Introduction to the Medical Home Part 1 What is the Medical Home Model?

1. Introduction to theMedical HomePart 1What is theMedical Home Model? Webinar Presentation ~ June 2010 ~

2. E-mail Questions to: admin@partnershipforchildhealth.org

3. Introduction to theMedical Home ~ 4 Part Webinar Presentation Series ~ P1 - What is the Medical Home Model? 2 - How does a Practice adopt the Medical Home Model? 3-What Tools Can We use to Assess the Medical Home Qualities of our Practice?4 - How Can Assessment Tools be Used to Quantify and Support a Practice’s Quality Improvement Process?

4. l Define – the medical home model l Describe – practical applications of the medical home philosophy and the benefits for children and families Objectives for Today…

5. A medical home is not a building, house or hospital, but rather an approach to providing comprehensive primary care. (American Academy of Pediatrics) What is a“Medical Home”?

6. The medical home concept differs little from the definition of primary care But– the day to day reality of primary care has come to differ broadly from its definition And– the elements required to improve outcomes for children with special needs stretch even the best intentions of traditional primary care Isn’t a Primary Care Practice already a Medical Home?

7. ... serves the 80% of children who do not have special health care needs ... effective at providing well child and preventive care and acute illness management ... supports a single service unit: the provider to patient encounter Realities of Today’s Primary Care

8. to… ... identify and monitor Children with Special Health Care Needs ... form active & lasting partnerships with families ... communicate with other community resources and pediatric specialty services ... increase efficiencies and coordinate care in a systematic manner Reframing Primary Care as the Medical Home

9. Medical Specialists Insurance providers/financial resources Community-Based Team School, Child Care and early intervention Child and Family Primary Care Physician and staff CMS / Ped-I-Care Nurse Care Coordinator Mental / Behavioral Health Recreational Programs Religious/Spiritual supports Social Services

10. A medical home is defined as primary care that is: l Accessible l Continuous l Comprehensive l Family-centered l Coordinated l Compassionate l Culturally effective (American Academy Of Pediatrics) A Medical Home is…

11. l Personally - Family/youth are able to speak directly to the physician - Practice meets ADA physical requirements. l Geographically - Care is provided in the family’s community. l Financially - All insurance, including Medicaid, is accepted. - Changes in insurance are accommodated. A Medical Home is…Accessible

12. l The same primary health care professionals are available from infancy through young adulthood. l Assistance with transitioning to adult care is available. l The physician participates as much as possible in care and discharge planning when the child is hospitalized. A Medical Home is…Continuous

13. Care is delivered or directed by a physician who is able to manage and facilitate essentially all aspects of preventive, primary, and tertiary care. lThe child’s and family’s medical, educational, developmental, psychosocial, & other service needs are identified and addressed. A Medical Home is…Comprehensive

14. The family is recognized as the principal caregiver, expert and center of strength and support for the child. Clear and complete information is discussed with the family to enable them to share responsibility in decision making. lFamily input is sought in practice policies. A Medical Home is…Family-centered

15. A plan of care is developed by the physician, nurse care coordinator, patient, and family and is shared with the providers involved with the care of the child. Care among multiple providers is coordinated through the medical home. lFamilies are linked to other family resources. A Medical Home is…Coordinated

16. lConcern for the well-being of the child and family is expressed and demonstrated in verbal and nonverbal interactions. lEfforts are made to understand and empathize with the feelings and perspectives of the family as well as the child. A Medical Home is…Compassionate

17. The child’s and family’s cultural background are recognized, valued, respected, and incorporated into the care plan. lWritten materials are provided in the family’s primary language. All efforts are made to ensure that the child and family understand the results of the medical encounter. A Medical Home is…Culturally Effective

18. Who areChildren with Special Health Care Needs?

19. Children with special health care needs (CSHCN) are: …those who have, or are at increased riskfor 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. (Maternal and Child Health Bureau)

20. l Physical diagnosis l Mental / Behavioral / Emotional l Social - Family environment - Socioeconomic environment - Foster care (Every Child Deserves a Medical Home) Special Needs “Categories”

21. The number of CSHCN has grown by 30% over the past 2 decades … … due to medical advancements and better access to specialized care resulting in: - improved diagnosis and early identification - increased chances for survival for children born prematurely or with birth defects - increased life expectancies for children with chronic illnesses

22. Facts…. Children with Special Health Care Needs*… … are 13 - 18% of the children in United States … account for 80% of pediatric health care expenditures … are in 1 out of 5 homes in the Unites States * Note: This does not include children and youth at risk for a chronic condition. MCHB/NCHS. National Survey of Children with Special Health Care Needs. 2002

23. More Facts…. Children with Special Health Care Needs… … have more than twice as many school absences than the typical child … have 2 times the number of unmet health needs … spend almost 6 times the number of days in the hospital each year than the typical child From Newacheck et al. Pediatrics, 102, July 1998

24. Reality for Families l39.5% indicate their child’s or youth’s condition impacts family’s financial situation l13.5% say they spend more than 11 hours/wk coordinating care for their child or youth l24.9% indicate families cut back on work due to child’s or youth’s condition l28.5% indicate families stop working due to child’s or youth’s condition MCHB/NCHS. National Survey of Children with Special Health Care Needs. 2002

