Current Care for Pediatric Applications (max 1) Score Patient Involvement (max 2) Score EHR Capacity (max 4) Score No to use 0 Active patient involvement 1 Meaningful Use achieved by one provider 0 Enrolling patients, using Viewer, Hospital alerts, or have Direct account 1 High-level of patient involvement 2 Registries for CYSHCN 0 Additional patient registries Add 1 point Geographic Distribution (max 2) Score % Medicaid for Pediatric Applications (max 3) Standard reporting from EHR capabilities Add 1 point New area Add 1 point 0-10 1 Standard plus custom reporting capability Add 1 point Area with CHT Add 1 point 10-20 2 Designated staff/support Add 1 NCM/CC Capacity (max 2) Score 20-30 3 Behavioral Health (max 3) Score None 0 NCQA (max 1) Score Compacts 1 Some experience with CC 1 Recognition achieved 1 Co-located 2 High of CC experience embedded in practice 2 Fully integrated 3 Prerequisites are highlighted in yellow and are required elements for acceptance, so are not assigned a point value APPENDIX A: PCMH Kids Service Delivery Requirements Practices agree to fulfill CTC’s Program care delivery requirements as described on line (). All reports and measures identified in the Care Delivery Requirements use methodology as defined and approved by the CTC Data and Evaluation Committee. Requirements may be subject to change based on updated guidelines from such parties as OHIC, NCQA Measurement Period PCMH-Kids Care Delivery Requirements Date Due (if applicable) last day of month Start Up (MP 1) 7/1/17 to 6/30/18 Care Management Hire 1.0 Care Manager (NCM)/Care Coordinator for every 3,000 attributed patients ($2.50 pmpm) Month 4 Develop High Risk Registry and reportable fields for care management. Confirm completion with CTC-RI. Month 6
NCM/CC completes standardized learning program as defined by CTC-RI. Month 7 Report level(s) of engagement of high risk patients as defined by CTC-RI. 9 Submit to OHIC Cost Management Attestation October 15 Planned Care: Population Health /Quality Reporting Submit clinical quality data as defined in Performance Incentives Exhibit 3 Month 6 Submits to OHIC quality measure information October 15 Access and Continuity Reports to CTC Quarterly Provider Panel Report indicating open/closed panel status for new patients and 3rd next available appointment for existing patients Month 6 Submit before and hours protocol, as defined by CTC-RI. Month 9 Patient/Family Engagement CAHPS survey: Submits patient panel to approved data vendor (or “How’s Your Health” option to be determined Timeframe determined by CTC Comprehensiveness and Coordination Submits Transition of Care Policy and Procedure Month 6 Identifies high volume specialists serving patient population and submits 2 compacts: a) high volume specialist, and b) behavioral health. 9 Practice transformation Submits budget and staffing plan and use of funds to support care delivery model to CTC Month 3 Submit NCQA PCMH work plan to CTC Month 9 Meets with Practice Facilitator 1-2 x a month Month 1 and on-going Attends 50% of learning network meetings 1 Month 1 and on-going 1 Learning Network Meetings: Orientation, Best Practice Meetings, Breakfast for Champions, and Large Learning Collaborative Measurement Period 2 (MP 2) 7/1/18 to 6/30/19 PCMH-Kids Care Delivery Requirements Due Date (if applicable) last day of month Care Management Submits reports on high risk patients, as defined by CTC, to Health and CTC and achieves 40% engagement rate Quarterly (July/October/January/April) Submits to OHIC Cost Management Strategy Attestation October 15 Submits report that demonstrates 75% of high risk patients who were hospitalized receive a follow up interaction including medication reconciliation within 2 business days Month 12 Planned Care: Population Health /Quality Reporting Submits quarterly quality data January/April/July/October Submits to OHIC quality data information October 15 Access and Continuity Reports to CTC Quarterly Provider Panel Report indicating open/closed panel status for new patients and 3rd next available appointment for existing patients Quarterly Submit to CTC screenshots demonstrating patient access to a secure web portal, enabling secure messaging, appointment requests, referrals, and prescription refills. Month 3
Reviewers Score Sheet Application Questions Total # PR 1 PR 2 PR 3 PR 4 (if applicable) Curr Care (max 1) Geo Dist (max 2) NCM/ CC Cap (max 2) Pt Inv (max 2) % Med (max 3) NCQA (max 1) EHR (max 4) BH (max 3) E #1 (max 10) E #2 (max 10) E #3 (max 10) E #4 (max 10) E #5 (max 10) E #6 (max 10) Pedi (max 78) 1 2 3 4 5 6 7 8 9 10