Transcript Nourishing Medical Homes

Essential Community Resources for
the Pediatric Medical Home –
Building a Strong Medical
Neighborhood for
Children with Special Needs
Kate Orville
Wendy Harris
Pediatric Resident Noon Conference
October 14, 2014
Kate Orville, MPH
• Co-Director, WA State Medical Home
Partnerships Project for CYSHCN
• UW Center on Human Development &
Disability
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Medical Home Teams
Community Coalitions to ID children with special
needs and services needed
Pediatric Resident Training
Wendy Harris
• Early Intervention Program Manager
• King County Developmental Disabilities
Division
Why we’re here
• Developmental-Behavioral
Pediatric Resident rotation
• Request for information
about community
resources earlier in
training
• Medical Home fuzzy
concept for many, despite
growing importance in
health care
Today
• The Medical Home Model
– Why does it matter for families with children
with special needs
– What does it mean for pediatricians as
primary care providers and as specialists?
• Key Community Resources for
Children with Special Needs
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Family Health Hotline
Early Intervention (ages 0-3)
School Districts (3-21)
Family Support
Public Health (0-18)
The Medical Home – Team-based,
Proactive Primary Health Care
• Comprehensive Care
• Patient-centered
• Coordinated Care
– Vertical- (e.g specialty care)
– Horizontal (e.g.community svs)
– Longitudinal
• Accessible Services
• Quality and Safety
• 2007 Joint Principles of Pt-Centered Medical Home
How is a Medical Home Different?
Today’s Care
• My patients are those who
make appointments to see me.
• Care is determined by today’s
problem and time available
today.
• I know I deliver high quality
care because I’m well trained.
• Patients/families are
responsible for coordinating
their own care.
• It’s up to the patient/family to
tell us what happened to them.
Source: WA State Dept of Health, WA Healthcare Improvement
Network (WHIN)
Pt-Centered Medical
Home Care
• Our patients are those who are
registered in our medical home.
• Care is determined by a
proactive plan to meet health
needs, with or w/o visits.
• We measure our quality and
make rapid changes to improve
it.
• A prepared team of
professionals coordinates all
patients’ care.
• We track tests and
consultations, and follow up
after ED and hospital visits.
Specialists & the Medical Home
• Key: Clear communication about roles
– Referrals
– Co-Management
– Specialist may BE the medical home doctor
• Medical Home neighbor recognition
programs and Communication Resources
– Coordinating Care in the Medical Neighborhood: Critical Components and
Available Mechanisms. White Paper. Agency for Healthcare Research and Quality.
(2011)
– The Patient-Centered Medical Home and Specialty Physicians - American College
of Physicians (Internal Medicine) Checklists for referrals between PCPs and
specialists, service agreements examples, FAQs and more
Medical Home Benefits for
CYSHCN
• Significantly less delayed or forgone care*
• Significantly fewer unmet needs for health
care and family support services*
• Better health status**
• Family centeredness **
• Improved Family Functioning **
•
* 2005-06 National Survey of CSHCN- parent report
•
**Homer et al, 2008
How Do You Measure and Build
Medical Homes?
• Formal National Recognition Programs
– National Committee for Quality Assurance (NCQA)
http://recognition.ncqa.org/ to see who in WA has certification (1222)
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Joint Commission, other accrediting bodies
• Quality Improvement/Skills Building
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AAP: Building Your Medical Home Toolkit
National Center for Medical Home Initiatives
Center for Medical Home Improvement
WA State Dept of Health – WA Healthcare Improvement
Network
– Institute for Healthcare Improvement (IHI) Open School
Medical Home Transformation
• Work in progress - Looks different in
different clinics
• Clinics that made the greatest
changes in their systems were those
that paid attention to the change
process, esp regarding their culture
and patient-centeredness
(Solberg, L, Challenges of Medical
Home Transformation Reported by 118 Patient-Centered Medical Home Leaders, JABFM, July 2014)
• Paradigm shift and Funding shift
Medical Home Impact on Cost and Quality
• PCMH studies continue to demonstrate impressive
improvements across a broad range of categories
including:
– cost, utilization, population health, prevention, access to care,
and patient satisfaction,
– a gap still exists in reporting impact on clinician satisfaction.
