The Medical Home System of Care in Connecticut

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The Medical Home System of Carein Connecticut





CT Department of Public Health J. Robert Galvin,
MD, MPH, Commissioner
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What is a Medical Home?

• Not a building, house or hospital, but rather
• An approach to providing health care services in
  a high-quality, cost-effective manner
• A means for children families to receive care
  they need from a professional they know trust
• An improved system where care coordination is the
  keystone

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In a Medical Home

• Professionals families act as partners to
  identify access all medical non-medical
  services
• These services help children families achieve
  their maximum potential
• AAP believes that every child deserves a medical
  home

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Medical Home Composition

• Physician champion within practice

• Nurse / Nurse Practitioner

• Family / Parent Partner

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AAP Medical Home Components

• Accessible
• Family-Centered
• Continuous
• Comprehensive
• Coordinated
• Compassionate
• Culturally-Competent

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ACCESSIBLE

• Care is provided in childs or youths community
• All insurance, including Medicaid, is accepted
  changes are accommodated
• Families or youth are able to speak directly to
  physician when needed

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FAMILY CENTERED

• Recognition that family is principal caregiver
  center of strength support
• Unbiased complete information is shared on an
  ongoing basis
• Family is recognized as expert in their childs
  care youth are recognized as experts in their
  own care

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CONTINUOUS

• Same primary pediatric health care professionals
  are available from infancy through adolescence
  young adulthood
• Assistance with transitions, including those to
  other pediatric providers or into adult health
  care systems, are planned organized with child
  family

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COMPREHENSIVE

• Health care is available 24 hours/day 7
  days/week 52 weeks/year
• Preventive, primary tertiary care needs are
  addressed
• Information is made available about private
  insurance public resources

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COORDINATED

• Plan of care is developed by physician, child or
  youth, family and is shared with other
  providers, agencies, organizations involved in
  patients care
• Central record containing all pertinent medical
  information maintained at practice
• Families are linked to support, educational
  community-based services

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COMPASSIONATE

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

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CULTURALLY COMPETENT

• Familys cultural background, including beliefs,
  rituals customs, are recognized, valued,
  respected incorporated into care plan
• All efforts are made to ensure child or youth
  family understand results of medical encounter
  care plan, including provision of translators or
  interpreters as needed

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Why is Medical Home System of Care so Important?

• 120,000 (14) of CT children have special needs
• 75,000 CT children under 18 have asthma
• 20 of all visits to pediatricians office are
  developmental or behavioral in nature
• 70 of children diagnosed with mental retardation
  are diagnosed by providers other than their
  pediatrician
• 80 of parental concerns are correct and accurate

Olson AC. How to establish family professional
partnerships. Presented at International Family
Centered Care Conference Sept. 5, 2003 Boston,
MA
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Medical Home Surveillance Screenings Assure
Early Detection of Genetic Disorders

• Early detection means
• Early access to services treatment
• Cost savings for health educational system
• Potential for improvement in quality of life for
  children families

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Practices Use Standardized Tools
To improve outcomes, Medical Homes use nationally
standardized clinical practice tools

• Pre-visit questionnaire
• Screener Complexity Index forms
• Individualized Health Plan (IHP)
• Medical plan
• Emergency health plan
• Portable Care Plan for Families

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Provider Benefits from Medical Homes

• More proactive approach towards family
  involvement in decision making
• Incorporation of new strategies at intake such as
  pre-visit questionnaire via phone interview to
  streamline visit/identify complexity of
  conditions
• Office practice changes including use of daily
  log to verify tests and follow through on results
• Interest in consolidating presenting case
  information in standardized fashion
• Improved relationship with DPH other agencies

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Family Benefits from Medical Homes

• Greater voice in decision-making
• Child/family needs assessment
• Coordination of specialty care and services
• Assistance in communicating with payers,
  providers, schools community services
• Advocacy support

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Family Benefits, cont.

