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Essential Community Resources for the Pediatric Medical Home


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

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

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

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

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

  • 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
  • Family Health Hotline
  • Early Intervention (ages 0-3)
  • School Districts (3-21)
  • Family Support
  • Public Health (0-18)

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

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.

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//
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

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

How Do You Measure and Build Medical Homes?
  • Formal National Recognition Programs
  • National Committee for Quality Assurance (NCQA)
  • http// 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

Medical Home Transformation
  • Work in progress - Looks different in different
  • 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

Medical Home Impact on Cost and Quality
  • PCMH studies continue to demonstrate impressive
    improvements across a broad range of categories
  • 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//
  • The Medical Homes Impact on Cost and Quality
    An Annual Update of the Evidence, 2012-2013 (jan
  • Patient-Centered Primary Care Collaborative

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
  • 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
  • http//
  • 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.

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

Key Community Resources for CSHCN Medical Home
Neighbors You Want to Know
(No Transcript)
  • WA State Health Information Information and
    Referral for Children and Families
  • Family Health Hotline / Answers for Special Kids
    (ASK) Line 1-800-322-2588
  • HelpMeGrow Developmental Screening

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

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

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

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

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

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

WHERE does the early intervention happen?
  • At Home
  • In Child Care Settings
  • In Community Programs With Typically Developing
  • 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

How to Access Early Intervention Evaluation
  • Statewide Lead Family Resources Coordinator for
    the County
  • (WithinReach or ESIT directory at
  • King County Call CHAP Line
  • Toll Free (800) 756-5437
  • OR Use Our NEW Map Tool
  • http//

Too complicated for King County?
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.

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

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
  • Smoother transitions IF child does qualify for
    school district services at 3.

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
  • 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.

  • Videos about Early Intervention for Families
  • Available in English, Somali, Vietnamese
  • https//
  • Parent Support
  • Preparing for your IFSP
  • Sibling Support

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
  • To ensure a timely response, parents need to
    track when they made the referral, and stay on
    top of it.

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.

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. 

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

Questions? Problems?
  • Office of the Education Ombuds (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.

Public Health CSHCN Coordinators (0-18 yrs)
  • http//

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Family Support
  • Kate Orville
  • 206-685-1279
  • Wendy Harris
  • 206-263-9052