DOH grant survey

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* 1. Practice Name

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* 2. Practice Address

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* 3. Name/title of representative submitting survey

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* 4. Is your practice pursuing, or has it achieved NYS PCMH recognition?

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* 5. Is NYS PCMH your first NCQA PCMH recognition? If not, please specify your previous recognition below

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* 6. Did you work with a practice transformation agent?

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* 7. In your opinion, has the NYS PCMH recognition process focused on the right capabilities to improve processes and efficiency in your practice?

Yes, we were new to PCMH recognition and found that the program was challenging but will benefit us in the future.

Yes, we are a sustaining PCMH practice; the NYS PCMH requirements were challenging but will help us improve performance in the future.

Not sure, aspects of NYS PCMH were helpful but doubtful that the model will be of use in the future.

No, we do/did not have a staffing model to support capabilities needed to achieve sustainable NYS PCMH recognition

No, NYS PCMH did not focus on business model development needed to improve ROI and increase incentive opportunities

No, we do not plan to complete NYS PCMH

Other (please specify)

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* 8. How comfortable are you in your knowledge of advanced payment models? Please use the following scale to rate your comfort.

Very: have acquired knowledge through education and/or staff business specialists
Somewhat: have participated in educational opportunities but lack internal practice capabilities to position us for participation in APMs.
Limited: knowledge is limited and don’t know how APMs can really benefit my practice at this time
Not at all: Either my practice is part of a large health system or organization: don’t need deeper understanding OR My practice will not likely qualify for an APM on its own OR No interest

	Very	Somewhat	Limited	Not at all
How comfortable are you in your knowledge of advanced payment models? Please use the following scale to rate your comfort	How comfortable are you in your knowledge of advanced payment models? Please use the following scale to rate your comfort Very	How comfortable are you in your knowledge of advanced payment models? Please use the following scale to rate your comfort Somewhat	How comfortable are you in your knowledge of advanced payment models? Please use the following scale to rate your comfort Limited	How comfortable are you in your knowledge of advanced payment models? Please use the following scale to rate your comfort Not at all

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* 9. Approximately how many commercial health plans in your practice have offered you a VBP contract?

All

1-2

3-5

Other, we are part of an ACO, health system or IPA with established VBP contracts

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* 10. Is your practice currently able to take on downside risk in a VBP arrangement?

Yes

No, but we can assume upside risk

N/A

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* 11. What would be the next step(s) to building a high functioning primary care environment in your geographical region? (Choose all that apply, examples given below, these are not exhaustive)

Health Plan/provider collaboration: convening local discussions on VBP, quality, clinical support for care management, population health, and other non-billable services

Health IT: Provider/EMR vendor/RHIO regional support discussions

Quality Measurement Alignment: provider, health plans, Medicaid discussions

Regional Resources: community-based (i.e. Population Health Improvement Programs), behavioral health, disease and/or social determinants management

Other (please specify)

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* 12. There are six concepts for NCQA’s PCMH Model:

1. Team-Based Care and Practice Organization (TC)

2. Knowing and Managing Your Patients (KM)

3. Patient-Centered Access and Continuity (AC)

4. Care Management and Support (CM)

5. Care Coordination and Care Transitions (CC)

6. Performance Measurement and Quality Improvement (QI)

What changes, if any, would you recommend for the model in the future, either for a specific concept or the model in general?

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* 13. Have you or your practice used anything to qualify for NY PCMH also for MOC?

Yes

If yes, what have you used for MOC?