The Medical Home in Pediatric Practice

1. The Medical Home in Pediatric Practice Forrest C. “Curt” Bennett, MD A. Chris Olson, MD, MHPA Carla Salldin Kate Orville, MPH Children’s Hospital & Regional Medical Center Grand Rounds May 13, 2004

2. What is a Medical Home? • A. A long-term care facility • B. A physician providing care out of his/her home • C. A physician making house calls • D. A concept or model of care provision

3. A Medical Home Is… • NOT just a building or place but a way of providing health care services that are: • Accessible • Family-centered • Coordinated • Comprehensive • Continuous • Compassionate • Culturally Sensitive

4. In a Medical Home… • Children and their families receive the care that they need from a pediatrician or other PCP whom they know and trust. • The pediatric health care professionals and parents act as partners to identify and access all the medical and non- medical services needed to help children and their families achieve their maximum potential.

5. While all children can benefit from a medical home, it is particularly important for children with special health care needs and their families.

6. Children with Special Health Care Needs • “Children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” • Adopted by the AAP (October 1998). McPherson M, Arango P, • Fox HB, A new definition of children with special health care • needs. Pediatrics 1998; 102:137-140

7. Medical Home Leadership Network • Coordinated,statewide network of families and professionals who promote the availability and accessibility of medical homes for CYSHCN in their communities • Started 1994 --Funded by DOH CSHCN Program and US MCHB • Housed at UW Center on Human Development & Disability

8. MHLN Teams • Volunteer • Interdisciplinary • Community-based

9. MHLN Team Composition • Parent of CSHCN • Pediatrician / Family Physician • Public Health Nurse • Family Resources Coordinator (0-3) • Plus: Reps from mental health, schools, oral health and others

10. Washington State Medical Home Leadership Network PEND OREILLE WHATCOM FERRY OKANOGAN SAN JUAN SKAGIT STEVENS SNOHOMISH CLALLAM CHELAN ISLAND DOUGLAS SPOKANE JEFFERSON LINCOLN KITSAP KING MASON GRAYS HARBOR GRANT ADAMS KITTITAS PIERCE WHITMAN THURSTON FRANKLIN GARFIELD PACIFIC YAKIMA LEWIS COLUMBIA WAHKIAKUM BENTON COWLITZ WALLA WALLA ASOTIN SKAMANIA KLICKITAT CLARK Regions Northwest Central King & Pierce East Southwest Regional Resource Teams

11. State Medical Home Partners • MAA (Medicaid) • Parent to Parent • Fathers Network • Family Voices • Molina Healthcare • CHPW • Pediatric Dentistry • Adolescent Health Transition Project • WA Dept. of Health, CSHCN Program • US MCHB • UW CHDD- CTU & LEND • American Academy of Pediatrics (WA & US) • Infant Toddler Early Intervention Program • CHRMC/Center for Children with Special Needs

12. How do we achieve a medical home for every child by 2010 ? • MCHB/AAP: Need for state-based, systemic approach • National Medical Home Mentorship Network • Washington State selected as one of 12 teams January 2001 • Each state team: Title V, AAP leadership, community pediatrician, CATCH Coordinator, Family Rep, Family Physician, other •  Washington State Medical Home Plan

13. Washington State Goal 1 • Families, providers, leaders of statewide initiatives, policymakers, insurers and others involved with children and adolescents will understand and endorse the medical home concept. • Identify which groups need to understand medical home concept & what medical home activities already exist • Assemble/develop medical home materials • Disseminate information

14. Washington State Goal 2 • PCPs and their office staff will have the skills, interest, and knowledge to participate as partners in medical homes • Support WA MHLN teams • Expand pool of providers and office staff available & skilled as medical home partners

15. Washington State Goal 3 • Families will have the skills, interest, and knowledge to participate as partners in medical homes • Expand pool of family organizations and individuals promoting concept and strategies to families and health care providers

16. The Medical Home in Pediatric Practice A. Chris Olson, MD, MHPA Spokane, WA

17. The Medical Home in Pediatric Practice • Olson Pediatrics • Data Collection • Care Coordination • Family-Centered Care • Marketing Pediatric Care

18. Olson Pediatrics • Spokane Medical Community • Two Pediatricians • Three Mid-level providers • Office Staff of 10 FTE’s • Approx. 9,000 patients • 1212 CYSHCN

