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Family Partnerships: Improving Quality of Care for Children with Special Health Care Needs in Manage

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Title: Family Partnerships: Improving Quality of Care for Children with Special Health Care Needs in Manage


1
Family Partnerships Improving Quality of Care
for Children with Special Health Care Needs in
Managed Care Plans
  • July 17, 2003
  • Sponsored by the Division of Services for
    Children with Special Health Care Needs

2
Lynda Honberg
  • Division of Services for Children with Special
    Health Care Needs, Maternal and Child Health
    Bureau

3
Shared Responsibilities Building Partnerships
between Health Plans and Families Caring for
Children with Special Health Care Needs
  • Susan G. Epstein
  • New England SERVE
  • July 17, 2003
  • MCHB Webcast

4
Why Build Partnerships?
  • Responsibility for assessing and improving the
    quality of care is shared by all stakeholders.
  • Health plans
  • Purchasers
  • Providers
  • State agencies/public policy makers
  • Researchers
  • and...
  • Consumers/families

5
In a complex health care system...
  • The quality of care for individuals is dependent
    on their knowledge of how to navigate the system,
  • and
  • The quality of the system of care is dependent on
    its knowledge of the needs and experience of its
    users.

6
Why Families are experts
  • CSHCN
  • low prevalence
  • use multiple systems
  • public/private
  • chronicity
  • dependent on changing technology
  • Families
  • high importance
  • both providers consumers of care
  • need updated information
  • heavy users of health care system

7
Why Do It? Health plan perspective
  • Belief in real benefits of consumer expertise
  • Leadership - Champion
  • Purchaser requirements
  • Environmental incentives
  • Consistent with mission
  • Importance of specific population
  • Limitations of consumer satisfaction tools

8
Why Do It? Consumer Perspective
  • Improve quality of care
  • Share expertise - tell the truth
  • Eliminate adversary mentality
  • Help other families
  • You cant improve systems without our help.

9
Expectations of Family Advisors
  • Process
  • To be heard
  • Respect dialogue
  • Avoid labels
  • Allow challenges
  • Family-centered
  • Focus on family strengths
  • Family Participation Statement-Advisory Council
    NHP, May 1999
  • Outcomes
  • Commitment to implement changes
  • Build systems that respect families as partners
  • Increase family supports within health plan

10
Challenges
  • Discomforts
  • Identifying consumers
  • Intensity of supports needed
  • Language cultural diversity
  • Variability of preparation
  • Preparation of staff
  • Mentoring

11
Ladder of Consumer Participation
  • Minimalist……………………..non-participation
  • Informing/Consulting…legitimate participation
  • Partnership….shared decision-making negotiation
  • Delegated Power….directly linked to policy
    making, control, governance
  • adapted from Arnstein, SR, A Ladder of Citizen
    Participation, Journal of the American Planning
    Association, vol 35, no.4,July 1969, pp. 216-224

12
Supports for Family Partnerships
  • Training…on both sides
  • Orientation - role definition, purpose of
    partnership
  • Preparation for specific tasks
  • Collaboration
  • Mentoring
  • Reimbursement
  • stipend
  • travel, childcare

13
Shared Responsibilities Toolkit for Health Plans
14
Purpose of Toolkit
  • Get attention of health plans
  • Identify CSHCN as a population
  • Make a business case for investing in quality
    improvement
  • Provide range of tools/resources to improve
    systems of care for CSHCN

15
Introductory Brochure
  • WHO are CSHCN?
  • WHY identify CSHCN?
  • WHY invest in collaboration?
  • HOW can health plans improve quality of care?
  • WHAT is ROI?

16
Tools
  • Identify
  • CSHCN Screener
  • QuICCC-R
  • Clinical Risk Groups
  • Administrative data algorithm
  • Improve
  • Health Plan Checklist
  • Organizational Readiness Measures
  • Best Practices
  • Collaborate
  • Family Survey
  • Provider Survey
  • Family Participation Statement
  • Family Advisor job description
  • List of state Title V contacts
  • Reporting format for information to PCPs

17
How Can Health Plans Improve Quality of Care?
  • Information for families
  • Simplify access to care
  • Enhance coordination
  • Match resources to needs
  • Help families navigate system
  • Promote best practices

18
How can Families Assist Health Plans to Improve
Quality?
  • Consumer Surveys
  • Identifying barriers within the system
  • Advisory Roles
  • Advisory Committees
  • Focus groups
  • Standing Committees
  • Grievance
  • Quality
  • Ethics
  • Staff/Consultant Roles
  • Review of written materials
  • Design outreach strategies
  • Training for health plan staff
  • Quality Improvement Teams

19
For more information on Shared Responsibilities
Toolkit...
  • http//www.neserve.org/publications/srt_overview.h
    tml

20
Family Partnerships Putting it into Practice
  • Childrens Choice of Michigan
  • Managed care program in Michigan for the
    Childrens Special Health Care Services
    population.
  • Serves any child who meets the state requirements
    determined by their qualifying diagnosis, and who
    elect to participate.
  • Contract with Title V requires family
    partnerships.

