Fillable DRAFT 2015 PCMH Progress Update (returning Clinics) (Montana Office of the Commissioner of Securities and Insurance, Montana State Auditor)

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DRAFT 2015 PCMH Progress Update (returning Clinics) (Montana Office of the Commissioner of Securities and Insurance, Montana State Auditor)

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The Progress Update is to help practices identify their PCMH focus, strengths, and weaknesses.
The responses also allow program administrators to connect participants with appropriate
resources, if the practice is interested. The administrators also use this information to highlight the
strengths of the Montana PCMH Program and to identify areas where improvement could occur and
assistance could be provided. The data helps program administrators make informed decisions
regarding program development, such as reporting requirements. PCMH providers can use the
information as an advocacy tool in their organizations and payors can use the information to plan
their PCMH contracts. The comparative data shows the progress of practices' PCMH
transformation year-to-year. Please complete the update by EOB on Thursday, October 29th.
2015 PCMH Progress Update - DUE October 29, 2015
Montana PCMH Program 2015 Annual PCMH Progress Update
1. Contact Person Name
Name of Practice
Name of Practice Site (if
applicable)
Address
City/Town
State/Province
ZIP/Postal Code
Email Address
Phone Number
2. Address
1
2
General Practice Information
Montana PCMH Program 2015 Annual PCMH Progress Update
Date
MM
/
DD
/
YYYY
3. What date did your practice receive PCMH recognition from NCQA or other approved accreditation
agency?
4. How many unique patients were seen by primary care providers in your practice between January and
December of 2014?
3
Included in the care team
Primary Care Physician
Primary Care Physician
Assistant
Primary Care Nurse
Practitioner
Integrated Primary Care
related Behavioral
Health Services
Care
Coordinators/Managers
or Patient Navigator
Certified Diabetes
Educator
Administrative Staff
Medical Assistant
Nurse (RN, LPN, etc.)
Dietitian
Clinical Pharmacist
Certified Asthma
Educator
Certified Lactation
Consultant
5. Does your practice integrate the following staff into your care model? Please indicate whether each of
the following roles is utilized for any amount of time.
4
Primary Care Physician
Primary Care Physician
Assistant
Primary Care Nurse
Practitioner
Integrated Primary Care
Related Behavioral Health
Services
Care
Coordinators/Managers or
Patient Navigator
Certified Diabetes
Educator
Administrative Staff
Medical Assistant
Nurse (RN, LPN, etc.)
Dietitian
Clinical Pharmacist
Certified Asthma Educator
Certified Lactation
Consultant
6. For each role included in your care team, please indicate how many full time equivalent staff (FTE) are
currently being used in your clinic. Please enter numbers only.
5
Enhanced Payment Information
Montana PCMH Program 2015 Annual PCMH Progress Update
7. Does your practice currently receive enhanced reimbursement from any commercial or public health
plan for primary care related services such as a PCMH participation fee, chronic disease management,
quality improvement, or other PCMH related components? (This question refers only to payor programs
labeled “Medical Home” or “Patient-Centered Medical Home.”)
Yes
No
8. If yes, which payor(s) are you receiving the payments from?
Blue Cross Blue Shield of Montana
PacificSource Health Plans
Medicaid
Allegiance
Humana
New West Health Plans
Montana Health Co-op
Other (please specify)
6
9. If you answered "yes" to Question 7, please indicate the percentage of your practice's total patient
population that your clinic receives PCMH compensation for?
0 - 10%
11 - 25%
26 - 50%
Above 50%
10. What do you feel is the most important work you do for PCMH that you should be reimbursed for in a
reformed payment model? Choose your top 3 only.
Preventive health care services
Chronic disease management
Care coordination
Population management patient outreach
Community partnerships
Primary care related integrated behavioral health services
Primary care related clinical pharmacy services
Scribes (or equivalent clinical assistant)
Electronic health record capabilities
Data registry capabilities
Patient involvement in quality and planning (e.g. patient advisory council)
Other (please specify)
7
Current PCMH Status: Transformation, Progress, and Measurement
Montana PCMH Program 2015 Annual PCMH Progress Update
11. Please select below, your current PCMH practice transformation focus points. Choose your top 3.
Preventive health care services
Chronic disease management
Care coordination
Population management patient outreach
Community partnerships
Primary care related integrated behavioral health services
Primary care related clinical pharmacy services
Scribes (or equivalent clinical assistant)
Electronic health record capabilities
Data registry capabilities
Patient involvement in quality and planning (e.g. patient advisory council)
Other (please specify)
8
