PCASG Quality and Performance Payment Programs - …lphi.org/LPHIadmin/uploads/PCASG-Quality-Program_M… ·  · 2009-02-08Optional Performance Payment Program ... D. Sets goals

PCASG Quality and Performance Payment Programs

Agenda

� Announcements

� Introduction/ Overview

� Baseline (Floor) Participation Requirements

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� Baseline (Floor) Participation Requirements

� Optional Performance Payment Program

� Technical Assistance

� Discussion

Goals for the Primary Care Access and Stabilization Grant

1. Increase access to care on a population basis

2. Develop sustainable business entities

3. Provide evidenced based, quality health care

4. Develop and organized system of care

Process for designing quality improvement program

� Responds to community priorities

� Interprets the NoA language and intent

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� Vetting with local grantees and state-level groups

� CMS approval pending

Principles for design of the quality improvement program

� Floor requirement and performance payments

� Establish a uniform set of quality standards for participation, and ensure this baseline improves

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participation, and ensure this baseline improves throughout the grant period

� Designed for maximum participation

Principles for design of the quality improvement program cont’

� Based on the NCQA Physician Practice Connection-Patient Centered Medical Home framework:

� Details of NCQA relationship still being worked out

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� Details of NCQA relationship still being worked out

� Meant to align with their system so we can:

1. Consistently measure/ test and fairly divide up grant funds

2. Offer possibility for NCQA recognition and focus on what is important with outcome improvement in mind

3. Not reinvent the wheel

4. Be anchored to a well-established measurement system

External Evaluation

� Funding from Commonwealth Fund committed

� Looking for changes in user experience, practice characteristics, and system costs

UCSF team working through proposal to CMWF� UCSF team working through proposal to CMWF

� Words about baseline data collection (Chatrian Reynolds)

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PCASG Quality Improvement Program Components and RulesProgram Components and Rules

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Overview

� Notice of Grant Award (NOA) establishes baseline (floor) grant requirements

� Access to Care is an eligibility requirement for continued participation

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participation� 24/7 clinician contact� Same day appointment access

� Quality program based on peer reviewed literature / NCQA� Establishes baseline (floor) quality requirements � Creates pay for performance guidelines� Allows organizational selection of participation / priorities

Access to Care: July 2008 Baseline (Floor) Requirements

� Schedule same day appointments based on practice’s

triage of patients’ conditions

� Minimum of 30 minutes of same day urgent care required per clinic per day

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per day

� Notification to established patients receiving ongoing care is required

� Submit written policy and procedure with attestation

� Random monitoring

� Provide urgent phone response with clinician support

available 24 hours a day, 7 days a week

� Minimum of XX hour phone response

� Notification to established patients receiving ongoing care is

Access to Care: July 2008 Baseline (Floor) Requirements

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� Notification to established patients receiving ongoing care is required

� Submit written policy and procedure with attestation

� Random monitoring

Quality of CareBaseline (Floor) Requirements

� Evidence based guidelines with Continuous Quality Improvement

� Complete a written quality of care plan

� Identify 3 important conditions

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� Identify 3 important conditions

� Implement one evidence based guideline organization wide

� Train and educate staff on evidence based guideline

� Evaluate evidence based guideline using PDSA cycle methodology

� Modify your evidence based guideline based on PDSA findings

Quality of Care: March 2008 Baseline (Floor) Requirements

� Written plan due to LPHI describing organizational plans to complete Quality Program

� Project officer follow-up

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� Evidence based guidelines with Continuous Quality Improvement

� Identify three (3) clinically important conditions

� Most frequently seen conditions

Quality of Care: September 2008 Baseline (Floor) Requirements

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� Most frequently seen conditions

� High volume by patient or by visit; High risk; High cost

� Ability to treat or change condition or problem

� Clinical guidelines are available

� Other evidence for selection; Pay for Performance

� Implementation plan for one (1) evidence based guideline organization wide

� Training plan to educate staff on evidence based guideline

� Evaluation plan for evidence based guideline monitoring using PDSA cycle methodology

� Evidence based guidelines with Continuous Quality Improvement

� Report data for 1st PDSA cycle

� By practice (or)

Quality of Care: December 2008 Baseline (Floor) Requirements

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� By practice (or)

� By de-identified clinician

� Plan for modification of evidence based guideline workflow or algorithm based on PDSA cycle data

� Evidence based guidelines with Continuous Quality Improvement

� Submit the adjusted evidence based guideline workflow or algorithm from Dec 2008

Quality of Care: June 2009 Baseline (Floor) Requirements

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� Report data for 2nd PDSA cycle

� By practice (or)

� By de-identified clinician

� Submit plan for 2nd modification of evidence based guideline workflow or algorithm based on 2nd PDSA cycle data

Quality of Care: Dec 2009 Baseline (Floor) Requirements

� Evidence based guidelines with Continuous Quality Improvement

� Submit the adjusted evidence based guideline workflow or algorithm from June 2009

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� Report data for 3rd PDSA cycle

� By practice (or)

� By de-identified clinician

� Submit plan for 3rd modification of evidence based guideline workflow or algorithm based on 3rd PDSA cycle data

Performance Payment Program:

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OPTIONAL

Performance Payment Criteria

� 3 Tiers � Graduated requirements / Graduated payments

� 5% of PCASG grant funds available for performance payments ($3.85M)3 opportunities for payment – Divided evenly

