Feeling Stuck in PCMH Transformation? Your Questions Answered

Advice from NCQA Evaluators to Help Manage Your Medical Home Journey.

Each health center in the process of attaining NCQA PCMH Recognition is assigned an evaluator—an expert on the PCMH transformation process. The evaluator leads your virtual check-ins and is available for all of your questions and concerns throughout the process.

To answer some of the most common questions about transformation, we conducted Q&As with three NCQA PCMH evaluators.

Q: What can health centers do to prepare for virtual reviews and submission deadlines?

A: Your health center will have three virtual reviews with the evaluator. To get the most out of these reviews, develop a timeline ahead of the first meeting that focuses on all reviews. In the timeline, aim to complete all requirements for transformation by the second virtual review. This will give the evaluator time to provide feedback that can be discussed in the final review.

Setback scheduling can help you develop an effective timeline for the transformation process. Begin by noting the deadline for requirements (the date of the second virtual review) and develop a workplan that goes back in time, to make sure you stay on schedule. Include specific deadlines for achieving certain requirements; look at tasks that can be completed in parallel and those that will have to be done in sequence.

Here are some additional tips for preparing for virtual reviews and deadlines:

  • Check for and resolve technical issues before the virtual reviews (e.g., will you need Skype or another platform, and is it working?).
  • Shortly before your virtual review, read the comments your evaluator left in your Q-PASS account. Look at all criteria: Are any marked unmet? Revisit the Standards and Guidelines to understand gaps in your requirements.
  • Ready all patient data that will be shared virtually.
  • If possible, all relevant staff who can speak to specific workflows and processes should join the virtual review. This can reduce confusion and time needed to address specific issues.

Q: How can centers manage the transformation process for multiple sites?

A: If you are looking to have additional sites earn Recognition, you can streamline the transformation process and reduce the time commitment.

Set up all sites under the same organization in Q-PASS. This means that your health center keeps the same evaluator and automatically shares credits among sites. You can add sites to the profile. You can request permission to combine very small sites with a larger health center site. Make sure you check in all sites you have added!

You may submit a single report for requirements that covers all sites. Although many requirements let you submit aggregated organization data, make sure you are aware of site-specific data requirements (for example, QI 08–QI 11). Each site may have different goals; you will need to show baseline data for each site and demonstrate improvement across criteria (subsequent data needs to be above the baseline).

Q: How can health centers prepare and organize the transformation process in case of PCMH staff turnover?

A: Health centers tend to have a high staff turnover rate. While this can sometimes make the transformation process more challenging, there are some things you can do to ensure that staff transitions don’t cause setbacks.

Work with a Certified Content Expert (CCE) to maintain continuity in the transformation process. If this isn’t possible because of cost issues, have at least two staff attend NCQA transformation classes. Alternatively, many state Primary Care Associations have practice coaches and other resources for centers that utilize PCMH CCEs at no additional cost. And stay organized: Maintain team minutes and a clearly structured, shared file system so you know exactly where documents are stored.

PCMH transformation is a team effort!

Q: What do successfully transformed centers have in common?

A: Successfully transformed health centers typically have a consultant CCE and/or someone on staff with updated PCMH training. CCEs have experience with the PCMH process and are aware of transformation’s expectations. You probably have CCEs in your area! But if you don’t have the resources to consult with a CCE, NCQA offers webinars and in-person trainings.

You can also perform a gap assessment before registering in Q-PASS. This gives you the chance to understand the changes required to become a PCMH and it maximizes the time for achieving transformation (12 months from the registration date). To save time, you can also delay enrollment until you are prepared for your first virtual review.

Other steps can make the transformation process go smoothly: Ensure team buy-in before beginning the PCMH process; target “low-hanging fruit” in the early phases of transformation; make the journey a team effort. For resources and tips to avoiding a stall in your transformation, read our PCMH Toolkit for Health Centers.

Q: What are health centers’ most common questions or concerns?

A: Health centers are often confused about prevalidation, corporate attestation and accelerated renewal attestation in Q-PASS. These processes can save a lot of time, so it’s important to complete them correctly. Here are some tips for navigating these processes:

  • Prevalidation lets your center receive credits for EHRs by entering the relevant documentation in Q-PASS. Pay close attention to the requirements that data fulfills.
  • Attestations let you receive credits for previously completed Recognition programs. The PCMH Standards and Guidelines is a good place to gain an in-depth understanding of differences in requirements. Here’s clarification for the most commonly misunderstood attestation criteria:
    • AC 01(Access and Continuity): Asking patients if your health center hours are adequate does not meet this requirement. Instead, be actionable and obtain comprehensive patient feedback by asking how well your center’s hours service community needs.
    • CC 14–CC 16 (Care Coordination and Care Transitions): You need a method of communicating information about admissions and ED visits with local hospital systems and EDs. How do you let EDs know you are transferring a patient? How do you follow up with patients individually? Demonstrating follow-up communication does not require patients to return to the hospital; you can fulfill this requirement by showing that you communicate via phone to prevent patient relapse.

Remember, virtual reviews or trainings are a great place to raise any questions you have!

Q: What typical roadblocks do centers usually see, and how can they be avoided?

A: PCMH transformation requires patience and a commitment of resources. It’s common for health centers to try to save time by cutting corners—but that can make the journey more difficult in the long term. Here are some tips for avoiding roadblocks:

  • Dedicate time to looking through NCQA PCMH resources. Browse the Education and Training webpage—it includes a list of upcoming trainings, webinars and on-demand tutorials. If you can’t find what you are looking for, contact your PCMH Representative via the “Ask a Question” function in Q-PASS. If you haven’t been assigned an evaluator, call NCQA Customer Service.
  • Attend NCQA trainings early in your transformation process; they will help you develop a thoughtful strategy for becoming a PCMH. Trainings also provide exercises that contain practical advice for building workflows and getting your team to practice at the top of their licenses.
  • Try out the navigation and other functions in Q-PASS. Many health centers are not familiar with the system, so it may take time to adjust. Q-PASS contains helpful resources and tutorials, as well.
  • Read the Standards and Guidelines carefully and in depth. Pay attention to how requirements are worded so you complete the process accurately. Provide only what is necessary to fulfill requirements.
  • Become familiar with your health center’s EHR system and make sure you are using all of its capabilities. (Tip: Sometimes you need to turn on specific features in the settings.) Many EHR systems can generate reports, making data submission less time consuming, but manual submission is acceptable if your system does not have this capability.
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