Transcript The Medical Home in Pediatric Practice

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
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
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
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 nonmedical services needed to help children
and their families achieve their
maximum potential.
While all children can benefit from a
medical home, it is particularly
important for children with special
health care needs and their families.
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
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
MHLN Teams
• Volunteer
• Interdisciplinary
• Community-based
MHLN Team Composition
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Parent of CSHCN
Pediatrician / Family Physician
Public Health Nurse
Family Resources Coordinator (0-3)
• Plus: Reps from mental health,
schools, oral health and others
Washington State
Medical Home Leadership Network
PEND
OREILLE
WHATCOM
FERRY
OKANOGAN
SAN JUAN
SKAGIT
STEVENS
SNOHOMISH
CLALLAM
CHELAN
ISLAND
DOUGLAS
JEFFERSON
SPOKANE
LINCOLN
KITSAP
KING
GRAYS
HARBOR
MASON
PIERCE
KITTITAS
GRANT
ADAMS
WHITMAN
THURSTON
PACIFIC
WAHKIAKUM
FRANKLIN
GARFIELD
YAKIMA
LEWIS
COLUMBIA
BENTON
COWLITZ
WALLA
WALLA
SKAMANIA
ASOTIN
KLICKITAT
CLARK
Regions
Northwest
Central
King & Pierce
East
Southwest
Regional Resource Teams
State Medical Home Partners
• 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
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MAA (Medicaid)
Parent to Parent
Fathers Network
Family Voices
Molina Healthcare
CHPW
Pediatric Dentistry
Adolescent Health
Transition Project
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
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
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
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
The Medical Home in
Pediatric Practice
A. Chris Olson, MD, MHPA
Spokane, WA
The Medical Home in Pediatric
Practice
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Olson Pediatrics
Data Collection
Care Coordination
Family-Centered
Care
• Marketing Pediatric
Care
Olson Pediatrics
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Spokane Medical Community
Two Pediatricians
Three Mid-level providers
Office Staff of 10 FTE’s
Approx. 9,000 patients
1212 CYSHCN
Mid-Level Providers
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Nursing background
Parents of CYSHCN
Lower costs
Timeline to train
Liability
Associated Staff
• Physical Therapist
• In office services
• Communication
issues
• Mental Health
services
Data Collection
• Data person
• FACCT survey
criteria
• 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 Coordination
• Office coordinator
• Inservice
presentations
• Care Plans
• Specialty follow up
• Chronic Care visits
– Reminder system
• Care Coordination
costs
Cost of Care Coordination
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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
Family centered care
• Family is the
constant in the care
of the patient
• Connecting families
– Newsletter
– Bulletin board
• Family advisory
council
• Asking
families/surveys
Medical Home Index
• Office/Family
• Organizational
capacity
• Community outreach
• Chronic condition
management
• Data management
• Care coordination
• Quality improvement
The Marketing of
Pediatric Care
• Differentiate pediatric
care
• Family practice
• Future of pediatric
care
• Data/care
coordination/family
centered
• Principles of
change/NICHQ
Medical Home Partnership:
Family and Provider in PEACE
Carla Salldin
Family Consultant
Medical Home is
our “PEACE” of Mind
Partnership
Education
Action
Care
Expertise
Building the Medical Home Puzzle
One “Peace” at a time
Adam Born October 30, 1995
(10 weeks early)
The beginning…
The first day I
held my son,
November 17th,
1995.
PEACE
Partnership 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.
Adam’s Medical home…
•Core Partnership
•Adam
•Parents
•Pediatrician
•Other partners
•Medical Specialist
•Interventionist/Therapists
•School
•Community programs
•Friends and Family
•Other Families
Successful Medical Home
Dr. Donna Smith and
Virginia Mason
Sandpoint Pediatrics
Carla, Adam and Dan Salldin
Adam 8-1/2 years old
Together as a Team, Family and Pediatrician, we have our PEACE of mind.
Success of Adam by Nature of his Medical Home
•Health
•Self esteem
•Social well being
•Academics
•Physical activities
•Future….
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Adolescence, adult,
and College?
“Miracles don’t happen in a day,
they happen over time.”
P. Tarczy-Hornoch 1996
Building a Successful
Medical Home
is like…..
• a Miracle,
– it happens over time and
• a Puzzle
– one PEACE at a time
Medical Home Tools and Support
for Washington State
Health Care Providers and
Families
Kate Orville, MPH
Co-Director, MHLN
Tools to Support Coordinated,
Family-Centered Care
• Links to community resources
• Information and organizers for families
• Website resources
– Medical Home
– Quality Improvement
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
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
2. Family Resources Coordinator (FRC)
•-- Serves children 0-3 years
•-- Can help families: arrange for further
developmental testing to verify eligibility
for early intervention (EI) services,
explain EI services and systems, access
community support programs, and
discuss possible funding sources for EI
services.
•-- Funded by ITEIP (IDEA Part C)
Key Resources Continued…
3. Family to Family Support• Parent to Parent
• Fathers Network
• PAVE
• Diagnosis-specific support groups
Family and Child/Youth
Self-Care Tools
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Family Care Notebook
County Resource Lists & Starting Point
Medical Home Toolkit
Adolescent Health Transition Notebook
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/
Support for Quality Improvement
• Center for Medical Home Improvement
-Medical Home Index
www.medicalhomeimprovement.org
• National Initiative for Children’s
Healthcare Quality (NICHQ)
www.nichq.org
• Improving Chronic Illness Care (RWJ)
www.improvingchroniccare.org
Contact Information
• Forrest C. “Curt” Bennett, MD
206-685-1356 [email protected]
• A. Chris Olson, MD
509-489-5110 [email protected]
• Carla Salldin 206-987-2063
[email protected]
• Kate Orville, MPH
206-685-1279 [email protected]