Setting the Stage for your Medical Home State Action Plan

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Setting the Stage for your Medical Home State
Action Plan

• American Academy of Pediatrics

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The Challenge Not to seek out new landscapes but
look out with new eyes
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Objectives

• Define the Medical Home Approach
• Describe your states CSHCN Goals
• Identify State-Level Strategies
• Identify Key Players
• Review Keys to Collaboration
• Work GroupsIdentify Opportunities Limitations

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is a direct result of
Dynamic change
BOLD ACTION
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Nine Characteristics of Big Thinkers

• On Fire
• Never lose in their imaginations
• Bet the farm
• Marinate in thought
• Think better together

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Big Thinkers

• Dont take no for an answer
• Turn reality into fantasy
• Live their lives with a purpose
• Think with their hearts

Joey Reiman, Thinking for a Living
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Whats a Medical Home?
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Approach to Health Care

• Comprehensive
• High Quality
• Cost Effective

• A partnership between the physician and the family

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Medical Home Common Elements
Accessible Family-centered Comprehensive Continuou
s Coordinated Compassionate Culturally effective
Care that is
and for which the PCP
Shares Responsibility
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Family Support Services
Specialists, Nurses and other medical providers
School includes early intervention
Medical Home Family/Child/PCP
Insurance providers/financial resources
Social Services includes mental health
Religious /spiritual supports
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Why the PCP?

• Available 24/7
• Continuous throughout childs life
• Central medical record
• Serve entire family
• In childs community

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Why Now?

• Healthy People 2010 Objectives and Title V
  Performance Measures accountability,
• CSHCN defined and operationalized,
• Six core outcomes for system defined,
• Measurement initiatives in place for
  national/state data,
• Presidents New Freedom Initiative provides
  strategy for implementation

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Why Now?

• Crossing the Quality Chasm
  How Do We Fix the System?
• Current care systems cannot do the job. Trying
  harder will not work. Changing systems of care
  will.

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Healthy People 2010 Objectives

• Increase the proportion of States and territories
  that have service systems for children with
  special health care needs (16-23)
• Increase the proportion of children with special
  health care needs who have access to a medical
  home (16-22)

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Definition

• Children with special health care needs are
  those who have or are at increased risk for a
  chronic 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.
• - The federal Maternal and Child Health Bureau
  (July 1998)
• - Definition adopted by AAP (October 1998)

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Core Systems Outcomes for CSHCN

• Children receive regular ongoing comprehensive
  care within a medical home,
• Families participate in decision making at all
  levels and are satisfied with the services they
  receive,
• Families have adequate private and/or public
  insurance to pay for the services they need,

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Core Systems Outcomes for CSHCN

• Children are screened early and continuously for
  special health care needs.
• Services for children and families are organized
  for easy use,
• Youth with special health care needs receive
  services necessary to make appropriate
  transitions to all aspects of adult life,
  including adult health care, work, and
  independence.

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• Why Do This?

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Children with Special Health Care Needs

• Intensity of services compared with those used by
  well children
• 202 More specimens handled
• 121 More x-rays
• 11 More sick child visits
• Data collected at Phoenix Pediatrics, Phoenix,
  AZ. Figures represent a comparative analysis of
  procedures and visits for Children with Special
  Health Care Needs compared with typical
  children in the Phoenix Pediatrics office during
  a 1-year period.

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Why Do This?

• Benefits of a Medical Home
• Establishment of a forum for problem solving
• Improved coordination of care
• Enhanced efficiency for children and families
• Efficient use of limited resources
• Increased professional satisfaction
• Increased wellness resulting from comprehensive
  care

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When stress increases in the lives of mothers of
CSHCN, there is a higher risk of ED or hospital
use for their children. (List, et al PAS
Meetings, 2002)
Why Do This?
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Why Do This?
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Physicians and Parents Ranking of Services
Why Do This?