• The PCMH continues to play a role in strengthening the larger
health care system, specifically Accountable Care Organizations
and the emerging medical neighborhood model.
• Significant payment reforms are incorporating the PCMH and its
key attributes.
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- See more at: http://www.pcpcc.org/resource/medical-homes-impact-cost-quality#sthash.80pHATzs.dpuf
The Medical Home’s Impact on Cost and Quality – An Annual Update of the Evidence, 2012-2013 (jan 2014)
Patient-Centered Primary Care Collaborative
Financing a Medical Home
• Traditional models: Select most appropriate CPT codes;
decrease down coding*.
• Medical Home Initiatives are expanding**- providers,
patients and payment incentives increased from 2009-13:
– 26 -> 114 Medical Home Initiatives
– Almost 5 million to almost 21 million patients
– Decrease from 77-> 20% those with planned end date
– Dominant Medical Home payment model is FFS
payments augmented by PMPM payments and pay for
performance bonuses. Increasing use of shared
savings models.
*HRSA Health Information Technology- How can a medical home be financed? Links to AAP coding info.
http://www.hrsa.gov/healthit/toolbox/Childrenstoolbox/BuildingMedicalHome/medicalhomefinanced.html
**Edwards, S et al. “Patient-Centered Medical Home Initiatives Expanded In 2009-12: Provides, Patients and Payment
Incentives Increase”. Health Affairs. Oct. 2014, 33:10., 1823-1831.
Care Coordination- Key to MH
• “A process that facilitates the linkage of
children and their families with
appropriate services and resources in a
coordinated effort to achieve good
health.”
•
American Academy of Pediatrics, Care Coordination in the Medical Home,
Pediatrics, 2005
Key Community Resources for
CSHCN – Medical Home
Neighbors You Want to Know
WithinReach
WA State Health Information Information
and Referral for Children and Families
• Family Health Hotline / Answers for
Special Kids (ASK) Line 1-800-322-2588
• www.ParentHelp123.org
• HelpMeGrow Developmental Screening
Early Intervention (0-36 months)
When to refer?
• When parents are concerned
for any reason
• Functional concerns—eating,
sensory, child care, etc.
• Possible delay of 25% in one
or more area
• If child/family would benefit
from services
What is Early Intervention?
• A comprehensive set of services and supports to
help enhance a child’s development and to help
parents understand how to help their
children grow and develop.
• Services are specifically tailored to meet a
child's and family’s individual needs.
• Services are available to all eligible children
ages birth to three with developmental delays
or disabilities and their families regardless of
income.
WHO gets Early Intervention?
Child is
Birth to Three Years and:
1. Has a 25% delay or 1.5
standard deviations in
one or more area.
2. Some diagnoses.
3. Evaluation team uses
“Informed Clinical
Opinion”
WHAT are the services?
• EVERYONE gets:
• Family Resources Coordinator
• Assessments—Both Initially and Ongoing
• MOST FREQUENT Services:
• Developmental Services
(Individual Education)
• Speech Therapy
• Motor Therapy (Occupational or
Physical Therapy)
• Feeding Therapy and/or
Nutrition Services
WHAT are the services?
• OTHER Services are also available:
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Audiology
Assistive technology devices & services
Family training, counseling, and home visits
Health services, Nursing services,
Medical services for evaluating
or diagnosing (most EI Providers
do NOT diagnose children)
• Psychological services
• Social work services
• Vision services
An Individual Family Service Plan (IFSP)
is developed by the WHOLE Team!
• Parents
• Family Resource Coordinator
• Service Provider(s)
WHERE does the early
intervention happen?
