Medical Home Implementation

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Medical Home Implementation

• Through Community-based, Primary Care Practices
  Moving to the Next Level
• Colleen A. Kraft, M.D.

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Medical Home

• Structure and Process of Care
• Headquarters for Care
• Families are Involved
• Link to Community Resources

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Medical Home

• Accessible
• Family Centered
• Comprehensive
• Coordinated
• Compassionate
• Culturally Effective

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Healthy People 2010

• Every child, especially children and youth with
  special health care needs, will be cared for in a
  Medical Home.

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Medical Home

• Physicians are interested
• Barriers

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Barriers to Change

• Lack of time
• Poor reimbursement for extra time spent with
  families
• No systematic method for improvement

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Medical Home Learning Collaborative

• Three practices from eleven states
• Sponsored by MCHB
• Conducted by NICHQ (National Initiative for
  Childrens Healthcare Quality) and the Center for
  Medical Home Improvement

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Virginia

• Three practices
• Inova Fairfax Pediatrics
• Richmond Pediatric Associates, Inc.
• Childrens Medical Group
• Care Connection for Children (Title V)

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Practice Assessment Tools

• From www.medicalhomeinfo.org
• Medical Home Index
• Family Satisfaction Survey
• Staff Satisfaction Survey

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Method

• Three conferences
• Monthly conference calls
• Improvement teams consisting of physician,
  parent, and staff member trying and documenting
  small, tangible changes

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Domains of Change

• Adapted from the Chronic Care Model developed by
  Dr. Ed Wagner, CMHI/NICHQ, January 24, 2003

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Community

• Partnership with State Title V program
• Partnership with Community and Parent Support
  Progams
• Database of Resources
• Medical Home Plus

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Health Systems

• Specific goals for improved health of CYSHCN are
  part of a practices strategic plan
• Coding for adequate reimbursement
• Documentation of improved quality of care
  improved reimbursement

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Care Partnership Support

• Parents as experts with their children
• Parent support and advisory groups to practices
• How can we gain from the knowledge and expertise
  of our families?

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Delivery System Design

• Access
• Physical
• Contact
• Care Coordination
• Transition
• Cultural Sensitivity

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Decision Support

• Evidence based guidelines
• Integration of family expertise with professional
  knowledge

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Clinical Information Systems

• CYSHCN Registry
• Monitoring
• Outcomes
• Information accessible

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Results

• All practices could document improvements
• Medical Home Index
• Family Satisfaction Survey
• Staff Satisfaction Survey

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Virginia

• Teams have continued to meet
• Monthly conference calls

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Virginia

• Inova Fairfax award a CATCH grant from American
  Academy of Pediatrics
• Richmond Pediatrics working with Care Connection
  on Insurance Access grant
• Statewide Medical Home Spread Conference

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Medical Home Plus

• Replication in two additional practices in
  Richmond, VA area

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The Medical Home can be a Reality!

• Practices can become more family-centered
• Parents feel that quality of care is improved
• Staff are happier
• State resource team for mentoring and advising
  helps other practices

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Medical Homes

• Family-friendly, cost efficient care for CYSCHN
• Decrease expensive care, including ED visits and
  hospitalizations
• Increased wellness for CYSHCN

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