12. In regard to PCMH transformation in your practice, what technical assistance or other support would be
most useful at this time?
13. Does your practice have a formal quality improvement strategy or use standardized quality
improvement methodologies?
Yes
No
14. Are you using one of the following standardized methods/strategies? Check all that apply.
Lean management principles
Six Sigma
Plan-Do-Study-Act (PDSA) cycles
Institute for Health Improvement's (IHI) model for improvement
Other (please specify)
15. Does your practice have a staff person who has dedicated quality improvement responsibilities?
Yes
No
Name
Title
Email Address
Phone Number
16. If yes, please provide the contact information for the quality improvement staff person.
9
17. Please enter the approximate number of hours your staff person spends on QI per week.
18. Does your practice utilize the following? Check all that apply.
Patient advisory council
Patient surveys
Other (please specify)
19. Has your practice enhanced access to care for patients?
Yes
No
20. Please select the ways in which your practice has enhanced access to care. Check all that apply.
Electronic communication/e-mail
Expanded office hours
Same day appointments
Clinical advice system available when office is not open
Patient portal
Telephonic or electronic visits
Other (please specify)
21. Has your practice incorporated care coordination and/or disease management into care delivery?
Yes
No
10
22. What elements of care coordination/disease management are parts of your clinic's care delivery?
Check all that apply.
Collaborate and assist patients in personal goals for their improved health (self-management and goal setting)
Patients receive paper or electronic copy of their Care Plan specific to their chronic disease
The clinic electronically generates lists of patients needing care and contacts these patients
The clinic has some system for the team to do pre-visit planning or huddles
The clinic does additional coordination of care for complex, high use patients (referrals, labs, tests)
System in place to follow-up pro-actively with patients having recent ER visit and/or hospitalization
Other (please specify)
11
EHR/EMR Use
Montana PCMH Program 2015 Annual PCMH Progress Update
23. Have you changed your EMR since October 2014?
Yes
No
24. If yes, what kind of EMR did you change to?
25. Have you updated the version of your EMR in the last year?
Yes
No
12
Available Unavailable Unknown
Chronic Disease
Registry
Clinical Decision Support
System
Patient Portal
Ability to document
patient referral
Ability to document
patient reminder or
follow-up
Ability to pull custom
reports
Ability to provide
electronic data exchange
(HL7)
26. For each EHR system function listed below, please check whether it is available in your practice's EHR
system.
Used Unused Unknown
Chronic Disease
Registry
Clinical Decision Support
System
Patient Portal
Ability to document
patient referral
Ability to document
patient reminder or
follow-up
Ability to pull custom
reports
Ability to provide
electronic data exchange
(HL7)
27. For each EHR system function that is available in your practice's EHR, please check whether it has
been used by your staff.
28. Do you have an EHR technical lead or professional IT support person on staff?
Yes
No
13
Name
Title
Email Address
Phone Number
29. If yes, please enter their contact information below.
14
Depression Screening
Montana PCMH Program 2015 Annual PCMH Progress Update
30. Does your practice use a standardized depression screening tool (such as PHQ-2, PHQ-9)?
Yes
No
31. If yes, which standardized depression screening tool(s) do you use for adolescents (12-17 years)?
Check all that apply.
Patient Health Questionnaire for Adolescents (PHQ-A)
Beck Depression Inventory-Primary Care Version (BDI-PC)
Mood Feeling Questionnaire (MFQ)
Center for Epidemiologic Studies Depression Scale (CES-D)
PRIME MD-PHQ-2
Other (please specify)
15
32. If yes to question 30, which standardized depression screening tool(s) do you use for adults (18 years
and older)?
Patient Health Questionnaire (PHQ-9)
Beck Depression Inventory (BDI or BDI-II)
Center for Epidemiologic Studies Depression Scale (CES-D)
Duke Anxiety-Depression Scale (DADS)
Geriatric Depression Scale (GDS)
Cornell Scale Screening
PRIME MD-PHQ-2
Other (please specify)
33. The CSI partners with the Montana Department of Public Health and Human Services (DPHHS) in
regard to collecting and analyzing quality metric data from PCMHs. Are you interested in receiving
information from the DPHHS about potential opportunities to support quality improvement initiatives in your
office (e.g. technical assistance, funding opportunities related to quality improvement and health information
technology)?
Yes
No
34. Please enter any questions or comments for CSI regarding the Montana PCMH Program here.
16
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DRAFT 2015 PCMH Progress Update (returning Clinics) (Montana Office of the Commissioner of Securities and Insurance, Montana State Auditor)

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Completed 13 August 2020

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