AAP Medical Home Chapter Champions Program on Asthma [insert name] [insert title] AAP [insert state] Chapter Champion

AAP Comprehensive Asthma Program Funded by the Merck Childhood Asthma Network (MCAN) through March 2012 Components: ▫ Chapter Quality Network (CQN) Asthma Project — a quality improvement project implemented through AAP chapters and supported by the national AAP office ▫ Medical Home Chapter Champions Program on Asthma (MHCCPA)

AAP Accelerating Improved Care for Children with Asthma Program Funded by The JPB Foundation Components: ▫ Chapter Quality Network (CQN) Asthma Project — a quality improvement project implemented through AAP chapters and supported by the national AAP office ▫ Medical Home Chapter Champions Program on Asthma (MHCCPA)

Program Overview: Overarching Goal To facilitate dissemination of best practices and advocacy related to asthma care within a medical home

Program Overview: Program Goals Increase access to a medical home for all children and youth, with a specific focus on reducing health disparities Facilitate pediatric practices’ adoption and implementation of NHLBI asthma guidelines within the context of a medical home Increase advocacy efforts for implementation of asthma care within medical homes at chapter/state level(s)

Imagine Staff recognizing a parent when appointment is made Adequate time scheduled for that child Prior asthma care plan in chart Specialist’s record in your hands prior to the visit with lab, allergy testing, spirometry, X-ray results Parent concerns identified before the visit; multiple tasks completed at the visit Lab slips ready and EMLA cream on child prior to visit Help by your staff for families with referrals, resources, equipment, forms Follow-up to assure completion of tasks

What is a Medical Home? “The Medical Home is the model for 21 st century primary care, with the goal of addressing and integrating high quality health promotion, acute care and chronic condition management in a planned, coordinated and family-centered manner.” - American Academy of Pediatrics

Joint Principles of Medical Home AAP, AAFP, ACP, AOA, 2007 Personal physician Physician-directed practice Whole-person orientation Coordinated care Quality and safety Enhanced access Appropriate payment

Essential Components of a Medical Home: The 6 R’s 1.Ready Access 2.Relationships/Respect 3.Registry and Records 4.Resources 5.Reimbursement 6.Recruitment

NIH Asthma Guidelines NHLBI NAEPP, 2007 Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma

Principle 1: Personal Physician Provide continuity of care in a partnership Schedule routine follow-up care Monitor use of beta2-agonist medications

Relationships/Respect Enhanced appointment and medication compliance Patient and Family Help with asthma teaching, spirometry, flu shots MH Staff Support for difficult cases, education Specialists Asthma care for when parents not present Schools Payment Surveillance for med overuse, noncompliance Insurers Medicaid managers, social workers, summer camps, smoking cessation Community Providers

Principle 2: Physician-Directed Medical Practice Coordinate services for children with asthma that are: ▫ Family-centered ▫ High quality ▫ Accessible ▫ Affordable

Principle 3: Holistic Orientation Control of environmental triggers ▫ Allergens ▫ Irritants, especially tobacco smoke Treat and prevent co-morbid conditions Promote physical fitness and nutrition for children with asthma Help address socioeconomic barriers to well- being

Principle 4: Coordinated Care Integrate care across the community Use information technology ▫ Asthma registry ▫ Electronic health record  Performance and outcomes measures  Accountability Refer to specialist, if needed Transition teens to adult care

Care Coordination: Key Components Visit planning, referral services, follow-up Assists with equipment needs (eg, local suppliers for environmental controls, spacers, nebulizers, oximeters) Collaborates with other providers (eg, specialists, school nurse, etc) Maintains a centralized database (paper or electronic) of local resources Connects families to support networks ▫ Family-to-family health information centers (F2F HICs) ▫ Community asthma education ▫ Smoking cessation programs (patient, family)

Care Coordination: Collaboration/Co-management with Specialists Bridges to service ▫ Between primary care and specialist ▫ Between multiple specialists and medical home Ensure referral data sent and visit accomplished Access to specialist records (letter, fax, electronic) Regular phone/ dialogue regarding patient care Specialty follow-up (hospital/ED follow-up, labs, etc)