25. “Building” aMedical Home requires… lVision and leadership by physician • Collaboration in all learning and improvement efforts lCommitment from: • - lead physician • - all office staff • - care coordinator

26. Let’s Get Started! Step # 1. Educate and engage all physicians and practice staff Step # 2.Identify the children with special health care needs in the practice Step # 3.Unite the medical home team and assess the current medical home qualities of the practice Step # 4. Implement a quality improvement process

27. Step #1.Educate and engage all physicians and practice staff lMedical Home Introductory Presentation 4 Part online webinar series

28. Step #2.Identify the children with special health care needs in the practice lCMS Nurse Care Coordinator can provide caseload list and care plans l Other CSHCN can be identified by implementing a system of regular screening of patient population. - Define chronic conditions within the practice - Utilize proven screening tools • - Review utilization reports to determine those • children seeing specialists on a regular basis - Consider potential social risks

29. Step # 3.Unite the medical home team and assess the current medical home qualities of the practice l Identify lead physician (if group practice) l Engage staff person for role of medical home facilitator l Identify and involve a “Parent Partner” l Establish protocol for communication to work closely with CMS nurse care coordinator

30. Assess the current medical home qualities of the practice • Refer to Building Block #5 of the Building Your Medical Home Toolkit “Practice Performance Measurement”

31. - Use the Medical Home Index to determine baseline of medical home qualities of the practice. - Collect family feedback by administering Medical Home Family Index tool to a group of parents to collect family perspective and offer ideas for change.

32. Medical Home Index - 25 areas to assess how well the practice functions as a Medical Home - Divided into 6 Domains 1. Organizational Capacity 4. Community Outreach 2. Chronic Condition Management 5. Data Management 3. Care Coordination 6. Quality Improvement/Change - Completed by each physician and staff person - Uses a scale showing levels of services as BasicaResponsiveaProactiveaComprehensivewhich is subdivided to be scored from 1 to 8 points to - quantify a baseline - identify strengths - select area for further development - measure progress

33. Medical Home Index

34. Medical Home Family Index - 25 questions to capture the family feedback Families rate specific areas of care provided by the PCP and staff using NeveraSometimes aOften aAlwayswhich can be scored from 1 to 4 points to - quantify a baseline - identify strengths - select area for further development - measure progress

35. Medical Home Family Index

36. Step #4.Implement a Quality Improvement (QI) process lInvolve all office staff lRefer to “Building Your Medical Home” Toolkit - Quality Improvement Basics section for how to design and implement a QI process lReview results of practice assessments to identify quality improvement needs lRefer to NCQA PPC-PCMH Standards and Guidelines for specific requirements of NCQA Recognition

37. Step #4.Continued…. lEstablish processes and protocols. - Define responsibilities of each staff member - Meet monthly for “learning sessions” - Refer to time between monthly learning sessions as “action periods” - Maintain good communication between staff persons l Make a clear plan for next steps – incrementally toward greater system changes • Choose and plan your first project!

38. Obstacles to Providing a Medical Home - At the Practice Level • Limited understanding of the medical home concept • Lack of population or systems approaches to caring for CSHCNs • Care coordination is diffused; usually expected of parent • Lack of co-located CMS care coordinator and/or shared comprehensive care plan • Staff turnover

39. Obstacles to Providing a Medical Home - At the Health System Level • Chronic disease is increasing but primary care is not structured to address these conditions • Inadequate communication channels between providers • Inadequate reimbursement • Unstable health insurance (lapses are common) • medical professionals (primary & specialty care) • schools • other health systems (mental health, etc.) • children’s services (foster care, etc.)

40. Challenges to Implementing Quality Improvement • No existing processes for practice change or improvement • Lack of leadership – physician must take the lead; appoint energetic key staff person (“facilitator”) to organize and engage others • Difficulty engaging parent partner • Lack of buy-in by all staff

41. What does a medical home look like?

42. A Medical Home… declares itself to be a medical home, and… • knows its patients and patient populations • partners with and learns from youth and families • uses a proactive team approach to chronic condition care - planned visits - coordination of complex services - co-management with specialists & assistance with transition to adult services • connects with other community-based organizations • offers quality, efficient care while preventing unnecessary or duplicative services, thus reducing health care costs

43. Benefits of a Medical Home… • Improved problem identification, diagnosis and early intervention • Increased patient & family satisfaction • Improved compliance (partnership) • Establishment of a forum for problem solving • Increased family support • Efficient use of limited resources

44. More benefits … • Streamlined office procedures • Greater sense of satisfaction by office staff who have the tools to respond to challenges • Improved wellness and quality of life for children with chronic conditions • Decreased use of emergency departments (2004 - 2007 UCLA Pediatric Medical Home Research Project)

45. Steps... revisited Step # 1. Educate and engage all physicians and practice staff Step # 2.Identify the children with special health care needs in the practice Step # 3.Unite the medical home team and assess the current medical home qualities of the practice Step # 4. Implement a quality improvement process

46. One Step at a Time…. Next Step… View Introduction to the Medical Home Webinar # 2 – “How does a Practice adopt the Medical Home Model?”

47. Q & A Please send us your questions and comments! admin@partnershipforchildhealth.org And return to the project website: http://www.partnershipforchildhealth.org/mhip_tools_and_resources.htm and click on the to take a brief survey