• Ranking Service Physicians Parents
• Respite 1 9
• Day care 2 21
• Parent support groups 3 3
• Help with behavior problems 4 10
• Financial info 5 2
• After School Child Care 6 20
• Assistance with physical/ 7 15household
  changes
• Vocational counseling 8 6
• Psychological services 9 5
• Homemaker Services 10 22
• Recreational opportunities 13 4
• Info on community resources 14 1
• Dental Treatment 16 8
• Summer camps 19 7

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Why Do This?
New Freedom Initiative
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Why Do This?
Theres No Place Like a Medical Home!!!
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State CSHCN Goals

• Adopt all six national goals
• Translate goals to your state initiatives
• E.g. Service systems families can use translates
  to improved care coordination

Polly Arango. June, 2003.
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State-Level Strategies

• Influence State Policy Resources
• Shape Internal Policies Strategies
• Increase Awareness Promote Collaboration
• Guide Measurement Evaluation

Polly Arango. June, 2003.
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Rethinking the Problem, Starting with Parents
Experience of Care

• Fragmented compartmentalized
• Overly medical
• Inefficient, expensive, full of hidden costs
• Confusing, demoralizing, and corrosive to family

Whit Garberson. MA Department of Public Health.
May, 2003
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• Change is disorienting as individuals confront
  cherished beliefs and assumptions. It cannot be
  done alone. It can only occur within a community
  of learners (p. xv).
• Senge, P. (1990). The Fifth Discipline. New
  York Doubleday

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Building Partnerships

• Responsibility for building and improving systems
  of care is shared and requires participation from
  multiple stakeholders
• Consumers/families
• Providers
• Health plans
• Other purchasers
• Researchers
• State agencies/public policy makers

MA Consortium for CSHCN. http//www.neserve.org
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Key Partners

• Agencies
• Department of Health
• Maternal and Child Health/CSHCN
• Birth Defects Registry
• EMS-C
• Brain and Spinal Cord Injury
• HIV/AIDS
• Multiple Advisory Councils

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Key Partners

• Agencies
• Department of Children Families
• Developmental Disabilities
• Foster Care
• Childrens Mental Health
• Agency for Health Care Administration
• Medicaid
• Department of Education

Polly Arango. June, 2003.
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Key Partners

• State Chapter of the AAP
• State Chapter of the AAFP
• State Hospital Association
• MR/DD Programs
• Healthy Start Coalitions
• Healthy Families
• Family Voices

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State Examples

• California
• Massachusetts
• Washington

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California

• 2001 individuals across the state created a
  core medical home team
• Developed a state plan at the NMHC
• Approached the California Health Care
• Foundation to finance the implementation of a
  comprehensive multi site medical home program

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CaliforniaStatewide Coalition

• Statewide steering committee
• 7 community-based coalitions
• Goal Increase access to medical homes by
  assisting practices in doing a QI process

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Washington Medical Home Leadership Network

• 2001 individuals across the state created a
  core medical home team
• Developed a state plan at the NMHC
• Applied for a medical home MCHB Grant

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Washington Medical Home Leadership Network

• Steering Committee
• Statewide network of 21 community based teams
• The approach is to bring each team together with
  a simple work plan 1 Goal. Remembering that
  these teams are made up of volunteers. 

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• Providing TA and resources which has been
  supported through their collaboration with the
  Health Department and University
• New web site and child health notes to
  disseminate the message http//depts.washington.ed
  u/medhome/
• The Health Department has written in the contract
  that the WA tea will consult, educate and
  coordinate medical homes to the tertiary care
  centers

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MA. Consortium for CSHCNHow Did it Start?

• Working Group on Identifying CSHCN -- 11 projects
• Shared needs
• Shared interests
• Collegial support
• Power of Collaboration
• Perceived Home for system improvement strategy

MA Consortium for CSHCN. http//www.neserve.org
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Before the Consortiumlots of good work, few
connections!

• Significant but separate areas of expertise
• History of barriers/competition between parties
• No natural forum for sharing ideas and
  experiences as equal partners
• Small number parent leaders known
• Assumptions about other stakeholders
• No guarantee of respect, safety

MA Consortium for CSHCN. http//www.neserve.org
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Evolution 1999-2003

• Phase 1 Clearinghouse
• Phase 2 Collaborative projects
• Phase 3 Coordinated projects
• Phase 4 Consensus
• Phase 5 Crafting a 2010 action agenda
• Phase 6 Joint funding activities

MA Consortium for CSHCN. http//www.neserve.org
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Measures of Success?

