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 [email protected]
• A. Chris Olson, MD 509-489-5110 [email protected]
• Carla Salldin [email protected]
• Kate Orville, MPH206-685-1279 [email protected]
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