19. Mid-Level Providers • Nursing background • Parents of CYSHCN • Lower costs • Timeline to train • Liability

20. Associated Staff • Physical Therapist • In office services • Communication issues • Mental Health services

21. Data Collection • Data person • FACCT survey criteria • Excel spreadsheet/Access • Disease specific data collection • Insurance plans

22. Diagnosis - CYSHCN

23. Severity

24. Insurance Coverage

25. Care Coordination • Office coordinator • Inservice presentations • Care Plans • Specialty follow up • Chronic Care visits • Reminder system • Care Coordination costs

26. Cost of Care Coordination • 774 encounters/not reimbursed services • Most complex consumed 25% of the time • 11% of the patients • 51% of the encounters not medical • Cost of time spent coordinating • $22,809 to $33,048 • Efforts to finance unreimbursable care coordination

27. Family centered care • Family is the constant in the care of the patient • Connecting families • Newsletter • Bulletin board • Family advisory council • Asking families/surveys

28. Medical Home Index • Office/Family • Organizational capacity • Community outreach • Chronic condition management • Data management • Care coordination • Quality improvement

29. The Marketing of Pediatric Care • Differentiate pediatric care • Family practice • Future of pediatric care • Data/care coordination/family centered • Principles of change/NICHQ

30. Medical Home Partnership:Family and Provider in PEACE Carla Salldin Family Consultant

31. Medical Home isour “PEACE” of Mind • Partnership • Education • Action • Care • Expertise

32. Building the Medical Home Puzzle One “Peace” at a time

33. Adam Born October 30, 1995 (10 weeks early) The beginning… The first day I held my son, November 17th, 1995.

34. PEACEPartnership Story • Family story • Problem • Tells Story/ gives details • Medical problem/concern • What do we do next • Family needs • Medical story • Symptoms • Vitals • Medical specialists • Referral to Intervention • Community Supports Questions and answers, partnership, responsibility and teamwork. We have PEACE of Mind, knowing our Primary Care Doctor listens to us, and we listen to her.

35. Adam’s Medical home… • Core Partnership • Adam • Parents • Pediatrician • Other partners • Medical Specialist • Interventionist/Therapists • School • Community programs • Friends and Family • Other Families

36. Successful Medical Home Carla, Adam and Dan Salldin Adam 8-1/2 years old Dr. Donna Smith and Virginia Mason Sandpoint Pediatrics Together as a Team, Family and Pediatrician, we have our PEACE of mind.

37. Success of Adam by Nature of his Medical Home • Health • Self esteem • Social well being • Academics • Physical activities • Future…. • Adolescence, adult, and College?

38. “Miracles don’t happen in a day, they happen over time.” P. Tarczy-Hornoch 1996

39. Building a Successful Medical Home is like….. • a Miracle, • it happens over time and • a Puzzle • one PEACE at a time

40. Medical Home Tools and Support for Washington State Health Care Providers and Families Kate Orville, MPH Co-Director, MHLN

41. Tools to Support Coordinated, Family-Centered Care • Links to community resources • Information and organizers for families • Website resources • Medical Home • Quality Improvement

42. One Number to Call? • ASK Line- Answers for Special Kids 1-800-322-2588 • Hotline for parents and providers looking for resources for CSHCN • Health, development, care, insurance parenting support, recreation, local & national disability-related orgs + • Sponsored by Healthy Mothers, Healthy Babies- Support from DOH

43. 3 Key Local Resources 1. Public Health Nurse CSHCN Coordinator • -- Serves children with or at risk for special needs ages 0-18 years. • -- Can provide or help families connect to: public health nursing, funding sources, & family support • -- Funded in part by DOH & works in your local health department

44. 2. Family Resources Coordinator (FRC) • -- Serves children 0-3 years • -- Can help families:arrangefor further developmental testing toverify eligibility for early intervention (EI) services, explain EI services and systems, access community support programs, anddiscuss possible funding sources for EI services. • -- Funded by ITEIP (IDEA Part C)

45. Key Resources Continued… 3. Family to Family Support- • Parent to Parent • Fathers Network • PAVE • Diagnosis-specific support groups

46. Family and Child/Youth Self-Care Tools • Family Care Notebook • County Resource Lists & Starting Point • Medical Home Toolkit • Adolescent Health Transition Notebook

47. Website resources • Center for Children with Special Needs– CHRMC www.cshcn.org • National Center for Medical Home Initiatives (AAP) www.medicalhomeinfo.org • WA State Medical Home Leadership Network (up July, 2004) www.medicalhome.org • Adolescent Health Transition Project www.depts.washington.edu/healthtr/