Learn more about the process and initiative of the Patient-Centered Medical Home model. This slideshow highlights the legislation, programs involved, and how to receive the PCMH certification and incentive funds.

1. Patient-Centered Medical Home: The Process & Initiative Adele Allison National Director of Government Affairs, SuccessEHS

2. Notable Acronyms

6. PCMH Initiatives

8. AHRQ * * Agency for Healthcare Research and Quality

11. Health Plans & NCQA Add Recognition Seals to Provider Directories Aetna Blue Cross Blue Shield Association Blue Cross Blue Shield of Western New York Blue Shield of Northeastern New York CIGNA CDPHP GeoAccess Highmark Blue Cross Blue Shield Humana Medical Mutual of Ohio MVP Health Plan, Inc. United Assistance with Recognition by Supporting Data Collection Blue Care Network of Michigan Highmark Blue Cross Blue Shield MVP Health Plan of New York Oxford of New York United (4 areas) Pay Rewards for Achieving Recognition or Supplement Fees for Recognized Providers Anthem (Virginia) Bridges to Excellence Blue Cross Blue Shield of South Carolina/Companion CareFirst (DC-Maryland and Georgia) CDPHP ConnectiCare HealthAmerica (Pennsylvania) Health First (Florida) Highmark Blue Cross Blue Shield Independence Blue Cross MVP Health Plan of New York Oxford of New York Priority Health Silicon Valley HIT Use Recognition as a Requirement for Entry into High-Performance Networks Aetna CIGNA United

12. PPACA – Accountable Care Organizations

15. PCMH Movement & The Hill

19. Legislation & Policy PPACA or Reconciliation Act Section Opportunity Description Effective Date PPACA § 5508 Workforce Development Authorizes health centers to develop residency programs and pays for CHCs operating teaching programs. FY 2010 - 2012 PPACA § 2706 Payment Delivery PPACA establishes Accountable Care Organization (ACO) contracting with CMS effective January 1, 2012. Included is a 5-year Medicaid pediatric demonstration with shared savings incentives. CY 2012 PPACA § 3022 Payment Delivery Establishment of ACOs for Medicare shared savings incentives with CMS. CY 2012 PPACA § 2703 Health Home Medicaid State Plan Option with enhanced FMAP for enrollees with 2 chronic conditions (or 1 condition with a risk for a second) can designate qualified provider as their health home for care management, coordination, health promotion, transitional care, and community / social support services. Beginning CY 2011 PPACA § 3502 Health Home Grants to create community health teams to support PCMH development for patients with chronic conditions. CY 2013 PPACA § 3503 Care Delivery Grants available to pharmacists for medication therapy management (MTM) May 1, 2010

21. NCQA – Role & Process

23. NCQA-PPC-PCMH 2011 Level 3 85-100 points + all 6 must pass elements Level 2 50-84 points + all 6 must pass elements Level 1 35-59 points + all 6 must pass elements No Recognition 34 points or less and/or less than 6 must pass elements

24. NCQA PCMH 2011 Scoring Points NCQA PCMH 2011 Standard and Element Number of Factors Must Pass? 20 PCMH Standard 1: Enhance Access and Continuity 34 4 Element A: Access during office hours 4 Yes 4 Element B: Access after hours 5 No 2 Element C: Electronic Access 6 No 2 Element D: Continuity 3 No 2 Element E: Medical Home Responsibilities 4 No 2 Element F: Culturally & Linguistically Appropriate Services (CLAS) 4 No 4 Element G: Practice Organization 8 No 17 PCMH Standard 2: Identify and Manage Patient Populations 35 3 Element A: Patient Information 12 No 4 Element B: Clinical Data 9 No 4 Element C: Comprehensive Health Assessment 10 No 5 Element D: Using Data for Population Management 4 Yes 17 PCMH Standard 3: Plan and Manage Care 23 4 Element A: Implement evidence-based guidelines 3 No 3 Element B: Identify High-Risk Patients 2 No 4 Element C: Manage Care 7 Yes 3 Element D: Management Medications 5 No 3 Element E: Electronic Prescribing 6 No 9 PCMH Standard 4: Provide Self-Care and Community Support 10 6 Element A: Self-Care Process 6 Yes 3 Element B: Referrals to Community Resources 4 No 18 PCMH Standard 5: Track and Coordinate Care 25 6 Element A: Test Tracking and Follow-up 10 No 6 Element B: Referral Tracking and Follow-up 7 Yes 6 Element C: Coordinate with Facilities / Care Transitions 8 No 20 PCMH Standard 6: Measure and Improve Performance 22 4 Element A: Measures of performance 4 No 4 Element B: Patient / Family feedback 4 No 4 Element C: Implements Continuous Quality Improvement 4 Yes 3 Element D: Demonstrates Continuous Quality Improvement 4 No 3 Element E: Performance Reporting 3 No 2 Element F: Report Data Externally 3 No 100 149 6

25. 10 Commandments of PCMH Health IT Support

30. HRSA & PCMH

35. Call to Action: Why do PCMH?

37. For more information about PCMH, visit our site for white papers, articles, blog posts and more! Click here