds participant’s organizational fiscal management capacity, diversifies and improves income streams, and enhances operational fiscal systems.

The HIV Education & Learning Program (HELP) is an exclusive, free online resource providing AIDS Service Organizations (ASOs) and Community Based Organizations (CBOs) access to current, relevant HIV educational materials to share with their clients.

The Exchange and Engage: Mayors and HIV Prevention project, funded through a cooperative agreement with the Centers for Disease Control and Prevention, supports mayors nationwide in leading implementation of the National HIV/AIDS Strategy. These efforts impact the health of the communities within their jurisdictions and influence other leaders nationwide to address HIV prevention.

HIV Primary Care Plus, a ground-breaking continuing medical education activity that focuses on building primary care providers skills and performance in the screening, treatment, and management of HIV.

The following sources were used in developing this guide: MGMA: Most Medical Practices in Process of Transforming to PCMH Model, Healthcare Finance News, www.healthcarefincancenews.com, 10 August 2011.

American Academy of Family Physicians, www.aafp.org, 1 August 2011.

American College of Physicians, www.acponline.org, 1 August 2011.

Patient-Centered Primary Care Collaborative, www.pcpcc.net, 1 August 2011.

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Notes

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For more information on HealthHIV, email info@healthhiv.org.

www.healthhiv.org 2000 S Street, NW | Washington, DC 20009 | Tel: 202.232.6749 | Fax: 202.232.6750

Special thanks to Hannah Grill for contributions to this guide.