Making Health Care Work For You: Medical Home 101

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Making Health Care Work For You Medical Home 101

• American Academy of Pediatrics

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Learning Objectives

• By the end of this session, participants will be
  able to
• Define the medical home concept.
• Define the common elements and assess whether
  they have been incorporated into your childs
  care.
• Understand the personal importance of having a
  medical home.

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Whats a Medical Home?
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Approach to Health Care

• Comprehensive
• High Quality
• Cost Effective

• A partnership between the physician and the family

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Medical Home Common Elements
Accessible Family-centered Comprehensive Continuou
s Coordinated Compassionate Culturally effective
Care that is
and for which the PCP
Shares Responsibility
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Accessible

• Personally
• Speak to physician
• ADA requirements

• Geographically
• Community-based
• Public transportation available

• Financially
• Accept all insurance
• Changes in insurance accommodated

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Family-centered

• Known to the child or youth and family.
• Mutual responsibility and trust
• The family is recognized as the expert in their
  childs care
• Complete information and options are shared with
  the family
• Families and youth are supported in care
  coordination
• Shared responsibility in decision making

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Continuous

• Same PCP available from infancy through
  adolescence
• Assistance with transitions
• Participates in discharge planning from hospital

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Comprehensive

• Care available 24 hours a day, 7 days a week 52
  weeks a year.
• Preventive, primary, and tertiary care needs are
  addressed
• All medical, educational, developmental,
  psychosocial, and other service needs are
  identified and addressed
• Information is made available about private
  insurance and public resources
• Extra time for an office visit is scheduled for
  children with special health care needs

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Coordinated

• Care plan shared with other providers, agencies,
  and organizations involved with the care of the
  patient
• Care among multiple providers is coordinated
  through the medical home
• A central record or database containing all
  pertinent medical information, including
  hospitalizations and specialty care, is
  maintained
• Shared information among the child or youth,
  family, and consultant and specific reasons for
  referrals

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Coordinated

• Links to family support groups, parent-to-parent
  groups, and other family resources
• Assistance to the child, youth, and family in
  communicating clinical issues
• Evaluation and interpretation of consultants
  recommendations for the child or youth and family
• Care plan is coordinated with educational and
  other community organizations

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Compassionate

• Concern for well-being of child and family is
  expressed
• Efforts are made to understand and empathize with
  the feelings and perspectives of the family as
  well as the child or youth

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Culturally Effective

• The childs or youths and familys cultural
  background are recognized, valued, respected, and
  incorporated into the care plan
• Provision of (para)professional translators or
  interpreters, as needed.
• Written materials are provided in the familys
  primary language.

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Child/Family includes family support resources
Pediatrician, Nurses and other medical providers
School includes early intervention
Community-Based Team
Insurance providers/financial resources
Social Services includes mental health
Religious /spiritual supports
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Does your child have a Medical Home?
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Physicians and Parents Ranking of Services

• Physicians
• Respite
• Day care
• Parent support groups
• Help with behavior problems
• Financial info
• After-school care
• Home modifications
• Vocational counseling
• Psychological services
• Homemaker services

• Parents
• Info on community resources
• Financial info
• Parent support groups
• Recreational opportunities
• Psychological services
• Vocational counseling
• Summer camps
• Dental Treatment
• Respite
• Help with behavior problems

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Benefits of a Medical Home

• Increased patient and family satisfaction
• Improved coordination of care
• Ease of care for children and families
• Efficient use of limited resources
• Increased professional satisfaction
• Increased wellness resulting from comprehensive
  care

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Barriers to Medical Homes

• Time
• Staff
• Resources
• REIMBURSEMENT

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Where Does the Money Go?

• Annual cost of medical care for 410 children with
  chronic illness or disability
• Hospitalization
  61.0
• Specialists 14.0
• Other
  15.0
• Primary care
  5.0
• Durable medical equipment 5.0
• Other includes cost such as therapies,
  pharmaceuticals, outpatient lab work, emergency
  department care, and, disposable goods.
• Excerpt from Health Partners/Institute for Health
  and Disability 2/97.

