Patient Centered Medical Homes (PCMH)
Licensing Test || All Questions & 100%
Correct Solutions
What is a patient centered medical home and how has this concept been included in the
patient protection and ACA - ANSWER - Patient centered medical home is an alternative practice model aimed at reducing costs, coordinating care efforts and utilizing health information technology as well as obtaining better quality outcomes for patients. It is woven into the ACA of 2010 and is broadly defined in 3502 of that act to further population health initiatives for communities as well as preventative health and ongoing care for chronic illnesses
Following the passage of ACA, how pervasive has the usage of PCMHs been in the delivery of health care services? - ANSWER - It has been robust. Half of the states have been implementing PCMHs for their medicaid populations.
What are the essential elements of a PCMH? - ANSWER - A patient can be said to have a medical home if she has a personal physician who provides a first point of contact as well as ongoing comprehensive and coordinated care that moves away from the traditional referral based gatekeeper system. Medical home exists when other elements are present as well. Including teams of providers with diverse medical backgrounds who leverage health information technology to manage a defined panel of patients for both acute and chronic conditions in a proactive patient centered manner.
What distinguishes a PCMH from a traditional care delivery model? - ANSWER - 1. Integration of health information
2. patient centered engagement in care
3. A team practice approach
If they have all of these characteristics, they can apply for recognition as a PCMH. Given that there are a number of bodies setting criteria for medical homes, no single organization is responsible for recognizing PCMHs
Summarize 3 tier PCMH recognition process established by the National committee for Quality Assurance - ANSWER - 3 tier process (tier 3 is the highest)
The NCQA recognition process is a three-tier process with six "must pass" elements.
1. Access during office hours
2. Use of data for patient population management
3. Care management supporting the self-care process for patients
4. referral tracking and follow-up
5. Implementation of continuous quality improvement How do the NCQA requirements for a PCMH align with the criteria for a PCMH as specified in section 3502 of ACA? - ANSWER - In 3502, a PCMH is defined as a model
of care with six core features:
1. use of personal physicians
2. whole person orientation
3. Coordinated and integrated care
4. safe and high quality care through evidence informed medicine
5. Appropriate use of health information technology
6. continuous quality improvements
7. expanded access to care
8. payment that recognizes added value from additional components of patient centered
care
How does the implementation of an electronic health record serve as a critical step in transforming a more traditional medical practice into a PCMH care delivery platform? - ANSWER - Proper utilization of health information technology allows for integration of processes across every aspect of the medical home, from appointment scheduling and follow up to analysis and evaluation of patient populations. use of health information technology is important to receive successful recognition from the NCQA.
How does patient engagement in care occur with PCMH? - ANSWER - Providing same
day appointments (Mandatory for NCQA). Proper education and consistent follow-ups. Some track patient engagement through follow-up surveys and monitor patient health statuses between visits.
What is key different between PCMH and traditional gatekeeper model? - ANSWER - 1. Team approach to patient care.
2. Instead of referring patients systematically from generalist to specialist they coordinate care efforts through a diverse array of providers.
3. Common to have team huddles to preview cases
4. Similar to the gatekeeper model there is a principle physician or nurse practitioner in change of patient care, but the principal can be generalist specialist or nurse practitioner
who acts as point person for care.
What is the rationale behind the team approach at PCMHs? - ANSWER - Patient may require more resources per visit, but will necessitate fewer visits in the long run and using such additional resources early in the medicare care process will prevent future emergencies. The model allows for patient needs to be met while requiring the same of fewer total medical resources.
What payment-approach elements are typically blended in a PCMH reimbursement method? - ANSWER - They vary but all approaches utilities a blend of pay per performance, monthly per enrollee payments and fee for service. 3 essential components:
1. Monthly care-coordination payment supporting the medical home structure to provide predictable funding for practices
Licensing Test || All Questions & 100%
Correct Solutions
What is a patient centered medical home and how has this concept been included in the
patient protection and ACA - ANSWER - Patient centered medical home is an alternative practice model aimed at reducing costs, coordinating care efforts and utilizing health information technology as well as obtaining better quality outcomes for patients. It is woven into the ACA of 2010 and is broadly defined in 3502 of that act to further population health initiatives for communities as well as preventative health and ongoing care for chronic illnesses
Following the passage of ACA, how pervasive has the usage of PCMHs been in the delivery of health care services? - ANSWER - It has been robust. Half of the states have been implementing PCMHs for their medicaid populations.
What are the essential elements of a PCMH? - ANSWER - A patient can be said to have a medical home if she has a personal physician who provides a first point of contact as well as ongoing comprehensive and coordinated care that moves away from the traditional referral based gatekeeper system. Medical home exists when other elements are present as well. Including teams of providers with diverse medical backgrounds who leverage health information technology to manage a defined panel of patients for both acute and chronic conditions in a proactive patient centered manner.
What distinguishes a PCMH from a traditional care delivery model? - ANSWER - 1. Integration of health information
2. patient centered engagement in care
3. A team practice approach
If they have all of these characteristics, they can apply for recognition as a PCMH. Given that there are a number of bodies setting criteria for medical homes, no single organization is responsible for recognizing PCMHs
Summarize 3 tier PCMH recognition process established by the National committee for Quality Assurance - ANSWER - 3 tier process (tier 3 is the highest)
The NCQA recognition process is a three-tier process with six "must pass" elements.
1. Access during office hours
2. Use of data for patient population management
3. Care management supporting the self-care process for patients
4. referral tracking and follow-up
5. Implementation of continuous quality improvement How do the NCQA requirements for a PCMH align with the criteria for a PCMH as specified in section 3502 of ACA? - ANSWER - In 3502, a PCMH is defined as a model
of care with six core features:
1. use of personal physicians
2. whole person orientation
3. Coordinated and integrated care
4. safe and high quality care through evidence informed medicine
5. Appropriate use of health information technology
6. continuous quality improvements
7. expanded access to care
8. payment that recognizes added value from additional components of patient centered
care
How does the implementation of an electronic health record serve as a critical step in transforming a more traditional medical practice into a PCMH care delivery platform? - ANSWER - Proper utilization of health information technology allows for integration of processes across every aspect of the medical home, from appointment scheduling and follow up to analysis and evaluation of patient populations. use of health information technology is important to receive successful recognition from the NCQA.
How does patient engagement in care occur with PCMH? - ANSWER - Providing same
day appointments (Mandatory for NCQA). Proper education and consistent follow-ups. Some track patient engagement through follow-up surveys and monitor patient health statuses between visits.
What is key different between PCMH and traditional gatekeeper model? - ANSWER - 1. Team approach to patient care.
2. Instead of referring patients systematically from generalist to specialist they coordinate care efforts through a diverse array of providers.
3. Common to have team huddles to preview cases
4. Similar to the gatekeeper model there is a principle physician or nurse practitioner in change of patient care, but the principal can be generalist specialist or nurse practitioner
who acts as point person for care.
What is the rationale behind the team approach at PCMHs? - ANSWER - Patient may require more resources per visit, but will necessitate fewer visits in the long run and using such additional resources early in the medicare care process will prevent future emergencies. The model allows for patient needs to be met while requiring the same of fewer total medical resources.
What payment-approach elements are typically blended in a PCMH reimbursement method? - ANSWER - They vary but all approaches utilities a blend of pay per performance, monthly per enrollee payments and fee for service. 3 essential components:
1. Monthly care-coordination payment supporting the medical home structure to provide predictable funding for practices
