What We Do
OPM helps primary care practices transform their clinics into patient-centered medical homes (PCMH) and in the National Committee for Quality Assurance (NCQA) submission and recognition process. Let us use our expertise to make your practice transformation and NCQA submission expedient and painless.
About Us
OPM is led by practicing physicians who understand the demands of keeping up with the changing medical market, changes in payment, the need to constantly evolve and optimize your clinic, and the clinical relevance of the NCQA standards. This is what makes OPM unique. OPM has steered practices through the NCQA recognition process successfully and developed a process-oriented practice-transformation model using the NCQA standards as a template to assist you in creating the practice you envision. OPM's goal is to help your practice transition into a patient-centered medical home and complete the NCQA application process.
OPM was founded by Sari Miettinen, MD, a board-certified pediatrician who practiced with Texas Children's Pediatrics, the largest pediatric group in the United States for 8 years. During this time, she helped transform the practice into a patient-centered medical home, and the practice obtained NCQA Level 3 recognition in August 2013. She realized how incredibly time consuming it can be to transform your practice into a medical home, continue to see patients, while simultaneously understanding, preparing, and submitting an application for NCQA recognition. In March 2014, she obtained her NCQA PCMH Certified Content Expert (CCE) Certification.
Services
- PCMH transformation
- PCSP for specialty practices
- NCQA submission, maintenance, and renewal
- Pediatric practice development
- Practice organization and quality improvement
Our Process
OPM believes in a TEAM-based approach where all team members contribute to the medical home. Free of charge and without obligation, we complete a review of your practice's current processes and procedures using the OPM practice questionnaire. We then discuss the practice results and your individual practice's goals.
If you choose to engage our services, our role and process involves 4 steps:
- Gap Analysis: We perform an in-depth gap analysis between your practice's existing processes and the changes required in order to meet NCQA standards. OPM visits your practice site to review your gap-analysis, and we collaborate with you and the practice team members to discuss which areas need immediate focus to obtain NCQA recognition. We can also determine which areas you may like to address at this stage to generally improve your practice's workflow.
- Implementation Plan: We develop an implementation plan and present the plan to the entire care team. We assign individual roles and resposibilities to the care team members and set goals for implementation times.
- Quality Improvement Cycle: For the next 3 months, your care team will implement your new processes and procedures as we guide you week-by-week. We provide you resources and the written documentation for office processes and procedures which may be lacking. Monthly, we will monitor whether the set goals have been met and which processes and procedures are not working and need to be re-worked. Weekly, we will meet with your practice leaders to address any obstacles or questions.
- NCQA Submission: After a minimum of 3 months, we reassess and determine if the practice has satisfied all of its goals and is ready for NCQA submission. We gather and upload all of the required documentation to the NCQA survey tool for your submission.
Frequently Asked Questions
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What is a patient-centered medical home (PCMH)?
A PCMH is an approach to providing comprehensive primary care to children, adolescents, and adults. It is a clinic which is able to provide a partnership between the patient/patient's family and their personal physician.
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Why become a PCMH?
The PCMH emphasizes whole person care, increased access, evidence-based medicine, and continuous quality improvement (QI). The goal is to improve patient compliance, outcomes, and satisfaction; therefore, decreasing health care costs and increasing physician satisfaction. The continuous quality improvement (QI) cycle provides opportunities for a more efficient clinic and increased reimbursement.
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Who is the National Committee for Quality Assurance (NCQA)?
NCQA is a private, independent non-profit health care quality oversight organization. Their mission is to improve the quality of health care, and their vision is to transform health care through quality measurement, transparency, and accountability.
www.ncqa.org -
Why obtain NCQA recognition?
The NCQA seal represents your commitment to quality patient care. It is an investment in your practice's future.
- Marketing: Use this as a marketing strategy to attract more patients and lead the competitive market.
- Financial: Payors recognize this with increased reimbursement to practices who can demonstrate improved quality metrics or decreased patient utilization of unnecessary resources. Payors are also providing practices with "PCMH Initiatives" which discount the NCQA application fees in order to incentivize practices to obtain recognition.
- Meaningful use (MU): MU is embedded in the NCQA standards. NCQA PCMH 2011 aligns with MU stage 1. PCMH 2014 aligns with MU stage 2. The practice can simultaneously accomplish both NCQA recognition and MU to receive MU dollars.
- Maintenance of Certification (MOC) 4 credit: complete MOC 4 with the QI cycle naturally imbedded in NCQA Recognition.
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What is a PCMH certified content expert (PCMH CCE)?
In an effort to help practices and other interested parties identify experts with a demonstrated understanding of the NCQA PCMH Recognition program and to provide professionals with a way to validate their knowledge base, NCQA developed the PCMH Content Expert Certification (CEC) program. These are individuals who have demonstrated expert level knowledge of all aspects of NCQA's PCMH recognition program.
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What are the levels of NCQA recognition?
There are 3 levels for NCQA recognition based on how many points are earned in the standards which are met.
Level 1: 35-59 points and all six must-pass elements
Level 2: 60-84 points and all six must-pass elements
Level 3: 85-100 points and all six must-pass elements
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How long does the process take?
This depends on the current state of your practice. The process is a continuous quality improvement (QI) cycle. New processes and procedures must be in place for a minimum of three months to be eligible for NCQA submission. After submission, you will receive a response from NCQA within 60 days.
Recognition is SITE specific, not physician specific. A site is considered a physical address; therefore, if a particular site would like to apply, all clinicians with-in that site must apply at once. If a practice has more than one site, they may submit one site at a time and add additional sites at a later time, or they may submit all practices at once.
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How long is the certification valid?
The certification is valid for three years. Six months prior to the expiration the practice will be notified that it is time for re-certification. Practices at level 2 or 3 are eligible for stream-lined renewals with reduced documentation requirements. An expired practice will lose the chance for stream-lined renewal.
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What if we do not qualify for NCQA recognition?
OPM will not submit your application until we are confident your practice will achieve NCQA recognition.
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What if we do not qualify at our desired level?
OPM will not submit your application until we are confident your practice will achieve NCQA recognition.
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What are the NCQA fees?
NCQA fees vary by number of practice sites and physicians within a practice site. Certain sponsors such as insurance companies may offer a "PCMH Initiative" discount of 20%.
NCQA Recognition Program Pricing -
What are the OPM fees?
The initial consultation is completed using the practice questionnaire. It is completely free of charge. After completing the practice questionnaire, we will discuss the practice's current standing, and any questions or concerns. At this time, the practice will decide whether or not it would like to move forward, and we will determine fees based on your practice's individual needs.
Contact Us
Optimum Practice Management
134 Birch Drive, Rindge, NH 03461
713-859-3978 | sari@optimumpracticemanagement.com
Please contact OPM to discuss your practice's needs or to receive the practice questionnaire to determine where your practice stands in the NCQA recognition process.
Join us at the following events:
Webinar hosted by AAP's Section on Administration and Practice Management "NCQA: Beyond the Basics"
Part 1 September 23, 7-9 pm EST,
Part 2 October 7, 7-9 pm
What our clients are saying about us:
"We worked with a pediatrician who knew both the medicine, as well as, the management side of a PCMH. She made it work for OUR clinic. Rather than feeling like we were jumping through hoops, we made relevant changes in our practice that improved work-flow and patient care."
- Sogol Pahlavan, MD, FAAP
ABC Pediatric Clinic, Houston, TX
NCQA's PCMH Congress
October 9-11
Hilton San Francisco Union Square
San Francisco, CA