• At Home
• In Child Care Settings
• In Community Programs With
Typically Developing Peers
• 93% of WA families received early intervention
in “Natural Environments”
Early Intervention Services- “ to the maximum extent
appropriate are provided in natural environments,
including the home, and community settings in which
children with out disabilities participate”
-Individuals with Disabilities Education Improvement Act of 2004 Reauthorization (IDEA), Part C: Sec.
632
How to Access Early
Intervention Evaluation
• Statewide: Lead Family Resources
Coordinator for the County
• (WithinReach or ESIT directory at
www.medicalhome.org/resources/local_contacts.cfm)
• King County: Call CHAP Line
Toll Free: (800) 756-5437
OR Use Our NEW Map Tool
http://www.kingcounty.gov/healthservices/DDD/service
s/babiesAndToddlers/EarlyInterventionProviderReferra
lMap.aspx
Too complicated for King
County?
Early Intervention works!
• 33 % of toddlers exiting EI did not qualify
for special education at age 3!
• 98% of families surveyed reported early
intervention helped them
effectively communicate
their child’s needs.
Who pays for Early Intervention?
• State, federal and school district funds
• Provider fundraising
• Parent Cost Participation (some services)
– Medicaid
– Private Insurance—family may have coinsurance, co-pays, or deductibles
– If family does not have insurance or declines to
provide access to insurance they may be
placed on sliding scale for fees
• If family below 200% of FPL family will pay no fees
Why Early Intervention?
Children close the gap on delays.
Whole family gets support and
skills to help child.
Parents learn how to advocate for
their children in education settings.
Smoother transitions IF
child does qualify for school district
services at 3.
Who are we missing?
More children are in need of services than are
currently being served.
• In 2012, King County served 2.1% of the
general population of children aged birth to 3.
However, research indicates that as many as
13% of birth to 3 year olds have delays that
would make them eligible.
• There is a need to serve children earlier. In
2012, King County served only 0.62% of the
general population of infants aged birth to 1.
Videos about Early Intervention for Families
Available in English, Somali, Vietnamese & Spanish
• https://www.youtube.com/watch?feature=player_
detailpage&v=7WtnMy0I_xc
• Parent Support
• Preparing for your IFSP
• Sibling Support
(45 days before 3rd Birthday or Older )
• Refer to Child Find in writing for testing to
determine if child is eligible for services
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Google School District Name +Child Find
Or Statewide directory of school officials:
www.k12.wa.us/SpecialEd/pubdocs/SpecialEdDirectory.pdf
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To ensure a timely response, parents need to
track when they made the referral, and stay on top
of it.
How MDs can help
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School more likely to do a meaningful
evaluation if understand what concerns
are.
• Write detailed letter explaining concerns
– Dx, if there is one, and how it is
interfering with school attendance,
behavior, engagement, safety, academic
achievement, social/emotional issues,
transportation etc.
Special Education Eligibility
• Student must meet following:
• The student has been identified as having
a disability (ies).
• The disability (ies) adversely affects the
student’s educational performance.
• The student requires specially designed
instruction in order to access the general
education curriculum.
District May
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Screen or Evaluate
Develop Individualized Education
Plan (IEP) or 504 Plan
• Provide Services
• 3-5 Services
• Kindergarten and older
Questions? Problems?
• Office of the Education Ombuds (OEO)
http://www.governor.wa.gov/oeo/
• Independent statewide agency within the
Governor’s Office
• Resolves disputes and conflict between
parents and elementary and secondary
public schools in all areas that affect
student learning.
• 1-866-297-2597. Phone interpreter svs.
www.waparentslearn.org
Public Health CSHCN
Coordinators (0-18 yrs)
• http://www.kingcounty.gov/healthservices/
health/child/cshcn.aspx
Family Support
Questions?
• Kate Orville
[email protected]
206-685-1279
www.medicalhome.org
• Wendy Harris
[email protected]
206-263-9052