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� 3 opportunities for payment – Divided evenly� Dec 2008 - $1.283M� June 2009 - $1.283M� Dec 2009 - $1.283M

� LPHI furnished input tool� Multi-site vs. Multiple single site applications

Performance Payment Criteria

� Tier I – Pays 1x

� 4 of 10 required and 20 points

� Data requirements for 2 months (instead of 3)

� Majority of sites must pass

Tier II – Pays 3x (May qualify for NCQA recognition)

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� Tier II – Pays 3x (May qualify for NCQA recognition)

� 5 of 10 required and 25 points

� Data requirements for 3 months

� Majority of sites must pass

� Tier III – Pays 6x

� 8 of 10 required and 50 points

� Data requirements for 3 months

� Majority of sites must pass

PPC-PCMH Content and ScoringStandard 1: Access and CommunicationA.A. Has written standards for patient access and patient Has written standards for patient access and patient

communication**communication**B.B. Uses data to show it meets its standards for patient Uses data to show it meets its standards for patient

access and communication**access and communication**

Pts

45

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Standard 2: Patient Tracking and Registry Functions A. Uses data system for basic patient information

(mostly non-clinical data) B. Has clinical data system with clinical data in

searchable data fields C. Uses the clinical data system D.D. Uses paper or electronicUses paper or electronic--based charting tools to based charting tools to

organize clinical information**organize clinical information**E.E. Uses data to identify important diagnoses and Uses data to identify important diagnoses and

conditions in practice**conditions in practice**F. Generates lists of patients and reminds patients and

clinicians of services needed (population management)

Pts

2

33

64

3

21

Standard 5: Electronic Prescribing A. Uses electronic system to write prescriptions B. Has electronic prescription writer with safety

checksC. Has electronic prescription writer with cost

checks

Pts33

2

8

Standard 6: Test Tracking A.A. Tracks tests and identifies abnormal results Tracks tests and identifies abnormal results

systematically**systematically**B. Uses electronic systems to order and retrieve

tests and flag duplicate tests

Pts7

6

13

Standard 7: Referral Tracking A.A. Tracks referrals using paperTracks referrals using paper--based or electronic based or electronic

system**system**

PT4

4

Standard 8: Performance Reporting and Pts

20Physician Practice Connections and Patient-Centered Medical Home

management) 21

Standard 3: Care ManagementA.A. Adopts and implements evidenceAdopts and implements evidence--based guidelines based guidelines

for three conditions **for three conditions **B. Generates reminders about preventive services for

clinicians C. Uses non-physician staff to manage patient care D. Conducts care management, including care plans,

assessing progress, addressing barriers E. Coordinates care//follow-up for patients who

receive care in inpatient and outpatient facilities

Pts3

4

35

5

20

Standard 4: Patient Self-Management Support A. Assesses language preference and other

communication barriersB.B. Actively supports patient selfActively supports patient self--management**management**

Pts24

6

Standard 8: Performance Reporting and Improvement

A.A. Measures clinical and/or service performance Measures clinical and/or service performance by physician or across the practice** by physician or across the practice**

B. Survey of patients’ care experience C.C. Reports performance across the practice or by Reports performance across the practice or by

physician **physician **D. Sets goals and takes action to improve

performance E. Produces reports using standardized measures F. Transmits reports with standardized measures

electronically to external entities

Pts

3

33

3

21

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Standard 9: Advanced Electronic Communications A. Availability of Interactive Website B. Electronic Patient Identification C. Electronic Care Management Support

Pts121

4**Must Pass Elements

NCQA PPC – PCMH Requirements:Must pass criteria

� 1A – Access to care

� 1B – Measure access to care – meets own standards

� 2D – Problem lists, med lists, et. al. – 25% to pass

� 2E – Identify top 3 conditions – 1 to pass

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� 3A – EBG for top 3 conditions – 2 to pass

� 4B – Patient self management

� 6A – Test tracking

� 7A – Referral tracking

� 8A – Measure performance

� 8C – Report performance

Discussion

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Questions?

Technical Assistance

� Our goal is to provide or link you to the resources you need to be successful

Look for an RFA from LPHI soon that will serve the

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� Look for an RFA from LPHI soon that will serve the following 3 purposes:1. Announce what technical assistance is available

2. Gather information to tailor the TA program and evaluate it

3. Describe what is required for participation and get commitment

Basic Technical Assistance available under PCASG

� Project officers are available to answer questions about the program rules or link you to the appropriate source for answers

� Website will have tools, links and other resources (e.g. model policies, links to established resources)

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Other TA resources being developed

� Learning collaboratives: LPHI and its partners will bring in experts on quality improvement that will tailor their assistance here to help PCASG organizations achieve the structural and process changes necessary to achieve better health outcomes, meet minimum PCASG achieve better health outcomes, meet minimum PCASG requirements and participate in performance payments

� Behavioral Health example with REACH-NOLA

� We are also working through the details of our partnership with NCQA

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Other possible TA resources

� We are working to see if we can pull together the resources necessary to bring TransforMED down to do team-level support for interested organizationssupport for interested organizations

� Recommended consultant resources

� Peer-to-peer learning

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Contact Info

PCASG Director:

Clayton Williams MPH

Phone: 504.301.9804

[email protected]

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[email protected]

Quality Improvement Program Design Consultant:

Dennis Weaver MD MBA

Phone: 703.626.7112

[email protected]

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