• Early continuous screenings for child
• Briefer periods in office waiting rooms
• Fewer hospitalizations
• Fewer ER visits
• Decreased health care costs
• Important component of school readiness

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Medical Home Learning Collaborative (MHLC) The
Beginning

• CT participation with the National Initiative for
  Childrens Healthcare Quality (NICHQ) the
  Medical Home Learning Collaborative (MHLC)
  commenced April 2003 and allowed for a more
  statewide, systems approach to the medical home
  that promotes the development of an
  infrastructure that will sustain itself into the
  future.

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MHLCThe Beginning

• Collaborative began with 3 practice sites
• The Pediatric Center (Stamford)
• Childrens Health Center at St. Marys Hospital
  (Waterbury)
• Whitney Pediatric Adolescent Medicine (Hamden)

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CTs 8 Current Medical Homes

• The Pediatric Center (Stamford)
• Childrens Health Center at St. Marys Hospital
  (Waterbury)
• Long Wharf Pediatric Adolescent Medicine (New
  Haven)
• Pediatric Medical Associates (New Haven)

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CTs 8 Current Medical Homes

• Pediatric Primary Care Center at Yale
• Primary Care Center at CCMC (Hartford)
• Roslyn Leslie Goldstein Childrens Health
  Center (Stamford)
• Barbara Ziogas, MD (Farmington)

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Regional Support Children Youth with Special
Health Care Needs Centers

• CT Childrens Medical Center for Children with
  Special Needs
• Yale Center for Children with Special Health Care
  Needs

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Conquest Through Collaboration

• CHDI Childrens Fund of CT
• Commission on Children
• AAP - Connecticut Chapter
• CT Medical Home Learning Collaborative
• DPH, DCF, DMR, DSS, UCHC
• Medicaid Managed Care Council
• CT Child Health Development Infoline
• CCMC Yale
• Early Childhood Partners

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CYSHCN Largest Pediatric Resource Consumer

• Children and youth with special health care needs
  (CYSHCN) are those who have or are at increased
  risk for a 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.
• CYSHCN consume 80 of pediatric health care
  expenditures

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CYSHCN Reality for Families

• 39.5 indicate their childs or youths condition
  impacts familys financial situation
• 13.5 say they spend 11 hours/week coordinating
  care for their child or youth
• 24.9 indicate families cut back on work due to
  childs or youths condition
• 28.5 indicate families stop working due to
  childs or youths condition

MCHB/NCHS. National Survey of Children with
Special Health Care Needs. 2002
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Barriers to Providing Medical Homes

• Current pediatric primary care system is
  designed
• For the 80 of children who DO NOT have special
  health care needs
• To provide preventive care services acute
  illness management
• To support single service encounters

Cooley WC. Developing primary care medical homes
for CSHCN. Presented at Institute for Leaders in
State Title V CSCHN Programs May 19, 2003
Baltimore, MD
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The CT Medical Home Academy

• To ensure durability sustainability, DPH will
  implement a Medical Home Academy (MHA) to
  establish a quality ongoing primary care practice
  improvement training system
• MHA will educate pediatricians, family
  physicians, pediatric sub-specialists, nurses
  office staff, families, SBHCs communities

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The CT Medical Home Academy

• Will develop Connecticut-specific curriculum
  utilizing national statewide modules
• Will be presented as a 1-day workshop on March 8,
  2005
• Training will be sustained though webcasts,
  practice in-service trainings, CDs, audio
  cassette tapes

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The CT Medical Home Academy Six Core Components

• Practice Improvement
• Family-Professional Partnerships
• Developmental Health
• Behavioral Health
• CYSHCN
• Transitioning Children Youth to Adulthood

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Medical Home Steps for the Future

• Evaluation of the medical homes what works,
  what doesnt
• Ongoing training via Medical Home Academy (MHA)
• Pediatric practice EPIC in-service trainings
• Consumer community involvement in
  cross-training of MHLC sites centers teach
  pediatricians other providers about
  involvement providers teach centers about
  medical homes

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In closing, Medical Homes

• Assure quality, efficient, family-centered care
• Ease the burden of caring for children youth,
  including those with special needs
• Improve family satisfaction
• Improve health outcomes for CTs children
• Decrease the cost of healthcare
• Allow children families to reach their maximum
  potential

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The Medical Home System of Carein Connecticut
CT Department of Public Health J. Robert Galvin,
MD, MPH, Commissioner