Fillable DRAFT 2016 Progress Update (Montana Office of the Commissioner of Securities and Insurance, Montana State Auditor)

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DRAFT 2016 Progress Update (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
Monday, November 14th.
2016 PCMH Progress Update - DUE November 14, 2016
Montana PCMH Program 2016 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
General Practice Information
Montana PCMH Program 2016 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 2015?
2
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.
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
6. Which of the following staff are you hoping to add to your practice next year?
Other (please specify)
7. What are your barriers to adding staff to your care team?
Workforce availability
Financial barriers
Physical space
Administrative support
4
Clinic Care Team Roles
Montana PCMH Program 2016 Annual PCMH Progress Update
5
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
8. 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.
Enhanced Payment Information
Montana PCMH Program 2016 Annual PCMH Progress Update
6
9. 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
10. If yes, which payor(s) are you receiving enhanced reimbursement from?
Blue Cross Blue Shield of Montana
PacificSource Health Plans
Medicaid
Allegiance
Humana
New West Health Plans
Other (please specify)
11. If you answered "yes" to Question 7, please indicate the percentage of your practice's total
patient population that your clinic receives PCMH enhanced reimbursement for?
0 - 10%
11 - 25%
26 - 50%
Above 50%
7
12. 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)
Current PCMH Status: Transformation, Progress, and Measurement
Montana PCMH Program 2016 Annual PCMH Progress Update
8
13. 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)
14. In regard to PCMH transformation in your practice, what technical assistance or other support
would be most useful at this time?
15. Does your practice have a formal quality improvement strategy or use standardized quality
improvement methodologies?
Yes
No
9
16. 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)
17. Does your practice have a staff person who has dedicated quality improvement responsibilities?
Yes
No
Name
Title
Email Address
Phone Number
18. If yes, please provide the contact information for the quality improvement staff person.
19. Please enter the approximate number of hours your staff person spends on QI per week.
20. Does your practice utilize the following? Check all that apply.
Patient advisory council
Patient surveys
Other (please specify)
21. Has your practice enhanced access to care for patients?
Yes
No
10
22. 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)
23. Has your practice incorporated care coordination and/or disease management into care
delivery?
Yes
No
24. 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 2016 Annual PCMH Progress Update
25. Have you changed your EMR since October 2015?
Yes
No
26. If yes, what kind of EMR did you change to?
27. 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)
28. 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)
29. For each EHR system function that is available in your practice's EHR, please check whether it
has been used by your staff.
13
30. Do you have an EHR technical lead or professional IT support person on staff?
Yes
No
Name
Title
Email Address
Phone Number
31. If yes, please enter their contact information below.
Depression Screening
Montana PCMH Program 2016 Annual PCMH Progress Update
32. Does your practice use a standardized depression screening tool (such as PHQ-2, PHQ-9)?
Yes
No
14
33. 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)
34. 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)
35. 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
15
36. Please enter any questions or comments for CSI regarding the Montana PCMH Program here.
16
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DRAFT 2016 Progress Update (Montana Office of the Commissioner of Securities and Insurance, Montana State Auditor)

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Completed 13 August 2020

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