21
Childrens Choice Promise to members
  • Family Centered Services
  • Community Based Care
  • Care Coordination

22
Family Centered Care at Childrens Choice
  • Respects critical role of family in caring for
    children with special needs.
  • Family approval of IHCP required.
  • Education and Information sharing
  • Consumer staff requirements
  • Members as Advisors

23
Challenges of Member Involvement
  • Unnatural Alliance
  • Requires a shift in the power base
  • Unfamiliar Territory, new way of doing business
  • Requires staff and financial resources
  • Its hard work

24
Benefits of Member Involvement
  • Adds expertise families are experts in
    receiving services
  • Provides up front evaluation
  • Shared Responsibility
  • Economic and operational efficiencies
  • Powerful marketing tool
  • Creative problem solving

25
The Good News!
  • We have good role models for partnership
  • Title V programs for
  • HIV and AIDS programs
  • Childrens Hospitals
  • Maternity Care
  • Early Intervention

26
Multiple Roles For Member Participation
  • Administrative staff
  • Member Services staff
  • Liaison to Community Groups
  • Board members
  • Quality Advisors

27
Manager of Family Centered Services
  • An employee of DMC who was enrolled in CSHCS or
    has a child who is/was enrolled in CSHCS
  • Monitors quality of care and ease of delivery
  • Monitors policy and procedures
  • Assist family in role as advocates
  • Member education
  • Monitors member appeals and grievances
  • Provider education on Family Centered Care

28
Internal Policy and Practices
  • Review all policies and procedures
  •  Participate in Senior Mgmt Team
  •  Participate in Clinical Improvement Team
  •  Monitor member appeals and grievances
  •  Participate in Quality Advisory Committee
  •  Staff support to members on Board
  •  Conduct annual member satisfaction survey

29
Member Education
  • Editor of Member Newsletter
  • Monitor Member listserv
  • Monitor and update website
  • Develop, review and maintain member handbook, and
    other documents for members
  • Conduct educational seminars for member families
    on topics related to CSHCN
  • Assure that member ed methods and tools promote
    and support family centered, culturally competent
    practice

30
Member Outreach
  • Community Forums 
  • Family Groups with Title V Parent Participation
    Program
  • Member marketing materials development and
    maintenance
  • Link with existing family groups and
    organizations Family Voices, Arc Michigan, CAUSE

31
Provider Education
  • Review All Provider Ed materials
  • Contribute to provider education materials
    regarding Family-Centered, Community Based,
    Culturally Competent Coordinated Care, and
    Medical Home.

32
Non-medical resources and supports
  • Monitor and disseminate community resource guide
  • Develop guidance material on steps to access
    community based supports such as respite,
    waivers, special education services, etc
  • Research and disseminate information to local
    care coordinators on non-medical supports for
    CSHCN
  • Assist families in obtaining medically necessary
    services that are not covered benefits

33
National, State and Community Relationships
  • Participate in local initiatives for CSHCN i.e.
    CHM Parent Professional Advisory Committee
  • Participate in state level initiatives for CSHCN,
    i.e. CSHCS Advisory Committee, Michigan Family
    Voices, Michigan Hospice and Palliative Care
  • Participate in national initiatives for CSHCN,
    i.e. Family Voices, American Academy of
    Pediatrics Committee on Children with
    Disabilities, National Center on Financing for
    CSHCN, etc.

34
Special Projects
  • Identify areas of need for special projects
  • Medical Home
  • Transition
  • Identify funding sources for special projects
  • Develop and submit grant proposals
  •  

35
For more information
  • Go to www.childrenschoicemi.com
  • or
  • Call 1-800-566-1110
  •  

36
Family Partnerships The Maryland Family Access
Project
  • Grace Pushparany Williams

37
(No Transcript)
38
Partners
  • Office of Genetics and CSHCN Title V
  • Office of Health Services Medicaid
  • Maryland Physicians Care MCO
  • AGs Health Education Advocacy Unit
  • American Academy of Pediatrics MD Chapter

39
Trainees
  • Nine parents of children with SHCN
  • Geographically distributed across state
  • Three placed with partner one day per week
  • All work in community
  • Ongoing training

40
Parent Training
  • On-site training once per month
  • Monthly conference calls
  • Weekly homework
  • Active listserv
  • Shared experiences
  • Partners train
  • Parents become trainers

41
Initial Placements
  • Medicaid
  • Health Education and Advocacy Unit
  • Maryland Physicians Care

42
Medicaid
  • Orientation to all divisions/activities
  • Special Needs Advisory Committee
  • Communication/EPSDT subcommittees
  • MCO enrollment cards
  • Review material from parent perspective
  • Policy formation
  • Develop own project

43
Health Education Advocacy
  • Orientation
  • Private insurance
  • Consumer Hotline
  • Over 2000 complaints annually
  • Mediation/arbitration

44
Maryland Physicians Care
  • Resource for MPC parents
  • Family Outreach for members with SHCN
  • Participate in CSHCN team meetings
  • Attend Consumer Advisory Board (CAB) meetings
  • In-service to case managers CAB
  • Develop managed care primer for parents

45
Other Activities
  • Survey of Pediatricians
  • Place in community pediatricians offices
  • Advise parents on managed care issues
  • Training for families in navigating health plan
    advocacy for change
  • Additional community contacts
  • Evaluation data collection

46
(No Transcript)
47
Questions and Answers
  • Division of Services for Children with Special
    Health Care Needs, Maternal and Child Health
    Bureau
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