the medical home in pediatric practice forrest c. “curt” bennett, md a. chris olson, md, mhpa...

The Medical Home in The Medical Home in Pediatric PracticePediatric Practice

The Medical Home in The Medical Home in Pediatric PracticePediatric Practice

Forrest C. “Curt” Bennett, MDForrest C. “Curt” Bennett, MD

A. Chris Olson, MD, MHPAA. Chris Olson, MD, MHPA

Carla SalldinCarla Salldin

Kate Orville, MPHKate Orville, MPH

Children’s Hospital & Regional Medical CenterChildren’s Hospital & Regional Medical Center

Grand Rounds May 13, 2004Grand Rounds May 13, 2004

Forrest C. “Curt” Bennett, MDForrest C. “Curt” Bennett, MD

A. Chris Olson, MD, MHPAA. Chris Olson, MD, MHPA

Carla SalldinCarla Salldin

Kate Orville, MPHKate Orville, MPH

Children’s Hospital & Regional Medical CenterChildren’s Hospital & Regional Medical Center

Grand Rounds May 13, 2004Grand Rounds May 13, 2004

What is a Medical Home?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 non- medical 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

• 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 StateMedical Home Leadership Network

Northwest

Regions

King & Pierce

Southwest

Central

East

Regional Resource Teams

COWLITZCOWLITZWAHKIAKUMWAHKIAKUM

PACIFICPACIFIC

GRAYSHARBORGRAYSHARBOR

JEFFERSONJEFFERSON

CLALLAMCLALLAM

WHATCOMWHATCOM

SKAGITSKAGIT

MASONMASON

LEWISLEWIS

THURSTONTHURSTON

SAN JUANSAN JUAN

ISLAND

SNOHOMISHSNOHOMISH

KITSAPKITSAP

KINGKING

PIERCEPIERCE

KLICKITATKLICKITAT

BENTONBENTONWALLAWALLAWALLAWALLA

COLUMBIACOLUMBIA

GARFIELDGARFIELD

ASOTINASOTIN

WHITMANWHITMAN

FRANKLINFRANKLIN

YAKIMAYAKIMA

SKAMANIASKAMANIA

CLARKCLARK

OKANOGANOKANOGANFERRYFERRY

STEVENSSTEVENS

PENDOREILLEPEND

OREILLE

SPOKANESPOKANE

LINCOLNLINCOLN

ADAMSADAMSGRANTGRANTKITTITASKITTITAS

DOUGLASDOUGLAS

CHELANCHELAN

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

• 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 1Families, 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

The Medical Home in Pediatric Practice

A. Chris Olson, MD, MHPA

Spokane, WA

The Medical Home in Pediatric PracticeThe Medical Home in Pediatric Practice

• Olson Pediatrics• Data Collection• Care Coordination• Family-Centered

Care• Marketing Pediatric

Care

Olson PediatricsOlson Pediatrics• Spokane Medical Community

• Two Pediatricians

• Three Mid-level providers

• Office Staff of 10 FTE’s

• Approx. 9,000 patients

• 1212 CYSHCN

Mid-Level ProvidersMid-Level Providers• Nursing background

• Parents of CYSHCN• Lower costs• Timeline to train• Liability

Associated StaffAssociated Staff• Physical Therapist• In office services• Communication

issues• Mental Health

services

Data CollectionData Collection• Data person• FACCT survey

criteria• Excel

spreadsheet/Access• Disease specific data

collection• Insurance plans

Diagnosis - CYSHCNDiagnosis - CYSHCN

24%

40%

4%

3%

1%

2%

3%

2%

4%

1%

1%

3%

1%

11%

ADHD

Asthma

Asthma +

Autism

CF

Cleft Lip

CP

Depression

Devel. Delay

Diabetes

Downs

Seizures

Myleodysplasia

Other

SeveritySeverity

73%

15%

4%

8%

Severity 1

Severity 2

Severity 3

Severity 4

Insurance CoverageInsurance Coverage

24%

41%

26%

9%

DSHS

Molina

PVT

PVT + Medicaid

Care CoordinationCare Coordination• Office coordinator• Inservice

presentations• Care Plans• Specialty follow up• Chronic Care visits

– Reminder system

• Care Coordination costs

Cost of Care CoordinationCost of Care Coordination• 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 careFamily 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 IndexMedical Home Index• Office/Family• Organizational

capacity• Community outreach• Chronic condition

management• Data management• Care coordination• Quality improvement

The Marketing of Pediatric CareThe 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

Medical Home Partnership:Family and Provider in PEACE

Carla Salldin

Family Consultant

Carla Salldin

Family Consultant

Medical Home isour “PEACE” of Mind

Medical Home isour “PEACE” of Mind

Partnership

Education

Action

Care Expertise

Building the Medical Home PuzzleBuilding the Medical Home Puzzle

One “Peace” at a time

Adam Born October 30, 1995 (10 weeks early)

Adam Born October 30, 1995 (10 weeks early)

The beginning…

The first day I held my son, November 17th, 1995.

PEACE Partnership Story

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.

•Core Partnership

•Adam

•Parents

•Pediatrician

•Other partners

•Medical Specialist

•Interventionist/Therapists

•School

•Community programs

•Friends and Family

•Other Families

Adam’s Medical home…Adam’s Medical home…

Successful Medical HomeSuccessful Medical Home

Together as a Team, Family and Pediatrician, we have our PEACE of mind.

Dr. Donna Smith andVirginia Mason

Sandpoint Pediatrics

Carla, Adam and Dan Salldin

Adam 8-1/2 years old

Success of Adam by Nature of his Medical Home

•Health

•Self esteem

•Social well being

•Academics

•Physical activities

•Future….

•

•

•

Adolescence, adult, and College?

“Miracles don’t happen in a day, they happen over time.”

P. Tarczy-Hornoch 1996

“Miracles don’t happen in a day, they happen over time.”

P. Tarczy-Hornoch 1996

Building a Successful Medical Home

is like…..

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

Medical Home Tools and Support for Washington State

Health Care Providers and Families

Kate Orville, MPH

Co-Director, MHLN

Kate Orville, MPH

Co-Director, MHLN

Tools to Support Coordinated, Family-Centered Care 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?One Number to Call?

• ASK Line- Answers for Special Kids1-800-322-2588

• 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 Resources3 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…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 Family and Child/Youth Self-Care Tools

• Family Care Notebook

• County Resource Lists & Starting Point

• Medical Home Toolkit

• Adolescent Health Transition Notebook

Website resourcesWebsite 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 Projectwww.depts.washington.edu/healthtr/

Support for Quality ImprovementSupport 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 InformationContact Information

• Forrest C. “Curt” Bennett, MD 206-685-1356 fbennett@u.washington.edu

• A. Chris Olson, MD 509-489-5110 olsonac@shmc.org

• Carla Salldin 206-987-2063carla.salldin@seattlechildrens.org

• Kate Orville, MPH206-685-1279 orville@u.washington.edu