Registry and Records: Knowing Who Needs Care Registry can be paper or electronic Notebooks  Excel  Access  EMR Alerts schedulers to need for more time for visit Assures key data to specialist for consult Tracks referrals and specialist reports Prompts pre-visit contacts Data management for flu shots, ACP on chart Data recall for self-assessment of care quality

Electronic Records Make Asthma Care Easier Chart is never “lost” Permits “tracking” of asthma visits, both acute and planned Medication doses, strengths, refill dates are recorded Specialty consults are easily accessed Asthma plan, allergies are on chart Asthma education printouts available

Principle 5: Quality and Safety Patient-centered, evidence-based care Establish the asthma diagnosis Provide asthma education for patient self- management Prescribe and adjust medications ▫ Inhaled corticosteroids are preferred for persistent symptoms ▫ Stepwise treatment based on age Develop a written asthma management plan

AAP Quality and Safety Resources Chapter Alliance for Quality Improvement (CAQI) Education in Quality Improvement for Pediatric Practice (EQIPP)  Medical Home for Pediatric Primary Care  Asthma — Diagnosing and Managing in Pediatrics  CME offered, MOC Part 4 available Medical Home Chapter Champions Program on Asthma

Principle 6: Enhanced Access Pediatrician availability to assess, classify, and monitor asthma severity and control Reduce disparities in processes and outcomes in asthma care ▫ Socioeconomic ▫ Racial/ethnic ▫ Geographical

Ready Access Accept Medicaid, many insurers Evening, weekend, and holiday office hours for asthma flares 24-hour advice nurses (to the ED or not?) Translation phone Privacy protection for teens (cigarettes, THC) ADA accessible physical plant and parking area Policy on transition to adult care (age, process, list of adult providers)

Principle 7: Appropriate Payment Added value provided to patients with asthma who receive care in a medical home Adequate fees Bundled payments Accountable care organizations

Reimbursement for Asthma Management Bill for what you do Chronic care management visits (schedule in advance) Spirometry (if available and trained) Education time (eg, MDI, asthma education, oximetry, nebulizations) After-hours visits Know the codes Refer to AAP Financing and Payment Resources Stay current on proper coding for care of CSHCN Payer contract negotiations Know what they pay for and address the things they don’t Know what your rates are for each payer on the activities you do the most Have the data that shows your effectiveness (eg, low ED or hospitalization rates)

Recruitment—Yes, YOU! One family in five has a CSHCN Asthma is one of most common chronic condition in pediatrics Parents, insurers, government are demanding quality improvement in care systems Planned, supported care is more fun to deliver! Where do you want to start?

MHCCPA Project Advisory Committee Members Chuck Norlin, MD, FAAP, Chairperson Julie Katkin, MD, FAAP Jennifer Lail, MD, FAAP John Meurer, MD, MBA, FAAP Matthew Sadof, MD, FAAP Jim Stout, MD, FAAP Parent Representative Karen VanLandeghem, MPH Liaisons Rhonda Hertwig, CPNP Marie Mann, MD, FAAP

Chapter Champion Regional “Networks” Districts I & II: Dr Sadof (CT, MA, ME, NH, NY1, NY2, NY3, RI, USE, VT) Districts III & IV Dr Lail (DE, DC, KY, MD, NC, NJ, PA, SC, TN, VA, WV) Districts V & VI Dr Meurer (IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, WI) Districts VII & X Dr Katkin (AL, AR, FL, GA, LA, MS, OK, PR, TX) District VIII Dr Stout (AK, AZ, CO, HI, ID, MT, NM, NV, OR, USW, UT, WA, WY) District IX Dr Norlin (CA 1, CA 2, CA3, CA 4)

MHCCPA Web Page

Thank You! Questions? Program Contact: Chelsea Rajagopalan Program Manager AAP Division of Children with Special Needs 800/ , ext 4311