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Essential Community Resources for the Pediatric Medical Home

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Essential Community Resources for the Pediatric Medical Home Building a Strong Medical Neighborhood for Children with Special Needs Kate Orville – PowerPoint PPT presentation

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Title: Essential Community Resources for the Pediatric Medical Home


1
Essential Community Resources for the
Pediatric Medical Home Building a Strong
Medical Neighborhood for Children with Special
Needs
  • Kate Orville
  • Wendy Harris
  • Pediatric Resident Noon Conference
  • October 14, 2014

2
Kate Orville, MPH
  • Co-Director, WA State Medical Home Partnerships
    Project for CYSHCN
  • UW Center on Human Development Disability
  • Medical Home Teams
  • Community Coalitions to ID children with special
    needs and services needed
  • Pediatric Resident Training

3
Wendy Harris
  • Early Intervention Program Manager
  • King County Developmental Disabilities Division

4
Why were here
  • Developmental-Behavioral Pediatric Resident
    rotation
  • Request for information about community resources
    earlier in training
  • Medical Home fuzzy concept for many, despite
    growing importance in health care

5
Today
  • The Medical Home Model
  • Why does it matter for families with children
    with special needs
  • What does it mean for pediatricians as primary
    care providers and as specialists?
  • Key Community Resources for Children with Special
    Needs
  • Family Health Hotline
  • Early Intervention (ages 0-3)
  • School Districts (3-21)
  • Family Support
  • Public Health (0-18)

6
The Medical Home Team-based, Proactive Primary
Health Care
  • Comprehensive Care
  • Patient-centered
  • Coordinated Care
  • Vertical- (e.g specialty care)
  • Horizontal (e.g.community svs)
  • Longitudinal
  • Accessible Services
  • Quality and Safety
  • 2007 Joint Principles of Pt-Centered Medical Home

7
How is a Medical Home Different?
  • Todays Care
  • Pt-Centered Medical Home Care
  • My patients are those who make appointments to
    see me.
  • Care is determined by todays problem and time
    available today.
  • I know I deliver high quality care because Im
    well trained.
  • Patients/families are responsible for
    coordinating their own care.
  • Its up to the patient/family to tell us what
    happened to them.
  • Source WA State Dept of Health, WA Healthcare
    Improvement Network (WHIN)
  • Our patients are those who are registered in our
    medical home.
  • Care is determined by a proactive plan to meet
    health needs, with or w/o visits.
  • We measure our quality and make rapid changes to
    improve it.
  • A prepared team of professionals coordinates all
    patients care.
  • We track tests and consultations, and follow up
    after ED and hospital visits.

8
The infographic includes definitions for each of
these features, sample strategies used by health
professionals, employers, and payers, and their
collective impact on the health system.
  - See more at http//www.pcpcc.org/resource/inf
ographic-why-medical-home-workssthash.AmZGtbjk.dp
uf
9
Specialists the Medical Home
  • Key Clear communication about roles
  • Referrals
  • Co-Management
  • Specialist may BE the medical home doctor
  • Medical Home neighbor recognition programs and
    Communication Resources
  • Coordinating Care in the Medical Neighborhood
    Critical Components and Available Mechanisms.
    White Paper. Agency for Healthcare Research and
    Quality. (2011)
  • The Patient-Centered Medical Home and Specialty
    Physicians - American College of Physicians
    (Internal Medicine) Checklists for referrals
    between PCPs and specialists, service agreements
    examples, FAQs and more

10
Medical Home Benefits for CYSHCN
  • Significantly less delayed or forgone care
  • Significantly fewer unmet needs for health care
    and family support services
  • Better health status
  • Family centeredness
  • Improved Family Functioning
  • 2005-06 National Survey of CSHCN- parent report
  • Homer et al, 2008

11
How Do You Measure and Build Medical Homes?
  • Formal National Recognition Programs
  • National Committee for Quality Assurance (NCQA)
  • http//recognition.ncqa.org/ to see who in WA
    has certification (1222)
  • Joint Commission, other accrediting bodies
  • Quality Improvement/Skills Building
  • AAP Building Your Medical Home Toolkit
  • National Center for Medical Home Initiatives
  • Center for Medical Home Improvement
  • WA State Dept of Health WA Healthcare
    Improvement Network
  • Institute for Healthcare Improvement (IHI) Open
    School