• Health Plans, Physicians, others adopt strategies
  for identifying CSHCN
• s MDs participating in Medical Home networking
  activities
• s organizations with policy partnerships with
  families
• Blended for care coordination
• Protecting existing public services

MA Consortium for CSHCN. http//www.neserve.org
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MA Consortium for CSHCN 2003

• Mission Statement adopted June 2001 (Healthy
  People 2010)
• Dedicated to improving systems of care for CSHCN
  their families
• 15 to 100 members
• 25 parents of CSHCN
• 46 organizations or agencies

• Members include
• Parents (25)
• Physicians (22)
• Researchers (14)
• Primary care sites or provider groups (13)
• Health plans (8)
• Public agencies (5)
• Advocates (8)
• Steering Committee -12

MA Consortium for CSHCN. http//www.neserve.org
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Support for the Consortium

• Operates under the leadership of New England
  SERVE, an independent health policy research and
  planning organization
• Variety of grants contracts
• MCHB
• AAP
• MA Department of Public Health
• Deborah Monroe Noonan Foundation
• In-kind donations of all members

MA Consortium for CSHCN. http//www.neserve.org
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Steering Committee

• 12 members
• 6 parents
• 5 MDs
• 2 health plans
• 2 state agencies
• 2 University-based researchers

MA Consortium for CSHCN. http//www.neserve.org
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Collaboration Goals

• Identify gaps and barriers in service systems
• Provide a forum for information exchange and
  strategic thinking
• Identify opportunities for innovation and
  collaboration across public and private sectors
• Seek ways to link related efforts for maximum
  effectiveness

MA Consortium for CSHCN. http//www.neserve.org
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Opportunities Limitations

• Opportunity Move toward Implementation
• Build on Existing State Framework
• Strong State Community Support
• Committed Leaders
• Limitations
• Fiscal Climate

MA Consortium for CSHCN. http//www.neserve.org
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Keys to Collaboration

• Maintain and enhance diversity of participants
• Value disagreement- different perspectives
• Leave room for many levels of participation
• Maintain non-judgmental atmosphere
• Share leadership responsibilities
• Permit efficient decision-making
• But.Dont change too fast

MA Consortium for CSHCN. http//www.neserve.org
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How can you create medical homes in your state?
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TASK LIST

• Build your team
• Address state and agency issues
• Identify gaps in services and barriers from a
  state and community level
• Identify what is working and how you can
  increase the effectiveness of current programs
  and agencies
• Develop an ACTION PLAN

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Your State Medical Home Team

• Who are the key players?
• Who are we missing? Think of strange
  bedfellows

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Try not to reinvent the wheel

• What group already exists that has a common
  objective and involves our key players?
• How often do they meet?

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Who are the Leaders of the pack?
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Strengths and Weaknesses of the Current System
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What systems in your state do CSHCN and families
rely on?
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What are the new opportunities and concerns
through the reconstruction?
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Successful Strategies

• Regular meetings
• Expand core team
• Utilize existing groups/committees
• Devise method of outreach
• Provide education/training
• Maintain strong family voices
• Celebrate your successes!!

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We need to create a centralized home for
improving systems of care and to do that, we need
just what families need

• Unity of purpose
• Mutual trust
• Clear roles and plans
• Coordination
• Resources

MA Consortium for CSHCN. http//www.neserve.org
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Partnership Outcomes

• Ongoing relationships based on knowledge,
  interests and trust
• Increased funding and resources
• Broadening of scope
• Sustainability
• Better understanding of issues facing the system
  of care as it navigates its own path of change

V. Fan Tait. June, 2003
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How can the National Center help?

• Technical assistance
• Interdisciplinary training initiatives
• Screening initiatives
• Co-management of CYSHCN condition initiative
• Listserv/e-Newsletter

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• www.medicalhomeinfo.org

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Mentorship Network
State MentorsPractice MentorsPromising
Practices

• State Mentors
• Ability to sustain or develop medical home
• Involve core team
• Collaborate with public and private agencies
• Partner with physicians, families, and state
  agencies

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So when are you meeting again?
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