The Medical Home in Pediatric Practice Forrest C. “Curt” Bennett, MD A. Chris Olson, MD, MHPA Carla Salldin Kate Orville, MPH Children’s Hospital & Regional Medical Center Grand Rounds May 13, 2004 Forrest C. “Curt” Bennett, MD A. Chris Olson, MD, MHPA Carla Salldin Kate Orville, MPH Children’s Hospital & Regional Medical Center Grand Rounds May 13, 2004

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:

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 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 State Medical Home Leadership Network Northwest Regions King & Pierce Southwest Central East Regional Resource Teams COWLITZ WAHKIAKUM PACIFIC GRAYS HARBOR GRAYS HARBOR JEFFERSON CLALLAM WHATCOM SKAGIT MASON LEWIS THURSTON SAN JUAN ISLAND SNOHOMISH KITSAP KING PIERCE KLICKITAT BENTON WALLA COLUMBIA GARFIELD ASOTIN WHITMAN FRANKLIN YAKIMA SKAMANIA CLARK OKANOGAN FERRY STEVENS PEND OREILLE PEND OREILLE SPOKANE LINCOLN ADAMS GRANT KITTITAS DOUGLAS CHELAN

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 1 Families, 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 A. Chris Olson, MD, MHPA Spokane, WA

The Medical Home in Pediatric Practice Olson Pediatrics Data Collection Care Coordination Family-Centered Care Marketing Pediatric Care

Olson Pediatrics Spokane Medical Community Two Pediatricians Three Mid-level providers Office Staff of 10 FTE’s Approx. 9,000 patients 1212 CYSHCN

Mid-Level Providers Nursing background Parents of CYSHCN Lower costs Timeline to train Liability

Associated Staff Physical Therapist In office services Communication issues Mental Health services

Data Collection Data person FACCT survey criteria Excel spreadsheet/Access Disease specific data collection Insurance plans

Diagnosis - CYSHCN

Severity

Insurance Coverage

Care Coordination Office coordinator Inservice presentations Care Plans Specialty follow up Chronic Care visits –Reminder system Care Coordination costs

Cost 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 care Family is the constant in the care of the patient Connecting families –Newsletter –Bulletin board Family advisory council Asking families/surveys

Medical Home Index Office/Family Organizational capacity Community outreach Chronic condition management Data management Care coordination Quality improvement

The 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 Carla Salldin Family Consultant Carla Salldin Family Consultant

Medical Home is our “ PEACE” of Mind P artnership E ducation A ction C are E xpertise

Building the Medical Home Puzzle One “Peace” at a time

Adam Born October 30, 1995 (10 weeks early) The beginning… The first day I held my son, November 17 th, 1995.

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…

Successful Medical Home Together as a Team, Family and Pediatrician, we have our PEACE of mind. Dr. Donna Smith and Virginia 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

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 Links to community resources Information and organizers for families Website resources –Medical Home –Quality Improvement

One Number to Call? ASK Line- Answers for Special Kids 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 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 … 3. Family to Family Support- Parent to Parent Fathers Network PAVE Diagnosis-specific support groups

Family and Child/Youth Self-Care Tools Family Care Notebook County Resource Lists & Starting Point Medical Home Toolkit Adolescent Health Transition Notebook

Website resources Center for Children with Special Needs– CHRMC National Center for Medical Home Initiatives (AAP) WA State Medical Home Leadership Network (up July, 2004) Adolescent Health Transition Project

Support for Quality Improvement Center for Medical Home Improvement -Medical Home Index National Initiative for Children’s Healthcare Quality (NICHQ) Improving Chronic Illness Care (RWJ)

Contact Information Forrest C. “Curt” Bennett, MD A. Chris Olson, MD Carla Salldin Kate Orville, MPH