12
Medical Home Transformation
  • Work in progress - Looks different in different
    clinics
  • Clinics that made the greatest changes in their
    systems were those that paid attention to the
    change process, esp regarding their culture and
    patient-centeredness (Solberg, L, Challenges of
    Medical Home Transformation Reported by 118
    Patient-Centered Medical Home Leaders, JABFM,
    July 2014)
  • Paradigm shift and Funding shift

13
Medical Home Impact on Cost and Quality
  • PCMH studies continue to demonstrate impressive
    improvements across a broad range of categories
    including
  • cost, utilization, population health, prevention,
    access to care, and patient satisfaction,
  • a gap still exists in reporting impact on
    clinician satisfaction.
  • The PCMH continues to play a role in
    strengthening the larger health care system,
    specifically Accountable Care Organizations and
    the emerging medical neighborhood model.
  • Significant payment reforms are incorporating the
    PCMH and its key attributes.
  • - See more at http//www.pcpcc.org/resource/medic
    al-homes-impact-cost-qualitysthash.80pHATzs.dpuf
  • The Medical Homes Impact on Cost and Quality
    An Annual Update of the Evidence, 2012-2013 (jan
    2014)
  • Patient-Centered Primary Care Collaborative

14
Financing a Medical Home
  • Traditional models Select most appropriate CPT
    codes decrease down coding.
  • Medical Home Initiatives are expanding-
    providers, patients and payment incentives
    increased from 2009-13
  • 26 -gt 114 Medical Home Initiatives
  • Almost 5 million to almost 21 million patients
  • Decrease from 77-gt 20 those with planned end
    date
  • Dominant Medical Home payment model is FFS
    payments augmented by PMPM payments and pay for
    performance bonuses. Increasing use of shared
    savings models.
  • HRSA Health Information Technology- How can a
    medical home be financed? Links to AAP coding
    info.
  • http//www.hrsa.gov/healthit/toolbox/Childrenstool
    box/BuildingMedicalHome/medicalhomefinanced.html
  • Edwards, S et al. Patient-Centered Medical
    Home Initiatives Expanded In 2009-12 Provides,
    Patients and Payment Incentives Increase. Health
    Affairs. Oct. 2014, 3310., 1823-1831.

15
Care Coordination- Key to MH
  • A process that facilitates the linkage of
    children and their families with appropriate
    services and resources in a coordinated effort to
    achieve good health.
  • American Academy of Pediatrics, Care Coordination
    in the Medical Home, Pediatrics, 2005

16
Key Community Resources for CSHCN Medical Home
Neighbors You Want to Know
17
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18
WithinReach
  • WA State Health Information Information and
    Referral for Children and Families
  • Family Health Hotline / Answers for Special Kids
    (ASK) Line 1-800-322-2588
  • www.ParentHelp123.org
  • HelpMeGrow Developmental Screening

19
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20
Early Intervention (0-36 months)
21
Babies Cant Wait Refer!
  • When to refer?
  • When parents are concerned for any reason
  • Functional concernseating, sensory, child care,
    etc.
  • Possible delay of 25 in one or more area
  • If child/family would benefit from services

22
What is Early Intervention?
  • A comprehensive set of services and supports to
    help enhance a childs development and to help
    parents understand how to help their children
    grow and develop.
  • Services are specifically tailored to meet a
    child's and familys individual needs.
  • Services are available to all eligible children
    ages birth to three with developmental delays or
    disabilities and their families regardless of
    income.

23
WHO gets Early Intervention?
  • Child is Birth to Three Years and
  • Has a 25 delay or 1.5 standard deviations in one
    or more area.
  • Some diagnoses.
  • Evaluation team uses Informed Clinical Opinion

24
WHAT are the services?
  • EVERYONE gets
  • Family Resources Coordinator
  • AssessmentsBoth Initially and Ongoing
  • MOST FREQUENT Services
  • Developmental Services (Individual Education)
  • Speech Therapy
  • Motor Therapy (Occupational or Physical Therapy)
  • Feeding Therapy and/or Nutrition Services

25
WHAT are the services?
  • OTHER Services are also available
  • Audiology
  • Assistive technology devices services
  • Family training, counseling, and home visits
  • Health services, Nursing services, Medical
    services for evaluating or diagnosing (most EI
    Providers do NOT diagnose children)
  • Psychological services
  • Social work services
  • Vision services

26
  • An Individual Family Service Plan (IFSP) is
    developed by the WHOLE Team!
  • Parents
  • Family Resource Coordinator
  • Service Provider(s)