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Children with Special Health Care Needs

• Intensity of services compared with those used by
  well children
• 202 More specimens handled
• 121 More x-rays
• 11 More sick child visits
• Data collected at Phoenix Pediatrics, Phoenix,
  AZ. Figures represent a comparative analysis of
  procedures and visits for Children with Special
  Health Care Needs compared with typical
  children in the Phoenix Pediatrics office during
  a 1-year period.

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What is the AAP doing?

• Medical Home Policy Statement
• Education Training
• Partnerships with other organizations

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Every Child Deserves a Medical Home Training
Program
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Training Program Goal

• to educate pediatricians, families, and allied
  health care professionals about the medical home
  and how they can work collaboratively to care for
  CSHCN

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Intended Audience

• Pediatricians
• Family Representatives
• Nurses
• Pediatric Subspecialists
• Insurance Administrators
• Government Officials
• Allied Healthcare Professionals

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Recommended Co-Facilitators

• Pediatrician

Nurse or Allied Healthcare Professional
Family Representative
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Training Program Format

• Transitioning Children and Youth to Adulthood
• Screening
• Advocacy

• Common Elements
• Family-Professional Partnerships
• Practices, Policies, and Procedures
• Comprehensive, Coordinated, Collaborative Care
  for CSHCN

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Practices, Policies, and Procedures

• Examine office practices and layout
• Identify strategies to enhance office
• Discuss financing and data management
• Identify practical methods of working with CSHCN
  in practice

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How could your childs physician improve his/her
practice?
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Practice Improvements for CSHCN

• Scheduling
• Telephone and triage management
• Billing and financial assistance
• Support for continuity of care
• Quality

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Practice Procedures Scheduling

• Longer appointment time
• Coordination of appointments and tests
• Review appropriate charts prior to the
  appointment.
• Flagging chart of CSHCN

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Practice Procedures Telephone and Triage
Management

• Courtesy
• Confidentiality
• Hours of operation
• After-hours access
• Telephone consultations or face-to-face meetings
• Telephone triage
• Language barriers

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Practice Procedures Billing and Financial
Assistance

• Options for payment
• Assistance with and knowledge of health plan,
  alternative funding, or both
• Advocating on behalf of family with managed care
  organizations and other health plans

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Practice Procedures Resource Support

• Tools to assist families in managing health care
  information
• Family resources in lobby (eg, Exceptional Parent
  magazine)
• Bilingual information on community resources
• Family- oriented reference material available in
  office
• Include updates about Children with Special
  Health Care Needs at staff meetings
• Inform on-call physicians of imminent or
  anticipated problems

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Measuring Qualityin a Practice
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How do you measure quality?

• Written or telephone patient and family
  satisfaction surveys
• Evaluation forms about specific policies/programs
  for families to complete during office visit
• Suggestion box in office waiting room

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How do you measure quality? (Continued)

• Informal/formal discussions, interviews, or focus
  groups
• Family participation on practice advisory board
• Employee self-assessment and evaluations
• Office improvement audit

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Division of Children with Special Needs (DOCSN)

• National Center of Medical Home Initiatives for
  Children with Special Needs
• Medical Home Screening and Surveillance
• Every Child Deserves a Medical Home Training
  Program

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The National Center of Medical Home Initiatives
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How can the National Center help?

• Technical Assistance
• Fact sheets
• Interdisciplinary training programs

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How can the National Center help?

• Website of resources
• List Serv/E-Newsletter
• Searchable database of resources-Coming Soon!
• Demonstrate model medical homes

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Do you have Resources to Support the medical home
concept?

• Education Materials
• Care Coordination Tools
• Articles
• Evaluation Tools
• Outcomes Data
• Surveys
• Screening Guidelines, Tools, Resources

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National Center Web Site

• www.medicalhomeinfo.org

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AAP Technical Assistance

• Amy Brin
• Manager, Training Programs
• e-mail abrin_at_aap.org
• phone [phone]

Lauri Levin Manager, Technical Assistance
e-mail llevin_at_aap.org phone [phone]
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