Pennsylvania

1
Pennsylvania Medical Home Initiative and the
Federal/State Partnership
Federal/State Partnership Meeting October 14-17,
2007
Renee Turchi, MD, MPH, EPIC IC, PA Chapter
AAP Molly Gatto, EPIC IC, PA Chapter AAP Michelle
Connors, PA DOH Suzanne Yunghans, MBA, PA Chapter
AAP
2
Overview

• Medical Home Implementation
• Data Collection Strategies and Results
• Parent Partners
• Access to Care and Cultural Competency
• State Partnerships

3
Who are children with special health care needs
(CSHCN)?

• Children who have or are at increased risk for
  chronic physical, developmental, behavioral, or
  emotional conditions
• and
• who also require health and related services
  of a type or amount beyond that required by
  children generally.
• (Maternal and Child Health Bureau 95)

4
How many children have special health care needs?

• Approximately 13-18
• (9-12.5 million children in US)
• Newacheck et.al.,1998 Strickland et.al., 2004
• 379,221 CYSHCN in PA
• -National Survey of CSHCN, 2001

5
Definition of Medical Home

• Approach and process to providing health care
  services
• Emphasize practice as the home where the family
  and child
• Feel recognized and supported
• Find centralized base for medical care
• Find connection to medical/non-medical resources
• Pediatrics,
  Policy Statement, 2002

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Medical Home Care Components

• The American Academy of Pediatrics, with support
  from the Maternal and Child Health Bureau, has
  defined 9 core elements of the medical home
• Family-centered
• Comprehensive
• Continuous
• Coordinated
• Compassionate
• Community-based
• Culturally-competent
• Accessible
• Environment of trust and
  mutual responsibility

7
Joint Statement Core Principles

• Personal physician
• Physician directed medical practice
• Whole person orientation
• Care coordination across multiple systems
• Quality and safety
• Enhanced access
• Appropriate payment for services
• 
  -AAP AAFP ACP, AOA- March 2007

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Care Model for Child Health in a Medical Home
9
Medical Home Implementation
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What is EPIC IC?

• Educating Practices In Community Integrated Care
• Quality improvement initiative
• Works with pediatric practices across
  Pennsylvania to implement Medical Home principles
  within the practice

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How do practices participate?

• EPIC IC practices
• Participate in monthly quality improvement
  teleconferences
• Attend bi-yearly quality improvement conferences
  that provide networking opportunities
• Are provided education on
• identification of CYSHCN (Children and Youth with
  Special Health Care Needs)
• Parent Partner recruitment
• utilization of Parent Partners
• coding strategies
• time management
• Topics-transition to adult healthcare, cultural
  competency, etc.

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EPIC IC Medical Home Sites
Medical Home Adopter (currently active in EPIC IC)
Medical Home Trainee (Received Training)
Medical Home Adopter (Achieved implementation)
In recruitment
Medical Home Adopter (First year of
implementation)
Satellite office
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Summary of EPIC IC Participation

• 62 practices trained in medical home principles
• 20 practices receive funding for care
  coordination
• Practices represent all 6 regions 29 counties
  in PA
• Practices represent urban, suburban, and rural
  communities

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Medical Home Team

• Project Leaders
• Physicians
• Nurses
• Social Workers
• Care Coordinators
• Administrative Staff
• Parent Partners

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Medical Home Implementation

• Identify the team in the practice
• Identify and engage Parent Partners
• Schedule regular team meetings
• Create a process to identify special needs
  patients
• Complete Medical Home Index
• Discover community resources
• Create special relationships w/ community
  resources
• Plan a special event

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www.pamedicalhome.org
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Data Collection Strategies and Results
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Why collect data?

• Quality improvement
• Feedback to families/patients
• Employers
• Insurance agencies
• Assist others

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Patient List
Pt ID DOB Insurance Sev. Score Homecare Diagnosis Status HIPAA
1 4/3/1997 Public 2 s/p MVA Active- temp Yes
2 2/4/2005 Public 3S DME Preemie, BPD, DHS involvement Active Yes
3 6/8/2003 Both 4 DME, RN Encephalopathy, G-tube Inactive- Deceased 8/2/05 No
4 5/17/1992 Private 3 Hermansky-Pudlak Syndrome, Blind, Equipment Seeing-eye dog Active Yes
5 1/14/1999 Both 1S ADHD, Behavioral Disorder Active No
6 11/3/1987 Private 1 Asthma, Food allergies Inactive-Transition 7/2005 Yes
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Diagnoses
Diagnosis Number of Patients Percentage
Asthma 2724 / 8805 31
Developmental Delay 1159 / 8805 13
Cerebral Palsy 557 / 8805 6
Autism Spectrum Disorder 965 / 8805 11
Obesity 350 / 8805 4
Fetal Alcohol Spectrum 22 / 8805 0.2
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Types of Insurance
Unknown (3)
Uninsured (0.6)
22
Time Tracking- Total Encounters
Unknown
9
Administrative/
support staff
13
Care
Coordinator
48
PCP
20
Nurse
Nurse
3
Practitioner
23
OutcomesTime Tracking Forms
Prevented Occurred
Hospitalizations 430 294
ED Visits 1129 496
School Absences 761 867
Work Days Missed 507 406
Out of 51,296 encounter forms
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Medical Home Index Scores
8
Year 1
Year 2
7
Year 3
6.3
6.0
5.9
5.7
6
5.5
5.5
5.4
5.3
5.2
5.0
5.0
4.8
5
4.7
4.3
4.4
4.0
MHI Score
3.8
3.7
4
3.7
3.4
3.2
3
2
1
0
Organizational Capacity
Chronic Care Mgmt
Care Coordination
Community Outreach
Data Mgmt.
Quality Improvement
Total Score
Domain
25
Parent Partners
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Why Parent Partners?

