Microsoft Word Document

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Developing Primary Care Medical Homes for CSHCN
Institute for Leaders in State Title V CSHCN
Programs Baltimore, MD May 19, 2003
W. Carl Cooley Center for Medical Home
Improvement Hood Center for Children and
FamiliesLebanon, NH
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What is a Medical Home?For whom?Why now?How
does a practice become more of a Medical Home?
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A Medical Home is

• Accessible
• Family-centered
• Continuous
• Comprehensive
• Coordinated
• Compassionate
• Culturally-effective

(American Academy of Pediatrics)
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A Medical Home

• Is not only a place
• But a process of care
• That emphasizes home as a
• Headquarters for care
• Place to feel recognized, welcomed, supported
• Part of a community of services

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And, the Medical Home is a

• Pivotal 2010 goal
• Medical Homes by definition provide services that
  meet most of the other 2010 goals
• If you make Medical Homes happen, the other goals
  will to some degree fall into place

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But

• Most of the would be Medical Homes in the
  United States are relatively small private
  enterprises struggling to survive
• They have no special obligation to meet federal
  or state objectives for 2010
• How can private practices be motivated to improve
  their model of care?

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For Whom?Children with Special Health Care Needs
. .

• are those who have (or are at risk for)
• chronic physical, developmental, behavioral, or
  emotional conditions and
• who require health and related services of a type
  or amount beyond that required by children
  generally
• 15 of all children

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Children with special health care needs account
for 80 of pediatric health care expenditures
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Annual Cost of Medical Care for Children with SHCN
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Why now?

• More children with chronic conditions
• Home and community-based services preferred
• Fragmented care
• Institute of Medicine report
• Healthy People 2010 goal
• All CSHCNs will receive coordinated,
  comprehensive care in a medical home

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Improvement Strategies in Primary Care Why are
they needed?
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Pediatric primary care

• Designed for the 80 of children who do not have
  special health care needs
• Designed to provide well child preventive care
  services and acute illness management
• Designed to support a single service unit the
  provider patient encounter

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A medical home should be able to

• Form active partnerships with families
• Identify and monitor CSHCNs
• Coordinate care in a systematic manner
• Communicate with other community resources and
  pediatric specialty services
• This requires a redesign of existing services

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Changing a pediatric practice is like trying to
change the tire on a bicycle while you are riding
it
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Obstacles to improving primary care for CSHCNs

• Offices lack systematic approaches to CSHCNs
• Care roles are not explicitly defined
• Practices lack intrinsic processes for
  improvement
• Reimbursement is inadequate and linked to well
  child care and acute care of healthy children
• Consumer involvement is limited or non-existent

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CMHI methodology The model emphasizes

• Partnerships with parents
• Primary care-based care coordination
• Continuous improvement process
• Linkages to community resources
• Improved office systems that
• Identify CSHCNs
• Track and monitor progress
• Evaluate outcomes

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The Medical Home Index

• Validated classification improvement tool
• Observable indicators
• Total score and sub-scores in six domains
• Matching measure of parent perceptions
• The Medical Home Family Index

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Outcomes of Medical Homes

• Outcomes for Medical Homes
• Outcomes for individual practices
• Exeter Pediatrics

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Mean item scores for each domain(National
sample, 2001 red MHIP 8 new sites 2001 and
2002 15 month interval)
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Next steps

• National learning collaborative of states and
  practices working on Medical Home improvement
  (starting early 2003)
• Examine relationship between Medical Home status
  and child/family outcomes

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Medical Home Learning Collaborative

• 11 states participating
• Title V director and state-level team
• 3 practices teams from each state
• Physician, office staff member, parent
• 15 month process with 3 national mtgs
• Each state conducts learning collaborative within
  state for 30 more practices (or other spread
  strategy)

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Learning CollaborativeBreakthrough Series
Participants
Select Topic
Pre-work
P
P
A
D
A
D
Develop Change Framework
S
S
Expert Panel
NICHQ Forum
LS 1
LS 2
LS 3
Supports E-mail Visits Phone Assessments
Senior Leader Reports
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Center for Medical Home Improvement

• Building a Medical Home Improvement Strategies
  in Primary Care for Children with Special Health
  Care Needs
• Improvement kit keyed to Medical Home Index
• Web site
• www.medicalhomeimprovement.org
• Download kit and measurement tools

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What Title V leaders can do

• Have a plan plan for action
• Involve families and promote their involvement at
  the practice level
• Build relationships and an understanding of
  primary care at practice level
• Partner with state chapters of AAP and AAFP

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What Title V leaders can do

• Foster policies that improve reimbursement for
  real Medical Homes/practice-based care
  coordination
• Look for ways to support the efforts of practices
• Identification and data management
• Celebrating/recognizing Medical Homes
• Facilitation of quality improvement efforts
• Sponsor a learning collaborative
• Facilitate information and resource access

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Home is the place where When you have to go
there They have to take you in Robert Frost