1. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 Objectives 1. Why the Medical Home concept was developed. 2. The Definition of the Medical Home 3. Proof of impact of the Medical Home Concept Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

2. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 Why a medical home concept? 1. Confusion 2. Lack of Care Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

3. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 Why a medical home concept? Confusion  Many, many doctors  Many, many appointments  So much information  All these conflict, little translates from one to the other  No overall movement to an overall goal Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

4. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 Why a medical home concept? Lack of Care  Each element of the system cares  It is very hard for a system to care  Without care, no overall movement to an overall goal Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

5. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 The Definition of a Medical Home  A standard of primary care  Key components of care Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

6. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 Primary Care- An Awkward Term for a Timeless Value. (A Doctor) Someone who knows you Someone who cares Someone who knows what to do Someone who will help you get what needs to be done, done A place where all this happens Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

7. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 Primary Care-  The primacy of relationship over procedure  How the rise of specialty medicine put procedure over relationship Organization- Appointments, Large Centers Cash Flow Prestige  Primary care under siege Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

8. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 Key Components of Care 1. Accessible 5. Coordinated 2. Continuous 6. Compassionate 3. Comprehensive 7. Culturally effective 4. Family-centered Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

9. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 Endorsed in 2007 by  American Academy of Pediatrics (1 st in 1967)  American Academy of Family Physicians  American College of Physicians  American Osteopathic Association Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

10. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 The Impact of a Medical Home- What Makes the Difference- Medication, Procedure, or Care? Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

11. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 The Impact of a Medical Home- The more care, the better health, the less cost Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

12. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 The Impact of a Medical Home- The more care, the better health, the less cost If everyone had a medical home, we would spend 5.6% less, $67 billion a year less Spann SJ, for the members of Task Force 6 and The Executive Editorial T: Report on Financing the New Model of Family Medicine. Ann Fam Med 2004; 2(suppl_3):S1 Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

13. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 The Impact of a Medical Home- The more care, the better health, the less cost If everyone had a medical home, they would be healthier- state v. state Shi L, Macinko J, Starfield B, Wulu J, Regan J, Politzer R: The Relationship Between Primary Care, Income Inequality, and Mortality in US States, 1980-1995. J Am Bd FamPract 2003; 412 Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

14. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 The Impact of a Medical Home- The more care, the better health, the less cost European nations with better primary care: Fewer hospitalizations, less use of specialists, less illness, fewer deaths Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

15. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 The Impact of a Medical Home- Medicaid in N Carolina $5/person in fee increase $200M in savings 2003 $250M in savings in 2004 Willson CF: Community care of North Carolina: saving state money and improving patient care. N C Med J 2005; 66(3):229-33 Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

16. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 The Impact of a Medical Home- A good MH decreased unmet needs 66-75% of children with complex needs had no MH Those with a good MH had more needs met. Benedict RE: Quality Medical Homes: Meeting children’s needs for therapeutic and supportive services. Pediatrics 2008; 121: e127-34. Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

17. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 The Impact of a Medical Home- Autism and the medical home Children with autism had half the chance of having an effective MH as children with asthma Brachlow AE et al: Comparison of indicators for a primary care medical home between children with autism or asthma and other special health care needs: National Survey of Children’s Health. Arch Pediatr Adolesc Med 2007; 161: 399-405. Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

18. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 The Impact of a Medical Home- Special needs and the medical home Half of complex kids had a MH, most have usual source of care, fewer have coordination Those with a MH had less delay, less foregone care, fewer unmet needs. Strickland B et al: Access to the Medical Home: Results of the National Survey of Children with Special Health Care Needs. Pediatrics 2004; 113(5 Supp): 1485-92. Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

19. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 The Impact of a Medical Home- PNP and Parent team in a practice Easier to get: letters of necessity, phone calls returned, appointments, specialist referrals, prescriptions, goals for care, understanding of situation, good relationship with doctor Palfrey J et al: The Pediatric Alliance for Coordinated Care: Evaluation of a medical home model. Pediatrics 2004; 113 (5 Suppl): 1507-16. Crison of indicators for a Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

20. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 Review of Objectives 1. Why the Medical Home concept was developed. 2. The Definition of the Medical Home 3. Proof of impact of the Medical Home Concept Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

21. BREAK SLIDE

22. The International Autism Summit The Medical Home- Implementation Dr. Arthur Lavin, October 11, 2008 Objectives 1. Review of Medical Home Concept 2. Specific Aspects of Implementing the Medical Home Idea or How to Evaluate How Close your Place of Care is a Medical Home 3. Specific Resources that Might be Helpful Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

23. The International Autism Summit The Medical Home- A Scientific Overview Dr. Arthur Lavin, October 11, 2008 The Medical Home 1. Accessible 5. Coordinated 2. Continuous 6. Compassionate 3. Comprehensive 7. Culturally effective 4. Family-centered Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

24. The International Autism Summit The Medical Home- Implementation Dr. Arthur Lavin, October 11, 2008 Aspects of Implementation The Relationship The Place Physical Needs Social Needs Mental/Cognitive Needs Resources Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

