AAAHC Medical Home Accreditation and On-site Certification

Case Study: Metro Community Provider Network (MCPN), Jefferson County, CO

Background

Metro Community Provider Network (MCPN) is a federally qualified health center that operates three school-based health centers in Jefferson County, Colorado. MCPN has prioritized PCMH recognition because they believe it drives payment reform and they also anticipate that it will soon be a requirement of payers. MCPN elected to pursue AAAHC medical home accreditation because it aligned more closely with outpatient primary care. (Note: they are currently pursuing NCQA PCMH Stage 3 recognition as well because they feel it has become the gold standard for FQHCs.) “If SBHCs want to be equal in today’s healthcare market, they need to come to the table as equals and do the work of recognition,” said Lynn Bakken, PNP-BC, MCPN Associate Medical Director of Pediatric and Adolescent Services (personal communication, January 29, 2016).

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The Approach Taken

It took approximately 12 months to prepare for the AAAHC onsite survey. A team lead spearheaded the process with a consultant provided at no charge by the Colorado Community Health Network. They formed a committee with broad representation from across the organization and divvied up the work of preparation. Their IT department was involved as well because the process required running reports and extracting data.

Challenges

MCPN’s biggest challenge was time because it involved a significant amount of work on the part of several people.

Impact/Lessons Learned

Ms. Bakken felt the AAAHC process was valuable to their SBHCs and other clinic sites. It provided an opportunity to discover ways to document many of the clinic processes that were already being done but not being captured. They revised several policies and procedures once they began scrutinizing them for patient education, team-based care, and patient engagement. The process also led to more standardization across providers and sites.


Case Study: True Health, Central Florida

Background

True Health is a federally qualified health center operating seven clinics in central Florida, including two SBHCs at Maynard Evans High School and Cheney Elementary in Orlando.

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Reason for Pursuing AAAHC Medical Home Accreditation

According to Janelle Dunn, MHA, Chief Operations Officer, and Deana Montella, BSN, RN, Director of Nursing (personal communication, May 25, 2016), True Health chose to pursue AAAHC Medical Home Accreditation for three main reasons: (1) to increase the confidence level of their patients in the quality of the services delivered; (2) to distinguish True Health from other medical providers in the community; and (3) to be well-positioned for payment reform within the changing health care landscape. They considered Joint Commission Accreditation to be too hospital-oriented for their ambulatory care setting and thus AAAHC was selected.

The Approach Taken

True Health took a team approach to prepare for the onsite survey. They used AAAHC resources, such as their accreditation handbook and checklists. They also attended an AAAHC conference, which provided an excellent opportunity to network and learn from other practices who were already accredited. They shared clinical and administrative updates on progress at monthly management meetings. They received their first AAAHC Medical Home Accreditation in 2012 before either SBHC was in operation. Once the SBHCs were up and running, they submitted a letter to AAAHC requesting that the SBHCs be added to the accreditation. In 2015 they were reaccredited and AAAHC visited the SBHCs at that time.

Challenges

The biggest challenge they faced was assuring that all of their policies and procedures were aligned with AAAHC standards.

Impact/Lessons Learned

Ms. Montella and Ms. Dunn shared that since undergoing the accreditation process; they feel more confident that they are clinically and operationally on par with other high quality health care organizations. The accreditation has enhanced their relationship with the schools they work with and solidified their reputation. They also say that the accreditation has strengthened grant applications.

Ms. Dunn and Ms. Montella had the following advice for SBHCs planning to pursue AAAHC Medical Home Accreditation:

  • Stay calm as it can be a stress-provoking process.
  • Attend an AAAHC conference to help prepare because the networking opportunity is invaluable.
  • Reach out to the helpful AAAHC staff with questions throughout the process.


Click here to view the Medical Home Accreditation standards covering the five tenets of the medical home model:

TABLE 3: AAAHC Medical Home Accreditation Standards

The AAAHC Medical Home Accreditation Standards process is an add-on to the comprehensive ambulatory accreditation survey. AAACH considers it to be the highest achievement for primary care practices.

