Patient Centered Medical Home - Kids

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Patient Centered Medical Home - Kids

• Wednesday, November 20, 2013
• 600-800 p.m.
• Department of Health, DOC
• Patricia Flanagan, MD, FAAP, Co-Chair
• Elizabeth Lange, MD, FAAP, Co-Chair

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CSI 101
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Mission

• PCMH Kids will engage providers, payers,
  patients, parents, purchasers and policy makers
  to develop high quality primary care medical
  homes for children and youth that will assure
  optimal health and development, be committed to
  quality measurement, accountable for cost and
  outcomes, focused on population health and
  dedicated to system improvement. PCMHs for
  children will be cost effective and sustainably
  resourced.

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Vision

• Children and youth in RI will be cared for in
  high quality patient and family-centered medical
  homes.

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Guiding Principles

• Families and patients are central to our work
• PCMHs address the physical, developmental,
  behavioral, social, emotional, environmental and
  oral health needs of children and youth.
• Children and youth need access to pediatric
  sub-specialty care. This entails workforce and
  payment issues as well as geographic and
  linguistic access.
• PCMHs must integrate and coordinate care with
  community organizations, state agencies, child
  care and schools.
• Prevention and public health functions of PCMH's
  are drivers of the health of the population of
  children and youth in our state. As such PCMHs
  are embedded in communities they serve.
• PCMHs must be accessible and affordable to all
  children, with a specific commitment to equity
  and cultural and socioeconomic diversity.
• Payment must not only appropriately recognize the
  cost efficient added value provided by PCMHs but
  also support the long-term sustainability of this
  transformative practice model.
• PCMH-kids is committed to innovation and
  data-driven reform of the health care system.
• PCMH-kids recognizes the importance of
  transitions, especially transitions from
  pediatric to adult care settings.

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Medicaid Perspective

• Populations of particular interest
• CSHN/Katie Beckett/CEDARR
• Children in substitute care
• Children with behavioral health needs, esp.
  adolescents
• Measures of Interest
• Developmental screening/Early recognition and
  response
• Care coordination
• Continuity of Care
• ED visit rate
• Oral Health
• EPSDT
• Screening for substance abuse
• Providers of interest
• High volume of Medicaid and/or populations of
  interest

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Medicaid Perspective

• Other Considerations
• Ability to qualify sites as Medicaid Health Homes
  under ACA
• Number of Sites
• Will depend on numbers of children at each site
  and total cost
• Need to collaborate with other payers
• Consider mix of sites (high Medicaid, high
  commercial)
• Which Sites
• How to meet challenge of high volume sites that
  may not feel ready to apply

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SHIP

• Public comments being sought by Nov. 26
• http//www.healthcare.ri.gov/healthyri/resources/r
  i_ship_comment_draft.pdf
• AAP Feedback

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Selection Sub-Committee

• Charge
• Develop criteria for selection of initial pilot
  PCMH-Kids practices
• Develop application and scoring process for
  practice selection
• Develop outreach strategy to insure eligible
  practices are informed
• Recommend selection process to Planning
  Committee/Conveners
• With staff support, conduct selection process,
  score applications, and make recommendations to
  Conveners

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Selection Sub-Committee

• Members
• Steve Davis
• Renee Rulin
• Tina Spears
• Andrea Galgay
• Deidre Gifford
• Beth Lange
• Blythe Berger
• Deb Florio
• Parent representative

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Measures Sub-committee

• Charge
• Review available data on quality, health
  disparities, disease prevalence, utilization and
  cost of healthcare for children in RI
• Review standardized measures of pediatric
  healthcare quality, including those used in other
  pediatric PCMH programs
• Review available measures for feasibility of
  collection and alignment with other RI programs
• Recommend set of quality, patient experience and
  utilization measures to Stakeholder coalition for
  inclusion in contract

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Measurement Sub-Committee

• Members
• Ronald Seifer
• Betty Vohr
• Nate Beraha
• Jose Polanco
• Shirley Spater
• Stacey Aguiar
• Bill Hollinshead
• Oral Health?
• Parent representative?
• Payer representative?

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Race to The Top Early Learning Challenge Updates

• Quality improvement and evidence-based practices
• Aligning screening

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Questions
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Contact Information

• Patricia Flanagan MD, FAAP, Co-Chair
• pflanagan_at_lifespan.org
• 401-444-7987
• Elizabeth Lange MD, FAAP, Co-Chair
• elizlange_at_cox.net
• 401-751-8683