introduction to the medical home part 1 what is the medical home model?

Affiliated with Children’s Medical Services

Introduction to theMedical Home

Part 1

What is theMedical Home

Model?

Introduction to theMedical Home

Part 1

What is theMedical Home

Model?

Webinar Presentation

~ June 2010 ~

Affiliated with Children’s Medical Services

E-mail Questions to:

admin@partnershipforchildhealth.org

P 1 - 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?

Introduction to theMedical Home

~ 4 Part Webinar Presentation Series ~

Objectives for Today…

l Define – the medical home model

l Describe – practical applications of the medical home philosophy and the benefits for children and families

What is a“Medical Home”?

A medical home is not a building, house or hospital, but rather an approach to providing comprehensive primary care.

(American Academy of Pediatrics)

Isn’t a Primary Care Practice already a Medical

Home?

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

Realities of Today’s Primary Care

... 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

Reframing Primary Care as the Medical Home

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

Child and Family

Insurance providers/financial

resources

Primary Care Physician and staff

School, Child Care and early

intervention

Mental / BehavioralHealth

Religious/Spiritual supports

CMS / Ped-I-CareNurse Care Coordinator

Medical Specialists

Recreational Programs

Social Services

Community-Based Team

A Medical Home is…

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…Accessible

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…Continuous

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…Comprehensive

Care is delivered or directed by a physician who is able to manage and facilitate essentially all aspects of preventive, primary, and tertiary care.

l The child’s and family’s medical, educational, developmental, psychosocial, & other service needs are identified and addressed.

A Medical Home is…Family-centered

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.

l Family input is sought in practice policies.

A Medical Home is…Coordinated

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.

l Families are linked to other family resources.

A Medical Home is…Compassionate

l Concern for the well-being of the child and family is expressed and demonstrated in verbal and nonverbal interactions.

l Efforts are made to understand and empathize with the feelings and perspectives of the family as well as the child.

A Medical Home is…Culturally Effective

The child’s and family’s cultural background are recognized, valued, respected, and incorporated into the care plan.

l Written 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.

Who areChildren with Special Health Care Needs?

Children with special health

care needs (CSHCN) are: …those 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.

(Maternal and Child Health Bureau)

Special Needs “Categories”

l Physical diagnosis l Mental / Behavioral / Emotionall Social

- Family environment - Socioeconomic environment - Foster care

(Every Child Deserves a Medical Home)

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

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

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

Reality for Families

l 39.5% indicate their child’s or youth’s condition impacts family’s financial situation

l 13.5% say they spend more than 11 hours/wk coordinating care for their child or youth

l 24.9% indicate families cut back on work due to child’s or youth’s condition

l 28.5% indicate families stop working due to child’s or youth’s condition

MCHB/NCHS. National Survey of Children with Special Health Care Needs. 2002

“Building” aMedical Home

requires…

l Vision and leadership by physician

Collaboration in all learning and improvement efforts

l Commitment from:

- lead physician

- all office staff

- care coordinator

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

Step #1. Educate and engage all physicians and practice staff

l Medical Home Introductory Presentation 4 Part online webinar series

Step #2. Identify the children with special health care needs in the practice

l CMS 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

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

Step # 3. Unite the medical home team and assess the current medical home qualities of the practice

Assess the current medical home qualities of the practice

Refer to Building Block #5 of the Building Your Medical Home Toolkit

“Practice Performance Measurement”

- 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.

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 Basic a Responsive a Proactive a Comprehensive

which is subdivided to be scored from 1 to 8 points to - quantify a baseline

- identify strengths- select area for further development- measure progress

Medical Home Index

Medical Home Family Index

- 25 questions to capture the family feedback

Families rate specific areas of care provided by the PCP and staff using

Never a Sometimes a Often a Always which can be scored from 1 to 4 points to

- quantify a baseline- identify strengths- select area for further development- measure progress

Medical Home Family Index

Step #4. Implement a Quality Improvement ( QI ) process

l Involve all office staff

l Refer to “Building Your Medical Home” Toolkit - Quality Improvement Basics section for how to design and implement a QI process

l Review results of practice assessments to identify quality improvement needs

l Refer to NCQA PPC-PCMH Standards and Guidelines for specific requirements of NCQA Recognition

Step #4. Continued….

l Establish 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!

Obstacles to Providing a Medical Home

Limited understanding of the medical home conceptLack of population or systems approaches to caring for

CSHCNsCare coordination is diffused; usually expected of parentLack of co-located CMS care coordinator and/or shared

comprehensive care planStaff turnover

- At the Practice Level

Obstacles to Providing a Medical Home

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)

- At the Health System Level

medical professionals (primary & specialty care) schools other health systems (mental health, etc.) children’s services (foster care, etc.)

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 partnerLack of buy-in by all staff

What does a medical home look like?

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

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

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)

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

One Step at a Time….

Next Step… View

Introduction to the Medical HomeWebinar # 2 –

“How does a Practice adopt the Medical Home Model?”

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

Q & A