StandardElement (example)Factors (examples)
RelationshipMedical home team – primary point of care for the patient
The practice provides services within a team framework which has been conveyed to the patient.
  • Observation of team concept in practice during patient visit - registration, interview, exam, education, take-home instructions, and documentation
  • AccessibilityAccess to care within the medical home
    The practice provides services in a timely manner that meets patients’ needs
    Onsite survey demonstrate:
  • Appointment protocols for routine and acute care
  • Processes for consultation and referrals
  • System for 24/7 access to care
  • Establishing secure
    communications with patients

  • Comprehensiveness
    of care
    Comprehensive scope of services
    The practice provides patients with services, support, and encouragement that empower them to accept responsibility for their health care.
  • Scope of services provided on website and/or brochure

  • Documentation of patient education specific to condition in electronic health record

  • Diagnostic tests and treatment documented in electronic health record

  • Continuity
    of care
    Coordination of the medical home patients’ health care needs
    The practice provides coordination of its patients’ consultations’ and referrals, lab and diagnostic testing, hospitalizations, transitions, and transfers.
  • Exchange of clinical information among providers related to the patients’ medical condition

  • Documentation in the electronic health record of diagnostic and lab tests, hospitalizations, missed appointments, consultations and referrals, and after hours care

  • Quality of
    Care
    Quality improvement (QI) is demonstrated within the medical home
    The practice has an active, integrated, organized, peer-based, and patient-centered QI program.
  • Evidence-based guidelines
  • Clinical performance measures
  • QI plan/program description
  • Two QI studies
  • Results of patient satisfaction surveys past 24 months
  • Emergency preparedness plan


  • Click here to view the Medical Home On-site Certification standards:

    TABLE 4: AAAHC Medical Home On-site Certification

    The Medical Home On-site Certification process is a stand-alone process that does not require accreditation through AAAHC. Eight standards exist for the Medical Home On-site Certification process.

    StandardElement (example)Factors (Example)
    Patient Rights, Responsibilities, and EmpowermentPatient rights, responsibilities, and empowerment
    Practice has a written process in place to inform patients of their rights, responsibilities, and empowerment
  • Copy of the practice’s patient rights, responsibilities, and empowerment statement

  • Observation of patient rights, responsibilities, and empowerment statement practiced during onsite survey

  • Governance and administrationEffective governing and administrative infrastructure
    Practice has a governing body that addresses and is fully responsible for the performance and operation of the organization, and the medical home is administered in a manner that assures high-quality patient-centered services
  • Minutes from last two governing body’s meeting

  • Current organizational chart, including committee structure and department/staff reporting relationships

  • Medical home policies and procedures
  • Results of patient satisfaction surveys past 24 months

  • RelationshipMedical home team – primary point of care for the patient
    The practice provides services within a team framework which has been conveyed to the patient.
  • Observation of team concept in practice during patient visit - registration, interview, exam, education, take-home instructions, and documentation
  • AccessibilityAccess to care within the medical home
    The practice provides services in a timely manner that meets patients’ needs
    Onsite survey demonstrate:
  • Appointment protocols for routine and acute care
  • Processes for consultation and referrals
  • 24/7 access to care
  • Establishment of secure communications method(s) with patients
  • Continuity of CareComprehensive scope of services
    The practice provides patients with services, support, and encouragement that empower them to accept responsibility for their health care.
  • Scope of services provided on website and/or brochure

  • Documentation of patient education specific to condition in electronic health record

  • Diagnostic tests and treatment documented in electronic health record

  • Clinical records and health informationClinical records and a health information system maintained
    The practice maintains a comprehensive, accurate, and up to date electronic health record and information system from which information can be retrieved promptly.
    Onsite survey:
  • Review of patient clinic record for completeness
  • Visits
  • Current problem list
  • Prescriptions in chart
  • Summaries from other providers
  • Diagnostic and lab test results
  • QualityQuality improvement (QI) is demonstrated within the medical home
    The practice has an active, integrated, organized, peer-based, and patient-centered QI program.
  • Evidence-based guidelines
  • Clinical performance measures
  • QI plan/program description
  • Two QI studies
  • Results of patient satisfaction surveys past 24 months
  • Emergency preparedness plan
  • Joint Commission Recognition Program
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