Celebrating Colorado

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Celebrating Colorados Medical Home Initiative

• Eileen Forlenza
• Colorado Dept. of Public Health and Environment
• Gina Robinson
• Health Care Policy and Financing

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• Why the Medical Home approach is a key component
  within Colorados Early Childhood Framework

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Objectives for Today

• Understand how the goals of Colorados Medical
  Home Initiative fit into the Early Childhood
  Colorado Framework
• Understand the impact of SB-07-130
• Review the Colorado Medical Home Standards
• Understand strategies to involve families in
  advocating for a Medical Home approach

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Colorados Medical Home Initiative

• The Colorado Medical Home Initiative is a
  statewide effort to build systems of quality
  health care for all children in Colorado while
  increasing the capacity of providers to deliver
  care to kids in our state.

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Colorado Medical Home Initiative

• Four Goals
• 1. Providers will understand the
  concepts/components of the Medical Home approach
  and will implement them in their practices.
• 2. Families will understand the
  concepts/components of the Medical Home approach
  and will advocate for them.

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Colorado Medical Home Initiative

• 3. Reimbursement will be adequate to provide
  Medical Homes.
• 4. A Medical Home awareness campaign will be
  conducted in Colorado.

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Community Resources
Primary Care
Recreational Services
Social Services
Patient Family
Mental Health
Specialty Care
Vocational Services
Oral Health
Educational Services
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Medical Home Components

• Accessible support of primary and specialty
  care capacity, insurance eligibility, advocacy
• Family Centered support of families as
  advocates, participants in community planning
• Continuous linking community resources, support
  of medical information transfer
• Comprehensive linking medical, mental health
  and dental providers to ensure global thinking
  about the total child and family

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Medical Home Components

• Coordinated working with medical components
  (inpatient and outpatient), educational and
  community resources to ensure efficiency
• Compassionate community resources include
  provision for respite care, linking to faith
  communities, and behavioral/mental health
• Culturally Responsive culturally sensitive
  partners are recognized and linked to families

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Colorados Medical Home Legislation

• Concerning Medical Homes for Children (SB-07-130)
• Integration of efforts
• Shared leadership - CDPHE and HCPF
• Increasing access to Medicaid providers
• Developing standards

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Colorados Medical Home Definition per
Legislation

• An appropriately qualified medical specialty,
  developmental, therapeutic, or mental health care
  practice that verifiably ensures continuous,
  accessible, and comprehensive access to and
  coordination of community-based medical care,
  mental health care, oral health care and related
  services for a child. ..If a childs medical home
  is not a primary medical care provider, the child
  MUST have a primary medical care provider to
  ensure that a childs primary medical care needs
  are appropriately addressed.

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Colorado Medical Home Standards

• Developed by the Evaluation Task Force
• Based on Quality Components
• Developed by key stakeholders
• Statewide consciousness
• Assurances

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Evaluation Task Force

• Membership Included
• Family leaders
• Mental health
• Physical health
• NCQA
• Pediatricians Colorado AAP
• AAFP
• Researchers

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Development Process

• Structured via 7 Domain Areas
• Literature outside of Medical Home literature
• Consolidation
• Crosswalk with NCQA standards
• Data sources for each standard
• Statewide survey for feedback
• Developed group for edits and consistent language
• Steering committee for approval

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Colorado Medical Home Standards

• 1. Provides 24 hour 7 day access to a provider
  or trained triage service.
• 2. Child/family has a personal provider or team
  familiar with their childs health history.
• 3. Appointments are based on condition (acute,
  chronic, well or diagnostic) and provider can
  accommodate same day scheduling when needed.

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Colorado Medical Home Standards

• 4. A system is in place for children and
  families to obtain information and referrals
  about insurance, community resources, non-medical
  services, education and transition to adult
  providers.
• 5. Provider and office staff communicates in a
  way that is family centered and encourages the
  family to be a partner in health care decision
  making.
• 6. Provider and office staff demonstrate
  cultural competency.

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Colorado Medical Home Standards

• 7. The designated Medical Home takes the primary
  responsibility for care coordination.
• 8. Age appropriate preventive care and screening
  are provided or coordinated by the provider on a
  timely basis.
• 9. The designated Medical Home adopts and
  implements evidence-based diagnosis and treatment
  guidelines.

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Colorado Medical Home Standards

• 10. The childs medical records are up to date
  and comprehensive, and (upon the familys
  authorization), records may be shared with other
  providers or agencies.
• 11. The Medical Home has a continuous quality
  improvement plan that references Medical Home
  standards and elements.

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What we learned

• Providers articulated technical assistance needs
• Families were eager for partnerships
• Providers had a format to express fears and
  concerns

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Assurances

• 1.  The Colorado Medical Home Initiative will
  continue to provide a platform whereby
  stakeholders input is encouraged, valued and
  incorporated.
•  
• 2. Providers who choose to be acknowledged as
  providing a medical home approach will be offered
  resources and support.
•  
• 3.  The term provider is intended to be
  inclusive of behavioral, oral and physical health
  care providers and specialists.
• 4.   Development and refinement of these
  standards is only the first step in the process
  of implementation.
•  
• 5.  Medicaid providers can choose to be
  acknowledged as medical home providers on a
  voluntary basis.
•  

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Principles

• 1.    The standards are a framework for
  continuous quality improvement.
• 2.   The standards are meant to describe
  Colorados goals for quality health care for all
  children, they are not meant to be punitive or
  prescriptive.
• 3.   The standards, based on the national
  components of a medical home, were developed in
  collaboration with multiple Colorado
  stakeholders, including physical and behavioral
  health care providers physicians, family
  members, community advocates and evaluators, and
  are aligned with established national standards.
• 4.   The standards are a way to acknowledge good
  practice while providing a shared vision and
  common language for a quality system of care for
  all children in Colorado.
• 5. The standards provide a means for evaluation
  to establish state, payer, family, and practice
  accountability.

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What is a Medical Home System?
  The state and local personnel, processes,
individuals, procedures, materials that support
providers to implement the practice-level medical
home standards. Often there are local and state
systemic issues such as lack of specialists,
access to insurance, and uncertainty of local
resources that prohibit providers from providing
a medical home approach. A state and local
infrastructure to overcome these barriers and to
provide technical assistance to providers is
called a medical home system.
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Families as Partners

• Embracing families as a resource not simply as a
  consumer of services
• Integrating the core concept that CYSHCN are not
  asking to be fixed
• Understanding the difference between family
  representatives and family leaders
• Invest in family leadership development and
  utilization thereof
• Respect the process of leadership development

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Examples of Integrating Family Leaders into
Medical Home Efforts

• Understanding that families are a valuable
  resource and human capital
• Supporting emerging family leaders to attend
  national and state conferences
• Equitable compensation
• Systems approach to leadership development

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Helpful Resources/References

• American Academy of Pediatrics, National Center
  of Medical Home Initiatives for Children with
  Special Needs www.medicalhomeinfo.org
• Center for Medical Home Improvement,
  www.medicalhomeimprovement.org
• National Initiative for Childrens Health
  Quality, www.NICHQ.org
• American Academy of Family Physicians,
  www.futurefamilymed.org
• American College of Physicians,
  www.acponline.org/advocacy/?hp
• Health Care Program for Children with Special
  Needs www.hcpcolorado.org
• Colorado Childrens Health Access Project
• www.cchap.org

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• Contact Info
• Eileen.Forlenza_at_state.co.us
• 303-692-2794
• Gina.Robinson_at_state.co.us
• 303-866-6167