27
WHERE does the early intervention happen?
  • At Home
  • In Child Care Settings
  • In Community Programs With Typically Developing
    Peers
  • 93 of WA families received early intervention in
    Natural Environments
  • Early Intervention Services- to the maximum
    extent appropriate are provided in natural
    environments, including the home, and community
    settings in which children with out disabilities
    participate -Individuals with Disabilities
    Education Improvement Act of 2004 Reauthorization
    (IDEA), Part C Sec. 632

28
How to Access Early Intervention Evaluation
  • Statewide Lead Family Resources Coordinator for
    the County
  • (WithinReach or ESIT directory at
    www.medicalhome.org/resources/local_contacts.cfm)
  • King County Call CHAP Line
  • Toll Free (800) 756-5437
  • OR Use Our NEW Map Tool
  • http//www.kingcounty.gov/healthservices/DDD/servi
    ces/babiesAndToddlers/EarlyInterventionProviderRef
    erralMap.aspx

29
Too complicated for King County?
30
Early Intervention works!
  • 33 of toddlers exiting EI did not qualify for
    special education at age 3!
  • 98 of families surveyed reported early
    intervention helped them effectively communicate
    their childs needs.

31
Who pays for Early Intervention?
  • State, federal and school district funds
  • Provider fundraising
  • Parent Cost Participation (some services)
  • Medicaid
  • Private Insurancefamily may have co-insurance,
    co-pays, or deductibles
  • If family does not have insurance or declines to
    provide access to insurance they may be placed on
    sliding scale for fees
  • If family below 200 of FPL family will pay no
    fees

32
Why Early Intervention?
  • Children close the gap on delays.
  • Whole family gets support and
    skills to help child.
  • Parents learn how to advocate for
    their children in education
    settings.
  • Smoother transitions IF child does qualify for
    school district services at 3.

33
Who are we missing?
  • More children are in need of services than are
    currently being served.
  • In 2012, King County served 2.1 of the general
    population of children aged birth to 3. However,
    research indicates that as many as 13 of birth
    to 3 year olds have delays that would make them
    eligible.
  • There is a need to serve children earlier. In
    2012, King County served only 0.62 of the
    general population of infants aged birth to 1.

34
  • Videos about Early Intervention for Families
  • Available in English, Somali, Vietnamese
    Spanish
  • https//www.youtube.com/watch?featureplayer_detai
    lpagev7WtnMy0I_xc
  • Parent Support
  • Preparing for your IFSP
  • Sibling Support

35
For Children 3-21 Schools
  • (45 days before 3rd Birthday or Older )
  • Refer to Child Find in writing for testing to
    determine if child is eligible for services
  • Google School District Name Child Find
  • Or Statewide directory of school officials
    www.k12.wa.us/SpecialEd/pubdocs/SpecialEdDirectory
    .pdf
  • To ensure a timely response, parents need to
    track when they made the referral, and stay on
    top of it.

36
How MDs can help
  • School more likely to do a meaningful evaluation
    if understand what concerns are.
  • Write detailed letter explaining concerns Dx,
    if there is one, and how it is interfering with
    school attendance, behavior, engagement, safety,
    academic achievement, social/emotional issues,
    transportation etc.

37
Special Education Eligibility
  • Student must meet following 
  • The student has been identified as having a
    disability (ies).
  • The disability (ies) adversely affects the
    students educational performance.
  • The student requires specially designed
    instruction in order to access the general
    education curriculum. 

38
District May
  • Screen or Evaluate
  • Develop Individualized Education Plan (IEP) or
    504 Plan
  • Provide Services
  • 3-5 Services
  • Kindergarten and older

39
Questions? Problems?
  • Office of the Education Ombuds (OEO)
    http//www.governor.wa.gov/oeo/
  • Independent statewide agency within the
    Governors Office
  • Resolves disputes and conflict between parents
    and elementary and secondary public schools in
    all areas that affect student learning.
  • 1-866-297-2597. Phone interpreter svs.
    www.waparentslearn.org
  •  

40
Public Health CSHCN Coordinators (0-18 yrs)
  • http//www.kingcounty.gov/healthservices/health/ch
    ild/cshcn.aspx

41
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42
Family Support
43
Questions?
  • Kate Orville
  • Orville_at_uw.edu
  • 206-685-1279
  • www.medicalhome.org
  • Wendy Harris
  • Wendy.Harris_at_kingcounty.gov
  • 206-263-9052
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