25. The International Autism Summit The Medical Home- Implementation Dr. Arthur Lavin, October 11, 2008 Relationship KEY: A person. Someone you know, who knows you, who you trust PERSPECTIVE: You v. Protocol RESPONSIVENESS ADVOCACY Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

26. The International Autism Summit The Medical Home- Implementation Dr. Arthur Lavin, October 11, 2008 Aspects of Implementation- The Place, The Staff Access- Geographic, ADA One stop Welcoming- your requests are a plus, not a burden Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

27. The International Autism Summit The Medical Home- Implementation Dr. Arthur Lavin, October 11, 2008 Aspects of Implementation- Physical Challenges Physical Therapy Respite Care Durable Medical Equipment Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

28. The International Autism Summit The Medical Home- Implementation Dr. Arthur Lavin, October 11, 2008 Aspects of Implementation- Language/Speech Challenges If social skills are the heart of autism, speech and language concerns are critical as well Speech therapy Unlocking the cognition within Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

29. The International Autism Summit The Medical Home- Implementation Dr. Arthur Lavin, October 11, 2008 Aspects of Implementation- Mental/Emotional Needs The Purpose of Feelings: Affect Primary Abnormalities of Function Reactions of a Frustrated Affect Behavior Programs and Supports Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

30. The International Autism Summit The Medical Home- Implementation Dr. Arthur Lavin, October 11, 2008 Aspects of Implementation- Social Challenges Social Cognition: The Heart of Autism Social Therapy: An Emerging Field ABA Floor Time Play: ableplay.org The Uncertain Path of Brain Developments Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

31. The International Autism Summit The Medical Home- Implementation Dr. Arthur Lavin, October 11, 2008 Aspects of Implementation- Record Keeping EMR helps manage information Organized binder with laid out forms for each category of information (medicalhomeinfo.org/tools/CarePlans/CHMCC %20notebook.doc) Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

32. The International Autism Summit The Medical Home- Implementation Dr. Arthur Lavin, October 11, 2008 Aspects of Implementation- Resources. Agencies American Academy of Pediatrics aap.org American Academy of Family Practice aafp.org Centers for Disease Control cdc.gov National Institutes of Health nih.gov Family Voices- a tremendous family run advocacy agency familyvoices.com Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

33. The International Autism Summit The Medical Home- Implementation Dr. Arthur Lavin, October 11, 2008 Aspects of Implementation- Resources. Autism Groups autismspeaks.org creates an autism community and works to make its future better. (merged with CAN in early 2007) autism-society.orggrassroots awareness, advocacy, information autism-resources.com Major list of websites about autism milestones.org Local grassroots autism group cdc.gov/ncbddd/autism The autism info page of the CDC Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

34. The International Autism Summit The Medical Home- Implementation Dr. Arthur Lavin, October 11, 2008 Aspects of Implementation- Resources. Money SSI- a disability insurance program- means tested ssa.gov/pubs/10026.html#ssi-benefits State disability health insurance, in Ohio, BCMH. Means-tested odh.ohio.gov/odhprograms/cmh/cwmh/bcmh1.aspx Boards of MR/DD www.oacbmrdd.org Help Me Grow- Finding problems, arranging services (Part C IDEA) ohiohelpmegrow.org/aboutus/AboutHelpMeGrow.aspx Medicaid- disability related health insurance jfs.ohio.gov/OHP Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

35. The International Autism Summit The Medical Home- Implementation Dr. Arthur Lavin, October 11, 2008 Aspects of Implementation- Resources. Newsletters autismspectrum.net/DesktopDefault.aspx Interactive autism website ianproject.org AAP Autism newsletter medicalhomeinfo.org/Publications/eNews/announce.html About.com’s newsletter autism.about.com/b/2008/04/17/keep-up-with-free-autism- autismaboutcom-newsletters-forums-and-e-courses- 3457.htm Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

36. The International Autism Summit The Medical Home- Implementation Dr. Arthur Lavin, October 11, 2008 Aspects of Implementation- Resources. Web Links medicalhomeinfo.org/index.htmlmedicalhomeinfo.org/index.html National Center for Medical Home Initiatives for Children with Special Health Care Needs (an American Academy of Pediatrics- US initiative) medicalhomeinfo.org/Publications/eNews/announce.htmlmedicalhomeinfo.org/Publications/eNews/announce.html An e- newsletter on medical home concerns for special needs medicalhomeinfo.org/states/state/ohio.htmlmedicalhomeinfo.org/states/state/ohio.html Great site to find out what Ohio agencies help Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com

37. The International Autism Summit The Medical Home- Implementation Dr. Arthur Lavin, October 11, 2008 Review of Objectives 1. Review of Medical Home Concept 2. Specific Aspects of Implementing the Medical Home Idea or How to Evaluate How Close your Place of Care is a Medical Home 3. Specific Resources that Might be Helpful Arthur Lavin MD Julie Hertzer MD Kelley Muldoon Rieger APRN, PNP 3733 Park East Drive | Suite 102 Beachwood, Ohio 44122-4334 phone: 216.591.1515 | fax: 216.591.1544 www.advancedped.com