Transcript The Medical Home in Pediatric Practice

The Medical Home in
Pediatric Practice
EMRs and Care Plans
Medical Home Conference
Washington State
May 30, 2007
A High-Performing System for
Well-Child Care:
A Vision for the Future*
‘…an ideal system would be characterized by:
• Advanced access to services
• Team-based care
• Individualized developmental and behavioral
screening
• Cultural beliefs and practices accommodated
• Care coordination through a medical home
• Knowledge transfer and electronic health records
• Health care financing
*Bergman D, Plsek P, Saunders M. CMWF
Report, October 2006.
In a nutshell, what is your vision of
an ideal system of well-child care?
David Bergman, M.D.
• First, we have to have some sense of biopsychosocial risk. A lot of
this can be determined at birth: Is the child born premature? Does
the baby have a congenital defect? Is the family situation chaotic?
These are all risk factors. We then have to assign the content of
care according to the level of risk. High-risk kids need more
visits with a different mix of health care professionals.
• In terms of financing, we need to align incentives to more
appropriately reimburse for kids with special health care
needs. This can be done through tiered capitation—defining kids
at a level of biopsychosocial risk and assigning a capitated rate.
• Leveraging new technologies is also key.
A High-Performing System for
Well-Child Care:
A Vision for the Future*
• Advanced access to services - Secure messaging
• Team-based care - Develop comprehensive plan,
including education and socialization
• Care coordination through a medical home
• Knowledge transfer and electronic health records
• Health care financing - Reimbursement for non-physician
members of health care teams (Care coordinators)
• Individualized developmental and behavioral screening
(Vanderbilt in EMR – MBCH, On-line form completion, e.g.
ASQ)
• Cultural beliefs and practices accommodated (Parent
information sheets, screening tools)
EMRs
• Scope:
– Practice-based
• Othello: Columbia Basin Health Association [CHARTLOGIC*],
• Spokane: Olson Pediatrics
– Hospital-based/System-based
• Mary Bridge - EPIC (with SmartSet subprogram – ADHD Module)
• Group Health Cooperative
– Community-wide
• Kittitas
• Whatcom
• Patient accessibility
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PHRs - test results, visit summaries, input health information
Email communication
Information resources
Other
EMRs – Discussion Points
• Pediatric-specific record issues/CSHCNspecific record issues (Needs/hopes/problems)
– Provider viewpoint
• Individual patient
• Diagnosis specific management
– Family/Child viewpoint (?cultural, PHRs, email
interface, adult child with DD,etc.)
– Health plan issues
• ID CSHCN
• Data pulls for
– Patient care issues (often by diagnostic group)
– Contract/reimbursement documentation
Olson Pediatrics
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Spokane Medical Community
One Pediatrician
Three Mid-level providers
Office Staff of 10 FTE’s
Approx. 9,000 patients
1212 CYSHCN
Data Collection
• Data person
• FACCT survey criteria – CSHCN
Screener (5 item, parent-survey
based tool)
• Excel spreadsheet/Access
• Disease-specific data collection
• Insurance plans
Diagnosis - CYSHCN
11%
1%
3%
24%
1%
1%
4%
2%
3%
2%
1%
3%
4%
40%
ADHD
Asthma
Asthma +
Autism
CF
Cleft Lip
CP
Depression
Devel. Delay
Diabetes
Downs
Seizures
Myleodysplasia
Other
Severity
8%
4%
15%
Severity
Severity
Severity
Severity
73%
1
2
3
4
Insurance Coverage
9%
24%
DSHS
Molina
PVT
PVT + Medicaid
26%
41%
Care Plans
• Who creates them? What do they look
like?
– Health plan
– PCP
– Family
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What else is needed?
Sample forms
Leveraging personnel and time
(Coding and Reimbursement)
Care Plans
Examples:
– Jack Stephens
– Jean Popalisky
• Health plan
• Primary care office
– CCSN website – Family
– Notebook - other examples
• Resources:
– WA medical home site
– National medical home site
– HRTW site