• Increases understanding and cooperation between
  families and staff
• Promotes respectful, effective, partnerships
  between families and professionals
• Ensures services meet family needs
• Provides mechanism for consumer input
• Increases practice awareness of cultural
  differences

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Family Centered Care

• The family and the care coordinator work together
  to
• Identify barriers
• Identify resources
• Gather information about the diagnosis
• Develop a care plan

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Different Priorities
Rank of Service
Parents
Physicians

• 9 1 Respite Care
• 21 2 Day Care
• 3 3 Parent Support Groups
• 10 4 Help with Behavior Problems
• 2 5 Financial information or help
• 20 6 After-school child care
• 15 7 Assistance with physical household
  changes
• 6 8 Vocational counseling
• 5 9 Psychological services
• 22 10 Homemaker services

-Liptak et al. Community physician's role in case
management of children with chronic illnesses.
Pediatrics,, 1989.
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EPIC IC Medical Home SurveyDomains

• Areas measured on the survey include
• Components of the Medical Home
• Accessibility
• Parental satisfaction/trust
• Health care utilization
• Unmet medical needs
• Demographic information

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Effects of CYSHCN on lives of parents/caregivers
EPIC IC Medical Home Survey
4/20/07
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Access to CareCultural Competency

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Cultural Competency

• National Center for Cultural Competence
• Adapted from Cross, Bazron, Dennis and Issacs,
  1989

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Medical Home and Cultural Competency

• Language Screener
• Fall Conference
• National Center for Cultural Competence
• Parent Panel
• Commonwealth and MCHB
• Break out session

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Community Health

• The health of the people is really the
  foundation upon which all their happiness and all
  their powers as a state depend.
• -Benjamin Disraeli (19th Century British Prime
  Minister)
• our communities are only as strong as the
  people. And if people are not getting the
  adequate health care they need, particularly
  underserved communities, our foundation- as
  Disraeli said- is truly in jeopardy.
• -Ron Sims, Speech on Health Disparity, 2005

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Health Disparity

• Inequality a difference in health status
• Inequity a difference that exits due to
  controllable and avoidable factors such as access
  to health care

• Health disparity is an example of an inequity

Disparities in health care Disparities in
health status
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PA Department of Health

• The mission of the PA DOH is to promote healthy
  lifestyles, prevent injury and disease, and to
  assure the save delivery of quality health care
  for all Commonwealth citizens.

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Goals

• Eliminate disparities
• A strategy to improve quality of care
• Linguistically effective care
• Provision of culturally competent care
• Effective treatment while respecting the beliefs,
  customs, and languages of patients

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Minority Groups

• Parents report providers do not understand them,
  their child rearing preferences or their needs

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Public Health

• Factors affecting public health
• Income
• Education
• Community
• Cultural competence must evolve from marginal to
  mainstream health care policy
• State partnerships

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The PA DOH Supports Medical Home

• A child with a Medical Home
• has the assistance of a care coordinator
• receives preventive care
• is more likely to take appropriate medication
• finds it easier to navigate the health care
  system, leading to increased benefits

41
Health Care

• Health care is not a privilege
• it is a right.

42
State Partnerships
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2005 Title V Needs Assessment

• Identified strengths weaknesses
• Families need to know of services that are
  available
• Partnership
• Collaboration
• Health and Human Services Call Center
• System of Care Program
• Peal Center (Family to Family Grant)
• Medical Home Initiative

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Recent ad for SKN
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PA Chapter, American Academy of Pediatrics

• Dedicated to the health and well-being of
  infants, children and adolescents
• Conducts work at the policy, advocacy, research
  and program level
• Currently administers 8 statewide programs with
  state, federal and foundation funding
• EPIC IC (PA Medical Home Initiative)
• Traffic Injury Prevention
• Suspected Child Abuse and Neglect Education
• Newborn Hearing Screening
• Clean Air for Healthy Children
• ECELS (Early Childhood Education Linkage System)
• Immunization Education Program
• PA Child Death Review

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PA AAPStatewide Collaborations

• Primary Care Coalition
• PA Section, American Academy of OB/GYN
• PA Medical Society
• PA Osteopathic Medical Society
• PA Forum for Primary Health Care
• PA Coroners Association
• PA Chiefs of Police
• PA Audiologists Association
• PA EMS
• PA child care organizations
• Parent to Parent
• PA insurers
• PA state government

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Together We Can Make a Difference

• There are many opportunities for synergy
• Impact on childrens services can be maximized
  through collaboration
• Children cannot speak for themselves our
  collective voice is the power needed to make
  change happen

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Contact information

• PA AAP
• Renee Turchi, MD, MPH
• St. Christophers Hospital for Children,
  Philadelphia, PA
• 215-427-5331
• renee.turchi_at_drexelmed.edu
• Molly Gatto
• PA Chapter, American Academy of Pediatrics,
  Media, PA
• 484-446-3039
• mgatto_at_paaap.org
• PA DOH
• Michelle Connors
• PA Department of Health, Harrisburg, PA
• 717-772-2763
• mconnors_at_state.pa.us